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At least 775 records · Page 43Linked to original sources

PubMed2003

[Laparoscopy in urology].

Since the past 10 years, results have established laparoscopy's efficacy. It is actually a consistent surgical option for a lot of indications met in urology. The rational behind performing laparoscopic procedures includes shorter hospital stays, less postoperative pain and a more rapid return to usual activity. Drawbacks of laparoscopy include significant learning curve, longer operative times and higher overall costs. One particular focus is the oncologic applications of laparoscopy for nephrectomy and specially for radical prostatectomy. Laparoscopy become nowadays an usual part of the armamenturium of urological teams.

Female↗

PubMed2003

[Gynecologic laparoscopy and abdominal scars: what approach for the peritoneal cavity?].

To identify and discuss the advantages of the different methods of entry into the peritoneal cavity during gynecological laparascopy in patients who have previously undergone abdominal surgical procedures. Literature review comparing the strengths of each method of entering the peritoneal cavity during gynecological laparoscopic procedures. Adhesions increase the risks of access into peritoneal cavity during laparoscopy. Many techniques or safety rules have recently been described or re-evaluated as an alternative to using the traditional combination "Veress needle and blind introduction of the first trocar". The most relevant were the "open laparoscopy", the use of optical trocar, the double laparoscopy and the use of microlaparoscope. There remains no clear conclusion regarding the optimal form of laparoscopic entry in high risk patients. Relevant data emphasizes that critical to the surgeon's choice of technique is the immediate ability to recognize accidental injury and the capacity to avoid the scarred area. According to the literature review on the procedures used for entering the peritoneal cavity in high risk patients, we conclude that double laparoscopy may indeed be an underused procedure in such cases.

Abdomen↗

PubMedDate not supplied

Operative laparoscopy in pregnancy.

OBJECTIVE: We compared the surgical outcomes of pregnant women undergoing laparotomy in the first 2 trimesters of pregnancy with those undergoing laparoscopy for the management of acute pelvic pain. METHODS: We performed a systematic retrospective chart review of patients whose discharge diagnosis included intrauterine pregnancy with exploratory laparotomy or laparoscopy from August 1, 1993 to October 31, 1999. The following factors were assessed: preoperative diagnosis, postoperative diagnosis, gestational age at the time of surgery, operative time, hospital stay, pathology, gestational age at delivery, complications, and outcome of the pregnancy in both groups. RESULTS: Sixteen pregnant patients underwent surgery during the study period. All but one had abdominopelvic pain, and all patients had an associated adnexal mass. The mean gestation age at the time of surgery was 15+/-6 weeks versus 13+/-4 weeks in the laparoscopic and laparotomy groups, respectively (P=NS). All patients undergoing laparoscopy remained in the hospital for one day compared with a mean of 4.4+/-1.1 days in the laparotomy group (P<0.0001). Pregnancy outcomes were similar and uniformly good. CONCLUSION: Laparotomy can be avoided and pregnant patients managed safely by operative laparoscopy, with shorter hospital stays.

Adnexal Diseases↗

PubMedDate not supplied

Perforated appendicitis: is laparoscopy safe?

OBJECTIVE: The purpose of this study was to demonstrate the safety and efficacy of laparoscopy in children with perforated appendicitis. METHODS: This is a retrospective review of consecutive patients under the age of 18, operated on for perforated appendicitis between September 1997 and December 1999. RESULTS: Sixty-nine patients were operated on for perforated appendicitis. Eleven appendectomies were performed laparoscopically. Fifty-four patients underwent an open appendectomy. Four laparoscopic appendectomies were converted to an open procedure. The mean operative time was 79 minutes for the laparoscopic group, and 87 minutes for the open group. The mean length of hospital stay was 5.4 days versus 7.6 days for the laparoscopic and open groups, respectively. Neither of these differences was statistically significant. CONCLUSIONS: The above data support the use of laparoscopy in the management of perforated appendicitis in children. In conclusion, laparoscopy is as safe as open appendectomy. Laparoscopy is an effective alternative with a shorter length of hospital stay compared with that for an open appendectomy for perforated appendicitis in children.

Appendectomy↗

PubMed2004

[Laparoscopy and robotics].

Telerobotics is a wide term and include multiple directions and aspects in its development. When speaking of different aspects of its development, one should think of its functionality, construction aspects, communication aspects, implementation safety and acceptance by the environment. Robotics is a science dealing with possibilities of implementing different tasks, through mechanical instruments, controlled by humans. Telesurgery does not include only aspects of teleconference but assists in surgical procedures, i.e. enables for the part of surgical procedure to be performed through electronic commands on bigger distances. Currently, two robotic systems are employed in clinical practice. One is ZEUS system, constructed by the Computer Motion and manufactured by AESOP. Second one is Da Vinci surgical system. For laparoscopic robotic telesurgery, identical set of apparatus and instruments as the one used in a routine laparoscopic surgical procedures is needed. In all reports, authors refer to safe and successful surgical method. Recovery of the patient is identical as in classic laparoscopy. No statistically significant difference has been found in the duration of the surgery between robotic and classic laparoscopy. When counting used instruments, it was found that less instruments were used in the robotic laparoscopy. From presented studies related to the robotic laparoscopy, it can be seen that there is an intention to present this method as safe and usable. One thing is sure--this method is the first step toward new model of planning and performing surgical procedures with only one goal--to help the patient.

Humans↗

PubMed2004

[Ureteral injury in gynecologic laparoscopies].

OBJECTIVE: To investigate the ureteral injury in gynecological laparoscopies and discuss its diagnosis, treatment and prevention. METHODS: Ureteral injury in gynecological laparoscopies during the past 13 years was reviewed retrospectively. The clinical features of initial operations including the types of disease, uterine size, pelvic adhesion, operative procedures and the methods of diagnosis, treatment and prognosis of ureteral injury were studied. RESULTS: There were 8 ureteral injuries (0.14%) in 5 541 gynecological laparoscopies with seven in laparoscopically assisted vaginal hysterectomy (LAVH)/total laparoscopic hysterectomy (TLH) (0.45%) and one in non-LAVH (0.03%). The main gynecological disorders included adenomyosis, endometriosis and leiomyoma. All patients had pelvic adhesions and 4 had previous pelvic operations. Uterine enlargement was found in 7. Patients presented increased vaginal drainage, flank pain, increased volumes of vaginal discharge, nausea and vomiting, fever, edema, or peritonitis from 0 to 13 days postoperatively. Ureteral injuries were mainly diagnosed via excretory urogram (IVP). The sites of injury were near the inferior margin of the sacroiliac joint in two women and at the inferior part of ureter (near the uterine vessel, uterosacral ligament and ureterovesical junction) in 6. Two patients whose injuries were found soon after operation received ureteral repair by laparotomy successfully. Two of the six patients whose injuries were found several days later were treated with internal ureteral stenting successfully, the other four failed with ureteral stenting and received ureteral repair by laparotomy. Outcomes were good in all cases. CONCLUSIONS: Ureteral injury is an uncommon and severe complication in gynecological laparoscopies. Symptoms like abnormally increased drainage, fever, flank pain, abnormal vaginal discharge and peritonitis after operation should be paid attention to and ureteral injury be considered. Surgical repair is the primary treatment.

Adult↗

PubMed2004

[Study of operative procedures of laparoscopy and laparoscopically assisted sigmoid transplantation for vaginal construction].

OBJECTIVE: To explore the procedures and the clinical significance of laparoscopy and laparoscopically assisted sigmoid transplantation for vaginal construction. METHODS: Nine cases were assigned randomly to laparoscopically assisted sigmoid colpopoiesis and laparoscopic sigmoid colon colpopoiesis. The procedure of laparoscopically assisted sigmoid colpopoiesis: with the auxiliary of laparoscopy, dissected the distal portion of the sigmoid with endoscopic linear cutter, then a 4-cm incision was made in the left lower abdomen to retract and dissect the proximal portion of sigmoid. After the proximal portion of transplant-sigmoid was closed, the proximal cut end of reserved-sigmoid was placed with the anvil and made a purse-string suture, then put back sigmoid into the peritoneal cavity. A curved intraluminal stapler was inserted from the anus to the most distal cut end of reserved-sigmoid to end-end anastomose the reserved-sigmoid. Finally, an artificial canal was made between urethravesicae and rectum and the transplant-sigmoid with the blood supply was placed into the artificial canal to create an artificial vagina. The procedure of laparoscopic sigmoid colpopoiesis was performed under laparoscopy thoroughly. RESULTS: We have successfully completed the operations for 9 patients, and made 1 - 19 month following-up. The results of the artificial vaginae of all cases were satisfactory; the abdominal scar was small with remarkable cosmetic effects. Moreover, 5 cases had pleasant sexual intercourses. CONCLUSION: The procedures of laparoscopy and laparoscopically assisted sigmoid transplantation for vaginal construction can replace the traditional laparotomy.

Adolescent↗

PubMed1979

["Second-look laparoscopy" (author's transl)].

The authors present a report on their experience with the so-called "second-look laparoscopy" which they have been performing systematically since 1974. 44 (12%) second-look laparoscopies were done among a total of 383 laparoscopies during 1974--1977. Second-look laparoscopy was performed on routine basis in women treated by radiology and/or pharmacotherapy for advanced carcinoma of the genitals, especially in the case of ovarian carcinoma. The diagnostic measure represents an important contribution to establishing whether chemotherapy has been successfull, especially in ovarian cancer.

Female↗

PubMed2005

Operative laparoscopy in tubal pregnancy: preoperative ultrasonographic measurement of hemoperitoneum as a predictor of blood loss and outcome.

OBJECTIVE: To study the relationship of ultrasonographic measurement of hemoperitoneum to estimated blood loss and outcome of operative laparoscopy in ectopic pregnancy. STUDY DESIGN: Retrospective study of all tubal pregnancy patients with preoperative ultrasonographic evidence of hemoperitoneum who underwent laparoscopy as part of the procedure at a tertiary referral center over a 3.5-year period. The largest transabdominal and transvaginal measurements of pelvic fluid collections in anterior-posterior, transverse and cranial-caudal dimensions were measured from all available preoperative ultrasound films. Patient characteristics, volume of estimated blood loss and complications were reviewed. RESULTS: A total of 29 patients were included in the study. Twenty-one underwent successful laparoscopic treatment (group 1). Four patients underwent conversion from laparoscopy to laparotomy because of bleeding (group 2). Four patients underwent conversion because of adhesions (group 3). There were no significant differences in patient characteristics. The single largest ultrasonographc diameter of pelvic fluid collection in any dimension seemed to correlate with estimated blood loss volume (R2 =.659; p <0.05), with significant volume present in those with a maximum diameter > 7 cm. The mean diameter of greatest measurements was significantly different between groups 1 and 2 and between groups 2 and 3 (p<0.05). However, such measurements did not predict the success of laparosocpic surgery. CONCLUSION: The greatest ultrasonographic measurement of pelvic fluid collection > or = 7 cm in any dimension appears to serve as a marker of significant hemoperitoneum. Hemoperitoneum alone does not appear to predict the outcome of surgery, and otherfactors should be considered prior to performing operative laparoscopy in ectopic pregnancy.

Blood Loss, Surgical↗

PubMed2005

[Gynecological laparoscopy and treatment of ectopic pregnancy].

The aim of the present study is to show the advantages of the gynecologic laparoscopy for the diagnosis and treatment of the intact tubal pregnancy. For the fulfillment of this aim was made a prospective study for 5 years' period of the patients with diagnosis "Ectopic pregnancy", treated in Gynecological clinic of UMBAL-Pleven. The objects of observation were 33 women with diagnosis: "Intact ectopic pregnancy". Methotrexate was used by plan for 6 patients, in 7 patients was made laparotomy, and in 20 patients--gynecological laparoscopy. From the performed 20 gynecological laparoscopy, 16 women were recovered laparoscopically, in 14 of which was made partial salpingectomy, and in 2--milking. In one of the last two patients was injected Methotrexate in the bed of the gestational bag. In 4 women was necessary laparotomy, because of impossibility of performing of laparoscopic surgery. The authors emphasized the advantages of the gynecological laparoscopy for precise diagnosis and contemporary treatment of the intact ectopic pregnancy.

Antimetabolites, Antineoplastic↗

PubMed2005

Laparoscopy treatment of adnexal sterility.

A total of 113 patients who were examined and treated for matrimonial infertility underwent surgical laparoscopy at the Sterility and Infertility Department, Clinic of Gynecology and Obstetrics, Clinical Center of Nis. Age distribution in the group of patients who were subjected to surgical laparoscopy after diagnosis was 31.39 +/- 6.1 years, out of whom 74.3% were treated for primary sterility. Out of corrective interventions in laparoscopy, the following procedures were performed: adnexiolysis, salpingo-ovariolysis, fimbrioplasty, terminal salpingoneostomy, cyst puncture and ovarian incision. During any surgical laparoscopy, ovarian biopsy was performed for evaluation of ovarian potency and verification of probable histopathological findings. The most commonly used technique was salpingo-ovariolysis--in 22.88% of cases, followed by fimbrioplasty--18.81%. A total of 42 pregnancies were verified: 36 intrauterine (29 completed at full term) and 6 extrauterine pregnancies. Average conception rate in our patients was 37.17%, while rate of parturition was 25.66%. The rate of pregnancy in different corrective laparoscopic procedures ranged from 18.18%-61.54%. The rate of intrauterine pregnancy was the highest after bilateral fimbrioplasty (47.83%), and the lowest after bilateral neosalpingostomy--9.09%. The rate of delivery after adhesiolysis was 30.8%, after salpingo-ovariolysis--28.8%, after fimbrioplasty--18.3%, and after neostomy--12.5% of the time.

Adnexal Diseases↗

PubMed2005

[Laparoscopy in chronic abdominal pain in children].

UNLABELLED: The recurrent chronic abdominal pain (RAP) is one of the most usual pathologies in pediatrics. It may appear in the form of periodical or continuous sharp crisis. In order to be accepted as chronic, the presence of this pain must last at least 3 months. In many of the reference publications, only between 5 and 1% of the cases are considered to have an organic ethiology and the rest are labelled as functional processes of psychological origin. The reason for our communication is to show our experience on 304 RAP patients from 1995 to 2001. We also want to highlight the usefulness of laparoscopy in order to diagnose and treat 14.45% (44) of cases of this group of patients. MATERIAL AND METHODOLOGY: 304 patients between 5 and 14 years old were studied from 1995 to 2001. We followed a protocol of: medical and personal medical record, specific anamnesis for RAP, detailed description of the diet and intestinal habits, physical exploration. Laboratory: 1) blood analysis, hepatic profile, glucose, cholesterol, creatinine, amylase, 2) urine sediment and may be urine culture, 3) faeces analysis and 4) vaginal flow analysis. Image diagnosis is: simple abdomen radiography, ultrasonography and intestinal Rx. Guided and specific determinations: spired urea test, gastric chemism, lactose test, gastroscopy and biopsy, colonoscopy and biopsy, laparoscopy. RESULTS: In short, we can say: 74 patients (23.4%) come with inappropiate feeding diets, 31 (10.1%) with helicobacter pilori, 20 (6.5%) with adenoids, pharynx and pharyngeal processes, the same figure from gynaecologic origin, 18 (5.9%) from psychological origin, and in 44 cases (14.45%) laparoscopy was indicated. CONCLUSIONS: The anatomopathological study in the cases in which we carried out laparoscopic appendicectomy does not allow us to accept the symptoms of chronic appendicitis. The exploratory laparoscopy and the appendectomy have meant benefits for the solution to this pathology in 14.45% of patients. It is essential to carry out a long-term follow-up, at least 12 months, to be sure RAP is cured. We must carry on looking for aetiological cause of RAP.

Abdominal Pain↗

PubMed1979

[Necessity of training and safety in gynecological laparoscopy--a contradiction?].

At the Gynaecological University Hospital Göttingen 1659 laparoscopies were performed 1961-1978 by 67 gynaecologists with an average of 24,8 laparoscopies per gynaecologist. Most of the doctors were still in their training period, assistance was always given by a specialist gynaecologist. Only in 5 cases (0,3 per cent) laparotomy was necessary due to complications following laparoscopy or laparoscopicsterilization. Injuries of the transverse colon, the greater omentum and a mesenteric artery-caused by the trocar-were seen, also diffuse bleeding from the parietal peritoneum and from the ramus of the Fallopian tube. No deaths due to laparoscopic complications occurred. The incidence of severe complications can be kept within tolerable limits in a training hospital where the majority of the operations are performed by doctors in training, when the following conditions are strictly adhered to: Careful consideration of the risks involved in laparoscopy/laparoscopic sterilization and other less invasive diagnostic and contraceptive methods, strict attention to the contraindications of laparoscopy and performance of a standardized laparoscopic technique under the supervision of an experienced operateur.

Burns↗

PubMed2005

[Laparoscopy assisted total mesorectal excision for rectal cancer].

OBJECTIVE: To evaluate the feasibility of laparoscopy assisted total mesorectal excision (TME) for rectal cancer. METHOD: From March 2000 to November 2003,67 patients with rectal cancer received laparoscopy assisted TME,in whom 45 cases received anterior resection (AR),and 22 cases received abdominal perineal resection (APR). RESULTS: The operation was performed according to the rules of TME. The operative bleeding volume ranged from 10 to 50 ml. The operative time ranged from 2.5 to 5 hours without operative related death. Gastrointestinal decompression time ranged from 8 to 24 hours after operation. The time of intaking fluid food ranged from 24 to 48 hours after operation; the time of taking general activity ranged from 1 to 3 days after operation,and the defecating time ranged from 1 to 5 days after operation. The time of the hospital stay ranged from 7 to 10 days. All patients were followed up from 3 to 43 months except 3 patients. Two patients had local recurrence, including 1 patient died of local recurrence; 2 patients had liver metastases including 1 patient died of tumor metastasis but another was still alive. No metastasis and recurrence was found in 19 patients within follow - up time of one year. CONCLUSION: The laparoscopy assisted TME is a feasible approach for rectal cancer if surgeons have experience in open operation of laparoscopy assisted TME and good managing skills.

Aged↗

PubMedDate not supplied

Laparoscopy or laparotomy for the management of endometrial cancer.

OBJECTIVE: The aim of this study was to evaluate the feasibility of laparoscopy in the management of early stage endometrial cancer. METHODS: Fifty-two patients with endometrial cancer who underwent surgical staging consisting of total hysterectomy, bilateral salpingo-oophorectomy with pelvic lymph node dissection, and cytology between 1998 to 2002 were included in the study. Laparotomy and laparoscopy were randomly offered to patients upon admittance. RESULTS: Of 52 patients, 26 underwent laparotomy and the remaining 26 underwent laparoscopic staging surgery. No significant difference existed between the demographic characteristics of the 2 groups. The mean number of harvested lymph nodes was 18.2 in the laparoscopic group and 21.1 in the laparotomic group (P>0.05). Pelvic lymph node metastases were detected in 7.7% of the patients in the laparoscopy group and 15.4% in the laparotomy group, and the difference was not significant. Adjuvant radiotherapy was applied later to 42.3% of the laparoscopy group and 38.5% of the laparotomy group. Operative morbidity was higher in the laparotomy group mainly because of postoperative wound infection, and the patients in the laparotomy group had a longer hospital stay. CONCLUSION: Laparoscopic surgery is a method that can be applied as well as laparotomy in the management of endometrial cancer. Lymph node number and detection of lymph node metastasis did not differ significantly in laparotomic and laparoscopic approaches. Wound infections were more frequent in laparotomies.

Aged↗

PubMedDate not supplied

Heated, humidified CO2 gas is unsatisfactory for awake laparoscopy.

BACKGROUND: The necessity for general anesthesia represents an impediment to using a laparoscopic approach for some procedures that are otherwise performed with the patient under local anesthesia using a conventional open technique. Heating and humidifying the insufflation gas reportedly reduces perioperative pain associated with a CO2 pneumoperitoneum, thus enabling awake laparoscopy. METHODS: Two cases are reported herein of laparoscopy performed with the patient under local anesthesia using heated, humidified CO2 gas for the pneumoperitoneum. RESULTS: Both patients experienced pain with insufflation of heated, humidified CO2 gas of sufficient magnitude that the procedure could not be performed. The CO2 gas was washed out and replaced with helium gas insufflation with complete resolution of pain. The laparoscopic procedures were accomplished without further discomfort with local anesthesia and using a helium gas pneumoperitoneum. CONCLUSIONS: Heated, humidified CO2 gas insufflation does not reduce pain sufficiently to permit satisfactory performance of laparoscopy with local anesthesia, especially when full volume insufflation is required. Cold, dry helium gas produces no pain. The theory that cold, dry insufflation gas is a source of peritoneal pain during laparoscopy needs to be reassessed.

Adult↗

PubMed2005

[The role of laparoscopy in emergency abdominal surgery].

Abdominal emergencies can also be operated on through the laparoscopic approach: the approach can be diagnostic laparoscopy, surgery assisted by laparoscopy or laparotomy directed according to the findings of the laparoscopy. The general contraindications refer above all to the state of haemodynamic instability of the patient and to seriously ill patients (ASA IV). In the absence of any specific counter-indications for the specific laparoscopic procedure to be carried out, many abdominal diseases requiring emergency surgery can be performed with the laparoscopic approach. The most frequent indications are appendicitis, acute colecistitis, gastroduodenal perforation, occlusion of the small intestine, and some abdominal traumas. With a correct selection of patients and the appropriate experience of the surgeon, the results are excellent and better than open surgery (less infection of the wound, complications, hospital stay and postoperative pain). A detailed explanation is given of the basic aspects of the surgical technique in the most frequent procedures of emergency laparoscopy.

Abdomen↗

PubMed1991

[Emergency laparoscopy in closed abdominal injuries].

Results of emergency laparoscopies in 240 patients with closed traumas of the abdomen are presented. No injuries were found in 154 patients when performing laparoscopy. By the authors' data the diagnostic informative value of laparoscopy in closed traumas made up 98%. Wide use of laparoscopy allowed to avoid diagnostic laparotomy in doubtful clinical picture of closed abdominal traumas.

Abdominal Injuries↗