摘要:

SummaryRecognition of the benefits derived from laparoscopic cholecystectomy led to the evaluation of a laparoscopic approach to the lumbar disc space. Goals included minimizing postoperative pain and disability while still achieving adequate access to the disc space, including adequate discectomy under direct visualization. Described herein are the methods used to develop the laparoscopic exposure necessary to allow anterior resection of the lumbar disc, as well as preliminary results of the first 15 patients to undergo laparoscopic discectomy.

ISSN:1051-7200    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

SummaryThoracoscopic surgery has been claimed to reduce patient disability, recovery time, and hospital costs compared with open surgery. We analyzed 25 patients who had undergone thoracoscopic surgery and compared the outcome to 24 patients who had undergone conventional surgery for spontaneous pneumothorax. The thoracoscopic group was able to return to work and daily activities earlier and had less impairment of shoulder movement. There was a loss of sensation corresponding to the dermatomes where the thoracoscopic ports were placed, which could have resulted from compression of the intercostal nerves by the instruments. However, a similar loss of sensation was found in the thoracotomy group. We conclude that thoracoscopy may be the method of choice for the treatment of spontaneous pneumothorax, although further methodological development should be done.

ISSN:1051-7200    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

SummaryCurrent videoendoscopic technology and percutaneous techniques of exposure and dissection have been successfully applied to abdominal surgery with favorable results. Application of this technology to our practice of thoracic surgery is the basis of this report. Video-assisted thoracic surgery was performed in 36 patients for the following indications: Raynaud's syndrome, undefined pulmonary nodule, persisting spontaneous pneumothorax, T1bronchial carcinoma, and mediastinal cyst. Videoendoscopic surgical procedures were accomplished using double-lumen endotracheal anaesthesia and a percutaneous stapling device. Procedures performed using this technique include thoracic sympathectomy, wedge or keel excision, blebectomy, lung apex stapling, parietal pleurectomy, and dissection of the mediastinal cyst. Median operating time was 45 min (range, 15 to 90 min). Tissue diagnosis was obtained in all patients. Median diameter of excised nodules was 10 mm (range, 7 to 70 mm). There were no operative deaths. The single complication was a pro-longed air leak. This new method of thoracic surgery appears to benefit the patients. For us it proved a secure way to perform thoracic surgery. Our case of removal of a benign cyst in the posterior mediastinum shows that video-assisted thoracic surgery has expanding applications in the field of general thoracic surgery.

ISSN:1051-7200    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

SummaryLaparoscopic surgery generally is regarded as a safe procedure when a preset pressure is used in the carbon dioxide insufflator. However, a fixed pressure setting is not appropriate when insufflating a very large or a very small abdomen. Presently, extrapolation from the commonly used 15 mm Hg to an appropriate and safe pressure cannot be easily determined except by a crude trial and error method. We developed an anthropometric formula to calculate the total abdominal cavity capacity and the corresponding pressure necessary to obtain safe pneumoperitoneum. This anthropometric formula calculates the total abdominal capacity by measuring one diameter from the symphysis pubis to the xyphoid bone, a second diameter as half the initial measurement, and a third diameter by dividing the waist measurement (minus an estimated percentage of body fat) and dividing that product by pi. The product of the three diameters is then multiplied by a constant (K = 0.5). We studied prospectively 20 patients whose indications for laparoscopic surgery necessitated creation of a pneumoperitoneum. The patients were divided into two groups: group A (n = 10), patients who were observed with the intra-abdominal pressure fixed at 15 mm Hg while recording the amount of distension produced in the abdominal cavity during creation of the pneumoperitoneum; and group B (n = 10) in whom pneumoperitoneum was obtained based on the initial volume of carbon dioxide insufflation previously calculated using our formula. Based on our observations, we conclude that this anthropometric formula can be used successfully in predicting a safe level of insufflation in relation to the patient's size.

ISSN:1051-7200    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

SummaryTwelve years of experience with tubal ligation by the laparoscopic route at two highly specialized centers of female sterilization are discussed; special attention is given to the technique and results achieved. The number of intraoperative and postoperative complications was very low compared with data reported elsewhere. This article attempts to present the knowledge gained by using the laparoscopic technique, at a time when the use of laparoscopic surgery is extending around the world. The direct insertion of trocars without prior pneumoperitoneum has proved to be safe, and the risks of intraabdominal (visceral or vascular) injuries are minimized by observing simple rules, such as clamping of the relaxed abdominal anterior wall with towel clips, maintaining sharpened trocars, and using the extended index finger as a limit to introduce only the tip of the trocars. We consider a medical history of previous laparotomy secondary to peritonitis and open abdominal treatment absolute contraindications for this technique.

ISSN:1051-7200    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

SummaryWe prospectively evaluated the cases of 52 patients who underwent laparoscopic Nissen fundoplication from October 1992 to January 1994 for patient outcome, satisfaction, hospital stay, hospital cost, and disability. All cases were evaluated with historical findings, routine chemistry studies, upper gastrointestinal series, fluoroesophagography for esophageal motor function, gallbladder ultrasonography, and esophagogastroduodenoscopy. Six patients required esophageal manometry for diagnosis. All patients had refractory esophageal reflux disease or complications of chronic esophageal reflux. Forty-nine (94%) of the 52 cases were completed laparoscopically. Ninety percent of those were cured of their symptoms and returned to a normal life-style. Ten percent had significant improvement, with rare episodes of reflux or dysphagia, and received antacids only occasionally. Hospital stay was reduced to 2.3 days, compared to 8.3 days for the open technique. Hospital cost was reduced to $6,870, compared to $11,990 for the open technique. Mean time until return to work was 15 days in the laparoscopic group, compared to 42 days in the open Nissen group. There were two major complications (4%) and 12 minor complications (24%). There were no deaths. Fifty-one of 52 patients stated that they would recommend the procedure for others with the same problem. Laparoscopic Nissen fundoplication is a safe and effective treatment for refractory esophageal reflux and its complications and has the extra benefit of reduced hospital cost and stay and a more rapid return to work. Preoperative esophageal manometry and 24-h esophageal pH testing may be used selectively with excellent results.

ISSN:1051-7200    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

SummaryTwo patients with the bile duct injury secondary to blunt liver trauma are presented. Endoscopic retrograde cholangiopancreatography (ERCP) proved to be a useful diagnostic and therapeutic modality in the treatment of these patients. This report advocates the use of ERCP and endobiliary stenting in the management of biliary injury resulting from liver trauma.

ISSN:1051-7200    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

SummaryWe report here the operative findings, the incidence of successful laparoscopic treatment, and the perioperative complications in patients with nonvisualized gallbladder on drip infusion cholangiography (DIC). Eighty-five patients with a nonvisualized gallbladder on DIC were entered into the study. None of the patients had a minimal adhesive gallbladder; 51 to 85 patients (60.0%) had moderate adhesive gallbladders, and 34 (40.0%) had severely adhesive ones. The rate of successful laparoscopic treatment, including laparoscopy-assisted abdominal surgery, was 97.6% (83 of 85 patients). Perioperative complications occurred in only three patients (3.5%), and there were no deaths related to the operation. Thus, when patients with a nonvisualized gallbladder on DIC undergo laparoscopic cholecystectomy, meticulous procedures must be carried out; however, as the rate of successful laparoscopic treatment is high, cholecystectomy under laparoscopy is feasible for experienced surgeons.

ISSN:1051-7200    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

SummaryNineteen women with acute lower abdominal pain of uncertain etiology underwent diagnostic laparoscopy during a 2-year period from August 1991 to August 1993 and were retrospectively reviewed. All patients, aged 12 to 44 years, were premenopausal. Laparoscopy provided definitive diagnosis in all 19 patients. Laparoscopic findings included appendicitis (11 cases), pelvic inflammatory disease (five cases), significant ovarian cysts (two cases), and ectopic pregnancy (one case). Successful laparoscopic procedures included appendectomy (five cases), and salpingo-oophorectomy (one case). Five patients required only diagnostic laparoscopy. Eight patients required conversion to an open procedure because of anatomical considerations (six cases) or equipment failure (two cases). Median operative time was 71 min, and median postoperative hospital stay was 2 days. Most diagnostic procedures were per-formed on the same day as admission, resulting in a median hospital stay of 3 days. Diagnostic laparoscopy performed in premenopausal female patients with acute lower abdominal pain of unknown etiology provides diagnostic accuracy as well as therapeutic capabilities and prevents unnecessary laparotomy.

ISSN:1051-7200    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

SummaryTwo cases of laparoscopic restoration of intestinal continuity are presented. The procedures were technically straightforward and both patients did well. These cases add to a small but growing literature documenting the technical feasibility of laparoscopic intestinal surgery. The potential risks and benefits of this minimally invasive technique are discussed.

ISSN:1051-7200    

出版商:OVID    

年代:1995

数据来源: OVID