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Results for “laparoscopy”

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PubMed1994

Pelvic adhesion formation after pelvic lymphadenectomy: comparison between transperitoneal laparoscopy and extraperitoneal laparotomy in a porcine model.

Compared to extraperitoneal laparotomy, the transperitoneal approach is associated with increased enteric morbidity. Recently, transperitoneal laparoscopy has been employed as a method to surgically stage patients with gynecologic malignancies. The objective of this study was to investigate pelvic adhesion formation in a porcine model after pelvic lymphadenectomy performed via transperitoneal laparoscopy (LS) compared to extraperitoneal laparotomy (EP). Ten adult, female hogs underwent LS and 10 underwent EP. A complete pelvic lymphadenectomy was performed in each animal. Three weeks after the lymphadenectomy, the animals underwent exploratory laparotomy, and the adhesions were quantified. Nineteen animals were evaluable. The adhesion scores for the laparoscopy group (N = 10, mean = 0.075 +/- 0.17) were not statistically different from those of the laparotomy group (N = 9, mean = 0.28 +/- 0.52, P > 0.5). Eight of 10 (80%) and 5 of 9 (56%) animals in the LS and EP groups, respectively, had no adhesions after pelvic lymphadenectomy. Adhesion formation is one of many critical issues concerning the utility of pretreatment surgical staging, especially for cancer of the cervix. It is remarkable that only 20% of the animals undergoing laparoscopy in this study had de novo adhesions after pelvic lymph node dissection and that the mean total adhesion score was not statistically different from the extraperitoneal laparotomy. Therefore, transperitoneal laparoscopic pelvic lymphadenectomy may not induce the degree of adhesion formation associated with the transperitoneal laparotomy technique.

Animals↗

PubMed1998

Unsuspected primary tubal carcinoma during operative laparoscopy.

OBJECTIVE: To evaluate the possible risk of dealing with an unsuspected primary carcinoma of the fallopian tube during laparoscopic surgery. METHODS: We performed a countrywide survey in Austria concerning laparoscopic procedures in cases of primary carcinoma of the tube. The questionnaire consisted of questions regarding the pre-, intra-, and postoperative management. RESULTS: Of 18,435 laparoscopies in cases of an adnexal mass, 5 cases were reported, when laparoscopy was performed on an unsuspected carcinoma of the tube. Therefore, the risk of detecting this malignancy during laparoscopy after preoperative evaluation is 1 in 3687 cases (0.028%). CONCLUSION: The risk of encountering an unsuspected primary carcinoma of the fallopian tube during laparoscopy in Austria is an extremely rare situation. In case of a malignancy, a staging or debulking laparotomy should be performed immediately or as soon as possible.

Aged↗

PubMed2000

Hysterectomy for obese women with endometrial cancer: laparoscopy or laparotomy?

OBJECTIVE: The aim of this study was to investigate the feasibility and safety of laparoscopic management of obese women with early stage endometrial cancer and to compare the surgical outcome, cost, hospital stay, recall of postoperative pain control, time to return to full activity and to work, and overall satisfaction among these women and those managed by laparotomy. METHODS: We conducted a prospective study over 2 years applying laparoscopic surgery to all women with clinical stage I endometrial cancer and body mass indices (BMIs) between 28.0 and 60.0 who can tolerate such surgery. As a control, we used women with clinical stage I endometrial cancer and similar BMIs who underwent laparotomy in the previous 2 years. Both groups were compared in their characteristics, surgical outcome, cost, and hospital stay, and interviewed regarding time to recovery, recall of postoperative pain control, and overall satisfaction with their management. RESULTS: Forty of 42 obese women who presented with clinical stage I endometrial cancer during the study period were offered laparoscopic surgery. The procedure was converted to laparotomy in 3 (7.5%) patients. Laparoscopic surgery was thus successful in 88.1% of all obese women. There was no significant difference between women who underwent laparoscopy and those who underwent laparotomy in patient characteristics, proportion of women who underwent lymphadenectomy, complications, total cost, patients' recall of postoperative pain, and patients' satisfaction with management. Women who underwent laparoscopy had a significantly longer operative time, more pelvic lymph nodes removed, a smaller drop in postoperative hematocrit, less pain medication, and a shorter hospital stay (194.8 versus 137.7 min, P <0.001; 11.3 versus 5.3, P < 0.001; 3.9 versus 5.4, P = 0.029; 32.3 versus 124.1 mg, P < 0.001; and 2.5 versus 5.6 days, P < 0.001, respectively). There was a trend toward earlier resumption of full activity and return to work among women who underwent laparoscopy (23.2 versus 45.0 days, P = 0.073, and 35.3 versus 67.0 days, P = 0.055, respectively). CONCLUSIONS: Most obese women with early stage endometrial cancer can be safely managed through laparoscopy with excellent surgical outcome, shorter hospitalization, and less postoperative pain than those managed through laparotomy.

Adult↗

PubMed1987

Diagnostic and therapeutic laparoscopy. An entity often overlooked by the surgeon.

For unknown reasons, only a few surgeons have become interested in diagnostic and therapeutic laparoscopy. Electronic imaging, the recent adjunct to endoscopy, has enhanced its value. In problematic cases, it is not only important to establish the diagnosis but also to be able to demonstrate the interesting findings during weekly conferences or to reevaluate or recapitulate the findings in the follow-up period. Ascites, pyrexia, abdominal pain with weight loss of unknown origin, a palpable mass, suspected primary or secondary liver tumors, staging, second look, and questionable operability of known primaries are examples of the indications for laparoscopy. If intra-abdominal malignancy is suspected, a computed tomographic (CT) scan or ultrasonic examination is the common current procedure. If liver or parietal peritoneal involvement is present, these costly examinations will not display lesions smaller than 1 cm, whereas they can often be seen during laparoscopy. Repeated CT or ultrasound examinations with guided needle biopsies have a high incidence of noninformative (cytological) specimen retrieval. Laparoscopy, providing a precise, well-aimed biopsy, can be performed under local anesthesia following premedication. It represents an important advantage for high-risk patients because it can be performed with a negligible incidence of complications.

Anesthesia, Local↗

PubMed1994

Value of laparoscopy in trauma ICU patients with suspected acute acalculous cholecystitis.

Patients who require prolonged intensive care following traumatic injuries are at risk for developing acute acalculous cholecystitis (AAC). The diagnosis of AAC is often difficult to establish, resulting in increased morbidity and mortality in this critically ill population. We reasoned that diagnostic laparoscopy might provide a more accurate and timely method of diagnosis. Laparoscopy was performed in nine trauma ICU patients with suspected AAC. Four procedures were considered positive and five were negative. There were no false-positive or false-negative laparoscopic exams, and no procedure-related morbidity occurred. Comparison of multiple clinical, laboratory, and radiologic findings showed that only laparoscopy accurately distinguished between those patients with AAC and those without AAC. We conclude that diagnostic laparoscopy is safe and definitive in trauma ICU patients with suspected AAC and should be performed prior to proceeding with laparotomy.

Acute Disease↗

PubMed1981

Laparoscopy and radioisotope imaging in the investigation of suspected liver disease.

We have reviewed the clinical and investigative details of 141 patients who underwent laparoscopy in order to determine how best this technique can be used. The clinical history and biochemical investigations usually only indicated some form of hepatobiliary disease, but all patients with spider telangiectasia, splenomegaly, or esophagogastric varices had diffuse parenchymal liver disease, and further investigation was only required to detect its cause. Laparoscopy succeeded in 129 patients (91%), and serious complications occurred in six (4%). The appearance of the liver did not accurately reflect the underlying pathology, indicating the need for biopsy in all cases. Laparoscopy and 99mTc-sulfur colloid liver imaging each failed to detect a few hepatic malignancies, but none were missed by both investigations combined, and similar results were obtained for parenchymal liver disease. Scanning and laparoscopy proved a highly accurate diagnostic combination.

Humans↗

PubMed1990

Irritable bowel syndrome in women having diagnostic laparoscopy or hysterectomy. Relation to gynecologic features and outcome.

We identified irritable bowel syndrome (IBS) in 47.7% of 86 women having diagnostic laparoscopy for chronic pelvic pain, 39.5% of 172 women having elective hysterectomy, and 32.0% of 172 controls age-matched for the hysterectomy group (P = NS). Constipation and pain subtype IBS were more common in hysterectomy patients than controls (P less than 0.05). In laparoscopy patients, dyspareunia was more common in those with IBS than in those without it (P less than 0.05). In the hysterectomy group, more IBS patients had chronic pelvic pain (P less than 0.005), and abnormal menses (P less than 0.01). Chronic pelvic pain was more frequently the only prehysterectomy diagnosis in IBS patients (P less than 0.05), and IBS was present more often when pain was a reason for hysterectomy (P less than 0.01). One year after laparoscopy, IBS patients gave lower overall status ratings (P less than 0.01) and lower pain improvement ratings (P less than 0.05) than non-IBS patients. In women who had a hysterectomy for pain, there was less pain improvement one year later in those with the pain subtype of IBS than in non-IBS patients (P less than 0.05). IBS is associated with gynecologic symptoms and affects the symptomatic outcome of diagnostic laparoscopy and hysterectomy.

Adult↗

PubMedDate not supplied

Management of groin hernias by laparoscopy.

The surgical treatment of groin hernias continues to undergo technical modifications. The introduction of minimally invasive surgery had added a possible new dimension, replacing an inguinal approach by laparoscopy. Conceived some 15 years ago, the thesis was subjected to a clinical trial where coincidental abdominal hernial openings were closed at laparotomy. This study was followed by an experimental study at which time the openings were closed laparoscopically. The satisfactory results led to the development of a stapling instrument that could be passed through a cannula at laparoscopy and used to close the abdominal hernial opening. The clinical trial of treating hernias by laparoscopy was originally directed to the management of indirect inguinal hernias, but its use has since been expanded to include treatment of direct, femoral, obturator, incarcerated, recurrent, and bilateral hernias. The laparoscopic anatomy of the inguinal hernia, different from that seen by an inguinal approach, is briefly reviewed. The details of the operative technique are presented, as are the bases of other laparoscopic techniques that have evolved. Thirty-one hernial orifices have been closed and followed over 18 months. The results appear to be satisfactory in 27 instances. There were early technical failures in 2: One patient developed a recurrence after 5 months, later shown to be due to a sliding hernia; and symptoms of meralgia paresthetica of indeterminate origin appeared in one case. The advantages over the traditional approach are described; the disadvantages of the laparoscopic approach are those of laparoscopy itself and the absence of a long-term follow-up.

Adolescent↗

PubMed1985

Open laparoscopy for tubal occlusion in the female.

Open laparoscopy was performed in 630 patients seeking permanent contraception for health reasons. Various electric and mechanical tubal occlusion methods were utilized. With few exceptions, uterine curettage was performed at the end of the laparoscopic procedure. Curettage revealed unexpected findings in 10 cases. Laparoscopic exploration of the peritoneal cavity showed pathologic findings in 10% of the patients. There were no intraoperative complications related to open laparoscopy. Fourteen patients (2%) underwent immediate laparotomy, to manage unexpected findings in six and to correct complications of unipolar tubal cautery technique in eight. Postoperative complications possibly related to open laparoscopy were limited to minor wound infection in 0.3% and febrile reaction of short duration in 0.1% of the cases. Two sterilization failures occurred in the series, both following unipolar techniques employing coagulation and resection. Many patients have now been followed for 5 or more years without noticeable increases in complaints of uterine bleeding and/or pelvic pain. The data indicate that open laparoscopy is a suitable means of performing tubal sterilization in the female.

Fallopian Tube Patency Tests↗

PubMed1994

Pomeroy tubal ligation by laparoscopy and minilaparotomy.

Pomeroy tubal ligation is a widely-used method for surgical female sterilization. A laparoscopic technique of Pomeroy tubal ligation using endoloop sutures is compared with the conventional technique of Pomeroy tubal ligation by minilaparotomy. Forty-four women requiring sterilization were randomly selected for either laparoscopy (n = 24) or minilaparotomy (n = 20). Mean operative time in the laparoscopy group (18.90 +/- 5.56 with a range of 12-35 minutes) was not significantly different from that in the minilaparotomy (23.12 +/- 8.24 with a range of 15-45 minutes) group. In all women, tubal specimens confirmed tubal histology. Both laparoscopy and minilaparotomy procedures may be performed for Pomeroy tubal ligation with minor morbidity. In clinics with appropriate conditions, Pomeroy tubal ligation by laparoscopy may be preferable to minilaparotomy.

Adult↗

PubMed1996

Intraperitoneal cell movement during abdominal carbon dioxide insufflation and laparoscopy. An in vivo model.

PURPOSE: Possible mechanisms of movement of malignant cells within the peritoneal cavity during CO2 insufflation and laparoscopy involve direct transfer via laparoscopic instruments or dispersion of cells by CO2 or water vapor. An in vivo model has been developed to study these mechanisms. METHODS: Laparoscopy was performed on an animal model (domestic white pig). Cells derived from colorectal cancer cell line Lim 1215 were injected to lie free within the peritoneal cavity. A polycarbonate filter system with a 5-micron pore diameter was used to examine CO2 expelled from the peritoneal cavity, during laparoscopy and manipulation of abdominal viscera, for malignant cells. Laparoscopic instruments and laparoscopic ports were washed independently, and fluid was centrifuged and examined for malignant cells. RESULTS: Malignant cells were identified on 1 of 30 filters used to examine exhaust carbon dioxide. Malignant cells also were identified from 2 of 10 washings from laparoscopic ports and from 4 of 10 washings of laparoscopic instruments. CONCLUSIONS: These results suggest that movement of cells throughout the peritoneal cavity during laparoscopy is via contaminated instruments, but local cell movement by dispersion possibly within water vapor from the port may also occur.

Animals↗

PubMedDate not supplied

Laparoscopy in the emergency setting.

Laparoscopy has been available for 90 years and was actively undertaken by the gynecologists. Today the vast majority of gynecological procedures are performed by this route. Despite the efforts of a few enthusiastic surgeons, the general surgical community did not incorporate laparoscopy into their armamentarium until the advent of laparoscopic cholecystectomy. However, this endoscopic technique has much to contribute, especially in the setting of emergency care. It is of value in formulating a treatment algorithm and in avoiding unnecessary laparotomy in both blunt and penetrating trauma. Laparoscopy helps to define the nature of obscure abdominal diagnoses, avoids unnecessary appendectomy, and provides the window of opportunity for surgery in mesenteric ischemia due to either arterial or venous thrombosis or embolus. It is also of value in patients with pain or fever of unknown origin, displaced gastrostomy or dialysis tubes, and in the rare patient with gastrointestinal bleeding where other diagnostic modalities have been unable to yield the diagnosis. In this article the instrumentation and techniques will be outlined and the role of laparoscopy in each of the above situations will be detailed. As with all surgical procedures, it is vital that the surgeon be well-trained and knowledgeable about the correct use of the technique, its possible pitfalls and how to avoid them, as well as knowing the contraindications.

Abdominal Injuries↗

PubMed1996

Laparoscopy: an important tool in the staging of malignant pleural mesothelioma.

BACKGROUND: The current standard for the noninvasive staging of patients with malignant pleural mesothelioma is computed tomography (CT). However, CT often cannot determine whether a tumor is unresectable because of direct extension through the diaphragm to the peritoneal cavity. The aim of this prospective study was to determine whether laparoscopy detected transdiaphragmatic tumor extension when CT findings were equivocal. METHODS: From June 1993 to July 1994, 12 of 36 patients considered for possible thoracotomy and surgical resection had equivocal CT findings of diaphragmatic invasion. All underwent laparoscopy using a multiport technique with diaphragmatic and peritoneal biopsies. RESULTS: The mean operative time was 83 min. There were no perioperative complications. The median hospital stay was 1 day. Six patients had biopsy-proven transdiaphragmatic extension, or peritoneal studding of tumor. The other six patients subsequently underwent thoracotomy: three had a complete resection, and three had unresectable tumor due to chest wall (N = 2) or mediastinal (N = 1) invasion. In no case was transdiaphragmatic extension of a tumor seen. CONCLUSIONS: This preliminary experience demonstrates that laparoscopy is a safe and accurate method for detecting transdiaphragmatic tumor extension when CT fails to do so. Laparoscopy should be considered a standard part of prethoracotomy staging in this subset of patients.

Aged↗

PubMedDate not supplied

Diagnostic laparoscopy in critically ill intensive-care-unit patients.

The diagnosis of intraabdominal sepsis in critically ill intensive-care-unit patients remains a challenge. Diagnostic laparoscopy has been performed in seven such patients following admission for coronary artery bypass surgery, gram-negative sepsis, major burns, pneumonia, myocardial infarction, and post-pneumonectomy. Laparoscopy revealed acalculous cholecystitis in two patients (one removed laparoscopically), gangrenous colon in two, cirrhosis with liver infarction in one, and, in two patients, no pathology. Although five patients died postoperatively, none was related to the laparoscopy. There were no intraoperative complications and no known pathology was missed. Because of its ease and accuracy, diagnostic laparoscopy should be considered in all critically ill patients suspected of harboring intraabdominal pathology. Further studies are needed to fully establish its efficacy and safety.

Abdominal Pain↗

PubMed2005

Laparoscopy vs inguinal exploration for nonpalpable undescended testis.

OBJECTIVE: The optimal initial surgical approach for nonpalpable undescended testis (UDT) is debated. The aim of the present study is to compare the results of initial laparoscopy and inguinal exploration in the management of unilateral nonpalpable undescended testes. METHODS: The results of 20 children with unilateral nonpalpable UDT managed by initial laparoscopy (group I) were compared with 20 age-matched children managed by inguinal exploration (group II). The location of testes and results of orchiopexy were compared in both groups. A single surgeon performed all the operative procedures. RESULTS: The majority of testes (16/20 group I, 17/20 group II) in both groups were canalicular or low abdominal. Vanishing testes accounted for one-third (13/40) of the testes, the majority (85%) of which were located in the inguinal canal. All children were discharged within 24 hours of the operation. The success of orchiopexy at 4-6 weeks post-operatively was 85% and 86% in the two groups respectively. Retrospectively, only 7/40 (18%) of the testes would benefit from laparoscopy. CONCLUSIONS: Initial laparoscopic and inguinal approaches to nonpalpable UDT give comparable results. This report failed to demonstrate any specific advantage of initial laparoscopy in the majority of children with unilateral nonpalpable UDT.

Child↗

PubMed1991

Nausea and vomiting after gynaecological laparoscopy depends upon the phase of the menstrual cycle.

Postoperative nausea and vomiting were compared in 68 women with regular menstrual periods undergoing gynaecological laparoscopy. The patients were divided into four group on the basis of the phase of the menstrual cycle as follows: premenstrum-menstrum (pre + menstrum) (Pd 25-6), early follicular phase (Pd 8-12), ovulatory phase (Pd 13-15) and luteal phase (Pd 20-24). The overall incidence of nausea and vomiting was 46%. Statistically significant differences in the incidence of nausea and retching were found among the groups by regression analysis. The incidence of nausea and vomiting was highest in women undergoing laparoscopy during the luteal phase (77%), which was greater than during the follicular phase (32%) or during pre + menstruation (18%). The need for antimetic was highest in women undergoing laparoscopy during the luteal phase (69%) and this was different from the follicular (18%, P less than 0.01) and pre + menstrum (19%, P less than 0.01) phases. It is concluded that the highest incidence of postoperative nausea and vomiting after gynaecological laparoscopy occurs during the luteal phase.

Adult↗

PubMed1999

Use of the Hasson cannula producing major vascular injury at laparoscopy.

Despite the recent demonstration that vascular lesions occur significantly more frequently in patients having closed rather than "open" laparoscopy, there never has been a published case report of injury to the great vessels associated with the open technique of initial access to the peritoneal cavity at laparoscopy. We present the first two such cases reported, along with a brief review of the literature related to such major vascular injuries (MVI) sustained at laparoscopy. Lacking appreciation of aortic anatomy and intraoperative technical factors contribute to the occurrence of these injuries. Delayed diagnosis and management contribute to poor outcomes. Secondary injury frequently is associated with MVI at laparoscopy.

Adult↗

PubMed2003

[Mesenteric ischemia. Is diagnostic laparoscopy of value?].

In the past decade laparoscopic surgery replaced many open operations in general surgery. Apart from therapeutic uses in cholecystectomy, appendectomy, hernia surgery, gastric fundoplication, and increasingly also large intestine surgery, it is indicated diagnostically first of all for unclear abdominal findings and for staging of intra-abdominal malignancies. To date laparoscopy has been used occasionally for diagnosis and therapy of mesenteric ischemia. Patients suffering from mesenteric ischemia are usually old and have comorbid conditions. Quick diagnosis and therapy are necessary due to the pathogenesis of the disease. The low rate of morbidity as well as the easy availability of laparoscopy in principle favor the employment of laparoscopy also for mesenteric ischemia. Against the background of increasing experience in the area of laparoscopic surgery, this study gives an overview of the present value of laparoscopy for mesenteric ischemia.

Abdomen, Acute↗