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PubMed1996

The role of laparoscopy in blunt abdominal trauma.

In a collective analysis of 11 reports with a total of 355 blunt abdominal trauma patients, the sensitivity and specificity of diagnostic laparoscopy in predicting the eventual need for therapeutic laparotomy were 94% and 98%, respectively, with an overall accuracy of 97%. Although fairly accurate and safe (morbidity rate about 1.2%), the invasiveness, cost and time-consuming nature of diagnostic laparoscopy limit its routine use in trauma patients. It could, however, be useful in selecting patients with minor or nonbleeding injuries for nonoperative management after positive peritoneal lavage or computed tomography, and in excluding occult bowel and diaphragmatic injuries in patients with equivocal findings, thereby reducing the number of unnecessary laparotomies. With the improvement of laparoscopic techniques and instrumentation, more injuries can probably be managed laparoscopically with all the benefits observed with the shift from open to laparoscopic procedures in other patient populations, and it is likely that laparoscopy will find its place as an integral part of evaluating and treating patients with blunt abdominal trauma. At present, however, laparoscopy cannot be recommended as a routine tool for evaluating patients with blunt abdominal trauma, except in controlled clinical trials.

Abdominal Injuries↗

PubMed2005

Selected adnexal cystic masses in postmenopausal women can be safely managed by laparoscopy.

The aim of this study was to assess the efficacy and safety of laparoscopic treatment for adnexal cystic masses that were predicted to be benign in postmenopausal women. Postmenopausal women found to have an adnexal cystic mass were retrospectively evaluated with transvaginal ultrasonography, and serum CA-125 levels. The selection criteria were adnexal cystic masses greater than 3 cm but less than 10 cm, the masses were in the benign range (4-8) of Sassone's scoring system for transvaginal ultrasonography, and the patients had serum CA-125 levels less than 65 IU/mL. Two hundred nineteen women fulfilled the criteria and underwent operative laparoscopy. Almost all the masses (99.5%) were accurately predicted to be benign except for one borderline ovarian tumor. Two hundreds thirteen (97.3%) women were successfully managed by operative laparoscopy and six (2.7%) required laparotomy. For the patients managed by laparoscopy, the mean operative time was 51.3 min; the mean hospital stay was 2.5 days. There was no significant morbidity and surgery-related mortality. The combination of the Sassone's scoring system for transvaginal ultrasonography and serum CA-125 level can accurately predict benign cystic masses, and operative laparoscopy is technically feasible and safe for the management of adnexal mass in postmenopausal women.

Adnexal Diseases↗

PubMed1999

Operative laparoscopy in treating benign ovarian cysts.

This study was undertaken to evaluate the clinical usefulness of operative laparoscopy in treatment of benign ovarian cysts. A retrospective study was carried on 468 operative laparoscopy cases performed from September 1995 to September 1998 at Yonsei University College of Medicine, Department of Obstetrics and Gynecology. Patient characteristics, specimen pathology, perioperative morbidity, and perioperative complications were reviewed. The percentage of operative laparoscopy increased steadily from 20.7% in 1996, 33.9% in 1997, to 49.7% in 1998. The mean age of patients was 33.66.5 (mean +/- SD) years and the mean hospital stay was less than 2 days. Types of surgery performed were cystectomy (n = 234), salpingo-oophorectomy (n = 126), oophorectomy (n = 63), and fulguration (n = 45), in decreasing order. Depending on the pathology of the ovarian cyst, the mean operation time was in the range of 80 to 110 minutes. Perioperative complications included 5 cases of subcutaneous emphysema, 10 cases of abdominal wall hematoma, 7 cases of trocar site bleeding, 3 cases of bowel injury, and 1 case of bladder injury. In conclusion, operative laparoscopy in treating benign ovarian cysts provides advantages such as less need to perform laparotomy, smaller skin incision, less perioperative discomfort, minimal tissue handling and trauma, and shorter hospital stay. Nevertheless, the risk of unrecognized ovarian malignancy cannot be absolutely excluded, therefore careful patient selection is mandated.

Adolescent↗

PubMed1981

Alice through the laparoscope: the place of laparoscopy in an infertility service.

A retrospective comparison was made of the findings at laparoscopy and hysterosalpingography in 115 infertile women. In 41 of the 92 women whose hysterosalpingograms were reported as being normal, laparoscopy revealed additional pelvic abnormalities relevant to fertility, most commonly pelvic adhesions or endometriosis. This gave a false negative rate of 44% for hysterosalpingography. Conversely, in the 23 women whose hysterosalpingograms were abnormal (usually blockage at one or other cornua), laparoscopy showed no abnormality in six (a false positive rate of 26% for hysterosalpingography). These figures are compared with data extracted from the literature, and a plea is made for earlier laparoscopy in the investigation of infertility.

False Negative Reactions↗

PubMed1996

[Clinical experience with laparoscopy-assisted live donor nephrectomy].

PURPOSE: Laparoscopic nephrectomy has become widely performed because of its minimally invasive nature. We have performed laparoscopic nephrectomies for non-functioning kidneys and laparoscopy-assisted radical nephrectomies for renal carcinomas. Recently, we have successfully performed laparoscopy-assisted transperitoneal living related donor nephrectomy for kidney transplantation. To determine the efficacy of laparoscopy-assisted live donor nephrectomy, we investigated the clinical results of 2 patients operated upon with this new operation. PATIENTS: Case 1 was a 64-year-old healthy male and the left kidney was removed for his son who had a history of 4 months hemodialysis. Case 2 was 67-year-old healthy female who decided to donate her left kidney for her son with the history of 3 years and 2 months hemodialysis. METHODS: An upper abdominal midline incision of approximately 10 cm in length was made. Two retractors were attached to either side of the midline incision. The abdominal wall was raised by suspending these retractors from a special hanger. Then three trocars were introduced. The Gerota's fascia was incised and the kidney was suspended by grasping the perirenal fatty tissues. The renal artery and vein were carefully isolated without any manipulations of the kidney (non-touch method). After the transection of the ureter, the renal artery was ligated with a free tie of 1-0 silk and a suture ligature of 3-0 silk and the renal vain was clamped with a Satinski forceps. Immediately after the transection of the renal pedicle, the kidney was irrigated and transplanted to the right iliac fossa of the recipient in the usual fashion. A pen-rose drain was placed in the retroperitoneal space and the posterior peritoneal membrane was completely closed with 3-0 silk interrupted sutures. RESULTS: The mean operating time was 298 minutes and the mean blood loss was minimal. The average time of warm ischemia and cold ischemia of the graft were 4.5 minute and 37 minutes, respectively. There were no complications during either the operation or the postoperative period in both patients. The donors began oral intake and ambulation within 48 hours and resumed their normal daily activities by postoperative day 6.5 on average. Postoperative recovery of the patients were far faster than that of the patients receiving open donor nephrectomy. The graft functions were also excellent. The serum creatinine concentration of the recipients fell down to 0.82 mg/dl and 1.02 mg/dl at the third postoperative day. CONCLUSION: Laparoscopy-assisted live donor nephrectomy might be advantageous for kidney transplantation because of its minimally invasive procedure.

Female↗

PubMed1999

[Laparoscopy in acute abdomen as diagnostic and surgical aid].

In cases of acute abdomen, the preoperative diagnostic options are limited. Diagnostic laparoscopy offers a superior overview of the abdominal cavity with minimal trauma to the patient. If further surgery is needed, it may take the form of either laparoscopic procedures or conversion to open surgery, the incision being guided by laparoscopy findings. Complications associated to laparoscopy are few and can be minimized further by using minilaparotomy techniques. Intensive educational programmes for all categories of staff are required to make a 24-hours-a-day laparoscopy service available.

Abdomen, Acute↗

PubMedDate not supplied

A comparison of the incidence of nausea after laparoscopic cholecystectomy and diagnostic laparoscopy.

Thirty-four patients undergoing gynecologic diagnostic laparoscopy and 30 patients undergoing laparoscopic cholecystectomies were followed prospectively for nausea and vomiting 24 hours postoperatively. Diagnostic laparoscopy patients had a significantly higher incidence of nausea and vomiting than laparoscopic cholecystectomy patients with similar anesthetic techniques, duration of surgery, and population parameters. All patients had their stomach contents suctioned after induction. While both procedures involve bowel manipulation, patient position and organ manipulation differ: diagnostic laparoscopy involves the Trendelenburg position and laparoscopic cholecystectomy involves the reverse Trendelenburg; diagnostic laparoscopy involves the uterus, ovaries, and fallopian tubes while laparoscopic cholecystectomy involves mainly the gall-bladder and its appendages. These factors may contribute to the differences found in this study.

Adult↗

PubMed1999

Laparoscopy in gynecologic malignancies.

One of the cornerstones of gynecologic cancer surgery is the assessment and removal of the retroperitoneal lymph nodes. Numerous reports have demonstrated that, when performed by highly skilled individuals, laparoscopic lymphadenectomies can be performed safely. This has led to the investigation of laparoscopy in the surgical staging and treatment of patients with ovarian, cervical, and endometrial cancers. This very promising approach has the potential to revolutionize numerous aspects of the management of gynecologic malignancies. However, it must be emphasized that the use of laparoscopy for gynecologic malignancies is still in its infancy. Studies that provide complication rates and long-term results are just beginning to be reported. More clinical data are necessary before the laparoscopic techniques are accepted as new surgical standards. Ongoing, prospective clinical trials will help answer many of the questions regarding the safety and efficacy of gynecologic laparoscopy. Until more data accumulate, operative laparoscopy will remain a promising, but unproven, tool in the management of patients with gynecologic malignancies.

Endometrial Neoplasms↗

PubMed1999

Experience with gynaecological laparoscopies in Wad Medani Hospital, Sudan.

OBJECTIVE: To assess the value and safety of laparoscopy in gynaecological practice in a tertiary care centre in Sudan to determine the magnitude of tubal disease as an aetiological factor in female infertility. DESIGN: A prospective case series study. SETTING: Department of Obstetrics and Gynaecology in a tertiary care Teaching Hospital in Sudan. SUBJECTS: Seven hundred and three women selected for laparoscopy for various reasons. MAIN OUTCOME MEASURES: Indications for laparoscopy findings and complications. RESULTS: Infertility was the main indication (94.32%). Tubal disease was diagnosed in 46.6% of all infertile women studied. The overall complication rate was 22.76 per 1000; two major complications and no death. CONCLUSION: Laparoscopy is a valuable and safe procedure and and is useful in solving patients' problems, especially infertility. Tubal disease is a major aetiological factor in female infertility.

Adolescent↗

PubMed1999

[Staging by immediate preoperative laparoscopy in adenocarcinoma of the distal esophagus and cardia].

Accurate preoperative staging of adenocarcinoma of the esophagus and cardia is critical to select the proper treatment in the individual patients, i.e., resection, neoadjuvant therapy, or endoscopic palliation. Aim of this study was to assess the role of laparoscopy in detecting intra-abdominal metastatic spread in patients with adenocarcinoma of the esophagus and cardia. Between November 1995 and May 1998, 45 patients with histologically-proven adenocarcinoma of the cardia--without any previous treatment--and negative or inconclusive findings at computed tomography (CT) and ultrasonography (US) underwent staging laparoscopy at the same session of the planned surgical resection. The mean operative time of the procedure was 25 minutes (range 15-55 min). Laparoscopy led to change the therapeutic approach in five patients (11.1%): three patients with peritoneal carcinomatosis and one with a liver metastasis undetected at preoperative imaging studies did not have resection; conversely, one individual with liver hemangioma simulating a metastatic mass at CT underwent esophagogastric resection. In patients with adenocarcinoma of the esophagus and cardia, laparoscopy is useful to increase accuracy of detection of metastases; when performed as the first step of a planed resection, it avoids unnecessary laparotomies and does not increase the complexity of preoperative evaluation.

Adenocarcinoma↗

PubMed2000

A prospective evaluation of the combined use of the modified Alvarado score with selective laparoscopy in adult females in the management of suspected appendicitis.

BACKGROUND: A diagnostic scoring system such as the modified Alvarado score, combined with selective laparoscopy in adult females, can be used in the assessment of acute abdominal pain suggestive of appendicitis. METHOD: A total of 84 consecutive patients presenting to our surgical team with suspected appendicitis were assessed prospectively using the modified Alvarado score. The definitive management of this study group was instigated according to a set algorithm based on the score. The algorithm included the use of diagnostic laparoscopy in adult female patients with scores suggestive of appendicitis. A negative appendicectomy rate was obtained from those undergoing appendicectomy using this approach and compared to that obtained from the 97 patients that had undergone appendicectomy under the care of the other surgical teams in our unit during the study period. RESULTS: The rate of negative appendicectomy in the study group was 0% compared to 18% in the control group (P < 0.05); 10% of adult female women had negative diagnostic laparoscopies for appendicitis thus saving this group an unnecessary appendicectomy. This was achieved without an increase in total in-patient stay. CONCLUSION: An algorithm combining the modified Alvarado score with selective laparoscopy is recommended for widespread use in the management of suspected acute appendicitis.

Acute Disease↗

PubMed1999

[The diagnostic approach in hepatic lesions--the role and place of laparoscopy with laparoscopic echography].

The study is designed to cases the potentials of laparoscopy with laparoscopic echography, and the role they play in the diagnostic algorithm, with the purpose to develop an optimal therapeutic approach to hepatic lesions. Laparoscope R. Wolf and 7.5 MHz linear transducer, obtained from the Aloka Company are employed in work. A total of 303 patients presenting primary and metastatic carcinoma of liver (58 and 145, respectively), cholangiocarcinoma (11), hemangioma(28), adenomatous hyperplasia (38) and other lesions (23) are studied. Morphologic verification of the diagnosis is done in over one third of cases. In 30 to 40 per cent of the series reviewed laparoscopic echography supplements the laparoscopic finding depending on the type of lesion. Without pretending to create a diagnostic algorithm in individual hepatic lesions, abiding to the following diagnostic approach is strongly recommended: stage one--echography (a noninvasive, not irradiating, cheap, readily accessible and often resolving method), stage two--noninvasive, stage three--invasive, stage four--preoperative or final (laparoscopy plus laparoscopic echography). In the event of properly established indications, the invasive methods of study (thin-needle biopsy under ultrasonographic control plus laparoscopy) may be considered as a second stage, without any need to apply the complete spectrum of examination accessible. Not infrequently, laparoscopy with laparoscopic ultrasonography play a crucial role in diagnosing liver lesions, exact determination of the stage and resectability of the neoplastic process, planning and shortening the duration of operation with simultaneous identification of intractable patients.

Algorithms↗

PubMed2000

[Urologic laparoscopy].

Recent applications of laparoscopy to urologic surgery have demonstrated the efficacy, safety, and shorter convalescence times with these techniques. Laparoscopy still is the most accurate diagnostic tool for impalpable testes and allows surgeons to select the proper treatment. Because of the need for general anesthesia, laparoscopic varicocelectomy is not considered less invasive than subinguinal low ligation under local anesthesia. However, a future trend toward day surgery might favor laparoscopy, which requires a smaller skin incision and thus enables young men to return to work earlier. Laparoscopic adrenalectomy has been established as a standard operative technique because it offers many advantages in comparison with conventional open surgery. Laparoscopic nephrectomy is also a minimally invasive operation, although the most appropriate method for kidney retrieval has not been determined, and currently in Japan insurance reimbursements are limited to benign disease. Laparoscopic nephrectomy for renal cell carcinoma and upper urinary tract transitional cell carcinoma is very promising, although there is debate on laparoscopic cancer surgery. Furthermore, the recent great success with laparoscopic radical prostatectomy in France is stimulating Japanese investigators. In the 21st century, laparoscopy will be standard for many surgical procedures in urology.

Adrenalectomy↗

PubMed2000

[Laparoscopy in the diagnosis and treatment algorithm for an acute surgical diseases and trauma of abdomen].

Laparoscopy was performed in 1977 patients in an acute surgical diseases and the abdominal cavity (AC) injuries, the curative one--in 895. In patients with clinical signs of the AC organs acute disease or trauma it is possible the four-variants diagnostic and curative program application: radial methods of investigation and laparocentesis--for diagnosis, laparoscopy and laparotomy--for diagnosis and treatment. The laparoscopy application is indicated even if the "acute abdomen" clinical features presence are confirmed the radial diagnosis and laparocentesis result. If necessary the diagnostical laparoscopy is transformed into curative procedure, which is used with the miniinvasive access application, resulting in low operative risk.

Abdominal Injuries↗

PubMed2000

Effect of laparoscopy on bacteremia in acute appendicitis: a randomized controlled study.

Laparoscopic appendectomy is increasingly used in treating acute appendicitis. Several controlled series have demonstrated the clinical benefit of the procedure. However, some basal pathophysiologic changes caused by the laparoscopy still need clarification, i.e., whether laparoscopy can give rise to bacteremia. The purpose of this randomized controlled study in 30 patients undergoing surgery due to suspected acute appendicitis, either by an open classic technique or by a laparoscopic technique, was (by collecting samples for blood culturing pre-, peri-, and postoperatively) to evaluate whether laparoscopy during carbon dioxide pneumoperitoneum could induce bacteremia. Six patients of 12 in the group treated by laparoscopy presented positive blood cultures peri- and postoperatively. No positive blood cultures were demonstrated in the open operated group. The difference was significant (P = 0.0183). The clinical significance of these findings should be clarified in further clinical investigations.

Acute Disease↗

PubMed2000

Can laparoscopy be performed safely early after laparotomy?

Early subsequent laparotomy has high morbidity and mortality rates. The majority of these procedures, such as control of intraabdominal bleeding, management of intraabdominal sepsis, assessment of bowel viability, or anastomotic suture line, which are performed during early subsequent laparotomy, can be managed safely by laparoscopy, with resultant decreased mortality and morbidity rates. However, fear of dehiscence and ventral hernia prevents widespread use of laparoscopy. The aim of this experimental study was to compare the deleterious effects of subsequent laparotomy with laparoscopy in abdominal wounds during the early postceliotomy period. A 4-cm median laparotomy was performed in 120 Wistar-Albino rats that were classified into three groups. The control group (1) did not receive additional treatment. On the third postoperative day, early subsequent laparotomy and pneumoperitoneum were performed in group 2 and group 3 rats, respectively. Ten rats from each group were selected randomly and killed after 5 days, 1 week, 2 weeks, and 4 weeks. Bursting pressure and tensile strength of the abdominal wound were assessed. Results of the study showed impaired abdominal wound healing in subsequent laparotomy group rats (group 2) (P < 0.05). Pneumoperitoneum did not cause statistical differences in wound healing parameters when compared with control group rats (P > 0.05). In conclusion, pneumoperitoneum does not affect abdominal wound healing adversely, but early subsequent laparotomy impairs wound healing severely. Laparoscopy would be an alternative to high-risk early subsequent relaparotomy.

Analysis of Variance↗

PubMed2001

The role of laparoscopy in the evaluation of liver transplant patients.

Diagnostic laparoscopy is safe and effective in the diagnosis of liver diseases. In liver transplant patients, laparoscopy has a valuable role in the early detection and staging of hepatic lesions. Laparoscopy is helpful in the early detection and staging of primary hepatic malignancy. With the increase of liver transplantation around the world, gastroenterology and hepatology programs should re-evaluate the role of laparoscopy in the diagnosis of liver diseases.

Contraindications↗

PubMed2001

[Laparoscopic tumor staging in gastrointestinal carcinomas: significance of internal medicine laparoscopy].

This study was performed to assess the role of additional diagnostic laparoscopy in the preoperative staging of patients with gastric cancer and pancreatic cancer prior to intended curative surgery. Furthermore patients with ascites of unknown origin were evaluated. 127 patients with primary solid abdominal tumors were eligible for evaluation; of those 66 patients had a gastric cancer and 61 a pancreatic cancer. Patients without histologically proven metastases proceeded to laparotomy. Ascites of unknown origin was the indication for performing a diagnostic laparoscopy in 23 patients. Metastases were detectable laparoscopically in 13 of 66 patients (20%) with gastric cancer. Intraoperatively metastases were evident in further 7 cases. In 14 of 61 patients (23%) with pancreatic cancer metastases were detected by laparoscopy and in further 5 patients intraoperatively. A peritoneal carcinosis was diagnosed laparoscopically in 17 of 23 patients with ascites of unknown origin. Preoperative staging by additional diagnostic laparoscopy proved effective in patients with gastric- and pancreatic cancer.

Ascites↗