ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

SummaryLaparoscopic surgery has recently been encouraged as an alternative to open procedures in patients infected with the human immunodeficiency virus (HIV). The laparoscopic technique reduces exposure to blood products and sharp instruments; however, it exposes the surgical team to the HIV-infected patient in a manner not encountered during open procedures. The evacuation of the pneumoperitoneum during laparoscopic procedures releases aerosolized HIV-infected blood and peritoneal fluid into the operative suite. Evacuation of the penumoperitoneum into a closed system and appropriate precautions during instrument changes will diminish the exposure of the surgical team to aerosolized HIV-infected blood and peritoneal fluid.

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

SummaryOur aim was to assess the feasibility and safety of performing totally intracorporeal laparoscopic small bowel resection and anastomosis using a linear stapling device. Laparoscopic small bowel resection and anastomosis were performed in five young domestic pigs. Five trocars were used (2–5 mm, 2–11 mm, and 1–12 mm) for video laparoscopic access to the peritoneal cavity. Segments of jejunum 5 to 10 cm long were excised using two firings of a 30-mm linear stapler (Endo-GIA). The bowel was anastomosed with the stapler in a functional end-to-end fashion, and the enterotomy was stapled closed. The excised bowel segment was then placed in a nylon entrapment sack, morcellated, and aspirated with an automatic electrical tissue morcellator. The pigs recovered uneventfully, were allowed oral feedings on the day after the operation, and gained weight normally in the postoperative period. Sacrifice after 4 to 10 weeks revealed few adhesions, no evidence of anastomotic leaks, and the anastomoses to be widely patent. Clinical application will be facilitated by the use of longer laparoscopic staplers, but surgeons must also develop suturing skills to assure safe performance of advanced laparoscopic surgery.

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

SummarySince the introduction of laparoscopic cholecystectomy in 1989, surgeons worldwide have become familiar with the basic techniques involved. Pregnancy has previously been considered an absolute contraindication to laparoscopic cholecystectomy; however, we present three cases of laparoscopic cholecystectomy in pregnancy. If conservative management fails, this method, far from being absolutely contraindicated, should be the procedure of choice in pregnancy, as it has already become in nonpregnant patients. Transvaginal ultrasound allows continuous monitoring of fetal heart rate in all stages of pregnancy after the 7th week. The open (Hasson) technique should be strongly considered if accidental uterine puncture and potential fetal damage are to be avoided.

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

SummaryThe role of intraoperative cholangiography during laparoscopic cholecystectomy is controversial. Between July 1990 and June 1991, 82 of 84 consecutive patients (mean age, 46 ± 14 years) with symptomatic cholelithiasis successfully underwent laparoscopic cholecystectomy with only one intraoperative cholangiogram. Fourteen patients underwent preoperative endoscopic retrograde cholangiopancreatography (ERCP) for suspected choledocholithiasis of which two demonstrated common duct stones and underwent sphincterotomy. Complications of laparoscopic cholecystectomy included one each of bilioma, umbilical wound infection, epigastric trochar site hernia, and flank seroma. No major bile duct or vascular injury occurred. Follow-up data was available on all patients for a mean of 7.4 months (range, 3–13 months). Three patients developed symptoms suggestive of biliary tract disease at 0.25, 4, and 8 months postoperatively. Symptoms spontaneously resolved in all three; all underwent ERCP, of which two were normal and one unsuccessful. We have concluded that (a) a meticulous operative dissection resulted in no major bile duct or vascular injury; (b) patients with unsuspected choledocholithiasis pre-operatively rarely developed postoperative symptoms; and (c) the practice of laparoscopic cholecystectomy can be conducted safely without intraoperative cholangiography.

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

SummaryProspective studies compared (a) laparoscopic and open cholecystectomy and (b) laparoscopic and open appendectomy. A second purpose of this study was to assess the value of laparoscopic staging of pancreatic and liver tumors. A total of 141 cholecystectomy cases were studied, comprising a laparoscopic group (n = 50), an open prospective control group (n = 50), and historical controls (n = 41). The need for postoperative analgesics was significantly reduced with the laparoscopic procedure compared with open cholecystectomy. Hospital stay was 1 (1–5) day after laparoscopic cholecystectomy versus 6 (5–28) days after open cholecystectomy. Time away from work was 9 (4–21) versus 28 (21–60) days. These differences were statistically significant (p < 0.001). Complication rates were 8% in both prospective groups. A similar comparative study of laparoscopic appendectomy versus the open technique was undertaken, with 10 patients in each prospective group. Again, hospital stay and time away from work proved shorter for laparoscopic procedures. Finally, 15 staging procedures for pancreatic and liver cancers were per-formed. One patient with unresectable liver metastases was spared explorative laparotomy.

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

SummaryLaparoscopic cholecystectomy (LC) is being used more frequently in patients undergoing gallbladder removal. Most initial studies have centered on the limited experience of a few select surgeons or institutions and may not accurately reflect the current state of LC. We used written and telephone survey tools to 103 community hospitals in Michigan to identify the utilization of LC, the criteria for training and credentialing, and patient outcome. Of 103 hospitals, 75 (73%) were involved with LC and 56% of these had <100 beds. We found a large variation in the indications, contraindications, equipment, methods, and credentialing criteria. Major complications, including some not previously reported, were identified and occurred more frequently than previously described. LC is being widely applied and the majority of hospitals have <100 beds. LC may carry higher risks than previously reported. Collected series and registry data that include community hospital experiences should better delineate the outcome of LC.

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

SummaryA prospective study of 15 patients undergoing elective laparoscopic herniorrhaphy was performed using the introduction of a polytetrafluorethylene (PTFE, GORE-TEX) patch fenestrated around the edges to facilitate the use of an Endo-Clip applier. Patient tolerance was increased, and time lost from work was reduced. Two patients treated for prostatitis resumed sexual activity within the first 10 days with no recurrences or intra-abdominal infections. Fenestration of the PTFE patch was possible without fraying the material and without compromising the strength of the patch. The Endo-Clip applier secures the patch to the ligamentous structures. Initial cases were followed for 6 months.

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

SummaryLaparoscopic techniques were used in five cases to repair incisional abdominal hernias ranging in size from 1.5 to 6 cm2. Four to five trocars were used in each case, one in the upper midline and three or four placed laterally. All repairs were made using 1-mm-thick expanded polytetrafluoroethylene patches inserted intraperitoneally and stapled to the anterior abdominal wall over the defects, making use of intra-abdominal pressure to secure the repair. The surgical technique is an extension of our current laparoscopic techniques for repairing inguinal hernias and potentially offers a significant decrease in morbidity.

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

SummaryLaparoscopic cholecystectomy has become the standard of care for symptomatic gallstone disease. One of the key steps in the procedure is to obtain pneumoperitoneum and insert the first trocar safely through the umbilicus. In our first 150 laparoscopic cholecystectomies, the pneumoperitoneum was obtained by inserting a Veress needle through the umbilicus, followed by blind insertion of the first trocar through the umbilicus. This was associated with several complications, including bowel laceration. Subsequently, we adopted the open laparoscopic technique described by Hasson in 1974. Using this, we have performed 150 laparoscopic procedures without complications. In this article, we compare and analyze the results and complications of both techniques. We find open laparoscopy to be a quicker, safer, and superior technique for obtaining pneumoperitoneum as well as a more cost-effective procedure.

ISSN:1051-7200    

出版商:OVID    

年代:1993

数据来源: OVID