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At least 793 records · Page 44Linked to original sources

PubMed1991

[Comparative evaluation of laparoscopy and laparocentesis in the diagnosis of abdominal injuries].

The article presents a comparative estimation of laparoscopy and laparocentesis in diagnostics of abdominal traumas. Based on an analysis of results of 20 laparoscopies and 861 laparocenteses the author makes a conclusion that both laparoscopy and laparocentesis have high informative value in diagnostics of abdominal traumas, their diagnostic reliability having no substantial distinctions. Laparocentesis takes 5-6 times less time than laparoscopy.

Abdominal Injuries↗

PubMedDate not supplied

Laparoscopy training in United States obstetric and gynecology residency programs.

OBJECTIVES: To assess laparoscopic training curriculums in US Obstetrics and Gynecology residency programs. METHODS: A list of E-mail addresses was obtained for the accredited Obstetrics and Gynecology residency programs in the US from the CREOG Directory of Obstetric-Gynecologic Residency Programs and Directors. An E-mail survey containing 8 questions regarding laparoscopy training was sent to all residency directors with current E-mail addresses. RESULTS: Seventy-four residency directors responded to the survey for a response rate of 41%. Residency programs from all sections of the US were included in the study. Results of the survey indicate that 69% of residency programs had implemented a formal laparoscopy training program. At least half of the program directors surveyed stated that lack of faculty time and funds were the main barriers to laparoscopic surgery training. Seventy-two percent of those surveyed thought that in the future the health-care industry would demand proof of competency in laparoscopy as standard of care. CONCLUSIONS: Most US Obstetrics and Gynecology residency programs have implemented a formal laparoscopy training curriculum, use more than one method to train their residents, and involve almost half of their faculty on average in training residents to perform laparoscopic surgery.

Curriculum↗

PubMed2006

Status of urologic laparoscopy in 2004: a survey of CUA members.

INTRODUCTION: The optimal method of acquiring laparoscopic skills has not been determined. We sought to examine the current status of urologic laparoscopy and how practicing urologists acquired the skills needed to perform laparoscopic procedures. METHODS: A mail questionnaire regarding laparoscopic practices and training was sent to 480 members of the Canadian Urological Association (CUA) using standard Dillman survey methodology. RESULTS: Three hundred (62.5%) urologists responded to the questionnaire; 56.5% practiced in the community and 41.1% in an academic setting. There were 59.9% who had completed some form of fellowship training. Recent graduates (who finished residency after 1995) were more likely to perform all types of laparoscopic procedures compared to older graduates (65% versus 29.7%, p < 0.001). Advanced procedures were also performed more frequently by recent graduates (52.5% versus 23.4%, p < 0.001). Of those who do not currently perform laparoscopy, 38.2% plan to learn in the future. The most common method of acquiring laparoscopic skills was with animal laboratory experience (39.4%), but only 20.9% relied solely on this method. A trip to a centre of excellence (28.5%) and training from an urologist at the same institution (25.7 %) was also commonly reported as methods of acquiring skills. There were 48.8% who reported beginning laparoscopic procedures without a mentor. CONCLUSIONS: A substantial portion of the Canadian urological community employs laparoscopy, although recent graduates are more likely to do so. Training methods in laparoscopy are variable, but a substantial portion of urologists begin practicing laparoscopic procedures without formal mentoring.

Adult↗

PubMed2006

[Development and validation of a model of training at home to the laparoscopy].

INTRODUCTION AND OBJECTIVES: Practice on a Pelvitrainer training is an essential part of the training of surgeons in laparoscopy. Most university departments are equipped with this type of model, but this equipment is expensive, cumbersome and often poorly accessible. The authors propose a new laparoscopy home training model and compare its performances with those of the reference training model. MATERIAL AND METHOD: The laparoscopy home training model is composed of a laptop computer; a Web Cam and a translucent plastic box. Ten operators with various levels of training were timed during 4 simple exercises performed on the home training model and were then timed when performing 6 interrupted sutures with this model and with a Pelvitrainer RESULTS: All operators successfully performed the proposed exercises. The mean operating time was correlated with the level of training (35 minutes versus 15 minutes for the 3 most experienced operators). The suture time was comparable with the home trainer (14 minutes) and the Pelvitrainer (13 minutes). The home training model is less expensive (75 euros), more accessible and easier to install (3 minutes) than the Pelvitrainer and can be used outside of medicalized structures. CONCLUSION: Trainee operators can practice laparoscopy at home. The manufacture of a Home-trainer requires simple material. The training capacities of this model are similar to those of a Pelvitrainer, but it is less cumbersome, less expensive and more readily available. This type of model could be used by each operator at home to improve his/her performances and to accelerate training.

Education, Medical, Graduate↗

PubMed2006

[Diagnostic laparoscopy in gunshot wounds of the abdomen in children].

Diagnostic laparoscopy in gunshot wounds of the abdomen was performed in 14 children. The diagnostic value of laparoscopic and other methods of diagnostics was evaluated. An analysis of the results has shown that laparoscopy for gunshot wounds of the abdomen in children is of great diagnostic value. The indications and contraindications for diagnostic laparoscopy in such cases have been formulated. The surgical strategy used reduced 3 times the number of unnecessary laparoscopies for gunshot wounds of the abdomen in children.

Abdomen↗

PubMed1991

Comparison of different treatment methods of endometriomas by laparoscopy.

In a prospective study designed to evaluate four methods of endometrioma treatment by laparoscopy, 26 patients had the endometriomas excised, 24 had them opened and the lining stripped off, 30 had them opened and the lining evaporated by CO2 laser, and 44 had them opened and drained. Only women who had laparoscopy because of pelvic pain and who had no immediate desire for pregnancy were included in this study. Those who did not undergo a second-look laparoscopy were excluded. Pain disappeared completely from all subjects regardless of the method of treatment. At second-look laparoscopy, all women in the excision group, nine (37%) in the group who had the lining stripped, nine (30%) in the group who had the lining evaporated, and 12 (27%) in the drainage group had periadnexal adhesions. Residual endometriosis was found in 23, 25, 33, and 30% of these groups, respectively. Because there was a statistical difference between the excision group and each of the remaining three groups in the formation of adnexal adhesions and because there was no statistical difference among the four groups regarding the presence of residual endometriosis, we conclude that laparoscopic treatment of endometriomas should not include excision but rather drainage with or without elimination of the inner lining.

Endometrial Neoplasms↗

PubMed1991

Second-look laparoscopy adhesiolysis. The procedure of choice for preventing adhesion recurrence.

A study was designed to determine the efficacy of second-look laparoscopy adhesiolysis in preventing adhesion recurrence seven days after conservative microsurgical reconstructive surgery on the uterotuboovarian complex. Third-look laparoscopy was used to evaluate the second-look laparoscopy adhesiolysis 6-18 months later. It indicated that second-look laparoscopy adhesiolysis was beneficial in preventing adhesion recurrence.

Endometriosis↗

PubMed1991

Mini-laparoscopy and fiber-optic lasers.

The use of the Adair Verres needle and an optical catheter system has enabled us to perform both diagnostic and laser mini-laparoscopy. The prefix mini refers to the fact that the three incisions placed in the abdomen were 3 mm in diameter. There were no complications in our pilot series. Because initial inspections of the abdomen may localize abnormalities such as intestinal adhesions and may show the surgeon a safer approach to subsequent trocar placement, nothing is lost and much may be gained by routinely performing mini-laparoscopy. The picture produced on the video monitor is now of excellent quality and seems likely to improve. In the near future, a three-chip camera, which is able to produce even better resolution, will become available. The further development of 3-mm instrumentation promises additional expansion in operative capability. Although mini-laparoscopy will not replace conventional operative laparoscopy with the 10-mm telescope in the near future, a significant proportion of diagnostic and minimally to moderately involved operative procedures may be safely carried out by this method.

Female↗

PubMed1991

[Diagnostic possibilities of laparoscopy in ovarian cysts].

Laparoscopy was used for the diagnosis of ovarian cysts in 90 patients. Ovarian cysts detected by ultrasonic examination, sterility, suspected external genital endometriosis were the indications for laparoscopy. In 32 cases the cysts were found in laparoscopy. In 23 patients a diagnostic puncture of the cyst and a subsequent cytologic examination were carried out. All the patients in whom ovarian cysts were diagnosed were operated on (endoscopically or via laparoscopy). Laparoscopic diagnoses coincided with the histologic findings in examinations of the removed formations in 100% of cases.

Adolescent↗

PubMed1991

[Economic aspects of laparoscopy in a cancer clinic].

The role of laparoscopy in reduction of the number of explorative laparotomies in cancer patients was studied. Laparoscopy was performed in 862 cases of whom 338 (39%) revealed definite signs of tumor dissemination which made potentially hazardous explorative laparotomy unjustified. The number of laparotomies was reduced by 78%. The laparotomized patients stayed in the hospital for the average of 15.86 +/- 0.76 days whereas those undergoing laparoscopy--3.56 +/- 0.14 days provided stage IV was diagnosed. Laparoscopy saved 12.30 days and 203 roubles for each case of stage IV cancer, and 3737 and 62,000 roubles for the entire group of 862 patients.

Cancer Care Facilities↗

PubMedDate not supplied

[Diagnostic laparoscopy in nontraumatic acute abdomen].

Laparoscopy was performed in 49 patients admitted to the Emergency Service of Hospital das Clínicas of the Medical School of the University of São Paulo with a possible diagnosis of acute non traumatic abdomen. The procedure was indicated because routine clinical and laboratory investigations had proved inconclusive. Accuracy (96%), sensitivity (97.5%), specificity (89%) and positive (97.5%) and negative (89%) predictive values of laparoscopy were assessed in 41 patients with a clinical suspicion of inflammatory acute abdomen, in 5 with a clinical diagnosis of vascular abdomen, in 1 with a perforative acute abdomen, and in 2 patients to assess the viability of the small bowel after and intestinal resection due to mesenteric ischemia. Laparoscopy proved to be a reliable and simple procedure which facilitated the choice of the best therapeutic alternative in each case. A significant number of unnecessary laparotomies was avoided. No complications imputable to laparoscopy were observed in this series.

Abdomen, Acute↗

PubMed1990

Efficacy of assisted reproductive technology during diagnostic and operative infertility laparoscopy.

Women being evaluated for infertility were offered assisted reproductive technology at the time of diagnostic laparoscopy. Oocyte retrieval was performed after ovulation induction in 33 women, of whom 19 had concurrent operative laparoscopy. Gamete intrafallopian transfer (GIFT) or in vitro fertilization (IVF) and embryo transfer were performed subsequently depending on laparoscopic assessment of pelvic architecture, oocyte maturity, and semen parameters. The clinical pregnancy rate was 24% per cycle and 28% per gamete or embryo transfer (four pregnancies after GIFT and four after IVF/embryo transfer). The clinical pregnancy rate per transfer did not differ significantly between the 19 women who had therapeutic operations in conjunction with laparoscopy (lysis of adhesions and/or fulguration of endometriosis) and the 13 who did not (25 versus 30%; P greater than .05). Assisted reproductive technology can be performed successfully during diagnostic infertility laparoscopy. Operative endoscopic manipulation did not adversely influence pregnancy outcome.

Adult↗

PubMed1990

Laparoscopy and liver biopsy: further evidence that the two procedures improve the diagnosis of liver cirrhosis. A retrospective study of 1,003 consecutive examinations.

We examined retrospectively 1,003 patients with chronic liver disease who underwent laparoscopy and liver biopsy. The diagnosis of cirrhosis was made in 411 patients and excluded in 570; in the remaining 22 patients, the laparoscopic/histologic diagnosis was inconclusive. When the two techniques were considered separately, a final diagnosis of cirrhosis was possible in 78.4% by laparoscopy and in 78.8% by biopsy of the total of 411 cases, whereas, doing both procedures improved the diagnostic yield to 97.7% by decreasing the percentage of false negatives for each technique. Laparoscopy can also provide important additional information by detecting intrabdominal signs of portal hypertension and so improve the macroscopic diagnosis of cirrhosis. In particular, splenomegaly seen at laparoscopy seems to be an important feature for the diagnosis and evaluation of chronic liver disease.

Adolescent↗

PubMed1990

Second-look laparoscopy after ectopic pregnancy.

During the 4-year period of 1984 to 1987, 102 women with ectopic pregnancy (EP) underwent second-look laparoscopy 6 to 10 weeks after EP surgery. Benefits of this procedure, e.g., adhesiolysis and/or selection of women for further fertility interventions (in vitro fertilization [IVF], gamete intrafallopian transfer [GIFT], tubal microsurgery), were evaluated. On the basis of the second-look laparoscopy, 13% of the women were offered tubal microsurgery and 14% recommended for IVF. Patients without risk factors for EP developed adhesions as frequently as those with known risk factors and no specific surgical procedure was correlated to impairment of the pelvic status. Almost 40% of the patients presented with an impairment of adhesions on the affected side compared with the status at the time of EP surgery. Lysis of adhesions was performed during the second-look laparoscopy in 42 patients (41%). We conclude that second-look laparoscopy should be recommended to all EP patients with a desire for pregnancy.

Female↗

PubMed1990

American Association of Gynecologic Laparoscopists' 1988 membership survey on operative laparoscopy.

The American Association of Gynecologic Laparoscopists' (AAGL) 1988 membership survey on operative laparoscopy had a response rate of 24%. A total of 880 respondents reported performing 36,928 operative laparoscopy procedures. A total of 75% of the respondents reported performing 47 or fewer procedures. The most frequently reported conditions managed with operative laparoscopy were endometrial implants, extensive adhesions and ovarian cysts. Most operative laparoscopies were performed because of infertility (40%) or pelvic pain (41%). The overall serious complication rate was 15.4 per 1,000 procedures. Complications that occurred in greater than 1 per 1,000 procedures included hospitalization greater than 72 hours, persistent human chorionic gonadotropin titer elevation after ectopic pregnancy, hospital readmission and unintended laparotomy to manage bowel injury, urinary tract injury or hemorrhage. Two deaths (5.4 per 100,000 procedures) were reported.

Gynecology↗

PubMed1990

Hysterosalpingogram, laparoscopy and hysteroscopy in the assessment of the infertile Nigerian female.

Sixty-nine infertile Nigerian females were evaluated with hysterosalpingogram (HSG), laparoscopy and hysteroscopy as part of infertility workup at the endocrine-infertility clinic of the Jos University Teaching Hospital. HSG showed evidence of tubo-peritoneal disease in 45 (65%) women. This was confirmed by laparoscopy in 41 women giving an accuracy of 91% and a false positive rate of 9%. Intrauterine abnormalities were shown on HSG in 4 women and confirmed in 3 women at hysteroscopy giving an accuracy rate of 75% or a false positive rate of 25%. Intrauterine abnormalities were detected in 21 women in whom HSG was normal, giving a false negative rate of 30.4% for HSG. Tuboperitoneal disease was found at laparoscopy in 6 women in whom HSG was normal, giving a false negative rate for HSG of 8%. Our data confirm that laparoscopy and hysteroscopy are superior to HSG in detecting tubo-peritoneal and uterine abnormalities. Despite these findings, we believe that the three procedures are complementary in the evaluation of infertile couples in this country.

Adolescent↗

PubMed1990

Early recourse to laparoscopy in the management of suspected ectopic pregnancy. Accuracy and morbidity.

Ninety-nine patients with suspected ectopic pregnancy (EP) who were subjected to laparoscopy/laparotomy over an 18-month period at Greenwich District Hospital, London, were audited. A third (32/99) of the cases had an EP, and 67 potentially avoidable laparoscopies were performed. A potentially avoidable laparoscopy was followed by a laparotomy in 27% of cases (18/67), and at least 13 of those laparotomies were unnecessary. In addition, two false-positive diagnoses of EP were made at laparoscopy, resulting in the avoidable loss of part or all of a single remaining fallopian tube. With the use of sensitive pregnancy testing at least 62 laparoscopies, 13 laparotomies and 1 case of pulmonary embolus might have been avoided in these patients and up to 195 days' hospitalization saved.

Female↗

PubMed1989

The diagnostic value of laparoscopy in women with pelvic pain.

One hundred and fifty-four patients who had a diagnostic laparoscopy for pelvic pain from 1 November 1984 to 30 October 1987 were reviewed. A total of 68 of these patients had normal pre-operative pelvic examinations; 40 (59%) had abnormal findings on diagnostic laparoscopy. Of the 86 patients with abnormal pre-operative pelvic examinations, 17 (20%) had normal findings on diagnostic laparoscopy. There is a significant error in evaluating the pelvis by clinical examination alone. The results are in accord with those of previous studies and emphasise the importance of laparoscopy in the management of women with pelvic pain.

Adolescent↗