摘要:

Summary:We describe the clinical course of 12 patients who underwent laparoscopic splenectomy. Two patients were converted to open surgery—the first patient in the series because of a hemorrhagic incident and the eighth, who had a 34-cm spleen, because of dissection difficulties. The remaining patients had no mortality, and perioperative morbidity was 10%. After an average postoperative stay of 3.5 days (range, 2–9), most patients were able to resume normal activities ≤2 weeks. Use of preoperative splenic artery embolization was begun with the third patient. The technique involved embolization of the spleen with coils placed proximally; and contour emboli, absorbable gelatin sponge, and small coils placed distally, taking care to spare vessels to the tail of the pancreas. A good linear correlation was established between operative blood loss and the percentage of splenic devascularization by preoperative splenic artery embolization (r− 0.8084). Laparoscopic splenectomy is becoming the preferred technique for elective removal of a normal sized or moderately enlarged spleen (<20 cm long) when hematologic indications are present.

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Summary:Between March 1991 and December 1992, we treated 63 patients with symptomatic inguinal hernias using a laparoscopic transabdominal preperitoneal approach adapted from Nyhus' technique. Treatment was individualized according to the classification of groin hernias described by Nyhus. We treated 32 type II hernia defects (indirect hernia) by preperitoneal closure of the internal ring with two to four stitches of 0-Prolene. Eighteen type IIIA (direct), three type IIIB (large indirect with weak posterior wall), and 10 type IV (recurrent) hernias were treated by fixing a prolene mesh with 0-Prolene sutures and staples from the pubic tubercle medially to the lateral aspect of the internal ring (including the cord into the mesh) laterally. The mesh was secured to the transversalis fascia and muscle and inferiorly to Cooper's ligament. No peroperative complications occurred. One patient had testicular pain of 1 week's duration after treatment of a type IV hernia. No mortality was recorded. Patients took, on an average, parenteral analgesia once (range, 0–5) and two enteral analgesics (range, 0–6). With a median follow-up of 8 months (range, 1–21), no recurrences were noted. Results are encouraging, and longer follow-up will determine the long-term efficacy of this procedure.

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Summary:Laparoscopic rectopexy has been performed in four female patients with rectal prolapse. Four or five trocars were used in each case, with the same introduction places as for laparoscopic anterior resection. After dissecting the rectum free, a polypropylene mesh was introduced and fixed to the promontorium with an endoscopic stapler device, and then sutured to the rectum leaving a fourth of the anterior rectal wall free. The average operating time was three hours and the hospital stay six days. No constipation has been observed postoperatively in the patients with preoperative normal bowel habit. The introduction of laparoscopic, rectopexy opens the possibility of performing different fixation techniques for various functional problems in the pelvis, offering a significant decrease in morbidity.

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Summary:We developed a new type of movable tying spatula for ligation of the cystic duct and artery in laparoscopic cholecystectomy. This spatula can be used to ligate any vascular or ductal structure before laparoscopic resection. This instrument should give strong support to surgeons performing laparoscopic procedures and eventually will replace the expensive clips and Endoloops.

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Summary:End-stage renal disease secondary to vesicoureteral reflux often necessitates removal of the affected kidney and its refluxing ureter. Advances in laparoscopic techniques have made nephroureterectomy through the laparoscope possible in a minimally invasive way. We describe our surgical steps for laparoscopic nephroureterectomy in all 11-year-old girl with end-stage reflux nephropathy. Reduced trauma of surgical access, minimal postoperative morbidity, shorter hospital stay, and minimal scarring make laparoscopic nephroureterectomy a comparatively desirable surgical approach, especially in pediatric patients.

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Summary:Laparoscopic common bile duct exploration is comparable with the open operation and it is usually finished with the insertion of external bile drainage such as a T-tube. We performed an antegrade placement of a biliary stent with primary suture of the common bile duct following common bile duct exploration. We thereby avoided the acquisition of the additional expensive equipment required for the transcystic approach and the placement of a T-tube, which in our eyes contradicts the idea of minimized discomfort in minimally invasive surgery.

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Summary:An improved technique for laparoscopic appendectomy based on an experience of >120 cases is presented. This method includes numerous additions to and modifications of previously described techniques and is effective for gangrenous and perforated appendicitis as well as for less severe cases. The most important elements are that (a) it is a safer procedure for attaining insertion of the Veress needle and the primary trocar; (b) it employs electrocautery to separate the appendix from the mesoappendix; (c) an Endosac can be used for removal of the appendix from the abdomen without contamination of the abdominal wall; (d) no laser is necessary; and (e) staples are rarely necessary.

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Summary:Premade chromic gut ligating Endoloops used in laparoscopic surgery are not always available. Handmade knots or loops, however, are equally effective, simpler, cheaper, and readily available. Techniques of making more than 10 handmade knots and loops are described and illustrated, and their uses are discussed. The thread can be introduced inside the abdominal cavity to loop around the proposed structure grasped by forceps, brought outside the abdomen, tied externally, and the knot pushed and tightened inside by pusher rod. Or, the knot may be fashioned outside the abdomen and introduced as a ready-made loop and tightened inside by a grasper.

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Summary:We present a case of colonoscopically assisted intracorporeal laparoscopic wedge resection of a benign right colon lesion. The operative technique is described and the rationale discussed with reference to current literature.

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Summary:Spillage of gallstones during laparoscopic cholecystectomy is not a rare event. We describe a patient who showed signs of an abdominal wall abscess 4 months postsurgery. The abscess was found to be due to gallstones trapped in the preperitoneal space behind the left rectus sheath.

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID