摘要:

SummaryThe technical development of equipment in the last decade has resulted in a rapid expansion in the range of procedures capable of being performed safely by a laparoscopic technique. For many procedures, the first step is induction of a pneumoperitoneum. This has inherent danger, and there is disagreement on the preferred technique. The Veress needle is an instrument developed in the 1930s that has continued to be used into the 1990s. In view of the controversy about its present role, the authors reviewed the article that provided the original description of the needle. This review demonstrates that the designer had a clear intention for its use and an understanding of the hazards involved. In his hands, the complications were few. A translation of the article from German into English is provided.

ISSN:1051-7200    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

SummaryThe characteristic working situation in laparoscopic surgery involves elongated instruments and limited mobility of the surgeon during the operation. These circumstances require new technical solutions to enhance the surgeon's comfort. In other surgical fields with special ergonomic situations, such as microsurgery, some surgeons prefer to operate from a seated position at the operating room table. We developed a new surgeon's chair dedicated to the ergonomic and functional requirements of laparoscopic surgery. The chair allows the surgeon to maintain a semi-standing position during the operation. Foot pedals for high frequency and suction/irrigation are integrated into the base of the chair. The pedals are purposely aligned to be comparable to foot pedals in a car. The chair is driven by electromotors, controlled with a special foot switch that operates independent of assisting personnel during surgery. Initial clinical testing of the chair could prove the theory that supporting the surgeon with a cockpit type of operating room chair helps to avoid fatigue during long endoscopic procedures. Such assistance is especially important in combination with robotic devices for use during solo surgery.

ISSN:1051-7200    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

SummaryAs technology and surgeon experience expand, laparoscopic surgery is playing a larger role in the treatment of gastric conditions. We present our technical approach to various laparoscopic gastric resections and outline our preliminary results. Contrary to the majority of publications on laparoscopic gastric resection, we believe gastric mobilization should be carried out by incising the avascular plane between the greater omentum and transverse colon. This gives easy access to the origin of the left gastric artery and permits an acceptable D1 oncologic resection. For small lesions, tumor localization and resection margins should be mapped with the aid of routine intraoperative endoscopy. Nine patients underwent formal gastric resections, six of which were done for malignancy. Median time to discharge and length of follow-up were 4.5 days (range 3–10) and 25 months (range 24–35), respectively. One patient died postoperatively, and the remaining five patients operated for malignancy are alive and well with no evidence of recurrent disease or port site metastases.

ISSN:1051-7200    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

SummaryOne of the most serious complications of percutaneous endoscopic gastrostomy (PEG) is premature removal of the gastrostomy tube. In an attempt to clarify the optimal therapy of this complication, the records of 197 patients undergoing PEG were reviewed. Six patients whose PEG tubes were removed 2.9 ± 1.3 days after placement were identified; only one patient required an emergent operation. The patients managed nonoperatively were treated by immediate replacement of tubes through the tracts (two patients), observation prior to repeat PEG (two), and delayed laparoscopic gastrostomy (one). Nonoperative management is feasible in the majority of patients suffering this complication. When an operation is indicated because of suspected intraperitoneal spillage, laparoscopy allows wide visualization and irrigation of the peritoneal cavity, closure of the gastrotomy, and placement of new enteral access while avoiding the morbidity associated with laparotomy in these often-debilitated patients.

ISSN:1051-7200    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

SummaryIn our initial experience of four cases from March to November 1994, large paraesophageal hernias were repaired by conventional primary closure of the hiatus with interrupted, nonabsorbable sutures, adding a 360° fundoplication. In all four cases the hernia recurred. Subsequently, we modified the procedure. The technique and results are described. From March 1995 to May 1998, 12 patients with paraesophageal hernia (4 following a previous Nissen procedure) underwent elective laparoscopic repair. In all patients a “tension-free” hiatoplasty and a floppy 360° fundoplication were performed. The hiatal defect was repaired with a polypropylene mesh, fixed to the diaphragm by staples. A gastrophrenic anchorage procedure was added in the eight patients undergoing surgery for the first time, utilizing the peritoneum of the hernia sac. There were no conversions to open surgery or intraoperative complications. Two patients developed postoperative pleural effusion, which was treated medically. Mean hospital stay was 5 days. Three patients developed postoperative transient dysphagia to solid food that lasted 10 days. At a mean follow-up of 22.7 months (range 1–40), all patients are asymptomatic without dysphagia, reflux, or hernia recurrence. Laparoscopic “tension-free” hiatoplasty, 360° fundoplication, and anterior gastrophrenic anchorage are effective in the treatment of large paraesophageal hernias.

ISSN:1051-7200    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

SummaryGallbladder rupture during laparoscopic cholecystectomy is a common event that may lead to increased postoperative morbidity. To evaluate this event, we reviewed 300 cases of laparoscopic cholecystectomy. Duration of surgery and hospitalization, postoperative symptoms, wound infection, and late complications were analyzed by comparing two groups of patients, one without gallbladder rupture (A) and one with rupture (B). Gallbladder rupture was found in 40 cases (13.9%). Duration of surgery averaged 81 min for group A and 96.5 min for group B. Postoperative symptoms in the first 24 hours were present in approximately 10% of patients in both groups. Within the first 24 hours, 92.3% of patients in group A were discharged compared with 85% in group B. One patient (0.4%) in group A developed wound infection compared with 2 patients (5%) in group B (p = 0.05). To date, no patients have developed late abdominal complications associated with the procedure. Although this was a retrospective and uncontrolled study, gallbladder rupture during laparoscopic cholecystectomy was found to be associated with increased wound infections. No other significant effects on postoperative morbidity were detected.

ISSN:1051-7200    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

SummaryThe aim of this study was to establish an anatomic rationale for liver bed arterial bleeding during laparoscopic cholecystectomy. Fifty consecutive human cadavers were dissected. A corrosion cast method was used. Six anastomotic branches (12%) of the cystic artery to the right or left hepatic artery ran underneath the gallbladder serosa surface and entered liver parenchyma after crossing the medial or lateral edge of the liver fossa without passing through the areolar tissue of the liver bed. Their mean length was 18.3 mm (range 4–60), and the mean diameter was 0.38 mm (range 0.2–0.8). Two cystic arteries that ascended in the midline between the gallbladder and liver bed were identified in 50 (4%) casts. Their lengths were 16 and 18 mm, and their diameters were 1.9 and 2.2 mm. Five and seven branches encircling the gallbladder arose radially. These two arterial branching patterns can cause arterial bleeding from the liver bed during and/or after laparoscopic cholecystectomy.

ISSN:1051-7200    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

SummaryWe conducted a retrospective analysis to assess the feasibility of laparoscopic appendectomy in cases of ruptured appendicitis. Between August 1993 and April 1998, a total of 328 laparoscopic appendectomies were performed in Min-Shen General Hospital. There were 34 cases of pathology-proven ruptured appendicitis. Patients were divided into three groups according to the operative findings: group 1 (10 cases) consisted of patients with a perforated appendix with local peritonitis, group 2 (15 cases) consisted of patients with perforated appendix with diffused peritonitis, and group 3 (9 cases) consisted of patients with abscess formation around the perforated appendix. Three cases in group 3 were converted to laparotomy and were excluded from this study. Mean age (± SD) was 30 ± 15 years in group 1, 39 ± 23 years in group 2, and 37 ± 13 years in group 3. Duration of symptoms was longer in group 3 (4.2 ± 1.2 days) than in group 1 (1.8 ± 1.3 days) and group 2 (2.3 ± 1.2 days). There was no difference in operation time among groups 1 (52 ± 10 min), 2 (64 ± 13 min), and 3 (67 ± 16 min). The time of flatus passage after operation was similar in the three groups (group 1, 17 ± 11 hours; group 2, 21 ± 12 hours; group 3, 24 ± 8 hours). Hospital stay was significantly shorter in group 1 (3.0 ± 1.1 days) than in group 2 (5.1 ± 2.2 days) and group 3 (4.2 ± 1.2 days). There were no complications and no readmissions. Our results indicate that the laparoscopic approach is feasible for ruptured appendicitis with local or diffuse peritonitis and in selected cases with abscess formation. However, prospective randomized controlled trials are needed to determine which procedure is to be recommended.

ISSN:1051-7200    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

SummaryEnthusiasm about the application of videolaparoscopy to oncologic diseases has been limited by the growing number of port site implants. Adult Wistar rats were submitted to 6–7 mm Hg carbonic gas pneumoperitoneum. Rats were randomly divided into two groups: group I rats with tumor (200,000 viable cells of Walker tumor) and group II rats with no tumor. The pneumoperitoneum was deflated after 30 min. Group I was further randomized into five groups: no treatment; or abdominal irrigation with saline, heparin, chemotherapy (doxorubicin), or chemotherapy associated with heparin. After a period lasting no more than 18 days, the abdominal wall and intraperitoneal organs macroscopically affected were studied histologically. Chemotherapy groups had no port site implants and were significantly different (p < 0.05) than the no treatment, saline, and heparin solution groups, which had incisional implants at frequencies of 100%, 85.7%, and 82.5%, respectively. Intraperitoneal irrigation with chemotherapy solution was effective in preventing incisional implants in this animal model.

ISSN:1051-7200    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

SummaryTo investigate the effects of laparoscopic surgery on the progression of cancers, it is necessary to establish a reliable and economical animal model. We describe a convenient murine pneumoperitoneal model for the study of laparoscopic cancer surgery. Under anesthesia using diethyl ether, peritoneal cavity was insufflated with gas through an intravenous catheter placed in the left lower quadrant. Syringe pump was used for continuous gas insufflation, and intraperitoneal pressure was measured. Intraperitoneal pressure increased and reached 10 cm H2O when 15 mL of CO2gas was injected, but fell to 1 cm H2O 5 min after stopping the injection. When the continuous flow was adjusted by syringe pump between 20 and 160 mL/hour, intraperitoneal pressure was easily maintained at 8 cm H2O for >60 min. We believe that this murine model for pneumoperitoneum may be useful for the study of laparoscopic cancer surgery.

ISSN:1051-7200    

出版商:OVID    

年代:1999

数据来源: OVID