SEARCH · PubMed Health

Results for “laparoscopy”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 163 records · Page 9Linked to original sources

PubMedDate not supplied

The role of laparoscopy in the management of the impalpable testicle.

BACKGROUND: Laparoscopy can identify patients who would benefit from further surgical intervention. Most importantly it is 100% sensitive in identifying the vanishing testicle. AIMS: To review the role of laparoscopy in the management of the undescended testis. METHODS: Thirty-one patients underwent a laparoscopy for an impalpable testicle over a nine-year period at this institution. RESULTS: There were 30 successful laparoscopies completed for 31 impalpable testes,13 of which were normal. All underwent groin exploration of which 11 were located. Seventeen had an abnormal laparoscopy. Of these, 11 were located in the abdomen and four were diagnosed as vanishing testes. DISCUSSION: Sixteen per cent of patients had an absent testicle at laparoscopy and were spared any further surgical intervention. In the remaining 84%, over half had their surgical procedure altered as a result of the laparoscopic findings. This experience, has led us to believe that laparoscopy is a safe, reliable and sensitive procedure crucial to the management of the impalpable testis.

Adult↗

PubMed2003

The utility of laparoscopy in the diagnosis of acute appendicitis in women of reproductive age.

AIM: To see whether laparoscopy improves the accuracy of a clinical diagnosis of acute appendicitis in women of reproductive age, and to determine what the long-term sequelae are of not removing an appendix deemed at laparoscopy to be normal. METHOD: The initial part of the study was undertaken during 1991-1992. Female patients between 16 and 45 years were eligible for inclusion once a clinical decision had been made to perform an appendicectomy for suspected acute appendicitis. Following consent, patients were randomized into two groups. One group had open appendicectomy, as planned. The other group had laparoscopy, followed by open appendicectomy only if the appendix was seen to be inflamed or was not visualized. The end points for the study were the clinical outcomes of all patients, and the results of histology, where appropriate. An attempt was made to contact all patients at 10 years to determine whether they had had a subsequent appendicectomy, or had been diagnosed with another abdominal condition that might be relevant to the initial presentation in 1991-1992. RESULTS: Laparoscopic assessment was correct in all cases in which the appendix was visualized. Diagnostic accuracy was improved from 75% to 97%. Laparoscopy was associated with no added complications, no increase in hospital stay in patients who went on to appendicectomy, and a reduction in hospital stay for those who underwent laparoscopy alone. No patients developed a problem over the 10-year follow-up period from having a normal-looking appendix not removed at laparoscopy. CONCLUSION: Laparoscopic assessment of the appendix is reliable, and to leave a normal-looking appendix at laparoscopy does not appear to cause any long-term problems.

Abdominal Pain↗

PubMed2004

Diagnostic laparoscopy for penetrating injuries in the thoracoabdominal region.

BACKGROUND: The role of laparoscopy in diagnosis of penetrating abdominal injuries is still controversial. In the present investigation diagnostic laparoscopy was studied in penetrating injuries of the thoracoabdominal region. METHODS: Between March 1998 and June 2003, 43 patients with penetrating thoracoabdominal injuries underwent diagnostic laparoscopy at the Rambam Medical Center. There were 41 males and two females; the average age was 30 years (range, 16-54 years). Thirty-one patients had a lower chest injury, eight patients had an upper abdomen and flank injury, and four patients had combined chest and abdomen injuries. In 11 patients intraperitoneal penetration was diagnosed. In 10 patients the procedure was converted to open laparotomy, and one patient with a small laceration of the right diaphragm opposite the liver was observed without laparotomy. RESULTS: The average operating time for the laparoscopy was 25 min (10-45 min), and 85 min (40-175 min) for laparotomy. Patients who underwent laparoscopy were discharged after an average of 1.6 (1-3) days, while those who underwent laparotomy were discharged after an average of 7.6 (2-15) days. CONCLUSIONS: Laparoscopy is a useful diagnostic tool in penetrating injuries of the chest, thoracoabdominal region, and flank. This procedure is particularly reliable in diaphragmatic tears. Laparoscopy should be considered the procedure of choice for the evaluation of penetrating injuries of the lower chest and upper abdomen for diagnosis of peritoneal penetration.

Abdominal Injuries↗

PubMed2006

Preconditioning-like amelioration of erythropoietin against laparoscopy-induced oxidative injury.

BACKGROUND: Laparoscopic surgery has gained wide acceptance for almost every kind of surgical procedure, although it has produced significant oxidative injury to intraabdominal organs depending on the pressure level and the kind of the gas used. The literature describes several preventive measures for decreasing the postlaparoscopic oxidative injury such as low intraabdominal pressure, gasless laparoscopy, and laparoscopic preconditioning. Erythropoietin was shown previously to decrease ischemia-reperfusion injury to the liver. The current study evaluated the effect of erythropoietin against laparoscopy-induced oxidative injury, as compared with laparoscopic preconditioning. METHODS: For this study, 64 male Spraque-Dawley rats were randomly assigned to one of the following groups. The control group was subjected to a sham operation. The laparoscopy group was subjected to 60 min of pneumoperitoneum. The laparoscopic preconditioning plus laparoscopy group was subjected to 5 min of insufflation and 5 min of desufflation followed by 60 min of pneumoperitoneum. The erythropoietin plus laparoscopy group was subjected to a subcutaneous injection of erythropoietin as a single 1,000-U/kg dose followed by 60 min of pneumoperitoneum. After 45 min of desufflation subsequent to cessation of pneumoperitoneum, blood, liver, and kidney samples were obtained from half of the rats. The other half of the rats were observed for a reperfusion period of 24 h. Tissue and blood samples also were obtained after this period. RESULTS: Laparoscopy produced significant oxidative injury, as compared with the sham treatment. Laparoscopic preconditioning produced significant amelioration of the ischemic injury. Although erythropoietin administration during the prelaparoscopic period decreased the pneumoperitoneum-induced oxidative injury, the beneficial effect of laparoscopic preconditioning was more pronounced. CONCLUSION: Laparoscopic preconditioning is more effective than the preischemic administration of erythropoietin in reducing laparoscopy-induced oxidative injury.

Animals↗

PubMed2000

Introducing diagnostic laparoscopy for patients with suspected acute appendicitis.

BACKGROUND: The diagnostic accuracy in patients with suspected acute appendicitis varies from 60% to 90% depending on age and gender. The aim of this study was to evaluate the use of diagnostic laparoscopy for diagnostic purposes in patients with suspected acute appendicitis to prevent unnecessary laparotomy and to leave a macroscopically normal appendix in place. METHODS: For this study, 500 consecutive patients with suspected acute appendicitis admitted between January 1994 and October 1996 were included prospectively in a surgical training program set to provide diagnostic laparoscopy on a 24-h-a-day basis. Primary open operation was performed when no laparoscopically trained surgeon was available. Short-term outcome measurements were recorded, and a retrospective long-term follow-up evaluation was performed. RESULTS: We succeeded in performing a diagnostic laparoscopy in 376 patients and a primary open operation in 124 patients. The overall appendicitis rate was 78%. A diagnostic laparoscopy alone was performed in 66 patients (56 of which were fertile women), with a median operating time of 36 min and a complication rate of 0%. The overall complication rate was 8.0%. During a median follow-up period of 19 months one patient returned on a later occasion with appendicitis. At completion of the study, 85% of the surgeons were skilled in diagnostic laparoscopy. CONCLUSIONS: Substantial education effort is needed to introduce diagnostic laparoscopy on a 24-h-a-day basis. Diagnostic laparoscopy has a high rate of accuracy, short operating time, and low associated morbidity, and prevents unnecessary laparotomy. It is possible to leave a macroscopically normal-appearing appendix in place.

Acute Disease↗

PubMed2001

Lavage by laparoscopy fares better than lavage by laparotomy: experimental evidence.

BACKGROUND: Although carbon dioxide (CO2) pneumoperitoneum is proposed increasingly for treatment of secondary peritonitis, associated deleterious effects have been reported in experimental models, with the hypothesis that increased intraperitoneal pressure might facilitate bacterial translocation. The purpose of this study was to compare the outcome (and qualitative microbiologic analysis) from peritonitis in rats after lavage by laparoscopy with the outcome after lavage by laparotomy. METHODS: After determination of the standard innoculum for this study in 30 animals, 120 male Wistar rats received 1 ml of Escherichi coli 10(6) colony-forming unit (CFU), Bacteroides fragilis 10(7) CFU, Enterococcus faecalis 10(7) CFU in a sterile rat feces-barium sulfate suspension adjuvant, were anesthetized with intramuscular ketamine, and then underwent peritoneal lavage by either laparotomy (n = 60) or laparoscopy (n = 60). The duration of peritonitis defined two groups: group A: duration less than 3 h (n = 20) and group B: duration 3 h or more (n = 40). Both groups underwent successive lavage with 10-ml aliquots (total, 50 ml) of 0.9% saline solution at 37 degrees C. Five 2-ml samples of liquid lavage were drawn for culture and microbiologic analysis. Blood (0.2 ml) and peritoneal liquid lavage samples were incubated 48 h at 37 degrees C and cultured. RESULTS: All the animals survived. Mean duration of peritoneal lavage was 13.2 min (range, 6-25 min) for laparoscopy and 9.7 min (range, 6-15 min) and for laparotomy. The difference was not statistically significant. The mean duration of operation was significantly longer with laparoscopy than with laparotomy: 44.5 min (range, 35-62 min) and 25 min (range, 16-40 min), respectively (p = 0.0001). The collected lavage volumes were not statistically different: 48.5 ml (range, 40-54 ml) and 46.7 ml (range, 37-56 ml), respectively. No statistically significant differences were found between the laparoscopy and laparotomy groups in terms of E. coli bacteremia, irrespective of peritonitis duration. The rates of positive blood culture for B. fragilis and E. faecalis were signficantly lower after laparoscopy than after laparotomy, both in the overall group (p = 0.025 and p = 0.045, respectively) and when duration of peritonitis exceeded 3 h (p = 0.001 and p = 0.044, respectively). CONCLUSIONS: In this animal model of secondary peritonitis, lavage by laparoscopy was associated with less bacteremia for B. fragilis and E. faecalis than peritoneal lavage by laparotomy.

Animals↗

PubMed2001

Laparoscopy reduces unnecessary appendicectomies and improves diagnosis in fertile women. A randomized study.

BACKGROUND: The aim of this study was to study the value of diagnostic laparoscopy prospectively in fertile women scheduled for acute appendectomy. METHODS: For this study, 110 women, with acute abdominal pain ages 15 to 47 years, in whom the surgeon had decided to perform an appendectomy, were randomized to either open appendectomy or diagnostic laparoscopy, then open appendectomy if necessary. RESULTS: Appendicitis was diagnosed in 66% of the women after open surgery, and in 73% after laparoscopy. During laparoscopy, was appendicitis misdiagnosed in only 7% of the women, from whom the appendix unnecessarily removed, whereas 34% in the open surgery group had a healthy appendix removed. No appendicitis was missed in the laparoscopic group. The relative risk of removing a healthy appendix in open surgery was 6.6 relative risk (range, 2-21 C.I.) as compared with laparoscopy. Among the women with a healthy appendix, a gynecologic diagnosis was found in 73% after laparoscopy, as compared with 17% after open surgery. CONCLUSIONS: Laparoscopy reduces unnecessary appendectomies and improves diagnosis in fertile women.

Adolescent↗

PubMed1998

The role of laparoscopy in the diagnosis and treatment of abdominal pain syndromes.

BACKGROUND: Diagnostic laparoscopy plays a significant role in the evaluation of acute and chronic abdominal pain in the era of therapeutic laparoscopic surgery. METHODS: We referred to our personal series of laparoscopy for both acute and chronic abdominal pain. This is a retrospective review of data accumulated prospectively between 1979 and the present. RESULTS: In our series, 387 consecutive patients underwent laparoscopy because of abdominal pain. In a group of 121 patients with acute abdominal pain, a definitive diagnosis was made in 119 cases (98%). Two patients needed laparotomy to confirm the diagnosis; both had a disease process that did not require laparotomy to treat. A definitive therapeutic laparoscopic procedure was performed in 53 cases 944%). In 45 patients (38%), a diagnosis was made that did not require therapeutic laparoscopy or laparotomy to treat. In the remaining 21 patients (17.5%), exploratory laparotomy was needed to treat the condition. In a chronic abdominal pain group of 265 patients, the etiology was established laparoscopically in 201 cases (76%). A definitive therapeutic laparoscopic procedure was performed in 128 patients (48%). There was a normal laparoscopic examination in 64 patients (24%). There was one false negative laparoscopy that required laparotomy to treat 1 month later. CONCLUSIONS: Laparoscopy is an accurate modality for the diagnosis of both acute and chronic abdominal pain syndromes. These data support the use of laparoscopy as the primary invasive intervention in patients with acute and chronic abdominal pain.

Abdomen, Acute↗

PubMed1992

Laparoscopy for the impalpable testes: experience with 53 testes.

Impalpable testes constitute approximately 20% of most series of undescended testes. From January 1986 to March 1991, we performed laparoscopies on 53 patients with impalpable testes. Thirty-two of them were found to have normal vasa and vessels entering each internal ring on the side in question. Of these, 14 were found to have "vanishing testes" at exploration, 12 others underwent successful orchiopexy, and the remaining 6 had excisional biopsies of fibrotic testicular remnants. Five patients had no visible vessels and a sixth had a blind-ending vas and vessels adjacent to the internal ring; in these cases no further investigations were deemed necessary. Fifteen patients were found to have abdominal testes and underwent high testicular vessel ligation and division at the time of the laparoscopy; 14 of them have undergone staged orchiopexy 6 months after laparoscopy and one is scheduled for this procedure. A 3-month follow-up of those who had orchiopexy showed excellent results in 10 patients and poor results in 3, all of whom had small testes that were unimproved or worse following vessel ligation. Four boys were spared operations as a result of findings at laparoscopy. Early in the series there was one failed laparoscopy, but it was successfully completed later. the procedure, but it was successfully treated with antibiotics. There were no other complications. Laparoscopy is a safe procedure that allows accurate diagnosis and may prevent additional intervention in the treatment of the absent testes. It facilitates the locating of the impalpable testis and the planning and timing of subsequent orchiopexy. We believe that laparoscopy is the preferred procedure in the management of impalpable testes.

Catheterization↗

PubMed2006

Minilaparotomy versus laparoscopy in the treatment of benign adnexal cysts: a randomized clinical study.

OBJECTIVE: To determine advantages and disadvantages of minilaparotomy and laparoscopy in managing patients affected by benign adnexal masses. STUDY DESIGN: Prospective, randomized, clinical trial on 127 patients affected by adnexal cysts. Patients were submitted to adnexal surgery through a laparoscopic or minilaparotomy approach on a random basis. RESULTS: Hundred and twenty-seven patients were enrolled in the study and randomly assigned to laparoscopy (63 patients) or minilaparotomy (64 patients). Characteristics of the patients and of the cysts were homogeneous between the two groups. No significant differences between the two groups were recorded in terms of operative time, intraoperative complications, ileus, length of stay and recovery time. The intraoperative rupture rate of the cyst was significantly higher in the laparoscopy group only in a subgroup of patients affected by cysts greater than 7 cm in diameter (p=0.01). Three patients randomized to laparoscopy required conversion to laparotomy. Concerning postoperative outcomes, postoperative pain and minor complications were significantly less in patients undergoing laparoscopy (p=0.001 and 0.04). CONCLUSIONS: Operative laparoscopy appears to be the preferable approach for the management of adnexal cysts. Minilaparotomy can be considered a mini-invasive approach as well, with acceptable operative and postoperative outcomes, and is a suitable alternative in case of contraindications to laparoscopy.

Adnexal Diseases↗

PubMedDate not supplied

Laparoscopy versus laparotomy in endometrial cancer: first analysis of survival of a randomized prospective study.

STUDY OBJECTIVE: Laparoscopy has been proved to be safe and reliable in staging of patients with endometrial cancer. It has definite advantages over laparotomy, but a comparable survival outcome is still to be verified in prospective randomized trials. DESIGN: Prospective, randomized clinical trial. SETTING: Department of Gynecology, Friedrich Schiller University, Jena, Germany. PATIENTS: One hundred twenty-two women with uterine cancer. INTERVENTIONS: Laparotomy and laparoscopy. MEASUREMENTS AND MAIN RESULTS: Sixty-three patients were allocated to the laparoscopy arm, and 59 were allocated to the laparotomy arm. Median follow-up for all patients was 44 months (range 5-96 months). Eight patients (12.6%) in the laparoscopy group had a recurrence versus five patients (8.5%) in the laparotomy group (p = .65). At median follow-up, disease-free survival (DFS) and overall survival (OS) in the laparoscopy group and laparotomy group were 87.4% versus 91.6% and 82.7% versus 86.5%, respectively. Cause-specific survival (CSS) was 90.5% in the laparoscopy group versus 94.9% in the laparotomy group. In patients with International Federation of Gynecology and Obstetrics stage I, DFS was 91.2% in the laparoscopy group versus 93.8% in the laparotomy group, OS was 86.5% versus 89.7%, and CSS was 93.4% versus 95.9%. CONCLUSION: Laparoscopic vaginal treatment of patients with endometrial cancer provides a survival outcome comparable with laparotomy. If these data are confirmed, laparoscopic procedures should be included in routine therapy for patients with endometrial cancer.

Adenocarcinoma↗

PubMedDate not supplied

Implementation of advanced laparoscopy into daily gynecologic practice: difficulties and solutions.

BACKGROUND: The implementation of laparoscopy into Dutch gynecologic practice is slow. This study was conducted to assess the current state of laparoscopy, to identify factors influencing the implementation and to find solutions toward a better implementation. METHODS: In 2003 a questionnaire was sent to all 151 gynecologists who finished residency within the previous 5 years. The questionnaire addressed practice demographics, performance of laparoscopy, factors influencing use of laparoscopy in practice and means of obtaining laparoscopic skills after residency. RESULTS: Of 151 gynecologists, 124 (82%) responded, 46 (37%) male and 78 (63%) female. Mean age was 39 years (range 32-47 years). Respondents (73%) believed they were adequately trained during residency for basic laparoscopic procedures, but not for the more advanced procedures (82%). Lack of caseload, lack of being a primary surgeon, and lack of simulator training caused the deficiency of laparoscopic skills at the end of the residency. Causes of the slow implementation were long operating time, lack of attention for laparoscopy during residency, and budgetary problems, but not the financial compensation for gynecologists. In current practice, only 9% believed they reached their preferred level of competence. Hiring an advanced laparoscopic gynecologist was believed to be the best opportunity to reach the preferred level of competence. A minority of respondents supported a referral system or fellowship program. CONCLUSIONS: Basic laparoscopy is sufficiently mastered during residency training; however, advanced laparoscopy is not. More emphasis should be placed on laparoscopic training of advanced procedures during residency and for gynecologists in practice. Hiring a gynecologist with advanced laparoscopic skills is expected to be the solution for this problem. However, a referral system or fellowship program is not.

Adult↗

PubMed2006

Diagnostic and therapeutic laparoscopy in pediatric abdominal trauma.

PURPOSE: The purpose of this study is to assess the role of emergent laparoscopy as a diagnostic and potentially therapeutic modality in pediatric trauma. We hypothesize that diagnostic laparoscopy provides important information for the treatment of children with abdominal trauma and is accompanied by improved diagnostic accuracy, reduction of nontherapeutic laparotomy rates, and a reduction of morbidity. METHODS: A 5-year (January 2000-December 2004) retrospective review of a pediatric level I trauma center database was performed after institutional review board approval was obtained, and information regarding patients who had operations for abdominal trauma was abstracted. Demographic variables, mechanism of injury, operative interventions, and patient outcomes were examined. Statistical analysis was performed using descriptive statistics and Student's t test (P < .05). RESULTS: There were 7127 trauma admissions, of which 113 had abdominal explorations for blunt (88%) and penetrating (12%) trauma. Thirty-two (28%) patients had laparoscopy performed. Laparotomy was avoided in 56% of these patients. Laparoscopic therapeutic interventions were performed in 6 (19%) patients. Laparoscopy assisted in the diagnosis and subsequent conventional repair of perforated viscera in 10, diaphragmatic rupture in 3, and distal pancreatic injury in 1. Patients who had a laparoscopic procedure of any kind were less severely injured leading to significantly lower number of intensive care unit (0.6 +/- 1.6, P = .0004) and hospital days (7.4 +/- 5.6, P = .002) than patients who had a laparotomy (3.7 +/- 7.1 and 12.5 +/- 11.4). No injuries were missed, or technical complications occurred, as a result of laparoscopic explorations. There were 6 deaths in the laparotomy group. No patients who underwent laparoscopy died. CONCLUSION: Laparoscopy in pediatric trauma is a safe method for the evaluation and treatment of selective blunt and penetrating abdominal injuries in hemodynamically stable patients. Laparoscopy serves as a diagnostic tool in abdominal trauma, which reduces the morbidity of a negative laparotomy.

Abdominal Injuries↗

PubMed2006

Laparoscopy vs minilaparotomy and full laparotomy preserves circulatory but not peritoneal and pulmonary immune responses.

PURPOSE: Laparoscopy has been associated with lower inflammatory responses. However, it has been postulated that minilaparotomy, in contrast to full laparotomy, is equally minimally invasive. OBJECTIVE: The aim of this study was to investigate local, systemic, and distant organ immune responses after different surgical approaches to the abdominal cavity, such as minilaparotomy, full laparotomy, and laparoscopy, in a small animal model. METHODS: Male Lewis rats received a permanent central venous catheter and were randomized to 4 groups (n = 6 per group). The animals were subjected to anesthesia alone (control), minilaparotomy (1 cm), full laparotomy (7 cm), or laparoscopy for 60 minutes. Blood was collected via the central venous catheter before as well as 1 hour and 6 hours after the start of intervention. Peritoneal and bronchoalveolar lavages, as well as heart puncture, were performed after 24 hours. RESULTS: All surgical interventions led to a significant migration of polymorphonucleocytes into the abdominal cavity. Full laparotomy resulted in a significant increase in nitric oxide production by peritoneal macrophages as compared with control. Macrophage nitric oxide production after laparoscopy and minilaparotomy was not significantly different. A shift in the expression of OX-6 and CD54 was only detected after full laparotomy. Systemically, O(2)(-) release by circulating mononuclear cells was significantly increased after minilaparotomy and full laparotomy, but not after laparoscopy. The systemic levels of IL6 were significantly accelerated only after full laparotomy, with a maximum after 6 hours. In the lungs, function of alveolar macrophages was not altered in any group. CONCLUSIONS: Any approach to the peritoneal cavity causes local inflammatory responses. Full laparotomy alters peritoneal macrophage functions more pronouncedly than does minilaparotomy or laparoscopy. Systemic inflammatory responses, such as free oxygen radical release, are significantly increased by both minilaparotomy and full laparotomy, whereas laparoscopy preserves systemic immune function. Our results may lead to further preference for the laparoscopic approach over minilaparotomy and full laparotomy.

Abdomen↗

PubMed2006

Negative laparoscopy is highly predictive of negative second-look laparotomy following chemotherapy for ovarian, tubal, and primary peritoneal carcinoma.

OBJECTIVE: To determine the negative predictive value of second-look laparoscopy compared to laparotomy for assessment of pathologic complete response (CR) in patients with epithelial ovarian, tubal, and peritoneal carcinoma who achieved a clinical CR. METHODS: Data were analyzed from patients who participated in two sequential phase II clinical trials following primary cytoreductive surgery. Both trials required surgical evaluation for pathologic CR in those patients who achieved clinical CR. Protocol specified that assessment begin with laparoscopy; if negative, conversion to laparotomy was required. Collection of peritoneal washings was performed laparoscopically. RESULTS: One hundred thirty-six patients entered the 2 sequential clinical trials. Ninety-nine patients achieved clinical CR and 95 underwent second-look surgery (SLO). Seventy patients began SLO with laparoscopy and converted to planned laparotomy after biopsies were negative. Eighteen cases were positive based on laparoscopy with frozen section. Five additional patients had peritoneal washings and/or permanent pathology positive based on laparoscopic findings, yielding a positive SLO rate of 32.9%. Four of the 52 patients who underwent laparotomy (7.7%) were found to have persistent disease that was not detected on laparoscopic biopsy or washings and represent false-negative laparoscopy; all four patients had disease at peritoneal-based sites. The sensitivity and negative predictive value for intraoperative diagnosis of persistent disease by laparoscopy were 66.6% and 82.7%, respectively. The sensitivity and negative predictive value of laparoscopic peritoneal biopsies and washings compared to laparotomy, as determined by final pathology, were 85.2% and 91.5%, respectively. CONCLUSION: A negative second-look laparoscopy with negative peritoneal pathology and cytology is 91.5% predictive of negative laparotomy and is associated with a low complication rate even in the setting of prior extensive cytoreductive surgery. The small increase in sensitivity and negative predictive value afforded by laparotomy does not warrant the increased morbidity.

Adult↗

PubMed1997

Laparoscopy during pregnancy: a study of five fetal outcome parameters with use of the Swedish Health Registry.

OBJECTIVE: Our purpose was to compare five fetal outcome variables between laparoscopy and laparotomy performed during pregnancy with use of the Swedish Health Registries from 1973 to 1993. STUDY DESIGN: A dataset was produced by linking computerized records from three Swedish Health Registries. The dataset includes records for women who were delivered between 1973 and 1993 and had an operation within 1 year before giving birth. The data were divided according to surgical procedure(s) and grouped according to diagnostic code(s). The following end points were studied in singleton births: birth weight, gestational duration, intrauterine growth restriction, congenital malformations, stillbirths, and neonatal deaths. In the analysis confounding by maternal age and parity, year of birth of the infant, maternal smoking, period of involuntary infertility, and maternal cohabitation was taken into consideration. A chi 2 analysis was used to compare proportions. Variables were stratified with use of the Mantel-Haenszel procedure. Risk ratios were calculated for observed/expected ratios when outcomes for the total population were compared or as odds ratios when laparoscopy and laparotomy cohorts were compared. Expected values were calculated from the total population of women with singleton pregnancies. RESULTS: The study covered 2,015,000 deliveries in Sweden from 1973 to 1993. Data for this study were restricted to singleton pregnancies who had nonobstetric operations between the fourth and twentieth weeks of pregnancy. Too few laparoscopic procedures were performed after 20 weeks to allow comparison. A total of 2181 laparoscopies and 1522 laparotomies met criteria for analysis. There were no significant differences between the two groups in any demographic variable. Pregnancies with operations were compared with the total population for birth weight, gestational duration, growth restriction, infant survival, and fetal malformations. On the basis of relative risks, there was an increased risk for infants in both laparoscopy and laparotomy groups to weigh < 2500 gm, to be delivered before 37 weeks, and to have an increased incidence of growth restriction compared with the total population. There was no difference between laparoscopy and laparotomy in cumulative infant survival up to 1 year (odds ratio 0.85, 95% confidence interval 0.48 to 1.51). There was no difference in the rate of fetal malformations between laparoscopy (risk ratio 1.09, 95% confidence interval 0.90 to 1.11), laparotomy (risk ratio 1.08, 95% confidence interval 0.85 to 1.11), and the total population. CONCLUSION: There is no difference in five fetal outcome variables for patients undergoing laparoscopy versus laparotomy in singleton pregnancies between 4 and 20 weeks of gestation.

Adolescent↗

PubMed1998

Laparoscopy versus laparotomy: an evaluation of adhesion formation after pelvic and paraaortic lymphadenectomy in a porcine model.

OBJECTIVE: Our purpose was to determine whether there is a difference in adhesion formation after pelvic and paraaortic lymphadenectomy with transperitoneal laparoscopy compared with both extraperitoneal laparotomy and transperitoneal laparotomy in a porcine model. STUDY DESIGN: Ninety female hogs underwent pelvic and paraaortic lymphadenectomy: 40 with transperitoneal laparoscopy, 40 with extraperitoneal laparotomy, and 10 with transperitoneal laparotomy. Three weeks after the initial surgery, a laparotomy was performed to assess adhesion formation. RESULTS: The transperitoneal laparotomy group had significantly higher adhesion formation, with a 100% (10 of 10) adhesion rate. In the transperitoneal laparoscopy group, 12 of 40 hogs (30%) had adhesions develop versus 8 of 38 (21%) in the extraperitoneal laparotomy group (p = not significant). Also no differences were found in the transperitoneal laparoscopy and extraperitoneal laparotomy groups when comparing adhesion thickness or the total surface area of adhesions. More anterior abdominal wall adhesions were noted in the extraperitoneal laparotomy group (5 of 38) than in the transperitoneal laparoscopy group (0 of 40, p = 0.02). CONCLUSIONS: Pelvic and paraaortic lymphadenectomy performed with transperitoneal laparoscopy does not increase adhesion formation when compared with extraperitoneal laparotomy in a porcine model. The transperitoneal laparoscopy (and extraperitoneal laparotomy) approach also induces significantly fewer adhesions than transperitoneal laparotomy.

Animals↗

PubMed1999

Trocar implantation metastasis after laparoscopy in patients with advanced ovarian cancer: can the risk be reduced?

OBJECTIVE: The purpose of this study was to determine risk factors for trocar implantation metastasis after diagnostic laparoscopy in patients with primary or recurrent advanced ovarian cancer. STUDY DESIGN: Eighty-three women with primary advanced ovarian cancer and 21 women with recurrent ovarian cancer undergoing a laparoscopy for a tissue diagnosis and for assessment of operability were included in the study. The occurrence of implantation metastasis at the trocar incision scars was analyzed according to clinicopathologic characteristics. RESULTS: A recurrence developed at the trocar site in 7 (58%) of 12 patients undergoing a laparoscopy in which only the skin was closed at the end of the procedure and in 2 (2%) of 92 patients undergoing a laparoscopy with closure of all layers (odds ratio, 63; 95% confidence interval, 10.3-385; P <.001). The International Federation of Gynecology and Obstetrics stage at initial presentation, tumor histologic type, tumor differentiation, maximal tumor diameter at the time of diagnosis, estimated weight of the metastatic tumor, residual tumor after cytoreductive surgery, surgical characteristics, and type of chemotherapy were well balanced among both groups. Patients with implantation metastasis had significantly more ascites (median, 700 mL vs 300 mL; P =.032) and a longer interval between the start of platinum-based chemotherapy or cytoreductive surgery (median, 6 days vs 17 days; P <.01) compared with patients without abdominal wall recurrence. A palpable abdominal wall metastasis developed in none of the patients undergoing a laparoscopy with closure of all layers of the abdomen followed by cytoreductive surgery or chemotherapy within 1 week after the laparoscopy. Kaplan-Meier survival analysis showed that patients with abdominal wall implantation metastasis had a survival rate similar to that of the other patients. CONCLUSIONS: Laparoscopy with careful closure of the peritoneum, rectus sheath, and skin followed by chemotherapy or cytoreductive surgery with excision of the trocar trajectories within 1 week is safe in patients with disseminated ovarian cancer.

Abdominal Muscles↗