摘要:

ABSTRACTForty-nine consecutive patients underwent laparoscopic assisted colorectal surgery for benign and malignant lesions of the colon. Thirty-eight of the 49 operations (78%) were completed successfully with laparoscopic assistance. A large tumor bulk or dense adhesions were the most common reasons for conversion to laparotomy. Twenty-eight of the 38 patients (74%) in the laparoscopically completed group were tolerating a diet by postoperative day 2, and 31 (82%) passed flatus or a bowel movement by the third postoperative day. The mean postoperative hospital stay for this group was 4.8 days, which compared very favorably to that reported in the literature for traditional open colorectal operations. Twelve patients developed complications, for a 24% morbidity in the series. However, only 3 (6%) of these complications were related to the laparoscopic part of the procedure. Inspection of the pathologic specimens revealed adequate margins and a lymph node harvest that averaged 11 nodes per specimen. We concluded that laparoscopic assisted colorectal surgery is a safe and feasible technique, which may be associated with a faster return of bowel activity and a shorter hospital stay. Although the extent of resection appears comparable to that of laparotomy, it is too early to assess long-term outcome when it is applied in the treatment of malignancy.

ISSN:1052-3901    

DOI:10.1089/lps.1994.4.1

年代:1994

数据来源: MAL

摘要:

ABSTRACTLaparoscopic cholecystectomy was performed in 467 patients between November 1989 and April 1991. Fifty-four patients (12%) had acute inflammatory changes. These were divided into three different groups: group 1—13 patients who admitted having an attack of right upper quadrant pain within 24—48 h of their scheduled elective laparoscopic cholecystectomy; group 2—23 patients who had a history of acute cholecystitis treated 4—6 weeks before their elective laparoscopic cholecystectomy; group 3—18 patients who were admitted to the hospital and were diagnosed with acute cholecystitis; they had laparoscopic cholecystectomy performed in the same admission. All patients had a successful laparoscopic removal of their gallbladder except 2 in group 3 who had to be converted to an open procedure. Analysis of the operative time, complications, and hospital stay showed that after adequate experience is gained in performing laparoscopic cholecystectomy, acute cholecystitis is not a contraindication. The procedure is faster and safer if performed in the first 24—48 h of the onset of the symptoms. Different technical maneuvers are needed due to the nature of

ISSN:1052-3901    

DOI:10.1089/lps.1994.4.9

年代:1994

数据来源: MAL

摘要:

ABSTRACTTen patients with carcinoma of the lower rectum and anus underwent laparoscopic abdominoperineal resection. They were 7 male and 3 female patients. The ages ranged from 32 to 81 years. The technique is fully described. The immediate results were satisfactory. There was 1 case of postoperative bleeding that required open surgery and 1 case of threatened colostomy gangrene that was easily corrected. There was no mortality. The advantages were less pain, less scar, easier care of the colostomy site, quicker return of bowel function, and less manipulation of the cancer. The laparoscopic approach was as efficient as open surgery.

ISSN:1052-3901    

DOI:10.1089/lps.1994.4.17

年代:1994

数据来源: MAL

摘要:

ABSTRACTThe purpose of this study was to evaluate the feasibility of performing an oncologic type of colectomy using laparoscopic techniques with intraperitoneal stapled ileorectal anastomosis in a canine model. In 21 dogs, laparoscopic oncologic colectomy was carried out using dissection with a contact Nd:YAG laser. The right, middle colic, and inferior mesenteric arteries were transected close to their origins, and all adjacent mesenteric lymph nodes were removed. Ileorectal anastomosis was performed using a circular end-to-end stapler especially designed for laparoscopic surgery. Two weeks after surgery, all animals were killed. The number of remaining mesenteric lymph nodes, bursting pressure of ileorectal anastomosis, and postoperative morbidity were evaluated. No major intraoperative complications were recorded. One dog died postoperatively from an anastomotic leak. All dogs passed feces in the first 24 postoperative hours. Median operative time was 145 min (90–240 min). The number of remaining colonic mesenteric lymph nodes was 0, and median anastomotic bursting pressure was 325 mm Hg (183–415 mm Hg). The median distance from ileocolic anastomosis to anal verge was 8.5 cm (6.0–11.0 cm). Laparoscopic oncologic colectomy with wide mesenteric clearance of lymph nodes and intraperitoneal stapled ileorectal anastomosis is feasible and safe in a canine

ISSN:1052-3901    

DOI:10.1089/lps.1994.4.23

年代:1994

数据来源: MAL

摘要:

ABSTRACTPrevious abdominal surgery has been reported as a relative contraindication to laparoscopic cholecystectomy. An analysis of 193 laparoscopic cholecystectomies was undertaken to determine whether this relative contraindication led to increased morbidity, an increased rate of conversion to open cholecystectomy, or longer operating time. The results of 55 patients who had previous abdominal surgery were compared with those of 138 patients without previous abdominal surgery. Morbidity, conversion rate, and operating time were not increased in patients with previous abdominal surgery. We found both previous upper and previous lower abdominal surgery to be risk for laparoscopic cholecystectomy. Laparoscopic cholecystectomy can be performed safely in patients with previous abdominal surgery if we (1) use the cutdown technique initially, (2) dissect the adhesion before the upper midline port is inserted, (3) retrogradely dissect the gallbladder from the liver bed, and (4) divide the cystic artery and duct last.

ISSN:1052-3901    

DOI:10.1089/lps.1994.4.31

年代:1994

数据来源: MAL

摘要:

ABSTRACTTo determine the role of open tube thoracoscopy in the diagnosis and management of thoracic diseases, a retrospective review of 48 patients was conducted. A mediastinoscope was used for open tube thoracoscopy. Eleven patients underwent diagnostic thoracoscopy, and 4 patients had thoracoscopy for cancer staging. All 11 diagnostic procedures yielded a diagnosis, and thoracic malignancies were staged accurately in all patients. Thirty-three patients underwent therapeutic thoracoscopy. Twelve therapeutic thoracoscopies were done for pneumothorax, 9 for loculated parapneumonic effusion or empyema, 4 for malignant effusions, 2 for traumatic hemothorax, 2 for wedge resection of peripheral lung cancers, and 4 for other indications. All but 1 therapeutic procedure were successful. Three patients experienced complications specific to thoracoscopy (empyema 1, prolonged air leak 1, chest tube site leakage 1). There were 5 deaths, but none were related to thoracoscopy. Open tube thoracoscopy is very effective for evacuation of loculated pleural fluid, pus, or blood, and it appears to have advantages over video thoracoscopy in these settings. Although open tube thoracoscopy is satisfactory for other simple pleural procedures and wedge resections of lung are possible, video thoracoscopic techniques are now preferred for these indications.

ISSN:1052-3901    

DOI:10.1089/lps.1994.4.37

年代:1994

数据来源: MAL

ISSN:1052-3901    

DOI:10.1089/lps.1994.4.41

年代:1994

数据来源: MAL

摘要:

ABSTRACTTo work with ease and comfort in laparoscopic cholecystectomy, four instruments (Tohoku dissector, Tohoku forceps, short mantis device, and long mantis device) have been developed that can be used by any surgeon, even one not accustomed to this new procedure. These instruments have the advantage of offering a feel of open surgery and have been in use since February 1991 with significant comfort and safety.

ISSN:1052-3901    

DOI:10.1089/lps.1994.4.45

年代:1994

数据来源: MAL

摘要:

ABSTRACTAcute colonic perforation is an uncommon but distressing complication of colonoscopic procedures. We describe the successful management of 3 such cases using laparoscopic techniques.

ISSN:1052-3901    

DOI:10.1089/lps.1994.4.51

年代:1994

数据来源: MAL

ISSN:1052-3901    

DOI:10.1089/lps.1994.4.55

年代:1994

数据来源: MAL