摘要:

ABSTRACTA new method of thoracoscopic T2-sympathectomy mentioned in a previous report was used on 36 cases of hyperhidrosis at Tainan Municipal Hospital in Taiwan between October 1,1989 and July 31, 1990. To reduce the possibility of incomplete resection of sympathetic nerve tracts, including ganglions and their regeneration, the method was modified on August 1, 1990. Thereafter, routine total removal of T2and T3sympathetic ganglions, as well as wide lateral incisions of the pleura on the second, third, and fourth rib beds were performed for treatment of hyperhidrosis. This newly modified method, "extended thoracoscopic T2-sympathectomy," can be performed easily by thoracoscopic approach in the treatment of hyperhidrosis palmaris. From August 1, 1990 to May 31, 1991, 130 consecutive cases of hyperhidrosis (56 males and 74 females) ranging in age from 8 to 51 years underwent extended thoracoscopic T2-sympathectomy. In addition to a nearly 100% cure rate of hyperhidrosis palmaris, significant saving in operative time and hospital stay were achieved. High simultaneous cure rate (70.6%) and subjective improvement (17.4%) of excessive sweating of feet (hyperhidrosis plantaris) were also noted in the 109 cases followed up, and complications were minor. Extended thoracoscopic T2-sympathectomy is not only a time-saving method but also a very simple and effective method in the treatment of hyperhidrosis. It is worthy of being propagated worldwide.

ISSN:1052-3901    

DOI:10.1089/lps.1992.2.1

年代:1992

数据来源: MAL

摘要:

ABSTRACTRecent technological innovations have improved our ability to perform thoracoscopy in children. Video imaging improves thoracoscopic visualization and enhances the role of the surgical assistant. The placement of multiple access ports improves the thoracoscopic manipulation of tissue. The laser permits the application of thermal energy to intrathoracic tissue for hemostasis without the risk of cardiac fibrillation. The endoscopic stapler allows hemostatic, airtight lung resection which obviates the need for routine tube thoracostomy.Our initial experience with these innovations applied to thoracoscopy was successful in 9 of 12 patients, ages 5 months to 17 years. For diagnostic cases, adequate tissue for histologic evaluation was always obtained. Complications of successful thoracoscopy included suspected air embolus on establishing the initial pneumothorax and persistent air leak requiring tube thoracostomy after resection of a bronchogenic cyst. There were no perioperative deaths.We performed biopsy of mediastinal masses or nodes, and lung, drainage of loculated pleural effusions, and excision of bronchogenic cysts. Thoracoscopy provides a safe, effective alternative to thoracotomy in children and will continue to be enhanced by improving technology.

ISSN:1052-3901    

DOI:10.1089/lps.1992.2.7

年代:1992

数据来源: MAL

摘要:

ABSTRACTWith increasing acceptance of routine cholangiography during laparoscopic cholecystectomy (for confirmation of anatomy) there has been increased identification of common duct calculi. A technique of laparoscopic transcystic common duct stone extraction is described and early clinical results are presented. Successful stone extraction was accomplished in 39 out of 41 consecutive attempts by one surgical team. Two cases required choledochotomy. There were four complications including hyperamylasemia (2), minor wound infection (1), and incidental pneumothorax (1). Recommendations regarding safety and indications are presented. Initial evaluation suggests laparoscopic transcystic stone extraction is safe and effective.

ISSN:1052-3901    

DOI:10.1089/lps.1992.2.15

年代:1992

数据来源: MAL

摘要:

ABSTRACTLaparoscopic cholecystectomy is now a well-established alternative to open cholecystectomy. It is less invasive and recovery generally is quicker and less painful. Several articles have been published in support of outpatient laparoscopic cholecystectomy. The main benefits are cost savings and patient and surgeon convenience. The main obstacles, however, are patient reluctance and surgeons' concern about sending a patient home without benefit of professional supervision after abdominal surgery and a few hours of general anesthesia. A new approach, consisting of surgery in an Ambulatory Surgery Center (ASC) and overnight observation in a free-standing Post Surgery Recovery Center (PSRC), is presented; and the first 100 patients in the study are reported. Laparoscopic cholecystectomy in the ASC with overnight observation in the PSRC offers the advantages of outpatient surgery, namely, lower cost and greater patient and surgeon satisfaction, while allowing the safety and convenience of remaining under professional supervision for the first 24 hours.

ISSN:1052-3901    

DOI:10.1089/lps.1992.2.23

年代:1992

数据来源: MAL

摘要:

ABSTRACTLaparoscopic surgery is now established as a major advance in modern surgery. Assurance of adequate training and credentialing is still a significant problem. Using laparoscopic cholecystectomy as an example, a survey was conducted to assess what criteria surgeons deem necessary for training and credentialing in a laparoscopic procedure. One hundred and forty-nine questionnaires were completed by surgeons from academic and private practice. A total of 110 (74%) surgeons consider that a course involving a hands-on animal lab should be required. Ninety-two (84%) of them answered that a preceptorship also should be required (average of 6.42 as surgeon and 5.86 as assistant). Ninety-nine (66%) responders believe that a surgeon should serve a probationary period (average of 11.6 cases) with review of morbidity, zprior to being given full privileges. No statistical difference was found when comparing the answers of academic surgeons with private practitioners or between surgeons who had performed laparoscopic cholecystectomy and those who had not.

ISSN:1052-3901    

DOI:10.1089/lps.1992.2.27

年代:1992

数据来源: MAL

摘要:

ABSTRACTHistopathological evaluation of infected tissue is critical in the diagnosis of hepatic candidiasis since cultures are unreliable. Percutaneous techniques are inaccurate because lesions often are small and multifocal, and open biopsy is not always well-tolerated in acutely ill patients. The authors investigated the feasibility of laparoscopically guided biopsy in patients suspected of having hepatic candidiasis. Preliminary results suggest that laparoscopically guided biopsy is highly accurate and less invasive than open biopsy.

ISSN:1052-3901    

DOI:10.1089/lps.1992.2.33

年代:1992

数据来源: MAL

摘要:

ABSTRACTLaparoscopic pelvic lymphadenectomy has been found to be efficacious in the staging of genitourinary cancers. Technological advances in endoscopic instrumentation have allowed an extraperitoneal approach to be performed. Presented are two patients who underwent an extraperitoneal endoscopic lymph node dissection as a staging procedure for prostatic carcinoma. Technical aspects of the procedure and advantages relative to the laparoscopic intraperitoneal approach are discussed.

ISSN:1052-3901    

DOI:10.1089/lps.1992.2.39

年代:1992

数据来源: MAL

摘要:

ABSTRACTParaesophageal hernias frequently present in an elderly population. Laparoscopic repair was performed in two patients. Each patient had an uncomplicated postop course with complete relief of their symptoms. The surgical technique utilized is presented. Laparoscopic paraesophageal hernia repair offers an alternative procedure to a group of patients who may at times be at increased risk for complications associated with traditional open approaches.

ISSN:1052-3901    

DOI:10.1089/lps.1992.2.45

年代:1992

数据来源: MAL

摘要:

ABSTRACTLaparoscopic laser cholecystectomy is becoming increasingly popular in the surgical community for the treatment of gallbladder disease. Physicians will need to familiarize themselves with the imaging consequences of this new therapy. Described below is a case report of a woman in whom calculi were incidentally found within the pelvis on a plain radiograph of the abdomen after she presented to the hospital with pancreatitis. Initial confusion regarding the etiology of these calculi was solved after it was discovered that the patient had proven gallstones and a recent laparoscopic procedure. In the appropriate clinical setting, gallstones should be added to the differential consideration of intrapelvic calcifications.

ISSN:1052-3901    

DOI:10.1089/lps.1992.2.49

年代:1992

数据来源: MAL

摘要:

ABSTRACTLymph collections are not uncommon after kidney transplantation. These have been treated classically by laparotomy with internal drainage and omental packing. A technique is described that allows this to be done via the laparoscope. The patient was discharged on postoperative day 1 and has had no recurrence of the lymphocele.

ISSN:1052-3901    

DOI:10.1089/lps.1992.2.53

年代:1992

数据来源: MAL