摘要:

SummaryThe technique of laparoscopic antegrade sphincterotomy is described. This procedure was used to clear the common bile duct in 22 selected patients with documented choledocholithiasis. Indications for attempting laparoscopic antegrade sphincterotomy included multiple common bile duct stones, one or more common hepatic or intrahepatic stones, a dilated common bile duct requiring a drainage procedure, and suspicion of papillary stenosis. No major complications or mortality was observed. Mild hyperamylasemia was observed in two patients. However, both were asymptomatic, and serum amylase levels rapidly returned to normal. One patient was noted to have a drop in her hematocrit from a preoperative value of 39% to a postoperative value of 33%. Laparoscopic antegrade sphincterotomy added a mean of 17 min to the operative procedure. The mean postoperative stay was 1.4 days. The results of this study suggest that laparoscopic antegrade sphincterotomy may prove to be a useful modality in selected patients with complicated choledocholithiasis.

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

SummaryA consecutive series of six patients admitted with perforated anterior duodenal ulcer were operated on using a laparoscopic technique. Only one operation was unsuccessful and required conversion to conventional open laparotomy. The remaining five patients had a completed laparoscopic omental patch repair with peritoneal washout. There was no mortality, and two patients developed a chest infection postoperatively. Early mobilisation and discharge from the hospital (mean, 6 days) were notable features in this series. In conclusion, laparoscopic repair of uncomplicated perforated duodenal is a safe and effective technique.

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

SummaryLaparoscopic cholecystectomy is rapidly replacing traditional cholecystectomy as the treatment of choice for patients with cholelithiasis. Complications of cholelithiasis are likewise being treated laparoscopically. Choledocholithiasis represents a major challenge for the laparoscopic surgeon. This report is of the early experience with laparoscopy as the primary treatment of common bile duct stones. Two methods are described: (a) transcystic duct choledochoscopy and (b) laparoscopic choledochotomy. Twenty-two patients were encountered with choledocholithiasis (4.8% of total cholecystectomies). Successful laparoscopic choledocholithotomy was performed in 18 cases (82%). Techniques and options are discussed.

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

SummaryIntraoperative ultrasonography during laparoscopic cholecystectomy is a new procedure for examining the bile duct. The ultrasonic probe used in this study utilized a 7.5-MHz convex array designed for easy insertion through a 10-mm cannula. This probe was 90 cm long, had a 10-mm diameter, and was equipped with an angulation system controlled by levers. Additionally, this ultrasound system could detect the direction of the blood flow using a color Doppler display. Both laparoscopic ultrasound and laparoscopic cholangiography were attempted in 45 patients. In 41 of the 45 patients, laparoscopic ultrasound was successful in visualizing the first-order hepatic branches and the common bile duct. On the other hand, laparoscopic cholangiography was successful only in 38 of the 45 patients. The color Doppler capability helped to distinguish the bile duct from the portal vein and hepatic artery. Visualization of the bile duct was achievable by laparoscopic ultrasound. Also, the color Doppler system easily identified the bile duct. However, further design improvements in the ultrasound probe are required to establish laparoscopic ultrasound as an effective intraoperative routine procedure.

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

SummaryLaparoscopic unroofing of a solitary liver cyst was performed in two patients. To give an accurate picture of the cyst-liver anatomic relationship, laparoscopic ultrasonography (US) was performed with a 5 mHz rotating 90° radial scanner. With this technique, an excellent resolution was obtained, and appropriate unroofing of the cysts could be performed. In both patients, additional information was gained that could not be obtained by percutaneous US or computerized tomography (CT).

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

SummaryLaparoscopic cholecystectomy is usually performed with peritoneal insufflation of carbon dioxide gas, which limits the free use of conventional surgical techniques and is accompanied by operative risks resulting from trocar insertion, hypercapnia, and increased intraabdominal pressure. We have improved the laparoscopic cholecystectomy procedure by using an abdominal wall-lift technique that does not utilize peritoneal insufflation. The operative field is almost the same as in the pneumoperitoneum method with the exception of morbidly obese patients. Because airtightness between manipulating instruments and the abdominal wall is not required, we are able to use conventional surgical instruments and techniques in addition to those specifically designed for laparoscopic surgery. The abdominal wall-lift method enables us to perform laparoscopic surgery with greater ease than the pneumoperitoneum method. It can also be extended to other kinds of abdominal surgery in addition to cholecystectomy.

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

SummaryCirrhosis, portal hypertension, and bleeding disorders are being considered as relative or absolute contraindications to laparoscopic cholecystectomy (LC). This report describes four cirrhotic patients with clinical portal hypertension in three and mild to severe bleeding tendency in all. Laparoscopic cholecystectomy was uniformly successful in these patients with no complications. If the surgeon exercises extreme caution in securing hemostasis and does not overlook some details concerning patient management, LC can be efficiently and safely performed in cirrhotic patients. Compared with open cholecysyectomy, LC may be even more advantageous concerning the virtual elimination of incision-related complications. Our preliminary experience is encouraging and suggests more liberal use of LC in cirrhosis-portal hypertension-bleeding tendency disease complex.

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

SummaryFifty-four patients underwent staging laparoscopic pelvic lymphadenectomy under general anesthesia for prostatic carcinoma (49), bladder carcinoma (3), penile carcinoma (1). and lymphoma (1). Conversion to an open procedure occurred only once in the series, but three patients received secondary open operations (5.5%). Complications recognized intraoperatively included bladder perforation (2) and mesenteric hematoma (1). One bladder perforation was repaired laparoscopically. The other was treated with catheter drainage. The mesenteric hematoma was explored surgically and found to be minor. Major postoperative complications included bleeding (4) requiring transfusion in two patients. One hematoma became infected requiring percutaneous drainage. One patient required intubation due to chronic obstructive pulmonary disease (COPD). Ureteral injury (1) was recognized late and required a psoas hitch and ureteroneocystostomy. Two patients developed small bowel obstructions due to herniation through a trocar site, requiring operative correction. Minor postoperative complications included ileus (4), diarrhea (2), bronchospasm (1), transient obturator nerve palsy (1), electrocardiogram changes (1). and fever (1). The overall major complication rate was 16.7%, and the overall minor complication rate was 18.4%. In this series, a substantial learning curve was seen with regard to complications, but the series compared favorably with open lymphadenectomy.

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

SummaryTechniques for laparoscopic-assisted vaginal hysterectomy are being developed in the hope that these new techniques will improve patient care. This article reviews the initial experience of the author with the Endo-GIA stapling device in performing laparoscopic-assisted vaginal hysterectomy. The results showed this technique to he an attractive alternative to the traditional abdominal approach.

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

SummaryWe investigated the current status of laparoscopic cholecystectomy in Japan. A retrospective survey of laparoscopic cholecystectomy was performed involving 1989 patients from eight Japanese institutions. The preoperative work-up and the operative technique were largely identical to those in the United States. Conversion to open cholecystectomy was required in 54 patients (2.7%) because of unexpected intraoperative findings such as inflammation and adhesions in 40 patients (2.0%) and intraoperative complications in 14 patients (0.7%). There were no deaths, and postoperative complications occurred in 34 of 1935 patients (1.75%) in whom laparoscopic cholecystectomy was completed. Only 10 patients (0.51%) had serious complications (hemorrhage and bile duct injury, for example) that required laparotomy. The incidence of bile duct injury was 11 of 1989 (0.55%). We conclude that the adoption of laparoscopic cholecystectomy in Japan has been highly successful.

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID