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PubMed1995

Small diameter laparoscopy using a microlaparoscope.

In order to determine the suitability of new microlaparoscopes of < 2.0 mm diameter for diagnostic laparoscopy, 28 small diameter laparoscopies (SDL) were performed during a 4 month period. These cases were performed under general anaesthesia with immediate follow-up confirmation with conventional laparoscopic equipment (group I). An additional 13 SDL procedures were performed under analgesic sedation plus local anaesthesia and were well tolerated by the patients (group II). For group I, the visualization results were comparable in 27 out of 28 procedures. In group II, patients were highly satisfied and reported less post-procedural discomfort and minimal scar formation due to the smaller access ports. In this study, two different types of microlaparoscopes were used; while both were adequate, the newer high-resolution microlaparoscope delivered an image much more similar to conventional laparoscopy and required little or no change in technique in order to obtain images. This new endoscopic technology, with optical performance comparable to that of conventional laparoscopy, has been demonstrated to be a useful procedure for certain clinical indications.

Abdominal Pain↗

PubMed1992

Laparoscopy in the evaluation of the intrathoracic abdomen after penetrating injury.

Penetrating trauma to the intrathoracic abdomen is a difficult clinical problem, especially with reference to the detection of diaphragmatic injuries. A retrospective analysis of 657 laparotomies for penetrating abdominal trauma at our institution revealed 78 laparotomies with negative results. The majority (44.8%) were for wounds in the lower chest and upper abdomen. The role of laparoscopy in evaluating these difficult areas was studied in 40 (34 stab wounds and 6 gunshot injuries) patients. Fifteen stab wounds and five gunshot wounds were nonpenetrating. Laparoscopy revealed eight clinically unsuspected diaphragmatic lacerations in seven patients. Twenty patients had hemoperitoneum. Five patients with omental bleeding and abdominal wall bleeding and four with nonbleeding liver lacerations underwent nontherapeutic laparotomies. One patient with a nonbleeding liver laceration was observed successfully without laparotomy. Ten of the 20 patients with hemoperitoneum had therapeutic laparotomies. The incidence of diaphragmatic lesions discovered by laparoscopy in this series was comparable with that reported after a mandatory laparotomy for thoracoabdominal wounds. It is concluded that laparoscopy is an excellent modality for the evaluation of the intrathoracic abdomen and the diaphragm.

Abdominal Injuries↗

PubMed1999

[Percutaneous removal of a brachiocephalic vein anchored venous catheter with wire loop and mini-laparoscopy scissors].

PURPOSE: The use of mini-laparoscopy scissors to remove a central venous catheter inadvertently fixed to the wall of the brachiocephalic vein is described. PATIENT AND METHODS: During a rethoracotomy in a 15-year-old female patient, a central venous catheter preoperatively introduced in the left subclavian vein was inadvertently trapped by a suture and fixed to the wall of the left brachiocephalic vein. The foreign body was removed by use of a transjugularly introduced venous sheath, a catheter wire snare, and mini-laparoscopy scissors. RESULTS: The fixed catheter was freed from the wall of the vein under fluoroscopic control with the help of a mini-laparoscopy scissors. Since the intravasal end of the catheter had already been grasped during mobilization with the wire snare it could be completely removed subsequently without any problem. CONCLUSIONS: The percutaneous, intravascular use of mini-laparoscopy instruments may be considered for foreign body removal in special cases.

Adolescent↗

PubMed2001

[Value of minilaparoscopy in comparison with conventional laparoscopy in diagnosis of liver diseases--intermediate term results of a prospective, randomized study].

INTRODUCTION: Laparoscopy plays an essential role in the diagnosis of hepatic diseases. During the past few years, minilaparoscopy (ML) has increasingly emerged as an alternative diagnostic method in this field. We hereby present the preliminary results of a randomized trial comparing ML with conventional laparoscopy (CL). PATIENTS AND METHODS: 92 with suspected hepatic disease were randomized either to undergo CL (n = 47) or ML (n = 45). For CL, we used a Hopkins-laparoscope (Ø 11 mm, Storz, Tuttlingen) and ML was performed with a 1.9 mm small-diameter optic (Wolf, Knittlingen). RESULTS: Laparoscopy with simultaneous liver biopsy could successfully be performed in 88/92 patients. ML could be performed in a significantly shorter time than CL (25 vs. 28 min, p < 0.05). Liver cirrhosis was diagnosed by laparoscopy in a similar proportion of patients (70% in CL, 56% in ML). In 76% of cases, histology confirmed macroscopic signs of liver cirrhosis. Cirrhosis was found in one patient of each group solely by histologic examination of biopsy specimens. The number of bleeding complications during CL equaled the proportion of hemorrhagias in the ML-group. DISCUSSION: In the workup of hepatic disease, ML is a diagnostic tool comparable with CL. The fact that ML can be performed in significantly shorter time and seems subjectively less invasive might be an argument for a better acceptance by patients.

Adult↗

PubMed1997

A review of laparoscopy and laparotomy in the management of tubal pregnancy.

A retrospective review was performed of all women who had undergone operation for a tubal pregnancy at the Prince of Wales Hospital, Hong Kong, from November 1992 to March 1994. One hundred and five patients were included---61 were managed by laparoscopy and 44 by laparotomy. There were no differences in age, parity, gestational age, frequency of previous ectopic pregnancy, or laparotomy between the two groups. Sixty per cent of patients in the laparotomy group had a diagnostic laparoscopy prior to the laparotomy. The laparoscopy group had a lower incidence of haemoperitoneum (45.9% vs 75.0%, P<0.05). There was no difference in the mean operating time. The laparoscopic approach was associated with a significant reduction in: intra-operative blood loss (46.7plus minus76.8 mL vs 213.4plus minus149.3 mL. P<0.001), post-operative analgesia requirement (odds ratio 0.08, 95% CI, 0.02-0.32), post-operative morbidity (odds ratio 0.27, 95% CI, 0.12-0.58), length of hospital stay (2.9plus minus2.2 days vs 5.1plus minus1.2days, P<0.001) and recuperation period (11.0plus minus9.3days vs 21.7plus minus8.5 days, P<0.001). Operative laparoscopy has the advantage of combining diagnostic and therapeutic procedures in a single operation, and is a better approach than laparotomy in the management of tubal pregnancy.

Journal Article↗

PubMed1976

A Mobile Laparoscopy Unit.

Our experience has led us to the construction of a Mobile Laparoscopy Unit. This unit increases safety and permits the adequate performance of laparoscopy. The Mobile Laparoscopy Unit is an alternative to a special laparoscopy room.

Germany, West↗

PubMed2003

[Radioimmunotherapy in patients with ovarian cancer in complete remission after the first line surgery and chemotherapy after second look laparoscopy procedure].

OBJECTIVES: The aim of the study was analysed a chance to successful radioimmunotherapy in patients with ovarian cancer as a consolidation procedure. DESIGN: Between 2000 and 2002 we introduced 56 patients into consolidation study with radioimmunotherapy after second look laparoscopy. MATERIALS AND METHODS: 17 patients during screening procedure have failed--mostly with positive CT scans (9/17). We have done 39 laparoscopies. Among 11 patients during laparoscopy we have found in 6 cases a residual disease and in 5 cases adhesions in abdomen or pelvis and this group was excluded from study. The remaining 28 patients were divided into two groups--14 in active and 14 in control arm. RESULTS: Only 50% of patients with ovarian cancer in complete clinical remission after first line surgery and chemotherapy can be candidates to consolidation therapy. Among patients subjected to laparoscopy in 70% there was no evidence of macroscopic disease and adhesions. CONCLUSIONS: Only 50% patients in complete clinical remission after first line surgery and chemotherapy have chance to successful radioimmunotherapy.

Antibodies, Monoclonal↗

PubMed1993

[Does laparoscopic appendectomy have advantages? Laparoscopic appendectomy in comparison with conventional appendectomy--an observational study during introduction of laparoscopy].

From October 1990 to October 1992 the first 23 laparoscopically operated patients were recorded. 11 patients retrospectively including a supplementary questioning to missing data, 12 patients prospectively with a follow-up 6-8 weeks later. They were compared with 35 from April 1991 to April 1992 conventionally operated and prospectively observed patients. Laparoscopy was performed on patients with subacute clinical signs. The median age was comparable. Acute appendicitis was histologically confirmed in 18% of the laparoscopically and in 80% of the conventionally operated patients. Operating time was in mean 110 minutes for laparoscopic and 65 minutes for open appendectomy. The postoperative complications for laparoscopy included 4 Douglas abscesses (2 x open and 2 x pararectal revisions), one peritonitis due to a defect Roeder-loop and an haematoma of the abdominal wall. One case of wound infection (3%), one pericoecal abscess which needed an ileoascendostomy and a postoperative fatigue syndrome were recorded for open appendectomy. The postoperative return to normal diet was faster for laparoscopy. Return to normal bowel habits, the need of analgesia and the nominal analogue scales concerning pain, quality of sleep, well-being and appetite showed no obvious differences between the two operation methods. The postoperative stay was on average 6.7 days for laparoscopy and 5.6 days for the open operation. The results show the severe complications which may happen when introducing this new operation method. The laparoscopic appendectomy should only be performed electively in subacute appendicitis or when diagnostic exploration shows an inflamed appendix. Careful rinsing of the operation site and perioperative antibiotic treatment are mandatory. We made good experiences when using a stapler for the removal of the appendix.

Adolescent↗

PubMed1995

[Incidence of nausea and vomiting after cholecystectomy performed via laparotomy or laparoscopy].

Postoperative nausea and vomiting (PONV) are commonly observed adverse effects of general anesthesia. In a retrospective study of laparoscopy group (101 patient) and laparotomy group (101 patient), we evaluated the incidence of PONV after laparoscopic cholecystectomy. Most factors which could influence the incidence of PONV were not significantly different between the groups. The overall incidence of PONV during the first 17h postoperatively was 25.7% in laparoscopy group and 18.8% for laparotomy group respectively, but the risk was 3.2 times greater in laparoscopy group (15.8%) than in laparotomy group (5.0%) (P < 0.05) during the first postoperative hour. The risk of PONV was greater in laparoscopy group in female patients (23.4% versus 9.3% in laparotomy group, P < 0.05) and in obese patients (25.0% versus 0% in laparotomy group, P < 0.01) during the first postoperative hour. We conclude that laparoscopic cholecystectomy increases the incidence of PONV in early postoperative period probably by the effect of residual stretching and irritation of the peritoneum, and the risk is increased in female and obese patients.

Anesthesia, General↗

PubMed1996

Laparoscopy in pediatric urology: challenge and opportunity.

The development of operative laparoscopic techniques in Pediatric Urology has been generally cautious. It is premature to attempt an assessment of the ultimate impact of laparoscopy in pediatric urology, yet several areas of application have significant potential. Diagnostic laparoscopy for cryptorchidism has evolved into operative laparoscopy for intra-abdominal testes, and a significant number of cases have been performed successfully, with the possibility of improved results over open techniques. Laparoscopic nephrectomy and nephroureterectomy have been spring-boards for complex reconstructive renal surgery, although it is clear that new tissue joining technologies are needed. Complex reconstructive surgery is just beginning, yet may have a role in practice. These developments and the current status of laparoscopy in pediatric urology will be reviewed.

Child↗

PubMed1996

Laparoscopy in pediatric urology: too much of a good thing?

Laparoscopy is still an evolving technique; its rightful place in pediatric urology has yet to be defined. Although both the first reported use of diagnostic laparoscopy in pediatric surgery and its initial use in pediatric urology were published in 1973, the field lay dormant until recently. Once operative laparoscopy was initiated with the report of laparoscopic cholecystectomy in 1987, a torrent of articles followed; many operative procedures in adult urology and subsequently in pediatric urology appeared. This article presents the advantages and the disadvantages of several of the more important and common possible indications for laparoscopy in pediatric urology.

Adult↗

PubMed1996

[Severe complications in diagnostic laparoscopy. 9 years experience in 747 examinations].

BACKGROUND: Despite the introduction of non-invasive imaging procedures, diagnostic laparoscopy is still indicated in suspected liver cirrhoses, cancer staging and ascites or fever of unknown origin. Although the use of laparoscopy decreased over the last decade, some centers still have much experience and their complication rates are of special interest. PATIENTS AND METHODS: The complication rate of 747 patients undergoing a diagnostic laparoscopy in our clinic during the last 9 years is listed retrospectively, and the respective therapy is examined. RESULTS: Severe complications were found in 11 cases (1.5%): 6 bleeding complications, 2 bowel perforations and 3 other complications. Five of these 11 patients had to be operated on (45%). One patient with metastatic gastric cancer died of a multiple organic failure following a lararoscopic tumor biopsy (0.13%). CONCLUSION: The diagnostic laparoscopy is of significant value and has still a low complication-rate in centers with special experience.

Abdominal Neoplasms↗

PubMed1998

[Laparoscopy in suspected Crohn disease in childhood].

The traditional diagnostic tools for the diagnosis of Crohn's disease barely reach the terminal ileum. For coloileoscopy in children, anesthesia is required. We have used it for an additional and simultaneous laparoscopy, including biopsies from lymph nodes or the liver. In 11 children (mean age 11.8 years) laparoscopies were performed in order to establish the diagnosis Crohn's disease. In 9 children laparoscopy was performed simultaneously with coloileoscopy. A 5-mm laparoscope was advanced through the umbilicus and a 1.7-mm forceps through the left lower anterior abdominal wall. There were no complications. Laparoscopy provides a novel, direct image of the early stages of Crohn's disease and may initiate a more adequate medical treatment.

Adolescent↗

PubMed1981

The impact of laparoscopy on tubal sterilization in United States hospitals, 1970 and 1975 to 1978.

During the 1970s, tubal sterilization became an important method of fertility control in the United States. Over the same period laparoscopy emerged as an important innovation, one that has been associated with both a shift from postpartum to interval sterilization and a dramatic decrease in length of hospital stay required for sterilization. The use of laparoscopy has also been associated with an increase in hospital-based outpatient sterilization, particularly in the West. The number of sterilizations performed in hospitals and the use of laparoscopy for interval sterilization in hospitals both appear to have peaked. The laparoscope is an example of a technologic advance that has reduced medical care costs.

Adolescent↗

PubMed1982

Minilaparotomy or laparoscopy for sterilization: a multicenter, multinational randomized study. World Health Organization, Task Force on Female Sterilization, Special Programme of Research, Development and Research Training in Human Reproduction.

A multicenter, multinational randomized comparison of minilaparotomy and modified Pomeroy tubal ligation and laparoscopy with tubal electrocoagulation for interval sterilization of women was conducted in eight centers. Results were analyzed for 791 women in the minilaparotomy group and 819 in the laparoscopy group. Major complications occurred in 1.5% of women in the former group and 0.9% in the latter. Technical problems or major anesthetic complications occurred in 0.5% of subjects undergoing minilaparotomy and 0.9% of subjects undergoing laparoscopy. For minor complications the figures were 11.6% and 6.0%, respectively, while for minor complaints the rates were 34.1% and 26.5%, respectively. It is concluded that the two methods of approach to the fallopian tubes are similar in their complication rates. Because of its more simple requirements in terms of equipment and training, minilaparotomy is the preferred approach for services provided away from a major institution.

Adult↗

PubMed1999

Cardiovascular and respiratory changes and convalescence in laparoscopic colonic surgery: comparison between carbon dioxide pneumoperitoneum and gasless laparoscopy.

HYPOTHESIS: Gasless laparoscopy produces smaller cardiopulmonary and systemic changes than carbon dioxide (CO2) laparoscopy during colonic surgery. DESIGN: Prospective randomized trial. SETTING: Department of Surgery in a university hospital. PATIENTS: Twenty-two patients scheduled for laparoscopic colonic resection; 5 patients were excluded because of conversion to open surgery (N = 17). INTERVENTIONS: Patients were randomized to either gasless (n = 9) or conventional CO2 (n = 8) surgery. MAIN OUTCOME MEASURES: Intraoperative assessment of hemodynamic factors and pulmonary function, and postoperative assessment of pain, pulmonary function, convalescence, and various injury factors were done several times until 30 days after surgery. Surgical complications were noted. RESULTS: Descending aorta blood flow after 30 minutes (P=.03) and heart rate after 150 minutes were higher in the CO2 group (P=.009). Central venous pressure, PaCO2 inspiration pressure, and end tidal CO2 level were significantly higher in the CO2 group (P = .05, .03, .04, and .01, respectively). Patients in the CO2 group had less pain during mobilization and coughing (P = .008 and .006, respectively), and were significantly more fatigued (P = .04). No other important differences were observed in intraoperative hemodynamic factors, postoperative convalescence, immunocompetence, or pulmonary function. CONCLUSION: No clinically important differences in cardiovascular and systemic response were observed between patients undergoing CO2 or gasless laparoscopy for colonic disease.

Aged↗

PubMed1996

Laparoscopy during pregnancy.

OBJECTIVE: To compare the safety and efficacy of laparoscopic surgery with that of open laparotomy in pregnant patients. DESIGN: Six-year case-control study. SETTING: Tertiary care, university and community hospitals. PATIENTS: Population-based sample. From 1990 through 1995, 16 pregnant patients underwent laparoscopic surgery (study group) and 18 underwent open laparotomy (control group) during the first or second trimester. Follow-up ranged from 1 month to 6 years. INTERVENTION: In the study group, 4 patients underwent appendectomies and 12 underwent cholecystectomies. The control group included 7 appendectomies and 11 cholecystectomies. MAIN OUTCOME MEASURES: The 2 groups were compared for age, trimester, surgical time, oxygen saturation, end-tidal carbon dioxide, return of gastrointestinal tract function, duration of intravenous or intramuscular narcotics, postoperative stay, gestational age of delivery, 1- and 5-minute Apgar scores, birth weights, and complications. RESULTS: Age, trimester, oxygenation, end-tidal CO2, gestational age at delivery, Apgar scores, and birth weights were not different between the 2 groups. The patients who underwent laparoscopy had significantly longer operative times 82 vs 49 minutes), shorter stay (1.5 vs 2.8 days), earlier resumption of regular diet (1.0 vs 2.4 days), and shorter duration of intravenous or intramuscular narcotics (1.2 vs 2.6 days) (all P < .01). Four complications were found in the laparotomy group vs 6 in the laparoscopy group. CONCLUSIONS: Laparoscopic surgery in pregnant women significantly decrease hospitalization, decreases narcotic use, and quickens return to a regular diet when compared with open laparotomy in pregnant women. No significant differences between the 2 groups in perioperative morbidity or mortality were present. These data suggest that therapeutic laparoscopy during pregnancy in the first or second trimester is safe.

Adolescent↗

PubMedDate not supplied

Management of adnexal masses: role and risk of laparoscopy.

Laparoscopic surgery has become the gold standard in the treatment of benign adnexal masses, whereas laparotomy remains the standard for the treatment of malignant tumors. The laparoscopic management of adnexal masses remains controversial because of the potential risks of cancer dissemination suggested by many case reports and national surveys. Experimental data show potential advantages and disadvantages for the laparoscopic treatment of gynecologic cancer. Since the risk of dissemination appears high when a large number of malignant cells are present, adnexal tumors with external growths and bulky lymph nodes may be considered contra-indications to CO(2) laparoscopy. Surgical diagnosis is the key to adequate management of adnexal masses. In our experience, laparoscopic diagnosis of malignancy is reliable after a careful pre-operative evaluation has been performed. Moreover, national surveys have revealed that despite suspicious laparoscopic findings, many malignant masses were considered benign at the outset. Using strict guidelines, laparoscopic diagnosis can be proposed for both non-suspicious and complex masses, thus avoiding many unnecessary laparotomies for benign masses suspicious at ultrasound. The more controversial limits of laparoscopic treatment are discussed. If a laparotomy was performed for all masses suspicious at surgery, 80% of the cases would be treated by laparoscopy. The role of laparoscopy for restaging and second-look operations for ovarian cancer requires further evaluation.

Adnexal Diseases↗