摘要:

SummaryToday's rigid endoscopic instruments limit the intracorporeal mobility of the surgical tool and are a severe impediment for the further spread of endoscopic techniques in operative medicine. Since 1992 flexible, steerable instruments with additional links for pivoting and rotating the tip have been developed and experimentally evaluated. The latest versions of this series of instruments are equipped with electromotors for better handling. The next aim in this development is a fully mobile telemanipulator with six motion axes dedicated to use in endoscopic surgery. Its first tests are planned for 1995. For successful operation of an electric telemanipulator, the man-machine interface (MMI) is of cardinal importance. For the definition of surgical requirements for the MMI, a conventional master-slave manipulator designed for technical application was modified for use in guiding a laparoscopic instrument. Master and slave sites of the system were 1.3 km apart and linked by means of a fiber-optic cable. Using this modified telepresence system, remote laparoscopic cholecystectomy was feasible in a phantom model. In a standardized test series using a test parcours, different parameters of the control system were modified, and their influence on the execution time of the parcours tasks was recorded. Well-suited parameter configurations were found and allowed experimental verification and completion of the important aspects of our concepts for development of an endoscopic manipulator MMI.

ISSN:1051-7200    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryThe success of peritoneal dialysis in the management of chronic renal failure depends on the proper function of the implanted catheter. Common causes of catheter drainage dysfunction include an omental wrap or block-age of the catheter by other intraperitoneal structures. The present report describes laparoscopic management of five patients with outflow obstruction of a peritoneal dialysis catheter. Epiplopexy of the greater omentum or epiploic appendices was employed in all cases to prevent potential recurrence of catheter dysfunction. Technique and other procedural details are described. Long-term successful function of the peritoneal dialysis catheter was restored in all patients.

ISSN:1051-7200    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryThe purpose of this study was to compare thoracoscopic treatment for spontaneous pneumothorax in patients over 50 years old (OG) and younger patients (YG). Thoracoscopic treatment was performed in both groups using the same patient selection criteria: persistence of an air leak after tube thoracostomy drainage, ipsilateral recurrence, and bilateral pneumothoraces. Thoracoscopic treatment was performed in nine older patients (OG) over a two-year period. Their ages ranged from 50 to 81 years (average: 66 years). The mean operative time, postoperative drainage period, and hospital stay after surgery were 120 min, 6.3 days, and 10.7 days, respectively. In the YG, these indices were 71 min, 1.5 days, and 5.3 days, respectively. Each factor was significantly prolonged in the OG (p < 0.05). However, there were no major perioperative complications or recurrences 3–24 months after surgery in either group. Thus, thoracoscopic surgery is also effective in the treatment of spontaneous pneumothorax in patients over 50 years old.

ISSN:1051-7200    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryThe purpose of the present study was to develop a technique for laparoscopic aortic aneurysm resection and aortobifemoral bypass through an anterior retroperitoneal approach. Eight piglets weighing between 75 and 80 kg were anesthetized. The concepts of Shumacker's anterior retroperitoneal exposure of the aorta were modified to allow laparoscopic exposure of the aorta in the first four animals. The other four animals were treated as if they had an aortic aneurysm. The piglet is placed in a supine position. The first port (1.5 cm) is placed laterally near the tip of the 12th rib. As much dissection of the retroperitoneum as possible is performed digitally through this port. A second port (1.5 cm), through which an abdominal lift device and a peritoneal retractor will be inserted, is created superiorly just lateral to the left rectus sheath, and a plane is developed that joins the original dissected space. Two other ports (1.5 cm) are placed in the flanks in a plane inferosuperior to the first port. The surgeon will use two of the lateral ports, and the third one is for the laparoscope. The last two ports (1.5 cm), from which the assistant will work, are placed in the left paramedian region. Using this approach, we performed four aortobifemoral bypasses in an average of 4.5 h after conventional i.v. heparinization (100 IU/kg) with minimal bleeding (blood loss < 550 cc). After infra-renal aortic cross-clamping, the external iliac and caudal vessels were either tied with 0-chromic or occluded with laparoscopic bull-dogs. The aorta was opened, and bleeding lumbar arteries and the aortoiliac junction were sutured with 4–0 Prolene. The vascular graft was sutured end-to-end to the aortic stump with running 4–0 Prolene. Tunneling to the femoral regions was made easy by the position of the animal. No mortality occurred before sacrifice of the animals. This laparoscopic animal model paves the way for human aortic aneurysm replacement.

ISSN:1051-7200    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryMany laparoscopic surgeons feel constrained by the two-dimensional (2-D) view provided by video monitors. Video-eye-hand coordination is further complicated by the diminished tactile feedback blunted by elongated instruments. Video systems capable of receiving and displaying three-dimensional (3-D) images are now available for laparoscopy. First-generation 3-D systems have been marketed with the promise of significant time savings in laparoscopic procedures compared with 2-D optics. We assessed whether laparoscopic task performance was better in 2-D or 3-D among individuals with varying levels of laparoscopic experience. Five different tasks were performed in random order using both 2-D and 3-D technology by medical students (n = 10), inexperienced surgical residents (n = 10), and laparoscopic attending surgeons (n = 10). There was no significant difference in task performance between 2-D and 3-D among groups performing simple or difficult tasks, although suturing and knot-tying were performed 12% (p = 0.06) faster in 3-D by all groups. With repetition of tasks three times, the difference between the 2-D and 3-D systems was indistinguishable. Subjective assessment of the video systems by participants revealed that only 46% (p = 0.72) preferred working in three dimensions, despite 60% (p = 0.27) sensing more motor control in 3-D. Our results suggest that first-generation 3-D video systems offer no significant advantage to the novice or expert surgeon performing laparoscopic procedures. Further trials with the next generation of 3-D video systems and a larger sample size may support the trend favoring 3-D for more complex maneuvers, such as suturing and knot-typing.

ISSN:1051-7200    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryIatrogenic bile duct injury during cholecystectomy is the most serious complication of this surgical procedure. Initial reports suggest that this complication is particularly troublesome during laparoscopic cholecystectomy. Proper identification of the biliary anatomy in the subhepatic region is the only way to avoid this catastrophe. The potential benefits of a simple, reliable method for intraoperative delineation of biliary anatomy are self-evident. In this experimental study on rabbits, we show how the simple i.v. injection of a fluorescent bile salt, cholyl-lysyl-fluorescein, enables the surgeon to visualize the entire biliary tree in anatomic detail.

ISSN:1051-7200    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryLaparoscopic cholecystectomy (lapchole) is a safe procedure. Most of the complications are operation related. The complications related to increased intraabdominal pressure (IAP) are well recognized, but not emphasized enough. The changes in physiological parameters at different IAPs were studied to evaluate the usefulness of reduced IAP in minimizing these changes. Thirty consecutive patients consisting of 16 ASA III, 2 ASA IV, and the rest ASA I and II, underwent lapchole under high and reduced IAP. The mean arterial pressure (MAP), heart rate (HR), arterial oxygen saturation (Sao2), airway pressure (AWP), and end-tidal carbon dioxide (ETco2) were recorded before insufflating carbon dioxide (T1), with IAP of 14 mm Hg (T2) and IAP of 6 mm Hg or less (T3). At T2, MAP increased by 41.15%, AWP by 44.3%, and ETco2by 20.5% as compared to T1 (p < 0.001). HR and Sao2showed no significant changes. At T3 there was an increase in MAP by 24.94%, in AWP by 10%, and ETco2by 10.6% with no significant changes in HR and Sao2. Thus, operating under reduced IAP may be beneficial to the patients with decreased cardiopulmonary reserve, especially while undergoing long surgical procedures.

ISSN:1051-7200    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryWe conducted a review of laparoscopic appendectomies (LA) and open appendectomies (OA) over a 3-year period, including 720 patients (253 LA, 467 OA) who underwent appendectomy during the study period. Computer records were reviewed with respect to demographics, length of stay, operating room time, operating room cost, hospital cost, and morbidity. All patients were sent surveys to assess their posthospitalization recovery. The LA patients had significant shorter hospital stays (2.06 days vs. 3.44 days, p <.001), lower morbidity rates (5 vs 14%, p <.02), and comparable overall hospital costs ($4,800 vs. $4,950). The LA patients also reported less postoperative pain and were able to return to work sooner. Our results show that LA can significantly decrease morbidity and hospital stay with a comparable hospital cost and result in quicker patient recovery.

ISSN:1051-7200    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryTo clarify the influence of carbon dioxide (CO2) on cerebral oxygen metabolism and blood volume during laparoscopy with CO2insufflation in 12 patients who underwent laparoscopic cholecystectomy, changes in the concentrations of cerebral oxyhemoglobin (HbO2), reduced hemoglobin (HbR), total hemoglobin (total Hb), and oxidized cytochrome aa3(Cyt aa3) were measured using near-infrared laser spectroscopy. Anesthesia was maintained with nitrous oxide (66%)-oxygen-sevoflurane. Pneumoperitoneum was maintained at an endoabdominal pressure of 10 to 12 mm Hg using CO2. Minute ventilation was constant before and after CO2insufflation. End-tidal CO2tension (PETCO2) increased significantly, from 33.9 ± 1.3 to 52.8 ± 3.3 mm Hg, after CO2insufflation. The concentration of HbO2increased significantly, from 0 to 7.3 ± 2.8 μmol/L, after CO2insufflation. The concentration of HbR increased significantly, from 0 to 2.2 ± 1.2 μmol/L, after CO2insufflation. Therefore, the concentration of total Hb increased significantly, from 0 to 8.8 ± 3.3 μmol/L after CO2insufflation. The concentration of Cyt aa3, however, did not change significantly during pneumoperitoneum. These results suggest that cellular respiration remained intact despite a concomitant increase in PETCO2and cerebral blood volume during laparoscopy with CO2insufflation.

ISSN:1051-7200    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryLaparoscopic colorectal surgery is in its infancy. From a series of over 200 colorectal procedures undertaken over the last 30 months, we have performed 84 anterior resections. In 55 women and 29 men, median age 64 years (range 32–86), median weight 72 kg (range 36–125), surgery was under-taken for benign pathology (n = 57) and adenocarcinoma (n = 27). Anterior resection was completed laparoscopically in 75 cases (89%) with a median operating time of 210 min (range 85–420). Minor morbidity occurred in 17 patients (20%) with major morbidity in 10 cases (12%). There was one post-operative death. Flatus was passed a median of two days (range 1–7) after surgery and feces at a median of four days (range 2–9). Total hospital stay was six days (range 2–33). Delayed morbidity during a maximum of 30 months' follow-up included two anastomotic strictures but no evidence of malignant seeding. Laparoscopic anterior resection appears both feasible and safe for both benign and malignant disease, with the caveat that long-term outcome in malignant disease is not yet available.

ISSN:1051-7200    

出版商:OVID    

年代:1996

数据来源: OVID