ISSN:1052-3901    

DOI:10.1089/lps.1990.1.1

年代:1990

数据来源: MAL

摘要:

Laparoscopic cholecystectomy is rapidly evolving as a therapeutic modality for the treatment of gallstone disease. The technical details of this procedure and the method by which the gallbladder is dissected and removed are critical to the safe, effective execution of the procedure. Our technique has been developed through extensive practice in porcine models and through experience with more than 250 patients. To perform laparoscopic cholecystectomy we employ a high-resolution video endoscopy system, two high-resolution color monitors, a high-flow CO2insufflator, a 300 W Xenon light source, electrocautery and/or lasers, and an endoscopic suction-irrigation system. This equipment permits the surgeon to obtain a clear field of view within the abdomen. With these tools, appropriately designed for laparoscopic surgery, including a laparoscope, graspers, dissectors, cholangiography equipment, scissors, and clip appliers, the surgeon can remove the gallbladder without opening the abdomen. The procedure requires the induction of a CO2pneumoperitoneum, insertion of four trocars, and placement of a grasping retractor to set the operative field. An additional retractor placed on Hartmann's pouch provides countertraction for dissection of the hilum. Careful dissection around the cystic duct and cystic artery with a combination of electrocautery and blunt dissection allows the surgeon to skeletonize the cystic duct and artery. After intraoperative cholangiography confirms the anatomy, the cystic artery and cystic duct are clipped and divided. Electrocautery or laser techniques can be used to perform retrograde dissection of the gallbladder from the liver bed and insure hemostasis. The gallbladder is detached and removed intact through the large trocars. This basic technique can be applied in a wide variety of patients with cholelithiasis. The surgeon proficient in this technique may apply it to a broad range of patients with gallbladder disease.

ISSN:1052-3901    

DOI:10.1089/lps.1990.1.3

年代:1990

数据来源: MAL

ISSN:1052-3901    

DOI:10.1089/lps.1990.1.17

年代:1990

数据来源: MAL

ISSN:1052-3901    

DOI:10.1089/lps.1990.1.31

年代:1990

数据来源: MAL

摘要:

The meteoric growth of laparoscopic cholecystectomy has sparked intense interest in lasers. This is a review of the laser technologies available for laparoscopic use. The relative merits and liabilities for each wavelength and delivery system are discussed.

ISSN:1052-3901    

DOI:10.1089/lps.1990.1.33

年代:1990

数据来源: MAL

ISSN:1052-3901    

DOI:10.1089/lps.1990.1.37

年代:1990

数据来源: MAL

摘要:

Laser laparoscopic inguinal herniorraphy represents an extension of current technology. Based on the principles of preperitoneal inguinal herniorraphy, it is performed by internal incision of the peritoneum and identification of the musculofascial defect through a laparoscope. Polypropylene mesh is then passed down the laparoscope, placed into the defect to obliterate the space, and the edges of the peritoneum are then reapproximated. Results in 20 patients with an 11 month followup indicates success in nineteen exhibiting early resumption of activity (3.3 days) and minimal pain (2.1 Tylenol #3 tablets per patient). One early recurrence suggests that anatomic identification of a direct space hernia may be difficult and that routine support of this area with additional mesh may be a requirement of a complete inguinal hernia repair.

ISSN:1052-3901    

DOI:10.1089/lps.1990.1.41

年代:1990

数据来源: MAL

摘要:

A small flexible microendoscope with an outside diameter (OD) of 0.5 mm has been developed for effective visualization of the entire length of the human fallopian tube. Using a transvaginal approach, a small flexible operating hysteroscope with an OD ranging from 3.3 to 4.5 mm, was used to visualize the uterotubal ostium (UTO) for cannulation of the tube. A coaxial technique, incorporating guidewire cannulation, placement of an "over the wire" Teflon catheter, and replacement of the guidewire with a falloposcope, for video documentation of endotubal surface anatomy has been carried out without complication in 55 women who had a total of 84 tubes available for tubal endoscopy. Characterization of normal and abnormal epithelial changes has been documented for the intramural, isthmic, ampullary, and fimbrial tube. Technical difficulties related to failure to negotiate the entire tubal lumen in the absence of obstructive disease occurred in 9 (11%) of the 84 endoscopy cases. These technical difficulties have been partly overcome by the incorporation of smaller directional guidewires, softer distortion-free Teflon catheters, improved microendoscopes, and the acquisition of new surgical skills necessary for safe and successful endoscopy of the fallopian tube. Minor difficulties were experienced in 7 (8%) of 84 endoscopies due to ostial spasm secondary to attempted guidewire cannulation. Cannulation was successful once spasm ceased. Of the 75 (89%) remaining successful tubal endoscopies, documentation of endotubal lesions ranging from accumulated debris, nonobstructive intraluminal adhesions, stenosis, polyps, to total fibrotic obstruction were observed in 43 (57%) examinations. The majority (70%) of these lesions were confined to the medial third of the tube, between the UTO and ampullary isthmic junction (AIJ). The tubal lumen was considered to be endoscopically normal in 32 (42%) examinations. Techiques of tubal aquadissection (TA), guidewire cannulation (GC), wire guide dilitation, and direct balloon tubuloplasty (DBT) under hysteroscopic-falloposcopic-laparoscopic control were devised for attempting to break down intraluminal adhesions, dilate a stenosis, or open up an obstruction in 35 of the 43 tubes containing a lesion. Combinations of these tubuloplasty techniques were effective for dislodging debris, breaking down adhesions, or dilating stenoses in 16 (58%) of 29 cases and consistently ineffective for bypassing true fibrotic obstructions in 6 (100%) of 6 cases. A detailed description of the falloposcope, its accessory instrumentation, and technique of falloposcopy is outlined. Additionally, preliminary evaluation of falloposcopically directed tuboplasty techniques and their effects on tubal lesions are described. This transvaginal endoscopic technique has been termed falloposcopy and the microendoscopic instrument, a falloposcope.

ISSN:1052-3901    

DOI:10.1089/lps.1990.1.47

年代:1990

数据来源: MAL

ISSN:1052-3901    

DOI:10.1089/lps.1990.1.57

年代:1990

数据来源: MAL

ISSN:1052-3901    

DOI:10.1089/lps.1990.1.59

年代:1990

数据来源: MAL