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Results for “laparoscopy”

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At least 721 records · Page 40Linked to original sources

PubMed2001

Excision of mature teratoma using culdotomy, with and without laparoscopy: a prospective randomised trial.

OBJECTIVE: To compare the results of removing mature teratoma with laparoscopy or without laparoscopy. DESIGN: A prospective, randomised trial. SETTING: Medical centre. PARTICIPANTS: Seventy-nine women with mature teratomas identified using results of ultrasound examinations and biochemical markers. INTERVENTION: Cystectomy with laparoscopic approach or without laparoscopic approach through a culdotomy. METHODS: Patients were randomly assigned to have their cysts removed via vaginal cystectomy without laparoscopy (n = 37, Group A) or laparoscopic cystectomy via culdotomy opening (n = 42, Group B). Inclusion criteria were history of vaginal delivery, no previous abdominal surgery, no history of pelvic inflammatory disease, no medical illness, and no presenting symptoms. Eight women randomised to Group A withdrew before surgery. The laparoscopically resected tumours were each put into a cellulose bag, and tumours without laparoscopic-assistance were removed directly via the vagina. RESULTS: Blood loss in Group A (88 +/- 37 ml) was significantly more than that in Group B (64 +/- 20 ml, P = 0.000). The post-operative recovery times were 20 and 17 hours, respectively (P = 0.030). The rates of successful surgery were 58.6 and 97.6%, respectively (P = 0.002). The spillage rates were 44.8% and 19.0%, respectively (P = 0.006). There were no significant differences in tumour size, patient age, and operative time between groups. CONCLUSION: Cystectomy without assistance of laparoscopy could be applied to manage mature teratoma of the ovary; however, because of the difficulty of this technique, we had high percentages of tumour spillage and more blood loss during operation and a high percentage of patients who required conversion to laparotomy compared with laparoscopic cystectomy. We favoured laparoscopically assisted cystectomy to manage mature teratoma.

Adolescent↗

PubMed1991

Laparoscopy in the management of women with chronic pelvic pain.

A review of 232 women who had diagnostic laparoscopy for chronic pelvic pain was undertaken. Diagnostic error in the preoperative pelvic examination in the series varied from 21% to 61%; of 135 patients who had normal pelvic examination findings preoperatively, 82 (61%) were found to have pelvic pathology on diagnostic laparoscopy, whereas 21 of 97 women (21.6%) who had abnormal pelvic examination, had normal findings on laparoscopy. The overall incidence of pelvic pathology in the series was found to be 69%. Our results suggest that there is poor correlation between findings of pelvic examination and the existence of pelvic disease. Laparoscopy has a definite place in the evaluation of patients with chronic pelvic pain and certainly justifies its increasing use in their management.

Adolescent↗

PubMed1997

The safety of laparoscopy performed by direct trocar insertion and carbon dioxide insufflation under vision.

The records of 6,173 laparoscopies performed by specialist gynaecologists in the course of routine gynaecological care using the technique of direct insertion of the umbilical trocar and insufflation of carbon dioxide under vision were reviewed to ascertain the incidence of serious complications. A review of the published literature on laparoscopy methodology was also undertaken to complement the data obtained from this study. The nature of the records precluded accurate assessment of both indications and minor complications. There were 4 perforating bowel injuries (0.06%) requiring laparotomy (s small intestine, 2 large intestine). There were no cases of major vascular injury or gas embolus necessitating surgical or resuscitative measures. On 3 of the 4 occasions where bowel injury occurred the patients had undergone prior abdominal surgery and had midline vertical subumbilical incisions. Review of the published literature demonstrated bowel or vessel perforation rates (requiring laparotomy or resuscitation) of 1 in 1,000 regardless of whether the method of gaining peritoneal access was open (Hasson) technique, Verres needle insufflation, or direct trocar. Direct trocar insertion may reduce the risk of gas embolism by insufflating only after intraperitoneal replacement has been confirmed, moreover it allows immediate recognition and rapid treatment of major blood vessel laceration, both of which have been identified as being crucial in reducing laparoscopy associated mortality. When compared to other available methods of gaining peritoneal access for laparoscopy, direct trocar insertion followed by insufflation of carbon dioxide under vision can be performed with the same degree of safety for the patient. It is simply wrong to deduce from the available data that one particular technique of gaining peritoneal access is superior to another. Each have their individual advantages and disadvantages and similar morbidity when performed by experienced operators with appropriate indications. In light of this observation, each alternative should be considered by the individual surgeon to assess which would best suit his or her operating technique and the particular circumstance of each patient. Indeed preference should be given to the method with which the surgeon is most comfortable or with which he or she has the most experience.

Carbon Dioxide↗

PubMedDate not supplied

Comparison of the results of surgical treatment using laparoscopy and laparotomy in patients with endometrial cancer.

The objective of the current study was to compare the results of surgical treatment in endometrial cancer with the use of laparoscopy and the traditional approach of laparotomy. Our goal was to evaluate and compare the morbidity, recurrence rate, and disease-free survival in both groups. This article is a retrospective study. A chart review of 45 patients treated by laparoscopy between 1994 and 2002 and 136 patients treated by laparotomy between 2001 and 2002 was performed. Disease-free survival in both groups was evaluated with the Kaplan-Meier method and was compared using the log-rank test. The rate of recidive was 6% in the laparoscopy group and 13% in the laparotomy group. There was no statistically significant difference in disease-free survival and recidive rate between the laparoscopy and laparotomy groups. Laparoscopic management in endometrial cancer does not worsen the prognosis, and the disease-free survival is similar to that resulting from the traditional approach. The benefits of minimal invasive surgery are quicker postoperative recovery, shorter hospital stay, and no wound complications.

Endometrial Neoplasms↗

PubMedDate not supplied

Role of laparoscopy to evaluate candidates for complete cytoreduction in advanced stages of epithelial ovarian cancer.

The objective of this study was to evaluate the role of laparoscopy in selecting candidates for complete cytoreduction surgery in epithelial ovarian carcinoma. We performed an explorative laparoscopy in 15 women presenting with advanced ovarian carcinoma, and for whom the preoperative evaluation was considered unsatisfactory, to define the possibility of achieving a complete cytoreduction. We focused on three sites of carcinomatosis: bowel, liver pedicle, and right diaphragmatic dome. Laparoscopic evaluation was successful in all 15 patients. Four patients were considered to have unresectable carcinomatosis because of extensive involvement of the small bowel and therefore had no laparotomy. These women underwent neoadjuvant chemotherapy in the following 2 weeks. Eleven patients were considered to have resectable peritoneal carcinomatosis (PC). Ten women had no macroscopic residual tumor after surgery. A modified posterior exenteration was performed in five patients. The laparoscopic exploration had underestimated the liver pedicle involvement in two patients, but only one had an infracentimetric residual tumor after surgery. Laparoscopy is a reliable method of exploring PC in advanced-stage ovarian cancer. Laparoscopy may obviate the need for unnecessary laparotomy in many cases and may, therefore, contribute to a better quality of life for patients found to have unresectable disease.

Adenocarcinoma↗

PubMed2006

The incidence of venous thromboembolism following gynecologic laparoscopy: a multicenter, prospective cohort study.

BACKGROUND: Information on the incidence of venous thromboembolism (VTE) following laparoscopic procedures is inadequate and there is currently no solid evidence to guide the use of thromboprophylaxis in this setting. Gynecologic laparoscopy is a common procedure, and is frequently performed in low-risk patients. To our knowledge, there are no clinical studies specifically designed to assess the incidence of VTE in this setting. METHODS: In a prospective cohort study, consecutive patients undergoing gynecologic laparoscopy underwent compression ultrasonography (CUS) and clinical assessment to evaluate the incidence of clinically relevant VTE. CUS was performed 7 +/- 1 and 14 +/- 1 days postoperatively. A subsequent telephone contact was scheduled at 30 and 90 days. No patient received pharmacologic or mechanical prophylaxis. Patients with malignancy or previous VTE were excluded from the study. RESULTS: We enrolled 266 consecutive patients; mean age was 36.3 years, range: 18-72. The most common indications for laparoscopy were ovarian cysts in 25.6% of patients, endometriosis in 21.0% of patients, unexplained adnexal masses in 12.4% of patients, and infertility in 7.5% of patients. The mean duration of the procedure was 60.5 min (range: 10-300 min). In particular, in 55.6% of patients the duration exceeded 45 min. There were neither episodes of CUS detected DVT (0/247; 0%, 95% CI 0-1.51%) or clinically relevant VTE after follow-up (0/256; 0%, 95% CI 0-1.48%). No patient died of fatal pulmonary embolism (0/266; 0%, 95% CI 0-1.42%). CONCLUSIONS: Gynecologic laparoscopy in non-cancer patients is a low-risk procedure for postoperative VTE.

Adult↗

PubMed2003

Liver assessment and biopsy in patients with marked coagulopathy: value of mini-laparoscopy and control of bleeding.

OBJECTIVE: Evaluation of liver disease in patients with a high risk of postbiopsy bleeding presents a diagnostic challenge. Mini-laparoscopy offers the possibility of coagulation of biopsy site and the additional advantage of macroscopic liver assessment. We wished to assess the value and safety of mini-laparoscopy with guided biopsy as a diagnostic approach in patients in whom percutaneous liver biopsy is considered contraindicated because of a marked coagulopathy. METHODS: We investigated 61 consecutive patients with marked coagulopathy (prolonged international normalized ratio > 1.5, thrombocytopenia < 50/nl, or both; von Willebrand's disease/hemophilia). Diagnostic mini-laparoscopy with visually guided liver biopsy was undertaken for the evaluation of liver disease. Biopsy sites were coagulated prophylactically (n = 4) or therapeutically (n = 52). Safety, diagnostic yield, and therapeutic consequences were assessed. RESULTS: Macroscopic assessment of the liver was possible in 60/61 high-risk patients and was considered diagnostic in 1/61. In 58 of the remaining 60 patients, liver biopsy was technically feasible. There was no persistent postbiopsy bleeding. One patient with fulminant hepatic failure had self-limiting bleeding from the abdominal wall. Ninety-seven percent of the biopsies were of adequate size for diagnostic histological evaluation. CONCLUSIONS: Mini-laparoscopy with guided liver biopsy allows reliable and safe evaluation of liver disease in patients with severe coagulopathy.

Adolescent↗

PubMed1978

Physician's use of laparoscopy.

The role of laparoscopy in medical practice was assessed by studying 238 consecutive laparoscopies performed under local anaesthesia by physicians in a single teaching hospital. Indications for laparoscopy were assessment of possible and known hepatic disease, possible disseminated abdominal malignancy, abdominal mass, and conditions such as ascites and splenomegaly. A definitive diagnosis was reached in 223 cases (76.5%). No organic disease was detected in 41 patients, though findings were false-negative in two of them (0.8%). The procedure failed in 15 (6.3%), mostly because adhesions from previous surgery hindered adequate visualisation. Six patients (2.5%) had complications, one of whom subsequently died. If patients are appropriately selected laparoscopy is relatively free of postoperative complications, and is an effective diagnostic procedure in abdominal malignancy and decompensated liver disease. Cost-effectiveness is an additional advantage.

Abdominal Neoplasms↗

PubMed2001

Future developments and perspectives in laparoscopy.

INTRODUCTION: As urologists head into the new millennium, it has become clear that laparoscopy will play a significant role in successful urologic practice. Issues that are addressed in this article include: (1) What are the new limits? (2) Technological advances. (3) Adequate training. (4) How to technically simplify the laparoscopic procedures? MATERIALS AND METHODS: To answer the stated questions a review of the literature has been undertaken together with interviews of the leading experts and laparoscopic working groups in urologic laparoscopy. The gathered information has been summarized and focussed with the aim of presenting the perspectives of laparoscopy in urology. RESULTS AND DISCUSSION: Standardized indications for laparoscopic urological surgery are benign nephrectomy, nephroureterectomy, cryptorchidism, adrenalectomy, renal cysts, lymphocele and bilateral or relapsing varicocele. Future indications might include living donor nephrectomy, partial nephrectomy and cyst decortication for adult polycystic kidney disease. Controversy exists about the laparoscopic treatment of malignancies in the urinary tract. Whereas pelvic lymph node dissection--even if performed with decreasing frequency--is accepted worldwide, retroperitoneal lymphadenectomy for low-stage testis cancer is currently performed only at few centers. The recent breakthrough in uro-oncological laparoscopic surgery has been laparoscopic radical prostatectomy changing our views on the limits of laparoscopic urology. Endoscopic suturing devices (i.e. Endostitch) are further being developed, and a prototype reapproximating micro-clips (VCS stapler) has been used to perform a uretero-ureterostomy laparoscopically in a porcine model. Nevertheless, the ability of endoscopic suturing using the standard equipment has still to be considered as a "conditio sine qua non". Improvements for tissue division and dissection include an electrosurgical snare to perform a partial nephrectomy, the development of a pneumodissector and hydrodissector. Robotics, including the AESOP 3000 and ZEUS represent a glimpse of the future. By positioning the optique in a voice-controlled full range motion mechanic arm, the image on the screen is very steady and the ergonomics of the surgeons is increased significantly. The da Vinci-System, however, is the first system that has translated all visions of telepresence surgery into clinical reality, recently also for laparoscopic radical prostatectomy. CONCLUSIONS: The future of laparoscopic urology is a two-tiered approach. On the first tier, the advancement of complex reconstructive and ablative surgery such as laparoscopic prostatectomy or, laparoscopic retroperitoneal node dissection, will be undertaken by referral centers of expertise. It is from these individuals that we will look to in order to separate what is feasible and what is reasonable. The second tier will be focusing on simplifying the procedure for the average urologist. As such, developments such as the pneumodissector, hydrodissection, and hand assistance will bring exstirpative laparoscopy into the realm of more urologists. What is critical is that the urologic community supports both groups of laparoscopists.

Education, Medical, Graduate↗

PubMed2002

Technique and value of staging laparoscopy.

Despite significant improvements in preoperative tumor staging due to sophisticated new imaging and interventional techniques, peritoneal tumor spread and occult liver and lymph node metastases are only detected during surgery in some patients. Newer treatment modalities using neoadjuvant regimens are only given if occult tumor spread is excluded. Diagnostic laparoscopy has therefore been introduced to prevent patients with advanced tumor disease from unnecessary laparotomy and as a diagnostic tool in neoadjuvant treatment protocols. Laparoscopic ultrasound represents an important technical improvement in diagnostic laparoscopy. The main indication for diagnostic laparoscopy is therefore exact tumor staging, especially in terms of peritoneal, liver, and lymphatic tumor spread, whereas determination of local tumor resectability is not the main issue. The aim of the current review is to summarize the technique of staging laparoscopy and to discuss its clinical value for a variety of gastrointestinal malignancies.

Biliary Tract Neoplasms↗

PubMed2004

Laparoscopy and laparoscopic ultrasound in the evaluation of pancreatic and periampullary tumours.

BACKGROUND AND AIMS: The pre-operative determination of resectability of pancreatic and peri-ampullary neoplasia assists the selection of patients for surgical or non-surgical treatment. This study investigated whether the addition of laparoscopy with laparoscopic ultrasound to dual-phase helical CT could improve the accuracy of assessment of resectability. PATIENTS AND METHODS: Prospective study of 305 patients referred to a single unit for consideration of pancreatic resection who underwent dual-phase helical CT scanning +/- laparoscopy with laparoscopic ultrasound. Data were collected on patient demographics, CT findings, assessment of operability, laparoscopic assessment (LA), surgical procedures and histology. RESULTS: LA was undertaken in 239/305 patients, 190 of whom were considered CT resectable, and 49 CT unresectable. Of the 190 CT resectable patients, LA correctly identified unresectability in 28 (15%: metastases in 15; vascular encasement in 6; anaesthesia for laparoscopy found 7 unfit for major resection) and incorrectly in 2 (vascular encasement), but did not identify unresectability in 33; LA correctly confirmed resectability in the remainder (prediction improved, chi(2) = 9.73, p < 0.01). Of the 49 CT unresectable patients, LA correctly identified resectability in 4, and incorrectly in 12, and correctly identified unresectability in the remaining 33. Sixty-six of the 305 patients did not undergo LA, of whom 23 underwent resection. CONCLUSION: When added to dual-phase helical CT, laparoscopy with laparoscopic ultrasound provides valuable information that significantly improves the selection of patients for surgical or non-surgical treatment.

Adult↗

PubMedDate not supplied

Laparoscopy in staging and restaging of 95 patients with ovarian carcinoma.

The merits of laparoscopy with inspection of diaphragmatic leaves were studied in 95 patients with ovarian carcinoma. Laparoscopy was positive in 19 out of 27 new cases, 11 out of 47 patients previously treated and in apparent complete remission, and 12 out of 21 patients previously treated and with the disease. Thirty-one out of 95 patients were shown to have diaphragmatic metastases alone and/or associated with other localizations of disease. In 5 out of 27 new cases the stage was modified after laparoscopy. The histologic-endoscopic correlation was correct in 28/36 positive cases (78%) and in 31/32 negative cases (97%). In conclusionall patients with ovarian carcinoma should be subjected to laparoscopy as staging and restaging before undergoing laparotomy.

Diaphragm↗

PubMed1998

Laparoscopy for the nonpalpable testis.

Cryptorchidism represents one of the most common childhood disorders with the incidence of testicular maldescent being 0.8% by 1 year of age. Nonpalpable testis occurs in approximately 20% of patients with cryptorchidism. Laparoscopy for diagnosis and management of nonpalpable testis has shown to be highly effective with few complications. This article reviews some of the special considerations in performing laparoscopy in children with descriptions about the unique features of a child's anatomy and physiology. The role of laparoscopy in the evaluation and management of nonpalpable testis is discussed, along with some of the controversies about how laparoscopy may be changing our approach to a child with a nonpalpable testis.

Cryptorchidism↗

PubMed1999

Diagnostic laparoscopy outside of the operating room.

Laparoscopy is increasingly being used as a diagnostic technique to characterize intraperitoneal processes. This technique can be highly informative when applied in settings such as the intensive care unit, the emergency room, the trauma bay, and the office. Diagnostic laparoscopy is an excellent method to evaluate intraperitoneal processes and should be part of the general surgeon's armamentarium of skills. In this paper, the technique of diagnostic laparoscopy and its role outside of the operating room setting is reviewed. Diagnostic laparoscopy is also compared with other diagnostic modalities.

Contraindications↗

PubMed2003

Laparoscopy and oncology: where do we stand today?

The clinical application of laparoscopic surgery has grown rapidly over the last few years. Since the first documentations of laparoscopic lymphadenectomy, many reports highlight the use of modern laparoscopy in the field of gynecologic oncology. Laparoscopic treatment of early-stage cervical and endometrial cancer, and laparoscopic evaluation and staging of cervical, ovarian, and endometrial carcinomas, are feasible procedures. The place of minimal-access surgery in the arsenal of gynecologic oncological surgery has been established, especially after the recent developments and practical application of video laparoscopy, novel instrumentation, and advanced surgical techniques. Although operative laparoscopy in gynecologic oncology is still in its infancy the potentiality of the procedure is underscored. Many patients may benefit from the treatment or staging of gynecologic malignancies with laparoscopic means. Literature reports highlight that laparoscopy may be an effective procedure with lower morbidity and complication rates than traditional abdominal surgery. The short hospital stay and recovery time have a positive impact in a cancer patient's quality of life, as they return to normal activities rapidly. Many risks, though, may arise from the application of minimal-access surgery in cancer patients, and many questions regarding safety and efficacy need answers, based on prospective clinical trials. We must emphasize that such studies with large patient numbers and long-term follow-up are lacking. Until results from these trials are available, laparoscopic oncologic procedures should be performed only in an investigational setting by expert teams.

Adult↗

PubMed2006

A laparoscopy-based score to predict surgical outcome in patients with advanced ovarian carcinoma: a pilot study.

BACKGROUND: Our objective was to set up a more objective quantitative laparoscopy-based model in predicting the chances of optimal cytoreductive surgery in advanced ovarian cancer patients. METHODS: Sixty-four advanced ovarian cancer patients were submitted to both laparoscopy and standard longitudinal laparotomy sequentially, to define the chances of optimal debulking surgery (residual disease < or = 1 cm). Three patients could not be evaluated by laparoscopy because of the presence of multiple and tenacious adherences. Sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy were calculated for each laparoscopic parameter. On the basis of the statistical probability of each factor to predict surgical outcome, seven laparoscopic features were selected for inclusion in the final model. Each parameter was assigned a numerical score based on the strength of statistical association, and a total predictive index value was tabulated for each patient. Receiver operating characteristic curve analysis was used to assess the ability of the model to predict surgical outcome. RESULTS: After debulking surgery, 41 (67.2%) of 61 patients were left with optimal residual disease. The presence of omental cake, peritoneal carcinosis, diaphragmatic carcinosis, mesenteric retraction, bowel and/or stomach infiltration, and liver metastases satisfied the basic inclusion criteria and were assigned a final predictive index value of 2. In the final model, a predictive index score > or = 8 identified patients undergoing suboptimal surgery with a specificity of 100%. The positive predictive value was 100%, and the negative predictive value was 70%. CONCLUSIONS: The reliability of laparoscopy in assessing the chance of optimal cytoreduction can be improved by using a simple scoring system.

Female↗

PubMed2004

Preoperative assessment of vascular anatomy around the stomach by 3D imaging using MDCT before laparoscopy-assisted gastrectomy.

OBJECTIVE: Our aim was to evaluate the efficacy of 3D imaging using MDCT in the preoperative assessment of the vascular anatomy around the stomach before laparoscopy-assisted gastrectomy. SUBJECTS AND METHODS. Thirty-six consecutive patients scheduled for laparoscopy-assisted distal gastrectomy were evaluated on MDCT. CT was performed at the arterial phase after a bolus IV injection of contrast material. Three-dimensional CT angiography (3D CTA) of the arterial and venous systems was reconstructed separately using a volume-rendering algorithm, and the images were fused. Three-dimensional CTA for the left gastric, right gastric, and replaced left hepatic arteries and the left gastric coronary vein was evaluated prospectively by three reviewers, and then a surgical correlation was made. RESULTS: In all 36 cases, the left gastric artery was correctly identified on 3D CTA. In 35 of 36 cases, the right gastric artery was correctly identified, whereas in one case, the right gastric artery could not be visualized on 3D CTA because of its small size. In 35 of 36 cases (i.e., one case with agenesis of the left gastric coronary vein was excluded), the left gastric coronary vein was correctly identified. In six cases, the replaced left hepatic artery was correctly identified on 3D CTA. All 36 cases underwent successful laparoscopy-assisted distal gastrectomy on the basis of the 3D CTA. Both the sensitivity and positive predictive values of 3D CTA revealed 100% correct determination of the left gastric artery, replaced left hepatic artery, and left gastric coronary vein. The sensitivity and positive predictive values for the right gastric artery were 97% and 100%, respectively. CONCLUSION: Three-dimensional CTA using MDCT clearly revealed individual vascular anatomies around the stomach and could play an important role in safely facilitating the laparoscopy-assisted gastrectomy procedure.

Algorithms↗

PubMedDate not supplied

The role of laparoscopy in gynecologic oncology.

In some patients and when performed by a skillful surgeon, gynecologic oncologist familiar with advanced laparoscopic techniques, laparoscopy results with less surgical trauma, reduced blood loss and hospitalization, and faster recovery. The complication rate has been found to increase as the complexity of the operation rises, but it is not higher than in open surgery. Preliminary studies show that recurrence and survival rates are comparable to those reported for patients treated by a standard abdominal approach. Future randomised trials are necessary to deal with long term recurrences and survival data and benefits of laparoscopy in management of gynecologic malignancies. At our institution 97 cancer patients underwent laparoscopic procedures, without complications: explorative and staging laparoscopies with biopsies of ovaries, peritoneal biopsies, retroperitoneal and mesenteric tumours; second look laparoscopy, ovariectomy, laparoscopic assisted vaginal hysterectomy (LAVH). Advanced ovarian cancer was found in 3 patients and laparotomy was performed. No complications were established.

Female↗