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Results for “laparoscopy”

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At least 631 records · Page 35Linked to original sources

PubMed1997

A randomized prospective study of laparoscopy and laparotomy in the management of benign ovarian masses.

OBJECTIVE: Our purpose was to compare the results of laparoscopy with laparotomy in the management of ovarian masses not suspected to be malignant. STUDY DESIGN: In a prospective randomized study 102 patients requiring surgical management of ovarian masses were randomly assigned to laparoscopy (52) or laparotomy (50) in a teaching hospital from July 1994 to September 1995. Inclusion criteria was tumor not suspected to be malignant with a diameter of < or = 10 cm as measured by ultrasonography. All operations were performed by trainees under the supervision of an experienced surgeon. Statistical analysis included t tests and chi2 tests. RESULTS: There were no differences in demographic characteristics between the two groups nor any difference in the size of ovarian masses, adnexal adhesion score, or frequency of bilateral disease. All the ovarian masses were benign. Endometriotic cysts and dermoid cysts were the most common disorder in the two groups. Cystectomy was performed in > 70% of cases in each group. Operating time was not increased with the laparoscopic approach, and the frequency of inadvertent rupture of the ovarian masses was just as high as in laparotomy. The laparoscopic approach was associated with a significant reduction in operative morbidity (odds ratio 0.34, 95% confidence interval 0.13 to 0.88), postoperative pain and analgesic requirement, hospital stay, and recovery period. Patients in general were satisfied with the operation, but significantly more patients were satisfied with the laparoscopy scar. CONCLUSION: Operative laparoscopy should replace laparotomy in the management of benign ovarian masses.

Adult↗

PubMed1994

Diagnostic laparoscopy: a survey of 92 patients.

From January 1991 to June 1993 the authors performed 92 diagnostic laparoscopies when physical examination, laboratory tests, and noninvasive imaging techniques failed to provide accurate diagnoses. Thirty-three patients (36%) underwent laparoscopy to ensure or exclude diagnosis in suspected intra-abdominal malignancy or to assess the operability in the cases of known cancer; 31 patients (34%) were evaluated for chronic abdominal pain; 15 patients (16%) were evaluated for acute abdominal pain; 9 trauma patients (10%) were evaluated to exclude or confirm penetration of the peritoneum or laceration of intra-abdominal organs; and 4 patients (4%) were operated on for miscellaneous conditions. Of the 92 patients, laparoscopy led to diagnosis in 80 patients (87%), a laparotomy was avoided in 78 patients (85%), and operative treatment was done laparoscopically in 65 patients (71%). Diagnostic laparoscopy will not replace laparotomy in every instance. However, in selected groups of patients, it may be used to yield diagnosis and help to avoid unnecessary laparotomy.

Abdomen↗

PubMed1983

Combined screening laparoscopy and timed follicle aspiration for human in vitro fertilization.

Twenty-seven patients underwent ultrasonographic and clinical monitoring of a spontaneous cycle so that human chorionic gonadotropin administration could be timed in an attempt to schedule the screening laparoscopy at the optimal time for oocyte aspiration. Inadequate ovarian access was encountered in only 2 of 26 laparoscopies. Seven patients had ovulated by the time of scheduled laparoscopy. Nine mature, seven immature, and three postovulatory oocytes were obtained, and seven embryo transfers were accomplished. The number of eggs obtained per laparoscopy was 0.73. The attempt to control the time of ovulation was unpredictable, few mature oocytes were obtained, and the procedure offered little ultimate benefit to the patient.

Adult↗

PubMed1984

Comparison of diagnostic accuracy of laparoscopy, hysteroscopy, and hysterosalpingography in evaluation of female infertility.

The diagnostic accuracy and therapeutic value of hysterosalpingography (HSG), laparoscopy, and hysteroscopy were evaluated in 77 women who underwent these procedures as part of their infertility evaluation. HSG revealed in 32 women (42%) evidence of tubal or peritoneal disease, and 16 other women (21%) had radiographic evidence of intrauterine abnormalities. These findings were confirmed by laparoscopy in 84% of patients and by hysteroscopy in 69%, giving false-positive rates of 16% and 31% for HSG. HSG had a false-negative rate of 13% for tubal or peritoneal disease as subsequently uncovered by laparoscopy, and 1.3% for intrauterine lesions as revealed by hysteroscopy. The data suggest that while laparoscopy is of value in detecting previously unsuspected tubal disease, hysteroscopy adds little information in the management of the infertile patient. For optimum evaluation, a combined approach using all three procedures is recommended, especially in patients with a history of uterotubal and peritoneal lesions.

Adult↗

PubMed1991

Intraoperative management of ureteral injury during operative laparoscopy.

Injury to the ureter from operative laparoscopy is rare. The diagnosis is usually made radiologically, in the postoperative period, when the patient presents with symptoms and signs suggestive of ureteral injury. We report herein a case of ureteral injury resulting from operative laparoscopy for endometriosis. The injury was diagnosed and treated via laparoscopy during the same procedure. The increased utilization of operative laparoscopy to perform more complex procedures increases the potential for operative injury to the ureter. Prior visualization or retroperitoneal dissection of the ureter, in appropriate cases, will help reduce this complication and/or permit a prompt diagnosis in the event of such injury.

Adult↗

PubMed1992

Salpingoscopy: systematic use in diagnostic laparoscopy.

OBJECTIVE: To evaluate the importance of salpingoscopy together with laparoscopy in the diagnosis of tubal pathology. DESIGN: Salpingoscopy was performed as a complementary method in patients who were subjected to diagnostic laparoscopy. The relationship between the salpingoscopy and (1) the patient's previous history of tubal disease and (2) laparoscopic diagnoses was evaluated. SETTING: Private patients referred to the Instituto de Fertilidad, Buenos Aires. PATIENTS, PARTICIPANTS: Forty-two patients undergoing a diagnostic laparoscopy during the evaluation of their fertility or as a follow-up of previous therapy. MAIN OUTCOME MEASURE(S): Salpingoscopy was performed, using a colpomicrohysteroscope. We evaluated alterations in major and minor folds and their vascularization, the presence of microadhesions, and cellular nuclei dyed with methylene blue in the tubal lumen. RESULTS: Fifty percent of the patients who had no previous history of tubal disease presented with endosalpingeal alterations, and in 37% of the normal laparoscopies the salpinx had unilateral or bilateral salpingoscopic abnormalities. CONCLUSIONS: Salpingoscopy is a useful method to evaluate oviducts, before assuming their normality, and consideration of these women for assisted reproductive technology.

Abortion, Spontaneous↗

PubMed1989

Second-look operative laparoscopy 1 year following reproductive surgery.

To evaluate the efficacy of a second-look operative laparoscopy following a reproductive surgery, a randomized study was conducted on women who failed to conceive 1 year following terminal salpingostomy or following salpingo-ovariolysis by laparotomy. There is no significant difference in the cumulative probability of pregnancy at 12, 24, and 36 months follow-up between women who underwent second-look operative laparoscopy 1 year after salpingo-ovariolysis (27%, 67%, and 67%) and women who were continued to be observed expectantly (27%, 45%, and 52%, respectively). The cumulative probability of conception at 12, 24, and 36 months follow-up in women who underwent second-look laparoscopy 1 year after salpingostomy was 6%, 18%, and 18% and in women who were observed expectantly was 5%, 21%, and 27%, respectively (P = no significant). The incidence of ectopic pregnancy which was high (about one-half of patients who conceived) was also not affected by this procedure. This study suggests that second-look operative laparoscopy 1 year after terminal salpingostomy or salpingo-ovariolysis does not increase the pregnancy rate or decrease the incidence of ectopic pregnancy. Women who fail to conceive 1 year after a reproductive surgery still maintain some of their reproductive potential, but the risk of having an ectopic pregnancy is high.

Adult↗

PubMed1997

Follow-up report on a randomized controlled trial of laser laparoscopy in the treatment of pelvic pain associated with minimal to moderate endometriosis.

OBJECTIVE: To assess the longer term efficacy of laparoscopic laser surgery in the treatment of painful pelvic endometriosis and to observe the natural history of the disease at second-look laparoscopy in a control group. DESIGN: One-year follow-up of a prospective, randomized, double-blind controlled trial. SETTING: A referral center for the laparoscopic laser treatment of endometriosis. PATIENT(S): Sixty-three patients with pelvic pain and minimal to moderate endometriosis. INTERVENTION(S): After the 6-month follow-up visit, the randomization code was broken, and follow-up was continued to 1 year. Symptomatic patients were offered second-look laser laparoscopy. MAIN OUTCOME MEASURE(S): Continued symptom relief at 1 year after treatment and findings at second-look laparoscopy in symptomatic controls. RESULT(S): Symptom relief continued at 1 year in 90% of those who initially responded. All symptomatic controls had a second-look procedure, with 7 (29%) showing disease progression, 7 (29%) showing disease regression, and 10 (42%) having static disease. CONCLUSION(S): The benefits of laser laparoscopy for painful pelvic endometriosis are continued in the majority of patients at 1 year. Untreated painful endometriosis will progress or remain static in the majority of patients but will spontaneously improve in others.

Adult↗

PubMedDate not supplied

The use of laparoscopy in retroperitoneal pathology.

Laparoscopy is usually not performed for retroperitoneal disease. However, if the retroperitoneal process is palpable or displaces viscera, laparoscopy may allow visualization and directed biopsy. In a personal series of 316 laparoscopies reviewed retrospectively, 19 (6%) were performed primarily for retroperitoneal pathology. All patients had CT scans documenting a retroperitoneal process. A confirmed histologic diagnosis was obtained on directed laparoscopic biopsy in 16 patients, including 9 non-Hodgkin's lymphomas. There was no mortality or morbidity in this series. Laparoscopy is a useful modality in selected patients with retroperitoneal diseases, and its use should be considered when a histologic diagnosis is necessary.

Biopsy↗

PubMed1996

Hypoxemia during diagnostic laparoscopy: a prospective study.

BACKGROUND: Laparoscopic liver biopsy can be safely performed using local anesthesia and intravenous sedation, but the frequency of hypoxemia is unknown. METHODS: We prospectively studied 68 patients undergoing diagnostic laparoscopy and liver biopsy managed by a standard protocol. RESULTS: The mean duration of laparoscopy was 27 +/- 5.53 minutes; the mean dose of diamorphine administered was 6.9 +/- 2.7 mg; diazepam, 7.05 +/- 3.52 mg. The baseline arterial oxygen saturation was 95.6% +/- 2.5% and trough was 85% +/- 5.1%. A fall of greater than 4% saturation from the baseline occurred in 64 out of 68 patients (94%). The mean decrease in saturation was 10.1% +/- 5.4%. An arterial oxygen saturation of less than 85% was seen in 32 patients (47%). There was no correlation between the fall in oxygen saturation and the dose of diamorphine or diazepam, the duration of procedure, body mass index, hemoglobin, or volume of pneumoperitoneum induced. One-way analysis of the variance failed to show a significant relationship between the degree of oxygen saturation and Child's class, etiology of liver disease, or smoking habit. CONCLUSIONS: In this study, we demonstrated that significant desaturation is common in diagnostic laparoscopy with liver biopsy and is likely due to a combination of different pharmacologic and physiologic effects. We recommend continuous monitoring of both arterial oxygen saturation and supplemental oxygen for all patients throughout laparoscopy.

Analysis of Variance↗

PubMed1998

Usefulness of laparoscopy with liver biopsy in the assessment of liver involvement at diagnosis of Hodgkin's and non-Hodgkin's lymphomas.

BACKGROUND: Staging of lymphoma at diagnosis determines therapeutic strategy and disease prognosis. Hepatic involvement, demonstrated by laparotomy or laparoscopy, is frequent in Hodgkin's and non-Hodgkin's lymphoma. However, it is unclear whether these procedures are still necessary or whether they should be replaced by less invasive techniques. METHODS: Laparoscopy-assisted liver biopsies, as well as laboratory studies, bone marrow biopsy, and thoracic and abdominal computed tomography, were performed as an initial staging evaluation in 112 consecutive patients who were diagnosed with Hodgkin's or non-Hodgkin's lymphoma. RESULTS: Hepatic lymphomatous involvement was demonstrated in 18 patients (16%). It was more frequent in non-Hodgkin's (24%) than in Hodgkin's (8%) lymphomas (p < 0.04) and among stage III and IV (24%) than stage I and 11 (10%) patients (p < 0.05). The laparoscopic finding of white spots or nodules on the liver surface had a 100% specificity in the diagnosis of lymphomatous liver involvement. Conversely, hepatomegaly on both laparoscopy and computed tomography, as well as laboratory studies, had a low sensitivity and specificity. CONCLUSIONS: Laparoscopy-assisted liver biopsy was a useful technique to establish hepatic lymphomatous involvement, which was not identified by either computed tomography or laboratory studies.

Adolescent↗

PubMed2002

Assessment of risk for intra-abdominal adhesions at laparoscopy for urological tumors.

PURPOSE: Abdominal wall adhesions at laparoscopy may predispose patients to access related injuries and increase the complexity of the procedure. We have observed concern from referring physicians regarding the safety of laparoscopy in patients who previously underwent surgery because of the risk of abdominal adhesions. To assess the risk of adhesions at laparoscopy a retrospective cohort study was performed. MATERIALS AND METHODS: All patients who underwent a transperitoneal urological laparoscopic procedure in a 6-year period at our institution were included in this study. A chart review was performed to obtain demographic/surgical data and identify preoperative risk factors for adhesions, such as previous abdominal or pelvic surgery, radiation and/or intra-abdominal inflammatory disease. Operative videotapes were reviewed to determine the presence and location of adhesions. Standard statistical analyses were performed. RESULTS: During the study period 127 patients underwent transperitoneal laparoscopy and videotapes on 82 (65%) were available for review. A total of 44 patients (54%) were identified with preoperative risk factors for adhesions (group 1), while 38 (46%) had no risk factors (group 2). The relative risk of adhesions was 1.34 (95% CI 0.89 to 2.01, p = 0.18) when risk factors were identified. There were no differences in the groups in patient age, operative time, access technique, conversion to open surgery or complications. Estimated blood loss was significantly higher in group 2, likely due to the preponderance of cytoreductive laparoscopic nephrectomy in this group. CONCLUSIONS: There was no difference in the risk of intra-abdominal adhesions in patients with and without identifiable preoperative risk factors. Preoperative risk factors for adhesions should not contraindicate the transperitoneal laparoscopic approach for urological oncology procedures.

Abdomen↗

PubMed1992

The value of laparoscopy for 106 impalpable testes relative to clinical presentation.

Laparoscopy was done in 104 consecutive patients with 106 impalpable testes. Three clinical presentations were identified and the value of laparoscopy in each was analyzed. 1) For unilateral impalpable and contralateral normal testes laparoscopic identification of testicular absence was made in 27% of the cases and intra-abdominal testes were found in 16%. Therefore, laparoscopy was of value in 43% of the cases. 2) For bilateral undescended testes (1 or both impalpable) laparoscopy was diagnostic in 75% of the cases (17% had blind-ending spermatic vessels above the internal ring and 58% had intra-abdominal testes). 3) For patients with previous negative inguinal exploration laparoscopic diagnosis was made in 100%.

Adolescent↗

PubMed1997

A randomized comparison of gasless laparoscopy and CO2 pneumoperitoneum.

OBJECTIVE: To determine if the theoretic advantages of gasless laparoscopy are realized in direct comparison to laparoscopy with pneumoperitoneum. METHODS: Fifty-seven patients undergoing laparoscopic surgery chose to participate in this trial and were randomized after the induction of general anesthesia. Twenty-nine of the 57 patients were randomized to the pneumoperitoneum group. Of the 28 patients in the gasless group, six were converted to pneumoperitoneum because of inadequate exposure. The adequacy of exposure and ease of surgery were assessed with a subjective score, and the times to exposure and for incision closure were recorded. Various anesthetic factors were measured. Patients completed an analog pain score in the recovery area and for the first 5 postoperative days. Analgesic and antiemetic use also was recorded, as was the number of days to return to normal activity. RESULTS: Times to achieve exposure and close incisions were longer, and exposure and ease of surgery were worse in the gasless group. Patients in the gasless group had lower diastolic blood pressure, minute ventilation, peak inspiratory pressures, and end tidal pCO2. There were no differences in body temperature, systolic blood pressure or heart rate, postoperative pain scores, analgesic or antiemetic use, or times to hospital discharge or return to activity between the groups. CONCLUSION: Performing laparoscopy using the Laparolift device compromised surgical exposure and thus increased technical difficulty. Patients realized no benefits from its use in terms of postoperative discomfort or return to activity. Eliminating the pneumoperitoneum allowed lower minute ventilation and peak inspiratory pressures, and end tidal pCO2 was lower. Although the concept of gasless laparoscopy holds appeal, the current prototype is not well-suited for infertility procedures.

Adult↗

PubMed2002

The role of laparoscopy in the multimodality treatment of colorectal cancer.

Ten years after the first reports of laparoscopic techniques in colorectal surgery the precise role for these approaches in future colorectal practice as still to be defined. However, it seems most unlikely that the application is going to disappear. Laparoscopic colectomy is undoubtedly a complex. time-consuming procedure and it is clear that the technique is intolerant of difficult cases and will likely remain thus. Therefore. the potential advantages of laparoscopy do not as yet appear to be attainable across the board in colorectal resection. Such generalized advantage may, however, be tantalizingly close. Although many studies have failed to show major benefits for laparoscopy in terms of postoperative recovery, it must be remembered that most of these have been of insufficient statistical power to settle the issue. What is clear to all involved in the field is that very many patients do gain major benefit from the minimally invasive approach. The challenge for the future lies in developing the technology to such a point that these benefits for patients are more reproducible. The requirement for a significant abdominal incision to deliver an intact specimen represents a significant hurdle in this regard. The importance of pathological staging for colorectal cancer at present mandates retrieval of an intact specimen. It is of course possible that radiological staging may develop to such a point that surgeons need only remove the lesion with minimal attention to lymphadenectomy. Alternatively, new adjuvant therapies may arrive that, by virtue of increased efficacy and low side-effect profiles, may be applicable to all but the earliest lesions. Finally, increasing health awareness and application of screening programs may lead to a preponderance of large polyps and preinvasive lesions for which a more limited resection may be appropriate. Obviously these scenarios remain almost entirely speculative. However, the trend towards less invasive local therapy for colorectal cancer seems inexorable, and we firmly believe that laparoscopy will come to play an increasing role. Finally, we suggest that the oncological safety of laparoscopy is of less concern than was the case some years ago. The specter of port-site metastasis, once so alarming, has faded. It is now apparent from all of the larger scale studies that port-site metastases are not a significant issue in the presence of adequate training and laparoscopic skills. Almost without exception, the accumulating evidence seems to point to equivalence in terms of disease-specific recurrence and survival between patients treated using conventional and laparoscopic techniques. We foresee these findings being confirmed by the North American and European trials.

Colectomy↗

PubMed1998

Laparoscopy for the evaluation and management of the nonpalpable testicle.

OBJECTIVE: To assess the usefulness of laparoscopy for the diagnosis and treatment of the nonpalpable testicle and to evaluate the results of laparoscopic orchidopexy. METHODS: We retrospectively reviewed the charts of 91 laparoscopies performed over a period of 4 years. We reviewed the following parameters: findings, complications, patency of the processus vaginalis, appearance of the cord structures, and the success of the different procedures performed for the intra-abdominal testicle. RESULTS: Fourteen patients had bilateral and 77 unilateral nonpalpable testicles. The mean age of the patients was 39.5 +/- 50.8 months. There were three laparoscopic complications (3.2%) one of which was a major bowel laceration. Laparoscopy defined the intra-abdominal anatomy accurately in 90 of the 91 cases Of the 26 intra-abdominal testicles above the ring, a one-stage laparoscopic orchidopexy was performed in five and a single-stage standard orchidopexy in seven. All of these testicles remain viable and are in good position. Eight patients underwent a staged Fowler-Stephens orchidopexy with laparoscopic clipping of the spermatic vessels as the first stage. Of these, a second-stage open orchidopexy was performed in five and a laparoscopic orchidopexy in three. Testicular atrophy occurred in two of the patients who underwent the second-stage open orchidopexy. Three one-stage Fowler-Stephens orchidopexies were performed with testicular atrophy occurring in two of these testicles. Laparoscopic orchiectomy was performed on two patients. CONCLUSIONS: Laparoscopy is a valuable tool in the diagnosis and treatment of the nonpalpable testicle. Laparoscopic orchidopexy may decrease the rate of testicular atrophy since most of these can be performed laparoscopically in one stage, thus preserving the vascular supply.

Adolescent↗

PubMed2003

Current status of robotics in urologic laparoscopy.

Urology has continuously embraced novel technologies like laparoscopy that reduce patient morbidity yet maintain an excellent standard of care. Because of limitations on maneuverability, operative vision, manual dexterity, and tactile sense, laparoscopy can be more difficult to perform than corresponding tasks in open surgery. To potentially increase clinical applicability of laparoscopy, robots that enhance operative performance have recently been introduced for a variety of laparoscopic procedures such as laparoscopic radical prostatectomy, pyeloplasty, and even laparoscopic cystectomy and neobladder construction. While these robots have generated excitement and many robotic applications have been described, the benefit of the advanced technology in expanded series of patients remains largely unknown. In addition, the ability of telerobotics to be used by surgeons inexperienced in conventional laparoscopy is also poorly understood. This review compares current features of available robots, advantages and limitations of robots, the emerging clinical applications, and the future potential of robotics in urology.

Humans↗

PubMed2001

Anesthesia for laparoscopy in the pediatric patient.

Pediatric laparoscopy is a novelty that has yet to be critically assessed in large, randomized controlled trials. Just because an operation can be performed laparoscopically does not mean it must be done that way. Many procedures can now be performed more quickly and cheaply through small incisions without the added cardiorespiratory risks seen in laparoscopy. Reports of serious complications are beginning to appear in publications. It will become important to compare laparoscopic techniques with both open surgery and the minimally invasive approach for the same procedure. Many published studies suggest laparoscopy offers significant advantages for some operations and for sicker patients. Practitioners must have a thorough understanding of the physiologic changes that follow pneumoperitoneum and extremes of positioning. As enthusiasm builds, it is essential to maintain safety standards. Endoscopists must be appropriately trained and peer reviewed. The use of virtual reality models now allows surgeons to develop and perfect their laparoscopic skills. When the laparoscopic approach is difficult, surgeons must be willing to convert to open surgery rather than persevere and risk iatrogenic damage. The role of pediatric laparoscopy has yet to be defined, although current trends suggest that it will assume an important position in pediatric surgery.

Anesthesia↗