摘要:

ABSTRACTMinimally invasive techniques are having an impact on a variety of surgical procedures. Before their widespread acceptance as the standard of care, studies need to document their efficacy in comparison to open techniques. This study compared 25 laparoscopic-assisted colectomies to 25 open colectomies all performed within the last five years by the same surgeon. In terms of adequacy of resection, laparoscopic assisted colectomy compared favorably with open colectomy in both length of resection (15.7 cm vs 19.3 cm) and average number of nodes (6 vs 10). In addition to lessening patient discomfort, the other advantages were earlier return of bowel function (regular diet postoperative day 2 vs postoperative day 5) and shorter length of stay (4 vs 8 days). Operating costs were significantly greater, but this was offset by the shorter length of stay. This study supports laparoscopic assisted colectomy as a technically safe procedure with substantial patient benefits.

ISSN:1052-3901    

DOI:10.1089/lps.1995.5.1

年代:1995

数据来源: MAL

摘要:

ABSTRACTThe objective was to identify and compare causes of unscheduled admission following ambulatory major operative gynecologic laparoscopy in a university hospital and a community hospital setting. Each patient admitted on an unscheduled basis was compared with 2 patients who did not require admission. Twenty-seven variables were evaluated by univariate analysis. Significant factors (p<0.5) were analyzed by multivariate stepwise logistic regression. Patients admitted at the university hospital were compared with patients at a community hospital. In a 7-year period, 43 patients at the University of Mississippi Medical Center and, in a 6-year period, 30 patients at Gilmore Memorial Hospital required unscheduled admission following ambulatory major operative gynecologic laparoscopy. Site-specific analysis was performed, and these groups also were combined for analysis. The only factor associated with admission by multivariate analysis was estimated operative blood loss. Postoperative emesis was the most common reason for unscheduled admission at both hospitals and occurred in 27 patients. An additional 17 patients were admitted because of the severity of postoperative pain. Operative blood loss seems to be associated with extensive operations. Furthermore, increased blood loss typically leads to a very conservative approach to the postoperative patient, whereas minimal blood loss allows patients to be managed in a routine fashion. Patients at the university hospital seem to be generally comparable to patients at a community hospital. Postoperative nausea and pain resulted in over one half of admissions. Successful therapy for nausea and pain may reduce unscheduled admissions.

ISSN:1052-3901    

DOI:10.1089/lps.1995.5.7

年代:1995

数据来源: MAL

摘要:

ABSTRACTPneumoperitoneum with CO2is associated with adverse effects, such as hypercarbia, arrhythmias, and circulatory depression, which may limit its use in patients with underlying disease. Some of these effects may be caused by CO2absorption resulting in acid-base disturbances. Laparoscopic insufflation with helium may be a good alternative for CO2, since it is chemically inert. Because there are few data on the use of helium for laparoscopy, we studied hemodynamics and gas exchange during insufflation with CO2or helium in 8 pigs at 10, 15, and 20 mm Hg intraabdominal pressure. Heart rate did not change significantly with both gases. Arterial blood pressure increased with CO2(p<0.05) but not with helium. Cardiac output, mixed venous oxygen saturation, and oxygen consumption did not decrease, whereas central venous filling pressures increased during insufflation with either gas. Insufflation with CO2resulted in mild increases in arterial, central venous, and end-expiratory CO2. The results suggest that pneumoperitoneum with helium will not be associated with profound circulatory depression or oxygen transport abnormalities. In addition, the use of helium is not associated with acid-base disturbances, although central venous filling pressures are similarly increased as with the use of CO2pneumoperitoneum.

ISSN:1052-3901    

DOI:10.1089/lps.1995.5.15

年代:1995

数据来源: MAL

摘要:

ABSTRACTThe low morbidity and early recovery associated with laparoscopic procedures have shown a new direction for many types of surgery. We performed a laparoscopic bilateral truncal vagotomy (BTV) with pyloric dilatation (PD) in 20 patients (11 men, 9 women, ranging in age from 32 to 56 years, with a mean age of 42 years). All patients had chronic duodenal ulcer diagnosed endoscopically, with a mean duration of symptoms of 2.6 years (range 2–8 years). The mean length of surgery was 55 min (range 45–90 min). The mean follow-up period was 16 months (range 3–25 months). In 1 patient, esophageal perforation occurred during the dissection of the left vagus nerve and was sutured laparoscopically. Acid secretion tests under basal conditions and pentagastrin stimulation preoperatively and 1 month postoperatively showed a decrease in basal acid output (BAO) of 76% and maximal acid output (MAO) of 84.2%. Endoscopy at the second and sixth postoperative month showed healing of the ulcer in 19 of 20 patients (95%). One patient had partial pyloric stenosis due to chronic duodenal ulcer before BTV and PD and developed complete pyloric stenosis after the surgery. Despite repeated pyloric balloon dilatation, he required an open drainage procedure (gastroduodenostomy, Jaboulay). Three patients (15%) had postoperative diarrhea and responded very well to medical treatment. The preliminary results showed that laparoscopic BTV with PD is a simple and effective procedure for the treatment of chronic duodenal

ISSN:1052-3901    

DOI:10.1089/lps.1995.5.21

年代:1995

数据来源: MAL

摘要:

ABSTRACTThe use of a Foley catheter to dissect the preperitoneal space for extraperitoneal hernia repair creates a satisfactory working space for hernia repair. This technique is simple and inexpensive and reduces the operating time to a range similar to that for open inguinal hernia repair.

ISSN:1052-3901    

DOI:10.1089/lps.1995.5.27

年代:1995

数据来源: MAL

摘要:

ABSTRACTWe report the use of an ultrasonically powered instrument (CUSA) for laparoscopic surgery. A total of 105 patients underwent laparoscopic or laparoscopic assisted surgical procedures. Ninety-one laparoscopic cholecystectomies (LC), 9 laparoscopic appendectomies (LA), 3 laparoscopic colon resections (LCR), and 2 laparoscopic partial gastrectomies (LPG) were done using CUSA. In LC, CUSA separates the areolar connective tissue between gallbladder and liver bed without dividing any sizable vessels or injuring the liver. In LA, LCR, and LPG, CUSA makes mesenteric vessel identification and division rapid and safe. We concluded that CUSA is useful for laparoscopic surgery.

ISSN:1052-3901    

DOI:10.1089/lps.1995.5.31

年代:1995

数据来源: MAL

ISSN:1052-3901    

DOI:10.1089/lps.1995.5.37

年代:1995

数据来源: MAL

摘要:

ABSTRACTParaaortic lymph node sampling has been found to be efficient in the staging of genitourinary cancers. However, the complications associated with this procedure using the traditional transperitoneal or extraperitoneal approach are considerable. Developments in endoscopic technology and instrumentation have allowed an extraperitoneal approach. Presented is a porcine model for extraperitoneal endoscopic paraaortic lymph node dissection as a staging procedure for genitourinary cancers. The pig is placed in a prone position, and an extraperitoneal pneumoperitoneum is created. Using a three-port technique, we were able to remove almost 95% of all paraaortic lymph nodes laparoscopically without any complications. The prone position allows for a fast and safe procedure because it minimizes the need for extra entry ports and gives a clear view, unobstructed by the bowel, of the back wall of the abdomen.

ISSN:1052-3901    

DOI:10.1089/lps.1995.5.41

年代:1995

数据来源: MAL

摘要:

ABSTRACTLeiomyosarcoma is a rare malignant tumor originating from the smooth muscular tissue in any part of the organism. The only therapy is its complete removal. We describe herein the operative treatment of a retroperitoneal leiomyosarcoma with gasless laparoscopic complete removal. The procedure was successfully performed in a consenting woman with an abdominal mass. Gasless laparoscopic removal was performed with a mechanical retractor (Laparolift, Origin Medsystem Inc.), obviating the creation of the pneumoperitoneum and of the sealed environment. The technique is a simple, safe, and effective surgical method. Gasless technique guarantees a clear vision, makes possible continuous suction of smoke and fluids, and allows the use of conventional instruments and easy management of suturing. The present case has proved to be another abdominal procedure that can be carried out with all the advantages of gasless miniinvasive surgery.

ISSN:1052-3901    

DOI:10.1089/lps.1995.5.47

年代:1995

数据来源: MAL

摘要:

ABSTRACTDetached catheters in the peritoneal cavity are among the complications following implantation of ventriculoperitoneal shunts. We present one case and discuss the value of a laparoscopic approach to retrieve this foreign body. Laparoscopic removal of these catheters is an effective and safe procedure and can be used in these ill patients, avoiding the possible complications of a laparotomy.

ISSN:1052-3901    

DOI:10.1089/lps.1995.5.55

年代:1995

数据来源: MAL