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PubMed1995

[Emergency laparoscopy. A 20-year experience].

We revised 7988 laparoscopies over twenty years. Three hundred and ninety three were urgent laparoscopies: 325 patients with acute spontaneous abdomen and 68 acute traumatic abdomen. Emergency laparoscopy is made in patients with, both spontaneous and traumatic acute abdomen, when diagnosis is not made in 8 hours with the usual clinical and imaging methods. Acute diffuse peritonitis was the commonest finding in the first group (21%) and splenic rupture in the traumatic group (34%). There were two severe complications (0.5%): pulmonary oedema in a patient with myocardial disease and a respiratory failure in a old patient, which were resolved. We had two deaths related to laparoscopic diagnosis: massive mesenteric thrombosis and fecal peritonitis. There are few contraindications and tolerance is very good. This study shows a sensitivity of 98%, a specificity of 90%, a predictive positive value greater than 98% and a negative predictive value of 100%. In summary, the present study demonstrates that emergency laparoscopy is a effective diagnostic method in acute abdominal pain of uncertain aetiology.

Abdomen, Acute↗

PubMed1995

[The value of laparoscopy in diagnosis and therapy of the traumatized abdomen].

The prognosis of abdominal trauma depends in most cases not only on the extent of existing injuries but also on prompt therapy. Thus, diagnostic measures have to clarify rapidly and accurately whether laparotomy has to be performed or not. Difficulties in decision for the surgeon arise especially in cases of abdominal trauma where diagnostic imaging (ultrasonography, CT scan) does not lead to clearcut results. From 1st June, 91 to 30th November, 93 we performed diagnostic laparoscopy in 18 cases of abdominal trauma. In 4 patients no injuries were discovered and 5 patients had negligible injuries so that no therapy was necessary. In 4 cases the detected injuries were managed laparoscopically, whilst the remaining 5 patients had to be laparotomied. Of the 11 patients who would normally have been laparotomied as a primary measure, laparotomy was avoided in 5 cases by performing a laparoscopy (45%). On the other hand, we detected injuries on laparoscopy in 3 of the 7 patients who would not have been laparotomied on the basis of the results of the prelaparoscopic investigations. In 2 of these patients the additional injuries would have led to later complications, which were avoided by timely laparotomy following laparoscopic diagnosis. In our opinion laparoscopy is not a substitute for proven diagnostic measures such as ultrasonography or CT scan. However, it is valuable extension of diagnostic and therapeutic methods on abdominal trauma.

Abdominal Injuries↗

PubMed1993

Laparoscopy in the management of nonpalpable testes and intersex states.

Cryptorchidism is the most frequent anomaly in sexual development in male children and is frequently detected in diseases that result in ambiguous external genitalia. Laparoscopy has become a minimally invasive procedure in the management of nonpalpable testis. A total of 45 patients (2 to 35 years old) underwent laparoscopy as a diagnostic method in the investigation of nonpalpable testis. Among them, 37 (82%) underwent exploration and a complete correlation between laparoscopy and operative findings was observed. One patient with ambiguous external genitalia was evaluated and laparoscopy showed an intersex state known as true hermaphroditism and a laparoscopic gonadectomy was performed. Based on our experience, in 37% of nonpalpable testes a confirmatory operation is not necessary. The procedure can also be indicated to localize müllerian ducts remnants and gonadal tissue in selected intersex states, and even to perform gonadal biopsies or gonadectomies, in order to avoid open surgical procedure.

Adolescent↗

PubMedDate not supplied

Laparoscopy for the impalpable testes. Initial experience of one center.

Twenty three patients with impalpable tests underwent diagnostic laparoscopy in our hospital between 1988 and 1991, in an attempt to evaluate this modality of investigation. Four of them had bilateral undescended, i.e. total of 27 tests, 12 on the right side and 15 on the left. Eight patients were adults, age between 23 and 38, average 30 years, 15 were children, age between 1 and 9, average 5 years. Twenty testes were intraperitoneal (74%), 6 intracanalicular (22.2%) and one absent (3.8%). Thirteen testes were removed and 2 were diagnostic only, the rest had successful orchiopexy. No operative or postoperative morbidity. Laparoscopy was diagnostic in all cases, assisted in planning the surgical procedure in 21 testes and saved one patient the surgical incision. Laparoscopy is a safe procedure, has a definite role in the management of impalpable testes, for diagnosis and planning of surgery. Future prospects of operative laparoscopy needs to be developed and evaluated.

Adult↗

PubMed1994

[Laparoscopy in the differential diagnosis of acute abdomen].

The work analyses the results of emergency laparoscopy in 4,730 patients with acute surgical pathology of the abdominal organs. There were 26.3% of males and 73.7% of females; 26.5% of patients were of an elderly age. Laparoscopy was undertaken in all cases in which the diagnosis was questionable but the clinical picture was that of "acute abdomen" and in patients with an established diagnosis for conducting therapeutic manipulations: microcholecystostomy, drainage of the abdominal cavity. The authors show differential endoscopic signs of some acute surgical diseases of the abdominal organs. Laparoscopy confirmed the clinical diagnosis in 45.5% of cases and revealed indications for an emergency operation in 896 patients (33.8%). Laparoscopic microcholecystostomy was performed 137 times and drainage of the abdominal cavity 398 times. The diagnostic value of laparoscopy came to 97.1% on the average.

Abdomen, Acute↗

PubMed1994

[The role of emergency laparoscopy in abdominal pain syndrome and in the assessment of abdominal trauma].

From January 1991 to June 1993 we performed 106 emergency laparoscopies. The patients' mean age was 31 years (17-90). There were 73 females (69%) and 33 males (31%). 8 (8%) laparoscopic evaluations of abdominal traumas were performed. Laparoscopy yielded a diagnosis in 89% of the cases. In 12 cases (11%) the laparoscopy was negative. Morbidity was 2% and mortality 3%. The mean hospital stay was 4.5 days. Today emergency laparoscopic evaluation of abdominal syndromes is performed routinely in most centers. The diagnostic rate is reported to be between 87-96% according to individual series. Laparoscopy may shorten the diagnostic delay, diminish the number of paraclinical investigations and in particular reduce the number of negative laparotomies.

Abdominal Injuries↗

PubMed1993

[Diagnostic laparoscopy in non-palpable testis].

In this article we present our experience with diagnostic laparoscopies in 45 patients with a total of 48 impalpable testes. Laparoscopy was performed before surgical exploration, in the same operative set-up. No complications were seen. One laparoscopy was a technical failure. In six children and one adult no testis, no deferent duct or spermatic vessels were found. The diagnosis of testicular absence was made. In 14 children no testis was found. In 13 cases atrophic spermatic vessels were seen, in one case histologically proven testicular tissue was found. In one case a blind-ending deferent duct was seen. In 27 patients an intra-abdominal testis was found, mostly 2-3 cm before the internal annulus. We performed an orchidectomy 10 times, an orchidopexy 3 times and an autotransplantation of the testis 9 times. Laparoscopy proved to be an easy, safe and reliable method to localise an impalpable testis. It is the method of choice in our clinic.

Adolescent↗

PubMed1993

Diagnostic laparoscopy at Ramathibodi Hospital: 1979-1988.

A 10-year review of diagnostic laparoscopy at Ramathibodi Hospital was presented. There was a total of 6,033 laparoscopies performed from 1979 to 1988, of which 1,416 (23.5%) were diagnostic. The three most frequent indications were suspected ectopic pregnancy (459 cases, 32.4%), endometriosis (409 cases, 28.9%) and infertility (308 cases, 21.8%). The trend in performing diagnostic laparoscopy has been increasing from 79 procedures in 1979 to 230 in 1988. Laparoscopy plays a major role in making definitive diagnosis in many cases. Complications were found in only 4 cases (2.8/1,000 procedures).

Female↗

PubMed1994

Diagnostic laparoscopy reduces unnecessary appendicectomy in fertile women.

OBJECTIVE: To assess the value of laparoscopy in the accurate diagnosis of appendicitis in women of child-bearing age. DESIGN: Prospective randomised trial. SETTING: University hospital, Kuwait. SUBJECTS: 100 patients who fulfilled the inclusion criteria between July 1988 and March 1990. INTERVENTIONS: 50 patients were randomised to have diagnostic laparoscopy followed by appendicectomy if necessary, and the other 50 to have immediate appendicectomy. MAIN OUTCOME MEASURES: Avoidance of unnecessary appendicectomy, length of operating time, and length of stay in hospital. RESULTS: 19 of 50 patients in the study group did not require appendicectomy (38%). One patient required an emergency operation for an ectopic pregnancy. Of the remaining 30, only 4 of the removed appendixes showed no histological abnormality (13%). There were no complications of laparoscopy. CONCLUSION: Laparoscopy is a safe and effective way of diagnosing acute appendicitis and should be used more often.

Acute Disease↗

PubMed1994

Potential of laparoscopy to reduce non-therapeutic trauma laparotomies.

Standard diagnostic methods used to evaluate patients sustaining abdominal trauma result in non-therapeutic laparotomy rates ranging from 5 to 40 per cent depending upon the clinical situation. The purpose of this study was to assess the safety and efficacy of diagnostic laparoscopy in the identification of intra-abdominal injuries in stable trauma patients. Twenty-one hemodynamically stable adult patients underwent laparoscopy prior to laparotomy for blunt (n = 10) or penetrating (n = 11) trauma, and the findings from each procedure were directly compared. Laparoscopy was 100 per cent accurate in detecting the need for laparotomy, although a number of specific injuries were not identified. There were no complications related to the procedure. Emergency laparoscopy is safe and should be considered in hemodynamically stable trauma patients with indications for laparotomy based on standard diagnostic criteria in order to minimize the incidence of non-therapeutic laparotomy.

Abdominal Injuries↗

PubMed1994

[The results of a 1993 AFU survey on laparoscopy in urology].

The development of laparoscopy in the field of urology has been considerable since 1991. In order to evaluate the use of this technique in the French urology community and the need to develop evaluating and teaching structures for this technique, a postal questionnaire was sent to 714 members of the Association Française d'Urologie (AFU) on June 23, 1993. The reply rate was 22% and 72 of the responders (46%) performed urological laparoscopy. A total of 684 laparoscopic urological procedures were reported, corresponding to an average of 9.5 procedures per operator. 45 operators had performed fewer than 16 laparoscopic procedures. The complication rate was 5% with a perioperative mortality of 0.3%. These figures should be considered to be minimal values. Eighty six responders (54%) did not perform laparoscopy. Forty seven of them (57%) were waiting for these techniques to demonstrate their practical value. Eighty two urologists thought that laparoscopic lymph node dissection had a role to play in the diagnostic and therapeutic strategy of prostatic cancer. One hundred and thirteen urologists (85%) considered that the development of urological laparoscopy would be moderate. Eighty nine urologists answer the question concerning possible training in these techniques and 77 of them intended to learn laparoscopic techniques.(ABSTRACT TRUNCATED AT 250 WORDS)

Academic Medical Centers↗

PubMed1993

[The value of laparoscopy in the staging of digestive system cancers].

Sixty two patients with a gastrointestinal carcinoma were evaluated pre-operatively by ultrasonography, CT scan and laparoscopy to seek liver metastases and/or peritoneal carcinomatosis. Performance levels of laparoscopy, ultrasonography and CT scan were comparable regarding the diagnosis of liver metastases. Laparoscopy was markedly better than CT scan and ultrasonography in the diagnosis of peritoneal carcinomatosis. Thus the investigation of choice for the detection of liver metastases is a single imaging technique. In contrast, if excision surgery is envisaged, all gastrointestinal carcinomas should be assessed by ultrasonography and/or CT scan and laparoscopy to definitely eliminate peritoneal carcinomatosis or small superficial liver metastases, in such a way as to avoid unnecessary laparotomy.

Carcinoma↗

PubMed1993

Laparoscopy in abdominal gunshot wounds.

The role of laparoscopy in the evaluation of abdominal trauma continues to evolve. It has been successfully used in blunt and penetrating trauma. We report our experience with diagnostic laparoscopy in 28 patients with abdominal gunshot wounds. We found a 100% accuracy and a 0% morbidity in patients with negative laparoscopy. We report a case in which laparoscopy was used to demonstrate an isolated nonbleeding liver injury due to a gunshot wound to the abdomen. Nontherapeutic laparotomy was avoided.

Abdominal Injuries↗

PubMed1993

Current status of operative laparoscopy in gynecologic oncology.

The role of laparoscopy in gynecologic oncology has expanded in the last few years to include a variety of situations and cancers. Patients with invasive cervical carcinoma can be spared radical hysterectomy if laparoscopy documents positive lymph nodes. Therapeutic laparoscopic pelvic lymphadenectomy has been performed successfully in patients with small cervical lesions. Laparoscopy can be used for staging in patients with advanced cervical cancer who are scheduled for definitive radiotherapy. Laparoscopically assisted surgical staging is also feasible, safe, and adequate in patients with clinical stage I endometrial cancer, and is being investigated in patients with stage I ovarian cancer. Second-look laparoscopy is proving useful in ovarian cancer patients who are candidates for a second-look procedure. Laparoscopic pelvic lymphadenectomy is being investigated in patients with small stage I vaginal carcinoma who are being considered for treatment with brachytherapy alone.

Female↗

PubMed1993

Urological laparoscopy: our preliminary results.

From the beginning of urological applications of laparoscopy, this technique has found many clinical indications. In our center, after an experimental training in animals, we performed 48 operations using laparoscopy: 18 pelvic lymphadenectomies (15 for prostate cancer, 2 for bladder tumor and 1 for penis carcinoma), 11 ligatures of the spermatic vein (3 bilateral), 4 orchidopexies, 10 excisions of renal cysts, 4 nephrectomies and 1 adrenalectomy. For cryptorchidism, laparoscopy is a less invasive alternative to surgical exploration; in case of prostate cancer, laparoscopic pelvic node dissection has a lower incidence of complications and requires few days of hospitalisation. The excision of renal cysts by laparoscopy, in case of large symptomatic pathology, is an efficacious operation with low morbidity. In case of nephrectomy for small wrinkled kidneys or severe hydronephrosis, long execution time makes cost/benefit ratio somewhat debatable; adrenalectomy, instead, is easier than nephrectomy and offers many advantages in comparison with traditional surgical approach. All indications will be better evaluated at a later date, with the indispensable learning period and the continuous progress of technical equipment.

Genital Diseases, Male↗

PubMed1993

[The effects of anesthetic techniques and insufflating gases on ventilation during laparoscopy].

The present study was performed to clarify the influences of anesthetic methods and insufflating gases on arterial blood gas and ventilation during laparoscopy. Forty five women undergoing laparoscopy for gynecological procedure were studied after dividing into four groups; general anesthesia with control ventilation or epidural anesthesia with spontaneous breathing, plus insufflation with carbon dioxide (CO2) or nitrous oxide (N2O). After CO2 insufflation, PaCO2 increased significantly in the patients who were mechanically ventilated, but not in the patients breathing spontaneously. After N2O insufflation, the decrease in tidal volume (VT) and the increase in VD/VT were significant, but minute ventilation was well maintained by the compensatory increase in respiratory frequency during spontaneous breathing. On the other hand, after CO2 insufflation VE and VD/VT increased significantly without any change in VT. PaO2 decreased significantly after both insufflation and Trendelenburg tilt in all groups, probably secondary to the decrease in functional residual capacity. These findings suggest that during laparoscopy, ventilation could be well maintained by spontaneous breathing, although the increase in VD/VT and costal breathing indicate the increase in respiratory work load. We recommend that ventilation and oxygenation should be closely monitored during laparoscopy to avoid hypercapnia and hypoxia.

Adolescent↗

PubMed1993

Adhesion formation and reproductive outcome after myomectomy and second-look laparoscopy.

OBJECTIVES: To evaluate adhesion formation after myomectomy and the reproductive outcome of infertile women with a large leiomyomatous uterus after myomectomy and second-look laparoscopy. METHODS: Twenty-six infertile women with a large leiomyomatous uterus underwent second-look laparoscopy 6 weeks after a myomectomy. At laparoscopy, the degree of adhesions was scored using the American Fertility Society classification of adnexal adhesions, and the adhesions were lysed. The pregnancy rates of these women were evaluated by life table analysis. RESULTS: A myomectomy incision on the posterior wall of the uterus was associated with more adnexal adhesions than that on the fundus or anterior uterine wall (93.7 versus 55.5%; P = .04). The degree of adnexal adhesions was also higher among women who underwent myomectomy with a posterior uterine incision (22.2 +/- 2.3 points) than in those with a fundal or anterior uterine incision (2.7 +/- 1.2 points) (P < .000001). The cumulative pregnancy rate was 33.4% at 6 months and 66.7% at 12 months after the procedures. CONCLUSIONS: Myomectomy incisions on the posterior uterine wall are associated with more and a higher degree of adnexal adhesions than those on the fundus and anterior wall. Conception occurs in the majority of infertile women with a large myomatous uterus who undergo myomectomy and second-look laparoscopy.

Adnexal Diseases↗

PubMed1993

Effect of intravenous diclofenac on pain and recovery profile after day-case laparoscopy.

Diclofenac sodium, 100 mg, or saline was given intravenously after the induction of anaesthesia to 169 patients undergoing outpatient gynaecological diagnostic laparoscopy or laparoscopic sterilization by tubal ligation. Propofol was used as the main anaesthetic agent and fentanyl and paracetamol were given for post-operative pain relief. In the post-anaesthesia care unit the amount of analgesics given and the incidence of nausea and vomiting were recorded. The time until oral intake, voiding and walking without assistance were recorded as parameters of recovery and guidelines for discharging the patient. In the diagnostic laparoscopy group, the patients given diclofenac needed significantly (P < 0.05) less fentanyl (25 +/- 33 micrograms, mean +/- SD) and paracetamol (230 +/- 40 mg) for post-operative pain than the patients given saline (fentanyl 47 +/- 53 micrograms and paracetamol 690 +/- 100 mg), which was not the case in the tubal ligation group. However, patients in the tubal ligation group needed significantly more post-operative analgesia than patients in the laparoscopy group. Diclofenac had no influence on the rapidity of recovery or home readiness in either group. It is concluded that diclofenac has no influence on home readiness, but prevents postoperative pain in patients undergoing diagnostic laparoscopies, whereas it was not a potent enough analgesic to prevent pain after laparoscopic tubal ligation.

Acetaminophen↗