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Results for “laparoscopy”

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PubMed1997

Cost analysis of diagnostic laparoscopy vs laparotomy in the evaluation of penetrating abdominal trauma.

BACKGROUND: Diagnostic laparoscopy for the evaluation of injuries in patients with penetrating abdominal trauma has been shown to decrease the morbidity and mortality associated with mandatory laparotomy. The overall impact on patient care and hospital costs has not been thoroughly investigated. The goal of this study was to determine the economic impact of laparoscopy as a diagnostic tool in the management of patients following penetrating trauma to the abdomen or flank. METHODS: Retrospective chart review of all hemodynamically stable patients with penetrating trauma to the abdomen or flank, but without other injuries requiring emergent intervention, admitted to a level I trauma center between January 1, 1992, and September 30, 1994. Those patients who underwent either laparoscopy (DL) or laparotomy (NL) or both (CONV) and who had no intraabdominal organ injuries requiring surgical therapeutic intervention were included in the study. Age, operative time, operative findings, length of hospitalization, Injury Severity Score (ISS), variable costs, and total costs were recorded for each patient. RESULTS: Fourteen patients underwent negative/nontherapeutic laparoscopy (DL), 19 patients underwent negative/nontherapeutic laparotomy (NL), and four patients underwent both laparoscopy and laparotomy, a conversion procedure (CONV). There was no significant difference in age, operative times, or ISS between the DL and NL groups. Mean ISS of CONV patients was significantly greater than that of DL patients, 5.75 +/- 1.97 vs 2.43 +/- 0.63 (p < 0.05). Mean operative time for CONV patients was also significantly greater than both DL and NL patients, 106.5 +/- 17.00 min vs 66.1 +/- 6.55 and 47. 3 +/- 7.50 min, respectively (p < 0.05). The mean length of stay was significantly shorter in the DL group as compared to the NL or CONV groups, 1.43 +/- 0.20 vs 4.26 +/- 0.31 and 5.0 +/- 0.82 (p < 0.0001). The variable costs for the DL group were significantly lower than those incurred by patients in the NL and CONV groups, $2,917 +/- 175 vs $3,384 +/- 102 and $3,774 +/- 286, (p < 0.05). Variable costs were not significantly different between the NL and CONV groups. Total costs were also significantly lower in the DL group when compared to NL and CONV, $5,427 +/- 394 vs $7,026 +/- 251 and $7,855 +/- 750 (p < 0.005), but again, they were not statistically different between the NL and CONV groups. The overall total costs for laparoscopy, including the costs incurred by conversion patients, was significantly less than the total costs for laparotomy patients, $5,664 +/- 394 vs $7,028.47 +/- 250 (p < 0.005). This resulted in an overall savings of $1,059.44 per laparoscopy performed. The overall negative/nontherapeutic laparotomy rate during this study was 19.1%, which was significantly lower than the negative or nontherapeutic exploration rate during the time period prior to the use of laparoscopy (p < 0.01, z = 2.550). CONCLUSION: Variable and total costs and length of stay were significantly lower in our population of patients who underwent DL as compared to NL. The rate of negative or nontherapeutic laparotomy was also significantly reduced when compared to the rate identified during the era prior to the use of laparoscopy. Laparoscopy resulted in an overall savings of $1,059 per laparoscopy performed when compared to laparotomy.

Abdominal Injuries↗

PubMed1999

Pelvic inflammation induced by diagnostic laparoscopy in baboons.

OBJECTIVE: To test the hypothesis that diagnostic laparoscopy can cause pelviperitoneal inflammation. DESIGN: Retrospective analysis of data collected during a prospective controlled study in baboons. SETTING: An academic research environment. ANIMAL(S): Samples were collected during laparoscopies in female baboons at the Institute of Primate Research, Kenya. INTERVENTION(S): In the first part of the study, 44 laparoscopies were performed in 16 baboons (5 with a normal pelvis, 11 with endometriosis) during the luteal phase, with a time interval of 1 month. In the second part of the study, 53 laparoscopies were performed in 15 baboons (6 with a normal pelvis, 9 with endometriosis) during the late follicular and luteal phases of one cycle, with a median time of 3-4 days between each laparoscopy. MAIN OUTCOME MEASURE(S): Peritoneal fluid (PF) was measured and analyzed for white blood cell (WBC) concentrations and, in the second part of the study, for the distribution of lymphocyte subsets (CD3, CD4, CD8, and CD20) and for the presence of cytokines transforming growth factor-beta1, interleukin (IL)-6, and IL-10. RESULT(S): In the first part of the study, PF volumes and WBC concentrations were comparable at the baseline and follow-up laparoscopies. In the second part of the study, PF obtained at the second laparoscopy showed a 10-fold increase in volume, a 3-fold increase in WBC concentration, a 10-fold increase in IL-6 concentration, and a 2-fold increase in transforming growth factor-beta1 concentration when compared with PF obtained at the first laparoscopy. The PF subset of granulocytes and CD3-positive cells was higher and the PF subset of macrophages was lower at follow-up laparoscopies than at the baseline laparoscopy. CONCLUSION(S): Diagnostic laparoscopy can cause peritoneal inflammation in baboons.

Analysis of Variance↗

PubMed1997

Complications and recovery from laparoscopy-assisted vaginal hysterectomy compared with abdominal and vaginal hysterectomy.

OBJECTIVE: To complete a systematic review of the published literature comparing complications, postoperative recovery time, and costs following laparoscopy-assisted vaginal hysterectomy, total abdominal hysterectomy (TAH), and vaginal hysterectomy. DATA SOURCES: We searched MEDLINE and several bibliographies, identifying all reports using the term "laparoscopy-assisted hysterectomy" published from 1989 to September 1995. METHODS OF STUDY SELECTION: We excluded case reports, letters, and reports of laparoscopy-assisted vaginal hysterectomy procedures used for radical cancer surgery, sex-change operations, total laparoscopic hysterectomy, or supracervical hysterectomy. TABULATION, INTEGRATION, AND RESULTS: Cases identified included 3112 laparoscopy-assisted vaginal hysterectomies, 1618 TAHs, and 690 vaginal hysterectomies. Laparoscopy-assisted vaginal hysterectomy cases compared with TAH cases demonstrated significantly greater incidence of bladder injury (1.8% for laparoscopy-assisted vaginal hysterectomy versus 0.4% for TAH; P = .01), significantly longer operating room time (115 minutes, standard deviation [SD] 37 minutes, for laparoscopy-assisted vaginal hysterectomy versus 87 minutes, SD 18 minutes, for TAH; P < .001), and significantly shorter hospitalization (49 hours, SD 16 hours, for laparoscopy-assisted vaginal hysterectomy versus 79 hours, SD 20 hours, for TAH; P < .001). Use of analgesia was consistently less for laparoscopy-assisted vaginal hysterectomy and return to full activity was always sooner when compared to TAH. Cost for the new procedure was higher in seven out of 11 studies, but when disposable instruments and hospital length of stay are considered, the remaining four studies reported a lower cost for laparoscopy-assisted vaginal hysterectomy. CONCLUSION: Although laparoscopy-assisted vaginal hysterectomy involves a shorter hospital stay, speedier postoperative recovery, and less analgesia use, there is also a higher rate of bladder injury and lengthier surgery. These outcomes must be weighed when choosing an intervention.

Female↗

PubMed2000

Laparoscopy for acute small-bowel obstruction secondary to adhesions.

BACKGROUND AND PURPOSE: Postoperative adhesions are the leading cause of small-bowel obstruction in developed countries. Several arguments suggest that laparoscopy may lead to fewer adhesions than does laparotomy. We report here the short-term results of laparoscopy in patients admitted on an emergency basis for acute small-bowel obstruction secondary to adhesions. PATIENTS AND METHODS: This prospective trial included 134 consecutive patients: 39 underwent emergency surgery, and 95 had laparoscopic adhesiolysis shortly after resolution of the obstruction with nasogastric suction. Of the previous operations for which the dates were known, 16% had taken place within 1 year of the obstruction and 33.5% within 5 years. In all, 27% of the patients had open laparoscopy, and 16% had conversions: 7% after elective laparoscopy and 36% after emergency laparoscopy. RESULTS: There were no operative deaths. One patient underwent a reoperation the following day for fistula after incomplete adhesiolysis attributable to multiple adhesions found during elective laparoscopy. If laparoscopy is considered to have failed when adhesiolysis was incomplete or conversion or reoperation was necessary, our success rate was 80% after elective laparoscopy and 59% after emergency laparoscopy. CONCLUSION: Emergency situations in acute small-bowel obstruction combine several circumstances unfavorable for laparoscopy: a limited work area and a distended and fragile small bowel. Laparoscopic adhesiolysis after the crisis has passed may produce better results, but only long-term follow-up can confirm the role of elective laparoscopy for this indication.

Acute Disease↗

PubMed2002

Laparoscopy-assisted resection of complicated Meckel's diverticulum in adults.

The era of videoendoscopic surgery in emergency surgery practice has facilitated a wide range of endoscopic operative procedures. In our unit the diagnosis of acute abdomen is made after sequential clinical and laboratory examination, and diagnostic laparoscopy is advocated. Laparoscopy-assisted resection of complicated Meckel's diverticulum in two adult patients was performed, and the results are discussed. Between December 1996 and June 2000, 98 patients underwent diagnostic laparoscopy at the Cerrahpasa Medical Faculty Emergency Surgery Unit of Istanbul University because of signs and symptoms of acute abdomen. Among these, we have diagnosed one case of intestinal obstruction due to a volvulus around Meckel's diverticulum and one of acute abdomen masquerading as acute appendicitis but actually involving omphalomesenteric duct cyst torsion. Both of these patients underwent diagnostic laparoscopy and laparoscopy-assisted Meckel's diverticulectomy. Diagnostic laparoscopies were performed on 46 male (47%) and 52 female (53%) patients. In all cases, laparoscopy successfully confirmed the diagnosis. Although in 27 patients the interventions were converted to open procedures, the operations were completed laparoscopically in 71 patients. Two of these patients underwent laparoscopy-assisted Meckel's diverticulectomy and their postoperative periods were uneventful. Both patients were discharged from the hospital on their fourth postoperative day. Diagnostic laparoscopy is a safe and effective method for diagnosis of acute abdomen. In emergency surgery practices in developing countries, advanced laparoscopy should be performed to reduce expenses. Laparoscopy-assisted Meckel's diverticulectomy is a safe and economic procedure and can be performed in adults for treatment of complicated cases without staplers.

Adult↗

PubMed1996

Transinguinal laparoscopy for nonpalpable testis.

BACKGROUND: About 20% of all undescended testes are nonpalpable. Although surgical exploration was previously the method of choice for management, laparoscopy from the inferior edge of the umbilicus has been established as a useful method of examining a testis that is nonpalpable. However, conventional subumbilical laparoscopy is unnecessary when the testis or its remnant is located below the internal inguinal ring. We evaluated the efficacy of transinguinal laparoscopy after inguinal exploration performed for nonpalpable testis. METHODS: Twelve children with 14 nonpalpable testes (2 children had bilateral nonpalpable testes) were considered for a novel method of laparoscopy. We performed laparoscopy through the internal inguinal ring after opening the inguinal canal. RESULTS: Inguinal exploration revealed the testis or its remnant in 5 patients, and thus prevented unnecessary laparoscopy in these individuals. Transinguinal laparoscopy identified the anatomy in 7 patients. Four of the latter were found to have blind-ending vas deferens and spermatic vessels, while in 3 patients, the testes were located in the peritoneal cavity. CONCLUSION: Transinguinal laparoscopy may become the accepted method for managing nonpalpable testes, as inguinal exploration can eliminate the need for laparoscopy in some cases, and the visualization achieved with transinguinal laparoscopy is just as good as that with conventional laparoscopy.

Child↗

PubMed2001

[Minilaparoscopy and open laparoscopy: prevention of laparoscopic complications].

BACKGROUND: The study aimed to compare laparoscopy, open-laparoscopy and mini-laparoscopy and to correlate the results of each technique with the respective percentages of laparotomic conversion. METHODS: A total of 101 laparoscopies were performed between November 1997 and April 1999: 18.8% were diagnostic and 81.2% operative. The latter included 54 traditional laparoscopies (65.9%), 18 open-laparoscopies (21.9%) and 10 minilaparoscopies (12.2%). RESULTS: Laparotomic conversion was required in 5.5% of laparoscopies. No laparotomic conversion was necessary for the open-laparoscoples and for mini-laparoscopies. CONCLUSIONS: The possibility of resorting to open-laparoscopy and mini-laparoscopy may represent a valid tool when the patient has previously undergone laparoscopic or laparotomic surgery, with the supposition of pelvo-abdominal adherences that would increase the risk of traditional laparoscopy.

Humans↗

PubMed1994

Hospital cost comparison between abdominal, vaginal, and laparoscopy-assisted vaginal hysterectomies.

OBJECTIVE: To evaluate and compare the hospital charges for total abdominal hysterectomy (TAH), vaginal hysterectomy, and laparoscopy-assisted vaginal hysterectomy performed with the linear stapler. METHODS: Thirty cases of each of the three types of hysterectomies, performed at the same hospital by various surgeons, were selected at random. The authors did not participate in any of the cases evaluated. Operating room, postoperative hospitalization, and pharmacy costs were compared. Independent, two-tailed Student t test analysis was performed. RESULTS: The mean cost of performing laparoscopy-assisted vaginal hysterectomy with the linear stapler ($7161.66) was significantly higher (P < .05) than that of both vaginal hysterectomy ($4868.06) and TAH ($4926.80). The cost of vaginal hysterectomy was nonsignificantly lower (P > .05) than that of TAH. The mean operating room supplies and equipment charge for laparoscopy-assisted vaginal hysterectomy with the linear stapler ($2468.43) was, as expected, significantly higher (P < .05) than those for both abdominal ($716.65) and vaginal ($676.16) procedures. The average operating room time charge for laparoscopy-assisted vaginal hysterectomy ($1264.56) was also significantly higher (P < .05) than for the other two procedures (TAH $642.76, vaginal hysterectomy $955.66). The mean total pharmacy charges were similar for all groups ($1114.27 for laparoscopy-assisted vaginal hysterectomy, $1163.16 for vaginal hysterectomy, and $1098.71 for TAH). Reflecting the longer operating time for laparoscopy-assisted vaginal hysterectomy, the intraoperative pharmacy costs were significantly higher for this type ($417.00) than for the TAH patients ($290.62). The difference, however, was almost erased when postoperative pharmacy charges were included, reflecting the lower cost of a shorter hospital stay in the laparoscopy-assisted vaginal hysterectomy group. Some savings were realized by laparoscopy-assisted vaginal hysterectomy when postoperative hospitalization charges were considered. The average hospitalization time was 2.3 days for laparoscopy-assisted vaginal hysterectomy, 3.0 days for vaginal hysterectomy, and 3.3 for TAH. CONCLUSIONS: The cost savings expected with the advent of laparoscopy-assisted vaginal hysterectomy when performed with the linear stapler have not been realized at present. In most cost categories studied, the use of laparoscopy to perform a hysterectomy was associated with much higher costs. The predicted savings associated with the shorter hospital stay in these patients failed to offset the exorbitant intraoperative costs. However, when bipolar electrocoagulation with the CO2 laser and reusable instruments replace staplers and disposables, respectively, the projected savings are appreciated.

Abdomen↗

PubMed1996

Complications of laparoscopy--operative and diagnostic.

OBJECTIVE: To assess the characteristics and rates of complications for operative laparoscopy and diagnostic laparoscopy. DESIGN: Retrospective review. SETTING: Tertiary-care university hospital. PATIENTS: Two thousand three hundred twenty-four patients undergoing operative laparoscopy or diagnostic laparoscopy. INTERVENTIONS: Operative laparoscopy including lysis of adhesions, tubal surgery, ovarian surgery, uterine surgery, or destruction of endometriosis. MAIN OUTCOME MEASURES: Complication rates for operative and diagnostic laparoscopies were tabulated and compared. RESULTS: The overall major complication rate for this series of 2,324 laparoscopies was 0.22%. There were five major and 15 minor complications. In the operative laparoscopy group, there were more complications from Veress needle and trocar insertion (n = 15) than from the actual operative procedures (n = 3). There were more total complications in the operative laparoscopy group (n = 18) than in the diagnostic laparoscopy group (n = 3). CONCLUSION: Operative laparoscopy is efficacious for a variety of gynecologic surgical procedures.

Abdominal Muscles↗

PubMed1984

Open laparoscopy.

Many of the complications of conventional closed, or sharp, laparoscopy result from the use of insufflation needles and sharp trocars. These instruments are not essential elements of the technique as laparoscopy can be easily performed with a small umbilical incision, entering the abdomen under direct vision. This variation is called open laparoscopy. Open laparoscopy eliminates the possibility of insufflation-needle and trocar injuries and lessens the probability of failed laparoscopy attempts and postoperative herniations. Furthermore, physicians performing open laparoscopy can become comfortably proficient in the technique faster than they can in closed laparoscopy because open laparoscopy utilizes standard and familiar surgical technique. Open laparoscopy can be easily performed under local anesthesia, particularly for female sterilization. The technique is suitable for the outpatient setting based on considerations of safety and reliability.

Diagnosis↗

PubMed2004

Diagnostic laparoscopy prior to planned hepatic resection for colorectal metastases.

HYPOTHESES: (1) A clinical risk score (CRS) is useful in selecting patients for diagnostic laparoscopy prior to planned resection of colorectal metastasis. (2) Preventing unnecessary celiotomy in these patients undergoing laparoscopy is associated with shorter hospital stays and earlier administration of systemic chemotherapy. DESIGN: Retrospective analysis of data collected in a prospective database. SETTING: Tertiary cancer hospital. PATIENTS: Two hundred seventy-six patients who underwent laparoscopy prior to planned partial hepatic resection (n = 264) for colorectal metastases or prior to hepatic artery infusion pump placement for colorectal metastases (n = 12). MAIN OUTCOME MEASURES: The yield of laparoscopy for patients with potentially resectable tumors was analyzed in the context of a CRS, calculated by assigning 1 point for each of the following adverse, disease-related factors: lymph node-positive primary tumor, disease-free interval less than 12 months, more than 1 hepatic tumor, hepatic tumor greater than 5 cm, and cardio embryonic antigen level less than 200 ng/mL. The CRS represents the sum for each patient. Length of hospital stay and time to initiation of chemotherapy were compared in those patients determined to be unresectable. RESULTS: Staging laparoscopy prevented nontherapeutic celiotomy in 10% of patients submitted to operation for a potentially curative partial hepatectomy (26 of 264) and in 33% of patients scheduled for pump placement only (4/12). The CRS correlated closely with the likelihood of identifying radiographically occult unresectable disease: 0 or 1, 4%; 2 or 3, 21%; and 4 or 5, 38%. Likewise, the percentage of patients avoiding an unnecessary celiotomy increased progressively with increasing CRS: 0 or 1, 0%; 2 or 3, 11%; and 4 or 5, 24%. Preventing an unnecessary celiotomy with laparoscopy was associated with a decreased length of hospital stay (P<.01) and earlier initiation of chemotherapy (P = .045). CONCLUSIONS: Diagnostic laparoscopy does not need to be performed routinely in all patients prior to hepatic resection for colorectal cancer metastasis. Laparoscopy has a very low yield in patients with a CRS of 1 or less and is unnecessary. The yield of laparoscopy increases with increasing CRS. Preventing celiotomy with laparoscopy is associated with a decreased length of hospital stay and earlier initiation of postoperative chemotherapy.

Colorectal Neoplasms↗

PubMed2001

A clinical scoring system predicts the yield of diagnostic laparoscopy in patients with potentially resectable hepatic colorectal metastases.

BACKGROUND: Laparoscopy may identify occult metastatic disease and prevent unnecessary laparotomy in some patients with potentially resectable colorectal liver metastases but is unnecessary in the majority of individuals who undergo resection. The objectives of the current study were to assess the impact of laparoscopy after extensive preoperative imaging and to determine whether a preoperative clinical risk score can identify those patients most likely to benefit from the procedure. METHODS: Between December 1997 and July 1999, 103 consecutive patients with potentially resectable colorectal liver metastases underwent laparoscopy prior to planned laparotomy and partial hepatectomy. Surgical findings, length of hospital stay, and hospital charges were analyzed. Patients were assigned a clinical risk score (CRS) based on five factors related to the primary tumor and the hepatic disease. The likelihood of finding occult unresectable disease and the yield of laparoscopy were analyzed with respect to the CRS. RESULTS: Seventy-seven patients (75%) underwent resection. Laparoscopy identified 14 of 26 patients with unresectable disease, 10 of whom were spared an unnecessary laparotomy. In patients who underwent biopsy only, the laparoscopic identification of unresectable disease shortened the hospital stay (1.2 +/- 0.6 days vs. 5.8 +/- 2.3 days; p = 0.0001) and reduced the total hospital charges by 55% (P = 0.0001). The CRS predicted the likelihood of occult unresectable disease, which was 12% in those with a score < or = 2 but increased to 42% in those with a score > 2 (P = 0.001). If laparoscopy were used only in high risk patients (CRS > 2), 57 laparoscopies would have been avoided and the net savings doubled. CONCLUSIONS: With extensive preoperative imaging, the vast majority of patients with potentially resectable hepatic colorectal metastases do not benefit from laparoscopy. However, in the minority of patients with occult unresectable disease, laparoscopy prevents unnecessary laparotomy and reduces hospital stay and the total hospital charges. The CRS, previously shown to predict survival after hepatic resection, identifies those high risk patients most likely to benefit from laparoscopy and may improve resource utilization.

Aged↗

PubMed1999

Analysis of failed and complicated laparoscopy on a gynecologic oncology service.

OBJECTIVE: To assess the incidence of and factors that predict failed or complicated operative laparoscopy on a gynecologic oncology service. METHODS: Two hundred four consecutive operative laparoscopies were reviewed. Procedures converted to laparotomy or associated with major operative or postoperative complications were compared with uncomplicated laparoscopies with respect to patient characteristics, details of operative procedure, and length of hospitalization. The influence of patient characteristics, operative findings, and specific procedures on the risk of failed or complicated laparoscopies was estimated. RESULTS: Twenty-five (12. 3%) procedures were either converted to laparotomy or associated with major operative or postoperative complications. Women with failed or complicated laparoscopies had significantly more previous laparotomies and adhesions, greater blood loss, and longer hospital stay than those with uncomplicated laparoscopies (60.0% vs 35.7%, P = 0.03, 68.0% vs 37.4%, P<0.001, 275 ml vs. 132 ml, P = 0.03; and 5. 9 days vs 0.98 days, P< 0.001, respectively). Age, body mass index, parity, menopausal status, preoperative CA-125, appearance of adnexal masses, and complexity of the procedure had no significant influence on failed or complicated laparoscopies. In univariate analysis, history of laparotomy and presence of adhesions and in multivariate analysis only presence of adhesions were predictive of failed or complicated laparoscopies (P = 0.03, <0.001, and 0.006, respectively). CONCLUSIONS: The incidence of failed and complicated laparoscopy is low on a gynecologic oncology service. Presence of adhesions is the only significant independent risk factor predictive of failed or complicated laparoscopy.

Adult↗

PubMed2002

Prospective evaluation of laparoscopy-assisted colectomy versus laparotomy with resection for management of complex polyps of the sigmoid colon.

Laparoscopy-assisted colectomy is technically feasible, but objective evidence of its benefits remains scarce. This study was done to evaluate the outcomes and operative stress of laparoscopy-assisted colectomy versus the traditional open method in the management of sigmoid complex polyps that cannot be safely or adequately removed by colonofibroscopy. Between January 1997 and December 1999, a total of 42 patients were equally randomized to the laparoscopy group and the laparotomy group by the blocked randomization method. Three patients randomized to the laparoscopy group did not complete the trial; therefore 18 patients treated by laparoscopy-assisted sigmoidectomy and the other 21 treated by the open method were prospectively evaluated. These two groups of patients were well matched in age, gender, symptoms, tumor location, localization method, tumor size, morphology, histopathology, and the accuracy of the clinical diagnosis. Two standardized surgical strategies, the lateral-to-medial and medial-to-lateral dissection sequences, were performed in 14 and 4 patients of the laparoscopy group, respectively, according to whether their tumors were located above or below 20 cm above the anal verge. After evaluating the surgical outcomes, we found that the laparoscopy group was significantly better than the laparotomy group in regard to parameters that included severity of postoperative pain, wound size, postoperative complication rate, and the duration of postoperative ileus, hospitalization, and disability. There was no significant difference in the operating times for these two groups. However, the costs of the laparoscopy group were significantly higher. To evaluate the surgical stress, we measured the serum C-reactive protein (CRP) level, erythrocyte sedimentation rate (ESR), total lymphocyte count, and CD4+/CD8+ ratio 24 hours before and after surgery. We found that the postoperative serum CRP level and the ESR were significantly less elevated and the total lymphocyte counts and CD4+/CD8+ ratio were significantly less depressed in the laparoscopy group than in the laparotomy group. We thus concluded that laparoscopy-assisted sigmoidectomy can be safely performed with shorter convalescence and less operative stress but at a higher cost. We strongly recommended the use of this technique in the management of sigmoid complex polyps if the patient's economic status permits.

Aged↗

PubMed1996

Second-look operation for epithelial ovarian cancer: laparoscopy or laparotomy?

OBJECTIVES: To compare the results, complications, and hospital charges associated with laparoscopy versus laparotomy in second-look operations for epithelial ovarian cancer. METHODS: We conducted a retrospective chart review of 109 patients with invasive epithelial ovarian cancer who underwent a second-look operation between July 1, 1992, and June 30, 1995. RESULTS: Thirty-one patients (28.4%) underwent laparoscopy, 70 patients (64.2%) underwent laparotomy, and eight patients (7.3%) underwent both procedures at the same operation. The majority of patients (60.6%) presented with stage IIIC disease. Persistent ovarian cancer was found in 65 of 109 (59.6%) patients, including 17 of 31 (54.8%) evaluated by laparoscopy, 43 of 70 (61.4%) by laparotomy, and five of eight (62.5%) by both procedures. Significantly lower mean blood loss was noted in patients undergoing laparoscopy (27 mL) compared with laparotomy (208 mL) (P < .01). In addition, the mean operating time for laparoscopy (129 minutes) was significantly shorter than that for laparotomy (153 minutes) (P < .01), and mean hospital stay was shorter for patients undergoing laparoscopy (1.6 days) compared with laparotomy (6.8 days) (P < .01). All intraoperative and immediate postoperative complications were noted in patients who underwent laparotomy. There was no difference in day of surgery charges between the two procedures; however, total hospital charges were significantly lower for patients undergoing laparoscopy ($ 9448) compared with laparotomy ($ 17,969) (P < .01). With a median follow-up of 22.0 months, recurrence after negative second-look surgery was noted in four of 27 (14.8%) patients evaluated by laparotomy and two of 14 (14.3%) patients evaluated by laparoscopy. CONCLUSION: Laparoscopy may be an acceptable alternative to second-look laparotomy for interval evaluation of epithelial ovarian cancer. Second-look laparoscopy probably results in less morbidity, shorter operating time, shorter hospital stay, and lower total hospital charges. These results require confirmation in a randomized clinical trial.

Adult↗

PubMed2004

Selective use of diagnostic laparoscopy prior to planned hepatectomy for patients with hepatocellular carcinoma.

BACKGROUND: Patients with hepatocellular carcinoma (HCC) are frequently found to be inoperable at surgical exploration. Laparoscopy may reduce the rate of unnecessary laparotomy in these patients. However, there are no criteria for selective use of laparoscopy. METHODS: Sixty patients with potentially operable HCC underwent laparoscopy prior to planned partial hepatectomy. Intraoperative findings and postoperative course were analyzed, and factors for the selective use of laparoscopy were identified. RESULTS: Fourteen of 19 inoperable patients (74%) were identified by means of laparoscopy, which increased the resectability rate from 68% to 89%. Compared with patients undergoing exploratory laparotomy only, patients determined to be inoperable on laparoscopy had significantly less intraoperative blood loss, a shorter operating room time, and a briefer hospital stay. In a multivariate analysis, clinically apparent liver cirrhosis and radiologic evidence of major vascular invasion or bilobar tumors predicted the likelihood of finding inoperable disease at laparoscopy. The initial use of laparoscopy avoided unnecessary laparotomy in almost 30% of patients with-but only 5% of patients without-these features. CONCLUSIONS: If high-risk patients with HCC are selectively targeted, the yield of laparoscopy is increased and unnecessary laparotomy may be avoided. In patients without cirrhosis, major vascular invasion, or bilobar tumors, the yield of laparoscopy is low and is therefore not generally recommended.

Adult↗

PubMed1999

Experience with staging laparoscopy in pancreatic malignancy.

BACKGROUND: The role of diagnostic laparoscopy in the staging of abdominal malignancies is not well defined. METHODS: We retrospectively reviewed the usefulness of diagnostic laparoscopy as a staging procedure in pancreatic malignancy. This experience between February 1988 and May 1997 involves 109 cases of suspected or proven pancreatic malignancy. All laparoscopies were performed with the patient under conscious sedation and local anesthesia in an endoscopy suite. RESULTS: Of the 109 patients with pancreatic cancer, 45 (42%) had metastatic disease. The use of computed tomography (CT) alone revealed the existence of liver metastases in 10 of 109 (9%) patients, which were confirmed laparoscopically. The further use of laparoscopy identified metastases in 29 more cases: hepatic, 23; hepatic and peritoneal, 3; peritoneal and mesenteric, 1; and mesenteric, 2. CT in conjunction with laparoscopy therefore revealed metastatic liver, peritoneal, or mesenteric lesions in 39 of 109 (36%) patients with pancreatic cancer. After staging laparoscopy, 67 of 69 patients underwent laparotomy. Metastatic disease was identified at laparotomy in 6 more patients; however, only 4 of these patients had metastases to the liver whereas 2 had metastases to the peripancreatic lymph nodes. Therefore, in patients with pancreatic malignancy, the negative predictive value for the diagnosis of metastases to the liver, peritoneum or mesentery was 94% (61 of 65 patients). The positive predictive value of laparoscopy alone for the detection of metastatic disease to the liver, peritoneum, or mesentery was 88% (29 of 33 patients). Laparoscopy was successfully performed without complications in all patients with pancreatic cancer; however, one had a technically unsatisfactory examination. The overall rate of resectability after staging by imaging studies and laparoscopy was 57% (35 of 61 patients). CONCLUSIONS: In patients with a negative CT for metastases, laparoscopic identification of metastases avoided unnecessary laparotomy in 29 of 99 (29%) patients with pancreatic cancer. Staging laparoscopy is indicated in all cases of pancreatic malignancy before an attempt at a surgical cure.

Aged↗

PubMed2002

Staging laparoscopy in patients with extrahepatic biliary carcinoma. Analysis of 100 patients.

OBJECTIVE: To evaluate the benefit of staging laparoscopy in patients with gallbladder cancer and hilar cholangiocarcinoma. SUMMARY BACKGROUND DATA: In patients with extrahepatic biliary carcinoma, unresectable disease is often found at the time of exploration despite extensive preoperative evaluation, thus resulting in unnecessary laparotomy. METHODS: From October 1997 to May 2001, 100 patients with potentially resectable gallbladder cancer (n = 44) and hilar cholangiocarcinoma (n = 56) were prospectively evaluated. All patients underwent staging laparoscopy followed by laparotomy if the tumor appeared resectable. Surgical findings, resectability rate, length of stay, and operative time were analyzed. RESULTS: Patients underwent multiple preoperative imaging tests, including computed tomography scan, ultrasound, magnetic resonance cholangiopancreatography, and direct cholangiography. Laparoscopy identified unresectable disease in 35 of 100 patients. In the 65 patients undergoing open exploration, 34 were found to have unresectable disease. Therefore, the overall accuracy for detecting unresectable disease was 51%. There was no difference in the accuracy of laparoscopy between patients with gallbladder cancer and hilar cholangiocarcinoma. Laparoscopy detected the majority of patients with peritoneal or liver metastases but failed to detect all locally advanced tumors. In patients undergoing biopsy only, laparoscopic identification of unresectable disease significantly reduced operative time and length of stay compared with patients undergoing laparotomy. The yield of laparoscopy was 48% in patients with gallbladder cancer (56% in those who did not undergo previous cholecystectomy), but only 25% in patients with hilar cholangiocarcinoma. However, in patients with locally advanced but potentially resectable hilar cholangiocarcinoma, the yield of laparoscopy was greater, 36% (12/33, T2/T3 tumors) versus 9% (2/23, T1 tumors). CONCLUSIONS: Laparoscopy identifies the majority of patients with unresectable hilar cholangiocarcinoma or gallbladder carcinoma, thereby reducing both the incidence of unnecessary laparotomy and the length of stay. The yield of laparoscopy is lower for hilar cholangiocarcinoma but can be improved by targeting patients at higher risk of occult unresectable disease. All patients with potentially resectable primary gallbladder cancer and patients with T2/T3 hilar cholangiocarcinoma should undergo staging laparoscopy before surgical exploration.

Adult↗