摘要:

SummaryWe present 20 cases (10 men, 10 women) of laparoscopically assisted colorectal anastomose. The patients' mean age was 52.8 years. The mean length of procedure was 130 min. There were two transoperative complications, a rectal perforation with the stapler and an incomplete anastomose. Six (35.2%) patients said they had no postoperative pain. Bowel sounds occurred in a mean time of 18.2 h, flatus in 26.4 h, and bowel movement in an average of 2.5 postoperative days. Liquid diet was started after an average of 1.5 days, and the mean hospital stay was 4 days. There were three (15%) conversions because of excessive pelvic adherence, pelvic neoplastic invasion, and rectal perforation with a stapler. Postoperative complications occurred in seven (41.1%) cases: an incisional hernia, two wound infections, one wound bleeding, an acute renal failure, an undetermined peritonitis, and a small pelvic abscess. No mortality occurred in these cases.

ISSN:1051-7200    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryLaparoscopic surgery has become accepted in the United States as the surgical procedure of choice for treatment of symptomatic chotetithiasis. The general surgeon is now presented with a vast array of instrumentation and new techniques that have rapidly developed since the introduction of laparoendoscopic surgery. Much of this new technology is designed for easier and less expensive laparoscopic cholangiography. We describe a technique for difficult cannulation of the cystic duct using a new introducer (the DeKalb wire introducer) when conventional methods have failed.

ISSN:1051-7200    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryIn the late 1980s, minimally invasive surgery experienced unprecedented growth. Centers appeared worldwide, providing a variety of training opportunities and laboratory experiences. Because standard surgical training varies greatly from country to country, it became apparent that this variety was even more pronounced in the area of minimally invasive and laparoscopic surgery, posing significant credentialling difficulties for professional standards committees wishing to certify surgical staff who submit unevaluable credentials from all over the world. In January 1993, the Center for Minimally Invasive Surgery at New England Medical Center and Tufts University School of Medicine was asked to plan and execute a program of education, training, and credentialling for a multispecialty surgical staff in the Eastern province of Saudi Arabia. A four-stage program was designed and developed to provide credentialling from the technician level through the instructor surgeon level. A multidisciplinary course was developed and a team placed on site for 1 month to execute the program. This program began with an 8-h didactic/video session in basic laparoscopy, covering areas common to the involved subspecialties: surgery, urology, and gynecology. This session was followed by hands-on training sessions in general surgery and urology and credentialling in gynecology. Physicians who successfully completed the examination in basic laparoscopy were later eligible for credentialling at one of three clinical specialty levels: basic clinical laparoscopy, advanced clinical laparoscopy, or instructor in clinical laparoscopy. Education and credentialling in minimally invasive surgery can be accomplished by executing a program of basic science and clinical training for physicians, technicians, and nurses that accommodates a wide range of experience of participants, from novice to master surgeon. Sup-port from the hospital administrators and department chairs was instrumental in the program's success. Among the goals we accomplished was identification of persons in an institution who could serve as future instructors and certifiers for the hospital's self-sustaining program as well as providing a relationship in which international institutions can serve as a resource for further continuing medical education and clinical and laboratory training. This program may well serve as the model template for international credential standards of the future.

ISSN:1051-7200    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryWe report the laparoscopic use of a novel perforator-grinderaspirator apparatus, specifically designed for the evacuation of hydatid cysts. Eleven hepatic hydatid cysts in six patients were treated by laparoscopic technique using this tool, which penetrates the cyst mainly by opening a hole in the cyst wall, grinds the particulate, and sucks it all out; classic surgical aspirators are almost always blocked by daughter cysts and laminated membranes. If the cyst is small, management of the cavity is achieved by simple drainage; otherwise, vacuum obliteration with the application of –250-mbar negative pressure may be necessary. High vacuum obliterates the cystic cavity by clinging to the opposing cyst walls. In the postoperative period, none of these patients had bile drainage. In the following 6 to 20 months period, computed tomography (CT) and ultrasound examinations revealed progressive decrease in the size of seven cysts and disappearance of the lesions in five cysts. We therefore conclude that laparoscopic treatment of hepatic hydatid cysts can be easily and effectively accomplished by using this novel instrument. Obliteration of the cystic cavity by high vacuum is a time-saving procedure that is easy to perform and that reduces or totally eliminates bile drainage.

ISSN:1051-7200    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryThe indications and best technique for peroperative cholangiography during laparoscopic cholecystectomy remain unclear, but the operation has been associated with an increased use of preoperative endoscopic retrograde cholangiography. Cystic duct cholangiography, particularly in the hands of the trainee, can be time consuming, and bile duct injury may be caused by attempts to cannulate the cystic duct. This study analyses 113 consecutive patients undergoing peroperative cholangiography through the gallbladder, or cholecystocholangiography. It was successful in 92 (81.4%) patients, the procedure adding less than 10 min to the operating time. There were no cholangiogram-related complications. Common anatomical variations included both short and particularly wide cystic ducts. This information helps to minimize the risk of damage to the common bile duct. This study demonstrates that cholecystocholangiography is a safe, simple, and effective alternative to cystic duct cholangiography with virtually no “learning curve.” It provides a “road-map” of biliary anatomy and identifies common bile duct stones prior to the commencement of dissection. Unsuccessful cholecystocholangiography does not preclude the use of cystic duct cholangiography later in the operation. Difficult anatomy is demonstrated prior to dissection. When unsuspected bile duct calculi necessitate open exploration, further laparoscopic dissection is avoided.

ISSN:1051-7200    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryThirty-five patients with acute cholecystitis were operated on in a period of 17 months at Bayindir Medical Center. Open cholecystectomy (OC) was performed in 12 patients, and laparoscopic cholecystectomy (LC) was attempted in 23 of the patients. LC was successfully completed in 20 patients (conversion rate 13%). LC and OC groups were compared according to the sex, age, operative time, postoperative hospital stay, and gallbladder wall thickness. The differences in the mean operative time and mean days of post-operative hospital stay between the two groups were significant (p < 0.01). There were three (15%) and two (13.3%) postoperative complications in the LC and OC groups, respectively. In acute cholecystitis, LC increases the operative time but decreases the hospital stay compared with OC. LC does not increase the intraoperative and postoperative complication rates.

ISSN:1051-7200    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryHepatic cryotherapy is used to treat unresectable liver tumors and could potentially be undertaken laparoscopically; however, the risk of gas embolism during laparoscopic hepatic cryotherapy has not been studied. Eight New Zealand White rabbits underwent laparoscopic hepatic cryotherapy with continuous precordial ultrasound monitoring for gas embolism. No episodes of gas embolism were detected, and at postmortem no intracardiac gas was found in any rabbit. In conclusion, this study found no evidence that gas embolism is any more likely to occur during laparoscopic than in open hepatic cryotherapy.

ISSN:1051-7200    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryLaparoscopic cholecystectomy has been rapidly adopted as a standard surgical treatment in symptomatic cholelithiasis. Its advantages over laparotomy are well described. However, its risks and long-term results have not been fully evaluated. We experienced three patients in whom intra-abdominal carcinomas failed to be recognized during laparoscopic surgery. The clinical manifestations, laboratory findings, and radiologic findings were carefully re-viewed in each case. Limited exploration of the abdominal cavity is one of the technical pitfalls in laparoscopic cholecystectomy; so surgeons can miss the carcinoma of extrabiliary system. To prevent such problems, a careful taking of the history and physical examination should be repeated by the responsible surgeon, who must be aware of the differential diagnosis of cholelithiasis, especially in elderly patients. If needed, additional radiologic studies are recommended.

ISSN:1051-7200    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryNineteen patients underwent laparoscopic placement of a peritoneal dialysis catheter with suture fixation into the pelvis. Operating time ranged from 20 to 60 min (median, 33), and the median postoperative stay for patients admitted solely for catheter placement was I day. No significant morbidity was associated with this procedure, and all but one catheter functioned well over the long term. Suture fixation of laparoscopically placed peritoneal dialysis catheters is straightforward, and may achieve better catheter function.

ISSN:1051-7200    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

SummaryAdvances in operative laparoscopic techniques have made possible the extension of this technology to the treatment of women with ovarian cancer. We present a detailed case series of eight patients with ovarian cancer who underwent a total of 11 operative laparoscopies for treatment of ovarian cancer ranging in stage from IA to IIIC. Three patients underwent initial laparoscopic staging and therapeutic debulking procedures. In three other cases that were incompletely staged via laparotomy, laparoscopy was used to complete the staging. Interval laparoscopic tumor debulking combined with second-look laparoscopy was performed in four cases. We describe our experience with these new applications of evolving techniques with particular regard to potential advantages, disadvantages, and complications. This detailed preliminary case series suggests the need for prospective clinical studies to establish the safety and efficacy of the approach.

ISSN:1051-7200    

出版商:OVID    

年代:1996

数据来源: OVID