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At least 19 recordsLinked to original sources
PubMed1976

[The risk of cardiac arrest during laparoscopy. A study of 50,000 laparoscopies and animal experimentation].

In a French national enquiry into 50,000 laparoscopies it emerges that the number of cardiac arrests works out at 1 in 2,000. The percentage of reversible cardiac arrests was 1 in 2500 and of irreversible cardiac arrests 1.2 in 10,000. 25 cases were studied in great detail, both clinically and physiopathologically. This was thanks to a very full questionnaire most kindly filled up by those who had told us that this type of accident had happened in their practice. The physiopathogenesis of circulatory arrests during laparoscopy is complex. It appears however that among the different potentiating factors are changes in haemodynamics and biological changes that give rise to the greatest risks. Experimental work carried out with a long-tailed baboon was performed by the authors with the idea on the one hand of confirming that haemodynamic and biological troubles resulting from the pneumoperitoneum were important and on the other hand of analysing the changes in detail and of working out prophylactic principles for the anaesthetist and the laparoscopist.

Animals↗
PubMedDate not supplied

A comparative study of the tubal ring applied via minilaparotomy and laparoscopy in postabortion cases.

Sterilization with tubal rings applied via minilaparotomy or laparoscopy was performed on 300 randomly selected postabortion subjects to evaluate the safety and effectiveness of the two surgical methods. One hundred and forty-nine procedures were performed by minilaparotomy and 151 by laparoscopy. Gas leakage due to equipment problems was the most common technical difficulty during laparoscopy, and difficulty in exteriorizing the tubes was the most common surgical difficulty. Women undergoing laparoscopy experienced significantly less pain during surgery and had significantly lower rates of immediate and early postoperative complications than those women undergoing minilaparotomy. The rates of gynecologic abnormalities at six and 12 months were similar for both procedures. At this writing, no pregnancies have been reported among the study subjects. The results of our study indicate that laparoscopy is superior to minilaparotomy when it is performed in a controlled hospital situation.

Abortion, Induced↗
PubMed1976

A comparative study of hysterosalpingography and laparoscopy in the investigation of infertility.

A comparison of hysterosalpingography and laparoscopy was carried out on 79 infertile women. Out of these, 60 had abnormal and 19 had normal hysterosalpingograms. Of the 19 patients with normal X-rays, nine (47%) had abnormal findings during laparoscopy. In 62% of patients with abnormal hysterosalpingograms, laparoscopic findings confirmed the radiological diagnosis, however in 38% the findings differed. Though hysterosalpingography is an important part of infertility evaluation, a final and definite diagnosis requires endoscopic evaluation of the pelvis.

Female↗
PubMed1978

Laparoscopy for the confirmation and prognostic evaluation of pelvic inflammatory disease.

A presumptive diagnosis of pelvic inflammatory disease (PID) is usually made in our gynecologic clinics when obscure, acute lower abdominal pain is accompained by fever and abnormal vaginal discharge, urinary and rectal discomfort, marked tenderness of the pelvic organs to palpation, or pelvic masses. In the present study, during a 2-year period, 223 women underwent laparoscopy to confirm this diagnosis. PID was confirmed in 103 (46.2%) of the cases; other serious conditions were diagnosed in 69 (30.9%) of the cases; and no evidence of disease was found in 51 (22.9%) of the cases. The authors conclude that laparoscopy is a valuable tool in the diagnosis of PID.

Diagnosis, Differential↗
PubMed1978

Diagnostic laparoscopy.

Six hundred fifty-eight laparoscopies were performed at St. Luke's Hospital, Kansas City, Missouri, USA, between March 1, 1976 and February 28, 1977. One hundred sixty-eight (25.5%) were performed for diagnostic purposes. A review of the preoperative diagnoses and the laparoscopic findings demonstrates the value of laparoscopy as a diagnostic procedure.

Acute Disease↗
PubMed2026

Intravenous lidocaine reduces the propofol EC50 for loss of consciousness and intraoperative anesthetic consumption in gynecological laparoscopy: A randomized controlled trial.

BACKGROUND: Intravenous lidocaine reduces propofol requirements and procedure-related adverse events. OBJECTIVES: The study aimed to test whether intravenous lidocaine would reduce the effect-site concentration of propofol required to achieve loss of consciousness and decrease propofol consumption during total intravenous anesthesia in gynecological laparoscopy. METHODS: This was a prospective, randomized, double-blind, placebo-controlled trial. Sixty patients were randomly allocated to receive either intravenous lidocaine (1.5 mg·kg-¹ bolus) followed by continuous infusion or an equal volume of saline. Propofol was administered via target-controlled infusion starting at an effect-site concentration of 3.5 μg/mL. The concentration was then adjusted in steps of 0.5 μg/mLaccording to Dixon's up-and-down sequential method: decreased if loss of consciousness was achieved, or increased if not. Loss of consciousness was defined as loss of response to verbal commands. The median effective concentration (EC50) of propofol for inducing loss of consciousness was calculated using the Dixon's up-and-down method. General anesthesia was maintained with propofol and remifentanil, guided by state entropy (target 40-60) and surgical pleth index (target 20-50). Drug consumption was normalized to anesthesia duration and body weight. RESULTS: The estimated EC50 of propofol for inducing loss of consciousness was significantly lower in the lidocaine group than in the saline group (3.32 μg/mL, 95% Confidence Interval (CI): 3.04-3.59 vs. 3.89 μg/mL, 95% CI: 3.50-4.28). Under the study protocol, the lidocaine group also required less propofol (8.62 mg·kg-1·h-1, 95% CI: 8.10-9.15 vs. 9.89 mg·kg-1·h-1, 95% CI: 9.05-10.73) and less remifentanil (0.23 μg·kg-1·min-1, 95% CI: 0.21-0.24 vs. 0.27 μg·kg-1·min-1, 95% CI: 0.24-0.30) compared with the saline group. CONCLUSION: Intravenous lidocaine reduced the propofol EC50 for Loss of Consciousness (LOC) and decreased intraoperative propofol and remifentanil consumptions in patients undergoing gynecological laparoscopy. These findings suggest a propofol- and opioid-sparing effect of intravenous lidocaine in this setting, although confirmation in larger multicenter trials is needed.

Humans↗
PubMed2026

Nondominant Hand Training in Laparoscopy for Surgical Interns: Feasibility and Impact.

OBJECTIVE: Laparoscopy requires bimanual proficiency, yet early trainees demonstrate underdeveloped nondominant hand (NDH) performance. Although deliberate practice of NDH skill contributes to overall performance, NDH training is rarely incorporated into residency simulation curricula and has not been formally evaluated in surgical trainees. We assessed feasibility and impact of integrating structured NDH training with established laparoscopic curriculum for surgery interns. DESIGN: Prospective, single-institution randomized pilot study. Interns were assigned the standard 4-week curriculum of laparoscopic dominant hand and bimanual tasks (Control) or completed assigned NDH tasks in addition to the standard curriculum (Intervention). Feasibility was determined by assigned task completion, daily standard and NDH-specific self-reported practice time, and improvement in bimanual task performance. Performance was video recorded weekly and assessed by blinded evaluators using MISTELS and GOALS scoring. Cognitive workload during laparoscopic tasks was measured via NASA-TLX. Exploratory analyses were conducted within a Bayesian framework. SETTING: A single academic institution with a surgical simulation training program. PARTICIPANTS: General surgery interns on their 4-week simulation rotation. RESULTS: Eleven general surgery interns (6 intervention, 5 controls; all right-hand dominant) completed the study with 100% task completion and practice log compliance. Both groups improved in bimanual performance and perceived cognitive load. Reduction in cognitive workload during bimanual task performance was greater in the NDH group. Time spent on NDH practice over 4 weeks was associated with improved bimanual performance, independent of time spent on standard curriculum tasks. CONCLUSIONS: Structured NDH training is feasible to implement within an existing curriculum and reduces perceived cognitive workload during bimanual laparoscopic tasks. NDH practice demonstrates a beneficial dose-response relationship with performance, supporting its integration into early laparoscopic training.

Laparoscopy↗
PubMed1976

A comparison of laparoscopy and culdoscopy for internal sterilization.

In recent years, the increased demand for sterilization by women who have achieved their desired family size has emphasized the need to improve both existing methods of tubal occlusion and the means of access to the Fallopian tubes. Utilization of diagnostic instruments such as the laparoscope and culdoscope to perform sterilization minimizes the trauma associated with standard laparotomy and colpotomy and promises to reduce morbidity occurring as a result of sterilization. In order to evaluate and compare the improved techniques of laparoscopy and culdoscopy for elective interval sterilization, 722 women were studied between January and August of 1973 at the Siriraj Hospital in Bangkok. For 279 patients (Group I), sterilization was performed by culdoscopic tubal ligation using a modified Pomeroy technique; for 443 patients (Group II), the procedure used was laparoscopic tubal cauterization and cutting. All procedures were performed using local anesthesia on an outpatient basis. Complication rates and required surgical time were similar for both procedures and compared favorably with rates reported by other investigators. Because of a low incidence of complications and the elimination of the need for general anesthesia and hospitalization, both endoscopic procedures appear to be of particular value in developing countries where hospital facilities and physician time are in short supply.

Adult↗
PubMed1976

Ventilatory and blood gas changes during laparoscopy with local anesthesia.

A study was performed on a series of healthy patients undergoing laparoscopy for tubal ligation with local anesthesia in a non-operating room setting. Ventilatory parameters, blood gas, pH, blood pressure, and pulse were monitored. The results revealed that no adverse effect on hemoglobin saturation or carbon dioxide exchange were found when fentanyl alone was used as a supplementary analgesic. An occasional vagal reflex was observed, and it is recommended that an intravenous line be established in the event that pharmacologic intervention should become necessary. Nitrous oxide produced les with this minimal analgesia.

Adult↗
PubMed1978

Acid aspiration during laparoscopy.

The prophylactic efficacy of pre-operative antacid administration was shown by comparing the pH and volumes of gastric contents in 50 female patients treated with 10 ml of Mist. Magnesium Trisilicate B.P.C. with that of 50 controls. Routine antacid prophylaxis was advocated for all patients undergoing pelvic laparoscopy as intra-operative conditions increase the risk of pulmonary acid aspiration.

Adolescent↗
PubMed1979

Acid-base balance during laparoscopy. The effects of intraperitoneal insufflation of carbon dioxide and nitrous oxide on acid-base balance during controlled ventilation.

During laparoscopy the carbon dioxide used to achieve a pneumoperitoneum is absorbed from the peritoneal cavity into the blood. The object of the present study was to clarify certain aspects concerned with anesthetic and ventilatory techniques, mostly in connection with the comparison between the effects of insufflation of either carbon dioxide or nitrous oxide. Anesthesia included ventilation with a volume controlled ventilator in curarised patients. Respiratory volumes were calculated according to the patient's body area. The results show a sharp rise in PaCO2 and a fall in pH after intraperitoneal insufflation with carbon dioxide, while no changes were observed when nitrous oxide was used. The clinical consequences of these findings are discussed.

Acid-Base Equilibrium↗
PubMed1976

A comparative study of electrocoagulation and tubal rings for tubal occlusion at laparoscopy.

The surgical and early postoperative complications and complaints associated with laparoscopic sterilization using electrocoagulation or tubal rings for tubal occlusion were evaluated in a comparative study. Procedures were randomly assigned to subjects (electrocoagulation to 151 subjects and tubal rings to 148 subjects). Difficulties in carrying out the sterillization procedures occurred more frequently when tubal rings were used (6.1%) than when electrocoagulation was used (2.0%). Rates of complications occurring at the time of surgery were similar for the two procedures. However, one patient in the electrocoagulation group had a bowel burn. Postoperative pelvic and abdominal pain were reported by a significantly higher proportion of the tubal ring cases (32.0%) than electrocoagulation cases (19.4%). It appears that although the incidence of surgical difficulties and pain may be somewhat more frequent with the tubal ring, the avoidance of such potentially serious complications as bowel burns may make femal sterilization by the tubal ring method preferable.

Electrocoagulation↗
PubMedDate not supplied

Tubal occlusion via laparoscopy in Latin America: an evaluation of 8186 cases.

Ease of performance, safety and effectiveness of laparoscopic sterilization techniques are evaluated for 8186 procedures (6995 interval, 680 postabortion and 511 postpartum) performed in Latin America from June 1972 through February 1978. The tubes were occluded via electrocoagulation or application of the spring-loaded clip or the tubal ring. Less than 1% of the procedures were declared technical failures (ie, those which were not completed as planned). For all the tubal occlusion techniques, interval patients had the lowest rate of surgical complications. Pregnancy rates were low for the electrocoagulation and for the tubal ring techniques; patients sterilized by the spring-loaded clip, however, had a significantly higher pregnancy rate.

Actuarial Analysis↗