摘要:

SummaryWe describe a new totally extracorporeal laparoscopy-assisted technique without insufflation of the peritoneum in the treatment of benign and malignant ascending and sigmoid colon lesions. Colon resection is performed using specially designed instruments that allow the surgeon to avoid insufflation of the peritoneum and, in case of cancer, allow for conventional lymphadenectomy. With this new technique, the restrictions associated with the laparoscopic technique are nullified, and the surgeon can directly examine intra-abdominal contents. Our preliminary results are encouraging and demonstrate the feasibility of this technique as well as its positive results in terms of curability in selected cases of colon cancer. Additional experience will delineate the real clinical value of this technique in the treatment of malignant disease.

ISSN:1051-7200    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryThoracoscopic (transthoracic endoscopic) sympathectomy, known worldwide as the best method for treatment of hyperhidrosis, is regarded as having two major contraindications: pleural adhesion and coagulopathy. We embarked on this study to prove that it is possible and highly feasible to do thoracoscopic sympathectomy, even in the presence of severe pleural adhesion, as long as the surgeon knows anatomy and is well-trained in performing this procedure. From October 1, 1989, through December 31, 1992, we treated 719 cases of hyperhidrosis palmaris (325 male and 394 female patients), by the thoracoscopic method at Tainan Municipal Hospital. Among them, 24 cases (3.5%), 19 male and 5 female patients, had concomitant pleural adhesions. The causes of pleural adhesion were pulmonary tuberculosis, chronic bronchitis, previous operations for hyperhidrosis, and a few with uncertain origins. Except for the first encountered case of hyperhidrosis with pleural adhesion, which was treated by mini-thoracotomy after failure of a thoracoscopic approach through the right thoracic cavity, the remainder of the 23 cases were treated successfully by the thoracoscopic method. In cases with bilateral pleural adhesions, the right thoracic cavity was more frequently involved and more severely. The incidence of pleural adhesion in hyperhidrosis is 3.5% in our series; all, except the first case, were treated thoracoscopically. Coagulopathy is for us, therefore, the only remaining contraindication of thoracoscopic sympathectomy.

ISSN:1051-7200    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryPercutaneous endoscopic gastrostomy (PEG) with the Ponsky “pull” technique has been the standard technique for pediatric gastrostomy tube placement since 1979. We evaluated safety and efficacy of PEG with the “push” technique and T-bar fixation. We reviewed PEGs performed in pediatric patients (≦ 17 years) over a 31-month period, excluding patients with previous abdominal surgery. We evaluated age, indications, location, time, and complications. Endoscopy was performed, the stomach insufflated, and the anterior abdominal wall transilluminated. T-bar fasteners were inserted percutaneously under endoscopic control. Fasteners were ejected from the needle tip with a stylet and secured. A 14 or 18 French gastrostomy tube was placed through the center of previously placed T-bar fasteners by using a modified Seldinger technique. Fifteen children (mean age, 9 years) underwent the procedure for the need for long-term enteral alimentation (severe closed head injury) (n = 7), for progressive neurologic dysfunction with feeding disorder (n = 7), or for failure to thrive (cystic fibrosis) (n = 1). No significant major postoperative complications occurred. The technique proved safe and effective for gastrostomy in children.

ISSN:1051-7200    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryLaparoscopic cholecystectomy (n = 250) was compared with the open procedure (n = 250) in a prospective comparative study focusing on complications. Severity grade was classified according to the Toronto system. The frequency of severity grade 1 complications was equal after open and laparoscopic cholecystectomy (5.6%), but major complications (grade 2 and higher) were significantly more frequent in the open group (10.4 versus 3.6%). The only postoperative death occurred after open cholecystectomy. The conventional advantages of laparoscopic cholecystectomy were also verified: The need for postoperative analgesics was significantly reduced from 7 (range, 4–16) standard opiate doses in the open group to 3 (range, 0–7) in the laparoscopic group. Hospital stay was reduced from 6 (range, 4–31) days after open surgery to 2 (range, 1–7) days after laparoscopic surgery and sick leave from 28 (range, 18–48) to 10 (range, 2–21) days, respectively. The overall complication rate was significantly higher in the open group (16 versus 9%, p < 0.01). In our hands, laparoscopic cholecystectomy carries a lower risk of serious complications than the open procedure.

ISSN:1051-7200    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryPreoperative common bile duct (CBD) clearance with endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES) is routinely performed in many centers where laparoscopic cholecystectomy (LC) is the procedure of choice for the treatment of cholelithiasis. The purpose of this study was to evaluate prospectively the results of the sequential endoscopic-laparoscopic management in patients with gallstones and suspected CBD stones. From November 1990 to May 1993, 700 consecutive patients were evaluated for LC. Preoperative workup included clinical history and physical examination; serum levels of bilirubin, alkaline phosphatase, and amylase; and ultrasonography. Preoperative ERCP was indicated in cases with previous or present jaundice or acute pancreatitis, altered liver or pancreatic blood tests, dilated CBD (>6 mm) and CBD stones at ultrasonography. If CDB pathology was confirmed, ES was performed and treatment attempted. All patients were assigned to undergo LC within 48 h. Morbidity, mortality, hospital stay, and disability were recorded. Of 700 patients, 49 (7%) underwent ERCP. In 26 patients (54.2%), CBD stones were identified; ES was performed and stone extraction succeeded in 22 patients (84.6%). Two patients with intrahepatic stones were successfully treated with a percutaneous transhepatic approach and then underwent surgery. Two patients with cholecystocholedochal fistula underwent open surgery. In two cases ERCP showed a papillary stenosis, which was treated with ES. Of 44 patients, 35 (79.5%) underwent LC within 48 h. The overall morbidity (ERCP/ES plus LC) was 10.4%. No mortality occurred. The mean hospital stay was 4.5 days. Return to normal activities occurred within 11 days after LC. This sequential approach resulted in a safe and effective treatment of cholecystocholedocholithiasis and a decrease in the overall costs.

ISSN:1051-7200    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryWe investigated the optimal position of the laparoscope in relation-ship to the working ports. The optical angle (&thetas;), defined as the angle formed by the line of action (determined by the working ports) and the line of vision (determined by the laparoscope), was varied by 30° intervals from 0° to 180° to the left and to the right. We also studied the time taken to accomplish a standardized task of tying a square knot with each optical angle in a laparoscopic simulator setting. The optimal position is at the optical angle of 0°. The optimal range of the optical angle is 60° to the left and 60° to the right of the optimal position of 0°.

ISSN:1051-7200    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryLaparoscopic techniques have only rarely been applied to procedures on the small bowel. A comparison of three handsewn intracorporeal anastomoses was carried out. Thirty pigs were divided into three groups, and a different technique was used in each group (SK, single knot; RS, running suture; CL, clip suture). Half of the animals had a relaparoscopy on day 4. The duration of the procedure was recorded, and the quality of anastomotic healing was assessed by morphological, radiological, mechanical, and biochemical examinations. The animals were sacrificed on postoperative day 14. The anastomoses in the SK group took significantly longer than in the RS or CL groups. The mean duration of relaparoscopy was 28 min. Bursting pressure values and hydroxyproline concentrations were without any significant difference. The SK and CL groups showed a good alignment of the layers and the RS showed necrosis and overlying mucosa. Most complications were noted in RS. The results demonstrate that manual small-bowel anastomoses can be performed laparoscopically. Single-knot and clip sutures are reliable techniques. The on-going development of new instruments and the three-dimensional technique will basically improve the construction of intracorporeal anastomoses.

ISSN:1051-7200    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryThe development of a postoperative lymphocele after renal trans-plantation is a well-described complication that occurs with relative frequency. Management options have previously included simple aspiration, percutaneous imaging-guided drainage with catheter placement, and operative marsupialization of the cyst into the peritoneal cavity. Because these collections are often multiloculated, catheter drainage may be of limited value, and the recurrence rate is unacceptably high. The operative approach is the most definitive method and is still considered the treatment of choice. This paper describes a laparoscopic approach to peritoneal fenestration and internal drainage of lymphoceles after renal transplant surgery and recommends that this technique be considered the primary mode of therapy for this complication.

ISSN:1051-7200    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryThe endoscopic stapler (Endo-GIA) was designed to divide tissue between two triple-stapled lines. The endoscopic surgeon frequently encounters situations where only stapling is required. Kirby described a staple closure method that uses a knifeless Endo-GIA cartridge. This method, although useful, has the problem of the modified Endo-GIA unit locking. Therefore, we devised a new technique for endoscopic stapling that involves two consecutive staplings using one cartridge without cutting. This method requires modification of the Endo-GIA system by removing the safety-lock system. In addition to enabling endoscopic stapling techniques without the risk of locking, the method can effect a significant cost savings.

ISSN:1051-7200    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryWe present the first case of esophagogastric devascularization and esophagogastric transection using a stapler through laparoscopic surgery. The procedure was performed in a 71-year-old diabetic woman with alcoholic liver cirrhosis (Child–Pugh B class), portal hypertension, bleeding grade III esophageal varices, and a previous bleeding episode. The surgical technique was carried out without problems, and the patient had an excellent postoperative condition. Esophagogastric devascularization with esophageal transection using a stapler through laparoscopic surgery is a feasible technique that accomplishes the same and all objectives of the open procedure. Operative time in both methods is the same, whereas surgical trauma, inmunologic depletion, amount of transfused blood, pain, use of analgesics, and hospital stay are reduced in the laparoscopic technique.

ISSN:1051-7200    

出版商:OVID    

年代:1996

数据来源: OVID