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At least 811 records · Page 45Linked to original sources

PubMed1987

Post-operative morbidity associated with the use of atracurium and vecuronium in day-case laparoscopy.

Patients were randomly allocated to receive either vecuronium or atracurium as the sole muscle relaxant for day-case gynaecological laparoscopy to determine if either agent was superior with respect to post-operative morbidity during the 48 h after operation. Intubating conditions and cardiovascular stability were similar in both groups. Post-operative morbidity prior to discharge was also similar except for a significantly higher incidence of abdominal pain in the vecuronium group. There was no statistical difference in specific morbidity during the 48 h after laparoscopy, but a greater number of patients in the vecuronium group was able to resume normal activity 24 h after laparoscopy. Both agents are very suitable for day-case laparoscopies and other short surgical procedures.

Ambulatory Surgical Procedures↗

PubMed1985

Uncommon indications for laparoscopy.

Laparoscopy was used as an ancillary method for infrequently occurring or unconventional indications in 140 patients. Diagnostic laparoscopy was done if other clinical, laboratory and biophysical methods were inconclusive or not conclusive in due time. Under some conditions operative laparoscopy or a combined vaginal and laparoscopic approach eliminated the need for laparotomy. No special equipment is required for such diagnostic and operative laparoscopy.

Female↗

PubMed1987

The role of laparoscopy in the evaluation of candidates for sterilization reversal.

An algorithm that avoids preliminary laparoscopy for sterilization reversal (SR) candidates with previous Pomeroy, loop, Hulka clip, Irving, and single-burn cautery tubal ligation techniques was used. Anastomosis was attempted only when it could be anticipated that the final length of at least one tube would be 3 cm or more. Of 259 SR candidates evaluated according to the algorithm, 235 had SR procedures. Seven of 185 patients (3.8%) who did not undergo laparoscopy were found to have inoperable tubes at laparotomy. Four of these patients had histories of a prior unilateral salpingectomy. The authors conclude that, given their criteria for proceeding with tubal anastomosis, laparoscopy can be avoided in properly selected SR candidates. The results also indicate that patients with a history of unilateral salpingectomy should undergo preliminary laparoscopy.

Fallopian Tubes↗

PubMed1986

[Emergency laparoscopy in the diagnosis of acute abdomen].

In our Country through the acquired experience, we have reached the 10 more frequent diagnostics in laparoscopies of urgency. 1) Our 10 more frequent diagnosis in laparoscopy were: Salpingitis 27.5%; Appendicitis 18%; Ovarian cyst 18%; Inflammatory localized processes 8.5%; Ectopic pregnancy 4.5%; Peritonitis 4%; Piosalpinx 3.5%; Cholecystitis 3%; Hemoperitoneum 3%; Metritis 2%. 2) That acute abdomen conditions should be diagnosed as early as possible. 3) That the maximum time employed to this diagnostic must not depass of six hours from the onset of the symptomatology. 4) That if at that time a diagnostic has not been established by all resources at the hands of the physician, an emergency laparoscopy shall be indicated. 5) That, this laparoscopy of urgency ought to be performed immediately at an Specialized Service and by a qualified endoscopist. 6) That, a qualified endoscopist shall be able to issue a laparoscopic diagnostic of the pathologies of the different abdominal organs, digestives and gynecological, in adults and children.

Abdomen, Acute↗

PubMedDate not supplied

[Laparoscopy in oncological pediatrics].

Laparoscopy permits direct inspection of the peritoneal cavity. Its role is very important in oncology both in the adult and in the pediatric patient. From 1973 to 1985, 147 laparoscopies were performed on 137 patients, aged 2-16; indications were: definition of the nature of neoplastic disease in 8 cases, staging of known neoplasia in 132, restaging in 7. On Hodgkin's disease, splenic involvement in 8/113 cases was revealed by laparoscopy with biopsy. Histological examination was positive in 4 out of 22 cases of ovarian tumors. Morbidity was 1.2%. Although a laparotomy performed after laparoscopy has shown some false negatives, in most cases the clinical and instrumental follow-up has proved reliability of laparoscopic examination.

Adolescent↗

PubMed1988

Second look laparoscopy after treatment of acute salpingitis with doxycycline/benzylpenicillin procaine or trimethoprim-sulfamethoxazole.

To have their diagnosis verified, etiology determined and treatment evaluated, 64 patients with a suspected acute salpingitis underwent laparoscopy during which isolates were taken. The patients were then randomized to one of two groups for treatment; doxycycline/benzylpenicillin procaine (DC + BP) or trimethoprim-sulfamethoxazole (TMP-SMZ). The results were evaluated three to six months later by second look laparoscopy when adhesions and tubal passage were looked for. Isolates from the cervix were culture positive for Chlamydia trachomatis (CT) in 37 (58%) patients and for Neisseria gonorrhoeae (NG) in 15 (23%). Isolates from the oviducts were positive in 17 (27%) patients of whom 12 had CT and two had NG. Mild salpingitis (Grade I) was found in 16 patients, moderate (Grade II) in 26 and severe (Grade III) in 22 patients. At second look laparoscopy, two patients had totally occluded oviducts, 31 had adhesions but tubal passage on at least one side while 31 patients had healed without any signs of residue. Results at second look laparoscopy showed no statistical difference between the two treatment groups.

Acute Disease↗

PubMed1988

Pelvic examination versus fiberoptic laparoscopy. A fictional study of patient preference in 1,534 women.

A fictional study of patient preference was conducted in 1,534 women who received both laparoscopy and a pelvic examination plus pelvic ultrasonography. The overwhelming majority of women (87%) preferred laparoscopy, with most patients (78%) indicating they would undergo a repeat examination if requested. Hospital occupancy rose 24% while gynecologists' incomes rose 58%. Radiologists' incomes declined 14%. Seven deaths occurring in conjunction with laparoscopy were determined to be statistically insignificant. Based on these findings, it is suggested that the pelvic examination be replaced by routine laparoscopy.

Consumer Behavior↗

PubMed1985

[Secondary cancer of the liver: value and efficacy of laparoscopy].

The indications for laparoscopy have been greatly reduced by the development of ultrasonography. However, laparoscopy is still indicated in secondary cancer of the liver, as it can provide histological proof of the diagnosis by means of biopsies taken under direct vision. It is therefore more effective than the non-invasive morphological examinations, but, in the future, it may be replaced by ultrasound guided biopsies. In general, laparoscopy only confirms a diagnosis which is very probable on the basis of clinical and laboratory data. Furthermore, it is very unlikely that laparoscopy will reveal small metastases; this is due to the multicentric nature of hepatic metastases, rather than to a deficiency in the investigation itself.

Humans↗

PubMed1985

CO2 laser laparoscopy for the treatment of endometriosis associated with infertility.

Both medical and surgical therapy have been used in the treatment of infertility associated with endometriosis. Danazol has been used following screening laparoscopy to avoid the discomfort, expense and risk of laparotomy. The CO2 laser offers the advantage of precise excisional surgery at the initial laparoscopy and thus potentially avoids further surgery and the use of danazol. In 50 infertile women in whom initial or second-look laparoscopy revealed the presence of endometriosis, CO2 laser laparoscopy was used to excise (vaporize) the endometriotic lesions. At 7-19 months of follow-up, 11 patients had become pregnant. One pregnancy was ectopic, and one aborted. The estimated long-term pregnancy rate was 60% or greater. Of those who were not yet pregnant at this writing, 59% had either a cervical factor, male factor or both. There was a 70% decrease in the use of danazol for stage I endometriosis and a 78% decrease for stage II endometriosis without a decrease in the overall pregnancy rates when compared to those for previous therapy with laparoscopic coagulation. However, the highest pregnancy rates resulted from a combination of laparoscopic laser excision and danazol.

Adult↗

PubMedDate not supplied

[Indications for laparoscopy in an internal medicine department in Dakar as indicated by echotomography].

A real time ultrasonography was set up in a senegalese hospital, resulting in a decrease of laparoscopy indications. Laparoscopy is given up for the diagnosis of liver abcess, jaundice and "abdominal masses". It must no more be included in the first step check up for hepatocellular carcinoma, because ultrasonography and cytology after puncture are enough to confirm the diagnosis. Laparoscopy remains essential for peritoneal diseases. Hepatic needle biopsy under laparoscopy control remains necessary to ensure with certainty the diagnosis of cirrhosis and especially chronic hepatitis, provided that no countraindications are found.

Abdomen, Acute↗

PubMed1982

Laparoscopy in the management of uterine perforation.

The introduction of laparoscopy as a routine diagnostic tool for pelvic disorders has prompted its use in the management of uterine perforation as well. A retrospective review of 52 patients with uterine perforation secondary to curettage is presented. In 23 (44.2%) the curettage was discontinued, and the postperforation course was uneventful. Eight patients (15.4%) underwent immediate exploratory laparotomy without laparoscopy; in three of them no internal organ injury or bleeding was found. Eighteen patients (34.6%) underwent postperforation laparoscopy; seven of these women underwent subsequent laparotomy. The indications and objectives of postperforation laparoscopy are outlined. Its judicious use allows proper selection of patients for exploratory laparotomy.

Dilatation and Curettage↗

PubMed1980

Noninvasive measurement of cardiac output during laparoscopy.

With the use of noninvasive transthoracic impedance cardiography we have demonstrated a consistent fall in stroke volume and cardiac output without significant clinical changes in heart rate in anesthetized patients undergoing laparoscopy. Cardiac output fell to a mean value of 60% in 14 patients undergoing laparoscopy and by a mean value of 6% in four patients undergoing laparotomy. The intraabdominal pressure did not exceed 20 torr in any laparoscopy patient. Some unexplained cardiac arrests during laparoscopy in healthy females may be caused by impaired venous return due to the increased intraabdominal pressure of pneumoperitoneum. Lethal values of cardiac output could result. The routine use of transthoracic impedance cardiography would alert the anesthesiologist to a dangerous situation that cannot be determined by current routine monitoring practice.

Abdomen↗

PubMed1980

[Laparoscopy and hysterosalpingography in sterility examination (author's transl)].

Hysterosalpingographic and laparoscopic findings were recorded from 90 patients and compared. They were identical in 71 per cent of all cases, but in some of the cases additional findings proved recordable from laparoscopy. The point is made by the authors that laparoscopy should in any case be preceded by hysterosalpingography, since the latter is a comparatively uninvolved method which even may have therapeutic effects. Laparoscopy is indicated particularly in pathological cases or in cases of uncertain diagnosis or prior to surgery for salpingoplasty. This is the only diagnostic method by which accurate assessment is possible of the organs in the minor pelvis and of tubal function. Today, laparoscopy may be considered a safe no-risk procedure, if all necessary conditions are provided, but adequate equipment actually is available only in larger institutions at present.

Adolescent↗

PubMed1980

[Indications of laparoscopy in abdominal diseases (author's transl)].

On the basis of 900 laparoscopies it is attempted to define the indications of laparoscopy in abdominal diseases. 6 groups of indications could be differentiated. The diagnostic accuracy of laparoscopy allows in many cases to replace exploratory laparotomy by laparoscopy.

Appendicitis↗

PubMed1995

[The 100th birthday of Heinz Kalk. A breakthrough in laparoscopy].

The method of laparoscopy, mainly being introduced as a diagnostic tool, has developed into an important therapeutic procedure during the last decade. This development is associated with the name of the German gastroenterologist Heinz Kalk. Born in Frankfurt/Main in 1895 he first published about laparoscopy in 1929 and also designed a new laparoscope with a prograde optic. He realized the great value of laparoscopy in the differential diagnosis of liver diseases. During the 40's Kalk introduced laparoscopically guided liver biopsy and was involved to a great extent in research of hepatic diseases, especially Hepatitis epidemica. The work of Kalk was of decisive influence for the development of laparoscopy in Europe. In 1949 he became chief of the Department of Internal Medicine of Kassel's hospital "Stadtkrankenhaus", making it one of the most interesting places to be in for hepatologists and laparoscopically working internists. Heinz Kalk died in 1973.

Animals↗

PubMed1995

The impact of pneumoperitoneum, pneumoretroperitoneum, and gasless laparoscopy on the systemic and renal hemodynamics.

BACKGROUND: The use of therapeutic laparoscopy has become widespread recently. It is important to assess the effects of gaseous and gasless laparoscopy on systemic and renal hemodynamics. STUDY DESIGN: A prospective controlled animal study was performed on 40 well-hydrated pigs. Systemic and renal hemodynamics were monitored during peritoneal insufflation, retroperitoneal insufflation, and abdominal wall lifting for a period of two hours. A laser Doppler flow meter was applied laparoscopically to measure the renal cortical tissue perfusion. RESULTS: Peritoneal insufflation of carbon dioxide to a pressure of 15 mm Hg elicited transient elevations of the aortic pressure and carotid arterial blood flow. Unilateral pneumoretroperitoneum caused a smaller change on systemic hemodynamics. Pneumoperitoneum and pneumoretroperitoneum caused oliguria. Superficial renal cortical blood flow reduction decreased by an average of 60 percent in the compressed kidney, and blood flow returned to the pre-insufflation level after the pressure was released. A gradual decrease of tissue perfusion in the contralateral kidney and a concomitant gradual increase of the intra-abdominal pressure were observed when pneumo-retroperitoneum was maintained for two hours. No significant changes in urinary output and in systemic and renal hemodynamics were found when the abdominal wall was lifted up with a force equivalent to 15 mm Hg. CONCLUSIONS: Significant systemic and renal hemodynamic changes were elicited in gaseous but not in gasless laparoscopy, which may explain the decreased urinary output observed during gaseous laparoscopy. Pneumoperitoneum caused greater systemic and renal hemodynamic alterations than pneumoretroperitoneum; however, the effects were transient and reversible after a period of two hours.

Animals↗

PubMed1995

Diagnostic laparoscopy: a 5-year experience in a hepatology training program.

Diagnostic laparoscopy continues to have a role in the evaluation and diagnosis of acute and chronic liver diseases, primary and metastatic liver tumors, and peritoneal diseases. We retrospectively reviewed the records of 1794 diagnostic laparoscopies performed at our institution from 1987 to 1992 to identify the indications, results, and safety of this procedure in our training program. A definitive diagnosis was made in 91% of cases with biopsy performed in 93%. Chronic liver disease was evaluated in 890 patients, and a diagnosis was made in 98%. Four hundred thirty-seven patients were evaluated for suspected primary or metastatic carcinoma, and a diagnosis was made in 85%. Ascites was evaluated in 73 patients, and a diagnosis was made in 82%. One-hundred sixty-four patients were evaluated for abnormal liver function tests, and a diagnosis was made in 91%. HIV-related liver function test abnormalities were evaluated in 67 patients, and a diagnosis was made in 81%. One hundred sixty-three patients underwent diagnostic laparoscopy for the evaluation of hepatomegaly, splenomegaly, unexplained portal hypertension, fever of unknown origin, and cholestasis, and a diagnosis was made in 74% of cases. Eight major complications (including abdominal viscus perforation, hemobilia, splenic laceration, bleeding) and thirty-one minor complications were seen. Our findings confirm that diagnostic laparoscopy is a safe and valuable procedure in the evaluation of chronic liver disease.

Chronic Disease↗

PubMed1995

Diagnostic laparoscopy in women with acute abdominal pain.

Nineteen women with acute lower abdominal pain of uncertain etiology underwent diagnostic laparoscopy during a 2-year period from August 1991 to August 1993 and were retrospectively reviewed. All patients, aged 12 to 44 years, were premenopausal. Laparoscopy provided definitive diagnosis in all 19 patients. Laparoscopic findings included appendicitis (11 cases), pelvic inflammatory disease (five cases), significant ovarian cysts (two cases), and ectopic pregnancy (one case). Successful laparoscopic procedures included appendectomy (five cases), and salpingo-oophorectomy (one case). Five patients required only diagnostic laparoscopy. Eight patients required conversion to an open procedure because of anatomical considerations (six cases) or equipment failure (two cases). Median operative time was 71 min, and median postoperative hospital stay was 2 days. Most diagnostic procedures were performed on the same day as admission, resulting in a median hospital stay of 3 days. Diagnostic laparoscopy performed in premenopausal female patients with acute lower abdominal pain of unknown etiology provides diagnostic accuracy as well as therapeutic capabilities and prevents unnecessary laparotomy.

Abdomen, Acute↗