摘要:

SummaryTwelve patients with benign and malignant esophageal diseases were treated by transhiatal esophagectomy, without thoracotomy, using abdominal-mediastinal dissection conducted by videolaparoscopy. A cervical approach was used to retrieve the esophagus and to perform the esophagogastric anastomosis. The procedure was indicated in patients with advanced achalasia of the esophagus, severe reflux stenosis, squamous cell carcinoma, and adenocarcinoma of the esophagus. Three pleural perforations occurred during surgery. Blood loss was minimal. One patient required conversion to open surgery, two patients were submitted to chest drainage, and three had transitory dysphonia. One patient had an anastomotic leak with subsequent stenosis requiring endoscopic dilatation. No mortality occurred in this small series.

ISSN:1051-7200    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

SummaryThe aim of this project was to replace the surgical assistant for common laparoscopic procedures with a robotic camera. The motions of the human camera operator were defined and expressed mathematically by a spherical displacement model. A revolving robotic arm with six degrees of freedom was employed in conjunction with this model as an automated camera in the performance of cholecystectomy, Taylor and Nissen procedures in animals, and cholecystectomy in humans. It represents a first step toward the introduction of robotic technology in laparoscopic surgery.

ISSN:1051-7200    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

SummaryThe advances in endoscopic capabilities expanded the potential role of laparoscopic and thoracoscopic surgery. The introduction of safe linear stapling devices made thoracoscopic assisted segmental lung resections possible. Because of the postoperative advantages of a thoracoscopic operation, a technique for thoracoscopic lobectomies was developed. Three case reports are presented using the same technique. The first two cases report a right lower lobectomy and the third case a bilobectomy, right middle and lower lobe.

ISSN:1051-7200    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

SummaryEndoscopic sphincterotomy (ES) was performed on 27 patients after cholecystectomy with a T tube in situ at a mean interval of 23 days after surgery. A precut papillotomy facilitated deep cannulation and subsequent standard ES in three patients with impacted ampullary stones. Bile duct clearance was successful at the first attempt in 22 of 25 (88%) patients who had common bile duct stones. Spontaneous passage of the stones occurred in two patients within 10 days of ES, while the T tube was still in situ. In one patient, the T tube had to be removed to facilitate spontaneous passage of the stone through the ES opening. Choledochoduodenal fistula occurring immediately above the ampulla of Vater was found in three (11%) of our patients. Common bile duct exploration is the most likely cause of these fistulae. Mild bleeding in one patient was the only complication encountered. It is concluded that ES is a relatively safe and efficient way of treating common bile duct stones with a T tube in situ.

ISSN:1051-7200    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

SummaryIn case 1, a 68-year-old woman with asymptomatic gallstones underwent laparoscopic cholecystectomy after radical mastectomy for breast cancer. Histological examination revealed gallbladder carcinoma with involvement confined to the mucosa and positive margin at the cystic duct. We resected the remnant cystic duct with open laparotomy. In case 2, a 63-year-old woman with a diagnosis of early rectal cancer underwent laparoscopic cholecystectomy for silent gallstones following transanal resection of the rectal tumor. Pathologic analysis illustrated a gallbladder carcinoma with wide mucosal spread and minimal invasion into the subserosal layer. No additional treatment was warranted. As laparoscopic cholecystectomy has become widely used, an increase in the number of resected cases of early gallbladder cancer can be expected, especially among asymptomatic gallstone patients. Additional treatment should be determined through meticulous microscopic investigation of the specimen, with special attention to the depth of invasion and the range of mucosal spread.

ISSN:1051-7200    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

SummaryThe application of new minimally invasive techniques in the diagnosis and treatment of surgically correctable diseases continues to produce impressive results. Herniae of the Foramen of Morgagni are unusual abdominal wall defects which have historically been difficult to diagnose. Interestingly, laparoscopy was utilized for the diagnosis and repair of three such herniae during a 5-month period. All of these repairs were performed by one primary author in conjunction with co-authors. In this report we will review this rare hernia and report our technique of repair. We believe that an aggressive approach to diagnostic laparoscopy may produce cost-effective solutions to old and new intraabdominal problems.

ISSN:1051-7200    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

SummaryA type II paraesophageal hernia is usually an asymptomatic condition found incidentally in an elderly patient. It is a potentially devastating problem because it can present as severe blood-loss anemia or acute, life-threatening gastric volvulus. The medical and surgical literature is replete with recommendations for surgical repair, but underlying medical illnesses have led to delays in the use of this treatment of choice. Five extreme elderly patients safely underwent the standard “Boerema” repair with gastropexy under laparoscopic guidance. With the advent of laparoscopy, a safe, minimally invasive approach is available to the high-risk patient group.

ISSN:1051-7200    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

SummaryWe report two surgical treatments by laparoscopic techniques of a leiomyoma in the stomach, each for one patient. The patients, one a 59-year-old man and the other a 28-year-old woman, were found to have an asymptomatic submucosal tumor in the stomach in an annual medical screening. One tumor, 1.5 cm in maximum diameter, was located on the anterior wall of the gastric body and was excised extracorporeally by laparoscopy-guided surgery. The other was 1.9 cm in maximum diameter, on the anterior wall of the antrum, and was excised intracorporeally using only laparoscopic surgery. Their post-operative courses were uneventful. They drank clear liquid after the removal of a nasogastric tube on the first postoperative day and had a solid meal on the second postoperative day. They were discharged from the -hospital on the seventh and eighth postoperative days.

ISSN:1051-7200    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

SummaryThe purpose of this clinical study was to demonstrate the usefulness of routine intraoperative cholangiography (IOC) and the safety of laparoscopic cholecystectomies (LC) in a community hospital. There were no ductal injuries and perioperative complications were extremely low. Patients (n = 236) with symptomatic gallstone disease, acalculus cholecystitis, or gallbladder polyps underwent LC from March 1991 to June 1993. During this period two patients were not considered appropriate candidates for this procedure. There were 172 women and 64 men ranging in age from 15 to 84 years. Four had preoperative endoscopic retrograde cholangiopancreatographies (ERCPs) for suspected choledocholithiasis. Elective LC was performed on 194 patients and emergency LC on 42 patients. The average operating time for elective LCs was 89 min and 97 min for emergency LCs. Thirty-six percent of patients had previous abdominal or pelvic surgery. IOC was attempted in 99% of patients and successful in 89%. Five percent had choledocholithiasis. Laparoscopic duct exploration was performed on four patients. Six patients had postoperative ERCP with stone extraction. Three percent of elective patients had additional surgery. One patient had LC during pregnancy (17 weeks), with a normal recovery and successful outcome of the pregnancy. Six elective and four emergency patients were converted to open cholecystectomy, a conversion rate of 4%. There were no ductal or vascular injuries, intraoperative haemorrhages or deaths. There was one small bowel laceration (0.4%). Postoperative complications included seven wound infections (3%), four bile leaks (2%), three trocar site haemorrhages (1%), one intraabdominal haemorrhage (0.4%), one suspected halothane hepatitis (0.4%), one drug-induced cholestatic jaundice (0.4%), and one subcutaneous emphysema (0.4%). Seventy-five percent of elective patients were discharged on the first or second postoperative day. Fifty-six percent of emergency patients were discharged by the second post-operative day and 83% by the fourth day. This study demonstrates the importance of routine IOC in preventing ductal injuries and diagnosing choledocholithiasis. The low complication rates demonstrate the safe application of this procedure in a community hospital.

ISSN:1051-7200    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

SummaryTwo new sutures are introduced for laparoscopic two-handed instrument suturing and knot tying, as well as a device for making them. In the first design, a nonslipping loop is placed at each end of a straight suture; they act as anchoring devices to maintain the suture in the two-dimensional plane of focus of the laparoscopic camera. The loops provide a large surface area that facilitates grasping the suture during the rotational and pulling maneuvers employed in instrument knot tying. The double-looped suture can be used for tying off and retracting tubular structures. The second design consists of a suture ligature with a curved or straight needle at one end and a single, non-slipping loop at the other. Illustrations demonstrate tying and suturing techniques for approximating tissue with the new sutures. A device consisting of two pairs of posts, for making the looped suture in a uniform fashion, is also discussed.

ISSN:1051-7200    

出版商:OVID    

年代:1995

数据来源: OVID