摘要:

Summary:Many advanced laparoscopic cases remain technically difficult and are less widely accepted. To a great extent, advanced laparoscopic surgery is handicapped by the loss of a surgeon's tactile sense. The concept of introducing the surgeon's hand as an aid to minimally invasive surgery has been described. We report a new hand-assist device designed to allow the introduction of the surgeon's hand, wrist, and forearm through a small incision in the abdomen to assist laparoscopic surgery with pneumo-peritoneum. Important factors in the hand-assist design are ease of use, reliable maintenance of pneumoperitoneum, and minimal hand/arm fatigue, which were met with this device.

ISSN:1051-7200    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Summary:We used laparoscopic surgery assisted by a transvaginal approach for gastrointestinal diseases. In the first case, a huge submucosal tumor enucleated laparoscopically from the minor curvature of the stomach was extracted through the vagina. In the second case, partial resection of the rectum to treat rectal endometriosis was performed laparoscopically with the assistance of manual handling inserted trans-vaginally. Although it can be applied only to female patients, especially to multipara, the vagina as an access point to the abdominal cavity can be widely used for various purposes in laparoscopic surgery.

ISSN:1051-7200    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Summary:We report the case of a 38-year-old man who, 2 weeks after a laparoscopic Nissen fundoplication, was referred to our Unit because of acute wrap herniation and intrathoracic gastric perforation. Although both of these complications have already been described, this is the first case in which they have occurred simultaneously and not as an immediate consequence of the operation. Intraoperative findings suggested that diaphragmatic crura had not been reapproximated and that the gastric wrap had not been fixed to them. This observation and the fact that immediately after hospital discharge the patient had sustained intense physical efforts can explain acute wrap herniation. Placement of full-thickness sutures may account for gastric perforation. These pathogenetic determinants and their preventive measures are discussed in the light of a review of the literature.

ISSN:1051-7200    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Summary:Trocar injuries to the small bowel during laparoscopic hernia repair are a rare complication, the most common complications being postoperative neuralgias, scrotal swelling, scrotal ecchymosis, and hematoma. A 15-year-old boy was admitted 5 days status-post transabdominal laparoscopic inguinal hernia repair of a symptomatic right pantaloon hernia, with signs and symptoms of a retrocecal abscess. Despite laparotic intervention and appendectomy, the next 2 years passed with almost daily, purulent, right lower quadrant wound drainage, in an otherwise asymptomatic patient. Superficial wound exploration and sinogram in 1996 revealed a sinus tract in direct communication with the small bowel. Elective laparotomy in December 1997 involved a successful resection of a 2.5-cm fistula with involved mesh, and the communicating small bowel through a midline incision, followed by a primary closure of the small-bowel opening. The patient has recovered without complications.

ISSN:1051-7200    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Summary:Right-sided colonic diverticulitis is an uncommon disorder that most frequently mimics appendicitis. During pregnancy, displacement of the diseased cecum and ascending colon into the right upper quadrant may result in symptomatology that mimics cholecystitis. A 37-year-old white woman with a history of previous benign incidental appendectomy presented at 20 weeks' gestation with right upper abdominal pain and nausea for 2 days. Significant findings included local rebound tenderness and palpable fullness over the gallbladder, leukocytosis, and low-grade fever, but otherwise unremarkable routine serum laboratory test results and sonographic evidence of biliary tract disease. Cholescintigraphy was rejected by the patient. Persistence of symptoms for 3 hospital days despite administration of broad-spectrum parenteral antibiotics prompted surgical intervention. Laparoscopy demonstrated a normal-appearing gall-bladder and an acutely infected, solitary diverticulum of the midascending colon with adhesions to the omentum and to the parietal peritoneum near the gallbladder. Adhesiolysis, omental biopsy, and peritoneal drainage were performed endoscopically. The patient recovered uneventfully and delivered vaginally at term without fetal or maternal complications. Right-sided colonic diverticulitis may present during pregnancy and may mimic symptoms of acute cholecystitis. Laparoscopic treatment of a solitary, acutely infected colonic diverticulum is feasible in this setting.

ISSN:1051-7200    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Summary:A 50-year-old woman presented with an adenocarcinoma at a port site of a previous laparoscopic cholecystectomy. A thorough investigation and exploratory laparotomy with excision of the tumor failed to detect its origin.

ISSN:1051-7200    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Summary:We report a case of a giant bulla in a 16-year-old boy who was oxygen and wheelchair dependent. He had been diagnosed with Marfan's syndrome and had severe kyphoscoliosis. The giant bulla occupying his entire left thoracic cavity compressed the contralateral lung. Until referral to our hospital, a bullectomy had been deferred during the preceding 5 years because of his poor pulmonary function and severe chest wall deformity. The patient was considered a candidate for thoracoscopic bullectomy. A stepwise resection technique was used. First, the bulla should be emptied by aspiration or wall perforation. Second, the redundant wall of the bulla should be resected by a looped ligation without opening the cavity. Third, a stapled resection of the downsized bulla should be performed. After a successful bullectomy, his subjective symptoms and pulmonary function improved. The reduction of the bulla makes bullectomy easily and decreases the number of staplers, and reduces operating time compared with opening the bulla and suturing it. Therefore, when treating a giant bulla, we recommend a stepwise resection technique.

ISSN:1051-7200    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Summary:A patient with a history of intermittent and intense pain in the upper abdomen secondary to an ulcer of a duodenal diverticulum underwent laparoscopic treatment. The diverticulum measured 2.5 cm in diameter and it was located on the lateral wall of the second portion of the duodenum. The diverticulum was inverted and the duodenal muscular defect was closed with interrupted sutures. Ambulation and a clear liquid diet was started on the same day as the operation, and the patient was discharged on the first postoperative day.

ISSN:1051-7200    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Summary:Various techniques have been reported for the laparoscopic treatment of benign gastric lesions, depending on the site of the lesion. Recently, a new technique of endo-organ gastric surgery has been developed that is particular useful for the treatment of lesions on the posterior gastric wall. We report on two patients with submucosal gastric tumors. A 79-year-old man was found to have a submucosal tumor near the esophagogastric junction in the posterior wall of the stomach. Endosonography suggested that the tumor was a gastric leiomyoma. Under endoscopic guidance, three ports were inserted into the stomach and the tumor could be successfully enucleated. A 78-year-old woman was found to have a 2 x 1cm submucosal tumor at the anterior wall of the antrum. The tumor was successfully removed by laparoscopic gastrotomy and resection. The various laparoscopic techniques for the treatment of gastric lesions are discussed.

ISSN:1051-7200    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:1051-7200    

出版商:OVID    

年代:1999

数据来源: OVID