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PubMed2002

Temporary ovarian suspension at laparoscopy for prevention of adhesions.

We performed an innovative technique of temporary ovarian suspension after operative laparoscopy for stage 3 and 4 endometriosis and evaluated the results in a retrospective study. Subjects were 20 women who underwent operative laparoscopy for infertility. Temporary ovarian suspension to the anterior abdominal wall was performed as the last step in the surgical procedure. It was done in an attempt to separate adhesiogenic surfaces during the initial phase of tissue healing (5-7 days). No complications occurred. After excluding patients who had additional infertility factors and/or were of advanced reproductive age, nine women tried to conceive spontaneously. Of these, five conceived (55%): three delivered, one pregnancy continues (80%), and one woman had an ectopic pregnancy (20%). Of the remaining 15 patients who failed to conceive spontaneously, 5 had a second-look laparoscopy. In four patients (80%), we found no evidence of recurrent adhesions. The remaining 20% had minimal adhesions. Temporary ovarian suspension appears to be simple and safe, and may be effective in preventing postoperative adhesions near the ovaries after operative laparoscopy for advanced endometriosis.

Adult↗

PubMed2001

Fertility outcome after tubal anastomosis by laparoscopy and laparotomy.

STUDY OBJECTIVE: To evaluate fertility outcome and benefit of laparoscopic tubal anastomosis compared with laparotomy. DESIGN: Retrospective study (Canadian Task Force classification II-2). SETTING: University hospital. PATIENTS: Eighty-one women requesting reversal of sterilization. Fertility outcome was analyzed in 76 patients for a minimum of 6 months. INTERVENTION: Laparoscopic tubal anastomosis in 37 women and abdominal tubal anastomosis in 44. MEASUREMENTS AND MAIN RESULTS: In both groups anastomosis was performed in two layers with four stitches using microsurgical technique. Overall pregnancy rates were 80.5% in the laparoscopy and 80.0% in the laparotomy group. The mean interval from operation to pregnancy was similar in the two groups (p = 0.9). Mean operating time was significantly longer for laparoscopy (201.9 +/- 33.8 min) than for laparotomy (148.7 +/- 32.5 min), including diagnostic laparoscopy. However, mean hospital stay was shorter for laparoscopy than for laparotomy (3.3 +/- 2.0 vs 6.1 +/- 0.6 days, p <0.05). CONCLUSION: Laparoscopic tubal anastomosis is less invasive and could be an alternative to laparotomy for reversal of tubal sterilization. Advanced laparoscopic equipment and much experience could enhance the pregnancy rate and reduce operating time.

Adult↗

PubMed2001

Effects of local bupivacaine instillation on pain after laparoscopy.

STUDY OBJECTIVE: To evaluate the effect of preincisional and intraperitoneal bupivacaine administration on immediate and late pain after operative laparoscopy. DESIGN: Randomized study (Canadian Task Force classification I). SETTING: University teaching hospital. PATIENTS: One hundred fifty women undergoing laparoscopy for various gynecologic indications. INTERVENTION: A dose of 0.5% bupivacaine 10 ml (50 mg) was injected into cannula sites before incisions and another 10 ml diluted with 100 ml saline into the peritoneal cavity at completion of the procedure. Equal amount of physiologic saline was used in controls. MEASUREMENTS AND MAIN RESULTS: Modified McGill pain intensity scores and amount of analgesic required in the recovery room and within 24 hours postoperatively were evaluated. Of 150 women, 142 completed the study (71 bupivacaine group, 71 controls). Groups did not differ significantly in body mass index, duration of surgery, return to consciousness, and analgesic requirement during 3-hour observation in the recovery room and 24 hours after discharge. Pain scores were highest 30 minutes after the procedure in both groups. At that time the pain score in the bupivacaine group was lower than that in the control group (1.8 +/- 0.2 vs 2.3 +/- 0.2, p <0.05). Beyond that time, the groups did not differ in pain scores and analgesic requirements. CONCLUSION: Postoperative pain is the highest within 30 minutes after laparoscopy. Local instillation of bupivacaine before incision and intraperitoneally was effective in reducing pain immediately after operative laparoscopy, but the effect was not seen beyond 30 minutes.

Anesthetics, Local↗

PubMed1996

Laparoscopy versus microsurgery by laparotomy for excision of ovarian cysts in patients with moderate or severe endometriosis.

STUDY OBJECTIVE: To compare the efficacy of laparoscopy versus microsurgery by laparotomy in the treatment of ovarian endometriomas. DESIGN: Retrospective study with historical controls. SETTING: A tertiary university hospital. PATIENTS: One hundred thirty-two women under 40 years of age with ovarian endometriotic cysts at least 3 cm in diameter (stage III and IV endometriosis, R-AFS classification). Interventions. A single surgeon (RM) treated 83 patients by laparoscopy for excision of ovarian endometriomas by the stripping technique and 49 by microsurgery at laparotomy. MEASUREMENTS AND MAIN RESULTS: Data regarding recurrence of ovarian cysts, symptomatic improvement, and reproductive outcome were comparable for the two groups. Postoperative febrile morbidity and length of hospitalization were significantly less for the laparoscopy group than for the laparotomy group (p <0.0005). CONCLUSIONS: Operative laparoscopy for excision of ovarian endometrial cysts by the stripping technique is as effective as microsurgery by laparotomy. It is associated with less febrile morbidity and a shorter hospitalization.

Endometriosis↗

PubMed1998

The effects of duration of CO2 insufflation and irrigation on peritoneal microcirculation assessed by free radical scavengers and total glutathion levels during operative laparoscopy.

STUDY OBJECTIVE: To investigate the effects of peritoneal exposure to carbon dioxide (CO2) on peritoneal microcirculation and free radical scavenger (FRS) metabolism, and its role in potential adhesion formation after operative laparoscopy. DESIGN: Randomized, controlled study (Canadian Task Force classification I). SETTING: University-affiliated hospital. PATIENTS: Twenty-eight women undergoing operative laparoscopy for adnexal masses. INTERVENTION: For each patient, a 1 x 1-cm sidewall peritoneal flap was excised at the end of laparoscopy and numbered randomly. Similar flaps obtained from 24 women immediately after entering the abdomen during laparotomy served as controls. MEASUREMENTS AND MAIN RESULTS: Changes in glutathione peroxidase (GSH-Px), superoxide dismutase (SOD), catalase (CAT), and glutathione (GSH) levels were studied in homogenized peritoneal tissues. The duration of CO2 exposure and amount of CO2 used were correlated with levels of free radical scavengers and compared with controls. Mean CO2 exposure, amount of CO2 used, and CO2 pressure (15 mm Hg) was similar between low irrigation and irrigated laparoscopy (118.3 +/- 25 and 39.2 +/- 8.81 min and 125 +/- 20 and 44.5 +/- 6.81 min, respectively). The change in FRS levels was significantly correlated with duration and amount of CO2 exposure (r = -0.92). Levels of GSH-Px, SOD, CAT, and GSH were significantly lower in the CO2 exposure group than in controls (0.57 micro mol, 1.8 ng, 48.5 micro mol, 1.5 nmol vs 0.8 micro mol, 2.6 +/- 0.4 ng, 79 micro mol, 3.6 nmol, respectively). CONCLUSION: Exposure to CO2 has adverse effects on peritoneal microcirculation and cell-protective systems, which are proposed mechanisms in adhesion formation. Avoiding long CO2 exposure and copiously irrigating the abdominal cavity throughout surgery may lessen these effects. The potential role of the peritoneal FRS system on postoperative adhesion formation and its relation to estrogen status mandates further studies.

Adnexal Diseases↗

PubMed1999

Laparoscopy using the left upper quadrant approach.

STUDY OBJECTIVE: To describe a technique of laparoscopy and multiport operative pelviscopy using left upper quadrant primary port insertion. DESIGN: Retrospective evaluation (Canadian Task Force classification II-2). SETTING: Private gynecologic oncology practice. PATIENTS: Ninety women with a history of gynecologic cancer and at least one laparotomy. INTERVENTIONS: Laparoscopy and operative pelviscopy. MEASUREMENTS AND MAIN RESULTS: The procedure was performed using the left upper quadrant as a single entry site for the Veress needle and primary laparoscopy port. In 88 women it was performed without complication. One woman experienced transverse colon injury from primary port insertion, which was repaired immediately by laparotomy. A second patient had a rectosigmoid injury that required temporary colostomy at laparotomy. CONCLUSION: Operative laparoscopy using the left upper quadrant approach seems to be safe in patients with advanced gynecologic malignancy. (J Am Assoc Gynecol Laparosc 6(3):323-325, 1999)

Female↗

PubMed1999

Mouse laparoscopy.

STUDY OBJECTIVE: To develop a technique for performing laparoscopy in the mouse. DESIGN: Controlled animal study (Canadian Task Force classification II-1). SETTING: University research laboratory. SUBJECTS: Twenty-eight CD-1 pregnant mice. INTERVENTION: Eight mice underwent anesthesia only and 20 had anesthesia plus laparoscopy at 5.5 and at 10.5 days' gestation (implantation occurs on day 4.5 and delivery on days 19-20). MEASUREMENTS AND MAIN RESULTS: Four mice in the laparoscopy group died early in the series, three due to hemorrhage and one due to anesthetic overdose. Among survivors, there were no differences between operated and control groups in number of pups delivered at term (8.7 +/- 5.1 and 8.9 +/- 3.8, respectively), frequency of pregnancy failure (18.8% and 12.5%), and presence of intraabdominal adhesions on autopsy after delivery (12. 5% and 12.5%). Intraabdominal contents could be manipulated to visualize both uterine horns in their entirety. The number of gestations could be counted accurately as early as 1 day after implantation. CONCLUSION: Given the fact that laparoscopy is not accompanied by the immunosuppression characteristic of laparotomy, this technique could prove useful for investigations requiring intraabdominal manipulations in mice when preservation of immune function is critical. The technique can be performed safely and repeatedly after an initial learning period. (J Am Assoc Gynecol Laparosc 6(2):173-177, 1999)

Animals↗

PubMedDate not supplied

Clinical value of diagnostic laparoscopy with laparoscopic ultrasound in patients with cancer of the esophagus or cardia.

Accurate pretherapeutic tumor staging becomes increasingly important for the selection of therapy in patients with cancer of the upper gastrointestinal tract. We prospectively assessed the clinical value of diagnostic laparoscopy with laparoscopic ultrasound and peritoneal lavage in 127 consecutive patients with cancer of the esophagus or cardia but no evidence of hepatic metastases, peritoneal tumor dissemination, or other systemic tumor manifestations on standard staging techniques. There was no mortality or morbidity associated with diagnostic laparoscopy. Diagnostic laparoscopy with laparoscopic ultrasound showed relevant previously unknown findings, particularly in patients with locally advanced adenocarcinoma of the distal esophagus or cardia (hepatic metastases in 22% and peritoneal tumor spread or free tumor cells in the abdominal cavity in 25%), whereas the diagnostic gain was low in those with squamous cell esophageal cancer. The sensitivity and specificity of laparoscopic ultrasound in predicting positive celiac axis lymph nodes were 67% and 92%, respectively. These data indicate that diagnostic laparoscopy with laparoscopic ultrasound and peritoneal lavage is safe and frequently provides therapeutically relevant new information in patients with locally advanced adenocarcinoma of the distal esophagus or cardia, whereas the clinical value in patients with squamous cell esophageal cancer is limited.

Adenocarcinoma↗

PubMedDate not supplied

The role of laparoscopy in the management of suspected pancreatic and periampullary malignancies.

Laparoscopic evaluation of patients with suspected periampullary malignancies has been utilized more frequently in recent years. Its exact role with regard to staging and surgical bypass for palliation have yet to be clearly defined. To better define the role of laparoscopy in the evaluation and palliation of periampullary malignancy, a retrospective review of the Duke experience was carried out. Fifty-three patients with suspected pancreatic or periampullary malignancies were referred for surgical evaluation at Duke University Medical Center between 1993 and 1995. All patients underwent CT scanning and lesions were classified as resectable or unresectable based on previously established criteria. Patients either underwent laparoscopic evaluation (n = 30; 11 with laparoscopic palliation) or proceeded directly to celiotomy (n = 23). Charts were reviewed for postoperative course including complications, length of stay, and hospital costs. Although laparoscopy had a sensitivity of 93.3% for metastatic disease, CT scans accurately staged 86.8% of patients missing only one patient with peritoneal/hepatic disease. Based on these results, laparoscopy may not be beneficial for every patient with a suspected pancreatic malignancy. Retrospectively an attempt was made to determine which patients benefited from laparoscopy and which patients are best served by proceeding directly to open exploration. From these data we devised an algorithm that outlines an efficient and cost-effective approach for this patient population.

Adult↗

PubMed2002

[Open laparoscopy: analysis of complications due to first trocar insertion].

OBJECTIVE: To evaluate the complications of open laparoscopy during the set-up of laparoscopy in gynecologic surgery. DESIGN: Retrospective study performed between February 1994 and January 2001 in a University Centre. PATIENTS AND METHODS: 1,562 patients underwent open laparoscopies. Procedures were performed by 8 gynaecological surgeons. Peri- and postoperative complications were assessed and analysed. RESULTS: Major injuries concerned gastrointestinal tract: 2 perforations with immediate diagnosis and one postoperative occlusion treated by delayed laparotomy (0.19%). No death occurred. No vascular injuries and no bladder complications were noted. CONCLUSION: We recommend open laparoscopy because of its innocuity and easiness. Advantages concern decrease of major vascular injuries and early recognition of bowel injuries.

Female↗

PubMed2004

Diagnostic conscious pain mapping using laparoscopy under local anaesthetic and sedation in general surgical patients.

BACKGROUND: Patients in whom extensive investigations have failed to identify the cause of abdominal pain present a challenge to surgeons. We present our initial experience of using laparoscopy under local anaesthetic and sedation in the diagnosis of chronic abdominal pain. METHODS AND PATIENTS: Nine patients with chronic abdominal pain and multiple normal investigations underwent laparoscopy under local anaesthetic and sedation. By touching and grasping intra-abdominal viscera and peritoneum, an attempt was made to reproduce the patient's pain. RESULTS: Two patients were found to have pain arising from the gall bladder and subsequently underwent laparoscopic cholecystectomy with resolution of their symptoms. A third patient had a clinical presentation of chronic acalculous cholecystitis and a normal laparoscopy. She decided to undergo laparoscopic cholecystectomy, which cured her pain. Another patient had pain arising from the appendix, which resolved after an appendicectomy. Three patients had pelvic adhesions, which caused chronic abdominal pain. After adhesiolysis, one is pain free; the others declined surgery for adhesions and their pain resolved. Conscious pain mapping was negative in two patients. CONCLUSION: Laparoscopy can be carried out in the conscious patient, who is then usually able to collaborate with the surgeon in establishing the source of the pain experienced during conscious pain mapping. Long-term effectiveness and diagnostic accuracy has not yet been established.

Abdominal Pain↗

PubMed2005

Laparoscopy and reported pain among patients with endometriosis.

OBJECTIVE: To compare the effectiveness of sharp excision of endometriosis with sham surgical excision in alleviating endometriosis-associated pain for up to 1 year following surgery. METHODS: Patients requiring a laparoscopy for severe pelvic pain were eligible. If endometriosis was visually identified at laparoscopy, a biopsy of a representative lesion was taken. The women were then randomized either to have all remaining endometriosis excised with laparoscopic scissors (the excision group) or to have no further surgical treatment (the control group). Patients were asked to complete daily pain scales for 1 month preoperatively and quarterly for 1 year postoperatively. Subjects were blinded to their treatment allocation for 1 year. RESULTS: Twenty-nine women underwent laparoscopy and biopsy and were randomized to have excision or no treatment of endometriosis. The excision and control groups were similar in age, parity, and revised American Society for Reproductive Medicine stage of disease. Sixteen women completed the full year of follow-up: 9 in the excision group, and 7 in the control group. Overall, recorded pain was significantly reduced at 1 year (P < 0.05), with no significant difference between the excision and control groups. CONCLUSION: Laparoscopy with diagnostic biopsy alone is associated with a significant reduction in pain for up to 1 year postoperatively. Although the study lacked sufficient statistical power to exclude an effect of excision, pain relief in each group was similar. These results indicate a potential benefit of sham surgical procedures in assessing novel surgical interventions.

Adult↗

PubMed2000

Systemic stress response during operations for acute abdominal pain performed via laparoscopy or laparotomy in children.

We compared the endocrine and metabolic changes during acute emergency abdominal surgery performed using either laparoscopy or laparotomy in children. Twenty-nine children aged 1.5-14 years were assigned to undergo laparoscopy (n = 15) or laparotomy (n = 14) with a standard anaesthesia technique. Arterial blood gases and blood prolactin, cortisol, interleukin-6, glucose, insulin, lactic acid and epinephrine levels were determined 5 min after the induction of anaesthesia, 30 min into surgery and at the end of surgery. Intra-operative heart rate and mean arterial pressure were stable in both groups. In the laparoscopy group, slight respiratory acidosis occurred during surgery (p < 0.01) but there were no changes in the laparotomy group. Insulin, cortisol, prolactin, epinephrine, lactate and blood glucose levels increased in both groups (p < 0.05) although there was no difference between the groups. The surgical stress and trauma imposed by laparoscopy seems similar to that caused by laparotomy in children undergoing emergency abdominal surgery.

Abdominal Pain↗

PubMed1999

Indication for and outcome of laparoscopy-assisted Billroth I gastrectomy.

BACKGROUND: Since 1991, laparoscopy-assisted Billroth I gastrectomy has been used for patients with early gastric cancer. The aim of this study was to clarify the outcome of 40 patients who underwent this operation and to examine the indications based on a retrospective histological study of 248 resected cases of early gastric cancer. METHODS: Operating time, blood loss, length of skin incision, and postoperative hospital stay and complications were examined using the operation records and medical charts. The presence or absence of lymph node metastasis, tumour size, site, gross type, histological type, depth of invasion, presence or absence of ulceration, and status of lymph node metastasis were investigated in 248 early gastric cancers. RESULTS: The mean operating time was 3 h and 48 min and the mean length of skin incision was 5.8 cm. Although one patient who had suffered from chronic bronchitis developed pneumonia and wound dehiscence, no other patients had a postoperative complication. The mean hospital stay after operation was 16 days and all patients were alive without recurrence at a median follow-up of 21 months. The incidence of lymph node metastasis in early gastric cancer was 2 per cent (three of 130) in mucosal cancers and 14 per cent (17 of 118) in submucosal cancers. These lesions could have been completely resected by laparoscopy-assisted gastrectomy. CONCLUSION: All 40 patients were treated successfully by laparoscopy-assisted Billroth I gastrectomy without significant complications and with no recurrences to date. Pathological study of conventionally resected stomach and lymph nodes confirmed that laparoscopy-assisted Billroth I gastrectomy would be a safe and useful operation for most early gastric cancers.

Adult↗

PubMed2000

The use of laparoscopy in the management of adnexal pathologies in children.

BACKGROUND: The authors' experience of using laparoscopy in the management of 23 girls (mean age: 8.9 years; range: 3 months-15 years) with various adnexal pathologies over a 3-year period is reviewed. METHODS: Of the 23 patients, seven were evaluated for congenital gonadal pathologies, 15 presented with abdominal pain and one patient had an antenatally diagnosed adnexal mass. Detailed laparoscopic examination of the pelvic cavity and laparoscopic gonadectomy were successfully performed in all seven patients with congenital gonadal pathologies: mosaic Turner's syndrome (n = 2), gonadal dysgenesis (n = 3) and testicular feminization syndrome (n = 2). Of 15 patients presenting with abdominal pain, 11 had an adnexal mass, two had acute appendicitis and two had pelvic inflammatory disease. RESULTS: Laparoscopic excision of the adnexal masses were successfully performed in 10 of 11 patients. Conversion to open surgery was required in one patient with a huge teratoma. Laparoscopic appendicectomy was successfully performed in both patients with acute appendicitis while diagnostic laparoscopy was the only procedure required in the two patients with pelvic inflammatory disease. Laparoscopy in the infant with an antenatally diagnosed adnexal mass confirmed this to be an omental cyst, which was successfully excised. All patients recovered without complications and good cosmetic result was universally achieved. CONCLUSION: Laparoscopy is safe and effective in both diagnosis and treatment of adnexal pathologies in children.

Adnexa Uteri↗

PubMed2003

Laparoscopy and its current role in the management of colorectal disease.

OBJECTIVE: To evaluate the current place of laparoscopy in the management of colorectal disease. METHOD: A literature search was undertaken on Medline between the period 1991 and 2002. RESULTS: From the literature there is good evidence that the laparoscopic approach is associated with at least some short-term advantages. Improved cosmesis and better patient's satisfaction are also evident. Because of this laparoscopy has been widely employed in various benign conditions. Among others, laparoscopic stoma formation, laparoscopic resection for diverticular disease and Crohn's disease, laparoscopic rectopexy, as well as laparoscopic assisted reversal of Hartmann's procedure were commonly reported. As port site recurrence and oncological safety are of less concern, there have been increasing reports on laparoscopic resection for colorectal cancer. Although long-term follow up data is still limited, results of large prospective studies as well as various randomized trials show that recurrence and survival rates of the laparoscopic approach were at least comparable to open surgery. As experience and confidence accumulates, there are also increasing reports on technically demanding, laparoscopic sphincter-saving rectal excision. Articles on functional aspects following this type of resection also start to appear, which might be one of the future directions. CONCLUSION: The applicability of laparoscopy to colorectal disease continues to expand. Laparoscopic approach should be considered for patients with benign conditions. For colorectal cancer, results from randomized trials so far have been favourable. Hence, the authors suggest the utility of laparoscopy in potentially curable cancer can also be judiciously relaxed.

Colonic Diseases↗

PubMed1996

Impact of diagnostic laparoscopy in the management of the unilateral impalpable testis.

OBJECTIVE: To evaluate the impact of laparoscopy on the management of children with a unilateral impalpable testis. PATIENTS AND METHODS: The study population consisted of 27 children who underwent a primary inguinal exploration for a unilateral impalpable testis. RESULTS: Twelve of 27 (44%) children had inguinal or 'peeping' testes and 10 of 27 (37%) had blind-ending vasa and vessels in the inguinal canal; four of these 10 had atrophic tubular tissue in the excised remant. Four of 27 (15%) had blind-ending vasa and vessels proximal to the internal ring. Only one child had a testis proximal to the internal ring. Only the four children (15%) with blind-ending vasa and vessels proximal to the internal ring would have benefited from a laparoscopy by avoiding an inguinal exploration. CONCLUSIONS: Because of the time, expense and limited usefulness of laparoscopy in altering the management of children with a unilateral unpalpable testis, we reserve laparoscopy for cases where inguinal exploration has failed.

Child↗

PubMedDate not supplied

Complications associated with cannula insertion techniques used for laparoscopy in standing horses.

OBJECTIVE: To report our experience and complications associated with different cannula insertion techniques for laparoscopy in standing horses. STUDY DESIGN: Retrospective study. SAMPLE POPULATION: Forty horses that had laparoscopy for diagnostic or surgical purposes. METHODS: After a physical examination, including rectal palpation, standing laparoscopy was performed in 40 sedated horses. Local anesthetic was injected at each site of cannula insertion in the left flank. Horses were divided into 5 groups: Pneumoperitoneum was induced before cannula insertion using a Verres needle (group 1, n = 3) or a 12-g catheter (group 2, n = 14); the cannula was inserted before inducing a pneumoperitoneum (group 3, n = 9); the cannula was inserted under visual control, using an operating laparoscope (group 4, n = 2) or a Visiport Optical Trocar (group 5, n = 12). Horses were observed for 7 days. RESULTS: Problems with insufflation or cannula insertion occurred in 12 horses: 6 had peritoneal detachment, 4 had a splenic puncture, and 2 had descending colon puncture. Eleven of these complications occurred in groups 1 to 3 and only 1 in groups 4 and 5. CONCLUSIONS: The Visiport optical device allows controlled insertion of the initial trocar, and thus avoided potential problems associated with "blind" cannula insertion techniques and was used effectively in horses that had feed withheld for 12 hours. This technique enables direct insertion of a cannula directly into the right flank. CLINICAL RELEVANCE: Complications associated with initial cannula insertion in the paralumbar fossa, for laparoscopy, in standing horses can be minimized with the use of an optical cannula.

Anesthetics, Local↗