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At least 865 records · Page 48Linked to original sources

PubMed1998

Lesser sac endoscopy and laparoscopy in pancreatic carcinoma definitive diagnosis, staging and palliation.

Laparoscopy with lesser sac endoscopy (LSE) were used in combination from 1987 to 1992 in 103 patients for differentiation between pancreatic carcinoma and other peripancreatic pathology, staging, and palliation. LSE identified pancreatic carcinoma in 38 patients; pancreatic cystadenocarcinoma in 2 patients; pancreatic cystadenoma in 3 patients; pancreatic adenoma in 1 patient; pancreatic metastases from liver in 2 patients; and pancreatic cysts in 5 patients. False negative diagnosis of pancreatic carcinoma occurred in two cases. Nontumor pancreatic pathology was revealed in 10 patients. Specifically, acute pancreatitis was found in four patients, and chronic pancreatitis was found in six patients. Extrapancreatic cancers were identified in 15 patients: retroperitoneal extraorgan tumors were found in 2 patients; extrahepatic biliary tract cancer in 6 patients; gallbladder cancer in 1 patient; liver cancer in 3 patients; and stomach cancer in 1 patient. In five cases no pathology was found. Overall correct definitive diagnosis was established in 101 patients. Sensitivity of laparoscopy with LSE for pancreatic carcinoma diagnosis proved to be 95 per cent (38 of 40 patients), for pancreatic tumors diagnosis 96.22 per cent (51 of 53 patients); specificity of the method 100 per cent; and accuracy of diagnosis 98 per cent (101 of 103 patients). Thus, the accuracy of the method was as high as the accuracy of combination of all known modalities. Criteria of unresectability were revealed with the combination of LSE and laparoscopy in 75 per cent (30 of 40 cases) of pancreatic carcinoma. Moreover, laparoscopy allowed palliation of pancreatic carcinoma. Laparoscopic cholecystostomy was performed in 10 patients, and laparoscopic cholecystojejunostomy with enteroenterostomy was performed in 6 patients.

Acute Disease↗

PubMed1998

[Prognostic importance of controlled ovarian hyperstimulation previous to therapeutic laparoscopy of infertile patients].

The use of the laparoscopic approach in the initial evaluation of the infertile couple without obvious disease is controversial; for these reason some centers has been done the initial treatment with ovarian stimulation (OS). The present article analyze two groups, the first for patients with OS for 4 cycles and laparoscopic approach after that and the second group with initial laparoscopy and medical treatment if they need it. Both groups has a OS after the laparoscopic procedure. The analysis of the prognosis of the OS before the laparoscopy and the impact in the reproductive outcome is done. The results shows that the OS does not have deleterious effects of the pregnancy rates if it is used before the procedure. However, the pregnancy are present early in the second group P < 0.05. In conclusion, in infertile woman without obvious disease that indicate the laparoscopy, the initial use of OS before the laparoscopy does not have a deleterious impact on the pregnancy rates.

Adult↗

PubMed1998

[Gynecologic laparoscopy at the ABC Hospital. Analysis of 882 cases].

The objective was to evaluate the indications and clinical evolution of patients treated with laparoscopy. Eight hundred eighty two women undergoing conventional laparoscopy for gynecological pathology, patients were not preselected, preoperative and postoperative data were registered retrospectively. Main indications to perform laparoscopy were dismenorrhea and infertility. Endometriosis and pelvic adhesions were the most frequent findings detected in the study subjects. Endoscopic treatment resulted in minimal complications and short postoperative stay. As conclusion classic laparoscopy is a safe and efficacious technique for treatment gynecological pathology.

Adolescent↗

PubMedDate not supplied

Office single puncture laparoscopy sterilization with local anesthesia.

BACKGROUND AND OBJECTIVES: Recently there has been a renewed interest in office based laparoscopy sterilization utilizing local anesthesia with conscious intravenous sedation. The safety of performing the procedure outside of a hospital environment has been questioned. The author attempts to determine the incidence of major complications with a review of the literature and a retrospective chart review of his personal cases. METHODS: During the period from 1971 to 1995, the author performed 1,753 laparoscopic procedures, utilizing local anesthesia in 1,562 cases and general anesthesia in the remainder. The focus of this chart study is the 1,190 laparoscopy sterilization cases performed in an office exam room setting, utilizing local anesthesia and conscious intravenous analgesia. Conventional 10 mm single puncture laparoscopy equipment was used. Major complications were defined as requiring laparotomy, blood transfusion, cardiopulmonary resuscitation, or emergency transfer to the hospital. RESULTS: The author's series contained one major complication, which was easily handled in the office environment. A review of the literature, including the author's series, revealed a major complication incidence of 5 out of 20,568 cases reviewed. None of these five complications would have required immediate laparotomy or blood transfusion to prevent a fatality. CONCLUSION: The author proposes that there is no documented evidence that office laparoscopy places the patient at increased risk for a life-threatening complication and should be considered by experienced gynecologic laparoscopists who are interested in cost containment.

Ambulatory Surgical Procedures↗

PubMedDate not supplied

Hans Frangenheim--culdoscopy vs. laparoscopy, the first book on gynecological endoscopy, and "cold light".

In the United States, culdoscopy (a vaginal approach to view the abdomen) replaced laparoscopy for about 20 years, circa 1950-1970. In contrast to many of his colleagues, Hans Frangenheim of Wuppertal, Germany, was not satisfied with culdoscopy and turned to an abdominal approach. Frangenheim began publishing his experiences with gynecological laparoscopy in 1958 and stressed technical improvements. He constructed a CO2 insufflator, wrote the first book on gynecological endoscopy, and introduced "cold light" into laparoscopy. Frangenheim strongly stimulated the rise of gynecological laparoscopy in Europe in the 1960s and later.

Culdoscopy↗

PubMed1994

[Second look laparoscopy after mesenteric infarct].

Second-look laparotomy is not always routinely performed after mesenteric infarction. Such operations are often not performed because of the high operative risk in aged patients and those with cardiovascular disease. We developed a minimally invasive technique for second-look laparoscopy with the aim of decreasing the operative morbidity. With the patient under general anaesthesia, the old incision is opened at the umbilicus. The running suture in the abdominal wall is lifted with a clamp and the incision line is gently reopened. A trocar with a blunt tip designed for open laparoscopy is then inserted and fixed. Following insufflation of CO2 through the trocar it is possible to explore the entire small bowel and colon. We operated on five patients after bowel resection performed for mesenteric infarction. Second-look laparoscopy was diagnostic in all but one, in whom laparoscopy failed due to massive small bowel dilatation. The technique described here is very promising and deserves further evaluation.

Aged↗

PubMed1999

Laparoscopy in the management of scirrhous gastric cancer.

BACKGROUND: Scirrhous gastric cancer frequently shows extensive tumor spread, and gastrectomy for cure of the disease is not possible in the presence of peritoneal dissemination, which is often overlooked by conventional computed tomography. The aim of this study was to evaluate our experience of 16 patients who underwent laparoscopy in the management of scirrhous gastric cancer, and to examine whether peritoneal dissemination could be diagnosed accurately by laparoscopy.METHODS: All patients had nonobstructed, nonbleeding scirrhous gastric cancer and had no evidence of metastatic disease by ultrasonography and computed tomography. Laparoscopy was performed under general anesthesia with CO(2) pneumoperitoneum. A Hasson trocar and two manipulating forceps were inserted, and the surfaces of the peritoneum, omentum, stomach, spleen, pancreas, liver, and diaphragm were examined.RESULTS: The mean time for laparoscopy was 20 min. Peritoneal dissemination was disclosed in 4 patients (25%), and systemic and intraperitoneal chemotherapy was done without laparotomy. In 12 patients, subsequent gastrectomy with a curative intent was successfully performed. Pathology revealed that the tumor diffusely invaded the whole thickness of the gastric wall; the mean size of resected tumors was 12 cm, and the mean number of positive nodes was 17. Nine patients died of the disease with a mean survival period of 10 months, and 7 patients were alive without recurrence during a mean follow-up period of 11 months.CONCLUSIONS: Laparoscopy is useful for the evaluation of peritoneal spreads of advanced gastric cancer, can avoid unnecessary laparotomy because of peritoneal dissemination, and is important for the choice of treatments in patients with scirrhous gastric cancer.

Journal Article↗

PubMed1998

Simplified abdominal wall-lifting device for gasless laparoscopy.

OBJECTIVE: To develop a simplified abdominal wall-lifting device for gasless laparoscopy. METHODS: The device is composed of an electric-power actuator, sliding arm and abdominal wall-retractor. All parts of the device are reusable. The device provides planar displacement of the anterior abdominal wall to enable space for laparoscopy. The valveless ports and conventional instruments, as well as laparoscopic instruments, were used without a gas leak problem. RESULTS: After preliminary success in the laboratory testing, a petition was made to the hospital's Ethic Committee. Since then we have performed 40 gasless laparoscopic procedures including 13 salpingo-oophorectomies, 10 diagnostic laparoscopies, five tubal ligations, five ovarian cystectomies, four salpingectomies, two removals of pelvic IUDs and one laparoscopic hysterectomy. There were no surgical complications, including no abdominal wall trauma. The operative field was almost the same as that of the pneumoperitoneum technique, with the exception of morbidly obese patients. CONCLUSIONS: This preliminary experience demonstrates the efficiency of the simplified abdominal wall-lifting device and the potential advantages of gasless laparoscopy. Continued modifications and applications are necessary to delineate the full range of benefits of this device and technique, especially in developing countries.

Abdominal Muscles↗

PubMed1994

Patient Selection for Myomectomy via Operative Laparoscopy

Removal of uterine myomas via operative laparoscopy is controversial. The ability to select patients who are likely to be successfully managed by this approach would eliminate unnecessary morbidity and extended operative times. We studied the ability of clinical examination, ultrasound evaluation, hysteroscopy, and laparoscopic assessment of the uterus to select appropriate candidates for operative laparoscopy. Candidates were women who requested myomectomy, who had uterine size less than 14 weeks on initial examination, who had no myoma greater than 7 cm after 3 months of GnRH agonist, and who were surgical candidates. Forty-two patients were entered into the study. Twenty patients were believed to be candidates for operative laparoscopy. They were all successfully operated on without conversion to laparotomy and without complications. Initial clinical examination and/or ultrasound and laparoscopic assessment of the uterus at the time of surgery were found to be the best predictors of successful operative laparoscopy. Magnetic resonance imaging is helpful in patients who desire fertility. All four patients who attempted pregnancy conceived. Three delivered at term by Cesarean section and one had a spontaneous abortion.

Journal Article↗

PubMed1994

Resolution of Free Intraperitoneal Air after Laparoscopy: Utility of Abdominal Radiography in the Diagnosis of Bowel Injury

Bowel perforation is a life-threatening complication of operative laparoscopy that warrants immediate treatment. The classic radiographic signs of a ruptured viscus may be indistinguishable from intraperitoneal CO2 introduced during insufflation. To examine whether abdominal radiology could be useful in diagnosing a ruptured viscus after laparoscopy, we obtained upright abdominal films on 31 patients 24 hours after operative laparoscopy. The laparoscopic procedures ranged from lysis of adhesions to radical hysterectomy with lymph node dissection. Twenty-eight of the patients had no radiologic evidence of free air 24 hours postoperatively. Of the three patients who were found to have free air, one was asymptomatic, one had an acute abdomen that resolved, and another died after multiple surgeries to resolve what was found to be an unrecognized bowel perforation from a prior laparoscopic lysis of adhesions. Based on our findings, we believe that the presence of free air 24 hours after laparoscopy to be presumptive evidence of a ruptured viscus until proven otherwise.

Journal Article↗

PubMed1996

Comparison of Hysterosalpingography with Laparoscopy and Chromopertubation

We compared two methods of determining tubal patency. Between January 1, 1993, and December 31, 1994, 55 women were evaluated for infertility by laparoscopy and chromopertubation and either traditional hysterosalpingogram (HSG; group 1, 25 patients, 16 primary, 9 secondary infertility) or a mixture of Hy-Co-Sy with Echovist (group 2, 30 patients, 14 primary, 16 infertility). In group 1 HSG showed 64% bilateral patency, 8% unilateral patency, and 28% bilateral occlusion; laparoscopy and chromopertubation showed 72%, 8%, and 20%, respectively. Identical findings were present in 92% of women, with method sensitivity and specificity of 100% and 89.4%, respectively. One case of allergic reaction occurred. In group 2, rates with Hy-Co-Sy and Echovist were 63.3% bilateral patency, 23.3% unilateral, and 13.3% bilateral occlusion; laparoscopy and chromopertubation results were 83.3%, 10%, and 6.7%, respectively. Identical findings were present in 86.7% of patients, with method sensitivity and specificity of 100% and 84.9%, respectively. No side effects were noted. The high sensitivity of both methods suggest that either one is of value in primary assessment of tubal patency, as neither requires general anesthesia and both may precede laparoscopy of hysteroscopy.

Journal Article↗

PubMed1996

Laparoscopy for Ovarian Endometriomas

Thanks to advances in endoscopic technique and instrumentation, it is possible to remove endometrial cysts by laparoscopy, including total ablation of the cyst capsules. It is difficult to make a clear diagnosis laparoscopically, because some of pathologies have the same appearance (e.g., luteal cysts, follicular cysts). Macroscopically, endometroid cysts are round or elongated. The external surface may be whitish or rust-colored, smooth or covered by adhesions. We analyzed 103 laparoscopic endometrioma resections performed from 1993 to 1995. Laparoscopies consisted of dissection of the ovarian cortex above the cyst, evacuation of cyst contents, cystoscopy, total ablation of its capsule, and bipolar coagulation of its site. Histologically we found endometriosis in 70% of cases, luteal cysts with blood effusion in 20%, follicular cysts in 4%, cysts deprived of epithelial lining in 2%, and serosal cysts in 4%. Unilateral endometriomas were found in 60.9%, and were bilateral in 39.1%. Each patient with a histologically proved diagnosis received danazol 400 to 600 mg/day for 6 to 8 months, and we performed 21 second-look laparoscopies among infertile women after therapy. No adhesion formation was seen. Follow-up was 12 to 14 months after laparoscopy and included vaginal sonography, which showed one (1.28%) recurrence of the ovarian endometrioma.

Journal Article↗

PubMed2000

Need for staging laparoscopy in patients with gastric cancer

AIMS: The aim of preoperative staging in gastric cancer is to correctly identify patients with advanced disease who should not be subjected to surgery and to allow the treatment of those who are admitted for operation to be planned accurately. This study assessed the impact of a policy of selective staging laparoscopy in patients deemed suitable for curative or palliative surgery, to ascertain whether the selective approach increased the frequency of abandoned or unplanned surgical procedures. METHODS: Fifty consecutive patients with gastric or type III gastro-oesophageal junction cancer staged by computed tomography (CT) alone, in whom surgery was felt to be appropriate for 'cure' or palliative symptom control, were studied. Specific CT, endoscopic and biochemical criteria were applied prospectively to select out a subgroup of 18 patients who also underwent preoperative staging laparoscopy. The overall accuracy of staging and operative outcomes were assessed. RESULTS: Using this selective approach the resection rate was 98 per cent, although three patients in each group had their planned procedure altered to a less radical (two in each group) or more radical (one in each group) resection (P = 0.23). Overall, 41 of 50 patients were staged correctly (accuracy 82 (95 per cent confidence interval 69-90) per cent) and 86 per cent of patients underwent the planned surgical procedure. The only abandoned operation occurred in the staging laparoscopy group. CONCLUSIONS: It is possible to plan a patient's operation accurately without the need for a staging laparoscopy in all cases.

Journal Article↗

PubMed1996

Laparoscopy for Acute Diseases of the Lower Abdomen and Pelvis.

Laparoscopy is an important tool for evaluating acute lower abdominal and pelvic pain. Although a complete history and physical examination often provide an accurate diagnosis, laparoscopy can serve as an adjunct in many patients with unclear symptoms. An acute abdomen can be caused by many pelvic sources. Laparoscopy can assist in the diagnosis of abdominal and pelvic pathologies and can often be therapeutic, eg, the treatment of adnexal torsion and endometriosis. The early use of laparoscopy for the diagnosis of acute lower abdominal and pelvic pain of unclear etiology often leads to an earlier diagnosis and allows for definitive treatment using minimal access techniques.

Journal Article↗

PubMed1996

Laparoscopy for Acute Abdominal Conditions in Children.

Laparoscopy for acute abdominal conditions if one area where laparoscopy is being used in children. However, because of the reduced abdominal surface area of small children, special concerns, are present and must be appreciated. The most common acute abdominal in children for which laparoscopy is used is appendicitis. Other indications include cholecystectomy for acute cholecystitis, Meckel's diverticulectomy, evaluation for trauma, and correction or excision of adnexal torsions. In addition, the future of laparoscopy for acute abdominal conditions is speculated.

Journal Article↗

PubMed2001

An audit of patients investigated by laparoscopy and dye for infertility.

We reviewed 100 laparoscopy and dye studies performed in the Coombe Women's Hospital to determine whether recommended guidelines were followed for the investigation of infertility. Individual chart review provided information on patient demographics, preoperative investigations, operative findings and outcome. Preoperative assessment of ovulation or a semen analysis was not performed in 20 and 30 women, respectively. At laparoscopy bilateral tubal patency was demonstrated in 86 patients, three patients had bilateral blocked tubes and 11 patients had unilateral tubal occlusion. In 54% of patients there were no other additional findings. Following laparoscopy five women were referred for in vitro fertilisation and five patients had further surgery as a result of the findings at laparoscopy. In addition, three women were treated for hyperprolactinaemia and three male partners were referred for further investigation. Within one year 20 women became pregnant, 18 delivered a baby and two had a miscarriage.

Journal Article↗

PubMed1998

The prevalence of continuing chronic pelvic pain following a negative laparoscopy.

This is a retrospective study to assess the prevalence of continuing symptoms in women following a negative laparoscopy for chronic pelvic pain. The case-notes of 347 laparoscopies were reviewed. Of the 189 laparoscopies in which the indication for the procedure was chronic pelvic pain, 67 were found to be negative. This group of patients were each sent a questionnaire asking about continuing symptoms. The results of the questionnaire show that 48% of patients remain dissatisfied with their clinical care, 53% continue to require regular analgesics for their pain, 43% feel that their quality of life had been affected in a major way and 30% admit to feeling depressed in a major way due to their symptoms. This data would suggest that despite a negative laparoscopy for chronic pelvic pain, a significant percentage of patients would benefit from continuing medical input in order to help deal with their symptoms.

Journal Article↗

PubMed1992

Metabolic and respiratory changes after cholecystectomy performed via laparotomy or laparoscopy.

We have compared metabolic and respiratory changes after laparoscopic cholecystectomy (n = 15) with those after open cholecystectomy (n = 15). The durations of postoperative i.v. therapy, fasting and hospital stay were significantly shorter in the laparoscopy group. During the first and second days after operation, analgesic consumption but not pain scores (visual analogue scale) were significantly smaller after laparoscopy, while vital capacity, forced expiratory volume in 1 s, and PaO2 were significantly greater. The metabolic and acute phase responses (glucose, leucocytosis, C-reactive protein) were less after laparoscopy compared with laparotomy. Although plasma cortisol and catecholamine concentrations were not significantly different between the two groups, after surgery interleukin-6 concentrations were less in the laparoscopy group.

Acute-Phase Reaction↗