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1

Ethical issues in laparoscopic hysterectomy.  

PubMed

Hysterectomy is performed for a wide range of benign and malignant conditions, such as fibroids, menorrhagia and pelvic pain, and gynaecological malignancies. One in four women has a chance of undergoing hysterectomy in her lifetime. Conventionally abdominal hysterectomy is done through the open approach. However, many patients assume that the modern laparoscopic hysterectomy is superior to the standard approach. Laparoscopic surgical centres are mushrooming in major cities. This article presents ethical considerations involved in the decision-making process of choosing from the surgical options available. PMID:16832925

Hebbar, Shripad; Nayak, Sathisha

2006-01-01

2

Is laparoscopic hysterectomy a waste of time?  

Microsoft Academic Search

SummaryLaparoscopic hysterectomy (LH) is a way to avoid laparotomy. However, there is evidence that most women treated by abdominal hysterectomy are suitable for vaginal surgery. To test this hypothesis, and to determine the relative merits of laparoscopic and vaginal hysterectomy (VH) and the best technique for LH, we prospectively studied 98 women who had relative contraindications for vaginal surgery by

R. E Richardson; N Bournas; A. L Magos

1995-01-01

3

Total Laparoscopic Hysterectomy Using the Harmonic Scalpel  

PubMed Central

Total laparoscopic hysterectomy (TLH) is the complete hysterectomy including transection of the uterine vessels and opening/closure of the vaginal vault performed laparoscopically. This procedure can be performed as an alternative to total abdominal hysterectomy in many cases. We previously found use of the harmonic scalpel to be extremely helpful in performing laparoscopically assisted vaginal hysterectomies. In this series, the harmonic scalpel was used to facilitate performing TLH. Our experience has shown this can be performed without major complications in a cost-effective manner. PMID:10527328

Mendelsohn, Susan A.

1999-01-01

4

Laparoscopic Hysterectomy and Prolapse: A Multiprocedural Concept  

PubMed Central

Background and Objectives: Today, laparoscopic intrafascial hysterectomy and laparoscopic supracervical hysterectomy are well-accepted techniques. With our multimodal concept of laparoscopic hysterectomy for benign indications, preservation of the pelvic floor as well as reconstruction of pelvic floor structures and pre-existing prolapse situations can be achieved. Methods: The multimodal concept consists of 3 steps: Intrafascial hysterectomy with preservation of existing structures Technique 1: Primary uterine artery ligationTechnique 2: Classic intrafascial hysterectomyA technique for the stable fixation of the vaginal or cervical stumpA new method of pectopexy to correct a pre-existing descensus situation Results and Conclustion: This well-balanced concept can be used by advanced endoscopic gynecologic surgeons as well as by novices in our field. PMID:24680150

Mettler, Liselotte; Peters, Goentje; Noé, Günter; Holthaus, Bernd; Jonat, Walter; Schollmeyer, Thoralf

2014-01-01

5

Total Laparoscopic Hysterectomy for Large Uterus  

PubMed Central

Aim: In this review, we assessed the feasibility of total laparoscopic hysterectomy (TLH) in cases of very large uteri weighing more than 500 grams. We have analyzed whether it is possible for an experienced laparoscopic surgeon to perform efficient total laparoscopic hysterectomy for large myomatous uteri regardless of the size, number and location of the myomas. Design: Retrospective review (Canadian Task Force Classification II-1) Setting: Dedicated high volume Gynecological laparoscopy centre. Patients: 173 women with symptomatic myomas who underwent total laparoscopic hysterectomy at our center. There were no exclusion criteria based on the size number or location of myomas. Intervention: TLH and modifications of performing the surgery by ligating the uterine arteries prior, myomectomy followed by hysterectomy, direct morcellation after uterine artery ligation. Results: 72% of patients had previous normal vaginal delivery and 28% had previous cesarean section. Average clinical size of the uterus was 18 weeks (10, 32). The average weight of the specimen was 700 grams (500, 2240). The average duration of surgery was 107 min (40, 300) and the average blood loss was 228 ml (10, 3200). Conclusion: Total laparoscopic hysterectomy is a technically feasible procedure. It can be performed by experienced surgeons for large uteri regardless of the size, number or location of the myomas. PMID:22442509

Sinha, Rakesh; Sundaram, Meenakshi; Lakhotia, Smita; Mahajan, Chaitali; Manaktala, Gayatri; Shah, Parul

2009-01-01

6

Total Laparoscopic Hysterectomy: 10 Steps Toward a Successful Procedure  

PubMed Central

Vaginal and laparoscopic hysterectomies have been clearly associated with decreased blood loss, shorter hospital stay, speedier return to normal activities, and fewer abdominal wall infections when compared with abdominal hysterectomies. In this review, the authors outline the 10 steps to a successful laparoscopic hysterectomy. PMID:19399296

Einarsson, Jon I; Suzuki, Yoko

2009-01-01

7

[Laparoscopic hysterectomy -- indications, technic, complications].  

PubMed

In recent decades, interest in laparoscopic gynecological practice increase. This technic applied first as a diagnostic tool in women with infertility. Subsequently starts to be used to perform surgery in small region of the fallopian tubes and ovaries, being increasingly developed and today, it is considered that any gynecological operation can be performed laparoscopically. PMID:24505638

Bechev, Bl; Kornovski, J; Kostov, I; Lazarov, I

2013-01-01

8

Total Laparoscopic Hysterectomy and Laparoscopy-Assisted Vaginal Hysterectomy  

PubMed Central

Background and Objectives: To compare the feasibility of total laparoscopic hysterectomy (TLH) and laparoscopy-assisted vaginal hysterectomy (LAVH) in the treatment of benign gynecologic diseases and to determine the selection criteria for each technique. Methods: This was a retrospective medical records review of 168 patients who underwent TLH or LAVH performed by one surgeon. A chi-square test was used to compare the difference between the TLH and LAVH groups. Pearson's correlation coefficient was calculated for the relationship between the clinico-demographic factors of the patients. Results: There were no differences between the 2 groups with respect to age, parity, history of abdominal delivery, body mass index, and indication for hysterectomy. The operative time was similar between the 2 groups (P>.99). The uterine weight was greater in the LAVH group compared to the TLH group (P<.01). Ten patients were converted from TLH to LAVH, because of a large uterus and/or a lower segmental mass on the uterus, making it difficult to expose the Koh cup rim contour. Conclusions: TLH and LAVH are safe, feasible methods by which to perform a hysterectomy. LAVH is preferred in patients with a mass involving the lower segment or a relatively large uterus. PMID:21902979

Lee, Ho Hyung; Lee, Soon Pyo; Park, Chan Yong

2011-01-01

9

Minimally Invasive Specialists and Rates of Laparoscopic Hysterectomy  

PubMed Central

Background and Objective: Despite the prevalence of hysterectomy for treatment of benign gynecologic conditions, providers nationwide have been slow to adopt minimally-invasive surgical techniques. Our objective is to investigate the impact of a department for minimally invasive gynecologic surgery (MIGS) on the rate of laparoscopic hysterectomy at an academic community hospital without robotic technology. Methods: This retrospective observational study included all patients who underwent hysterectomy for benign indications from January 1, 2004, through December 31, 2012. The primary outcome was route of hysterectomy: open, laparoscopic, or vaginal. Secondary outcomes of interest included length of stay and factors associated with an open procedure. Results: In 2004, only 24 (8%) of the 292 hysterectomies performed for benign conditions at Newton-Wellesley Hospital (NWH) were laparoscopic. The rate increased to more than 50% (189/365) by 2008, and, in 2012, 72% (316/439) of hysterectomies were performed via a traditional laparoscopic approach. By 2012, more than 93% (411/439) of all hysterectomies were performed in a minimally invasive manner (including total laparoscopic hysterectomy [TLH], laparoscopic supracervical hysterectomy [LSH], total vaginal hysterectomy [TVH], and laparoscopy-assisted vaginal hysterectomy [LAVH]). More than 85% of the hysterectomies at NWH in 2012 were outpatient procedures. By this time, the surgeon's preference or lack of expertise was rarely cited as a factor leading to open hysterectomy. Conclusions: A large diverse gynecologic surgery department transformed surgical practice from primarily open hysterectomy to a majority (>72%) performed via the traditional laparoscopic route and a large majority (>93%) performed in a minimally invasive manner in less than 8 years, without the use of robotic technology. This paradigm shift was fueled by patient demand and by MIGS department surgical mentorship for generalist obstetrician/gynecologists.

Morris, Stephanie N.; Isaacson, Keith B.

2015-01-01

10

Laparoscopic Versus Abdominal Hysterectomy for Endometrial Cancer  

PubMed Central

Objective To compare the demographics, cancer characteristics, and hospital outcomes of endometrial cancer patients undergoing a laparoscopically assisted vaginal hysterectomy (LAVH) versus a total abdominal hysterectomy (TAH). Methods Two California population databases (Office of Statewide Health Planning and Development and the California Cancer Registry) were linked using patient identifiers. Patients who underwent endometrial cancer surgery from 1997 to 2001 were identified. The combined database was queried for type of surgery, patient demographics, hospital outcomes, comorbidities, and cancer characteristics. Statistical analyses included the t test, ?2 test, and logistic regression. Results In this study, 978 endometrial cancer patients (7.7%) had an LAVH and 11,765 (92.3%) had a TAH. The mean ages for the 2 groups were 63.3 and 64.8 years, respectively. Lymphadenectomy was performed more frequently in LAVH patients compared with TAH patients (45.6 vs 41.1%; P = 0,006). Patients undergoing LAVH were more likely to be younger and healthier and have stage 1 or grade 1 disease (P < 0.0001). Total abdominal hysterectomy patients were more likely to have significant medical comorbidities. Mean length of stay for LAVH was 2.40 versus 4.36 days for TAH (P < 0,001), but mean hospital charges were comparable. Perioperative complications such as vascular and bowel injuries, pulmonary embolism, wound problems, and transfusions were significantly more common in TAH patients. Conclusion Surgeons seem to carefully select endometrial cancer patients for laparoscopic surgery. Although surgical staging was performed in less than 50% of endometrial cancer patients, the rate was not worse in laparoscopic procedures. Short-term hospital complications were less common in the laparoscopy group. PMID:20009892

Leiserowitz, Gary S.; Xing, Guibo; Parikh-Patel, Arti; Cress, Rosemary; Abidi, Alireza; Rodriguez, Anne O.; Dalrymple, John L.

2015-01-01

11

Comparison of Robotic and Laparoscopic Hysterectomy for Benign Gynecologic Disease  

PubMed Central

Objective Utilization of robotically assisted hysterectomy for benign gynecologic conditions is increasing. Using the most recent, available nationwide data, we examined clinical outcomes, safety, and cost of robotic compared to laparoscopic hysterectomy. Methods Women undergoing robotic or laparoscopic hysterectomy for benign disease were identified from the United States 2009 and 2010 Nationwide Inpatient Sample. Propensity scores derived from a logistic regression model were used to assemble matched cohorts of patients undergoing robotic and laparoscopic hysterectomy. Differences in in-hospital complications, hospital length of stay, and hospital charges were assessed between the matched groups. Results Of the 804,551 hysterectomies for benign conditions performed in 2009 and 2010, 20.6% were laparoscopic and 5.1% robotically-assisted. Among minimally invasive hysterectomies, the use of robotic hysterectomy increased from 9.5% to 13.6% (P=0.002). In a propensity-matched analysis, the overall complication rates were similar between robotic and laparoscopic hysterectomy (8.80 vs. 8.85%; relative risk [RR], 0.99; 95% confidence interval [CI], 0.89 to 1.09; P=0.910). There was a lower incidence of blood transfusions in robotic cases (2.1% vs. 3.1%; P<0.001, but patients undergoing robotic hysterectomy were more likely to experience postoperative pneumonia (RR= 2.2; 95% CI, 1.24 to 3.78; P=0.005). The median cost of hospital care was $9788 (IQR, $7105-$12780) for RH and $7299 (IQR, $5650-$9583) for LH (P<0.001. Hospital costs were on average $2489 (95% CI, $2313 to $2664) higher for patients undergoing robotic hysterectomy. Conclusion The utilization of robotic hysterectomy has increased. Perioperative outcomes are similar between laparoscopic and robotic hysterectomy, but robotic cases cost substantially more. PMID:24084534

Rosero, Eric B.; Kho, Kimberly A.; Joshi, Girish P.; Giesecke, Martin; Schaffer, Joseph I.

2013-01-01

12

Large Abdominal Wall Endometrioma Following Laparoscopic Hysterectomy  

PubMed Central

Background: Endometriosis is a common condition in women that affects up to 45% of patients in the reproductive age group by causing pelvic pain. It is characterized by the presence of endometrial tissue outside the uterine cavity and is rarely found subcutaneously or in abdominal incisions, causing it to be overlooked in patients with abdominal pain. Methods: A 45-year-old woman presented with lower abdominal pain 2 years following a laparoscopic supracervical hysterectomy. She was found to have incidental cholelithiasis and a large abdominal mass suggestive of a significant ventral hernia on CT scan. Results: Due to the peculiar presentation, surgical intervention took place that revealed a large 9cm×7.6cm×6.2cm abdominal wall endometrioma. Conclusion: Although extrapelvic endometriosis is rare, it should be entertained in the differential diagnosis for the female patient who presents with an abdominal mass and pain and has a previous surgical history. PMID:21902990

Borncamp, Erik; Mehaffey, Philip; Rotman, Carlos

2011-01-01

13

Comparative Effectiveness of Robotic Versus Laparoscopic Hysterectomy for Endometrial Cancer  

PubMed Central

Purpose Use of robotics in oncologic surgery is increasing; however, reports of safety and efficacy are from highly experienced surgeons and centers. We performed a population-based analysis to compare laparoscopic hysterectomy and robotic hysterectomy for endometrial cancer. Patients and Methods The Perspective database was used to identify women who underwent a minimally invasive hysterectomy for endometrial cancer from 2008 to 2010. Morbidity, mortality, and cost were evaluated using multivariable logistic and linear regression models. Results We identified 2,464 women, including 1,027 (41.7%) who underwent laparoscopic hysterectomy and 1,437 (58.3%) who underwent robotic hysterectomy. Women treated at larger hospitals, nonteaching hospitals, and centers outside of the northeast were more likely to undergo a robotic hysterectomy procedure, whereas black women, those without insurance, and women in rural areas were less likely to undergo a robotic hysterectomy procedure (P < .05 for all). The overall complication rate was 9.8% for laparoscopic hysterectomy versus 8.1% for robotic hysterectomy (P = .13). The adjusted odds ratio (OR) for any morbidity for robotic hysterectomy was 0.76 (95% CI, 0.56 to 1.03). After adjusting for patient, surgeon, and hospital characteristics, there were no significant differences in the rates of intraoperative complications (OR, 0.68; 95% CI, 0.42 to 1.08), surgical site complications (OR, 1.49; 95% CI, 0.81 to 2.73), medical complications (OR, 0.64; 95% CI, 0.40 to 1.01), or prolonged hospitalization (OR, 0.85; 95% CI, 0.64 to 1.14) between the procedures. The mean cost for robotic hysterectomy was $10,618 versus $8,996 for laparoscopic hysterectomy (P < .001). In a multivariable model, robotic hysterectomy was significantly more costly ($1,291; 95% CI, $985 to $1,597). Conclusion Despite claims of decreased complications with robotic hysterectomy, we found similar morbidity but increased cost compared with laparoscopic hysterectomy. Comparative long-term efficacy data are needed to justify its widespread use. PMID:22291073

Wright, Jason D.; Burke, William M.; Wilde, Elizabeth T.; Lewin, Sharyn N.; Charles, Abigail S.; Kim, Jin Hee; Goldman, Noah; Neugut, Alfred I.; Herzog, Thomas J.; Hershman, Dawn L.

2012-01-01

14

Massive Delayed Vaginal Hemorrhage after Laparoscopic Supracervical Hysterectomy  

PubMed Central

Background. A known complication of supracervical hysterectomy is cyclical bleeding from the retained cervix when functioning endometrial tissue is not totally removed. We present a rare case of delayed postoperative vaginal hemorrhage after supracervical hysterectomy. Case. A 44-year-old woman presented on postoperative day 15 after laparoscopic supracervical hysterectomy with massive vaginal hemorrhage requiring emergent re-operation. Her bleeding was controlled with vaginally placed sutures. Ultrasound confirmed no intraperitoneal free fluid. The etiology was thought to be induced by postoperative tissue necrosis from cautery applied to the endocervical canal during the original surgery. Conclusion. Delayed vaginal hemorrhage from a retained cervix is a rare complication of laparoscopic supracervical hysterectomy. Caution should be exercised when cauterizing the endocervical canal as induced tissue necrosis may increase the risk of postoperative bleeding. PMID:22919525

Holloran-Schwartz, M. Brigid; Potter, Shannon J.; Kao, Ming-Shian

2012-01-01

15

Rate of Vaginal Cuff Separation Following Laparoscopic or Robotic Hysterectomy  

PubMed Central

Objective Vaginal cuff separation is a rare but serious complication following hysterectomy. The goal of our study was to determine the rate of vaginal cuff separation and associated risk factors in patients undergoing laparoscopic or robotic hysterectomy. Methods We retrospectively identified patients who underwent a minimally invasive simple or radical hysterectomy at one institution between January 2000 and 2009. Fisher's exact test, Wilcoxon rank sum test and multiple logistic regression was used to determine associations between variables and increased risk of separation. Results A total of 417 patients underwent laparoscopic (n=285) or robotic (n=132) hysterectomy during the study period. Three hundred and sixty-two underwent simple hysterectomy (249 laparoscopic, 113 robotic) and 57 underwent radical hysterectomy (36 laparoscopic, 19 robotic). Seven (1.7%) patients developed a cuff complication and all had a diagnosis of malignancy. Three (1.1%) patients in the laparoscopy group suffered a vaginal cuff evisceration (n=2) or separation (n=1). Four patients in the robotic group (3.0%) had a vaginal evisceration (n=1) or separation (n=3). There was no difference based on surgical approach (p=0.22). Vaginal cuff complications were 9.46-fold higher among patients who had a radical hysterectomy (p<0.01). Median time to presentation of vaginal cuff complication was 128 days (58–175) in the laparoscopy group and 37 days (range: 32–44) in the robotic group. Conclusions The overall risk of vaginal cuff complication was 1.7%. There appears to be no difference in cuff complication rates based on surgical approach. Radical hysterectomy, however, was associated with a 9-fold increase in vaginal cuff complications. PMID:20869763

Nick, Alpa M.; Lange, Jimena; Frumovitz, Michael; Soliman, Pamela T.; Schmeler, Kathleen M.; Schlumbrecht, Matthew P.; dos Reis, Ricardo; Ramirez, Pedro T.

2015-01-01

16

Total Laparoscopic Hysterectomy: Our 5-Year Experience (1998–2002)  

PubMed Central

Purpose: To review our experience performing total laparoscopic hysterectomy since we first introduced this procedure in 1998. Methods: A retrospective cohort study was performed for patients undergoing total laparoscopic hysterectomy at Ochsner Clinic Foundation from February 1998 through December 2002. Rates of complications, successful completion, length of hospital stay, readmission, and reoperation were determined for this period. Results: Among 511 patients who underwent attempted total laparoscopic hysterectomy, 487 procedures (95.3%) were completed by laparoscopy. The major intraoperative complication rate was 3.9%, and the major postoperative complication rate was 4.7%. No significant differences were seen in the intraoperative and postoperative complication rates of patients who were morbidly obese (body mass index ?30 kg/m2), patients with enlarged uteri (?300 g), or patients who underwent concomitant procedures (unilateral or bilateral salpingo-oophorectomy and lysis of adhesions). The readmission rate was 4.1%, and the reoperation rate was 2%. None of the variables studied, including age, medical problems, morbid obesity, concomitant procedures, or enlarged uterus, were found to have an association with readmission or reoperation rates. Conclusions: Total laparoscopic hysterectomy can be performed successfully in most patients with benign indications. Morbidity is comparable to that of other types of hysterectomies, and this technique may be a more reasonable approach under some circumstances. PMID:21603347

Bonilla, David J.; Mains, Lindsay; Rice, Janet; Crawford, Benjamin

2010-01-01

17

Comparison of Two Bipolar Systems in Laparoscopic Hysterectomy  

PubMed Central

Objective: To compare the efficacy of 2 bipolar systems during total laparoscopic hysterectomy (TLH): the pulsed bipolar system (PlasmaKinetic; Olympus, Japan) vs. conventional bipolar electrosurgery (Kleppinger bipolar forceps; Richard Wolf Instruments, Vernon Hills, IL). Methods: We retrospectively reviewed medical records of 80 women who underwent TLH for benign gynecologic disease between 2009 and 2010. Forty women received TLH using the conventional bipolar system and another 40 using the pulsed bipolar system. The clinical outcomes and complications were compared between the 2 groups. Results: No significant differences between the 2 groups were observed in terms of age, body mass index, and hospital stay. However, the blood loss was greater (515.3 ± 41.2mL vs. 467.9 ± 33.4mL, P < .05) and the operation time was longer (173.4 ± 33.4min vs. 157.3 ± 21.3min, P < .05) in the conventional group. Additionally, the uterine weight was lighter in the conventional group (218.5 ± 23.4g vs. 299.4 ± 41.1g, P < .05). None of the surgeries were required to be converted to laparotomy. No significant differences were found in intraoperative or postoperative complications between the groups. Conclusion: The pulsed bipolar system has some advantages over the conventional system, and therefore, may offer an alternative option for patients undergoing TLH. PMID:23318073

Cho, Hye-Yon; Choi, Kong-Ju; Lee, Young-Lan; Chang, Kylie Hae-Jin; Kim, Hong-Bae

2012-01-01

18

Converting Potential Abdominal Hysterectomy to Vaginal One: Laparoscopic Assisted Vaginal Hysterectomy  

PubMed Central

Background. The idea of laparoscopic assisted vaginal hysterectomy (LAVH) is to convert a potential abdominal hysterectomy to a vaginal one, thus decreasing associated morbidity and hastening recovery. We compared intraoperative and postoperative outcomes between LAVH and abdominal hysterectomy, to find out if LAVH achieves better clinical results compared with abdominal hysterectomy. Material and methods. A total of 48 women were enrolled in the study. Finally 17 patients underwent LAVH (cases) and 20 underwent abdominal hysterectomy (controls). All surgeries were performed by a set of gynecologists with more or less same level of surgical experience and expertise. Results.None of the patients in LAVH required conversion to laparotomy. Mean operating time was 30 minutes longer in LAVH group as compared to abdominal hysterectomy group (167.06 + 31.97?min versus 135.25 + 31.72 min; P < 0.05). However, the mean blood loss in LAVH was 100?mL lesser than that in abdominal hysterectomy and the difference was found to be statistically significant (248.24 + 117.79?mL versus 340.00 + 119.86?mL; P < 0.05). Another advantage of LAVH was significantly lower pain scores on second and third postoperative days. Overall complications and postoperative hospital stay were not significantly different between the two groups. PMID:24729873

Shetty, Jyothi; Shanbhag, Asha

2014-01-01

19

Safe total intrafascial laparoscopic (TAIL™) hysterectomy: a prospective cohort study  

PubMed Central

This study directly compares total intrafascial laparoscopic (TAIL™) hysterectomy with vaginal (VH) and abdominal (AH) hysterectomy with regard to safety, operating time and time of convalescence. The study is a prospective cohort study (Canadian Task Force classification II-2), including data from patients of a single university-affiliated teaching institution, admitted between 1997 and 2008 for hysterectomy due to benign uterus pathology. Patient data were collected pre-, intra- and postoperatively and complications documented using a standardised data sheet of a Swiss obstetric and gynaecological study group (Arbeitsgemeinschaft Schweizerische Frauenkliniken, Amlikon/Switzerland). Classification of complications (major complications and minor complications) for all three operation techniques, evaluation of surgeons and comparison of operation times and days of hospitalisation were analysed. 3066 patients were included in this study. 993 patients underwent AH, 642 VH and 1,431 total intrafascial hysterectomy. No statistically significant difference for the operation times comparing the three groups can be demonstrated. The mean hospital stay in the TAIL™ hysterectomy, VH and AH groups is 5.8?±?2.4, 8.8?±?4.0 and 10.4?±?3.9 days, respectively. The postoperative minor complications including infection rates are low in the TAIL™ hysterectomy group (3.8%) when compared with either the AH group (15.3%) or the VH group (11.2%), respectively. The total of minor complications is statistically significant lower for TAIL™ hysterectomy as for AH (O.R. 4.52, CI 3.25–6.31) or VH (O.R. 3.16, CI 2.16–4.62). Major haemorrhage with consecutive reoperation is observed statistically significantly more frequent in the AH group when compared to the TAIL™ hysterectomy group, with an O.R. of 6.13 (CI 3.05–12.62). Overall, major intra- and postoperative complications occur significant more frequently in the AH group (8.6%) when compared to the VH group (3%) and the TAIL™ hysterectomy group (1.8%). The incidence of major complications applying the standardised TAIL™ hysterectomy technique is not related to the experience of the surgeons. We conclude that a standardised intrafascial technique of total laparoscopic (TAIL™) hysterectomy using an anatomically developed special uterine device is associated with a very low incidence of minor and major intra- and postoperative complications. The direct comparison of complication rates with either vaginal or abdominal hysterectomy favours the total laparoscopic technique, and therefore, this technique can be recommended as a relatively atraumatic procedure. The operation times are comparable for all three techniques without any statistically significant differences. This technique for laparoscopic hysterectomy is shown to be equally safe when applied by experienced gynaecologic surgeons or by residents in training. Electronic supplementary material The online version of this article (doi:10.1007/s10397-010-0569-0) contains supplementary material, which is available to authorized users. PMID:20700518

Hohl, Michael K.

2010-01-01

20

Barbed Suture for Vaginal Cuff Closure in Laparoscopic Hysterectomy  

PubMed Central

Background and Objectives: Our aim was to evaluate whether the use of barbed suture for vaginal cuff closure is associated with a decrease in postoperative vaginal bleeding compared with cuff closure with polyglactin 910 in patients who have undergone laparoscopic hysterectomy. Methods: We performed a cohort study of patients who underwent laparoscopic hysterectomy between January 2008 and July 2012 by the minimally invasive gynecologic surgery division of the Gynecology, Obstetrics and Human Reproduction Department at Fundación Santa Fe de Bogotá University Hospital, Bogotá, Colombia. Results: A total of 232 women were studied: 163 were in the polyglactin 910 group, and 69 were in the barbed suture group. The main outcome, postoperative vaginal bleeding, was documented in 53 cases (32.5%) in the polyglactin 910 group and in 13 cases (18.8%) in the barbed suture group (relative risk, 0.57; 95% confidence interval, 0.34–0.9; P = .03). No statistically significant differences were found in other postoperative outcomes, such as emergency department admission, vaginal cuff dehiscence, infectious complications, and the presence of granulation tissue. Conclusion: In this study an inverse association was observed between the use of barbed suture for vaginal cuff closure during laparoscopic hysterectomy and the presence of postoperative vaginal bleeding. PMID:24680149

Medina, Byron Cardoso; Riaño, Giovanni; Hoyos, Luis R.; Otalora, Camila

2014-01-01

21

Laparoscopic splenectomy using conventional instruments  

PubMed Central

Introduction: Laparoscopic splenectomy (LS) is an accepted procedure for elective splenectomy. Advancement in technology has extended the possibility of LS in massive splenomegaly [Choy et al., J Laparoendosc Adv Surg Tech A 14(4), 197–200 (2004)], trauma [Ren et al., Surg Endosc 15(3), 324 (2001); Mostafa et al., Surg Laparosc Endosc Percutan Tech 12(4), 283–286 (2002)], and cirrhosis with portal hypertension [Hashizume et al., Hepatogastroenterology 49(45), 847–852 (2002)]. In a developing country, these advanced gadgets may not be always available. We performed LS using conventional and reusable instruments in a public teaching the hospital without the use of the advanced technology. The technique of LS and the outcome in these patients is reported. Materials and Methods: Patients undergoing LS for various hematological disorders from 1998 to 2004 were included. Electrocoagulation, clips, and intracorporeal knotting were the techniques used for tackling short-gastric vessels and splenic pedicle. Specimen was delivered through a Pfannensteil incision. Results: A total of 26 patients underwent LS. Twenty-two (85%) of patients had spleen size more than 500 g (average weight being 942.55 g). Mean operative time was 214 min (45–390 min). The conversion rate was 11.5% (n = 3). Average duration of stay was 5.65 days (3–30 days). Accessory spleen was detected and successfully removed in two patients. One patient developed subphrenic abscess. There was no mortality. There was no recurrence of hematological disease. Conclusion: Laparoscopic splenectomy using conventional equipment and instruments is safe and effective. Advanced technology has a definite advantage but is not a deterrent to the practice of LS. PMID:21206648

Dalvi, A. N.; Thapar, P. M.; Deshpande, A. A.; Rege, S. A.; Prabhu, R. Y.; Supe, A. N.; Kamble, R. S.

2005-01-01

22

Feasibility and Safety of Outpatient Total Laparoscopic Hysterectomy  

PubMed Central

Background and Objective: Ambulatory total laparoscopic hysterectomy (TLH) could lead to significant cost savings, but some fear the effects of what could be premature postsurgical discharge. We sought to estimate the feasibility and safety of TLH as an outpatient procedure for benign gynecologic conditions. Methods: We report a prospective, consecutive case series of 128 outpatient TLHs performed for benign gynecologic conditions in a tertiary care center. Results: Of the 295 women scheduled for a TLH, 151 (51%) were attempted as an outpatient procedure. A total of 128 women (85%) were actually discharged home the day of their surgery. The most common reasons for admission the same day were urinary retention (19%) and nausea (15%). Indications for hysterectomy were mainly leiomyomas (62%), menorrhagia (24%), and pelvic pain (9%). Endometriosis and adhesions were found in 23% and 25% of the cases, respectively. Mean estimated blood loss was 56 mL and mean uterus weight was 215 g, with the heaviest uterus weighing 841 g. Unplanned consultation and readmission were infrequent, occurring in 3.1% and 0.8% of cases, respectively, in the first 72 hours. At 3 months, unplanned consultation, complication, and readmission had occurred in a similar proportion of inpatient and outpatient TLHs (17.2%, 12.5%, and 4.7% versus 18.1%, 12.7%, and 5.4%, respectively). In a logistic regression model, uterus weight, presence of adhesions or endometriosis, and duration of the operation were not associated with adverse outcomes. Conclusion: Same-day discharge is a feasible and safe option for carefully selected patients who undergo an uncomplicated TLH, even in the presence of leiomyomas, severe adhesions, or endometriosis. PMID:25788825

Lemyre, Madeleine; Couture, Vanessa; Bernier, Gabrielle; Laberge, Philippe Y.

2015-01-01

23

Total Laparoscopic Hysterectomy with Prior Uterine Artery Ligation at Its Origin  

PubMed Central

We compared the duration of surgery, blood loss, and complications between patients in whom both uterine arteries were ligated at the beginning of total laparoscopic hysterectomy (TLH) and patients in whom ligation was done after cornual pedicle. Using a prospective study in a gynecologic laparoscopic center, a total of 52 women who underwent TLH from June 2013 to January 2014 were assigned into two groups. In group A, uterine arteries were ligated after the cornual pedicles as done conventionally. In group B, TLH was done by ligating both uterine arteries at the beginning of the procedure. All the other pedicles were desiccated using harmonic scalpel or bipolar diathermy. Uterus with cervix was removed vaginally or by morcellation. The indication for TLH was predominantly dysfunctional uterine bleeding and myomas in both groups. In group A, the average duration of surgery was 71 minutes, when compared to 60 minutes in group B (P < 0.001). In group A, the total blood loss was 70?mL, when compared to 43#x2009;mL in group B (P value < 0.001). There were no major complications in both groups. To conclude, prior uterine artery ligation at its origin during TLH reduces the blood loss and surgical duration as well as the complications during surgery.

Poojari, Vidyashree Ganesh; Bhat, Vidya Vishwanath; Bhat, Ravishankar

2014-01-01

24

Sentinel node mapping in high risk endometrial cancer after laparoscopic supracervical hysterectomy with morcellation?  

PubMed Central

INTRODUCTION Occult endometrial cancer after supracervical hysterectomy is very uncommon. Even if optimal management of those rare cases is still unproven, to guide the need for further therapies, restaging should be recommended in this situation. PRESENTATION OF CASE We report of a 60-year old woman with occult high risk endometrial cancer after supracervical hysterectomy with morcellation. We describe the feasibility of laparoscopic intraoperative sentinel node identification with cervical stump removing to restage the suspicious early stage high risk endometrial cancer. DISCUSSION In high risk endometrial cancer surgical restaging is important, considering that 10–35% of cases can present pelvic nodal metastasis. To reduce the treatment related morbidity maintaining the benefit of surgical staging, with a negative preoperative PET/CT, we performed a laparoscopic SN mapping with cervical stump removing. CONCLUSION This report highlight the fact that SN mapping with cervical injection is a feasible and safe technique also without the uterine corpus after supracervical hysterectomy with morcellation. PMID:23959405

Buda, Alessandro; Marco, Cuzzocrea; Dolci, Carlotta; Elisei, Federica; Baldo, Romina; Locatelli, Luca; Milani, Rodolfo; Messa, Cristina

2013-01-01

25

Leiomyoma mimicking an incarcerated inguinal hernia: A rare complication of laparoscopic hysterectomy  

PubMed Central

A 52-year-old, obese, female patient was referred for a right inguinal mass, which appeared seven months after a laparoscopic hysterectomy, which was performed because of myomatosis. Despite several examinations, including ultrasound, computed tomography (CT)-Scan, positron emission tomography (PET)-CT, and ultrasound-guided biopsy, the diagnosis remained unclear until surgical exploration, which disclosed a well-encapsulated solid tumour corresponding to a fibrotic leiomyoma. Spilling of leiomyoma cells is a rare and unusual complication of laparoscopic surgery. Tumour development in the inguinal canal after laparoscopic gynaecological surgery should be kept in mind in the differential diagnosis of inguinal hernia and other uncommon pathologies. PMID:21523240

Apestegui, Carlos; Tamer, Saadallah; Ciccarelli, Olga; Bonaccorsi-Riani, Eliano; Marbaix, Etienne; Lerut, Jan

2011-01-01

26

Total laparoscopic radical hysterectomy with pelvic lymphadenectomy using the argon-beam coagulator: pilot data and comparison to laparotomy  

Microsoft Academic Search

ObjectivesThe aim of this study was to describe the feasibility and outcome of total laparoscopic radical hysterectomy with pelvic lymphadenectomy for stage I cervical cancer using the argon-beam coagulator.

Nadeem R Abu-Rustum; Mary L Gemignani; Kathleen Moore; Yukio Sonoda; Ennapadam Venkatraman; Carol Brown; Elizabeth Poynor; Dennis S Chi; Richard R Barakat

2003-01-01

27

Barriers for the Uptake of LaparoScopic Hysterectomy  

ClinicalTrials.gov

The Outcomes of the Project Will Provide the Basic Data and Impetus; Necessary to Achieve at Least a 10% Reduction in Rate of Hysterectomies; Performed by Open Abdominal Surgery Within the Next 5 Years.

2014-06-17

28

Hysterectomy throughout history.  

PubMed

Hysterectomy, which is one of the most common surgeries performed on women, dates back to ancient times. The history of hysterectomy comprises biographies of many humble men and the significant individual efforts that they made to fight the skepticism of the medical communities of their times. Many of the pioneers were ignored. Although there are a number of alternatives to hysterectomy available, it remains one of the most frequently performed gynaecological operations. The introduction of antisepsis, anaesthesia, antibiotics and blood transfusion made hysterectomy a safe procedure. Nowadays, we distinguish three different surgical approaches to hysterectomy: vaginal, abdominal and laparoscopic. The limitations of conventional laparoscopy have led to the development of robotic surgery, which has evolved over the past decade from simple adjustable arms to support cameras in laparoscopic surgery to more sophisticated four-armed machines now being in use worldwide. PMID:22519184

Spari?, Radmila; Hudelist, Gernot; Berisava, Milica; Gudovi?, Aleksandra; Buzadzi?, Snezana

2011-01-01

29

Surgical Outcomes of Robotic Radical Hysterectomy Using Three Robotic Arms versus Conventional Multiport Laparoscopy in Patients with Cervical Cancer  

PubMed Central

Purpose To compare surgical outcomes of robotic radical hysterectomy (RRH) using 3 robotic arms with those of conventional laparoscopy in patients with early cervical cancer. Materials and Methods A retrospective cohort study included 102 patients with stage 1A1-IIA2 cervical carcinoma, of whom 60 underwent robotic and 42 underwent laparoscopic radical hysterectomy (LRH) with pelvic lymph node dissection performed between December 2009 and May 2013. Perioperative outcomes were compared between two surgical groups. Results Robotic approach consisted of 3 robotic arms including the camera arm and 1 conventional assistant port. Laparoscopic approach consisted of four trocar insertions with conventional instruments. There were no conversions to laparotomy. Mean age, body mass index, tumor size, cell type, and clinical stage were not significantly different between two cohorts. RRH showed favorable outcomes over LRH in terms of estimated blood loss (100 mL vs. 145 mL, p=0.037), early postoperative complication rates (16.7% vs. 30.9%, p=0.028), and postoperative complications necessitating intervention by Clavien-Dindo classification. Total operative time (200.5±61.1 minutes vs. 215.6±83.1 minutes, p=0.319), mean number of lymph node yield (23.3±9.3 vs. 21.7±9.8, p=0.248), and median length of postoperative hospital stay (11 days vs. 10 days, p=0.129) were comparable between robotic and laparoscopic group, respectively. The median follow-up time was 44 months with 2 recurrences in the robotic and 3 in the laparoscopic cohort. Conclusion Surgical outcomes of RRH and pelvic lymphadenectomy were comparable to that of laparoscopic approach, with significantly less blood loss and early postoperative complications. PMID:25048478

Yim, Ga Won; Kim, Sang Wun; Nam, Eun Ji; Kim, Sunghoon; Kim, Hee Jung

2014-01-01

30

Short-Term Effects of Salpingectomy During Laparoscopic Hysterectomy on Ovarian  

PubMed Central

Objective To examine the short-term effects of salpingectomy during laparoscopic hysterectomy on ovarian reserve when ovarian preservation is planned in order to determine the feasibility of conducting this study on a large scale. Design Pilot Randomized controlled trial. Setting Tertiary care, academic medical center. Patients Thirty premenopausal women aged 18 to 45 years underwent laparoscopic hysterectomy with ovarian preservation for benign indications from April 2012 to September 2012. Intervention Bilateral salpingectomy (n=15) versus no salpingectomy (n=15) at the time of laparoscopic hysterectomy with ovarian preservation. Main Outcome Measures Antimüllerian hormone (AMH) was measured preoperatively, 4–6 weeks postoperatively, and 3 months postoperatively. Operative time and estimated blood loss were abstracted from the medical record. Results Mean AMH levels were not significantly different at baseline (2.26 vs. 2.25ng/ml), 4–6 weeks postoperatively (1.03 vs. 1.25ng/ml), or 3 months postoperatively (1.86 vs. 1.82ng/ml) among women with salpingectomy versus no salpingectomy, respectively. There was also no significant temporal change in mean AMH level from baseline to 3 months postoperatively (?.07 vs. ?.08ng/ml) between groups. No difference in operative time (116 vs. 115min) or estimated blood loss (70 vs. 91ml) was observed. Conclusion Salpingectomy at the time of laparoscopic hysterectomy with ovarian preservation is a safe procedure that does not appear to have any short-term deleterious effects on ovarian reserve, as measured by AMH level. Conducting a trial of this nature that is adequately powered with long-term follow-up would be feasible and is required to definitively confirm these results. PMID:23993887

Findley, Austin D.; Siedhoff, Matthew T.; Hobbs, Kumari A.; Steege, John F.; Carey, Erin T.; McCall, Christina A.; Steiner, Anne Z.

2013-01-01

31

Laparoscopic sacrocolpopexy for uterine and post-hysterectomy prolapse: anatomical results, quality of life and perioperative outcome—a prospective study with 101 cases  

Microsoft Academic Search

Our prospective study evaluates laparoscopic sacrocolpopexy for vaginal vault prolapse focusing on perioperative data, objective\\u000a anatomical results using the pelvic organ prolapse quantification (POP-Q) system and postoperative quality of life using the\\u000a Kings Health questionnaire. One hundred one patients completed the study. Fifty five had laparoscopic supracervical hysterectomy\\u000a and sacrocolpopexy for uterine prolapse and 46 had laparoscopic sacrocolpopexy for post-hysterectomy

Dimitri Sarlos; Sonja Brandner; LaVonne Kots; Nicolle Gygax; Gabriel Schaer

2008-01-01

32

Fiber Optical Improvements for a Device Used in Laparoscopic Hysterectomy Surgery  

NASA Astrophysics Data System (ADS)

Hysterectomy removes uterus from patients suffering different pathologies. One of the most common techniques for performing it is the laparoscopically-assisted vaginal hysterectomy (LAVH). In the final stage of the procedure, surgeons face the need to unambiguously identify the vaginal cuff before uterus removal. The aim of this research is to adapt a local source of illumination to a polymer cup-like device adapted to a stainless steel shaft that surgeons nowadays use to manipulate the uterus in LAVH. Our proposal consists in implementing a set of optical fiber illuminators along the border of the cup-like device to illuminate the exact vaginal cupola, using an external light source. We present experimental results concerning temperature increases in quasi adiabatic conditions in cow meat under different light intensity illumination.

Hernández Garcia, Ricardo; Vázquez Mercado, Liliana; García-Torales, G.; Flores, Jorge L.; Barcena-Soto, Maximiliano; Casillas Santana, Norberto; Casillas Santana, Juan Manuel

2006-09-01

33

Dexamethasone before total laparoscopic hysterectomy: a randomized controlled dose–response study  

Microsoft Academic Search

Purpose  A prospective, randomized, double blind, placebo-controlled study was undertaken to evaluate the efficacy of a single preoperative\\u000a dose of dexamethasone, in different dosages, in providing postoperative analgesia in patients undergoing total laparoscopic\\u000a hysterectomy (TLH).\\u000a \\u000a \\u000a \\u000a Method  The study included 55 patients randomly divided into three groups. Patients in Groups P, D4, and D8 received saline, 4, and\\u000a 8 mg dexamethasone, respectively, intravenously, 2 h

Chitra Rajeswari Thangaswamy; Vimi Rewari; Anjan Trikha; Maya Dehran; Chandralekha

2010-01-01

34

Disseminated peritoneal leiomyomatosis after laparoscopic supracervical hysterectomy with characteristic molecular cytogenetic findings of uterine leiomyoma.  

PubMed

Disseminated peritoneal leiomyomatosis (DPL) is a rare condition characterized by scattered smooth muscle nodules over the peritoneal surfaces. The pathogenesis of DPL remains unclear. Herein, we report a case of DPL occurring 7 years after laparoscopic supracervical hysterectomy with morcellation for uterine leiomyomata (UL). We analyzed both the original UL and the subsequent DPL by molecular cytogenetics to assess the role of chromosomal abnormalities in DPL pathobiology. Interestingly, all of the chromosomal aberrations detected in this case of DPL, including r(1)(p34.3q41), del(3)(q23q26.33), and t(12;14)(q14.3;q24.1), are characteristic chromosomal abnormalities detected in UL. Fluorescence in situ hybridization analysis of the initial UL confirmed an interstitial deletion spanning at least 3q24 and 3q25.1, suggesting that functional alteration of a potential gene in this chromosomal region may play a role in DPL development from UL. With the increasing rate of hysterectomy through laparoscopic approach to UL, the unique complications of laparoscopy with morcellation, especially seeding and proliferation of tumor cells over abdominal organs and peritoneum, are becoming more significant and may necessitate review of current surgical protocols to prevent future seeding of the pelvic region with tumor particles. PMID:20842731

Ordulu, Zehra; Dal Cin, Paola; Chong, Wilson W S; Choy, Kwong Wai; Lee, Charles; Muto, Michael G; Quade, Bradley J; Morton, Cynthia C

2010-12-01

35

Immediate Laparoscopic Nontransvesical Repair without Omental Interposition for Vesicovaginal Fistula Developing after Total Abdominal Hysterectomy  

PubMed Central

Background and Objective: We conducted this study to evaluate the feasibility and efficacy of immediate laparoscopic nontransvesical repair without omental interposition for vesicovaginal fistula (VVF) developing after total abdominal hysterectomy (TAH), which causes not only social and economic misery for the patient but also considerable stress to the physicians who perform the surgery. Methods: We performed a retrospective review of 5 women who underwent immediate laparoscopic nontransvesical repair without omental interposition for VVFs, developing after TAH from October 2007 to March 2009. In terms of laparoscopic procedure, cystoscopy was performed to confirm the location of fistula and ureteral openings, initially. Without opening the bladder, the fistula tract was identified, and the bladder was dissected from the vagina. The bladder defect was closed by using intracorporeal, continuous, and double-layer suturing, laparoscopically. The vaginal defect was closed using interrupted and single-layer suturing, vaginally. A Foley catheter was inserted for 2 weeks and removed after bladder integrity was confirmed with a retrograde cystogram. Results: The median age and body mass index of the patients were 47 years and 22.3 kg/m2, respectively. Operating time, hemoglobin change, and hospital stay were 95 minutes, 1.1 g/dL, and 5 days, respectively. There were no complications or laparoconversions. During follow-up (median 56.1 weeks; range 26.6 to 74.0), there was no evidence of recurrence. Conclusions: Immediate laparoscopic nontransvesical repair without omental interposition might be an effective, feasible alternative to the traditional methods in select patients with small sized (<1 cm) VVF developing after TAH. PMID:20932366

Lee, Jung Hun; Lee, Kyo Won; Han, Jong Sul; Choi, Pil Cho; Hoh, Jeong-Kyu

2010-01-01

36

Hysterectomy  

MedlinePLUS

... hysterectomy is performed with the help of a robotic machine controlled by the surgeon. In general, it ... in a better outcome than laparoscopy performed without robotic assistance. What are the benefits and risks of ...

37

Cervical Detachment Using Monopolar SupraLoop™ Electrode versus Monopolar Needle in Laparoscopic Supracervical Hysterectomy (LSH): An Interventional, Comparative Cohort Study  

PubMed Central

Objective: Currently available monopolar loop electrodes are difficult to handle in laparoscopic supracervical hysterectomy (LSH) and are entirely disposable devices, generating additional operating costs. The aim of this interventional study was the comparison of the efficiency and safety of cervical detachment with a newly developed monopolar loop electrode (SupraLoop™) with a conventional method of cervical detachment in LSH. Material and Methods: Our study sample included 1598 patients; 1070 patients that underwent LSH with cervical detachment using the monopolar SupraLoop™ (study group) and 528 patients that underwent LSH with cervical detachment using the monopolar needle (control group). We also assessed cervical detachment time and total device application and cutting time in a subgroup of 49 patients (23 patients from the study group and 26 patients from the control group). Results: Total operation time for LSH was significantly shorter among SupraLoop™ patients (93?±?41 minutes) when compared to patients in whom cervical detachment was performed with the needle (105?±?44 minutes) (p?laparoscopic supracervical hysterectomy, and performed better than the needle, offering a significantly shorter operating time and less complications for the hysterectomy compared to the conventional method. PMID:24771898

Brucker, S.; Rothmund, R.; Krämer, B.; Neis, F.; Schönfisch, B.; Zubke, W.; Taran, F. A.; Wallwiener, M.

2013-01-01

38

Laparoscopic Supracervical Hysterectomy With Transcervical Morcellation and Sacrocervicopexy: Initial Experience With a Novel Surgical Approach to Uterovaginal Prolapse  

PubMed Central

The objective of this retrospective study was to evaluate the feasibility, safety, and efficacy of a new laparoscopic technique for the treatment of uterovaginal prolapse using a transcervical access port to minimize the laparoscopic incision. From February 2008 through August 2010, symptomatic pelvic organ prolapse in 43 patients was evaluated and surgically treated using this novel procedure. Preoperative assessment included pelvic examination, the pelvic organ prolapse quantification scoring system (POP-Q), and complex urodynamic testing with prolapse reduction to evaluate for symptomatic or occult stress urinary incontinence. The surgical procedure consisted of laparoscopic supracervical hysterectomy with transcervical morcellation and laparoscopic sacrocervicopexy with anterior and posterior mesh extension. Concomitant procedures were performed as indicated. All procedures were completed laparoscopically using only 5-mm abdominal port sites, with no intraoperative complications. Patients were followed up postoperatively for pelvic examination and POP-Q at 6 weeks, 6 months, and 12 months. The median (interquartile range) preoperative POP-Q values for point Aa was 0 (?1.0 to 1.0), and for point C was ?1.0 (?3.0 to 2.0). Postoperatively, median points Aa and C were significantly improved at 6 weeks, 6 months, and 12 months (all p < .001). One patient was found to have a mesh/suture exposure from the sacrocervicopexy, which was managed conservatively without surgery. We conclude that laparoscopic supracervical hysterectomy with transcervical morcellation and laparoscopic sacrocervicopexy is a safe and feasible surgical approach to treatment of uterovaginal prolapse, with excellent anatomic results at 6 weeks, 6 months, and 12 months. Potential advantages of the procedure include minimizing laparoscopic port site size, decreasing the rate of mesh exposure compared with other published data, and reducing the rate of postoperative cyclic bleeding in premenopausal women by removing the cervical core. Longer follow-up is needed to determine the durability and potential long-term sequelae of the procedure. PMID:23084680

Rosenblatt, Peter L.; Apostolis, Costas A.; Hacker, Michele R.; DiSciullo, Anthony

2013-01-01

39

Postoperative pain and perioperative outcomes after laparoscopic radical hysterectomy and abdominal radical hysterectomy in patients with early cervical cancer: a randomised controlled trial  

PubMed Central

Background Non-randomised studies have suggested that the postoperative complications of (Campos LS, Limberger LF, Stein AT, Kalil AN) laparoscopic radical hysterectomy are similar to those in abdominal radical hysterectomy. However, no study evaluating postoperative pain comparing both techniques has been published thus far. Our objective was to compare pain intensity and other perioperative outcomes between laparoscopic radical hysterectomy (LRH) and abdominal radical hysterectomy (ARH) in early cervical cancer. Methods This single centre, randomised, controlled trial enrolled 30 cervical cancer patients who were clinically staged IA2 with lymph vascular invasion and IB according to the FIGO (International Federation of Gynaecology and Obstetrics) classification, and underwent LRH or ARH between late 1999 and early 2004. Postoperative pain, as measured by a 10-point numerical rate scale, was considered the primary endpoint. Postoperative pain was assessed every six hours during a patient’s usual postoperative care. Perioperative outcomes were also registered. Both surgical techniques were executed by the same surgical team. Secondary outcomes included intraoperative and other postoperative surgicopathological factors and 5-year survival rates. Results IA2 patients with lymphatic vascular space invasion and IB cervical cancer patients were randomised to either the LRH group (16 patients) or the ARH group (14 patients). Four patients (25%) in the LRH group and 5 patients (36%) in the ARH group presented with transoperative or serious postoperative complications. All of the transoperative complications occurred in the LRH group. The relative risk of presenting with complications was 0.70; CI 95% (0.23–2.11); P?=?0.694. LRH group mean pain score was significantly lower than ARH after 36 h of observation (P?=?0.044; mean difference score: 1.42; 95% CI: 0.04–2.80). The survival results will be published elsewhere. Conclusions LRH provided lower pain scores after 36 h of observation in this series. The perioperative and serious postoperative complications ratios were comparable between the groups. Trial Registration NCT01258413 PMID:24028441

2013-01-01

40

Hysterectomy  

MedlinePLUS

... cuts in the belly, in order to perform robotic surgery You and your doctor will decide which ... through the vagina using a laparoscope or after robotic surgery. When a larger surgical cut (incision) in ...

41

Hysterectomy  

NSDL National Science Digital Library

This patient education program reviews female reproductive anatomy, symptoms, and treatments, including the benefits and risks of a hysterectomy, the surgical removal of the uterus, for treating certain gynecological diseases. This is a MedlinePlus Interactive Health Tutorial from the National Library of Medicine, designed and developed by the Patient Education Institute. NOTE: The tutorial requires a special Flash plug-in, version 4 or above. If you do not have Flash, you will be prompted to obtain a free download of the software before you start the tutorial. You will also need an Acrobat Reader, available as a free download, in order to view the Reference Summary.

Patient Education Institute

42

Single incision laparoscopic colectomy for colorectal cancer: comparison with conventional laparoscopic colectomy  

PubMed Central

Purpose The aim of this retrospective study was to evaluate the feasibility of single incision laparoscopic surgery (SILS), and to compare the short-term surgical outcomes with those of conventional laparoscopic surgery for colorectal cancer. Methods Forty-four patients who underwent SILS were compared with 263 patients who underwent conventional laparoscopic surgery for colorectal adenocarcinoma between November 2011 and September 2012. Results In the SILS group, eleven cases (25.0%) of right hemicolectomy, 15 (34.1%) anterior resections, and 18 (40.9%) low anterior resections were performed. Additional ports were required in 10 rectal patients during SILS operation. In the 32 patients with rectosigmoid and rectal cancer in the SILS group, patients with mid and lower rectal cancers had a tendency to require a longer operation time (168.2 minutes vs. 223.8 minutes, P = 0.002), additional ports or multiport conversion (P = 0.007), than those with rectosigmoid and upper rectal cancer. Both SILS and conventional groups had similar perioperative outcomes. Operation time was longer in the SILS group than in the conventional laparoscopic surgery group (185.0 minutes vs. 139.2 minutes, P < 0.001). More diverting stoma were performed in the SILS group (64.7% vs. 24.2%, P = 0.011). Multivariate analysis showed that tumor location in the rectum (95% confidence interval [CI], 1.858-10.560; P = 0.001), SILS (95% CI, 3.450-20.233; P < 0.001), diverting stoma (95% CI, 1.606-9.288; P = 0.003), and transfusion (95% CI, 1.092-7.854; P = 0.033) were independent risk factors for long operation time (>180 minutes). Conclusion SILS is a feasible, not inferior treatment option for colorectal cancer, and appears to have similar results as standard conventional multiport laparoscopic colectomy, despite the longer operative time. PMID:25247166

Lim, Sang Woo; Kim, Hyeong Rok

2014-01-01

43

A prospective, randomized trial comparing laparoscopic versus conventional techniques in colorectal cancer surgery: a preliminary report  

Microsoft Academic Search

Background: Uncontrolled studies using laparoscopic techniques in colorectal surgery have not demonstrated clear advantages to these procedures compared with conventional ones, and surgeons are concerned about unusual early recurrences reported after laparoscopic colorectal cancer surgery.Study Design: We conducted a prospective, randomized trial in one surgical department comparing laparoscopic (LAP) and conventional (CON) techniques in 109 patients undergoing bowel resection for

Jeffrey W Milsom; Bartholomäus Böhm; Katherine A Hammerhofer; Victor Fazio; Ezra Steiger; Paul Elson

1998-01-01

44

Health-related quality of life after laparoscopically assisted vaginal hysterectomy: Is uterine weight a major factor?  

Microsoft Academic Search

Objective  To assess uterine size, symptom severity, and hemoglobin level as determinants of health-related quality of life (HRQOL) in\\u000a women subsequently undergoing laparoscopically assisted vaginal hysterectomy (LAVH).\\u000a \\u000a \\u000a \\u000a Methods  Sixty-one consecutive women with uterine leiomyoma or adenomyosis undergoing LAVH were studied using a prospective cohort\\u000a design. The Chinese version of the Uterine Fibroid Symptom and Quality of Life (UFS-QOL) questionnaire was assessed preoperatively.

Pao-Ling Torng; Wen-Chun Chang; Jing-Shiang Hwang; Wen-Chiung Hsu; Jung-Der Wang; Su-Cheng Huang; Chen-Fang Chen; Ta-Chen Su

2007-01-01

45

Single incision tans-umbilical laparoscopic cholecystectomy using conventional laparoscopic instruments: initial experience of single institute.  

PubMed

Laparoscopic cholecystectomy (LC) had been considered the gold standard treatment for symptomatic gall bladder (GB) stones. Single incision laparoscopic cholecystectomy (SILC) was emerged as a less invasive alternative with better cosmesis and less post operative pain. This study evaluated the feasibility, safety, advantages and complications of SILC using the conventional laparoscopic instruments. A total of 52 patients (47 females and 5 males) with symptomatic GB stones underwent elective SILC using the conventional laparoscopic instruments. The mean operative time was 61.75 min and the mean estimated blood loss was 17.21 ml. Gall bladder perforation occurred in 5 cases (9.6%) in which 3 cases calculi spillage occurred. Troublesome cystic artery bleeding occurred in 2 cases (3.8%) while gall bladder bed bleeding happened in 1 case (1.9%). An intraoperative cholangiogram was performed in 3 cases and a drain was inserted in one case. No conversions of the technique occurred. 49 patients discharged in the first post operative day and 3 patients (5.8 %) in the 2nd day. Three month post operative wound length was an average of 1.58 cm while patient satisfaction of the surgery was an average of 9.32. PMID:22435160

Hassan, Ahmed Mohamed Abdelaziz; Hedaya, Mohamed Saied; Nasr, Magid Mahmoud; Nafeh, Ayman Ihab; Elsebae, Magdey Mohamed

2011-12-01

46

Enclosure module design thesis for Endoblend : a novel surgical device for laparoscopic hysterectomy  

E-print Network

The Endoblend device concept was developed by a 2.75 design team,of which I was a member; the purpose of the device is to remove tissue laparoscopically. The detailed design of one of its modules, the enclosure module, is ...

Hernandez-Stewart, Daniel

2007-01-01

47

A Prospective, double-blinded randomized controlled study comparing two different Trendelenburg tilts in laparoscopically assisted vaginal hysterectomy positioning  

PubMed Central

Background: Bispectral index (BIS) used for intra-operative depth assessment under general anesthesia (GA) can be altered by different factors. This study was designed to detect the alteration in BIS reading with two different Trendelenburg (TBG) tilt in laparoscopically assisted vaginal hysterectomy (LAVH) procedure. Materials and Methods: A prospective, double-blinded, randomized controlled study was designed involving 40 American Society of Anesthesiologists Grade I and II female patients, aged 35-60 years, scheduled to undergo LAVH under GA. Patients were divided into two groups with TBG >30° and TBG <30°. BIS readings; systolic and diastolic blood pressure, heart rate were recorded in supine position. Patients were then shifted to desired TBG position either (>30°) or (<30°) as per group allotment. Data were recorded at 30 min intervals and all the patients were followed upto 24 h postoperatively for any recall. Results: A rise in BIS value was noticed, when position was changed from supine to head down in both groups. During comparison between two groups with different angulations, TBG >30° showed a higher BIS value than TBG <30°. This statistically significant (P < 0.05) trend was observed at all the 30, 60, 90, and 120th min interval. Interestingly, BIS values returned to preoperative levels following adopting final supine position. No incidence of awareness was reported in both the series throughout the study. Conclusion: Though awareness remains unaltered BIS value gets increased with higher angle of inclination in TBG position during LAVH operation.

Mallick, Shibananda; Das, Anjan; Dutta, Sanjib; Chattopadhyay, Surajit; Das, Tanuka; Banu, Rezina

2015-01-01

48

Supracervical hysterectomy – the vaginal route  

PubMed Central

Removal of the cervix during hysterectomy is not mandatory. There has been no irrefutable evidence so far that total hysterectomy is more beneficial to patients in terms of pelvic organ function. The procedure that leaves the cervix intact is called a subtotal hysterectomy. Traditional approaches to this surgery include laparoscopic and abdominal routes. Vaginal total hysterectomy has been proven to present many advantages over the other approaches. Therefore, it seems that this route should also be applied in the case of subtotal hysterectomy. We present 9 cases of patients who underwent subtotal hysterectomy performed through the vagina for benign gynecological diseases. PMID:25097688

Cie?lak, Jaros?aw; Malinowski, Andrzej

2014-01-01

49

Single port laparoscopic appendectomy in children using glove port and conventional rigid instruments  

PubMed Central

Purpose To further improve the advantages of minimally invasive surgery, single port laparoscopic techniques continue to be developed. We report our initial experience with single port laparoscopic appendectomy (SPLA) in children and compare its outcomes to those of conventional laparoscopic appendectomy (CLA). Methods Clinical data were prospectively collected for SPLA cases performed at Chung-Ang University Hospital by a single surgeon between March 2011 and December 2011, including operative time, perioperative complications, conversion rate, and length of hospital stay. Each case of SPLA was performed using conventional laparoscopic instruments through Glove port placed into the single umbilical incision. To compare outcomes, a retrospective review was performed for those patients who underwent CLA between March 2010 and December 2010. Results Thirty-one patients underwent SPLA and 114 patients underwent CLA. Mean age (10.5 years vs. 11.1 years, P = 0.43), weight (48.2 kg vs. 42.9 kg, P = 0.27), and operation time (41.8 minutes vs. 37.9 minutes, P = 0.190) were comparable between both groups. Mean hospital stay was longer for CLA group (2.6 days vs. 3.7 days, P = 0.013). There was no conversion to conventional laparoscopic surgery in SPLA group. In CLA group, there were nine complications (7.9%) with 3 cases of postoperative ileuses and 6 cases wound problems. There was one complication (3.2%) of umbilical surgical site infection in SPLA group (P = 0.325). Conclusion The results of this study demonstrated that SPLA using conventional laparoscopic instruments is technically feasible and safe in children. SPLA using conventional laparoscopic instruments might be popularized by eliminating the need for specially designed instruments. PMID:24761405

Choi, Yoo Shin; Kim, Beom Gyu; Cha, Seong-Jae; Park, Joong-Min; Chang, In Taik

2014-01-01

50

Perioperative Outcomes of Robotic Assisted Laparoscopic Surgery Versus Conventional Laparoscopy Surgery for Advanced-Stage Endometriosis  

PubMed Central

Background and Objectives: To determine perioperative outcome differences in patients undergoing robotic-assisted laparoscopic surgery (RALS) versus conventional laparoscopic surgery (CLS) for advanced-stage endometriosis. Methods: This retrospective cohort study at a minimally invasive gynecologic surgery center at 2 academically affiliated, urban, nonprofit hospitals included all patients treated by either robotic-assisted or conventional laparoscopic surgery for stage III or IV endometriosis (American Society for Reproductive Medicine criteria) between July 2009 and October 2012 by 1 surgeon experienced in both techniques. The main outcome measures were extent of surgery, estimated blood loss, operating room time, intraoperative and postoperative complications, and length of stay, with medians for continuous measures and distributions for categorical measures, stratified by body mass index values. Robotically assisted laparoscopy and conventional laparoscopy were then compared by use of the Wilcoxon rank sum, ?2, or Fisher exact test, as appropriate. Results: Among 86 conventional laparoscopic and 32 robotically assisted cases, the latter had a higher body mass index (27.36 kg/m2 [range, 23.90–34.09 kg/m2] versus 24.53 kg/m2 [range, 22.27–26.96 kg/m2]; P < .0079) and operating room time (250.50 minutes [range, 176–328.50 minutes] versus 173.50 minutes [range, 123–237 minutes]; P < .0005) than did conventional laparoscopy patients. After body mass index stratification, obese patients varied in operating room time (282.5 minutes [range, 224–342 minutes] for robotic-assisted laparoscopy versus 174 minutes [range, 130–270 minutes] for conventional laparoscopy; P < .05). No other significant differences were noted between the robotic-assisted and conventional laparoscopy groups. Conclusion: Despite a higher operating room time, robotic-assisted laparoscopy appears to be a safe minimally invasive approach for patients, with all other perioperative outcomes, including intraoperative and postoperative complications, comparable with those in patients undergoing conventional laparoscopy. PMID:25489208

Sirota, Ido

2014-01-01

51

Changing the route of hysterectomy into a minimal invasive approach.  

PubMed

Objective. To describe the route of hysterectomy in a county hospital and evaluate the shift towards a minimal invasive approach. Design. Retrospective cohort study. Setting. A county hospital in Norway. Population. All women were scheduled for hysterectomy. Methods. Audit the route of hysterectomy in the period 2004-2012. Analyze the outcome of total laparoscopic hysterectomies. Main Outcome Measures. Complications after total laparoscopic hysterectomy. Results. A shift towards a minimal invasive approach has been achieved during the study period. In 2012 only 17.4% of the hysterectomies were performed abdominally, compared to yearly percentages of above 50% in the period 2004-2009. Laparoscopic supracervical hysterectomy was introduced in 2003, but the percentage of abdominal hysterectomy remained above 50% until total laparoscopic hysterectomy was introduced in 2010. Since the introduction of total laparoscopic hysterectomy in April 2010, 58 procedures have been performed. There have been no major complications. Two vaginal vault hematomas and one case of urinary tract infection were reported. Conclusions. It is possible for a county hospital to alter their praxis and perform mini-invasive hysterectomies, but it requires dedicated gynecologists. This change to an advanced procedure like total laparoscopic hysterectomy could be achieved without patients suffering from major complications. PMID:23762574

Hoyer-Sorensen, Christian; Hortemo, Sigurd; Lieng, Marit

2013-01-01

52

Hysterectomy - laparoscopic - discharge  

MedlinePLUS

... or vomiting. You are unable to pass any gas or have a bowel movement. You have pain or burning when you urinate, or you are unable to urinate. You have a discharge from your vagina that has a bad odor. ...

53

Laparoscopic Supracervical Hysterectomy  

MedlinePLUS Videos and Cool Tools

... just because there is no longer any blood flow to it. And they're coming right across ... on the "Request Information" button on your webcast screen and open the door to informed medical care. ...

54

An Economic Analysis of Robotically Assisted Hysterectomy  

PubMed Central

OBJECTIVE To perform an econometric analysis to examine the influence of procedure volume, variation in hospital accounting methodology, and use of various analytic methodologies on cost of robotically assisted hysterectomy for benign gynecologic disease and endometrial cancer. METHODS A national sample was used to identify women who underwent laparoscopic or robotically assisted hysterectomy for benign indications or endometrial cancer from 2006 to 2012. Surgeon and hospital volume were classified as the number of procedures performed before the index surgery. Total costs as well as fixed and variable costs were modeled using multivariable quantile regression methodology. RESULTS A total of 180,230 women, including 169,324 women who underwent minimally invasive hysterectomy for benign indications and 10,906 patients whose hysterectomy was performed for endometrial cancer, were identified. The unadjusted median cost of robotically assisted hysterectomy for benign indications was $8,152 (interquartile range [IQR] $6,011–10,932) compared with $6,535 (IQR $5,127–8,357) for laparoscopic hysterectomy (P<.001). The cost differential decreased with increasing surgeon and hospital volume. The unadjusted median cost of robotically assisted hysterectomy for endometrial cancer was $9,691 (IQR $7,591–12,428) compared with $8,237 (IQR $6,400–10,807) for laparoscopic hysterectomy (P<.001). The cost differential decreased with increasing hospital volume from $2,471 for the first 5 to 15 cases to $924 for more than 50 cases. Based on surgeon volume, robotically assisted hysterectomy for endometrial cancer was $1,761 more expensive than laparoscopy for those who had performed fewer than five cases; the differential declined to $688 for more than 50 procedures compared with laparoscopic hysterectomy. CONCLUSION The cost of robotic gynecologic surgery decreases with increased procedure volume. However, in all of the scenarios modeled, robotically assisted hysterectomy remained substantially more costly than laparoscopic hysterectomy. PMID:24785857

Wright, Jason D.; Ananth, Cande V.; Tergas, Ana I.; Herzog, Thomas J.; Burke, William M.; Lewin, Sharyn N.; Lu, Yu-Shiang; Neugut, Alfred I.; Hershman, Dawn L.

2014-01-01

55

Prospective randomized trial to determine the influence of laparoscopic and conventional colorectal resection on intravasal fibrinolytic capacity  

Microsoft Academic Search

  Background: Although the pneumoperitoneum decreases venous reflux from the lower extremities, the rate of thromboembolic complcations\\u000a seems to be lower after laparoscopic than after conventional procedures. Therefore, it has been assumed that laparoscopic\\u000a surgery better preserves the intravasal fibrinolytic capacity. The aim of this study was to determine the influence of the\\u000a operative technique on intravasal fibrinolytic capacity in colorectal

J. Neudecker; T. Junghans; S. Ziemer; W. Raue; W. Schwenk

2003-01-01

56

Hysterectomy debate focuses on cost efficiency, quality.  

PubMed

Watch that high-tech device: it might be more costly than you think. Recent studies find surgeons performing hysterectomies using laparoscopic devices are actually racking up higher costs, despite marketers' claims to the contrary. Greater Baltimore Medical Center found this high-tech procedure costs $1,000 to $2,000 more than traditional hysterectomy techniques, and a watchdog group offers guidelines to lower costs without sacrificing quality. PMID:10175070

1997-05-01

57

Transumbilical single incision laparoscopic cholecystectomy with conventional instruments: A continuing study  

PubMed Central

INTRODUCTION: The feasibility of the single incision, multiport transumbilical approach(SILC) for the treatment of symptomatic gallbladder calculus disease has been established. AIMS: The study examines both short and long term morbidity of the SILC approach. MATERIALS AND METHODS: All the 1338 patients were operated by the same surgeon through a transversely placed umbilical incision in the upper third of the umbilicus. Three conventional ports,10,5 and 5 mm were introduced through the same skin incision but through separate transfascial punctures. The instruments were those used for standard laparoscopic cholecystectomy(SLC).Patients with acute cholecystitis and calculous pancreatitis were included,while those with choledocholithiasis were excluded. Results were compared with those of SLC. RESULTS: Forty patients had difficult gall bladders, 214 had acute cholecystitis, and 16 had calculous pancreatitis. The mean operating time was 24.7 mins as compared to 18.4 mins in SLC. Intracorporeal knotting was required in four patients. Conversion to SLC was required in 12 patients. Morrisons pouch drain was left in 3 patients. Injectable analgesics were required in 85% vs 90% (SILC vs SLC) on day 1 and 25% vs 45% on day 2 and infection was seen in 6(0. 45%) patients. Port site hernia was seen in 2 patients. The data was compared with that of SLC and significance calculated by the student ‘t’ test. A p value less than 0.05 was considered as significant. CONCLUSIONS: Trans umbilical SILC gives comparable results to SLC, and is a superior alternative when cosmesis and postoperative pain are considered, but the operative time is significantly more. PMID:25336816

Sinha, Rajeev; Yadav, Albel S

2014-01-01

58

Types of radical hysterectomies  

PubMed Central

Abstract The treatment for cervical cancer is a complex, multidisciplinary issue, which applies according to the stage of the disease. The surgical elective treatment of cervical cancer is represented by the radical abdominal hysterectomy. In time, many surgeons perfected this surgical technique; the ones who stood up for this idea were Thoma Ionescu and Ernst Wertheim. There are many varieties of radical hysterectomies performed by using the abdominal method and some of them through vaginal and mixed way. Each method employed has advantages and disadvantages. At present, there are three classifications of radical hysterectomies which are used for the simplification of the surgical protocols: Piver-Rutledge-Smith classification which is the oldest, GCG-EORTC classification and Querlow and Morrow classification. The last is the most evolved and recent classification; its techniques can be adapted for conservative operations and for different types of surgical approaches: abdominal, vaginal, laparoscopic or robotic. Abbreviations: GCG-EORTC = Gynecologic Cancer Group of the European Organization of Research and Treatment of Cancer; LEEP = loop electrosurgical excision procedure; I.O.B. = Institute of Oncology Bucharest; PRS = Piver-Rutledge-Smith PMID:25408722

Marin, F; Plesca, M; Bordea, CI; Moga, MA; Blidaru, A

2014-01-01

59

Conventional myomectomy.  

PubMed

In addition to the conventional/older treatments of myomectomy and hysterectomy, the options now available to the woman with symptomatic fibroids, especially if she wishes to conserve her uterus, include medical treatments such as mifepristone, minimally invasive therapies such as uterine artery embolization (UAE) or magnetic-resonance-guided focused ultrasound surgery (MRgFUS), and laparoscopic or vaginal myomectomy. It is generally accepted, and with justification, that conventional myomectomy is associated with significant morbidity, especially excessive peri-operative blood loss, recurrence of the fibroids and adhesion formation, which might compromise the very reason, i.e. fertility, which the operation is performed to preserve. However, the newer treatments have significant limitations: medical treatments are promising but, to date, have been found to be of limited efficacy; UAE is still under evaluation and its impact on fertility has yet to be researched; and MRgFUS is an even newer therapy which is limited to centres with high technology and hugely expensive open magnetic resonance imaging facilities. Both UAE and MRgFUS cause shrinkage rather than removal of the fibroids, and have limited efficacy when used with really large, multiple fibroids. Laparoscopic myomectomy is also limited by the size and number of fibroids that can be treated by this approach, and demands laparoscopic skills that are still lacking in most institutions; limitations which also apply to vaginal myomectomy. It is therefore evident that conventional abdominal myomectomy still has a major role to play. There are no limitations on size and number of fibroids, and there are good data showing improvement in outcomes of assisted reproduction treatments following myomectomy. The widespread fallacy is probably the assumption that any gynaecological surgeon can perform a myomectomy; good conventional myomectomy demands no less skill than the laparoscopic approach. There is a need to continue to refine and innovate, especially with regard to reducing blood loss during surgery, reducing the risk of adhesion formation, reducing the risk of recurrence, and reconstruction of uteri to approximate anatomical normality and physiological integrity so that they can carry a pregnancy without complications such as scar rupture. This chapter will review the position of conventional myomectomy and describe approaches to optimizing outcomes following myomectomy. PMID:18395493

Mukhopadhaya, Neelanjana; De Silva, Chaminda; Manyonda, Isaac T

2008-08-01

60

Clinical results between single incision laparoscopic cholecystectomy and conventional 3-port laparoscopic cholecystectomy: prospective case-matched analysis in single institution  

PubMed Central

Purpose The aim of our study was to compare single incision laparoscopic cholecystectomy (SILC) and conventional laparoscopic cholecystectomy (CLC) with respect to clinical outcomes. Methods Patients with less than a 28 body mass index (BMI) and a benign gall bladder disease were enrolled in this study. From January 2011 to February 2012, 30 consecutive patients who underwent SILC were compared with 30 patients who underwent CLC during the same period. In this study, all operations were performed by one surgeon. In each group, patient characteristics and perioperative data were collected. Results There was no significant difference in the preoperative characteristics. There was no significant difference in the postoperative laboratory result (alanine aminotransferase, aspartate aminotransferase, and alanine aminotransferase), number of conversion and complication cases, and length of hospital stay. The operation time was significantly longer in the SILC group (78.5 ± 17.8 minutes in SILC group vs. 34.9 ± 5.75 minutes in CLC group, P < 0.0001). The total nonsteroidal antiinflammatory drug usage during perioperative period showed significantly higher in SILC groups (162 ± 51 mg in the SILC group vs. 138 ± 30 mg in the CLC group), but there was no statistically significant difference in opioid usage between two groups. The postoperative pain score was significantly higher in the SILC group at second, third, and tenth postoperative day. Satisfaction of postoperative wound showed superiority in SILC group. Conclusion SILC seems to be an acceptable alternative to CLC with acceptable results. However, it is not enough to propose any real benefits of SILC when compared with CLC in terms of operation time and postoperative pain. PMID:23230556

Jung, Gum O; Park, Dong Eun

2012-01-01

61

Laparoscopic versus conventional live donor nephrectomy: experience in a community transplant program.  

PubMed

Fifty-nine consecutive patients underwent live donor nephrectomy for transplantation. Twenty-nine patients (Group I) had open kidney procurement, and 30 patients (Group II) had laparoscopic procurement. The mean operative time in Group I was 2:30 hours (range 1:55-2:59), whereas in Group II it was 3:01 hours (1:54-5:21). All kidneys functioned immediately after transplantation. The average warm ischemia time was not calculated in Group I; it was 3.9 minutes (2-15) in Group II. Intraoperative complications occurred in two patients in Group II. One patient had bleeding from an accessory renal artery. The second patient had a tear in the splenic capsule. No ureteral complications occurred in either group. Postoperatively one patient in Group I developed incisional hernia, one developed pneumothorax, and two developed atelectasis. In Group II one patient developed pancreatitis, one developed flank ecchymosis, and two had suprapubic wound hematomas. Using the laparoscopic approach the hospital stay decreased from 4.1 to 1.27 days (69%) (P < 0.001) and return to work decreased from 28.4 to 14.8 days (49%) (P < 0.01). Live donation increased by 67 per cent. We conclude that the laparoscopic procurement of kidneys for transplantation compares well with the open method. It offers several advantages that may increase the living donor pool. PMID:11308000

Hawasli, A; Boutt, A; Cousins, G; Schervish, E; Oh, H

2001-04-01

62

Laparoscopic myomectomy using ultrasonic dissection.  

PubMed

Laparoscopic myomectomy is gaining in popularity as a means of treating leiomyoma uteri, avoiding hysterectomy, and thereby preserving or restoring fertility, when compared with traditional laparotomic surgery. While technically demanding, a laparoscopic procedure has advantages beneficial to the patient; these include decreased postoperative pain and discomfort, decreased length of stay and cost, and more rapid return to full activity. The disadvantages of laparoscopic myomectomy include increased operative time, inability to palpate the uterus at myomectomy, and the requirement of advanced technical skills. We report on our experience with laparoscopic myomectomy for treatment of infertility, habitual abortion, or to treat symptomatic myomata while preserving fertility. PMID:21400440

Miller, C E; Johnston, M

1995-01-01

63

Operative Outcomes of Robotic Partial Nephrectomy: A Comparison with Conventional Laparoscopic Partial Nephrectomy  

PubMed Central

Purpose To determine the feasibility and safety of robotic partial nephrectomy (RPN), we compared the operative outcomes of patients who had undergone RPN with those of patients who had undergone laparoscopic partial nephrectomy (LPN). Materials and Methods Between February 2009 and June 2010, 13 patients underwent transperitoneal RPN (group 1) and 14 patients underwent transperitoneal LPN (group 2) by a single surgeon. The operative outcomes of the 2 groups were compared by using Mann-Whitney U and Fisher's exact tests. Results All cases were completed successfully without conversion to open surgery. The mean operative time was 153.2±22.3 and 117.5±32.0 minutes in groups 1 and 2, respectively (p=0.003). The mean robotic console time of group 1 was 101.2±21.5 minutes, and the mean laparoscopic time of group 2 was 86.8±32.3 minutes (p=0.139). The mean warm ischemic time was 35.3±8.5 minutes and 36.4±6.8 minutes in groups 1 and 2, respectively (p=0.823). The mean estimated blood loss was 283.6±113.5 ml and 264.1±163.7 ml (p=0.382), respectively. The mean length of hospital stay was 6.1 and 5.3 days (p=0.290), respectively. The mean tumor size was 2.7±1.2 cm and 2.0±1.2 cm (p=0.035), respectively. The surgical margins were negative in all cases. Conclusions Although the operative time of RPN was longer than that of LPN, there were no significant differences in operative outcomes including robotic console time and laparoscopic time between the procedures. PMID:21556216

Choi, Hoon; Boldbaatr, Yanjmaa; Lee, Jea Whan; Rim, Joung Sik

2011-01-01

64

[Laparoscopic gastrectomy].  

PubMed

Laparoscopy-assisted gastrectomy has become a popular surgical option, particularly for the treatment of early gastric cancer. A multi-institutional clinical trial has recently demonstrated that satisfactory results have been obtained with the clinical outcomes of laparoscopic gastrectomy for early gastric cacer, which was not inferior to those obtained by a conventional open procedure. However, the indication of laparoscopic gastrectomy for the treatment of patients with advanced gastric cancer has remained controversial. In this paper, we describe the current status of gastric cancer treatment, including lymph node dissection and reconstruction procedures. We also provide future perspectives concerning the robot-assisted laparoscopic gastrectomy for gastric cancer. PMID:23198560

Yoshimura, Fumihiro; Uyama, Ichiro

2012-10-01

65

Minimally Invasive Hysterectomy at a University Teaching Hospital  

PubMed Central

Background and Objectives: To evaluate the feasibility of a minimally invasive approach for hysterectomy for benign disease at a university teaching hospital. Methods: Five hundred thirty-seven consecutive patients underwent hysterectomy for benign disease at Penn State Milton S. Hershey Medical Center in 2010. No cases were excluded. Minimally invasive approaches included total vaginal hysterectomy, laparoscopy-assisted vaginal hysterectomy, total laparoscopic hysterectomy, and laparoscopic supracervical hysterectomy. All surgeries were completed with the resident as the primary surgeon or first assistant. Results: The median age was 45 years, the median body mass index was 30 kg/m2, the median estimated uterine size was 11 cm, and 22% of patients had a prior cesarean section. Of the 537 hysterectomies, 526 (98%) were started with a minimally invasive approach and 517 (96%) were completed in that fashion; thus only 9 conversions (2%) were required. Of the cases in which a minimally invasive approach was used, 16% were vaginal and 84% were laparoscopic. The median operative time was 86 minutes, the median blood loss was 95 mL, the median hospital stay was 1 day, and the median uterine weight was 199 g. For the minimally invasive hysterectomies, there was a 5% major complication rate. Conclusion: Our residency training institution completed 96% of 537 hysterectomies using a minimally invasive approach while maintaining an acceptable operative time, amount of blood loss, hospital stay, and complication rate. Thus our study supports that a minimally invasive approach for hysterectomy for benign disease at an academic resident teaching facility is feasible. PMID:25392620

Mitri, Michael; Davies, Matthew; Kesterson, Joshua; Ural, Serdar; Kunselman, Allen; Harkins, Gerald

2014-01-01

66

Ureteral injury after laparoscopic surgery  

Microsoft Academic Search

Ureteral injuries are uncommon but serious complications of laparoscopic pelvic surgery. When unrecognized, patients experience fever, abdominal pain, signs of peritonitis, and leukocytosis usually 48 to 72 hours after the surgical procedure. A 48-year-old woman underwent laparoscopic-assisted vaginal hysterectomy, bilateral salpingo-oophorectomy, and anterior and posterior colporrhapy due to a large, symptomatic uterine myoma. Postoperatively, she suffered from progressive left lower

Cheng-Hsien Liu; Peng-Hui Wang; Wei-Ming Liu; Chio-Chung Yuan

1997-01-01

67

Laparoscopic assisted adenomyomectomy using double flap method  

PubMed Central

Objective The purpose of this study was to evaluate postoperative prognosis and progression in patients who received laparoscopic-assisted adenomyomectomy using the double flap method. Methods The pelvic cavity was explored by the conventional laparoscopic method, and drainage was achieved through a 5-mm trocar. After a small incision in the abdomen, the uterus was incised from the fundus to the upper cervical margin until exposing the endometrial cavity. Adenomyotic tissue was removed using a scalpel, scissors, or monopolar electrical bovie. The endometrial cavity was repaired with interrupted sutures using 2-0 vicryl. One side of the serosal flap was used to cover the endometrial side of the uterus. The second serosal flap covered the first flap after removal of the serosal surface of the first flap. Results From January 2008 to March 2012, there were 11 cases of laparoscopic-assisted adenomyomectomy at Chungnam National University Hospital. Nine cases were analyzed, excluding two cases with less than one year of follow-up. The average patient age was 37.0 years and average follow-up duration was 32.8 months. All patients showed improvement in dysmenorrhea (P < 0.001) and hypermenorrhea (P = 0.001) after surgery and were evaluated by visual analogue scale score. However, symptoms of adenomyosis were aggravated in three patients. Adenomyosis was progressed in the side opposite the site of operation. One patient required a total laparoscopic hysterectomy 27 months after surgery. Conclusion Laparoscopic-assisted adenomyomectomy using the double flap method is effective for uterine reduction and relief of dysmenorrhea and hypermenorrhea. Conservative management and careful follow-up are needed because adenomyosis can recur or progress in some patients. PMID:24678486

Kim, Jang-Kew; Shin, Chang-Soo; Ko, Young-Bok; Nam, Sang-Yun; Yim, Hyun-Sun

2014-01-01

68

Medical effectiveness and safety of conventional compared to laparoscopic incisional hernia repair: A systematic review  

Microsoft Academic Search

Background  Incisional hernias are a common complication following abdominal surgery and represent about 80% of all ventral hernia. In\\u000a uncomplicated postoperative follow-up they develop in about 11% of cases and in up to 23% of cases with wound infections or\\u000a other forms of wound complications. While conventional mesh repair has been the standard of care in the past, the use of

Falk Müller-Riemenschneider; Stephanie Roll; Meik Friedrich; Juergen Zieren; Thomas Reinhold; J.-Matthias Graf von der Schulenburg; Wolfgang Greiner; Stefan N. Willich

2007-01-01

69

Comparison of laparoscopic versus conventional open cryptorchidectomies on intraoperative and postoperative complications and duration of surgery, anesthesia, and hospital stay in horses.  

PubMed

Objective-To compare surgical preparation time, surgery and anesthesia times, hospitalization duration, and intra- and postoperative complications between laparoscopic and conventional open cryptorchidectomy in horses. Design-Retrospective cohort study. Animals-60 horses that underwent cryptorchidectomy. Procedures-Medical records were reviewed to identify horses that had undergone cryptorchidectomy from 1991 to 2012. Thirty horses that underwent laparoscopic cryptorchidectomy (case horses) were matched with 30 control horses that had undergone open cryptorchidectomy (ie, inguinal and parainguinal surgical approaches). Horses were matched according to history of previous surgery, testicle location, and type of closure following removal of an undescended unilateral testicle. Duration of surgery, surgical preparation and anesthesia times, hospitalization duration, and number of intra- and postoperative complications were compared between horses that underwent laparoscopic cryptorchidectomy versus open cryptorchidectomy. Comparisons were also made between horses in terms of whether there was a history of previous failed cryptorchidectomy or unknown location of testicle prior to surgery. Results-Horses that underwent laparoscopic cryptorchidectomy had significantly longer surgery and anesthesia times overall, compared with horses that underwent open cryptorchidectomy. No difference in surgery time was found between case and control horses that had a previous surgical attempt to remove an undescended testicle or in which the testicle location was unknown prior to surgery. Overall, horses undergoing laparoscopy had a nonsignificant increase in intraoperative complications, compared with control horses, and had significantly more postoperative complications. Conclusions and Clinical Relevance-Horses undergoing laparoscopic cryptorchidectomy had increased surgical preparation time, increased surgery and anesthesia times, and more postoperative complications, compared with horses undergoing open cryptorchictomy. Laparoscopy may be advantageous for a second attempt at cryptorchidectomy or if the testicle location is unknown prior to surgery. PMID:25835173

Cribb, Nicola C; Koenig, Judith; Sorge, Ulrike

2015-04-15

70

Health Technology Assessment of laparoscopic compared to conventional surgery with and without mesh for incisional hernia repair regarding safety, efficacy and cost-effectiveness  

PubMed Central

Introduction Incisional hernias are a common complication following abdominal surgery and they represent about 80% of all ventral hernia. In uncomplicated postoperative follow-up they can develop in about eleven percent of cases and up to 23% of cases with wound infections or other forms of wound complications. Localisation and size of the incisional hernia can vary according to the causal abdominal scar. Conservative treatment (e. g. weight reduction) is only available to relieve symptoms while operative treatments are the only therapeutic treatment option for incisional hernia. Traditionally, open suture repair was used for incisional hernia repair but was associated with recurrence rates as high as 46%. To strengthen the abdominal wall and prevent the development of recurrences the additional implantation of an alloplastic mesh is nowadays commonly used. Conventional hernia surgery as well as minimally invasive surgery, introduced in the early 90s, make use of this mesh-technique and thereby showed marked reductions in recurrence rates. However, there are possible side effects associated with mesh-implantation. Therefore recommendations remain uncertain on which technique to apply for incisional hernia repair and which technique might, under specific circumstances, be associated with advantages over others. Objectives The goal of this HTA-Report is to compare laparoscopic incisional hernia repair (LIHR) and conventional incisional hernia repair with and without mesh-implantation in terms of their medical efficacy and safety, their cost-effectiveness as well as their ethical, social und legal implications. In addition, this report aims to compare different techniques of mesh-implantation and mesh-fixation as well as to identify factors, in which certain techniques might be associated with advantages over others. Methods Relevant publications were identified by means of a structured search of databases accessed through the German Institute of Medical Documentation and Information (DIMDI) as well as by a manual search. The former included the following electronic resources: SOMED (SM78), Cochrane Library – Central (CCTR93), MEDLINE Alert (ME0A), MEDLINE (ME95), CATFILEplus (CATLINE) (CA66), ETHMED (ED93), GeroLit (GE79), HECLINET (HN69), AMED (CB85), CAB Abstracts (CV72), GLOBAL Health (AZ72), IPA (IA70), Elsevier BIOBASE (EB94), BIOSIS Previews (BA93), EMBASE (EM95), EMBASE Alert (EA08), SciSearch (IS90), Cochrane Library – CDSR (CDSR93), NHS-CRD-DARE (CDAR94), NHS-CRD-HTA (INAHTA) as well as NHSEED (NHSEED). The present report includes German and English literature published until 31.08.2005. The search parameters can be found in the appendix. No limits were placed on the target population. The methodological quality of the included clinical studies was assessed using the criteria recommended by the “Scottish Intercollegiate Guidelines Network Grading Review Group“. Economic studies were evaluated by the criteria of the German Scientific Working Group Technology Assessment for Health Care. Results The literature search identified 17 relevant medical publications. One of these studies compared laparoscopic and conventional surgery with and without mesh for incisional hernia repair, while 16 studies compared laparoscopic and conventional surgery with mesh for incisional hernia repair. Among these studies were 14 primary studies (one randomised controlled trial (RCT), two systematic reviews and one HTA-Report. The only study comparing laparoscopic and conventional surgery without mesh found substantial differences in terms of baseline characteristics between treatment groups. The outcome parameters showed decreased recurrence rates for the laparoscopic repair and similar safety of the procedures. Studies comparing laparoscopic and conventional surgery with mesh found similar outcome in terms of medical efficacy and safety. However, there was a trend towards lower recurrence rates, length of hospital stay, and postoperative pain as well as decreased complication rates for laparoscopic repair in

Friedrich, Meik; Müller-Riemenschneider, Falk; Roll, Stephanie; Kulp, Werner; Vauth, Christoph; Greiner, Wolfgang; Willich, Stefan; von der Schulenburg, Johann-Matthias

2008-01-01

71

Fallopian Tube Prolapse after Hysterectomy: A Systematic Review  

PubMed Central

Background Prolapse of the fallopian tube into the vaginal vault is a rarely reported complication that may occur after hysterectomy. Clinicians can miss the diagnosis of this disregarded complication when dealing with post-hysterectomy vaginal bleeding. Objectives We performed a systematic review in order to describe the clinical presentation, therapeutic management and outcome of fallopian tube prolapse occurring after hysterectomy. Search Strategy A systematic search of MEDLINE and EMBASE references from January 1980 to December 2010 was performed. We included articles that reported cases of fallopian tube prolapse after hysterectomy. Data from eligible studies were independently extracted onto standardized forms by two reviewers. Results Twenty-eight articles including 51 cases of fallopian tube prolapse after hysterectomy were included in this systematic review. Clinical presentations included abdominal pain, dyspareunia, post- coital bleeding, and/or vaginal discharge. Two cases were asymptomatic and diagnosed at routine checkup. The surgical management reported comprised partial or total salpingectomy, with vaginal repair in some cases combined with oophorectomy using different approaches (vaginal approach, combined vaginal-laparoscopic approach, laparoscopic approach, or laparotomy). Six patients were initially treated by silver nitrate application without success. Conclusions This systematic review provided a precise summary of the clinical characteristics and treatment of patients presenting with fallopian tube prolapse following hysterectomy published in the past 30 years. We anticipate that these results will help inform current investigations and treatment. PMID:24116117

Ouldamer, Lobna; Caille, Agnès; Body, Gilles

2013-01-01

72

Implementation of a Robotic Surgical Program in Gynaecological Oncology and Comparison with Prior Laparoscopic Series  

PubMed Central

Background. Robotic surgery in gynaecological oncology is a rapidly developing field as it offers several technical advantages over conventional laparoscopy. An audit was performed on the outcome of robotic surgery during our learning curve and compared with recent well-established laparoscopic procedure data. Method. Following acquisition of the da Vinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, California, USA), we prospectively analysed all cases performed over the first six months by one experienced gynaecologist who had been appropriately trained and mentored. Data on age, BMI, pathology, surgery type, blood loss, morbidity, return to theatre, hospital stay, and readmission rate were collected and compared with a consecutive series over the preceding 6 months performed laparoscopically by the same team. Results. A comparison of two consecutive series was made. The mean age was somewhat different, 55 years in the robotic versus 69 years in the laparoscopic group, but obesity was a feature of both groups with a mean of BMI 29.3 versus 28.06, respectively. This difference was not statistically significant (P = 0.54). Three subgroups of minimal access surgical procedures were performed: total hysterectomy and bilateral salpingooophorectomy (TH + BSO), total hysterectomy and bilateral salpingooophorectomy plus bilateral pelvic lymphadenectomy (TH + BSO + BPLND), and radical hysterectomy plus bilateral pelvic lymphadenectomy (RH + BPLND). The mean time taken to perform surgery for TH + BSO was longer in the robotic group, 151.2?min compared to 126.3?min in the laparoscopic group. TH + BSO + BPLND surgical time was similar to 178.3?min in robotic group and 176.5?min in laparoscopic group. RH + BPLND surgical time was similar, 263.6?min (robotic arm) and 264.0?min (laparoscopic arm). However, the numbers in this initial analysis were small especially in the last two subgroups and do not allow for statistical analysis. The rate of complications necessitating intervention (Clavien-Dindo classification grade 2/3) was higher in the robotic arm (22.7%) compared to the laparoscopic approach (4.5%). The readmission rate was higher in the robotic group (18.2%) compared to the laparoscopic group (4.5%). The return to theatre in the robotic group was 18.2% and 4.5% in laparoscopic group. Uncomplicated robotic surgery hospital stay appeared to be shorter, 1.3 days compared to the uncomplicated laparoscopic group, 2.5 days. There was no conversion to the open procedure in either arm. Estimated blood loss in all cases was less than 100?mL in both groups. Conclusion. Robotic surgery is comparable to laparoscopic surgery in blood loss; however, the hospital stay in uncomplicated cases appears to be longer in the laparoscopic arm. Surgical robotic time is equivalent to laparoscopic in complex cases but may be longer in cases not requiring lymph node dissection. The robotic surgery team learning curve may be associated with higher rate of morbidity. Further research on the benefits to the surgeon is needed to clarify the whole picture of this versatile novel surgical approach. PMID:25785195

Povolotskaya, Natalia; Woolas, Robert; Brinkmann, Dirk

2015-01-01

73

Laparoscopic surgery in endometriosis.  

PubMed

Endometriosis (the presence of endometrial glands and stroma outside of the uterine cavity) is a common gynecologic problem affecting 10% of women in the general population, 40% of women with infertility and 60% of women with chronic pelvic pain. Laparoscopy has revolutionized management of women with endometriosis. Diagnosis of endometriosis depends on visualization of endometriotic lesions and histologic confirmation. Endometriotic implants have a multitude of appearances: powder burns, red, blue-black, yellow, white, clear vesicular and peritoneal windows. Diagnostic laparoscopy is often combined with operative procedures to treat manifestations and symptoms of endometriosis. This often includes removal or laser vaporization of endometriotic implants, lysis of adhesions, restoration of normal anatomy and removal or fulguration of ovarian endometriomas (conservative surgery). Severe incapacitating endometriosis, recurrent endometriosis following conservative surgery and symptomatic endometriosis in women not desiring more children is often treated by laparoscopic unilateral or bilateral salpingo-oophorectomy or laparoscopically-assisted vaginal hysterectomy with bilateral salpingo-oophorectomy (radical surgery). Endometriosis affecting the appendix, ureters, bladder wall and rectosigmoid colon could be treated with laparoscopic appendectomy, excision of endometriotic implants or laparoscopic colectomy and anastomosis, respectively. Hydrodis-section and use of CO2 super pulsed laser aid in removal of adherent endometriotic implants without damage to normal underlying structures. Robotic-assisted laparoscopic surgery promises to provide advantages in the management of women with severe endometriosis secondary to 3-dimensional visualization, decreasing surgeon's fatigue and hand tremors and improving surgical precision. PMID:18560348

Eltabbakh, G H; Bower, N A

2008-08-01

74

Niti CAR 27 Versus a Conventional End-to-End Anastomosis Stapler in a Laparoscopic Anterior Resection for Sigmoid Colon Cancer  

PubMed Central

Purpose The Niti CAR 27 (ColonRing) uses compression to create an anastomosis. This study aimed to investigate the safety and the effectiveness of the anastomosis created with the Niti CAR 27 in a laparoscopic anterior resection for sigmoid colon cancer. Methods In a single-center study, 157 consecutive patients who received an operation between March 2010 and December 2011 were retrospectively assessed. The Niti CAR 27 (CAR group, 63 patients) colorectal anastomoses were compared with the conventional double-stapled (CDS group, 94 patients) colorectal anastomoses. Intraoperative, immediate postoperative and 6-month follow-up data were recorded. Results There were no statistically significant differences between the two groups in terms of age, gender, tumor location and other clinical characteristics. One patient (1.6%) in the CAR group and 2 patients (2.1%) in the CDS group experienced complications of anastomotic leakage (P = 0.647). These three patients underwent a diverting loop ileostomy. There were 2 cases (2.1%) of bleeding at the anastomosis site in the CDS group. All patients underwent a follow-up colonoscopy (median, 6 months). One patient in the CAR group experienced anastomotic stricture (1.6% vs. 0%; P = 0.401). This complication was solved by using balloon dilatation. Conclusion Anastomosis using the Niti CAR 27 device in a laparoscopic anterior resection for sigmoid colon cancer is safe and feasible. Its use is equivalent to that of the conventional double-stapler. PMID:24851217

Kwag, Seung-Jin; Kim, Jun-Gi; Kang, Won-Kyung; Lee, Jin-Kwon

2014-01-01

75

Perioperative Complications of Robot-Assisted Laparoscopic Surgery Using Three Robotic Arms at a Single Institution  

PubMed Central

Purpose The aim of this study was to evaluate perioperative complications of robot-assisted laparoscopic surgery in gynecology. Materials and Methods Patients who underwent elective robot-assisted laparoscopic surgery between February 2006 and December 2013 were identified. Robotic procedures were performed using the da Vinci robotic system. Patient demographic data and operative outcomes were prospectively collected in a computerized database and extracted for this study. Results Two hundred and ninety eight patients were identified during the study period. One case was converted to conventional laparoscopy due to mechanical failure of the robot system before the procedure and excluded from review. The median age and body mass index of patients were 48 years and 23.0 kg/m2, respectively. The majority (n=130, 43.6%) of operative procedures was radical hysterectomy, followed by endometrial cancer staging (n=112, 37.6%), total hysterectomy (n=39, 13.1%), and myomectomy (n=17, 5.7%). The median operative time, estimated blood loss, and postoperative hospital stay were 208.5 min, 184.8 mL, and 8.9 days, respectively. The overall complication rate was 18.8% and that for only oncologic cases was 16.1%. Intraoperative complications (n=5, 1.7%) consisted of three vessel injuries, one bowel content leakage during an appendectomy during endometrial cancer staging and one case of bladder injury during radical hysterectomy. Early and late postoperative complications were 14.4% and 2.7%, respectively. Five patients (1.7%) experienced grade 3 complications according to Clavien-Dindo classification and therefore needed further intervention. Conclusion Robot-assisted laparoscopic surgery is a feasible approach in gynecology with acceptable complications. PMID:25683998

Yim, Ga Won; Kim, Sang Wun; Nam, Eun Ji; Kim, Sunghoon

2015-01-01

76

A Comparison of Open Surgery, Robotic-Assisted Surgery and Conventional Laparoscopic Surgery in the Treatment of Morbidly Obese Endometrial Cancer Patients  

PubMed Central

Background and Objectives: The intent of this retrospective study was to assess the operative outcomes of morbidly obese endometrial cancer patients who were treated with either open surgery (OS) or a minimally invasive procedure. Methods: Morbidly obese (body mass index [BMI] > 40 kg/m2) patients with endometrial cancer who underwent OS, robotic-assisted laparoscopic surgery (RS), or conventional laparoscopic surgery (LS) were eligible. We sought to discern any outcome differences with regard to operative time, perioperative complications, and hospital stay. Results: Sixteen patients were treated with LS (BMI = 47.9 kg/m2), 13 were managed via RS (BMI = 51.2 kg/m2), and 24 underwent OS (BMI = 53.7 kg/m2). The OS (1.35 hours) patients had a significantly shorter operative duration than the LS (1.82 hours) and RS (2.78 hours) patients (P < .001); blood loss was greater in the OS (250 mL) group in comparison with the RS (100 mL) and LS (175 mL) patients (P = .002). Moreover, the OS (4 days) subjects had a significantly longer hospital stay than the LS (2 days) and RS (2 days) patients (P = .002). Conclusion: In the present study, we ascertained that minimally invasive surgery was associated with longer operative times but lower rates of blood loss and shorter hospital stay duration compared with treatment comprising an open procedure.

Mendivil, Alberto A.; Rettenmaier, Mark A.; Abaid, Lisa N.; Brown, John V.; Micha, John P.; Lopez, Katrina L.

2015-01-01

77

Hysterectomy - vaginal - discharge  

MedlinePLUS

... cut. Your surgeon may have also used a laparoscope (a thin tube with a small camera on ... on your skin unless your doctor used a laparoscope and other instruments that were inserted through your ...

78

Conventionalism  

E-print Network

Certain fundamental philosophical disputes, in contrast to disputes in the empirical sciences, are characterized by the persistence of disagreement. This has led some to endorse conventionalism, the view that the 'facts ...

Einheuser, Iris, 1969-

2003-01-01

79

Cost-effectiveness of hysterectomy for benign gynecological conditions: a systematic review.  

PubMed

The objective of this study was to assess the cost-effectiveness of hysterectomy performed for benign indications. Hysterectomy remains the most common major gynecological operation in the Western world. Rates of hysterectomy have not declined as expected with the introduction of new treatment options. Furthermore, use of laparoscopic techniques varies widely within the Nordic countries. We designed a systematic review in a University Central Hospital. The sample included all published studies regarding the cost-effectiveness of hysterectomy performed for benign indications (n = 1666). Medline, Cochrane Library, PsycINFO, CINAHL, and Nursing databases were searched. Inclusion criteria were the availability of pre- and post-intervention health-related quality of life measures (HRQoL) and data on costs. HRQoL, costs, and cost-effectiveness of treatment were the main outcome measures. Studies (n = 24) focused on treatment of symptomatic fibroids (n = 8), treatment of heavy menstrual bleeding (n = 10), various surgical techniques (n = 5) and the effect of various indications for hysterectomy (n = 2). Follow-up periods varied from 4 months to over 10 years. SF/RAND-36 or EQ-5D measures and societal cost perspective were most commonly used. Only 11 studies used individual patient data. HRQoL following hysterectomy was generally good but costs were high. The cost-effectiveness depended on indication, age, and duration of follow-up. The cost-effectiveness of hysterectomy has been surprisingly poorly studied. Conclusions are difficult to draw due to different study designs, indications, follow-up times, and HRQoL instruments used. Rates of hysterectomy have declined less than expected with the introduction of new treatment modalities. Costs of surgery are high. Laparoscopic hysterectomy seems to be the least cost-effective, although further data from original patient cohorts with long-term follow-up are needed. PMID:24180560

Pynnä, Kristiina; Vuorela, Piia; Lodenius, Leena; Paavonen, Jorma; Roine, Risto P; Räsänen, Pirjo

2014-03-01

80

Virtual reality in laparoscopic surgery.  

PubMed

Although the many advantages of laparoscopic surgery have made it an established technique, training in laparoscopic surgery posed problems not encountered in conventional surgical training. Virtual reality simulators open up new perspectives for training in laparoscopic surgery. Under realistic conditions in real time, trainees can tailor their sessions with the VR simulator to suit their needs and goals, and can repeat exercises as often as they wish. VR simulators reduce the number of experimental animals needed for training purposes and are suited to the pursuit of research in laparoscopic surgery. PMID:15747974

Uranüs, Selman; Yanik, Mustafa; Bretthauer, Georg

2004-01-01

81

Hysterectomy after endometrial ablation  

Microsoft Academic Search

OBJECTIVES: Our purpose was to determine the number of women undergoing hysterectomy after endometrial ablation and the indications for the subsequent surgery. STUDY DESIGN: Forty-two premenopausal women, who had severe menorrhagia associated with a clinically normal examination result, underwent rollerball endometrial ablation between November 1990 and December 1991. Thirty-seven women whom we gave ongoing care were evaluated by chart review.

James B. Unger; G. Rodney Meeks

1996-01-01

82

Laparoscopic repair of urogenital fistulae: A single centre experience  

PubMed Central

CONTEXT: Sparse literature exists on laparoscopic repair of urogenital fistulae (UGF). AIMS: The purpose of the following study is to report our experience of laparoscopic UGF repair with emphasis on important steps for a successful laparoscopic repair. SETTINGS AND DESIGN: Data of patients who underwent laparoscopic repair of UGF from 2003 to 2012 was retrospectively reviewed. MATERIALS AND METHODS: Data was reviewed as to the aetiology, prior failed attempts, size, number and location of fistula, mean operative time, blood loss, post-operative storage/voiding symptoms and episodes of urinary tract infections (UTI). RESULTS: Laparoscopic repair of 22 supratrigonal vesicovaginal fistulae (VVF) (five recurrent) and 31 ureterovaginal fistulae (UVF) was performed. VVF followed transabdominal hysterectomy (14), lower segment caesarean section (LSCS) (7) and oophrectomy (1). UVF followed laparoscopy assisted vaginal hysterectomy (18), transvaginal hysterectomy (2) and transabdominal hysterectomy (10) and LSCS (1). Mean VVF size was 14 mm. Mean operative time and blood loss for VVF and UVF were 140 min, 75 ml and 130 min, 60 ml respectively. In 20 VVF repairs tissue was interposed between non-overlapping suture lines. Vesico-psoas hitch was done in 29 patients of urterovaginal fistulae. All patients were continent following surgery. There were no urinary complaints in VVF patients and no UTI in UVF patients over a median follow-up of 3.2 years and 2.8 years respectively. CONCLUSION: Laparoscopic repair of UGF gives easy, quick access to the pelvic cavity. Interposition of tissue during VVF repair and vesico-psoas hitch during UVF repair form important steps to ensure successful repair. PMID:25336817

Sharma, Sumit; Rizvi, Syed Jamal; Bethur, Santhosh Shivanandaiah; Bansal, Jyoti; Qadri, Syed Javid Farooq; Modi, Pranjal

2014-01-01

83

Comparison of a flexible-tip laparoscope with a rigid straight laparoscope for single-incision laparoscopic cholecystectomy.  

PubMed

This study assessed whether a flexible-tip laparoscope improves operative outcomes including operative length while performing single-incision laparoscopic cholecystectomy (SILC) compared with the use of a conventional straight laparoscope. The flexible-tip laparoscope decreased the operative time compared with the straight laparoscope. Although SILC has potential benefits, surgeons experience problems for in-line viewing through a laparoscope and from contact of instruments with the laparoscope, resulting in longer operative times and the need for additional ports. The aim of this study was to determine whether a flexible-tip laparoscope improves operative outcomes, including operative length and the rate of insertion of additional ports, while performing SILC compared with the use of a conventional rigid straight laparoscope. We reviewed data on patients for whom we performed SILC at the Department of Surgery, Kansai Medical University, for the period from November 1, 2009, to February 28, 2013. The information was assessed with respect to patient characteristics, types of laparoscope used, operative data as well as postoperative outcomes. Operating time for SILC using the flexible-tip laparoscope was significantly shorter than with the straight laparoscope (81.5 ± 23.2 vs 94.4 ± 21.1 minutes) as a result of a better view of the operating field without contact with working instruments. Although a trend was shown toward a reduced rate of the need for extra ports in the flexible-tip laparoscope group, the difference did not reach statistical significance. Using the flexible-tip laparoscope solved the problem of in-line viewing and decreased the operative time for SILC. PMID:25513924

Matsui, Yoichi; Ryota, Hironori; Sakaguchi, Tatsuma; Nakatani, Kazuyoshi; Matsushima, Hideyuki; Yamaki, So; Hirooka, Satoshi; Yamamoto, Tomohisa; Kwon, A-Hon

2014-12-01

84

Laparoscopic surgery - series (image)  

MedlinePLUS

... of different procedures can be performed laparoscopically, including gallbladder removal (laparoscopic cholecystectomy), esophageal surgery (laparoscopic fundoplication), colon surgery (lapraoscopic colectomy), and surgery ...

85

An Audit of Indications, Complications, and Justification of Hysterectomies at a Teaching Hospital in India  

PubMed Central

Objective. Aim of this audit was to analyze indications, complications, and correlation of preoperative diagnosis with final histopathology report of all hysterectomies, performed in a premier teaching hospital. Methods. Present study involved all patients who underwent hysterectomy at a premier university hospital in Southern India, in one year (from 1 January, 2012, to 31 December, 2012). Results. Most common surgical approach was abdominal (74.7%), followed by vaginal (17.8%), and laparoscopic (6.6%) hysterectomy. Most common indication for hysterectomy was symptomatic fibroid uterus (39.9%), followed by uterovaginal prolapse (16.3%). Overall complication rate was 8.5%. Around 84% had the same pathology as suspected preoperatively. Only 6 (5 with preoperative diagnosis of abnormal uterine bleeding and one with high grade premalignant cervical lesion) had no significant pathology in their hysterectomy specimen. Conclusion. Hysterectomy is used commonly to improve the quality of life; however at times it is a lifesaving procedure. As any surgical procedure is associated with a risk of complications, the indication should be carefully evaluated. With the emergence of many conservative approaches to deal with benign gynecological conditions, it is prudent to discuss available options with the patient before taking a direct decision of surgically removing her uterus.

Sehgal, Kriti; Hebbar, Shripad; Nambiar, Jayaram; Bhat, Rajeshwari G.

2014-01-01

86

Solo surgeon single-port laparoscopic surgery with a homemade laparoscope-anchored instrument system in benign gynecologic diseases.  

PubMed

The objective of this study was to present the initial operative experience of solo surgeon single-port laparoscopic surgery (SPLS) in the laparoscopic treatment of benign gynecologic diseases and to investigate its feasibility and surgical outcomes. Using a novel homemade laparoscope-anchored instrument system that consisted of a laparoscopic instrument attached to a laparoscope and a glove-wound retractor umbilical port, we performed solo surgeon SPLS in 13 patients between March 2011 and June 2012. Intraoperative complications and postoperative surgical outcomes were determined. The primary operative procedures performed were unilateral salpingo-oophorectomy (n = 5), unilateral salpingectomy (n = 2), adhesiolysis (n = 1), and laparoscopically assisted vaginal hysterectomy (n = 5). Additional surgical procedures included additional adhesiolysis (n = 4) and ovarian drilling (n = 1).The primary indications for surgery were benign ovarian tumors (n = 5), ectopic pregnancy (n = 2), pelvic adhesion (infertility) (n = 1), and benign uterine tumors (n = 5). Solo surgeon SPLS was successfully accomplished in all procedures without a laparoscopic assistant. There were no intraoperative or postoperative complications. Our laparoscope-anchored instrument system obviates the need for an additional laparoscopic assistant and enables SPLS to be performed by a solo surgeon. The findings show that with our system, solo surgeon SPLS is a feasible and safe alternative technique for the treatment of benign gynecologic diseases in properly selected patients. PMID:24509292

Yang, Yun Seok; Kim, Seung Hyun; Jin, Chan Hee; Oh, Kwoan Young; Hur, Myung Haeng; Kim, Soo Young; Yim, Hyun Soon

2014-01-01

87

Laparoscopic splenectomy  

Microsoft Academic Search

Summary Splenectomy has traditionally been done through a generous laparotomy incision, requiring complete mobilization of the spleen for removal. In selected cases, however, splenectomy may either be facilitated or performed entirely by laparoscopic means. Two patients with Hodgkin's disease in whom splenectomy was facilitated laparoscopically are described; in another patient with idiopathic thrombocytopenic purpura (ITP), the splenectomy was successfully performed

Brendan J. Carroll; Edward H. Phillips; Chester J. Semel; Moses Fallas; Leon Morgenstern

1992-01-01

88

Laparoscopic and open incisional hernia repair: A comparison study  

Microsoft Academic Search

Background: Techniques for performing laparoscopic incisional hernia repair have been described and some advantages over conventional open repair reported. However, most reported series of laparoscopic incisional hernia procedures are small, and only one has included a comparison with open repairs. Methods: From December 1993 to January 1998, we prospectively collected operative and outcome data on 56 consecutive laparoscopic prosthetic repairs

Adrian Park; Daniel W. Birch; Peter Lovrics

1998-01-01

89

The Hysterectomy ExperienceAn Ethnographic Study  

Microsoft Academic Search

Women who undergo a hysterectomy typically experience preoperative symptoms that severely affect quality of life. The purpose of this study was to understand the hysterectomy experience from the informants' perspective. The research design chosen was ethnography. Research aims included (a) describing the quality of life before hysterectomy, (b) understanding the decision-making process involved in having a hysterectomy, (c) describing the

Virginia Kinnick; Debra Leners

1995-01-01

90

Robot-Assisted Radical Hysterectomy for Cervical Cancer: Review of Surgical and Oncological Outcomes  

PubMed Central

Robot-assisted procedures are being increasingly incorporated in gynaecologic oncology. Several studies have confirmed the feasibility and safety of robotic radical hysterectomy for selected patients with early-stage cervical cancer. It has been demonstrated that robotic radical hysterectomy offers an advantage over other surgical approaches with regard to operative time, blood loss, and hospital stay. Also initial evidences concerning oncological outcomes seem to confirm the equivalence to traditional open technique. Despite the fact that costs of robotic system are still high, they could be partially offset by several health-related and social benefits: less pain, faster dismissal, and return to full activity than other surgical approaches. The development of robotic technology may facilitate the spread of minimally invasive surgery in gynaecological oncology, overcoming some drawbacks of laparoscopic technique for challenging intervention such as radical hysterectomy. Further studies are needed to evaluate overall and disease-free survival of this technique and associated morbidity after adjuvant therapies. PMID:22111022

Renato, Seracchioli; Mohamed, Mabrouk; Serena, Solfrini; Giulia, Montanari; Giulia, Ferrini; Giulia, Giovanardi; Diego, Raimondo; Riccardo, Schiavina

2011-01-01

91

COMPARATIVE OUTCOMES OF OPEN VERSUS LAPAROSCOPIC SACROCOLPOPEXY AMONG MEDICARE BENEFICIARIES  

PubMed Central

Introduction Since the first reported laparoscopic sacrocolpopexy in 1991, a limited number of single-center studies have attempted to assess the procedure’s effectiveness and safety. Therefore, we analyzed a national Medicare database to compare real-world short-term outcomes of open and laparoscopic-assisted (including robotic) sacrocolpopexy on a United States sample of patients. Methods Public Use File data for a 5% random national sample of all Medicare beneficiaries age 65 and older were obtained from the Centers for Medicare and Medicaid Services for years 2004–2008. Women with pelvic organ prolapse were identified using ICD-9 diagnosis codes. CPT-4 procedure codes were used to identify women who underwent open (code 57280) or laparoscopic (code 57425) sacrocolpopexy. Individual subjects were followed for one year post-operatively. Outcomes measured, using ICD-9 and CPT-4 codes, included medical and surgical complications and re-treatment rates. Results 794 women underwent open and 176 underwent laparoscopic sacrocolpopexy. Laparoscopic sacrocolpopexy was associated with a significantly increased rate of re-operation for anterior vaginal wall prolapse (3.4% vs. 1.0%, p = 0.018). However, more medical (primarily cardiopulmonary) complications occurred post-operatively in the open group (31.5% vs. 22.7%, p = 0.023). When sacrocolpopexy was performed with concomitant hysterectomy, mesh-related complications were significantly higher in the laparoscopic group (5.4% vs. 0%, p = 0.026). Conclusion Laparoscopic sacrocolpopexy resulted in increased rate of reoperation for prolapse in anterior compartment. When hysterectomy was performed at the time of sacrocolpopexy, the laparoscopic approach was associated with an increased risk of mesh-related complications. PMID:23652338

Khan, Aqsa; Alperin, Marianna; Wu, Ning; Clemens, J. Quentin; Dubina, Emily; Pashos, Chris L.; Anger, Jennifer T.

2014-01-01

92

The Impact of Different Surgical Modalities for Hysterectomy on Satisfaction and Patient Reported Outcomes  

PubMed Central

Background There is an ongoing debate regarding the cost-benefit of different surgical modalities for hysterectomy. Studies have relied primarily on evaluation of clinical outcomes and medical expenses. Thus, a paucity of information on patient-reported outcomes including satisfaction, recovery, and recommendations exists. Objective The objective of this study was to identify differences in patient satisfaction and recommendations by approach to a hysterectomy. Methods We recruited a large, geographically diverse group of women who were members of an online hysterectomy support community. US women who had undergone a benign hysterectomy formed this retrospective study cohort. Self-reported characteristics and experiences were compared by surgical modality using chi-square tests. Outcomes over time were assessed with the Jonkheere-Terpstra trend test. Logistic regression identified independent predictors of patient satisfaction and recommendations. Results There were 6262 women who met the study criteria; 41.74% (2614/6262) underwent an abdominal hysterectomy, 10.64% (666/6262) were vaginal, 27.42% (1717/6262) laparoscopic, 18.94% (1186/6262) robotic, and 1.26% (79/6262) single-incision laparoscopic. Most women were at least college educated (56.37%, 3530/6262), and identified as white, non-Hispanic (83.17%, 5208/6262). Abdominal hysterectomy rates decreased from 68.2% (152/223) to 24.4% (75/307), and minimally invasive surgeries increased from 31.8% (71/223) to 75.6% (232/307) between 2001 or prior years and 2013 (P<.001 all trends). Trends in overall patient satisfaction and recommendations showed significant improvement over time (P<.001).There were differences across the surgical modalities in all patient-reported experiences (ie, satisfaction, time to walking, driving and working, and whether patients would recommend or use the same technique again; P<.001). Significantly better outcomes were evident among women who had vaginal, laparoscopic, and robotic procedures than among those who had an abdominal procedure. However, robotic surgery was the only approach that was an independent predictor of better patient experience; these patients were more satisfied overall (odds ratio [OR] 1.31, 95% CI 1.13-1.51) and on six other satisfaction measures, and more likely to recommend (OR 1.64, 95% CI 1.39-1.94) and choose the same modality again (OR 2.07, 95% CI 1.67-2.57). Abdominal hysterectomy patients were more dissatisfied with outcomes after surgery and less likely to recommend (OR 0.36, 95% CI 0.31-0.40) or choose the same technique again (OR 0.29, 95% CI 0.25-0.33). Quicker return to normal activities and surgery after 2007 also were independently associated with better overall satisfaction, willingness to recommend, and to choose the same surgery again. Conclusions Consistent with other US data, laparoscopic and robotic hysterectomy rates increased over time, with a concomitant decline in abdominal hysterectomy. While inherent shortcomings of this retrospective Web-based study exist, findings show that patient experience was better for each of the major minimally invasive approaches than for abdominal hysterectomy. However, robotic-assisted hysterectomy was the only modality that independently predicted greater satisfaction and willingness to recommend and have the same procedure again. PMID:25048103

2014-01-01

93

Vaginal Hysterectomy (Beyond the Basics)  

MedlinePLUS

... may require hysterectomy. Fibroids — Fibroids (also known as leiomyoma) are noncancerous growths of uterine muscle. Fibroids may ... and myomectomy may be used to treat symptomatic leiomyoma (fibroids). (See "Patient information: Uterine fibroids (Beyond the ...

94

Hysterectomy versus hysterectomy plus oophorectomy for premenopausal women.  

PubMed

Background Prophylactic oophorectomy alongside hysterectomy in premenopausal women is a common procedure. The decision to remove or conserve the ovaries is often based on the perceived risk for ovarian cancer and the need for additional gynaecological surgical interventions,and is weighed against the perceived risk of negative health effects caused by surgically induced menopause. The evidence needed to recommend either prophylactic bilateral oophorectomy or conservation of ovaries at the time of hysterectomy in premenopausal women is limited. This is an update of the original version of this systematic review published in 2008.Objectives To compare hysterectomy alone versus hysterectomy plus bilateral oophorectomy in women with benign gynaecological conditions,with respect to rates of mortality or subsequent gynaecological surgical interventions.Search methods We searched the Cochrane Menstrual Disorders and Subfertility Group Trials Register (December 2005 to January 2014) and the following electronic databases: CENTRAL (The Cochrane Library 2013, Issue 12), MEDLINE (January 1966 to January 2014),EMBASE (January 1985 to January 2014), and PsycINFO (1806 to January 2014).Selection criteria Randomised controlled trials (RCTs) of hysterectomy alone versus hysterectomy with bilateral oophorectomy in premenopausal women with benign gynaecological conditions were eligible. Any surgical approach could be used.Data collection and analysis Three review authors independently assessed trials for inclusion. Study authors were contacted if information was unclear.Main results Only one RCT comparing the benefits and risks of hysterectomy with or without oophorectomy was identified. The results of this pilot RCT have not been published and we have not been able to obtain the results. Therefore, no data could be included in this review. Authors' conclusions The conclusions of this review are limited by a lack of RCTs. Although no evidence is available from RCTs, there is growing evidence from observational studies that surgical menopause may impact negatively on cardiovascular health and all cause mortality. PMID:25101365

Orozco, Leonardo J; Tristan, Mario; Vreugdenhil, Maria M T; Salazar, Arturo

2014-01-01

95

Laparoscopic Sacrocolpopexy  

PubMed Central

Laparoscopy offers great exposure and surgical detail, reduces blood loss and the need for excessive abdominal packing and bowel manipulation making it an excellent modality to perform pelvic floor surgery. Laparoscopic repair of level I or apical vaginal prolapse may be challenging, due to the need for extensive dissection and advanced suturing skills. However, it offers the efficacy of open abdominal sacrocolpopexy, such as lower recurrence rates and less dyspareunia than sacrospinous fixation, as well as the reduced morbidity of a laparoscopic approach. PMID:24753860

Manodoro, S.; Werbrouck, E.; Veldman, J.; Haest, K.; Corona, R.; Claerhout, F.; Coremans, G.; De Ridder, D.; Spelzini, F.; Deprest, J.

2011-01-01

96

Laparoscopic ventral and incisional hernioplasty  

Microsoft Academic Search

.  \\u000a \\u000a Background: While the first laparoscopic ventral hernia repair was reported in 1992, there have been no studies comparing laparoscopic\\u000a to conventional ventral herniorrhaphy.\\u000a \\u000a \\u000a \\u000a \\u000a \\u000a Methods: Twenty-one ventral hernias repaired laparoscopically are compared to a similar group of 16 patients undergoing traditional\\u000a open repair during a 2-year period. Operative and hospital courses along with outcomes and cost analysis are analyzed.\\u000a \\u000a \\u000a \\u000a \\u000a \\u000a Results:

M. D. Holzman; C. M. Purut; K. Reintgen; S. Eubanks; T. N. Pappas

1997-01-01

97

Three-dimensional imaging laparoscope  

NASA Astrophysics Data System (ADS)

A laparoscope that generates three-dimensional images in real time by the VISIDEPtm technique of alternating frames has been tested. Images from two separate viewpoints are combined through special folded optics and brought out along a single light path where they are viewed with a single eye or with a single video camera. Liquid-crystal shutters are used to alternately switch between the two stereoscopically related views at a rate of 10 Hz in accordance with the VISIDEPtm teachings. The resulting three-dimensional image is autostereoscopic and may be viewed on any standard television monitor. Although the instrument provides for two separate viewpoints, it is built to the same external dimensions as conventional monocular laparoscopes with an outside diameter of 11 mm. This laparoscope can be adapted to field-sequential stereo for presentation of separate images to separate eyes with the aid of electro-optic glasses.

Jones, Edwin R., Jr.; McLaurin, A. P.; Mason, J. L., Jr.

1991-08-01

98

Laparoscopic-guided transversus abdominis plane block for colorectal surgery.  

PubMed

The transversus abdominis plane block has been used as a component of postoperative analgesia after hysterectomy and open abdominal surgery. This block involves the injection of anesthetic between the internal oblique and transversus abdominis muscles. We demonstrate an improved method by the use of laparoscopic guidance for transversus abdominis plane blocks.Transversus abdominis plane blocks are performed at the conclusion of an elective laparoscopic procedure by an experienced colorectal surgeon. With the use of direct visualization with a laparoscope, a Braun Stimuplex A insulated needle is passed through the skin at the level of the midaxillary line, midway between the iliac crest and the costal margin. The needle is inserted further until 2 distinct "pops" are felt, indicating the correct needle position between the internal oblique and transversus abdominis muscle. The laparoscope confirms a bulge, which signifies the injectate covered by the transversus abdominis muscle. The procedure is performed at a second injection site on the same side and bilaterally.The transversus abdominis plane block is useful as an adjunct to reduce postoperative analgesia in patients undergoing laparoscopic colorectal surgery. Our method for transversus abdominis plane blocks with the use of laparoscopy is easily performed at the conclusion of any laparoscopic procedure. Prospective randomized trials are necessary to assess the significance of these blocks in postoperative pain control, length of stay, and cost benefit. PMID:23392158

Favuzza, Joanne; Delaney, Conor P

2013-03-01

99

Obstetric outcomes after uterine myomectomy: Laparoscopic versus laparotomic approach  

PubMed Central

Objective To compare the pregnancy-related complications after laparoscopic and laparotomic uterine myomectomy. Methods A retrospective study of 415 women who received laparoscopic (n = 340) or laparotomic (n = 75) resection of uterine leiomyomas in one center. The mean follow-up period was 26.5 months in laparoscopic group and 23.9 months in laparotomic group. Results Fifty-four and 12 pregnancies occurred in laparoscopic and laparotomic myomectomy group, respectively. The major obstetric outcomes were similar between two groups. There was no ectopic pregnancy or preterm birth. There were two cases of obstetric complication in laparoscopic group only; one experienced neonatal death and postpartum hemorrhage due to placental abruption and the other underwent subtotal hysterectomy due to uterine dehiscence identified during Cesarean section. Conclusion Uterine rupture or dehiscence after laparoscopic myomectomy occurred in 3.7% (2/54) which lead to unfavorable outcome. Appropriate selection of patients and secure suture techniques appears to be important for laparotomic myomectomy in reproductive-aged women. PMID:24396816

Kim, Myo Sun; Uhm, You Kyoung; Kim, Ju Yeong; Kim, Yong Beom

2013-01-01

100

Total Microlaparoscopic Radical Hysterectomy in Early Cervical Cancer  

PubMed Central

Background and Objective: In less than 2 decades, laparoscopy has contributed to modification in the management of early cervical cancer patients, and all comparisons between open and laparoscopic-based radical operations showed an identical oncological outcome. The aim of this study is to describe surgical instrumentations and technique to perform total microlaparoscopy radical hysterectomy in early cervical cancer patients and report our preliminary results in terms of operative time and perioperative outcomes. Methods: Between January 1, 2012, and March 25, 2012, 4 consecutive early cervical cancer patients were enrolled in this study. Results: We performed 3 type B2 and 1 type C1-B2 total microlaparoscopy radical hysterectomy, and in all cases concomitant bilateral salpingo-oophorectomy and pelvic lymphadenectomy were carried out. Median operative time was 165 minutes (range: 155 to 215) (mean: 186), and median estimated blood loss was 30 mL (range: 20 to 50). Median number of pelvic lymph nodes removed was 12 (range: 11 to 15). All procedures were completed without 5-mm port insertion and without conversion. No intraoperative or early postoperative complications were reported. Conclusions: This report suggests a role of microlaparoscopy in the surgical management of early cervical cancer with adequate oncological results, superimposable operative time, and perioperative outcomes with respect to standard laparoscopy. PMID:23743381

Gallotta, Valerio; Fagotti, Anna; Rossitto, Cristiano; Piovano, Elisa; Scambia, Giovanni

2013-01-01

101

Laparoscopic Radical Prostatectomy  

Microsoft Academic Search

Purpose: The laparoscopic access for radical prostatectomy offeres an alternative to the open surgical procedure with less morbidity. We report on our experience with 125 laparoscopic prostatectomies, especially with respect to making the laparoscopic approach a routine procedure and with a view to the oncological and functional results.Material and Methods: From June 1999 to September 2000, we performed 125 laparoscopic

Ingolf Türk; Serdar Deger; Björn Winkelmann; Bernd Schönberger; Stefan A. Loening

2001-01-01

102

Laparoscopic pancreaticoduodenectomy  

PubMed Central

Laparoscopic pancreaticoduodenectomy (LPD) is one of the most complex operations in general surgery. With the development and maturation of surgical technology, more and more of such surgeries have been reported each year. Five LPDs have been performed in our department in the past year. We have achieved very satisfying clinical results with very few complications. The average operation takes 6.5 hours, which is significantly shorter compared to prior operations. In addition, the average hospitalization time was significantly shortened. Here we present a case report on one of the LPDs. PMID:25568867

Zhou, Xinhua; Ying, Dongjian; Zheng, Siming

2014-01-01

103

Laparoscopic Vertical Banded Gastroplasty and Laparoscopic Gastric Bypass: a Comparison  

Microsoft Academic Search

Background: Vertical banded gastroplasty (VBG) and gastric bypass (GBP) are the two bariatric procedures recommended by NIH\\u000a consensus conference. Recent advancement in laparoscopic (L) techniques has made LVBG and LGBP alternatives for the conventional\\u000a open approach. Methods: From December 2000 to February 2002, 80 patients (24 men and 56 women; mean age 32 years, range 18-57)\\u000a with morbid obesity (mean

Wei-Jei Lee; Ming-Te Huang; Po-Jui Yu; Weu Wang; Tai-Chi Chen

2004-01-01

104

Recent results of laparoscopic surgery in inflammatory bowel disease  

PubMed Central

Inflammatory bowel diseases are an ideal indication for the laparoscopic surgical approach as they are basically benign diseases not requiring lymphadenectomy and extended mesenteric excision; well-established surgical procedures are available for the conventional approach. Inflammatory alterations and fragility of the bowel and mesentery, however, may demand a high level of laparoscopic experience. A broad spectrum of operations from the rather easy enterostomy formation for anal Crohn’s disease (CD) to restorative proctocolectomies for ulcerative colitis (UC) may be managed laparoscopically. The current evidence base for the use of laparoscopic techniques in the surgical therapy of inflammatory bowel diseases is presented. CD limited to the terminal ileum has become a common indication for laparoscopic surgical therapy. In severe anal CD, laparoscopic stoma formation is a standard procedure with low morbidity and short operative time. Studies comparing conventional and laparoscopic bowel resections, have found shorter times to first postoperative bowel movements and shorter hospital stays as well as lower complication rates in favour of the laparoscopic approach. Even complicated cases with previous surgery, abscess formation and enteric fistulas may be operated on laparoscopically with a low morbidity. In UC, restorative proctocolectomy is the standard procedure in elective surgery. The demanding laparoscopic approach is increasingly used, however, mainly in major centers; its feasibility has been proven in various studies. An increased body mass index and acute inflammation of the bowel may be relative contraindications. Short and long-term outcomes like quality of life seem to be equivalent for open and laparoscopic surgery. Multiple studies have proven that the laparoscopic approach to CD and UC is a safe and successful alternative for selected patients. The appropriate selection criteria are still under investigation. Technical considerations are playing an important role for the complexity of both diseases. PMID:21448415

Kessler, Hermann; Mudter, Jonas; Hohenberger, Werner

2011-01-01

105

Gallbladder removal - laparoscopic  

MedlinePLUS

Laparoscopic gallbladder removal is surgery to remove the gallbladder using a medical device called a laparoscope. ... lets the doctor see inside your belly. Gallbladder removal surgery is done while you are under general ...

106

Challenges of Laparoscopic Surgery  

NSDL National Science Digital Library

Students teams use a laparoscopic surgical trainer to perform simple laparoscopic surgery tasks (dissections, sutures) using laparoscopic tools. Just like in the operating room, where the purpose is to perform surgery carefully and quickly to minimize patient trauma, students' surgery time and mistakes are observed and recorded to quantify their performances. They learn about the engineering component of surgery.

Integrated Teaching and Learning Program,

107

[Robotic assisted laparoscopic colposacropexy in the treatment of pelvic organ prolapse].  

PubMed

Laparoscopic colposacropexy has become a substitute for open surgery in the treatment of pelvic organ prolapse. In the same way, robotic assisted surgery is a new step in the evolution of the procedure. In this paper we intend to show our surgical technique and preliminary results. From November 2006 to date, 10 patients have undergone this procedure at the Hospital Clinico San Carlos. The main indication for the operation was existence of symptomatic pelvic prolapse. Both patients with or without hysterectomy have been operated, without making significant differences between them. Preoperative evaluation workout included: cystogram, urinary tract ultrasound and urodynamics in all cases; urinary tract MRI was performed only in selected cases. All patients underwent surgery under general anesthesia, with at least three robotic trocars (8 mm) and one conventional trocar for the assistant; 2 accessory trocars were necessary in some cases, mainly at the beginning of the series. Most procedures in our series were associated with a transobturator suburethral sling for the treatment of stress urinary incontinence or prevention of its appearance after prolapse repair. Our results are comparable to those reported in other larger series in terms of operative time, hospital stay and early or late complications. Pending an evaluation on the long term with larger series, we can include robot assisted colposacropexy among the therapeutic options for symptomatic pelvic floor prolapse repair. PMID:17626540

Moreno Sierra, Jesús; Galante Romo, Isabel; Ortiz Oshiro, Elena; Núñez Mora, Carlos; Silmi Moyano, Angel

2007-05-01

108

Laparoscopic repair of recurrent lateral enterocele and rectocele.  

PubMed

It is difficult to determine what types of procedures should be attempted in patients who have recurrent prolapse. We present a case of recurrent lateral enterocele and rectocele after the patient had undergone multiple surgeries for pelvic organ prolapse (POP), including a vaginal hysterectomy, bladder-neck suspension, anterior colporrhaphy, site-specific rectocele repair, apical mesh implant, iliococcygeus vault suspension, and transobturator suburethral sling procedure. With recurrence, the patient underwent robot-assisted laparoscopic sacral colpopexy, tension-free vaginal tape transobturator sling insertion, rectocele repair, and perineorrhaphy with cystoscopy. She then presented with defecatory outlet obstruction and constipation and subsequently was treated with a stapled transanal rectal resection. The patient returned with continued defecatory dysfunction and a recurrent lateral enterocele and rectocele. The recurrence was treated laparoscopically using a lightweight polypropylene mesh. The postoperative period was uneventful. Two years later, the patient reported decreased defecatory symptoms and no further symptomatic prolapse. PMID:25224146

Solomon, Ellen R; Muffly, Tyler M; Hull, Tracy; Paraiso, Marie Fidela R

2015-01-01

109

Hysterectomy - Multiple Languages: MedlinePlus  

MedlinePLUS

... Hindi (??????) Japanese (???) Korean (???) Portuguese (português) Russian (???????) Somali (af Soomaali) Spanish (español) Vietnamese ( ... PDF Health Information Translations Return to top Portuguese (português) Hysterectomy Histerectomia - português (Portuguese) Bilingual PDF Health Information ...

110

Laparoscopic infrared imaging  

Microsoft Academic Search

.   A system was developed to determine the potential role of infrared imaging as a tool for localizing anatomic structures and\\u000a assessing tissue viability during laparoscopic surgical procedures. A camera system sensitive to emitted energy in the midinfrared\\u000a range (3–5 ?m) was incorporated into a two-channel visible laparoscope. Laparoscopic cholecystectomy, dissection of the ureter,\\u000a and assessment of bowel perfusion were

W. W. Roberts; T. A. Dinkel; P. G. Schulam; L. Bonnell; L. R. Kavoussi

1997-01-01

111

Lateral transperitoneal laparoscopic adrenalectomy  

Microsoft Academic Search

Several laparoscopic approaches to the adrenal gland have been described. The lateral transperitoneal approach has several\\u000a distinct advantages when contrasted with other techniques for laparoscopic adrenalectomy (LA). We present our technique and\\u000a results obtained in 50 consecutive transperitoneal LAs. We review 50 consecutive laparoscopic adrenalectomies (28 female,\\u000a 19 male) performed from 1993 to 1998. S.J. Shichman or R.E. Sosa was

Steven J. Shichman; C. D. Anthony Herndon; R. Ernest Sosa; Giles F. Whalen; Dougald C. MacGillivray; Carl D. Malchoff; E. Darracott Vaughan

1999-01-01

112

42 CFR 441.255 - Sterilization by hysterectomy.  

Code of Federal Regulations, 2010 CFR

...not possible; and (2) The physician who performs the hysterectomy...retroactive Medicaid eligibility if the physician who performed the hysterectomy...of this section was met. The physician must supply the information specified...

2010-10-01

113

42 CFR 441.255 - Sterilization by hysterectomy.  

Code of Federal Regulations, 2011 CFR

...not possible; and (2) The physician who performs the hysterectomy...retroactive Medicaid eligibility if the physician who performed the hysterectomy...of this section was met. The physician must supply the information specified...

2011-10-01

114

Hysterectomy  

MedlinePLUS

... problems. Sense of loss. Some women may feel grief or depression over the loss of fertility or ... problems. Sense of loss. Some women may feel grief or depression over the loss of fertility or ...

115

Single Incision Laparoscopic Myomectomy  

PubMed Central

Single port laparoscopic surgery (SPLS), also called SILS is the natural extension of multi-incisional laparoscopic surgery, in the quest for reduction of traumatic insult and residual scarring to the patient. Today with the evolution of newer instruments, bidirectional self-retaining sutures, and surgical experience we are able to perform many surgeries in gynecology. PMID:22442539

Ramesh, B; Vidyashankar, Madhuri; Bharathi, BV

2011-01-01

116

Laparoscopic total abdominal colectomy  

Microsoft Academic Search

The aim of this study was to prospectively assess the impact of laparoscopy upon the outcome of total abdominal colectomy (TAC). Specifically, patients underwent standard laparotomy with TAC and ileoproctostomy (TAC + IP), TAC and ileoanal reservoir (TAC + IAR), laparoscopically assisted TAC + IP (L-TAC + IP), or laparoscopically assisted TAC + IAR (L-TAC + IAR). Parameters studied included

Steven D. Wexner; Olaf B. Johansen; Juan J. Nogueras; David G. Jagelman

1992-01-01

117

Competence Acquisition for Single-Incision Laparoscopic Cholecystectomy  

PubMed Central

Background and Objectives: Within the past few years, there has been a push for an even more minimally invasive approach to biliary disease with the adoption of single-incision laparoscopic cholecystectomy. We sought to compare 4 individual surgeon experiences to define whether there exists a learning curve for performing single-incision laparoscopic cholecystectomy. Methods: We performed a retrospective review 290 single-incision laparoscopic cholecystectomies performed by a group of general surgeons, with varying levels of experience and training, at 3 institutions between May 2008 and September 2010. The procedure times were recorded for each single-incision laparoscopic cholecystectomy, ordered chronologically for each surgeon, and subsequently plotted on a graph. The patients were also combined into cohorts of 5 and 10 cases to further evaluate for signs of improvement in operative efficiency. Results: Of the 4 surgeons involved in the study, only 1 (surgeon 4, laparoscopic fellowship trained with <5 years' experience) confirmed the presence of a learning curve, reaching proficiency within the first 15 cases performed. The other surgeons had more variable procedure times, which did not show a distinct trend. When we evaluated the cases by cohorts of 5 cases, surgeon 4 had a significant difference between the first and last cohort. Increased body mass index resulted in a slightly longer operative time (P < .0063). The conversion rate to multiport laparoscopic surgery was 3.1%. Conclusions: Our results indicate that among experienced general surgeons, there does not seem to be a significant learning curve when transitioning from conventional laparoscopic cholecystectomy to single-incision laparoscopic cholecystectomy. The least experienced surgeon in the group, surgeon 4, appeared to reach proficiency after 15 cases. Greater than 5 years of experience in laparoscopic surgery appears to provide surgeons with a sufficient skill set to obviate the need for a single-incision laparoscopic cholecystectomy learning curve.

Deutsch, Gary B.; Sathyanarayana, Sandeep Anantha; Giangola, Matthew; Akerman, Meredith; DeNoto, George; Klein, Jonathan D. S.; Zemon, Harry

2015-01-01

118

Evaluation of a novel laparoscopic camera for characterization of renal ischemia in a porcine model using digital light processing (DLP) hyperspectral imaging  

NASA Astrophysics Data System (ADS)

Digital light processing hyperspectral imaging (DLP® HSI) was adapted for use during laparoscopic surgery by coupling a conventional laparoscopic light guide with a DLP-based Agile Light source (OL 490, Optronic Laboratories, Orlando, FL), incorporating a 0° laparoscope, and a customized digital CCD camera (DVC, Austin, TX). The system was used to characterize renal ischemia in a porcine model.

Olweny, Ephrem O.; Tan, Yung K.; Faddegon, Stephen; Jackson, Neil; Wehner, Eleanor F.; Best, Sara L.; Park, Samuel K.; Thapa, Abhas; Cadeddu, Jeffrey A.; Zuzak, Karel J.

2012-03-01

119

Acute phase response in laparoscopic and open colectomy in colon cancer  

Microsoft Academic Search

PURPOSE: All types of trauma to the organism produce a systemic response that is proportional to the severity of the lesion caused. The more rapid clinical recovery during the postoperative period of patients undergoing laparoscopic-assisted colectomyvs. patients receiving conventional surgery suggests that laparoscopic surgery produces less surgical trauma. The aim of this randomized, prospective study was to compare acute phase

Salvadora Delgado; Antonio M. Lacy; Xavier Filella; Antoni Castells; Juan C. García-Valdecasas; Josep M. Pique; Dulce Momblán; Josep Visa

2001-01-01

120

Robotic single-site combined cholecystectomy and hysterectomy: Advantages and limits  

PubMed Central

INTRODUCTION Robotic single-site surgery (RSS) represents the latest innovation for clinical use of single incision surgery. Several applications have been reported in urology, general surgery and gynecology with potential application in benign cases as well as in oncology. PRESENTATION OF CASE To further explore potential applications of RSS, we present the first case reported in the literature of combined cholecystectomy and total hysterectomy using the da Vinci Si single-port platform (Intuitive Surgical Inc., Sunnyvale, CA). DISCUSSION A critical description of the procedure with potential advantages and limitations of the current platform for combined surgical procedure is provided. CONCLUSION Robotics may facilitate the widespread diffusion of single incision surgery, overcoming current laparoscopic and LESS limitations. However, the available robotic platform still has technical features that will limit its uptake amongst surgeons and further technological development is needed for a wider diffusion of single incision surgery. PMID:25460464

Pluchino, Nicola; Buchs, Nicolas C.; Drakopoulos, Panagiotis; Wenger, Jean Marie; Morel, Philippe; Dällenbach, Patrick

2014-01-01

121

Laparoscopic partial adrenalectomy  

Microsoft Academic Search

Background: Most laparoscopic adrenalectomies involve total removal of the whole adrenal gland, and reports of laparoscopic partial adrenalectomies\\u000a have been very few. The criteria for performing a laparoscopic partial adrenalectomy have not been described.\\u000a \\u000a \\u000a \\u000a \\u000a Methods: (a) Patients with functioning adrenal tumors smaller than 3 cm in diameter were selected. (b) The solitary adrenal tumors\\u000a were evaluated by preoperative thin-slice computed

T. Imai; Y. Tanaka; T. Kikumori; M. Ohiwa; N. Matsuura; T. Mase; H. Funahashi

1999-01-01

122

Single-incision laparoscopic cecectomy for low-grade appendiceal mucinous neoplasm after laparoscopic rectectomy  

PubMed Central

In this case report, we discuss single-incision laparoscopic cecectomy for low-grade appendiceal neoplasm after laparoscopic anterior resection for rectal cancer. The optimal surgical therapy for low-grade appendiceal neoplasm is controversial; currently, the options include appendectomy, cecectomy, right hemicolectomy, and open or laparoscopic surgery. Due to the risk of pseudomyxoma peritonei, complete resection without rupture is necessary. We have encountered 5 cases of low-grade appendiceal neoplasm and all 5 patients had no lymph node metastasis. We chose the appendectomy or cecectomy without lymph node dissection if preoperative imaging studies did not suspect malignancy. In the present case, we performed cecectomy without lymph node dissection by single-incision laparoscopic surgery (SILS), which is reported to be a reduced port surgery associated with decreased invasiveness and patient stress compared with conventional laparoscopic surgery. We are confident that SILS is a feasible alternative to traditional surgical procedures for borderline tumors, such as low-grade appendiceal neoplasms. PMID:24868331

Fujino, Shiki; Miyoshi, Norikatsu; Noura, Shingo; Shingai, Tatsushi; Tomita, Yasuhiko; Ohue, Masayuki; Yano, Masahiko

2014-01-01

123

Single-incision laparoscopic cecectomy for low-grade appendiceal mucinous neoplasm after laparoscopic rectectomy.  

PubMed

In this case report, we discuss single-incision laparoscopic cecectomy for low-grade appendiceal neoplasm after laparoscopic anterior resection for rectal cancer. The optimal surgical therapy for low-grade appendiceal neoplasm is controversial; currently, the options include appendectomy, cecectomy, right hemicolectomy, and open or laparoscopic surgery. Due to the risk of pseudomyxoma peritonei, complete resection without rupture is necessary. We have encountered 5 cases of low-grade appendiceal neoplasm and all 5 patients had no lymph node metastasis. We chose the appendectomy or cecectomy without lymph node dissection if preoperative imaging studies did not suspect malignancy. In the present case, we performed cecectomy without lymph node dissection by single-incision laparoscopic surgery (SILS), which is reported to be a reduced port surgery associated with decreased invasiveness and patient stress compared with conventional laparoscopic surgery. We are confident that SILS is a feasible alternative to traditional surgical procedures for borderline tumors, such as low-grade appendiceal neoplasms. PMID:24868331

Fujino, Shiki; Miyoshi, Norikatsu; Noura, Shingo; Shingai, Tatsushi; Tomita, Yasuhiko; Ohue, Masayuki; Yano, Masahiko

2014-05-27

124

[Laparoscopic cholecystectomy].  

PubMed

Forty-one patients with uncomplicated gall stone disease were laparoscopied with the object of cholecystectomy. The procedure was accomplished in 36 patients, but the operation had to be transformed to a conventional open operation in five: Fibrosis made dissection of the gall bladder hazardous in four and bleeding during the procedure made immediate laparotomy necessary in one patient, whose postoperative course was uneventful. The median operating time was 100 minutes, range was 60-250 minutes. The only operative complication was bleeding from a trocar puncture hole on the first postoperative day which stopped spontaneously in one patient. Eighteen were sent home on the first postoperative day and 12 patients on the second day. Peroperative cholangiography was performed employing the Olsen-Reddick cholangiography forceps. We have designed a special catheter, which greatly facilitates the procedure. The procedure was accomplished in 27 of 32 planned cases. Two patients had common bile duct or common hepatic duct stones. A trans-sphincteric endoprosthesis was applied through the cholangiography forceps in both patients, to prevent postoperative bile duct outlet obstruction. The endoprosthesis made the following endoscopic sphincterotomy, which was performed at a convenient time rapid and safe. The stones were extracted and the prosthesis removed on the same occasion. A reliable flushing system was developed on the basis of the "Kidde" automatic tourniquet frequently used in orthopaedic surgery. All patients were seen in the outpatient clinic 1 month after the operation. Superficial infection in the trocar holes in ten patients were the only problem the patients had encountered and all had returned to their normal work.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8430471

Kiil, J; Thorlacius-Ussing, O; Høstrup, H; Videbaek, P A; Vestergaard, L

1993-01-25

125

Endoscopic removal of intravesical polypropylene suture with plasmakinetic resection after abdominal hysterectomy  

PubMed Central

INTRODUCTION Intravesical foreign substances such as mesh or suture are among the rare reasons of recurrent urinary tract infections. Anti-incontinence and prolapsus procedures are associated with mesh/suture extrusion into the bladder, however, this complication is uncommon with abdominal hysterectomy. PRESENTATION OF CASE A 61-year-old female, obese patient admitted to our clinic with recurrent urinary tract infections and voiding symptoms which were worsened after abdominal hysterectomy. Radiological evaluation revealed an intravesical foreign material within the bladder. The cytoscopy was performed and a polypropylene suture which was inserted from dome, passed through the base and exited from the dome of bladder during abdominal hysterectomy. Transurethral plasmakinetic resection of superficial layer of urothelium between suture entrance and exit sites was performed and suture was removed from the bladder. DISCUSSION Urogynecological procedures are associated with the increased risk of urethral or ureteral injury, intravesical mesh or suture erosion and fistulae formation. Many different techniques including open, laparoscopic and transvaginal approaches were described for the removal of intravesical mesh/suture extrusion in the literature. Transurethral approach with its minimally invasive and safe nature was used to remove suture in this patient. This technique with the use of plasmakinetic energy has the advantage of decreased risk of bleeding and urothelial injury when compared to monopolar cautery. It also avoids the need for open or extensive surgery which may have a high rate of complications. CONCLUSION Transurethral resection is the treatment of choice for the removal of intravesical foreign substances. Use of plasmakinetic energy will decrease the risk of complications and avoid the need for open interventions. PMID:25437667

Küçükdurmaz, Faruk; Can, Selman; Barut, Osman

2014-01-01

126

Robotic Versus Laparoscopic Colorectal Surgery  

PubMed Central

Background: Robotic approaches have become increasingly used for colorectal surgery. The aim of this study is to examine the safety and efficacy of robotic colorectal procedures in an adult population. Study Design: A systematic review of articles in both PubMed and Embase comparing laparoscopic and robotic colorectal procedures was performed. Clinical trials and observational studies in an adult population were included. Approaches were evaluated in terms of operative time, length of stay, estimated blood loss, number of lymph nodes harvested, and perioperative complications. Mean net differences and odds ratios were calculated to examine treatment effect of each group. Results: Two hundred eighteen articles were identified, and 17 met the inclusion criteria, representing 4,342 patients: 920 robotic and 3,422 in the laparoscopic group. Operative time for the robotic approach was 38.849 minutes longer (95% confidence interval: 17.944 to 59.755). The robotic group had lower estimated blood loss (14.17 mL; 95% confidence interval: –27.63 to –1.60), and patients were 1.78 times more likely to be converted to an open procedure (95% confidence interval: 1.24 to 2.55). There was no difference between groups with respect to number of lymph nodes harvested, length of stay, readmission rate, or perioperative complication rate. Conclusions: The robotic approach to colorectal surgery is as safe and efficacious as conventional laparoscopic surgery. However, it is associated with longer operative time and an increased rate of conversion to laparotomy. Further prospective randomized controlled trials are warranted to examine the cost-effectiveness of robotic colorectal surgery before it can be adopted as the new standard of care. PMID:25489216

Jackson, Nicole R.; Hauch, Adam T.; Hu, Tian; Kandil, Emad

2014-01-01

127

Laparoscopic pancreatic reconstruction technique following laparoscopic pancreaticoduodenectomy.  

PubMed

With the advance of laparoscopic experiences and techniques, it is carefully regarded that laparoscopic pancreaticoduodenectomy (lap-PD) is feasible and safe in managing perimapullary pancreatic pathology. Especially, laparoscopic management of remnant pancreas can be a critical step toward completeness of minimally invasive PD. According to available published reports, there is a wide range of technical differences in choosing surgical options in managing remnant pancreas after lap-PD. For the evidence-based surgical approach, it would be ideal to test potential techniques by randomized controlled trials, but, currently, it is thought to be very difficult to expect those clinical trials to be successful because there are still a lack of expert surgeons with sound surgical techniques and experience. In addition, lap-PD is so complicated and technically demanding that many surgeons are still questioning whether this surgical approach could be standardized and popular like laparoscopic cholecystectomy. In general, surgical options are usually chosen based on following question: (1) Is it simple? (2) Is it easy and feasible? (3) Is it secure and safe? (4) Is there any supporting scientific evidence? It would be interesting to estimate which surgical technique would be appropriate in managing remnant pancreas under these considerations. It is hoped that a well standardized multicenter-based randomized control study would be successful to test this fundamental issues based on sound surgical techniques and scientific background. PMID:25546026

Kang, Chang Moo; Lee, Sung Hwan; Chung, Myung Jae; Hwang, Ho Kyoung; Lee, Woo Jung

2015-03-01

128

Environmental impacts of surgical procedures: life cycle assessment of hysterectomy in the United States.  

PubMed

The healthcare sector is a driver of economic growth in the U.S., with spending on healthcare in 2012 reaching $2.8 trillion, or 17% of the U.S. gross domestic product, but it is also a significant source of emissions that adversely impact environmental and public health. The current state of the healthcare industry offers significant opportunities for environmental efficiency improvements, potentially leading to reductions in costs, resource use, and waste without compromising patient care. However, limited research exists that can provide quantitative, sustainable solutions. The operating room is the most resource-intensive area of a hospital, and surgery is therefore an important focal point to understand healthcare-related emissions. Hybrid life cycle assessment (LCA) was used to quantify environmental emissions from four different surgical approaches (abdominal, vaginal, laparoscopic, and robotic) used in the second most common major procedure for women in the U.S., the hysterectomy. Data were collected from 62 cases of hysterectomy. Life cycle assessment results show that major sources of environmental emissions include the production of disposable materials and single-use surgical devices, energy used for heating, ventilation, and air conditioning, and anesthetic gases. By scientifically evaluating emissions, the healthcare industry can strategically optimize its transition to a more sustainable system. PMID:25517602

Thiel, Cassandra L; Eckelman, Matthew; Guido, Richard; Huddleston, Matthew; Landis, Amy E; Sherman, Jodi; Shrake, Scott O; Copley-Woods, Noe; Bilec, Melissa M

2015-02-01

129

Gallbladder Removal: Laparoscopic Method  

MedlinePLUS

... Method Gallbladder Removal: Laparoscopic Method How is the gallbladder removed? The surgery to remove the gallbladder is called a cholecystectomy ( ... it hard for your doctor to see your gallbladder, an open surgery may be better for you. Your doctor will ...

130

Single-Incision Laparoscopic Total Colectomy  

PubMed Central

Background and Objectives: To present our experience with a single-incision laparoscopic total colectomy, along with a literature review of all published cases on single-incision laparoscopic total colectomy. Methods: A total of 22 cases were published between 2010 and 2011, with our patient being case 23. These procedures were performed in the United States and United Kingdom. Surgical procedures included total colectomy with end ileostomy, proctocolectomy with ileorectal anastomosis, and total proctocolectomy with ileopouch-anal anastomosis. Intraoperative and postoperative data are analyzed. Results: Twenty-two of the 23 cases were performed for benign cases including Crohns, ulcerative colitis, and familial adenomatous polyposis. One case was performed for adenocarcinoma of the cecum. The mean age was 35.3 years (range, 13 to 64), the mean body mass index was 20.1 (range, 19 to 25), mean operative time was 175.9 minutes (range, 139 to 216), mean blood loss was 95.3mL (range, 59 to 200), mean incision length was 2.61cm (range, 2 to 3). Average follow-up was 4.6 months with 2 reported complications. Conclusions: Single-incision laparoscopic total colectomy is feasible and safe in the hands of an experienced surgeon. It has been performed for both benign and malignant cases. It is comparable to the conventional multi-port laparoscopic total colectomy. PMID:22906326

Ojo, Oluwatosin J.; Carne, David; Guyton, Daniel

2012-01-01

131

Laparoscopic management of huge ovarian cysts.  

PubMed

Objectives. Huge ovarian cysts are conventionally managed by laparotomy. We present 5 cases with huge ovarian cysts managed by laparoscopic endoscopic surgery without any complications. Materials and Methods. We describe five patients who had their surgeries conducted in a tertiary care center in Riyadh, Saudi Arabia (King Fahad Medical City). Results. Patients age ranged between 19 and 69 years. Tumor markers were normal for all patients. The maximum diameter of all cysts ranged between 18 and 42?cm as measured by ultrasound. The cysts were unilocular; in some patients, there were fine septations. All patients had open-entry laparoscopy. After evaluation of the cyst capsule, the cysts were drained under laparoscopic guidance, 1-12 liters were drained from the cysts (mean 5.2?L), and then laparoscopic oophorectomy was done. The final histopathology reports confirmed benign serous cystadenoma in four patients and one patient had a benign mucinous cystadenoma. There was minimal blood loss during surgeries and with no complications for all patients. Conclusion. There is still no consensus for the size limitation of ovarian cysts decided to be a contraindication for laparoscopic management. With advancing techniques, proper patients selection, and availability of experts in gynecologic endoscopy, it is possible to remove giant cyst by laparoscopy. PMID:23766763

Alobaid, A; Memon, A; Alobaid, S; Aldakhil, L

2013-01-01

132

Laparoscopic pancreatectomy for malignancy.  

PubMed

Utilization of laparoscopic techniques for resection of the pancreas has slowly gained acceptance in specific situations and is now being applied to more challenging endeavors, such as pancreaticoduodenectomy for cancer. This review provides a summary of laparoscopic applications for pancreatic malignancy, with specific attention to the most common methods of pancreatic resection and their respective oncologic outcomes, including margin status, lymph node retrieval, and survival. PMID:22991263

Fisher, Sarah B; Kooby, David A

2013-01-01

133

Hemobilia post laparoscopic cholecystectomy  

PubMed Central

Hepatic artery pseudoaneurysm is a rare complication of laparoscopic cholecystectomy. A high index of suspicion and early identification and therapy are important points needed to prevent rupture. We report a case of complex biliary and vascular injuries 4 weeks after a laparoscopic cholecystectomy. The patient had recurrent bleeding from a hepatic artery pseudoaneurysm that has been treated successfully with angiographic stenting and embolization. PMID:25666365

Bin Traiki, Thamer A.; Madkhali, Ahmad A.; Hassanain, Mazen M.

2015-01-01

134

Expanding Patient Options: Minilaparotomy for Hysterectomy  

MedlinePLUS

... recovery, it’s very comparable. Again, one approach is never something that you should always use for every hysterectomy. Last week ... finally, I’d like to end by leaving you with a story that I recently heard. There was a concept ... they took the best of everything. I like to talk about the company like ...

135

Open Versus Laparoscopic Radical Prostatectomy  

PubMed Central

Expert laparoscopic surgeons have demonstrated that laparoscopic radical prostatectomy with or without robotic assistance can be performed with excellent results. There is no evidence that laparoscopic radical prostatectomy with or without robotic assistance offers any clinically relevant advantage over open radical prostatectomy. Laparoscopic radical prostatectomy with or without robotic assistance requires a significant learning curve, is a longer surgical procedure, carries greater costs, and requires an expanded operating room team. The literature suggests that laparoscopic radical prostatectomy is associated with more intraoperative complications and higher positive surgical margins. The lesser amount of postoperative bleeding associated with laparoscopic radical prostatectomy is not clinically relevant. Laparoscopic radical prostatectomy is not associated with less pain and does not facilitate earlier urinary catheter removal. The best way to improve overall outcomes after radical prostatectomy is to direct patients to expert open or laparoscopic surgeons. PMID:16985822

Lepor, Herbert

2005-01-01

136

The comparison of single incision laparoscopic cholecystectomy and three port laparoscopic cholecystectomy: prospective randomized study  

PubMed Central

Purpose Laparoscopic techniques have allowed surgeons to perform complicated intra-abdominal surgery with minimal trauma. Single incision laparoscopic surgery (SILS) was developed with the aim of reducing the invasiveness of conventional laparoscopy. In this study we aimed to compare results of SILS cholecystectomy and three port conventional laparoscopic (TPCL) cholecystectomy prospectively. Methods In this prospective study, 100 patients who underwent laparoscopic cholecystectomy for gallbladder disease were randomly allocated to SILS cholecystectomy (group 1) or TPCL cholecystectomy (group 2). Demographics, pathologic diagnosis, operating time, blood loss, length of hospital stay, complications, pain score, conversion rate, and satisfaction of cosmetic outcome were recorded. Results Forty-four SILS cholesystectomies (88%) and 42 TPCL cholecystectomies (84%) were completed successfully. Conversion to open surgery was required for 4 cases in group 1 and 6 cases in group 2. Operating time was significantly longer in group 1 compared with group 2 (73 minutes vs. 48 minutes; P < 0.05). Higher pain scores were observed in group 1 versus group 2 in postoperative day 1 (P < 0.05). There was higher cosmetic satisfaction in group 1 (P < 0.05). Conclusion SILS cholecystectomy performed by experienced surgeons is at least as successful, feasible, effective and safe as a TPCL cholecystectomy. Surgeons performing SILS should have a firm foundation of advanced minimal access surgical skills and a cautious, gradated approach to attempt the various procedures. Prospective randomized studies comparing single access versus conventional multiport laparoscopic cholecystectomy, with large volumes and long-term follow-up, are needed to confirm our initial experience. (ClinicalTrials.gov Identifier: NCT01772745.) PMID:24368985

Barbaros, Umut; Kapakli, Mahmut Sertan; Manukyan, Manuk Norayk; ?im?ek, Selçuk; Kebudi, Abut; Mercan, Selçuk

2013-01-01

137

Abdominal Cavity and Laparoscopic Surgery  

NSDL National Science Digital Library

For students interested in studying biomechanical engineering, especially in the field of surgery, this lesson serves as an anatomy and physiology primer of the abdominopelvic cavity. Students are introduced to the abdominopelvic cavity—a region of the body that is the focus of laparoscopic surgery—as well as the benefits and drawbacks of laparoscopic surgery. Understanding the abdominopelvic environment and laparoscopic surgery is critical for biomechanical engineers who design laparoscopic surgical tools.

Integrated Teaching and Learning Program,

138

Complete laparoscopic resection of the rectum using natural orifice specimen extraction  

PubMed Central

AIM: To investigate how complete laparoscopic anterior resection with natural orifice specimen extraction (NOSE), as a novel minimally invasive surgery, compares to conventional laparoscopic surgery. METHODS: Twenty patients who underwent complete laparoscopic anterior resection with NOSE and 50 patients who underwent laparoscopic assisted anterior resection by the conventional method between 2011 and 2012 were studied. Selection for complete laparoscopic anterior resection with NOSE was decided on the basis of tumor size, localization of the tumor, and body mass index. Outcomes related to surgery, including operation time, postoperative wound pain, hospital stay after surgery, the number of totally dissected lymph nodes, postoperative complications (suture failure and wound infection), and anal function, were reviewed retrospectively. Anal function was assessed at 3 and 6 mo after surgery using the Wexner fecal incontinence scoring system. RESULTS: Complete laparoscopic resection with NOSE was performed to completion in all 20 patients. There was no patient emergency that required conversion to conventional laparoscopic surgery or open surgery. The comparison between complete laparoscopic resection with NOSE and conventional laparoscopic surgery showed no significant differences in the maximal diameter of the tumor, number of totally dissected lymph nodes, bleeding volume, mean operation time, time to start of oral ingestion, postoperative hospital stay, and postoperative complications. On the other hand, with regard to pain after epidural anesthesia, the total usage of analgesia in this novel surgical technique was 1.85 ± 1.8 times, whereas it was 5.89 ± 2.86 in conventional laparoscopic surgery (P < 0.001). The postoperative pain period was 1.9 ± 1.9 d in this novel surgical technique, whereas it was 3.43 ± 1.41 d in conventional laparoscopic surgery (P < 0.004). In complete laparoscopic surgery with NOSE, the mean postoperative follow-up period was 20 mo (range: 12-30 mo). Neither local recurrence nor remote metastasis was observed during the follow-up period. CONCLUSION: Complete laparoscopic anterior resection using NOSE does not require any incision and has excellent cosmetic properties, with mitigated postoperative pain. PMID:25469041

Hisada, Masayuki; Katsumata, Kenji; Ishizaki, Tetsuo; Enomoto, Masanobu; Matsudo, Takaaki; Kasuya, Kazuhiko; Tsuchida, Akihiko

2014-01-01

139

Single-port laparoscopic surgery for sigmoid volvulus  

PubMed Central

AIM: To report our experience with single-port laparoscopic surgery (SPLS) for sigmoid volvulus (SV). METHODS: Between October 2009 and April 2013, 10 patients underwent SPLS for SV. SPLS was performed transumbilically or through a predetermined stoma site. Conventional straight and rigid-type laparoscopic instruments were used. After intracorporeal, segmental resection of the affected sigmoid colon, the specimen was extracted through the single-incision site. Patient demographics and perioperative data were analyzed. RESULTS: SPLS for SV was successful in all 10 patients (4, resection and primary anastomosis; 6, Hartmann’s procedure). The median operative time and postoperative hospitalization period were 168 (range, 85-315) min and 6.5 (range, 4-29) d, respectively. No intraoperative complications were noted; there were 2 postoperative complications, including 1 anastomotic leak. CONCLUSION: SPLS was a safe and feasible therapeutic approach for SV, when performed by a surgeon experienced in conventional laparoscopic surgery. PMID:25741145

Choi, Byung Jo; Jeong, Won Jun; Kim, Say-June; Lee, Sang Chul

2015-01-01

140

Laparoscopic surgery in weightlessness  

NASA Technical Reports Server (NTRS)

BACKGROUND: Performing a surgical procedure in weightlessness has been shown not to be any more difficult than in a 1g environment if the requirements for the restraint of the patient, operator, and surgical hardware are observed. The feasibility of performing a laparoscopic surgical procedure in weightlessness, however, has been questionable. Concerns have included the impaired visualization from the lack of gravitational retraction of the bowel and from floating debris such as blood. METHODS: In this project, laparoscopic surgery was performed on a porcine animal model in the weightlessness of parabolic flight. RESULTS: Visualization was unaffected due to the tethering of the bowel by the elastic mesentery and the strong tendency for debris and blood to adhere to the abdominal wall due to surface tension forces. CONCLUSIONS: There are advantages to performing a laparoscopic instead of an open surgical procedure in a weightless environment. These will become important as the laparoscopic support hardware is miniaturized from its present form, as laparoscopic technology becomes more advanced, and as more surgically capable crew medical officers are present in future long-duration space-exploration missions.

Campbell, M. R.; Billica, R. D.; Jennings, R.; Johnston, S. 3rd

1996-01-01

141

[Radical cystectomy - pro laparoscopic].  

PubMed

Although the technical feasibility of laparoscopic radical cystectomy (LRC) has been proven and the procedure has been accepted in the EAU guidelines 2011 as a valid alternative, its actual position has to be determined. On the one hand the advantages of LRC (less blood loss, lower transfusion rates, shorter analgesia time) have been proven in retrospective studies; however, the technical difficulties of purely laparoscopic urinary diversion result in very long operating times and in cases of a laparoscopic-assisted creation of a neobladder, the question of the advantage of this approach remains doubtful. Despite case reports of port metastases and peritoneal carcinosis following laparoscopic and robot-assisted radical cystectomy, there is no difference in terms of oncological long-term data (up to 10 years) between laparoscopy and open surgery performed at centres of excellence. Evidently, the curative options for the patients do not depend on the type of surgery (open versus minimally invasive) but on the efficacy of adjuvant treatment strategies (polychemotherapy). Currently it is believed that LRC should be considered for patients with low risk of progression (pT1-2). The final position of laparoscopic radical cystectomy can only be evaluated in a multicentric randomized controlled trial. PMID:22532364

Rassweiler, J; Godin, K; Goezen, A S; Kusche, D; Chlosta, P; Gaboardi, F; Abbou, C C; van Velthoven, R

2012-05-01

142

Laparoscopic treatment of intussusception  

PubMed Central

Introduction The success of laparoscopic approach in children has encouraged the application of this technique in young (<2 years) children with non-complicated intussusception. Material and method A retrospective analysis of our database provided a total of 4 patients who underwent laparoscopic reduction of intestinal intussusception between 8/2008 and 4/2013. A comprehensive review of each case was done including the video description of the laparoscopic technique of one of them. Results Four patients (2 boys) were treated by laparoscopy for intestinal intussusception. Mean age was 9 months (5–20 months). Delay time between initial symptoms and diagnosis and between diagnosis and surgery were 3.5 days and 6 h respectively. Mean operative time was 35 min. There were no conversions. There were no complications. Patients were discharged after 2.5 days (2–4 days). We herein report (video) the laparoscopic approach in a 5 month male child who suffered from a ileocecal intussusception. A 10 mm trocar was placed in the left lower quadrant and two 5 mm trocars were placed in the upper left quadrant and suprapubic just to the right midline. The cause of the intussusception was identified and the bowel was reduced. A concomitant appendectomy was performed. Conclusion Laparoscopic reduction of intussusception appears to be a safe procedure, in young children with uncomplicated intussusception. PMID:25574769

Vilallonga, Ramon; Himpens, Jacques; Vandercruysse, Femke

2014-01-01

143

Simulation in laparoscopic surgery.  

PubMed

Nowadays surgical trainees are faced with a more reduced surgical practice, due to legal limitations and work hourly constraints. Also, currently surgeons are expected to dominate more complex techniques such as laparoscopy. Simulation emerges as a complementary learning tool in laparoscopic surgery, by training in a safe, controlled and standardized environment, without jeopardizing patient' safety. Simulation' objective is that the skills acquired should be transferred to the operating room, allowing reduction of learning curves. The use of simulation has increased worldwide, becoming an important tool in different surgical residency programs and laparoscopic training courses. For several countries, the approval of these training courses are a prerequisite for the acquisition of surgeon title certifications. This article reviews the most important aspects of simulation in laparoscopic surgery, including the most used simulators and training programs, as well as the learning methodologies and the different key ways to assess learning in simulation. PMID:25039039

León Ferrufino, Felipe; Varas Cohen, Julián; Buckel Schaffner, Erwin; Crovari Eulufi, Fernando; Pimentel Müller, Fernando; Martínez Castillo, Jorge; Jarufe Cassis, Nicolás; Boza Wilson, Camilo

2015-01-01

144

Laparoscopic pancreatic surgery.  

PubMed

Laparoscopic pancreatectomy may be associated with lower operative morbidity, less postoperative pain, lower wound infection rates, decreased physiological stress, and fewer postoperative hernias and bowel obstructions. In this review, we summarize the current data on laparoscopic and robotic assisted pancreaticoduodenectomy/distal pancreatectomy/central pancreatectomy. We reviewed the indications, the perioperative and oncologic outcomes, and the cost analysis following minimally invasive pancreatic resections. In conclusion, we found minimally invasive approaches to pancreatic resections are feasible, safe, and appear to have comparable oncologic outcomes to the standard open approaches when performed by experienced surgeons at high-volume centers. The potential advantages of a minimally invasive approach to pancreatic surgery, such as reduced blood loss and shorter length of hospital stay, have now been well established. The overall cost of laparoscopic pancreatectomy appears to be similar to that of the open approach. PMID:25077736

He, J; Pawlik, T M; Makary, M A; Wolfgang, C L; Weiss, M J

2014-12-01

145

Malignant transformation of persistent endometriosis after hysterectomy  

PubMed Central

The malignant transformation of persistent endometriotic implants into endometrioid adenocarcinoma is rare, especially after remote hysterectomy and salpingo-oophorectomy (TAH-BSO), and there are few cases reported in the English language literature. Patients receiving estrogen replacement therapy are common among the reported cases. We present a case that demonstrates the possibility of malignant transformation in a 53-year-old female, known case of endometriosis, who underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy with no evidence of malignancy in the final pathology report. After 9 years, she presented with lower abdominal mass, and histopathological studies confirmed the diagnosis of well-differentiated endometrioid adenocarcinoma. The possibility of malignant transformation and possible risk factors are discussed with a brief literature review. PMID:25399218

Bawazeer, Naif A.; Al-Jifree, Hatim M.; Gari, Abdulrahim M.

2014-01-01

146

Fallopian tube prolapse after abdominal hysterectomy.  

PubMed

A 38 year old lady who had total abdominal hysterectomy, for chronic pelvic pain, presented with profuse vaginal discharge per vaginum along with a cystic pelvic mass of 10 week size. There was a polypoidal fleshy growth present in the vault. It was diagnosed to be a fallopian tube on histopathology. Patient was treated with bilateral salpingo-ophorectomy through an open laparotomy. PMID:15455626

Noor, Shehla; Halimi, Mussarat; Faiz, Nasreen Ruby; Sadaf, Farhadia; Akhtar, Perveen; Zahoor, Shafaq

2004-01-01

147

Laparoscopically assisted transhiatal resection for malignancies of the distal esophagus  

Microsoft Academic Search

Background Resection of the esophagus remains the only curative therapy for esophageal cancer. Conventional resections are right-side thoracotomy in combination with laparotomy, gastric tube creation, and the transhiatal approach according to Orringer. This study evaluated laparoscopically assisted transhiatal esophagus resection, which offers perfect visualization of the esophagus during mediastinal dissection without the necessity of a thoracotomy. Methods In this study,

W. T. Van den Broek; Ö. Makay; F. J. Berends; J. Z. Yuan; A. P. J. Houdijk; S. Meijer; M. A. Cuesta

2004-01-01

148

21 CFR 884.1730 - Laparoscopic insufflator.  

Code of Federal Regulations, 2013 CFR

...Laparoscopic insufflator. (a) Identification. A laparoscopic insufflator is a device used to facilitate the use of the laparoscope by filling the peritoneal cavity with gas to distend it. (b) Classification. (1) Class II (performance...

2013-04-01

149

21 CFR 884.1730 - Laparoscopic insufflator.  

Code of Federal Regulations, 2014 CFR

...Laparoscopic insufflator. (a) Identification. A laparoscopic insufflator is a device used to facilitate the use of the laparoscope by filling the peritoneal cavity with gas to distend it. (b) Classification. (1) Class II (performance...

2014-04-01

150

21 CFR 884.1730 - Laparoscopic insufflator.  

Code of Federal Regulations, 2012 CFR

...Laparoscopic insufflator. (a) Identification. A laparoscopic insufflator is a device used to facilitate the use of the laparoscope by filling the peritoneal cavity with gas to distend it. (b) Classification. (1) Class II (performance...

2012-04-01

151

21 CFR 884.1730 - Laparoscopic insufflator.  

Code of Federal Regulations, 2011 CFR

...Laparoscopic insufflator. (a) Identification. A laparoscopic insufflator is a device used to facilitate the use of the laparoscope by filling the peritoneal cavity with gas to distend it. (b) Classification. (1) Class II (performance...

2011-04-01

152

21 CFR 884.1730 - Laparoscopic insufflator.  

Code of Federal Regulations, 2010 CFR

...Laparoscopic insufflator. (a) Identification. A laparoscopic insufflator is a device used to facilitate the use of the laparoscope by filling the peritoneal cavity with gas to distend it. (b) Classification. (1) Class II (performance...

2010-04-01

153

Single-port Laparoscopic Reversal of Hartmann's Procedure: Technique and Results  

PubMed Central

In general, reversal of Hartmann's procedure is associated with a high morbidity and therefore leads to a low rate of intestinal restoration. Reversal of Hartmann's procedure has to be seen as a complex abdominal operation with the same possible complications as in other colorectal resections. By using the laparoscopic technique, operative access trauma by laparotomy can be minimized. After introducing single-port access into laparoscopic surgery beginning with cholecystectomies and sigmoid resections, we started with the first single-port laparoscopic reversal of Hartmann's procedure in January 2010. After excision of the colostoma, mobilization, and reponing into the abdominal cavity, the single-port trocar was placed at the stoma incision without any extra scar. We investigated whether the single-port laparoscopic reversal is as safely feasible as the “conventionallaparoscopic procedure. Till December 2010, single-port reversal operation was performed in 8 patients 2–4 months after Hartmann's procedure because of complicated diverticulitis. No conversion to “conventionallaparoscopic or open procedure was necessary in 1 patient one extra 5?mm trocar was used. The average operation time was 74?min. Except for one wound complication, the postoperative course was uncomplicated. The patients were discharged after 4 to 8 postoperative days. Single-port reversal of Hartmann's procedure has showed as a new method for minimizing the access trauma even further than “conventionallaparoscopic surgery. PMID:22096620

Carus, Th.; Emmert, A.

2011-01-01

154

Single-port Laparoscopic Reversal of Hartmann's Procedure: Technique and Results.  

PubMed

In general, reversal of Hartmann's procedure is associated with a high morbidity and therefore leads to a low rate of intestinal restoration. Reversal of Hartmann's procedure has to be seen as a complex abdominal operation with the same possible complications as in other colorectal resections. By using the laparoscopic technique, operative access trauma by laparotomy can be minimized. After introducing single-port access into laparoscopic surgery beginning with cholecystectomies and sigmoid resections, we started with the first single-port laparoscopic reversal of Hartmann's procedure in January 2010. After excision of the colostoma, mobilization, and reponing into the abdominal cavity, the single-port trocar was placed at the stoma incision without any extra scar. We investigated whether the single-port laparoscopic reversal is as safely feasible as the "conventional" laparoscopic procedure. Till December 2010, single-port reversal operation was performed in 8 patients 2-4 months after Hartmann's procedure because of complicated diverticulitis. No conversion to "conventional" laparoscopic or open procedure was necessary in 1 patient one extra 5?mm trocar was used. The average operation time was 74?min. Except for one wound complication, the postoperative course was uncomplicated. The patients were discharged after 4 to 8 postoperative days. Single-port reversal of Hartmann's procedure has showed as a new method for minimizing the access trauma even further than "conventional" laparoscopic surgery. PMID:22096620

Carus, Th; Emmert, A

2011-01-01

155

Hysterectomy and Disability Among U.S. Women  

PubMed Central

CONTEXT Hysterectomies are the second most common surgery performed on women in the United States, and most are done for elective reasons. Although women with disabilities appear to have an increased risk of undergoing the procedure, little research has evaluated the relationship between disability and hysterectomy. METHODS Data on 42,842 women aged 18 or older from the 2000, 2005 and 2010 National Health Interview Surveys were used to evaluate the relationship between disability and the risk of having a hysterectomy over the life course. Piecewise exponential event history models were estimated to identify associations between timing of disability onset, type of disability, and the occurrence and timing of hysterectomy. RESULTS Women with multiple disabilities experienced a higher risk of undergoing a hysterectomy than women with no disability (hazard ratio, 1.3), and this heightened risk was concentrated at younger ages. During their 20s, 30s and early 40s, women who had multiple disabilities were more likely to have had a hysterectomy than their same-age counterparts with no or one disability (1.3–2.4). Women with a single type of disability, as well as most women who had multiple disabilities and were aged 46 or older, were not at increased risk of having had a hysterectomy. CONCLUSIONS Additional research is needed to investigate why young women with multiple disabilities appear to face an increased risk of having a hysterectomy, especially because it is major surgery that can carry significant health risks. PMID:24020777

Drew, Julia A. Rivera

2013-01-01

156

Complications of laparoscopic herniorrhaphy  

Microsoft Academic Search

Anterior inguinal hernia repair is the second-most-commonly performed abdominal operation and has been associated with low morbidity and mortality rates. The principle of laparoscopy has been applied to this surgical problem in a series of 762 patients with 841 inguinal hernias. Four types of laparoscopic repairs were conducted: (1) high ligation of the indirect inguinal hernia sac and closure of

Bruce V. MacFadyen; Maurice E. Arregui; John D. Corbitt; Charles J. Filipi; Robert J. Fitzgibbons; Morris E. Franklin; J. Barry McKernan; Douglas O. Olsen; Edward H. Phillips; Daniel Rosenthal; Leonard S. Schultz; Robert W. Sewell; Roy T. Smoot; Albert T. Spaw; Frederick K. Toy; Robert L. Waddell; Karl A. Zucker

1993-01-01

157

Laparoscopic esophagomyotomy for achalasia  

Microsoft Academic Search

Results of an ongoing clinical study treating achalasia patients with a transabdominal laparoscopic Heller myotomy and Toupet partial fundoplication are presented. Twelve patients underwent surgery between January 1992 and October 1993. All patients had barium esophagograms, preoperative endoscopy, esophageal manometry, 24-h pH studies, and extensive GI history preoperatively. Surgical complications included two perforations of the mucosa at the gastroesophageal junction

L. L. Swanstrom; J. Pennings

1995-01-01

158

Telesurgical Laparoscopic Radical Prostatectomy  

Microsoft Academic Search

Introduction: Telepresence surgery offers theoretically to overcome two main problems of laparoscopic surgery, i.e. the limitation to only four degrees of freedom and the lack of stereovision. Since 1998, telesurgical minimally invasive procedures have been performed with the da Vinci system mainly for cardiac bypass surgery. Clinical experience in urology is still very limited. We want to present our initial

Jens Rassweiler; Thomas Frede; Othmar Seemann; Christian Stock; Ludger Sentker

2001-01-01

159

[Laparoscopic appendectomy. Our experience].  

PubMed

The advantages and applications of the videolaparoscopic technique (VL) versus open surgery in the treatment of acute and complicated appendicitis are not well defined. Our study examined 150 patients, 67 males and 83 females. They underwent surgery for acute appendicitis in emergency. The choice between open or laparoscopic tecnique was due to patient's clinical conditions and surgeon's experience. Two of these patients had no infiammatory process. Eleven patients were affected by gynaecological diseases. The last 137 patients underwent surgery for acute appendicitis and the diagnosis was confirmed. Among them, 35 (25%) were affected by a complicated appendicitis with diffuse or clearly defined peritonitis. In 134 patients the surgery was completed laparoscopically. The conversion rate was 2%. Morbility rate was 3%, due to intra abdominal abscesses secondary to acute complicated appendicitis. The mean operative time was 76 min and the mean hospital stay was 4.8 days. The death rate was 0%. In our experience, laparoscopic appendectomy has significant advantages over traditional open surgery in both acute and complicated appendicitis, especially in young women. In this way, we can diagnose pelvic disease that could be characterized by the same symptoms of acute appendicitis, then we suggest laparoscopic appendectomy even just to complete the diagnostic iter. Laparoscopy is useful in terms of convalescence, postoperative pain, hospital stay, aesthetic outcome and an easier exploration of the peritoneal cavity. PMID:22595725

Pezzolla, Angela; Milella, Marialessia; Lattarulo, Serafina; Barile, Graziana; Pascazio, Bianca; Ialongo, Paolo; Fabiano, Gennaro; Palasciano, Nicola

2012-01-01

160

Laparoscopic Reconstructive Urology  

Microsoft Academic Search

PurposeAlthough laparoscopy has emerged as a feasible and effective alternative for a majority of open ablative abdominopelvic urological procedures, minimally invasive reconstruction has come to the forefront only recently. We present the current state of the art of laparoscopic reconstructive urology.

JIHAD H. KAOUK; INDERBIR S. GILL

2003-01-01

161

Laparoscopic cholecystectomy during pregnancy  

Microsoft Academic Search

Summary  There is a strong association between pregnancy and gallstones. When acute cholecystitis or recurring bouts of biliary colic occur during pregnancy, medical therapy is usually initiated but occasionally fails. Laparoscopic cholecystectomy has recently been described for the treatment of symptomatic cholelithiasis, but many authors consider pregnancy to be an absolute contraindication to this operation. We herein describe the management of

Nathaniel J. Soper; John G. Hunter; Roy H. Petrie

1992-01-01

162

Laparoscopic vs . Hand-Assisted Laparoscopic Sigmoidectomy for Diverticulitis  

Microsoft Academic Search

Introduction Sigmoid colectomy for diverticulitis can be technically challenging because of severe inflammation in the left-lower quadrant and pelvis. We hypothesized that hand-assisted laparoscopic technique may facilitate laparoscopic completion of this surgery while retaining the short-term benefits associated with “pure” laparoscopic surgery, in which an incision is made only for extracting the specimen. This study was designed to compare the

Sang W. Lee; James Yoo; Nadav Dujovny; Toyooki Sonoda; Jeffrey W. Milsom

2006-01-01

163

Intralaparoscopic endoscopy: its value during laparoscopic repair of choledochal cyst  

Microsoft Academic Search

Aim  We report our experience of laparoscopic repair of choledochal cyst (CC).\\u000a \\u000a \\u000a \\u000a Methods  We reviewed 10 CC patients (mean age 3.3 years) who had lap CC repair. Eight patients had minimally dilated\\/fusiform type\\u000a CC (fusiform CC) and presented with pancreatitis, and two had cystic type CC (cystic CC). Using conventional trocar placement\\u000a (right upper quadrant, left paraumbilical, left upper quadrant; laparoscope in the

Go Miyano; Hiroyuki Koga; Akihiro Shimotakahara; Tsubasa Takahashi; Yoshifumi Kato; Tadaharu Okazaki; Atsuyuki Yamataka

2011-01-01

164

Multiresolution foveated laparoscope with high resolvability.  

PubMed

A key limitation of the state-of-the-art laparoscopes for minimally invasive surgery is the tradeoff between the field of view and spatial resolution in a single-view camera system. As such, surgical procedures are usually performed at a zoomed-in view, which limits the surgeon's ability to see much outside the immediate focus of interest and causes a situational awareness challenge. We proposed a multiresolution foveated laparoscope (MRFL) aiming to address this limitation. The MRFL is able to simultaneously capture wide-angle overview and high-resolution images in real time; it can scan and engage the high-resolution images to any subregion of the entire surgical field in analogy to the fovea of human eye. The MRFL is able to render equivalently 10 million pixel resolution with a low data bandwidth requirement. The system has a large working distance (WD) from 80 to 180 mm. The spatial resolvability is about 45 ?m in the object space at an 80 mm WD, while the resolvability of a conventional laparoscope is about 250 ?m at a typically 50 mm surgical distance. PMID:23811873

Qin, Yi; Hua, Hong; Nguyen, Mike

2013-07-01

165

Therapeutic advances: Single incision laparoscopic hepatopancreatobiliary surgery  

PubMed Central

Single-port laparoscopic surgery (SPLS) is proposed to be a step towards minimizing the invasiveness of surgery, and has since gained popularity in several surgical sub-specialties including hepatopancreatobiliary surgery. SPLS has since been applied to cholecystectomy, liver resection as well as pancreatectomy for a multitude of pathologies. Benefits of SPLS over conventional multi-incision laparoscopic surgery include improved cosmesis and potentially post-operative pain at specific time periods and extra-umbilical sites. However, it is also associated with longer operating time, increased rate of complications, and increased rate of port-site hernia. There is no significant difference between length of hospital stay. SPLS has a significant learning curve that affects operating time, rate of conversion and rate of complications. In this article, we review the literature on SPLS in hepatobiliary surgery - cholecystectomy, hepatectomy and pancreatectomy, and offer tips on overcoming potential technical obstacles and minimizing the complications when performing SPLS - surgeon position, position of port and instruments, instrument crossing position, standard hand grip vs reverse hand grip, snooker cue guide position, prevention of incisional hernia. SPLS is a promising direction in laparoscopic surgery, and we recommend step-wise progression of applications of SPLS to various hepatopancreatobiliary surgeries to ensure safe adoption of the surgical technique. PMID:25339820

Chang, Stephen Kin Yong; Lee, Kai Yin

2014-01-01

166

Laparoscopic Kasai portoenterostomy for biliary atresia.  

PubMed

Conventional surgery for extrahepatic bile-duct atresia (EHBDA) usually requires a large, painful, muscle-cutting laparotomy, dislodgment of the liver, and wide manipulations, followed by adhesions and possible complications that may disturb the postoperative course and hamper liver transplantation (LT). The main role of laparoscopy in EHBDA has been for diagnostic purposes. Besides all the advantages of minimally-invasive access, it allows excellent visibility and dissection of tiny hilar structures. The authors present the first two cases of successful Roux-en-Y laparoscopic portoenterostomy (LARP) for EHBDA, showing the importance of advanced technical skills and a new approach for extracorporeal enteroanastomosis. Laparoscopic hilar dissection and portoenterostomy was accomplished using four trocars. The umbilical site was used for extracorporeal Roux-en-Y enteroenterostomy, in the first case using a laparoscopic stapler and in the second a hand-sewn suture. Mean operative time was 190 min, and no operative complications were observed. Both girls became anicteric. The first is doing well 15 months after the operation with good hepatic function. The other was anicteric for 6 months, had one episode of cholangitis, developed an umbilical hernia, has shown slow and progressive hepatic failure, and is now being evaluated for possible LT. It is concluded that LARP for EHBDA can be done safely in infants using an extracorporeal transumbilical enteric anastomosis, with several advantages compared with open surgery. The role of LARP in facilitating LT is yet to be defined. PMID:12598978

Esteves, Edward; Clemente Neto, Eriberto; Ottaiano Neto, Miguel; Devanir, José; Esteves Pereira, Ruy

2002-12-01

167

A ‘critical view’ on a classical pitfall in laparoscopic cholecystectomy!  

PubMed Central

INTRODUCTION Laparoscopic cholecystectomy is the most common laparoscopic surgery performed by general surgeons. Although being a routine procedure, classical pitfalls shall be regarded, as misperception of intraoperative anatomy is one of the leading causes of bile duct injuries. The “critical view of safety” in laparoscopic cholecystectomy serves the unequivocal identification of the cystic duct before transection. The aim of this manuscript is to discuss classical pitfalls and bile duct injury avoiding strategies in laparoscopic cholecystectomy, by presenting an interesting case report. PRESENTATION OF CASE A 71-year-old patient, who previously suffered from a biliary pancreatitis underwent laparoscopic cholecystectomy after ERCP with stone extraction. The intraoperative situs showed a shrunken gallbladder. After placement of four trocars, the gall bladder was grasped in the usual way at the fundus and pulled in the right upper abdomen. Following the dissection of the triangle of Calot, a “critical view of safety” was established. As dissection continued, it however soon became clear that instead of the cystic duct, the common bile duct had been dissected. In order to create an overview, the gallbladder was thereafter mobilized fundus first and further preparation resumed carefully to expose the cystic duct and the common bile duct. Consecutively the operation could be completed in the usual way. DISCUSSION Despite permanent increase in learning curves and new approaches in laparoscopic techniques, bile duct injuries still remain twice as frequent as in the conventional open approach. In the case presented, transection of the common bile duct was prevented through critical examination of the present anatomy. The “critical view of safety” certainly offers not a full protection to avoid biliary lesions, but may lead to a significant risk minimization when consistently implemented. CONCLUSION A sufficient mobilization of the gallbladder from its bed is essential in performing a critical view in laparoscopic cholecystectomy. PMID:25437680

Dziodzio, Tomasz; Weiss, Sascha; Sucher, Robert; Pratschke, Johann; Biebl, Matthias

2014-01-01

168

The Investigation of Laparoscopic Instrument Movement Control and Learning Effect  

PubMed Central

Laparoscopic surgery avoids large incisions for intra-abdominal operations as required in conventional open surgery. Whereas the patient benefits from laparoscopic techniques, the surgeon encounters new difficulties that were not present during open surgery procedures. However, limited literature has been published in the essential movement characteristics such as magnification, amplitude, and angle. For this reason, the present study aims to investigate the essential movement characteristics of instrument manipulation via Fitts' task and to develop an instrument movement time predicting model. Ten right-handed subjects made discrete Fitts' pointing tasks using a laparoscopic trainer. The experimental results showed that there were significant differences between the three factors in movement time and in throughput. However, no significant differences were observed in the improvement rate for movement time and throughput between these three factors. As expected, the movement time was rather variable and affected markedly by direction to target. The conventional Fitts' law model was extended by incorporating a directional parameter into the model. The extended model was shown to better fit the data than the conventional model. These findings pointed to a design direction for the laparoscopic surgery training program, and the predictive model can be used to establish standards in the training procedure. PMID:23984348

Lin, Chiuhsiang Joe

2013-01-01

169

Study on an infrared endoscope for energized laparoscopic method  

NASA Astrophysics Data System (ADS)

An infrared endoscopic system has been developed to investigate thermal spread and collateral damage during energized laparoscopic surgery, the system consists of an infrared endoscope and a thermal camera (3-5 ?m) with combined thermal sensitivity of 0.05°C. The system performance was evaluated in live animals with electrosurgical devices to monitor intraoperative thermal changes. During activation periods, the peak temperature of the jaws averaged 100.5 ± 5.8 ° with a thermal spread of 3.0 ± 0.9 mm. For laparoscopic dissections of the esophagus-gastric junction with the 10 mm Atlas, the maximum jaw temperature was 105.2 ± 2.1 ° with a bigger thermal spread of 11.5 ± 7.2 mm). The study has confirmed that infrared endoscopy is a very useful tool adjunct to conventional endoscopy, which may improve the safety of energized laparoscopic dissections.

Chen, Minghui; Song, Chengli

2014-11-01

170

Laparoscopic liver resection with the water-jet dissector.  

PubMed

Laparoscopic liver resection requires careful patient selection. Tumor size and location have a major influence on the feasibility of a laparoscopic operation. Isolation and ligation of blood vessels and bile ducts after selective liver dissection by suitable techniques are important for visual control of the operating field. Since the Jet-Cutter has proven to give excellent clinical results in conventional liver surgery, we carried out laparoscopic liver resections with the Jet-Cutter in six patients. Five tumors were located in the left liver lobe; the fifth was in segment 6. There were no intra- or postoperative complications. The patients were discharged from the hospital after a mean of 5.4 +/- 2.1 days. PMID:7482205

Rau, H G; Meyer, G; Cohnert, T U; Schardey, H M; Jauch, K; Schildberg, F W

1995-09-01

171

Supernumerary kidney laparoscopically treated  

PubMed Central

Congenital anomalies of the kidney and urinary tract are part of a family of diseases with different anatomical origins. Duplicated collecting systems can be defined as a renal unit containing 2 pyelocalyceal systems associated with a single ureter or with double ureters. The supernumerary kidney is a definitive accessory organ with its own collecting system, blood supply, and distinct encapsulated parenchima. The true incidence of supernumerary kidney remains unknown, but most cases are in males, are unilateral and on the left side. We present a case of an adult woman with a hypoplastic supernumerary kidney with a complete ureteral duplication and an ectopic junction. The case has been laparoscopically treated. We demonstrate that a laparoscopic nephro-ureterectomy is feasible and that the management of the complication (urinoma and fistula) can be managed conservatively. PMID:24282475

Innocenzi, Michele; Casale, Paolo; Alfarone, Andrea; Ravaziol, Michele; Cattarino, Susanna; Grande, Pietro; Minisola, Francesco; Gentilucci, Alessandro; Gentile, Vincenzo; Sciarra, Alessandro

2013-01-01

172

Supernumerary kidney laparoscopically treated.  

PubMed

Congenital anomalies of the kidney and urinary tract are part of a family of diseases with different anatomical origins. Duplicated collecting systems can be defined as a renal unit containing 2 pyelocalyceal systems associated with a single ureter or with double ureters. The supernumerary kidney is a definitive accessory organ with its own collecting system, blood supply, and distinct encapsulated parenchima. The true incidence of supernumerary kidney remains unknown, but most cases are in males, are unilateral and on the left side. We present a case of an adult woman with a hypoplastic supernumerary kidney with a complete ureteral duplication and an ectopic junction. The case has been laparoscopically treated. We demonstrate that a laparoscopic nephro-ureterectomy is feasible and that the management of the complication (urinoma and fistula) can be managed conservatively. PMID:24282475

Innocenzi, Michele; Casale, Paolo; Alfarone, Andrea; Ravaziol, Michele; Cattarino, Susanna; Grande, Pietro; Minisola, Francesco; Gentilucci, Alessandro; Gentile, Vincenzo; Sciarra, Alessandro

2013-01-01

173

Total Laparoscopic Pancreaticoduodenectomy  

PubMed Central

Introduction: Total laparoscopic pancreaticoduodenectomy (TLPD) remains one of the most advanced laparoscopic procedures. Owing to the evolution in laparoscopic technology and instrumentation within the past decade, laparoscopic pancreaticoduodenectomy is beginning to gain wider acceptance. Methods: Data were collected for all patients who underwent a TLPD at our institution. Preoperative evaluation consisted of computed tomography scan with pancreatic protocol and selective use of magnetic resonance imaging and/or endoscopic ultrasonography. The TLPD was done with 6 ports on 3 patients and 5 ports in 2 patients and included a celiac, periportal, peripancreatic, and periduodenal lymphadenectomy. Pancreatic stents were used in all 5 cases, and intestinal continuity was re-established by intracorporeal anastomoses. Results: Five patients underwent a TLPD for suspicion of a periampullary tumor. There were 3 women and 2 men with a mean age of 60 years and a mean body mass index of 32.8. Intraoperatively, the mean operative time was 9 hours 48 minutes, with a mean blood loss of 136 mL. Postoperatively, there were no complications and a mean length of stay of 6.6 days. There was no lymph node involvement in 4 out of 5 specimens. The pathological results included intraductal papillary mucinous neoplasm in 2 patients, pancreatic adenocarcinoma in 1 patient (R0 resection), benign 4-cm periampullary adenoma in 1 patient, and a somatostatin neuroendocrine carcinoma in 1 patient (R0, N1). Conclusion: TLPD is a viable alternative to the standard Whipple procedure. Our early experience suggests decreased length of stay, quicker recovery, and improved quality of life. Complication rates appear to be improved or equivalent. PMID:23925010

Kamyab, Armin

2013-01-01

174

Totally laparoscopic feeding jejunostomy  

Microsoft Academic Search

  Background: A feeding jejunostomy should be used for nutritional support in a small subset of patients. Minimal-access approaches\\u000a for the placement of jejunal tubes have been described, but they often require special equipment not common to all operating\\u000a theaters. We describe a technique of totally laparoscopic jejunostomy tube (LJT) placement using equipment found in most operating\\u000a theaters. Methods: Thirty-five patients

J. W. Allen; A. Ali; J. Wo; J. M. Bumpous; R. N. Cacchione

2002-01-01

175

Laparoscopic Adjustable Gastric Banding  

Microsoft Academic Search

. We introduced open adjustable silicone gastric banding (ASGB) for treatment of morbid obesity in our institution\\u000a in 1991. It was done in a prospective study comparing ASGB with vertical banded gastroplasty (VBG) with regard to weight loss.\\u000a After 200 cases of open ASGB and 210 VBG procedures and the encouraging weight loss results, we started laparoscopic placement\\u000a of the

Mitiku Belachew; Marc Legrand; Vernon Vincent; Michel Lismonde; Nicole Le Docte; Veronique Deschamps

1998-01-01

176

Laparoscopic transvesical repair of recurrent vesicovaginal fistula using with fleece-bound sealing system  

Microsoft Academic Search

Background  Vesicovaginal fistula (VVF) is an epithelium-lined communication between the urinary bladder and vagina. Most of VVFs are\\u000a repaired by conventional open surgery. Laparoscopic repair of VVFs is rare and so far no report is available about laparoscopic\\u000a repair of persistent VVF using fleece-bound sealing system as a tissue barrier in the literature. Here we describe the operative\\u000a technique and briefly

Tibet Erdogru; Ahmet Sanl?; Orcun Celik; Mehmet Baykara

2008-01-01

177

Comparison between single and three portal laparoscopic splenectomy in dogs  

PubMed Central

Background Single incision laparoscopic surgery (SILS) is a newly growing technique to replace a more invasive conventional multiple portal laparoscopic surgery. The objective of this study was to compare single (SILS) with three portal (Conventional) laparoscopic splenectomy in dogs. Mongrel dogs (n?=?18), weighting 15?±?3?kg, were selected for this study (n?=?12 SILS; n?=?6 conventional). The area from xiphoid to pubis was prepared under aseptic conditions in dorsal recumbency with the head down and tilted 30 degree in the right lateral position. Pneumoperitoneum was established by CO2 using an automatic high flow pressure until achieving 12?mm Hg. Instrumentation used consisted of curved flexible-tip 5?mm Maryland forceps and ultracision harmonic scalpel for sealing and cutting of the vessels and splenic attachments. Results All dogs recovered uneventfully. The splenectomy procedure using SILS and conventional methods were significantly different in the respective operative time (29.1?±?1.65 vs. 42.0?+?2.69?min) and the length of the surgical scar (51.6?±?1.34?mm vs. 72.0?±?1.63?mm; P?Conventional) for splenectomy in dog. PMID:22963734

2012-01-01

178

Laparoscopic radical prostatectomy: preliminary results  

Microsoft Academic Search

Objectives. To evaluate our preliminary experience with laparoscopic radical prostatectomy. The indications for laparoscopy are currently being extended to complex oncologic procedures.Methods. Forty-three men underwent laparoscopic radical prostatectomy. We used five trocars. The surgical technique replicates the steps of traditional retropubic prostatectomy, except that the rectoprostatic cleavage plane is developed transperitoneally at the beginning of the procedure. In the first

C. C Abbou; L Salomon; A Hoznek; P Antiphon; A Cicco; F Saint; W Alame; J Bellot; D. K Chopin

2000-01-01

179

Trends in laparoscopic and robotic surgery among gynecologic oncologists: A survey update  

PubMed Central

Objectives To assess the use of traditional and robotic assisted laparoscopy by Society of Gynecologic Oncology (SGO) members and to compare the results with those of our published survey in 2004. Methods Surveys were mailed to SGO members, and anonymous responses were collected by mail or through a web site. Data were analyzed and compared with those of our previous survey. In addition, we gathered information on the effect of robotic assisted surgery on the management of gynecologic malignancies. Results Three hundred eighty-eight (46%) of 850 SGO members responded to the survey. Three hundred fifty-two (91%) indicated that they performed laparoscopic surgery in their practice (compared with 84% in the 2004 survey). The three most common laparoscopic procedures were laparoscopic hysterectomy and staging for uterine cancer (43%), diagnostic laparoscopy for adnexal masses (39%), and prophylactic bilateral oophorectomy for high-risk women (11%). Although 76% of respondents had received either limited or no laparoscopic training during their fellowship, 78% now believe that maximum or much emphasis should be placed on laparoscopic training (55% in the 2004 survey). Twenty-four percent of respondents indicated that they performed robotic assisted surgery, with 66% indicating that they planned to increase their use of the procedure in the next year. Conclusions We found an overall increase in the use of and perceived indications for minimally invasive surgery in gynecologic oncology among SGO members. Endometrial cancer staging has become an accepted indication for laparoscopy. In addition, most respondents were planning on increasing their use of robotic assisted surgery in the next year. PMID:19138793

Mabrouk, Mohamed; Frumovitz, Michael; Greer, Marilyn; Sharma, Sheena; Schmeler, Kathleen M.; Soliman, Pamela T.; Ramirez, Pedro T.

2014-01-01

180

STUDY PROTOCOL Open Access Open versus laparoscopically-assisted  

E-print Network

STUDY PROTOCOL Open Access Open versus laparoscopically-assisted oesophagectomy for cancer%, respectively, for both the abdominal and thoracic approaches. The worldwide popularity of laparoscopic to the reduced postoperative trauma. We hypothesise that the laparoscopic abdominal approach (laparoscopic

Paris-Sud XI, Université de

181

Laparoscopic Sacropexy: A Retrospective Analysis of Perioperative Complications and Anatomical Outcomes  

PubMed Central

Background and Objective: The aim of this study was to evaluate the surgical outcomes and complications of laparoscopic sacropexy with regard to 3 varying mesh attachment points: the vaginal stump, the cervical stump, and the posterior side of the cervix in the case of uterus preservation. Method: A retrospective study was conducted among 310 women treated for descensus with laparoscopic sacropexy between January 2000 and December 2007. Information was obtained from medical files and follow-up examinations. Results: Sacropexies with mesh attachment to the cervical stump, to the vaginal stump, and with uterus preservation were performed in 213, 67, and 30 cases, respectively. In 40 cases, no concomitant interventions were necessary. One perioperative conversion and 2 terminations occurred. Short-term complications included fever in 15 cases and urinary incontinence in 7 cases. Average follow-up was 7.9 mo with 211 patients completing follow-up. Prolapse recurrence rate was 10.4%; the reoperation rate was 4%. No significant differences between groups were detected for cystocele recurrence. Rectocele recurrence was significantly higher (P < .05) for sacropexy with vaginal mesh attachment. A reduction of incontinence was observed, which was significant (P < .05) for those patients treated with simultaneous or previous hysterectomy. Conclusion: Laparoscopic sacropexy shows good short-term results with low reprolapse and complication rates. PMID:23318069

Tchartchian, Garri; Waldschmidt, Matthias; Schollmeyer, Thoralf; De Wilde, Rudy L.

2012-01-01

182

Comparison of oxycodone and fentanyl for postoperative patient-controlled analgesia after laparoscopic gynecological surgery  

PubMed Central

Background Opioids are widely used in boluses and patient-controlled analgesia (PCA) for postoperative pain control. In this study, we compared the effects of oxycodone and fentanyl on postoperative pain in patients with intravenous patient-controlled analgesia (IV-PCA) after laparoscopic gynecological surgery. Methods Seventy-four patients undergoing elective total laparoscopic hysterectomy or laparoscopic myomectomy were randomly assigned to the administration of either fentanyl or oxycodone using IV-PCA (potency ratio 1 : 60). The cumulative dose administered in the patient-controlled mode during the initial 48 hours after the operation was measured. Patients were also assessed for postoperative pain severity, adverse effects, and patient satisfaction. Results No significant differences were observed in patient satisfaction with the analgesia during the postoperative period. Patients in the oxycodone group experienced significantly more dizziness compared to the fentanyl group. Patients in the oxycodone group showed significantly lower consumption of opioid in the patient-controlled mode (10.1 ± 8.5 ml vs. 16.6 ± 12.0 ml, P = 0.013). Conclusions Our data suggest that oxycodone and fentanyl demonstrated similar effects, and therefore oxycodone may be a good alternative to fentanyl in postoperative pain management. Further studies in various clinical settings will be needed to determine the adequate potency ratio.

Park, Joong-Ho; Lee, Chiu; Shin, Youngmin; Ban, Jong-Seouk; Lee, Ji-Hyang

2015-01-01

183

Adult Stentless Laparoscopic Pyeloplasty  

PubMed Central

Background and Objectives: Pyeloplasty, whether open or laparoscopic, has been the mainstay of treatment for ureteropelvic junction obstruction (UPJO). A nonstented pyeloplasty has only been reported in the pediatric literature. Herein, to the best of our knowledge, we report the first published experience with laparoscopic stentless pyeloplasty (LSP) in the adult population. Methods: Patients with a normal contralateral kidney who underwent a laparoscopic pyeloplasty were included in this study. A dismembered pyeloplasty was performed without the placement of a ureteral stent. Functional Tc-99m MAG3 renal-scan data were compared with results at 4 weeks and 6 months postoperatively. Perioperative complications and long-term follow-up were prospectively gathered. Results: To date, 5 patients have undergone LSP with a mean follow-up of 15.7 months. Mean age and body mass index of this group were 42.8 years and 29.3 kg/m2, respectively. Mean operative time, estimated blood loss, and hospital stay were 196 minutes, 58 mL, 1.6 days, respectively. Three patients had right-sided UPJO, and 2 patients had left UPJO. No patient had undergone previous surgery for UPJO. All patients had a ureteral stent in place at the time of surgery. No intraoperative complications occurred. Only one patient complained of flank pain on POD1. No obstruction or urinary extravasation was seen on retrograde pyelography, but a ureteral stent was placed. During our follow-up, all patients had complete resolution of their symptoms. Postoperative renal scans demonstrated improved urinary drainage in all patients. Conclusion: Our initial experience suggests that in experienced hands, LSP may be an effective method for treating UPJO. PMID:17651549

Shalhav, Arieh L.; Mikhail, Albert A.; Orvieto, Marcelo A.; Gofrit, Ofer N.; Gerber, Glenn S.

2007-01-01

184

Laparoscopic sterilization kit.  

PubMed

A suitcase size laparoscopic sterilization kit produced by Medical Technology Internationale, Inc. was tested on 50 patients at the Johns Hopkins Hospital and field tested in San Jose, Costa Rica. The pneumoperitoneum device has reduced overall size with 2 "pop-off" valves, one to prevent more than one l carbon dioxide from entering the abdomen and one to protect against sudden expansion of any carbon dioxide within the peritoneal cavity. Electrocoagulation capacity has been adequate for fulguration of the uterine tube. The miniaturization of the equipment should provide greater mobility in delivering family planning services. PMID:4269087

Wheeless, C R

1973-08-01

185

Complications of laparoscopic pyeloplasty  

Microsoft Academic Search

Objectives  With the development of new video-endoscopic techniques like endopyelotomy, laparoscopy and retroperitoneoscopy the treatment\\u000a of UPJO has become less invasive. The complications and learning curve of laparoscopic pyeloplasty are presented together\\u000a with recommendations for adequate management.\\u000a \\u000a \\u000a \\u000a Materials and methods  Based on the personal experience with 189 cases of retroperitoneoscopic pyeloplasty, a literature review (PubMed) was performed\\u000a focussing on complication and success

Jens J. Rassweiler; Dogu Teber; Thomas Frede

2008-01-01

186

Laparoscopic partial splenectomy  

Microsoft Academic Search

Background  The immunologic function of the spleen and its important role in immune defense has led to splenic-preserving surgery. This\\u000a study aimed to evaluate whether laparoscopic partial splenectomy is safe.\\u000a \\u000a \\u000a \\u000a Methods  Data on consecutive patients presenting with localized benign or malignant disease of the spleen were included in a prospective\\u000a database. The surgical technique consisted of six steps: patient positioning and trocar

S. Uranues; D. Grossman; L. Ludwig; R. Bergamaschi

2007-01-01

187

Laparoscopically assisted colon surgery  

PubMed Central

Laparoscopy has been used in surgical procedures more frequently in the past decade because it reduces postoperative pain, decreases the length of hospitalization, decreases the duration of disability, and provides a better cosmetic result. We retrospectively reviewed our experience with laparoscopic colon surgery at Baylor University Medical Center. Since 1995, we have done 17 procedures, including 10 colon resections and 7 colostomies. The results in these patients have been quite good: only 1 patient was converted to an open procedure, and the remaining 16 patients experienced no mortality, major morbidity, or wound infection. PMID:16389383

2000-01-01

188

Robot-assisted laparoscopic urological surgery in children.  

PubMed

Robot-assisted laparoscopic surgery (RALS) has been proven to be safe and effective for various urological procedures in children, including pyeloplasty, orchiopexy, nephrectomy, and bladder augmentation. The robot system enables delicate and precise movements, which are ideal for the types of reconstructive surgeries that children with urological issues often require, overcoming many of the impediments associated with the conventional laparoscopic approach. RALS helps the relative novice to perform fine surgical techniques and is thought to reduce the learning curve associated with some surgical techniques, such as intracorporeal suturing, owing to the improved freedom of movement of the surgical instruments, the ergonomic positioning of the surgeon, and the 3D vision provided by the robotic system. Given the favourable safety profile and associated benefits of the robot system, including reductions in mean postoperative hospital stay compared with conventional procedures, RALS is becoming more widely adopted by paediatric urologists. PMID:24100517

Sávio, Luís F; Nguyen, Hiep T

2013-11-01

189

Stereoscopic visualization of laparoscope image using depth information from 3D model.  

PubMed

Laparoscopic surgery is indispensable from the current surgical procedures. It uses an endoscope system of camera and light source, and surgical instruments which pass through the small incisions on the abdomen of the patients undergoing laparoscopic surgery. Conventional laparoscope (endoscope) systems produce 2D colored video images which do not provide surgeons an actual depth perception of the scene. In this work, the problem was formulated as synthesizing a stereo image of the monocular (conventional) laparoscope image by incorporating into them the depth information from a 3D CT model. Various algorithms of the computer vision including the algorithms for the feature detection, matching and tracking in the video frames, and for the reconstruction of 3D shape from shading in the 2D laparoscope image were combined for making the system. The current method was applied to the laparoscope video at the rate of up to 5 frames per second to visualize its stereo video. A correlation was investigated between the depth maps calculated with our method with those from the shape from shading algorithm. The correlation coefficients between the depth maps were within the range of 0.70-0.95 (P<0.05). A t-test was used for the statistical analysis. PMID:24444752

Kumar, Atul; Wang, Yen-Yu; Wu, Ching-Jen; Liu, Kai-Che; Wu, Hurng-Sheng

2014-03-01

190

Laparoscopic Ovarian Surgery in Children and Adolescents  

PubMed Central

Background and Objectives: Although laparoscopy is widely used in gynecologic surgery in adults, few studies have been undertaken to examine its use in young and adolescent patients. This study was conducted to investigate the safety and feasibility of laparoscopic surgery for the treatment of benign ovarian disease in children and adolescents. Methods: A retrospective chart review was conducted on 106 patients (age, <20 years) who underwent laparoscopic surgery at Kangnam Sacred Heart Hospital from 2006 through 2012. Results: The mean patient age was 17.1 years, and the youngest one was 8. Pathologic analyses revealed that 32 (30.2%) patients had dermoid cyst, 30 (28.3%) had simple cyst, and 15 (14.2%) had endometrioma. Conservative procedures, such as cystectomy (48.1%), aspiration (5.7%), fulguration (4.7%), and detorsion (3.8%), were performed in 65.1% of all cases. A subanalysis revealed that the surgical outcomes of children (age, ?15 years), including operative time, estimated blood loss, postoperative hemoglobin decrease, and postoperative length of hospital stay, were comparable to those of adolescents (age, 16–19 years), despite significant differences in mean height between the 2 groups (156.1 ± 10.71 cm in children vs. 162.1 ± 5.14 cm in adolescents; P < .0001). (The age break between the study groups was set at 15 years, because most girls reach their adult height between the ages of 15 and 16 years.) No intra- or perioperative complications were noted. In a comparison study of surgical outcomes in 433 women (age, 20–50 years) and the 106 young and adolescent girls in our sample (age, <20 years), those in our patients were not inferior. Conclusion: In children and adolescents, laparoscopic surgery can be successfully performed with conventional instruments designed for use in adults.

Cho, Hye-yon; Park, Sung-ho; Park, Sung-taek

2015-01-01

191

Mesh-Based Transperineal Repair of a Perineal Hernia After a Laparoscopic Abdominoperineal Resection  

PubMed Central

A perineal hernia (PH) is formed by a protrusion of intra-abdominal viscera through a defect in the pelvic floor. This is a rare complication after a conventional abdominoperineal resection (APR). However, the risk of a PH may be increased after a laparoscopic resection because this technique can cause fewer postoperative adhesions, predisposing the small bowel to sliding down toward the pelvis. However, only a few case reports describe the transperineal approach for the repair of a PH after a laparoscopic APR. We present a case of a PH after a laparoscopic APR; the PH was repaired with synthetic mesh by using a transperineal approach. A transperineal approach using a mesh to reconstruct the pelvic floor is less invasive and more effective. We suggest that this technique should probably be the first choice for treating an uncomplicated PH that occurs after a laparoscopic APR. PMID:25210690

Lee, Taek-Gu

2014-01-01

192

Hybrid laparoscopic and anterior approach for postsurgical inguinal hernia after iliofemoral arterial bypass.  

PubMed

Laparoscopic hernia repair has become popular due to its rapid recovery time, fewer postoperative complications, and less chronic pain compared with conventional approaches. Currently, laparoscopic hernia repair is also used for more complex pathogenesis, including extra-anatomic bypass surgery for femoral artery. To the best of our knowledge, cases of inguinal hernia after femoral arterial bypass are extremely rare. We report the case of a 77-year-old Japanese man who was diagnosed with inguinal hernia after a previous left external iliac artery-right common femoral artery bypass. We used a hybrid laparoscopic and anterior approach, and the procedure was completed successfully without perioperative complications. A laparoscopic approach is useful for the diagnosis and treatment of inguinal hernia after extra-anatomic bypass surgery for femoral artery. While complicated, the addition of anterior reinforcement should be considered in cases of insufficient preperitoneal repair using transabdominal preperitoneal patch plasty. PMID:25785323

Tsukada, Tomoya; Saito, Hiroto; Amaya, Koji; Terada, Itsuro; Kaji, Masahide; Shimizu, Koichi

2015-03-01

193

Laparoscopic excision of Meckel's diverticulum in children: What is the current evidence?  

PubMed Central

Complications aroused from Meckel’s diverticulum tend to developed in children. Children presented with abdominal pain, intestinal obstruction, intussusception or gastrointestinal bleeding may actually suffered from complicated Meckel’s diverticulum. With the advancement of minimally invasive surgery (MIS) in children, the use of laparoscopy in the diagnosis and subsequent laparoscopic excision of Meckel’s diverticulum has gained popularity. Recently, single incision laparoscopic surgery (SILS) has emerged as a new technique in minimally invasive surgery. This review offers the overview in the development of MIS in the management of children suffered from Meckel’s diverticulum. The current evidence in different laparoscopic techniques, including conventional laparoscopy, SILS, the use of special laparoscopic instruments, intracorporeal diverticulectomy and extracorporeal diverticulectomy in the management of Meckel’s diverticulum in children were revealed. PMID:25386065

Chan, Kin Wai Edwin; Lee, Kim Hung; Wong, Hei Yi Vicky; Tsui, Siu Yan Bess; Wong, Yuen Shan; Pang, Kit Yi Kristine; Mou, Jennifer Wai Cheung; Tam, Yuk Him

2014-01-01

194

Laparoscopic treatment of perforated appendicitis  

PubMed Central

The use of laparoscopy has been established in improving perioperative and postoperative outcomes for patients with simple appendicitis. Laparoscopic appendectomy is associated with less wound pain, less wound infection, a shorter hospital stay, and faster overall recovery when compared to the open appendectomy for uncomplicated cases. In the past two decades, the use of laparoscopy for the treatment of perforated appendicitis to take the advantages of minimally invasiveness has increased. This article reviewed the prevalence, approaches, safety disclaimers, perioperative and postoperative outcomes of the laparoscopic appendectomy in the treatment of patients with perforated appendicitis. Special issues including the conversion, interval appendectomy, laparoscopic approach for elderly or obese patient are also discussed to define the role of laparoscopic treatment for patients with perforated appendicitis. PMID:25339821

Lin, Heng-Fu; Lai, Hong-Shiee; Lai, I-Rue

2014-01-01

195

Emergency peripartum hysterectomy in a tertiary hospital in southern Nigeria  

PubMed Central

Introduction Emergency peripartum hysterectomy, a maker of severe maternal morbidity and near miss mortality is an inevitable surgical intervention to save a woman's life when uncontrollable obstetric haemorrhage complicates delivery. This study was conducted in order to determine the incidence, types, indications and maternal complications of emergency peripartum hysterectomy at the University of Uyo Teaching Hospital, Uyo, Nigeria. Methods The case records of all women who underwent emergency peripartum hysterectomy between 1st January 2004 and 31st December 2011 were studied. Results There were 12,298 deliveries during the study period and 28 emergency peripartum hysterectomies were performed resulting in a rate of 0.2% or 1 in 439 deliveries. The modal age group of the patients was 26-30 years (35.7%), majority were of low parity (64.4%), while 17.9% attained tertiary level education. Half of the patients (50.0%) were unbooked while 14.3% were antenatal clinic defaulters. Extensive uterine rupture (67.8%) was the most common indication for emergency hysterectomy distantly followed by uterine atony with uncontrollable haemorrhage (17.9%). Subtotal abdominal hysterectomy was performed in 92.8% of the cases. The case fatality rate was 14.3% while the perinatal mortality rate was 64.3%. Conclusion Emergency peripartum hysterectomy is not uncommonly performed in our centre and extensive uterine rupture from prolonged obstructed labour is the most common indication. In addition, it is associated with significant maternal and perinatal mortality. There is need to enlighten women in our communities on the benefits of ANC and hospital delivery as well as the dangers of delivering without skilled attendance. Government should consider enacting legislation to discourage people or organisations who operate unlicensed maternity homes in our environment. PMID:24147186

Abasiattai, Aniekan Monday; Umoiyoho, Aniefiok Jackson; Utuk, Ntiense Maurice; Inyang-Etoh, Emmanuel Columba; Asuquo, Otobong Peter

2013-01-01

196

Robotic-Assisted Laparoscopic Heminephrectomy  

Microsoft Academic Search

\\u000a Ehrlich et al.1 first reported the use of laparoscopic nephrectomy in children, and Jordon and Winslow 2 reported the first\\u000a laparoscopic partial nephrectomy (LPN) in a 14-year-old girl with bilateral duplicated systems. Since these reports, there\\u000a has been a boom in the utilization of laparoscopy in pediatric urology, where it has been aggressively pursued as an alternative\\u000a to traditional open

Drew A. Freilich; Hiep T. Nguyen

197

Laparoscopic Repair of Inguinal Hernias  

Microsoft Academic Search

For patients with recurrent inguinal hernia, or bilateral inguinal hernia, or for women, laparoscopic repair offers significant\\u000a advantages over open techniques with regard to recurrence risk, pain, and recovery. For unilateral first-time hernias, either\\u000a laparoscopic or open repair with mesh can offer excellent results. The major drawback of laparoscopy is that the technique\\u000a requires a significant number of cases to

Jonathan Carter; Quan-Yang Duh

198

Laparoscopic-assisted colon resection  

Microsoft Academic Search

The popularity and success of laparoscopic biliary tract surgery have persuaded surgeons to explore other applications for\\u000a rigid endoscopic surgery. From July 1990 to February 1993 a total of 65 patients (mean age 57 years; range 41–82) underwent\\u000a attempted laparoscopic colon resection. Indications for surgical intervention included cancer (39), adenomatous polyps (14),\\u000a diverticulosis (10), stricture (1), and foreign-body perforation (1).

K. A. Zucker; D. E. Pitcher; D. T. Martin; R. S. Ford

1994-01-01

199

The Psychosocial Dimensions of Hysterectomy: Private Places and the Inner Spaces of Women at Midlife  

Microsoft Academic Search

Although the literature on hysterectomy is well represented by the medical and nursing professions, there is a paucity of social work research on the psychosocial dimensions of hysterectomy and surgical menopause. With over one-half million women undergoing the surgical removal of their reproductive organs each year, clinical social workers need to be aware of the potential effects of hysterectomy on

Jessica Cabness

2010-01-01

200

[Hepatic and pancreatic laparoscopic surgery].  

PubMed

The development of laparoscopic surgery also includes the more complex procedures of abdominal surgery such as those that affect the liver and the pancreas. From diagnostic laparoscopy, accompanied by laparoscopic echography, to major hepatic or pancreatic resections, the laparoscopic approach has spread and today encompasses practically all of the surgical procedures in hepatopancreatic pathology. Without forgetting that the aim of minimally invasive surgery is not a better aesthetic result but the reduction of postoperative complications, it is undeniable that the laparoscopic approach has brought great benefits for the patient in every type of surgery except, for the time being, in the case of big resections such as left or right hepatectomy or resections of segments VII and VIII. Pancreatic surgery has undergone a great development with laparoscopy, especially in the field of distal pancreatectomy due to cystic and neuroendocrine tumours where the approach of choice is laparoscopic. Laparoscopy similarly plays an important role, together with echolaparoscopy, in staging pancreatic tumours, prior to open surgery or for indicating suitable treatment. In coming years, it is to be hoped that it will continue to undergo an exponential development and, together with the advances in robotics, it will be possible to witness a greater impact of the laparoscopic approach on the field of hepatic and pancreatic surgery. PMID:16511579

Pardo, F; Rotellar, F; Valentí, V; Pastor, C; Poveda, I; Martí-Cruchaga, P; Zozaya, G

2005-01-01

201

Laparoscopic Anti-Reflux (GERD) Surgery  

MedlinePLUS

... Exhibit Opportunities Sponsorship Opportunities Login Patient Information for Laparoscopic Anti-Reflux (GERD) Surgery from SAGES Download PDF ... suffer from “heartburn” your surgeon may have recommended Laparoscopic Anti-Reflux Surgery to treat this condition, technically ...

202

RETROPERITONEAL LAPAROSCOPIC VERSUS OPEN RADICAL NEPHRECTOMY  

Microsoft Academic Search

PurposeWe analyze the retroperitoneal approach to laparoscopic radical nephrectomy in regard to feasibility, safety, morbidity and cancer control, and compare results and outcomes in patients who underwent retroperitoneal laparoscopic or open radical nephrectomy from 1995 to 1998.

C. C. ABBOU; A. CICCO; D. GASMAN; A. HOZNEK; P. ANTIPHON; D. K. CHOPIN; L. SALOMON

1999-01-01

203

Design of a pressure sensing laparoscopic grasper  

E-print Network

With smaller incisions, laparoscopic, or minimally invasive, surgery is considered safer for patients than open surgery. However, the safety of current laparoscopic grasping instruments can still be improved. Current devices ...

Reyda, Caitlin J. (Caitlin Jilaine)

2011-01-01

204

Complete laparoscopic removal of a gastric trichobezoar  

PubMed Central

Trichobezoars are seen usually in adolescent girls and laparotomy is required to remove them, though recently laparoscopic assisted and laparoscopic removal have been reported in adults and older children. We report this 4-year-old boy who underwent complete laparoscopic removal of a gastric trichobezoar, both for its rarity in such young boys and also because he is the youngest reported patient to undergo complete laparoscopic removal of a gastric trichobezoar. PMID:25013333

Vepakomma, Deepti; Alladi, Anand

2014-01-01

205

Laparoscopic partial splenic resection.  

PubMed

Twenty domestic pigs with an average weight of 30 kg were subjected to laparoscopic partial splenic resection with the aim of determining the feasibility, reliability, and safety of this procedure. Unlike the human spleen, the pig spleen is perpendicular to the body's long axis, and it is long and slender. The parenchyma was severed through the middle third, where the organ is thickest. An 18-mm trocar with a 60-mm Endopath linear cutter was used for the resection. The tissue was removed with a 33-mm trocar. The operation was successfully concluded in all animals. No capsule tears occurred as a result of applying the stapler. Optimal hemostasis was achieved on the resected edges in all animals. Although these findings cannot be extended to human surgery without reservations, we suggest that diagnostic partial resection and minor cyst resections are ideal initial indications for this minimally invasive approach. PMID:7773460

Uranüs, S; Pfeifer, J; Schauer, C; Kronberger, L; Rabl, H; Ranftl, G; Hauser, H; Bahadori, K

1995-04-01

206

Development of a laparoscope with multi-resolution foveation capability for minimally invasive surgery  

NASA Astrophysics Data System (ADS)

Laparoscope is the essential tool for minimally invasive surgery (MIS) within the abdominal cavity. However, the focal length of a conventional laparoscope is fixed. Therefore, it suffers from the tradeoff between field of view (FOV) and spatial resolution. In order to obtain large optical magnification to see more details, a conventional laparoscope is usually designed with a small working distance, typically less than 50mm. Such a small working distance limits the field of coverage, which causes the situational awareness challenge during the laparoscopic surgery. We developed a multi-resolution foveated laparoscope (MRFL) aiming to address this limitation. The MRFL was designed to support a large working distance range from 80mm to 180mm. It is able to simultaneously provide both wide-angle overview and high-resolution image of the surgical field in real time within a fully integrated system. The high-resolution imaging probe can automatically scan and engage to any subfield of the wide-angle view. During the surgery, MRFL does not need to move; therefore it can reduce the instruments conflicts. The FOV of the wide-angle imaging probe is 80° and that of the high-resolution imaging probe is 26.6°. The maximum resolution is about 45um in the object space at an 80mm working distance, which is about 5 times as good as a conventional laparoscope at a 50mm working distance. The prototype can realize an equivalent 10 million-pixel resolution by using only two HD cameras because of its foveation capability. It saves the bandwidth and improves the frame rate compared to the use of a super resolution camera. It has great potential to aid safety and accuracy of the laparoscopic surgery.

Qin, Yi; Hua, Hong; Nguyen, Mike

2013-03-01

207

Laparoscopic Management of Kidney Cancer: Updated Review  

Microsoft Academic Search

Background: Laparoscopy has emerged as the preferred option for the surgical management of kidney cancer. Although many reports have been published regarding the operative outcome of renal cell carcinoma (RCC) and upper-tract transitional cell carcinoma (TCCA) treated laparoscopically, few review the oncologic outcome of these pathologies treated with laparoscopic techniques. Methods: We review the literature regarding the laparoscopic approaches, the

Hosam S. Al-Qudah; Alejandro R. Rodriguez; Wade J. Sexton

2007-01-01

208

Laparoscopic tubal anastomosis: reversal of sterilization.  

PubMed

A case of laparoscopic reversal of tubal sterilization is reported. The patient was a 38 year old woman sterilized by bipolar diathermia two years earlier. Refertilization was performed by laparoscopic end to end anastomosis of one tube. Postoperatively, the patient had one menstruation and then achieved an intrauterine pregnancy. The laparoscopic method of refertilization saves expensive hospitalization costs. PMID:8259759

Istre, O; Olsboe, F; Trolle, B

1993-11-01

209

Preoperative Surgical Planning Using Virtual Laparoscopic Camera  

E-print Network

Preoperative Surgical Planning Using Virtual Laparoscopic Camera Dmitry Oleynikov, M.D Leonid require the surgeon to operate based on a 2-dimensional (2D) image visible through the laparoscopic camera. The objective of this study is to generate a 3D laparoscopic simulation of peri- toneal surface anatomy based

Zhukov, Leonid

210

Laparoscopic repair of bilateral morgagni hernia.  

PubMed

Morgagni hernias are rare and comprise approximately 3% of the congenital diaphragmatic hernias that are observed in 1 in 4800 live births. A 50-year-old female patient who complained of nonspecific chest pain radiating to the right arm for approximately 1 year presented. Chest x-ray revealed a right-sided paracardiac mass diagnosed Morgagni hernia by computerized tomography of the thorax. Laparoscopic exploration showed that the retrosternal hernia was actually a bilateral one. After reducing the contents of the hernial sacs, the defects were closed as a single defect with hernia stapler starting from each end and an appropriate sized polyprolene mesh was closed over the repair site. The patient did not have any symptoms of recurrence after 3 months. Recent advances in video-endoscopic surgery made it possible to perform repairs of these hernias less traumatic and more comfortable to the patients than the conventional transabdominal or transthoracic methods. PMID:15287610

Tarim, Akin; Nursal, Tarik Zafer; Yildirim, Sedat; Ezer, Ali; Caliskan, Kenan; Törer, Nurkan

2004-04-01

211

Hysterectomies and Urologic Symptoms: Results from the Boston Area Community Health (BACH) Survey  

PubMed Central

Objectives To describe the characteristics of women who have had a hysterectomy and to assess the association of a past hysterectomy on current urologic symptoms. Methods The Boston Area Community Health (BACH) survey is a random sample of Boston, Massachusetts residents aged 30–79 years using a stratified two-stage cluster design (3202 women; 1067 Black, 1111 Hispanic, 1024 White). Urologic symptoms, hysterectomy, co-morbidities, lifestyle factors, and medical indications for a hysterectomy were by self-report. Socioeconomic status was measured as a combination of education and income. Results Hysterectomies were reported by 587 women and 1782 women reported one or more urologic symptoms. Minorities and those of lower socioeconomic status are more likely to have had a hysterectomy, even after adjusting for age and potential medical indications for a hysterectomy. Hispanic women were least likely to report fibroids, polycystic ovarian syndrome, or genitourinary cancers, but they were more likely to have had a hysterectomy if they reported these conditions than Black or White women. Women with a hysterectomy were more likely to report lower urinary tract symptoms, painful bladder syndrome, urinary frequency, urgency, and overactive bladder after adjusting for age, race/ethnicity, socioeconomic status, body mass index, depression, diabetes, heart disease, hypertension, smoking history, alcohol use, and physical activity. Conclusions Minorities and those of lower socioeconomic status are more likely to report having a hysterectomy and urologic symptoms (including painful bladder syndrome) may be an unintended consequence of a hysterectomy. PMID:21423814

Link, Carol L.; Pulliam, Samantha J.; McKinlay, John B.

2011-01-01

212

Controlled balloon dilatation of the extraperitoneal space for laparoscopic urologic surgery.  

PubMed

Laparoscopic urologic surgery has become increasingly more popular, with the majority of procedures and techniques that have been described based on intraperitoneal experience and anatomic considerations. Urologic surgery, traditionally confined mostly to the extraperitoneal space, has followed these intraperitoneal descriptions when undertaken laparoscopically. Our experience of controlled, laparoscopically monitored dilatation of the extraperitoneal space using a new trocar-mounted balloon dissector can create a working space in a surgical environment familiar to traditional open urologic surgery. We report our initial experience with the preperitoneal distention balloon in 15 patients, emphasizing the technique of extraperitoneal access and the laparoscopic visualization of anatomy relevant to pelvic lymph node dissection, varicocele ligation, nephropexy, and renal biopsy. In this early experience, laparoscopic pelvic lymph node dissection was performed successfully in 7 of 11 patients and in all other patients undergoing the retroperitoneal procedures. Patients with a prior history of hernia repair or appendectomy do not appear to be suitable to this approach when used for pelvic lymphadenectomy. The trocar-mounted balloon device allows direct visualization and control of the dissection process. Avoiding the transperitoneal approach may eliminate many of the complications associated with the transperitoneal access and procedure completion. We conclude that the extraperitoneal technique using this device merits further investigation and more widespread application in the laparoscopic approach to conventional extraperitoneal urologic procedures. PMID:7949382

Hirsch, I H; Moreno, J G; Lotfi, M A; Gomella, L G

1994-08-01

213

[Laparoscopic surgery in day surgery].  

PubMed

Since ten years laparoscopic techniques have been employed as alternatives of many established open procedures in gynecologic, abdominal and finally urologic surgery. Laparoscopic techniques show significant advantages compared to open surgery, such as less hospitalization, reduced need of analgesic drugs, quick return to daily activities and far a better cosmetic results. Laparoscopic surgery has been advocated for urologic, uro-gynecologic and andrologic diseases. Since 1983 one-day surgery was proposed for only a few gynecologic and abdominal procedures and only recently for laparoscopic renal biopsy and abdominal testis evaluation. In these preliminary experiences the conditions for a correct management of laparoscopic one-day surgery have been clearly pointed out: 1. correct surgical indication; 2. through knowledge of surgical technique; 3. duration of the procedure less than 90 minutes; 4. correct anesthesia. Technique of anesthesia must be adapted to the surgical procedure required, its duration and the physical features of the patient. General anesthesia is usually preferred for either longer and more complex procedures or when a higher abdominal insufflation pressure is needed. Spinal or local anesthesia are preferred for simpler procedures or when only one trocar is required. At date only few urologic procedures seem to be suitable to one-day laparoscopic surgery. 1) Varicocele: although laparoscopic varicocelectomy in one-day surgery has never been reported previously, it can be performed in a short time, only 3 trocars are needed and insufflation pressure can be maintained within 15 mm Hg. 2) Renal biopsy and marsupialization of renal cysts. These are usually managed percutaneously but in some particular indications procedures under direct vision should be preferable. Both are short-lasting and only superficial general anesthesia is required; as surgical access is retroperitoneal only two trocars are sufficient; at date only renal biopsies have previously been reported. 3) Diagnostic procedures on abdominal testis. The procedure is brief only superficial general anesthesia is needed and only one trocar is required. Conclusions. One-day laparoscopic surgery will require in the future a more and more strict cooperation between urologists and anesthetists in order to tailor the correct anesthesiological and laparoscopic technique to the procedure required and the features of the patient. PMID:9707775

Micali, S; Bitelli, M; Torelli, F; Valitutti, M; Micali, F

1998-06-01

214

Perioperative intravenous flurbiprofen reduces postoperative pain after abdominal hysterectomy  

Microsoft Academic Search

Purpose: To assess whether perioperative intravenous administration of flurbiprofen, a non-steroidal anti-inflammatory drug, reduced\\u000a postoperative pain after abdominal hysterectomy.\\u000a \\u000a \\u000a Methods: Forty-five patients undergoing abdominal hysterectomy were randomly assigned to one of three groups of equal size. A control\\u000a group (CONT) received a placebo 30 min before and at the end of surgery. The other two groups, PRE and POST, received

Masayasu Nakayama; Hiromichi Ichinose; Shuji Yamamoto; Ken-ichi Nakabayashi; Osamu Satoh; Akiyoshi Namiki

2001-01-01

215

Intracorporeal Anastomosis in Laparoscopic Gastric Cancer Surgery  

PubMed Central

Laparoscopic gastrectomy has become widely used as a minimally invasive technique for the treatment of gastric cancer. When it was first introduced, most surgeons preferred a laparoscopic-assisted approach with a minilaparotomy rather than a totally laparoscopic procedure because of the technical challenges of achieving an intracorporeal anastomosis. Recently, with improved skills and instruments, several surgeons have reported the safety and feasibility of a totally laparoscopic gastrectomy with intracorporeal anastomosis. This review describes the recent technical advances in intracorporeal anastomoses using circular and linear staplers that allow for totally laparoscopic distal, total, and proximal gastrectomies. Data that demonstrate advantages in early surgical outcomes of a total laparoscopic method compared to laparoscopic-assisted operations are also discussed. PMID:23094224

Hosogi, Hisahiro

2012-01-01

216

Laparoscopic reversal of Hartmann's procedure.  

PubMed

Reestablishing continuity after a Hartmann's procedure is considered a major surgical procedure with high morbidity/mortality. The aim of this study was to assess the short-/long-term outcome of laparoscopic restoration of bowel continuity after HP. A prospectively collected database of colorectal laparoscopic procedures (>800) performed between June 2005 and June 2013 was used to identify 20 consecutive patients who had undergone laparoscopic reversal of Hartmann's procedure (LHR). Median age was 65.4. Ten patients (50 %) had undergone surgery for perforated diverticulitis, 3 (15 %) for cancer, and 7 (35 %) for other reasons (volvulus, posttraumatic perforation, and sigmoid perforation from foreign body). Previous HP had been performed laparoscopically in only 3 patients. Median operative time was 162.5 min. All the procedures were completed laparoscopically. Intraoperative complication rate was nil. Post-operative mortality and morbidity were respectively 0 and 10 % (1 pneumonia, 1 bowel obstruction from post-anastomotic stenosis which required resection and redo of the anastomosis). Median time to first flatus was 3 days, to normal diet 5 days. Median hospital stay was 9 days without readmissions. We followed up the patients for a median of 44 months: when asked, all 20 (100 %) said they would undergo the operation (LHR) again; 3 (15 %) had been re-operated of laparoscopic mesh repair for incisional hernia. When performed by experienced surgeons, LHR is a feasible, safe, reproducible operation, which allows early return of bowel function, early discharge and fast return to work for the patient. It has a low morbidity rate. PMID:25262377

Fiscon, Valentino; Portale, Giuseppe; Mazzeo, Antonio; Migliorini, Giovanni; Frigo, Flavio

2014-12-01

217

Hemostasis in laparoscopic renal surgery  

PubMed Central

Hemorrhage is a potential risk at any step of laparoscopic nephrectomies (LNs). The advances in surgical equipment and tissue sealants have increased the safety and efficiency of performing LN and laparoscopic partial nephrectomy (LPN). However, hemostasis remains a major issue and there is still scope for further development to improve haemostatic techniques and devices. In this article a literature review of the current methods and techniques of hemostasis was carried out using the MEDLINE ®/PubMed® resources. The results of the review were categorized according to the three main operative steps: Dissection, control of renal pedicle and excision of the renal lesion. PMID:22557709

Hassouna, Hussam A.; Manikandan, Ramaswamy

2012-01-01

218

Laparoscopic ultrasound and gastric cancer  

NASA Astrophysics Data System (ADS)

The management of gastrointestinal malignancies continues to evolve with the latest available therapeutic and diagnostic modalities. There are currently two driving forces in the management of these cancers: the benefits of minimally invasive surgery so thoroughly demonstrated by laparoscopic surgery, and the shift toward neoadjuvant chemotherapy for upper gastrointestinal cancers. In order to match the appropriate treatment to the disease, accurate staging is imperative. No technological advances have combined these two needs as much as laparascopic ultrasound to evaluate the liver and peritoneal cavity. We present a concise review of the latest application of laparoscopic ultrasound in management of gastrointestinal malignancy.

Dixon, T. Michael; Vu, Huan

2001-05-01

219

Laparoscopic management of gallbladder duplication.  

PubMed

Gallbladder duplication is a rare condition. Because laparoscopic cholecystectomy is the primary treatment modality for the diseased single gallbladders, it should be the choice of treatment for double gallbladders. However, preoperative imaging methods may be unsatisfactory for the correct diagnosis. As a result, incomplete resections may be performed. Intraoperative cholangiography should be performed in suspected cases to prevent inadvertent injury to the biliary system. In this report, we present a symptomatic patient with double gallbladders with separate cystic ducts in whom the gallbladders were successfully resected as a single specimen by laparoscopic means. The pitfalls of diagnostic modalities and surgical strategy are discussed in the context of the available literature. PMID:18050826

Nursal, Tarik Zafer; Ulusan, Serife; Tercan, Fahri; Yildirim, Sedat; Tarim, Akin; Noyan, Turgut; Bilgin, Nevzat

2007-01-01

220

21 CFR 884.1720 - Gynecologic laparoscope and accessories.  

Code of Federal Regulations, 2012 CFR

...2012-04-01 false Gynecologic laparoscope and accessories. 884.1720 ...Devices § 884.1720 Gynecologic laparoscope and accessories. (a) Identification. A gynecologic laparoscope is a device used to...

2012-04-01

221

TRAININGANATOMY RECOGNITION THROUGH REPETITIVE VIEWING OF LAPAROSCOPIC SURGERYVIDEO CLIPS  

E-print Network

TRAININGANATOMY RECOGNITION THROUGH REPETITIVE VIEWING OF LAPAROSCOPIC SURGERYVIDEO CLIPS Stephanie of procedural steps using edited laparoscopic surgeryvideos to enforce absorption,expose the learnerto varied recognitionduring minimallyinvasive (laparoscopic)surgery. Currently,novice surgeonslearn these skills primarily

Virginia, University of

222

21 CFR 884.1720 - Gynecologic laparoscope and accessories.  

Code of Federal Regulations, 2014 CFR

...2014-04-01 false Gynecologic laparoscope and accessories. 884.1720 ...Devices § 884.1720 Gynecologic laparoscope and accessories. (a) Identification. A gynecologic laparoscope is a device used to...

2014-04-01

223

A multi-institutional internet-based hysterectomy database  

Microsoft Academic Search

Objective and methods: We have devised an easy to use, valid, comprehensive database for hysterectomy to measure patient care; to allow physician benchmarking, interaction, and collaboration; and to allow research investigations. It includes demographic stratification and medical, financial, and satisfaction factors. It can be used as a standalone or as an Internet system. A query is in place that allows

Victor P. Trinkus; H. K. Jacobs; Y. Castellanos; R. A. Jorgensen; T. E. Grande; K. A. Hallman; E. A. Jacobson

2000-01-01

224

Histopathological Audit of 373 Nononcological Hysterectomies in a Teaching Hospital  

PubMed Central

Hysterectomy, the most common gynecological surgery, provides a definitive cure to various diseases like DUB (dysfunctional uterine bleeding), leiomyoma, adenomyosis, chronic pelvic pain, prolapse, and malignancy. However, with advent of effective medical and conservative treatment modalities for nononcological causes it is now posing question mark on justification of hysterectomy. Therefore, an audit is required to assess the correlation between preoperative diagnosis and histopathological examination of specimen for justification of the procedure. In this study over period of one year (April 2013 to March 2014) 373 hysterectomies specimens were received in the department of pathology for nononcological causes. The age of patients ranged from 22 to 85 years with mean 45 ± 9.2 years. All cases were divided into five categories on the basis of age and audit was done. In this study the most common finding was leiomyoma (43.7%) followed by adenomyosis (19.3%). Almost 50% of hysterectomies causes were justified as preoperative diagnosis matched with histopathology. Cohen kappa statistics were used to measure agreement between preoperative and postoperative histopathological diagnosis which was found to be fair with ? value being 0.36. This study highlights that regular audit of surgeries can help improve quality of health care services and provide safe conservative option to patients. PMID:25295217

Tiwana, Kanwardeep Kaur; Nibhoria, Sarita; Monga, Tanvi; Phutela, Richa

2014-01-01

225

Granulosa cell tumor induced massive recurrence of post hysterectomy leiomyoma.  

PubMed

The authors report a very unusual occurrence of a massive recurrence of leiomyoma from post hysterectomy stump diagnosed on fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18-FDG PET/CT). The case also has an additional complexity of granulosa cell tumor (GCT) of ovary probably contributing to the recurrence and massive size. PMID:25210289

Chalanki, Mohana Vamsy; Dattatreya, Satya; Padmaja, Parvathaneni; Dayal, Monal; Parakh, Megha; Rao, Vatturi Venkata Satya Prabhakar

2014-07-01

226

Laparoscopic management for Seprafilm-induced sterile peritonitis with paralytic ileus: report of 2 cases.  

PubMed

Postoperative adhesions after abdominopelvic surgery can be prevented with the use of mechanical barriers such as Seprafilm membranes. However, this procedure is not without complications. Herein are reported 2 cases of Seprafilm-associated sterile peritonitis after gynecologic surgical procedures. Both patients had symptoms that mimicked intraabdominal abscess formation soon after the initial surgery (1 patient had delivered via cesarean section, and the other had undergone total hysterectomy because of adenomyosis). However, laparoscopic examinations in these 2 patients revealed only gel-like hydrated Seprafilm without evidence of infection. Symptoms resolved after the abdominal cavity was thoroughly irrigated and the Seprafilm residue was completely removed. Both patients had an uneventful recovery. Previous reports suggested that Seprafilm-related complications were most commonly observed in patients who underwent gynecologic debulking surgery because Seprafilm might react with the large area of the injured peritoneum and induce a strong inflammatory response. However, our experience showed that such complications could also be observed in patients who underwent nondebulking surgery. A laparoscopic approach should be considered the treatment of choice under these conditions to avoid unnecessary laparotomy. PMID:22935311

Huang, Jui-Chien; Yeh, Chun-Chieh; Hsieh, Chi-Hsun

2012-01-01

227

Laparoscopic arcuate line hernia repair.  

PubMed

Arcuate line hernia is considered a surgical rarity. This type of hernia is characterized by protrusion of intraperitoneal structures in a concave parietal fold in the abdominal wall. In this report, we aim to describe the diagnostic images of 2 cases of arcuate line hernia. Laparoscopic repair using a polypropylene mesh with a preattached inflatable balloon has been illustrated as well. PMID:24710227

Messaoudi, Nouredin; Amajoud, Zainab; Mahieu, Geert; Bestman, Raymond; Pauli, Steven; Van Cleemput, Marc

2014-06-01

228

Day-case laparoscopic cholecystectomy  

PubMed Central

Objectives: To assess the safety and feasibility of laparoscopic cholecystectomy as a day-case procedure. Methods: All consecutive patients who were admitted to the day-surgery unit for laparoscopic cholecystectomy at the Department of Surgery, King Saud Medical City, Riyadh, Saudi Arabia from July 2009 to June 2013 were considered for this retrospective study. The medical records were reviewed for age, gender, presenting symptoms, laboratory findings, imaging studies, American Society of Anesthesiology (ASA) grade, anesthesia, conversion to open cholecystectomy, complications, the operating surgeons, pain management, nausea, and vomiting, overnight stay, readmission, morbidity, mortality, and outpatient follow up were collected and analyzed. Results: A total of 487 patients underwent laparoscopic cholecystectomy as a day case (ASA I=316, ASA II=171). Surgery was performed by high surgical trainees (HSTs) (n=417) and consultants (n=70) with conversion to open cholecystectomy in 4 patients. Twenty-two (5%) patients were admitted for overnight stay for different reasons, while 465 (95%) patients were discharged before 8 pm. Two patients (0.4 %) were re-admitted to the hospital due to abdominal pain. Five patients developed umbilical port site infection (1%). A total of 443 patients were satisfied (97%), while 14 (3%) were unsatisfied. There was no mortality or intra-abdominal septic collection. Conclusion: Day-case laparoscopic cholecystectomy is safe and feasible with optimal patient selection, education, and planned postoperative antiemetic and analgesia management. PMID:25630004

Al-Qahtani, Hamad H.; Alam, Mohammed K.; Asalamah, Saleh; Akeely, Mohammed; Ibrar, Mouhammed

2015-01-01

229

Laparoscopic Repair of Perineal Hernia  

PubMed Central

Perineal hernia is a rare but known complication following major pelvic surgery. It may occur spontaneously or following abdominoperineal resection, sacrectomy, or pelvic exenteration. Very little is known about spontaneous perineal hernia. Surgical repair via open transabdominal and transperineal approaches has been previously described. We report laparoscopic repair of spontaneous and postoperative perineal hernia in 2 patients. PMID:19660225

Rayhanabad, Jessica; Sassani, Pejvak

2009-01-01

230

Spleen removal - laparoscopic - adults - discharge  

MedlinePLUS

Your spleen was removed after you were given general anesthesia (asleep and pain-free). The surgeon made 3 to ... Recovering from laparoscopic spleen removal usually takes about 1 to 3 weeks. You may have some of these symptoms as you recover: Pain ...

231

Laparoscopic colectomy: A critical appraisal  

Microsoft Academic Search

A multicenter retrospective study was undertaken to assess the efficacy and safety of laparoscopy in colon and rectal surgery. To minimize potential bias in interpretation of the results, all data were registered with an independent observer, who did not participate in any of the surgical procedures. Sixty-six patients underwent a laparoscopic procedure. Operations performed included sigmoid colectomy (19), right hemicolectomy

P. M. Falk; R. W. Beart; S. D. Wexner; A. G. Thorson; D. G. Jagelman; I. C. Lavery; O. B. Johansen; R. J. Fitzgibbons

1993-01-01

232

Laparoscopic management of appendicular mass  

PubMed Central

BACKGROUND: Laparoscopic appendectomy is becoming the preferred technique for treating acute appendicitis. However, its role in the treatment of complicated appendicitis is controversial. This study was undertaken to assess the feasibility of laparoscopic appendectomy for appendicular mass. MATERIALS AND METHODS: A retrospective review was performed of all the patients who were treated laparoscopically for appendicular mass from March 2007 to October 2009. Setting: Tertiary care hospital. RESULTS: A total of 120 patients were treated for appendicitis. A retrospective review of the patients’ records demonstrated that 19 patients (15.8%) had appendicular mass at the time of admission. The average operative time was 95 minutes (range 45-140 minutes). Pathological evidence of appendicitis was present in all the patients. The average length of hospital stay was six days (rang 6-9 days). Three patients (15.7%) had post- operative complications. Two patients developed wound infections and one patient was re-admitted with pain and a lump below the umbilical port. CONCLUSION: The findings suggest that laparoscopic appendectomy is feasible in patients with appendicular mass. The authors propose a prospective, randomized trial to verify this finding. PMID:21523236

Shindholimath, Vishwanath V; Thinakaran, K; Rao, T Narayana; Veerappa, Yenni Veerabhadrappa

2011-01-01

233

Systems and instruments for laparoscopic surgery without pneumoperitoneum.  

PubMed

The insufflation of carbon dioxide into the peritoneal cavity is a routine technique of abdominal exposure in laparoscopic surgery. Because of adverse physiological effects and technical disadvantages of the pneumoperitoneum, alternative methods of abdominal wall lifting have been explored recently. Two groups of retraction systems exist: intraabdominal lifting and subcutaneous lifting of the abdominal wall. Some systems require additional pneumoperitoneum, because the extent of intraabdominal exposure is not sufficient. Other systems are working completely without gas insufflation. Two systems combine abdominal wall lifting with pressure on the internal organs. Every method allows the use of standard laparoscopic instruments, which originally were designed for a regular pneumoperitoneum. The use of a low-pressure pneumoperitoneum in combination with mechanical augmentation of the peritoneal cavity reduces physiological disadvantages of laparoscopy. But technical advantages, such as combination of laparoscopic and open techniques, can be realized only without gas insufflation. Conventional instruments have been designed to fit the ergonomical needs of isopneumic laparoscopy and to be employed with simple valveless cannulae. PMID:9266655

Gutt, C N; Daume, J; Schaeff, B; Paolucci, V

1997-08-01

234

Laparoscopic transabdominal preperitoneal inguinal hernia repair for recurrent inguinal hernia.  

PubMed

Laparoscopic transabdominal preperitoneal inguinal herniorrhaphy (TAPP) was attempted on 989 hernias in 708 patients. Of these 137 (14%) hernias were recurrent after conventional anterior repair. Laparoscopic repair was performed on 135 recurrences in 120 patients (the study cohort). There were 119 males and three females with an average age of 59 years (22-83 years). One hundred twelve (83%) were the first recurrences, and 23 (17%) were multiple recurrences. In 90 recurrences (66.7%) the last repair was performed more than 10 years previously. Seventy-seven patients (64%) had a prior or concomitant repair of a contralateral hernia. Direct recurrences and right-side recurrences were more common (73% and 61% respectively). Postoperative complications occurred in 18 repairs (13%). These included 15 hematomas, two seromas, and one urinary retention. Re-recurrence occurred in one patient (0.7%) in whom hernia staples were not used. No recurrence has occurred since the hernia staples became available. We conclude that the overall incidence of recurrent inguinal hernia is high (14%). Patients with recurrent hernia have a tendency toward a contralateral hernia (64%). Most recurrences occurred 10 or more years after the previous repair (66.7%). The laparoscopic repair (TAPP) offers a good repair for recurrent inguinal hernia avoiding the scar tissue and with low complication and recurrence rates. PMID:11894858

Hawasli, Abdelkader; Thao, Umeng; Chapital, Alyssa

2002-03-01

235

A randomised trial comparing endometrial resection and abdominal hysterectomy for the treatment of menorrhagia  

Microsoft Academic Search

OBJECTIVE--To determine the advantages and disadvantages of endometrial resection and abdominal hysterectomy for the surgical treatment of women with menorrhagia. DESIGN--Randomised study of two treatment groups with a minimum follow up of nine months. SETTING--Royal Berkshire Hospital, Reading. SUBJECTS--51 of 78 menorrhagic women without pelvic pathology who were on the waiting list for abdominal hysterectomy. TREATMENT--Endometrial resection or abdominal hysterectomy

M J Gannon; E M Holt; J Fairbank; M Fitzgerald; M A Milne; A M Crystal; J O Greenhalf

1991-01-01

236

Expanding Laparoscopic Cholecystectomy to Rural Mongolia  

Microsoft Academic Search

Background  Although laparoscopic cholecystectomy was first introduced in Mongolia in 1994, the benefits of the laparoscopic approach\\u000a have been largely unavailable to the majority of the population. The burden of gallbladder disease in Mongolia is significant.\\u000a Despite the barriers to expanding laparoscopic surgery in Mongolia (lack of physical resources and adequate training opportunities,\\u000a a difficult political situation, and an austere environment),

Catherine M. Straub; Raymond R. Price; Douglas Matthews; Diana L. Handrahan; Davaatseren Sergelen

2011-01-01

237

Hand-Assisted Laparoscopic Surgery (HALS) With the HandPort System  

PubMed Central

Objective To evaluate the feasibility and potential benefits of hand-assisted laparoscopic surgery with the HandPort System, a new device. Summary Background Data In hand-assisted laparoscopic surgery, the surgeon inserts a hand into the abdomen while pneumoperitoneum is maintained. The hand assists laparoscopic instruments and is helpful in complex laparoscopic cases. Methods A prospective nonrandomized study was initiated with the participation of 10 laparoscopic surgical centers. Surgeons were free to test the device in any situation where they expected a potential advantage over conventional laparoscopy. Results Sixty-eight patients were entered in the study. Operations included colorectal procedures (sigmoidectomy, right colectomy, resection rectopexy), splenectomy for splenomegaly, living-related donor nephrectomy, gastric banding for morbid obesity, partial gastrectomy, and various other procedures. Mean incision size for the HandPort was 7.4 cm. Most surgeons (78%) preferred to insert their nondominant hand into the abdomen. Pneumoperitoneum was generally maintained at 14 mmHg, and only one patient required conversion to open surgery as a result of an unmanageable air leak. Hand fatigue during surgery was noted in 20.6%. Conclusions The hand-assisted technique appeared to be useful in minimally invasive colorectal surgery, splenectomy for splenomegaly, living-related donor nephrectomy, and procedures considered too complex for a laparoscopic approach. This approach provides excellent means to explore, to retract safely, and to apply immediate hemostasis when needed. Although the data presented here reflect the authors’ initial experience, they compare favorably with series of similar procedures performed purely laparoscopically. PMID:10767793

Litwin, Demetrius E. M.; Darzi, Ara; Jakimowicz, Jacek; Kelly, John J.; Arvidsson, Dag; Hansen, Paul; Callery, Mark P.; Denis, Ronald; Fowler, Dennis L.; Medich, David S.; O’Reilly, Michael J.; Atlas, Henry; Himpens, Jacques M.; Swanstrom, Lee L.; Arous, Elias J.; Pattyn, Piet; Yood, Steven M.; Ricciardi, Rocco; Sandor, Andras; Meyers, William C.

2000-01-01

238

Laparoscopic Fluorescence Diagnosis for Intraabdominal Fluorescence Targeting of Peritoneal Carcinosis  

PubMed Central

Objective To assess 5-aminolevulinic acid (ALA)-induced protoporphyrin IX accumulation and fluorescence in peritoneal colon carcinoma metastases and its benefits for laparoscopic fluorescence diagnosis. Summary Background Data Occult, macroscopically nonvisible peritoneal micrometastases can be missed in laparoscopy or open surgery. Laparoscopic fluorescence diagnosis allows detection of these lesions after intraperitoneal lavage with ALA and subsequent fluorescence induction by blue-light excitation. Methods A disseminated peritoneal carcinosis was induced by laparoscopic implantation of colon carcinoma cells (CC531) in the peritoneum of 55 WAG/Rij rats. After 12 days of tumor growth the animals were randomized into 11 groups with different photosensitization parameters. Peritoneal lavage was performed either with 1.5% or 3.0% ALA solution, except for one control group. Photosensitization times were 0.5, 1, 2, 4, or 8 hours. Spectrometry was performed using an optical multichannel analyser. ALA and protoporphyrin IX serum levels were measured by high-performance liquid chromatography to determine systemic load. Results Protoporphyrin IX tumor accumulation and fluorescence peaked 2 to 4 hours after ALA application in both main groups, 1.5% and 3.0% ALA. Tumor detection rate was most effective in the 1.5% ALA group. Compared with conventional white-light laparoscopy alone, blue-light excitation detected 35% additional intraabdominal tumor foci. Conclusions Laparoscopic fluorescence diagnosis can increase the sensitivity and specificity of diagnostic staging laparoscopy. It allows determination of the extent of peritoneal carcinosis. Improved preoperative assessment helps to avoid unnecessary laparotomies and radical resections. PMID:11807366

Gahlen, Johannes; Prosst, Ruediger L.; Pietschmann, Matthias; Haase, Thomas; Rheinwald, Markus; Skopp, Gisela; Stern, Josef; Herfarth, Christian

2002-01-01

239

Percutaneous transhepatic cholangiography for choledocholithiasis after laparoscopic gastric bypass surgery  

PubMed Central

INTRODUCTION Gallstones are a common condition in bariatric patients after a laparoscopic Roux-en-Y gastric bypass (LRYGB). The management of ductal stones is challenging due to the altered gastrointestinal anatomy. Various techniques have been reported to manage bile duct stones. PRESENTATION OF CASE We present the successful percutaneous trans hepatic management of common bile duct stones after LRYGB. One year after a LRYGB for morbid obesity, a 59-year-old female presented with acute cholecystitis. One month after laparoscopic cholecystectomy a 1 cm calculus was found within the distal CBD and patient underwent a percutaneous trans hepatic cholangiography under local anesthetic. This involved a right sided anterior segmental duct puncture. With the sphincter dilated to 10 mm, a balloon catheter was used to push the stone into the duodenum leaving an internal- external drain. Patient recovered completely at follow up. DISCUSSION Patients with morbid obesity have a higher incidence of gallstones. After LRYGB, the altered anatomy does not allow the conventional endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis. Various techniques have been reported as means of managing bile duct stones in LRYGB patients. These include a double balloon enteroscope-assisted ERCP, laparoscopic transgastric ERCP, laparoscopic or open biliary surgery and interventional radiology. We report a non-surgical approach using percutaneous transhepatic technique under local anesthetic that resulted effective and could be applied more extensively. CONCLUSION Due to the increase of global obesity, bariatric centers need to strategically plan resources such as interventional radiology in order to manage post LRYGB choledocholithiasis safely, efficiently and in a cost effective manner. PMID:24705194

Milella, Marialessia; Alfa-Wali, Maryam; Leuratti, Luca; McCall, James; Bonanomi, Gianluca

2014-01-01

240

Laparoscopic splenectomy in patients of ? thalassemia: Our experience  

PubMed Central

BACKGROUND: Laparoscopic splenectomy has become a standard treatment of various haematological disorders, but its feasibility in the setting of ? thalassemia has not been established. MATERIALS AND METHODS: Fifty patients of ? thalassemia underwent laparoscopic splenectomy between January 2006 and December 2008. “Anterior approach” method was practiced in all cases, with early ligation of splenic artery and delayed ligation of splenic vein. Specimen was extracted piecemeal via the umbilical port in initial 12 cases, while in 37 cases the specimen was extracted through a 7-8-cm pfannenstiel incision. Twelve patients of ? thalassemia having grade IV splenomegaly with hepatomegaly were electively operated by conventional open method. RESULTS: The procedure was completed in 49 patients. One (2%) patient required conversion to open surgery. Mean operating time in the first 12 cases was 151 minutes (110-210 minutes), while in 37 cases of splenectomy completed laparoscopically it was 124 minutes (80-190 minutes) [P < 0.05]. Mean intra-operative blood loss was 73.8 ml (30–520 ml). No major intra-operative complications occurred. No patient required per-operative blood transfusion. Mean postoperative hospital stay was 4.7 days (2-11 days). Mean preoperative blood transfusion requirement was 11.98 units per patient per year, while mean postoperative blood transfusion requirement was 4.04 units [P< 0.05]. CONCLUSION: Laparoscopic splenectomy is feasible and safe even in patients of ? thalassemia with massive splenomegaly. Removal of specimen via a pfannenstiel incision significantly saves time, carries low morbidity and is a cosmetically acceptable alternative. PMID:20877478

Patle, Nirmal M; Tantia, Om; Sasmal, Prakash Kumar; Khanna, Shashi; Sen, Bimalendu

2010-01-01

241

Transumbilical Single-Incision Laparoscopic Resection of Focal Hepatic Lesions  

PubMed Central

Background and Objectives: Transumbilical single-incision laparoscopic surgery (SILS) is gaining in popularity as a minimally invasive technique. The reduced pain and superior cosmetic appearance it affords make it attractive to many patients. For this study, we focused on SILS, analyzing the outcomes of transumbilical single-incision laparoscopic liver resection (SILLR) achieved at our institution between January 2010 and February 2013. Patients and Methods: Pre- and postoperative data from 17 patients subjected to transumbilical SILLR for various hepatic lesions (8 hemangiomas, 2 hepatocellular carcinomas, 2 metastases, 2 calculi of left intrahepatic duct, and 3 adenomas) were assessed. Altogether, eight wedge resections, seven left lateral lobectomies, a combination wedge resection/left lateral lobectomy, and a proximal left hemihepatectomy segmentectomy were performed, as well as four simultaneous laparoscopic cholecystectomies. In each instance, three ports were installed through an umbilical incision. Once vessels and bleeding were controlled, the lesion(s) were resected with 5-mm margins of normal liver. Resected tissues were then bagged and withdrawn through the umbilical incision. The follow-up period lasted for a minimum of 6 months. Results: All 17 patients were successfully treated through a single umbilical incision. The procedures required 55 to 185 minutes to complete, with blood loss of 30 to 830 mL. Subjects regained bowel activity 0.8 to 2.3 days postoperatively and were discharged after 3 to 10 days. There were few complications (23.5%), limited to pleural effusion, wound infection, and incisional hernia. Conclusions: Transumbilical SILLR is challenging to perform through conventional laparoscopic instrumentation. The risk of bleeding and technical difficulties is high for lesions of the posterosuperior hepatic segment. Surgical candidates should be carefully selected to optimize the benefits of this technique. PMID:25392646

Yu, Xiao-Peng; Tian, Yu; Siwo, Ernest Amos; Li, Yongnan; Yu, Hong; Yao, Dianbo; Lv, Chao

2014-01-01

242

Efficacy of Laparoscopic Sacrocervicopexy for Apical Support of Pelvic Organ Prolapse  

PubMed Central

Background and Objectives: To evaluate the efficacy of laparoscopic sacrocervicopexy for apical support in sexually active patients with pelvic organ prolapse. Methods: One-hundred thirty-five women with symptomatic prolapse of the central compartment (Pelvic Organ Prolapse Quantitative [POP-Q] stage 2) underwent laparoscopic sacrocervicopexy. The operating physicians used synthetic mesh to attach the anterior endopelvic fascia to the anterior longitudinal ligament of the sacral promontory with subtotal hysterectomy. Anterior and posterior colporrhaphy was performed when necessary. The patients returned for follow-up examinations 1 month after surgery and then over subsequent years. On follow-up a physician evaluated each patient for the recurrence of genital prolapse and for recurrent or de novo development of urinary or bowel symptoms. We define “surgical failure” as any grade of recurrent prolapse of stage II or more of the POP-Q test. Patients also gave feedback about their satisfaction with the procedure. Results: The mean follow-up period was 33 months. The success rate was 98.4% for the central compartment, 94.2% for the anterior compartment, and 99.2% for the posterior compartment. Postoperatively, the percentage of asymptomatic patients (51.6%) increased significantly (P < .01), and we observed a statistically significant reduction (P < .05) of urinary urge incontinence, recurrent cystitis, pelvic pain, dyspareunia, and discomfort. The present study showed 70.5% of patients stated they were very satisfied with the operation and 18.8% stated high satisfaction. Conclusion: Laparoscopic sacrocervicopexy is an effective option for sexually active women with pelvic organ prolapse. PMID:23925017

Rosati, Maurizio; Bracale, Umberto; Pignata, Giusto; Azioni, Guglielmo

2013-01-01

243

Laparoscopic inguinal herniorrhaphy. Results of a multicenter trial.  

PubMed Central

OBJECTIVE: The purpose of this study was to determine if laparoscopic inguinal herniorrhaphy represents a viable alternative to the conventional repair and to assess whether a prospective randomized controlled trial comparing both procedures is warranted. METHODS: Three types of laparoscopic inguinal herniorrhaphies (transabdominal preperitoneal [TAPP], intraperitoneal onlay mesh [IPOM], and totally extraperitoneal [EXTRA]) were studied in a phase II design. Twenty-one investigators from 19 institutions participated. Approval from the local human research committee was required at each institution before patients could be enrolled. RESULTS: There were 686 patients with 869 hernias; 366 (42.1%) were direct, 414 (47.6%) were indirect, 22 (2.5%) were femoral, and 67 (7.7%) were combination hernias. The TAPP procedure was used for 562 hernias, the IPOM was used for 217 hernias, and the EXTRA was used for 87 hernias. Sixty-one patients had additional abdominal procedures performed at the time of laparoscopy without any adverse affects on their herniorrhaphies. The overall recurrence rate was 4.5%, with a minimum follow-up of 15 months. Complications were divided into the following three groups: 1) those related to laparoscopy, 2) those related to the patient, and 3) those related to the herniorrhaphy. Complications related to the laparoscopy occurred in 5.4% of patients; bleeding or abdominal wall hematomas occurred 31 times, (two patients required transfusion); one patient had bowel perforation, which was sutured laparoscopically; a bladder injury required laparotomy for management. Patient complications occurred in 6.7%. The majority involved the urinary tract (5.8%). Two patients required secondary abdominal procedures for adhesions, one for pain in the right lower quadrant and the other for adhesive small bowel obstruction. Postoperative myocardial infarction on day 5 resulted in the only operative mortality, for a rate of 0.1%. Complications related to the herniorrhaphy itself occurred in 17.1%. Most of these were minor, consisting of transient groin pain (3.5%), seroma (3.5%), transient leg pain (3.3%), hematoma (1.5%), or transient cord or testicular problems (0.9%). The incidence of leg pain decreased dramatically as surgeons became more familiar with the anatomy of the nerve supply to the groin when viewed laparoscopically. Ninety-three percent of patients were discharged within 24 hours of their operations. CONCLUSIONS: Laparoscopic inguinal herniorrhaphy is an effective method to correct an inguinal hernia. It can be offered safely to patients undergoing other abdominal procedures. The TAPP, IPOM, and EXTRA procedures appear to be equally effective. A controlled randomized trial is needed to compare this procedure with conventional inguinal herniorrhaphy. PMID:7826159

Fitzgibbons, R J; Camps, J; Cornet, D A; Nguyen, N X; Litke, B S; Annibali, R; Salerno, G M

1995-01-01

244

Laparoscopic management of gastric gastrointestinal stromal tumors  

PubMed Central

Gastrointestinal stromal tumors (GISTs) are the most frequent gastrointestinal tumors of mesodermal origin. Gastric GISTs represent approximately 70% of all gastrointestinal GISTs. The only curative option is surgical resection. Many surgical groups have shown good results with the laparoscopic approach. There have not been any randomized controlled trials comparing the open vs laparoscopic approach, and all recommendations have been based on observational studies. The experience obtained from gastric laparoscopic surgery during recent decades and the development of specific devices have allowed the treatment of most gastric GISTs through the laparoscopic approach. PMID:25031788

Correa-Cote, Juan; Morales-Uribe, Carlos; Sanabria, Alvaro

2014-01-01

245

Gasless laparoscopic hepatic resection for cirrhotic patients with solid liver tumors.  

PubMed

Gasless laparoscopic hepatic resection with a 5-cm minilaparotomy was performed in 10 cirrhotic patients with small liver tumors. To maintain good visualization and working space during hepatic resections, we developed a simple retraction system. Mean operative time and blood loss were 291 minutes and 249 mL, respectively. No blood transfusion was required during the operations. No serious complications occurred such as gas embolism. Our laparoscopic procedures had various advantages. Blood, smoke, and water vapor could be aspirated by suction without disturbance of the visual field. There was no risk of gas embolism. It was possible to use conventional instruments through the ports or the wound made by a minilaparotomy. Hemostasis therefore could be performed easily. The procedure could be applicable to cirrhotic patients with some complications. This laparoscopic procedure is recommended for patients with small HCCs associated with liver cirrhosis who are not candidates for major hepatectomy. PMID:12409698

Itamoto, Toshiyuki; Katayama, Koji; Miura, Yoshio; Hino, Hiroshi; Ohdan, Hideki; Tashiro, Hirotaka; Nakahara, Hideki; Sugino, Keizo; Asahara, Toshimasa

2002-10-01

246

Magnifying lenses assisted nerve-sparing radical hysterectomy and prevention of nerve plexus trauma.  

PubMed

The objectives of the study were to present a new approach for nerve-sparing radical hysterectomy (NSRH) with the assistance of magnifying lenses and to describe the differences in autonomic nerve plexus trauma between NSRH type III and conventional radical hysterectomy (RH) types II and III with the aid of immunohistochemistry. Eighteen women with FIGO stage IB(1)-IB(2) cervical cancer underwent loupes-assisted NSRH (n = 8), RH type II (n = 6), and RH type III (n = 4). Biopsies were taken intraoperatively from uterosacral ligament (USL) and cardinal ligament (CL), as well as from anterior vaginal wall (AVW) and posterior vaginal wall (PVW). Immunohistochemistry was approached with the use of S-100 protein, a general nerve marker. The percentage area of immunoreactivity (PAI) was used as an objective quantitative measure of nerve fibers within the ligaments. The PAI was greater in RH-III biopsies from both USL and CL (P < 0.001) when compared with RH-II and NSRH biopsies. For AVW and PVW, PAI differences were not statistically significant (AVW, P = 0.119; PVW, P = 0.067). Uterine-supporting ligaments represent a major pathway for autonomic nerves to the pelvic organs. As significantly more autonomic nerves are transected during the division of the uterine-supporting ligaments in RH type III, a more careful approach in the dissection of the ligaments through nerve-preserving techniques seems to be necessary in order to prevent iatrogenic intraoperative injury of the pelvic plexus and reduce or prevent postoperative complications. PMID:17892457

Mantzaris, G; Rodolakis, A; Vlachos, G; Athanasiou, S; Theocharis, S; Sotiripoulou, Ch M; Antsaklis, A

2008-01-01

247

Laparoscopic Management of Adnexal Masses  

PubMed Central

Background and Objective: Although laparoscopic surgery for removal of adnexal masses is common, controversy exists about the safety and efficacy of this procedure for patients with malignancies. The aim of this study was to evaluate the effectiveness and safety of laparoscopic surgical treatment for patients with adnexal masses. Methods: This was a retrospective chart review of one surgeon's experience in managing patients diagnosed with adnexal masses at 2 urban referral teaching hospitals in New York City. We reviewed the charts for 100 consecutive patients who underwent operative laparoscopy for management of adnexal masses between March 4, 1996 and November 9, 1998. Conversion to laparotomy, malignancy rate, complications, length of stay, and blood loss were recorded for each patient. Results: Laparoscopic management was successfully completed for 81 of the 100 patients in this study; however, 19 required conversion to laparotomy. All 81 patients managed laparoscopically had a benign diagnosis, whereas 7 of the 19 patients who underwent laparotomy were diagnosed with malignancy. The median length of stay, estimated blood loss, and operating room time were significantly lower for those treated by laparoscopy alone compared with those converted to laparotomy (2 vs. 7 days; 100 vs. 500 ccs; 130 vs. 235 minutes, respectively; P < 0.05). Though few patients were in the laparotomy group, that data are presented for completeness. A total of 10 complications occurred, 4 in the group of patients managed laparoscopically (2 enterotomies, 1 pneumothorax, and 1 vaginal cuff cellulitis). Six complications occurred in those managed with laparotomy (2 enterotomies, 2 wound infections, 1 pneumonia, and 1 postoperative fever). The indications for conversion to laparotomy were: 7 malignancies (5 ovarian cancers and 2 uterine cancers), 7 dense adhesions, 2 small bowel enterotomies, 1 intraoperative bleeding, 1 secondary to a large uterus (880 grams), and 1 secondary to a large myoma (13 cm x 14.5 cm x 6 cm). Conclusions: The laparoscopic approach is effective and safe for managing patients with adnexal masses of unknown pathology. Malignancies can be diagnosed accurately, converted to laparotomy, and staged appropriately. Adequate surgical skills along with timely use of frozen sections are required for successful operative management. PMID:11394427

Emeney, Pamela L.; Byrne, Daniel W.

2001-01-01

248

Is laparoscopic colorectal cancer surgery equal to open surgery? An evidence based perspective  

PubMed Central

Laparoscopic colorectal surgery (LCS) is an evolving subject. Recent studies show that LCS can not only offer safe surgery but evidence is growing that this new technique can be superior to classical open procedures. Fewer perioperative complications and faster postoperative recovery are regularly mentioned when studies of LCS are presented. Even though the learning curve of LCS is frequently debated when limitations of laparoscopic surgeries are reviewed, studies show that in experienced hands LCS can be a safe procedure for colorectal cancer treatment. The learning curve however, is associated with high conversion rates and economical aspects such as higher costs and prolonged hospital stay. Nevertheless, laparoscopic colorectal cancer surgery (LCCR) offers several advantages such as less co-morbidity and less postoperative pain in comparison with open procedures. Furthermore, the good exposure of the pelvic cavity by laparoscopy and the magnification of anatomical structures seem to facilitate pelvic dissection laparoscopically. Moreover, recent studies describe no difference in safety and oncological radicalness in LCCR compared to the open total mesorectal excision (TME). The oncological adequacy of LCCR still remains unproven today, because long-term results do not yet exist. To date, only a few studies have described the results of laparoscopic TME combined with preoperative adjuvant treatment for colorectal cancer. The aim of this review is to examine the various areas of development and controversy of LCCR in comparison to the conventional open approach. PMID:21160858

Künzli, Beat M; Friess, Helmut; Shrikhande, Shailesh V

2010-01-01

249

Laparoscopic implementation of the Altemeier procedure for recurrent rectal prolapse. Technical note  

PubMed Central

INTRODUCTION Many surgical options exist to treat rectal prolapse with different indications, feasibility and results in urgent and complicated cases. These include perineal or abdominal approaches including rectopexy with or without resection. Perineal approaches have reduced surgical invasivity and hospital stay if compared to transabdominal approaches by open surgery or laparoscopy. Up to now there was still a clear dividing line for surgical treatment between the perineal approach, used more for complicated emergency case while the transabdominal open, or laparoscopic approach more common in elective surgery, but more complex to perform. PRESENTATION OF CASE A 37 year old female patient affected by psychiatric disease presented with an unreducible second recurrence of a complicated rectal prolapse. The patient was treated with a third Altemeier procedure but now performed under laparoscopic control. The patient recovered promptly without any complication or recurrence up to the 24 months follow-up. DISCUSSION To the best of our knowledge, this is the first case report describing the combined laparoscopic-perineal approach for the treatment of a complicated recurrence of rectal prolapse. The technical feasibility, the rapidity, the optimal outcome and the rationale behind this option all suggest that this laparoscopic assistance certainly allows an implementation of the effectiveness, safety and results of an established effective perineal approach. CONCLUSION This combined approach has the advantage of maintaining the simplicity and rapidity of conventional perineal surgery, adding the advantages of abdominal control and avoiding the risks, the invasivity, and the longer duration of more complex laparoscopic procedures. PMID:24846791

La Greca, Gaetano; Sofia, Maria; Primo, Stefano; Randazzo, Valentina; Lombardo, Rosario; Russello, Domenico

2014-01-01

250

Single incision laparoscopic adjustable gastric band: technique, feasibility, safety and learning curve  

PubMed Central

Introduction Single incision laparoscopic surgery (SILS) is established in many procedures but not in bariatric surgery. One explanation may be that SILS is technically demanding in morbidly obese patients. This report describes our technique and experience with single incision laparoscopic adjustable gastric banding (SILAGB). Methods Prospective data collection was performed on consecutive obese patients who underwent SILAGB between November 2009 and February 2011. A single 3cm transverse incision in the right upper quadrant was used for a Covidien SILS™ multichannel access port. The technique is described with a standard pars flaccida approach and the ‘tips and tricks’ needed for a wide range of candidates using standard laparoscopic equipment. Results A total of 29 patients (27 female) with a median body mass index of 41kg/m2 (range: 35–52kg/m2) and median age of 44 years (range: 22–57 years) underwent SILAGB. There were no ‘conversions’ to a standard laparoscopic technique. Two cases required the addition of one single 5mm port. The only complications were two postoperative wound infections (one with a port site infection requiring replacement of the port) and one faulty band requiring replacement. There were therefore two returns to theatre and no 30-day deaths. All patients were discharged on the first postoperative day. In this series, operative times reduced significantly to be comparable with the conventional laparoscopic approach. Conclusions SILAGB is safe and feasible in the morbidly obese. Proficiency in this technique using conventional laparoscopic equipment can be achieved with a short learning curve. PMID:23484996

Osborne, AJ; Clancy, R; Clark, GWB

2013-01-01

251

Simultaneous laparoscopic adrenalectomy and laparoscopic nephron-sparing surgery – new experience with port placement  

PubMed Central

The aim of the study was to describe simultaneous laparoscopic adrenalectomy and laparoscopic nephron-sparing surgery, to discuss the details of a convenient laparoscopic approach and the way of port placement, as well as to present a review of the literature concerning combined laparoscopic procedures. A 72-year-old woman was admitted to our department because of a tumor of the right adrenal gland and a small tumor of the right kidney. The patient underwent simultaneous laparoscopic adrenalectomy and laparoscopic nephron-sparing surgery. The postoperative period was uncomplicated. The patient was discharged from the hospital on the 4th postoperative day. We believe that the proposed way of trocar placement would help to avoid a ‘rollover’ problem between the laparoscope and a Satinsky clamp or a ‘crossing swords’ problem between a Satinsky clamp and manipulators. PMID:24501608

Panek, Wojciech; Lewandowski, Jaroslaw; Tuchendler, Tomasz; Urba?czyk, Grzegorz; Litarski, Adam; Apozna?ski, Wojciech

2013-01-01

252

Vaginal antisepsis for hysterectomy: a review of the literature.  

PubMed

Infectious complications of hysterectomy remain common despite the use of prophylactic antibiotics. Most are caused by contamination of the surgical site by vaginal bacteria which are not controlled by current methods of pre-operative antisepsis. The medical literature concerning antiseptic preparation of the vagina for surgery was reviewed to discover the evidence on which practice may be based. A search using Medline, Current Contents, the Cochrane Library and the reference lists of articles on the subject and of major gynaecology textbooks produced 13 comparative studies. No conclusive randomized controlled trials were found and most of the studies had severe methodological problems limiting interpretation of their results. The scant available data suggest that use of vaginal antiseptics before the patient arrives in the operating room is probably not useful, and that application of povidone-iodine vaginal gel at the beginning of abdominal hysterectomy is sufficiently promising to justify further investigation. PMID:9403256

Eason, E L

1997-01-01

253

Postpartum Prolapsed Leiomyoma with Uterine Inversion Managed by Vaginal Hysterectomy  

PubMed Central

Background. Uterine inversion is a rare, but life threatening, obstetrical emergency which occurs when the uterine fundus collapses into the endometrial cavity. Various conservative and surgical therapies have been outlined in the literature for the management of uterine inversions. Case. We present a case of a chronic, recurrent uterine inversion, which was diagnosed following spontaneous vaginal delivery and recurred seven weeks later. The uterine inversion was likely due to a leiomyoma. This late-presenting, chronic, recurring uterine inversion was treated with a vaginal hysterectomy. Conclusion. Uterine inversions can occur in both acute and chronic phases. Persistent vaginal bleeding with the appearance of a prolapsing fibroid should prompt further investigation for uterine inversion and may require surgical therapy. A vaginal hysterectomy may be an appropriate management option in select populations and may be considered in women who do not desire to maintain reproductive function. PMID:25379314

Pieh-Holder, Kelly L.; DeVente, James E.

2014-01-01

254

Why Do Women Choose Endometrial Ablation Rather Than Hysterectomy?  

Microsoft Academic Search

Objective: To determine why women choose endometrial ablation rather than hysterectomy for the treatment of menorrhagia.Design: Observational study based on postal questionnaires.Setting: A university hospital.Patient(s): One hundred eighty randomly selected patients from a cohort of 658 patients who underwent endometrial ablation for the treatment of menorrhagia during the past 7 years.Intervention(s): None.Main Outcome Measure(s): Patient attitude about endometrial ablation.Result(s): One

Fritz Nagele; Tarina Rubinger; Adam Magos

1998-01-01

255

Laparoscopic Liver Resection in the Netherlands: How Far Are We?  

Microsoft Academic Search

Background: The objective of this study was to provide a systematic review on the introduction of laparoscopic liver surgery in the Netherlands, to investigate the initial experience with laparoscopic liver resections and to report on the current status of laparoscopic liver surgery in the Netherlands. Methods: A systematic literature search of laparoscopic liver resections in the Netherlands was conducted using

Jan H. M. B. Stoot; Edgar M. Wong-Lun-Hing; Ione Limantoro; Ruben Visschers; Olivier R. Busch; Richard Van Hillegersberg; Koert M. De Jong; Arjen M. Rijken; Geert Kazemier; Steven W. M. Olde Damink; Toine M. Lodewick; Marc H. A. Bemelmans; Ronald M. van Dam; Cornelis H. C. Dejong

2012-01-01

256

Complications of Laparoscopic Donor Nephrectomy  

Microsoft Academic Search

\\u000a “Laparoscopic donor nephrectomy is a unique surgical procedure due to the fact that the surgeon is operating on a healthy\\u000a individual in order to benefit another patient he or she is unlikely managing, with a potential for complications ensuing\\u000a in both the donor and the recipient patients. Overall surgical technique, anatomic considerations, and perioperative management\\u000a remain important for minimizing the

Alexei Wedmid; Michael A. Palese

257

Parametrial spread in patients with endometrial carcinoma undergoing radical hysterectomy.  

PubMed

The objective of this paper is to study parametrial involvement in patients with endometrial carcinoma undergoing radical hysterectomy. We reviewed indications for surgery, pathology findings, and outcome of a series of 24 patients with endometrial carcinoma who underwent radical hysterectomy. The uterus, cervix and parametrial tissue were processed as step-serial sections. Histologically, 16 patients (67%) had carcinoma involving the cervix. Two of these patients (8%) had frank histologic parametrial involvement and four (17%) had disease extending to the transitional zone of the cervix. Parametrial involvement was continuous and seen only in patients with involvement of the cervical stroma. Six patients (25%) had pelvic node metastases. With a median follow-up of 53 months (range 2-140), four patients (17%) developed recurrences (all within 24 months). Twelve patients (50%), including one of the two with parametrial invasion, were free of disease for 5 years or longer. We conclude that direct parametrial extension can occur in locally advanced endometrial cancer. Radical hysterectomy with lymphadenectomy can be an adequate operation for such patients. PMID:11240692

Tamussino, K. F.; Reich, O.; Gücer, F.; Moser, F.; Zivkovic, F.; Lang, P. F. J.; Winter, R.

2000-07-01

258

Pure laparoscopic hepatectomy as repeat surgery and repeat hepatectomy  

PubMed Central

AIM: To assess clinical outcomes of laparoscopic hepatectomy (LH) in patients with a history of upper abdominal surgery and repeat hepatectomy. METHODS: This study compared the perioperative courses of patients receiving LH at our institution that had or had not previously undergone upper abdominal surgery. Of the 80 patients who underwent LH, 22 had prior abdominal surgeries, including hepatectomy (n = 12), pancreatectomy (n = 3), cholecystectomy and common bile duct excision (n = 1), splenectomy (n = 1), total gastrectomy (n = 1), colectomy with the involvement of transverse colon (n = 3), and extended hysterectomy with extensive lymph-node dissection up to the upper abdomen (n = 1). Clinical indicators including operating time, blood loss, hospital stay, and morbidity were compared among the groups. RESULTS: Eighteen of the 22 patients who had undergone previous surgery had severe adhesions in the area around the liver. However, there were no conversions to laparotomy in this group. In the 58 patients without a history of upper abdominal surgery, the median operative time was 301 min and blood loss was 150 mL. In patients with upper abdominal surgical history or repeat hepatectomy, the operative times were 351 and 301 min, and blood loss was 100 and 50 mL, respectively. The median postoperative stay was 17, 13 and 12 d for patients with no history of upper abdominal surgery, patients with a history, and patients with repeat hepatectomy, respectively. There were five cases with complications in the group with no surgical history, compared to only one case in the group with a prior history. There were no statistically significant differences in the perioperative results between the groups with and without upper abdominal surgical history, or with repeat hepatectomy. CONCLUSION: LH is feasible and safe in patients with a history of upper abdominal surgery or repeat hepatectomy. PMID:25624731

Isetani, Masashi; Morise, Zenichi; Kawabe, Norihiko; Tomishige, Hirokazu; Nagata, Hidetoshi; Kawase, Jin; Arakawa, Satoshi

2015-01-01

259

[Possibilities of laparoscopic ultrasound diagnosis].  

PubMed

Both pre-operative transvaginal sonography and laparoscopical diagnosis leave gaps in the diagnosis of adnexal tumors. The combination of both methods seems to fill these gaps. For diagnosis with Laparoscopical Sonography a special scan head is needed: After removing the optical components there was a little linear-array installed into the original gastroscope with a diameter of only 9 mm which enables maximum flexibility during examinations. The linear-array consists of 128 crystals with a frequency of 7.5 MHz (penetration depth: 6 cm), enabling B-Image Sonography, Pulsed and Color Doppler as well as Angio-Color-Technique. Laparoscopical Sonography in addition to transvaginal and transabdominal sonography leads to progress in diagnosis and therapy. As the scan head can be placed directly in front of the area which is normally hardly detectable diagnosis is possible and plannings for the further operations as well as color-doppler controls during operations can be improved. In several cases this method allowed detection of metastases of the liver which were not visible by transabdominal ultrasound. PMID:8851098

Sohn, C; Wallwiener, D

1996-01-01

260

Laparoscopic pancreatectomy: Indications and outcomes  

PubMed Central

The application of minimally invasive approaches to pancreatic resection for benign and malignant diseases has been growing in the last two decades. Studies have demonstrated that laparoscopic distal pancreatectomy (LDP) is feasible and safe, and many of them show that compared to open distal pancreatectomy, LDP has decreased blood loss and length of hospital stay, and equivalent post-operative complication rates and short-term oncologic outcomes. LDP is becoming the procedure of choice for benign or small low-grade malignant lesions in the distal pancreas. Minimally invasive pancreaticoduodenectomy (MIPD) has not yet been widely adopted. There is no clear evidence in favor of MIPD over open pancreaticoduodenectomy in operative time, blood loss, length of stay or rate of complications. Robotic surgery has recently been applied to pancreatectomy, and many of the advantages of laparoscopy over open surgery have been observed in robotic surgery. Laparoscopic enucleation is considered safe for patients with small, benign or low-grade malignant lesions of the pancreas that is amenable to parenchyma-preserving procedure. As surgeons’ experience with advanced laparoscopic and robotic skills has been growing around the world, new innovations and breakthrough in minimally invasive pancreatic procedures will evolve. PMID:25339811

Liang, Shuyin; Hameed, Usmaan; Jayaraman, Shiva

2014-01-01

261

Laparoscopic pancreatectomy: indications and outcomes.  

PubMed

The application of minimally invasive approaches to pancreatic resection for benign and malignant diseases has been growing in the last two decades. Studies have demonstrated that laparoscopic distal pancreatectomy (LDP) is feasible and safe, and many of them show that compared to open distal pancreatectomy, LDP has decreased blood loss and length of hospital stay, and equivalent post-operative complication rates and short-term oncologic outcomes. LDP is becoming the procedure of choice for benign or small low-grade malignant lesions in the distal pancreas. Minimally invasive pancreaticoduodenectomy (MIPD) has not yet been widely adopted. There is no clear evidence in favor of MIPD over open pancreaticoduodenectomy in operative time, blood loss, length of stay or rate of complications. Robotic surgery has recently been applied to pancreatectomy, and many of the advantages of laparoscopy over open surgery have been observed in robotic surgery. Laparoscopic enucleation is considered safe for patients with small, benign or low-grade malignant lesions of the pancreas that is amenable to parenchyma-preserving procedure. As surgeons' experience with advanced laparoscopic and robotic skills has been growing around the world, new innovations and breakthrough in minimally invasive pancreatic procedures will evolve. PMID:25339811

Liang, Shuyin; Hameed, Usmaan; Jayaraman, Shiva

2014-10-21

262

Laparoscopic vs open hemicolectomy for colon cancer  

Microsoft Academic Search

Background: The role of laparoscopic resection in the management of colon cancer is still a subject of debate. In this clinical study, we compared the perioperative results and long-term outcome for two unselected groups of patients undergoing either laparoscopic or open hemicolectomy for colon cancer. Methods: This prospective nonrandomized study was based on a series of 248 consecutive patients operated

E. Lezoche; F. Feliciotti; A. M. Paganini; M. Guerrieri; A. De Sanctis; S. Minervini; R. Campagnacci

2002-01-01

263

Preoperative Evaluation of Complex Laparoscopic Patients  

Microsoft Academic Search

Complex laparoscopic patients require careful preoperative planning for optimal outcome. These patients present unique problems that necessitate special consideration and a surgeon experienced in basic laparoscopic cases. This chapter discusses a number of such patient groups, including patients with previous abdominal surgery, significant cardiopulmonary comorbidity, obesity, and pregnancy. When evaluating any of these patients, six questions should be asked: 1.

Dmitry Oleynikov; Karen D. Horvath IV

264

Cicatrical cecal volvulus following laparoscopic cholecystectomy.  

PubMed

Laparoscopic cholecystectomy is the procedure of choice for the treatment of symptomatic biliary disease. There is currently no agreement on the management of spilled gallstones, which commonly occurs during laparoscopic cholecystectomy and may produce significant morbidity. We present a case of spilled gallstones causing cicatrical cecal volvulus and also provide a review of pertinent literature. PMID:23925032

Morris, Michael W; Barker, Andrea K; Harrison, James M; Anderson, Andrew J; Vanderlan, Wesley B

2013-01-01

265

Comparative Study of Laparoscopic and Open Adrenalectomy  

Microsoft Academic Search

Background: Laparoscopic adrenalectomy (LA) had become the preferred operation for management of adrenal neoplasm. We conducted this cohort study to evalu- ate the outcome of laparoscopic and open adrenalectomy (OA). Methods: A total of 67 patients with complete medical records were included in this study. Thirty patients underwent OA and the other 37 patients received LA. The intraoperative and perioperative

Chun-Te Wu; Yang-Jen Chiang; Chien-Chung Chou; Kuan-Lin Liu; Sheng-Hui Lee; Ying-Hsu Chang; Cheng-Keng Chuang

266

[Laparoscopic sterilization using the tubal ring].  

PubMed

Interval ring laparoscopic sterilization, in line with law, was in the last four years performed in 103 women on the principles applied to other laparoscopic operations. There were ten immediate complications (7 technical and 3 surgical). One patient was subfebrile following surgery and one became pregnant a few months after sterilization. PMID:1836246

Rizner, T; Gregorac, D; Lavric, M

1991-01-01

267

[Laparoscopic partial nephrectomy: technique and outcomes].  

PubMed

The indication of laparoscopic partial nephrectomy (LPN) has evolved considerably, and the technique is approaching established status at our institution. Over the past 5 years, the senior author has performed more than 450 laparoscopic partial nephrectomies at the Cleveland Clinic. Herein we present our current technique, review contemporary data and oncological outcomes of LPN. PMID:16884101

Colombo, J R; Gill, I S

2006-05-01

268

Cicatrical Cecal Volvulus Following Laparoscopic Cholecystectomy  

PubMed Central

Laparoscopic cholecystectomy is the procedure of choice for the treatment of symptomatic biliary disease. There is currently no agreement on the management of spilled gallstones, which commonly occurs during laparoscopic cholecystectomy and may produce significant morbidity. We present a case of spilled gallstones causing cicatrical cecal volvulus and also provide a review of pertinent literature. PMID:23925032

Morris, Michael W.; Barker, Andrea K.; Harrison, James M.; Anderson, Andrew J.

2013-01-01

269

Comparison of Clinical Safety and Outcomes of Early versus Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis: A Meta-Analysis  

PubMed Central

Objective. To compare the clinical safety and outcomes of early laparoscopic cholecystectomy versus delayed laparoscopic cholecystectomy for acute cholecystitis. Methods. Pertinent studies were selected from the Medline, EMBASE, and Cochrane library databases, references from published articles, and reviews. Seven randomized controlled trials (early laparoscopic cholecystectomy versus delayed laparoscopic cholecystectomy) were selected. Conventional meta-analysis according to Cochrane Collaboration was used for the pooling of the results. Results. Seven trials with 1106 patients were included. There was no significant difference between the two groups in terms of bile duct injury (Peto odds ratio 0.49 (95% confidence interval 0.05 to 4.72); P = 0.54) or conversion to open cholecystectomy (risk ratio 0.91 (95% confidence interval 0.69 to 1.20); P = 0.50). The total hospital stay was shorter by 4 days for early laparoscopic cholecystectomy (mean difference ?4.12 (95% confidence interval ?5.22 to ?3.03) days; P < 0.00001). Conclusion. Early laparoscopic cholecystectomy during acute cholecystitis is safe and shortens the total hospital stay. PMID:25133217

Zhou, Min-Wei; Gu, Xiao-Dong; Xiang, Jian-Bin; Chen, Zong-You

2014-01-01

270

Successful Transfer of Open Surgical Skills to a Laparoscopic Environment Using a Robotic Interface: Initial Experience With Laparoscopic Radical Prostatectomy  

Microsoft Academic Search

PurposeFor a skilled laparoscopic surgeon the learning curve for achieving proficiency with laparoscopic radical prostatectomy (LRP) is estimated at 40 to 60 cases. For the laparoscopically naïve surgeon the curve is estimated at 80 to 100 cases. The development of a robotic interface might significantly shorten the LRP learning curve for an experienced open yet naïve laparoscopic surgeon. To our

THOMAS E. AHLERING; DOUGLAS SKARECKY; DAVID LEE; RALPH V. CLAYMAN

2003-01-01

271

A cost comparison of hysterectomy and hysteroscopic surgery for the treatment of menorrhagia  

Microsoft Academic Search

Objectives: To estimate and compare the costs of treating women with menorrhagia by hysterectomy or hysteroscopic surgery, in the form of transcervical resection of the endometrium (TCRE) or endometrial laser ablation (ELA). Study design: Randomised controlled trial set in the gynaecological department of a large British teaching hospital. Under usual circumstances, 204 women who would have undergone hysterectomy for menorrhagia

Isobel M. Cameron; Jill Mollison; Sheena B. Pinion; Audrey Atherton-Naji; Ken Buckingham; David Torgerson

1996-01-01

272

Peritoneal Closure vs. Non-Closure: Estimation of Pelvic Fluid by Transvaginal Ultrasonography after Abdominal Hysterectomy  

Microsoft Academic Search

Objective: To determine the volume of pelvic fluid and febrile morbidity after hysterectomy in which the peritoneum was or was not closed. Design: Prospective single-center study. Participants: Fifty-four women undergoing abdominal hysterectomy were enrolled in the study. Patients were randomized into two groups according to peritoneal closure: group I (n = 28) in which the peritoneum was closed, and group

Hesham Al-Inany

2004-01-01

273

Results of tension-free vaginal tape in patients with or without vaginal hysterectomy  

Microsoft Academic Search

Objective: To assess complications and cure rates of tension-free vaginal tape (TVT) procedure performed with or without vaginal hysterectomy. Study design: Retrospective comparison of 41 women with urinary incontinence treated by a TVT procedure alone and 40 combined with vaginal hysterectomy. Objective cure was evaluated by clinical and urodynamic examination and by the contilife questionnaire. All patients were operated under

Louis Jeffry; Bruno Deval; Anca Birsan; Olivier Kadoch; David Soriano

2002-01-01

274

A Qualitative Study of Women's Decisions Not to Have a Hysterectomy  

ERIC Educational Resources Information Center

In focusing on individual and physician demographics and system characteristics that lead to hysterectomy rate variations, researchers overlook the impact of culturally mediated meanings women assign to their bodies, hysterectomy, and other treatments. In this study I sought to provide a fuller description of this decision-making process by…

Fredericks, Erin

2013-01-01

275

Laparoscopic vs. laparoscopically assisted management of Meckel’s diverticulum in children  

PubMed Central

To investigate the management of Meckel’s diverticulum in children and the feasibility of using laparoscopic and laparoscopically assisted Meckel’s diverticulum resection and intestinal anastomosis according to the different subtypes classified laparoscopically. 55 symptomatic Meckel’s diverticulum cases were classified into two categories, the simple and the complex types depending on Meckel’s diverticulum appearance upon laparoscopic exploration. Forty-one cases of simple Meckel’s diverticulum were treated with simple diverticulectomy during laparoscopy, and 14 cases of complicated Meckel’s diverticulum were treated with laparoscopically assisted Meckel’s diverticulum resection and intestinal anastomosis. The operation time for the laparoscopically assisted was significant longer than laparoscopic-only surgeries [45~123 min (54.57 ± 20.17min) vs 29~78min (38.85 ± 9.75 min)], P = 0.013. Among the 55 cases, Just one child with simple type MD during laparoscopic exploration, and presented a diverticulum with a base that was considered to be in the mesangial margin. The remaining 54 patients were cured, and follow-up for 4~36 months revealed that they did not present abdominal pain, and no hematochezia occurred as a complication. Surgery selection either laparoscopy only or transumbilical laparoscopically assisted intestinal resection and intestinal anastomosis by laparoscopic exploration for Meckel’s diverticulum treatment, based on the type of Meckel’s diverticulum in children, is safe, feasible, and effective. PMID:25784978

Duan, Xufei; Ye, Guogang; Bian, Hongqiang; Yang, Jun; Zheng, Kai; Liang, Chong; Sun, Xuan; Yan, Xueqiang; Yang, Hu; Wang, Xin; Ma, Jingwei

2015-01-01

276

Single-Port Onlay Mesh Repair of Recurrent Inguinal Hernias after Failed Anterior and Laparoscopic Repairs  

PubMed Central

Background and Objectives: Despite the exponential increase in the use of laparoscopic inguinal herniorrhaphy, overall recurrence rates have remained unchanged. Therefore, a growing number of patients are presenting with recurrent hernias after conventional anterior and laparoscopic repairs have failed. This study reports our experience with single-incision laparoscopic (SIL) intraperitoneal onlay mesh (IPOM) repair of these hernias. Methods: Patients referred with two or more recurrences of inguinal hernia underwent SIL-IPOM from November 1, 2009, to June 24, 2014. A 2.5-cm infraumbilical incision was made, and an SIL port was placed intraperitoneally. Modified dissection techniques were used: chopstick and inline dissection, 5.5-mm/52-cm/30° angled laparoscope, and conventional straight dissecting instruments. The peritoneum was incised above the pubic symphysis, and dissection was continued laterally and proximally, raising the inferior flap below the previous extraperitoneal mesh while reducing any direct, indirect, femoral, or cord lipoma before placement of antiadhesive mesh, which was fixed to the pubic ramus, as well as superiorly, with nonabsorbable tacks before the inferior border was fixed with fibrin sealant. The inferior peritoneal flap was then tacked back onto the mesh. Results: Nine male patients underwent SIL-IPOM. Their mean age was 53 years and mean body mass index was 26.8 kg/m2. Mean mesh size was 275 cm2. Mean operation time was 125 minutes, with a hospital stay of 1 day. The umbilical scar length was 23 mm at the 6-week follow-up. There were no intra-/postoperative complications, port-site hernias, chronic groin pain, or recurrence of the hernia during a mean follow-up of 24 months. Conclusion: Inguinal hernias recurring after two or more failed conventional anterior and laparoscopic repairs can be safely and efficiently treated with SIL-IPOM.

Tran, Kim; Zajkowska, Marta; Lam, Vincent; Hawthorne, Wayne J.

2015-01-01

277

Laparoscopic intersphincteric resection using needlescopic instruments.  

PubMed

Intersphincteric resection (ISR) is a procedure designed to preserve anal function in cases with very low rectal cancer. We report our clinical experience with laparoscopic ISR (Lap ISR) performed using needlescopic instruments. First, a camera port is created at the umbilicus. Two 5-mm ports are then inserted at the right upper and lower quadrants. Two needlescopic forceps (Endo-Relief(™) Hope Denshi Co., Chiba, Japan) are inserted at the left upper and lower quadrants. We then perform the following procedures; ligation of the inferior mesenteric artery and vein, total mesorectal excision and dissection of the intersphincteric space. After the transanal intersphincteric dissection, the specimen is extracted through the anus and a hand -sewn coloanal anastomosis is performed. The covering ileostomy is finally created at the right upper port. We performed Lap ISR using needlescopic forceps in two patients with very low rectal cancer. In both cases, we were able to perform this procedure without insertion of an additional port or to change the needlescopic forceps to conventional 5-mm forceps. Lap ISR with needlescopic instruments is a feasible procedure for minimally invasive surgery. PMID:25336828

Sakamoto, Kazuhiro; Okazawa, Yu; Takahashi, Rina; Sugimoto, Kiichi; Komiyama, Hiromitsu; Takahashi, Makoto; Kojima, Yutaka; Goto, Michitoshi; Okuzawa, Atsushi; Tomiki, Yuichi

2014-10-01

278

Laparoscopic cholecystectomy: technique, safety, and results  

NASA Astrophysics Data System (ADS)

Laparoscopic cholecystectomy (LC) is a minimally invasive method of removing the diseased gallbladder. It was introduced into Lithuania in December 1992 and has gained wide acceptance. While LC offers many advantages over the conventional laparotomy procedure one of its drawbacks is delayed biliary complications. Those complications may be avoided with appropriate precautions. The aim of this research is to maximize the safety of LC. The potential way to solve this problem is to minimize the possible heat damage and electrical injury remote from the site of surgery during dissection of the cystic duct, cystic artery, and the gallbladder. Neodymium:YAG laser applications with endoscopic fiber have been investigated. The possibilities to use it as a scalpel and as coagulator to release the gallbladder from all its peritoneal attachments during LC have been investigated. The controversy over optimal sources for thermal dissection of the gallbladder has been performed. The potential benefits of Nd:YAG laser in surgery -- precise cutting, limited collateral tissue damage, and improved capillary and arteriole hemostasis -- have been found.

Simutis, Gintaras; Bubnys, A.; Vaitkuviene, Aurelija

1994-12-01

279

Hysterectomy and predictors for opioid prescription in a chronic pain clinic sample  

PubMed Central

Objectives To describe the prevalence of hysterectomy for women aged 18-45 seeking treatment at a chronic pain clinic, to describe patient characteristics (pain intensity, age, smoking status, hormone replacement status, and psychosocial factors) based on opioid and hysterectomy status, and to determine whether hysterectomy status predicted receipt of opioid prescription. Design Retrospective cross-sectional chart review. Participants Total 323 new female patients aged 18-45 who completed the Brief Pain Inventory-Short Form at initial evaluation at a chronic pain clinic during a 12-month period (July 2008- June 2009). Measures Data were collected from the Brief Pain Inventory and medical charts. Variables included opioid prescription, average pain intensity, pain type, age, hysterectomy status, smoking status, and pain-related dysfunction across domains measured by the Brief Pain Inventory. The association of opioid prescription with hysterectomy and other factors were determined by logistic regression. Results Prevalence of hysterectomy was 28.8%. Average pain intensity was not associated with either hysterectomy or opioid prescription status. However, hysterectomy and high levels of pain-related dysfunction were significantly and independently associated with opioid prescription after adjusting for age and pain intensity. More than 85% of women with hysterectomy and high pain-related dysfunction had opioid prescription. Conclusions Hysterectomy may confer risk for pain-related dysfunction and opioid prescription in women 45 and younger. More research is needed to understand (1) how patient characteristics influence prescribing patterns; and (2) the specific medical risks and consequences of chronic opioid therapy in this population. PMID:21223499

Darnall, Beth; Li, Hong

2010-01-01

280

First experience on laparoscopic near-infrared fluorescence imaging of hepatic uveal melanoma metastases using indocyanine green.  

PubMed

Background. Uveal melanoma is the most common primary intraocular tumor in adults, and up to 50% of patients will develop liver metastases. Complete surgical resection of these metastases can improve 5-year survival, but only a few patients are eligible for radical surgical treatment. The aim of this study was to introduce a near-infrared (NIR) fluorescence laparoscope during minimally invasive surgery for intraoperative identification of uveal melanoma hepatic metastases and to use it to provide guidance during resection. Methods. Three patients diagnosed with one solitary liver metastasis from uveal melanoma are presented. Patients received 10 mg indocyanine green (ICG) intravenously 24 hours before surgery. A NIR fluorescence laparoscope was used to detect malignant liver lesions. Results. In all 3 patients, laparoscopic NIR fluorescence imaging using ICG successfully identified uveal melanoma metastases. In 2 patients, multiple additional lesions were identified by inspection and NIR fluorescence imaging, which were not identified by preoperative conventional imaging. In one patient, one additional lesion, not identified by computed tomography, magnetic resonance imaging, laparoscopic ultrasonography, and inspection, was observed with NIR fluorescence imaging only. Importantly, NIR fluorescence imaging provided guidance during resection of these metastases. Conclusions. We describe the successful use of laparoscopic identification and resection of uveal melanoma liver metastases using NIR fluorescence imaging and ICG. This procedure is minimally invasive and should be used as complementary to conventional techniques for the detection and resection of liver metastases. PMID:24902685

Tummers, Quirijn R J G; Verbeek, Floris P R; Prevoo, Hendrica A J M; Braat, Andries E; Baeten, Coen I M; Frangioni, John V; van de Velde, Cornelis J H; Vahrmeijer, Alexander L

2015-02-01

281

Single-Port Laparoscopic Parastomal Hernia Repair with Modified Sugarbaker Technique  

PubMed Central

Introduction: Laparoscopic parastomal hernia repair with modified Sugarbaker technique has become increasingly the operation of choice because of its low recurrence rates. This study aimed to assess feasibility, safety, and efficiency of performing the same operation with single-incision laparoscopic surgery. Materials and Methods: All patients referred from March 2010 to February 2013 were considered for single-port laparoscopic repair with modified Sugarbaker technique. A SILS port (Covidien, Norwalk, Connecticut, USA) was used together with conventional straight dissecting instruments and a 5.5- mm/52-cm/30° laparoscope. Important technical aspects include modified dissection techniques, namely, “inline” and “chopsticks” to overcome loss of triangulation, insertion of a urinary catheter into an ostomy for ostomy limb identification, safe adhesiolysis by avoiding electocautery, saline -jet dissection to demarcate tissue planes, dissection of an entire laparotomy scar to expose incidental incisional hernias, adequate mobilization of an ostomy limb for lateralization, and wide overlapping of defect with antiadhesive mesh. Results: Of 6 patients, 5 underwent single-port laparoscopic repair, and 1 (whose body mass index [BMI] of 39.4 kg/m2 did not permit SILS port placement) underwent multiport repair. Mean defect size was 10 cm, and mean mesh size was 660 cm2 with 4 patients having incidental incisional hernias repaired by the same mesh. Mean operation time was 270 minutes, and mean hospital stay was 4 days. Appliance malfunction ceased immediately, and pain associated with parastomal hernia disappeared. There was no recurrence with a follow-up of 2 to 36 months. Conclusion: Compared with multiport repair, single-port laparoscopic parastomal repair with modified Sugarbaker technique is safe and efficient, and it may eventually become the standard of care. PMID:24680140

Turingan, Isidro; Zajkowska, Marta; Tran, Kim

2014-01-01

282

Splenic artery embolization using contour emboli before laparoscopic or laparoscopically assisted splenectomy.  

PubMed

The present study assessed preoperative splenic artery embolization using spherical embolic material, super absorbent polymer microspheres (SAP-MS), before laparoscopic or laparoscopically assisted splenectomy. Distal splenic artery embolization using 250 to 400 microm SAP-MS was performed in nine cases with ITP and in seven cases with the other diseases with splenomegaly. Laparoscopic or laparoscopically assisted splenectomies, including a hand-assisted procedure and the procedure involving left upper minilaparotomy, were done 2 to 4 hours after embolization. Conversion to traditional laparotomy was not required in any of the 16 cases, while conversion to 12-cm laparotomy was required in one case with massive splenomegaly. Mean operating time was 161 minutes, and mean intraoperative blood loss was 290 mL. No major postoperative complications were identified, and only one patient reported postembolic pain before surgery. Preoperative splenic artery embolization using painless embolic material, SAP-MS, would be effective for easy and safe laparoscopic or laparoscopically assisted splenectomy. PMID:12409699

Iwase, Kazuhiro; Higaki, Jun; Yoon, Hyung-Eun; Mikata, Shoki; Miyazaki, Minoru; Nishitani, Akiko; Hori, Shinichi; Kamiike, Wataru

2002-10-01

283

Laparoscopic splenectomy: lessons from the learning curve  

PubMed Central

Objective Initial reports suggest that laparoscopic splenectomy is a difficult procedure with a steep learning curve and limited scope. The objective of this study was to review various approaches to simplify the operation. Design A descriptive study of a prospective database. Setting A tertiary care teaching hospital. Patients Fifty-one consecutive patients, seen over a 4-year period, who underwent laparoscopic splenectomy (partial laparoscopic splenectomy in 1 patient) for a wide variety of disorders. Interventions Anterior and lateral surgical approaches to laparoscopic splenectomy and the selective use of preoperative splenic artery embolization. Main outcome measures Blood loss, morbidity, mortality and rate of conversion to open splenectomy, operating time and postoperative hospital stay. Results The morbidity (11%), death rate (2%), and rate of conversion were low. The recovery rate of accessory spleens was high (24%). Average operating time (3 hours), postoperative stay (3 days) and volume of blood loss improved with time. Conclusions Laparoscopic splenectomy is a reliable procedure for patients with spleens less than 20 cm long. For spleens 20 to 30 cm long, preoperative embolization is advisable, and the surgeon should be experienced. Laparoscopic splenectomy should not be performed for spleens more than 30 cm long. The lateral approach has eliminated most of the difficulty with this procedure for spleens less than 20 cm long (no embolization). The anterior approach is reserved for large spleens and partial laparoscopic splenectomy (with embolization). PMID:9492745

Poulin, Eric C.; Mamazza, Joseph

1998-01-01

284

Laparoscopic Repair of Paraesophageal Hernias  

PubMed Central

Background and Objectives: Laparoscopy has quickly become the standard surgical approach to repair paraesophageal hernias. Although many centers routinely perform this procedure, relatively high recurrence rates have led many surgeons to question this approach. We sought to evaluate outcomes in our cohort of patients with an emphasis on recurrence rates and symptom improvement and their correlation with true radiologic recurrence seen on contrast imaging. Methods: We retrospectively identified 126 consecutive patients who underwent laparoscopic repair of a large paraesophageal hernia between 2000 and 2010. Clinical outcomes were reviewed, and data were collected regarding operative details, perioperative and postoperative complications, symptoms, and follow-up imaging. Radiologic evidence of any size hiatal hernia was considered to indicate a recurrence. Results: There were 95 female and 31 male patients with a mean age (± standard deviation) of 71 ± 14 years. Laparoscopic repair was completed successfully in 120 of 126 patients, with 6 operations converted to open procedures. Crural reinforcement with mesh was performed in 79% of patients, and 11% underwent a Collis gastroplasty. Fundoplications were performed in 90% of patients: Nissen (112), Dor (1), and Toupet (1). Radiographic surveillance, obtained at a mean time interval of 23 months postoperatively, was available in 89 of 126 patients (71%). Radiographic evidence of a recurrence was present in 19 patients (21%). Reoperation was necessary in 6 patients (5%): 5 for symptomatic recurrence (4%) and 1 for dysphagia (1%). The median length of stay was 4 days. Conclusion: Laparoscopic paraesophageal hernia repair results in an excellent outcome with a short length of stay when performed at an experienced center. Radiologic recurrence is observed relatively frequently with routine surveillance; however, many of these recurrences are small, and few patients require correction of the recurrence. Furthermore, these small recurrent hernias are often asymptomatic and do not seem to be associated with the same risk of severe complications developing as the initial paraesophageal hernia. PMID:25392650

Borao, Frank; Squillaro, Anthony; Mansson, Jonas; Barker, William; Baker, Thomas

2014-01-01

285

Laparoscopic repair of complicated umbilical hernia with Strattice Laparoscopic™ reconstructive tissue matrix  

PubMed Central

INTRODUCTION Complex hernias continue to present a challenge. Surgical techniques for repair are carefully considered to reduce risk for complications. Laparoscopic repairs improve postoperative infection rates, and placement of biologic mesh decreases mesh infection rates. However, laparoscopic repairs using biologic mesh is generally challenging due to difficulty with maneuverability. PRESENTATION OF CASE We present a case of a complex ventral hernia that was laparoscopically repaired using a new FDA cleared laparoscopic biologic graft. The patient had multiple comorbidities, including obesity, hepatitis C, endocarditis secondary to IV drug use, tobacco smoking, bilateral inguinal hernia, and recurrent umbilical hernia. The recurrent hernia was larger, irreducible, and discolored compared to original defect. The patient underwent laparoscopic repair with primary closure and reinforcement with Strattice™ Tissue Matrix Laparoscopic (LifeCell Corporation, Branchburg, NJ). At nine months postoperative, the patient had no evidence of recurrence, infection, or chronic pain, demonstrating early success from the surgical management. DISCUSSION Presence of multiple comorbidities and incarcerated recurrent hernia increase risk for complications during and/or after hernia repair. Considering these factors, laparoscopic repair with Strattice Laparoscopic and defect closure was a reasonable technique for repair. CONCLUSION Laparoscopic suture repair reinforced with biologic dermal tissue matrix was successfully performed during a complex hernia repair. PMID:25437666

Tsuda, Shawn

2014-01-01

286

Present status of endoscopic surgery in Japan: laparoscopic surgery and laparoscopic assisted surgery for gastric cancer  

NASA Astrophysics Data System (ADS)

In this report, I would like to explain the latest data from the 7th National Survey 2004, by the Japan Society for Endoscopic Surgery (1). Next, I will explain you the comment on laparoscopic gastric cancer operation, in particular. We perform the following 3 surgical procedures. (1) Intragastric method (2) Laparoscopic lesion lifting method (3) Laparoscopic assisted gastric resection Mastery of basic techniques and thorough understanding of topographic anatomy are the most important (2). Furthermore, it is necessary for a surgeon with experience of at least 50 cases of laparoscopic surgery to be involved in surgery as an assistant.

Hiki, Yoshiki; Kitano, Seigo

2005-07-01

287

Alterations in hepatic function during laparoscopic surgery  

Microsoft Academic Search

Background: Very few studies have been done on the consequences of pneumoperitoneum on hepatic function. At present, there is no consensus\\u000a on the physiopathological hepatic implications of pneumoperitoneum. The purpose of this clinical study was to evaluate the\\u000a effects of pneumoperitoneum on hepatic function in 52 patients treated with laparoscopic procedures.\\u000a \\u000a \\u000a \\u000a \\u000a Methods: Thirty-two laparoscopic cholecystectomies and 20 nonhepatobiliary laparoscopic procedures

M. Morino; G. Giraudo; V. Festa

1998-01-01

288

Laparoscopic Heminephrectomy of a Horseshoe Kidney  

PubMed Central

Minimally invasive surgery has revolutionized surgery for urologic disorders, and laparoscopic procedures have become widely available for several different ablative and reconstructive operations. Laparoscopic heminephrectomy in patients with horseshoe kidney can be a technically challenging procedure due to aberrant vessels, functional parenchyma in the isthmus, and abnormal location. We report the management of a case of symptomatic nonfunctioning left moiety of a horseshoe kidney with emphasis on its surgical technique combined with a review of the literature. Laparoscopic heminephrectomy is a feasible option in the surgical management of benign and malignant conditions of the horseshoe kidney and can be performed safely using a transperitoneal or a retroperitoneal approach. PMID:21985738

Khan, Atif; Myatt, Andrew; Palit, Victor

2011-01-01

289

Fever and Diarrhea after Laparoscopic Bilioenteric Anastomosis  

PubMed Central

Bile duct injuries are well-known complications of laparoscopic and open cholecystectomies. Here, we report anastomosis of the common bile duct to the transverse colon that occurred as a complication of laparoscopic cholecystectomy. To the best of our knowledge, a similar case has not been reported in the literature so far. As in our patient, persistent diarrhea (in addition to fever and icterus) can be a warning sign of complication after these procedures. Surgeons who do advanced laparoscopic techniques must be familiar with this complication. PMID:21912066

Fazeli, Mohammad S.; Kazemeini, Alireza; Safari, Saeed; Larti, Farnoosh

2011-01-01

290

Technical Progress in Single-Incision Laparoscopic Cholecystectomy in Our Initial Experience  

PubMed Central

Single-incision laparoscopic cholecystectomy (SILC) has rapidly spread throughout the world because of its low invasiveness and because it is a scarless procedure. Various surgical methods of performing SILC are present in each institute; however, it is necessary to develop a standardized procedure that we can perform safely, such as the conventional 4-port laparoscopic cholecystectomy (LC). The SILC experiment in our institute was started by use of the commercial SILS Port and changed from a 3-port method via an umbilicus to a 2-port method to improve some problems. Although none of the conversions to conventional 4-port LC and also none of the complications such as bile duct injury occurred in each method, the 2-port method functioned best and was also economical. However, it is most important to adopt strict criteria and select the patients suitable for SILC to demonstrate SILC safety same as 4-port LC. PMID:22091367

Adachi, Tomohiko; Okamoto, Tatsuya; Ono, Shinichiro; Kanematsu, Takashi; Kuroki, Tamotsu

2011-01-01

291

[The role of hysterectomy during the repair of prolapse by promonotofixation].  

PubMed

In the past, hysterectomy was routinely performed at the time of pelvic organ prolapse repair. Nowadays, in patients with abnormal uterus (fibroma, dysplasia...), hysterectomy should be performed at the time of surgery. In contrast, in young women especially with desire of childbearing, uterus preservation is the best choice. But there is still a debate in postmenopausal patients with normal uterus and POP. There is currently no argument for choosing hysterectomy or uterus preservation at the time of POP repair in regard of the anatomical results for the middle as well as the anterior and posterior compartments. But it has been proven that hysterectomy increased the perioperative morbidity. Subtotal hysterectomy decreases this morbidity and result in a decreased rate of mesh erosion. To date, literature is not conclusive about the impact of hysterectomy on lower urinary tract symptoms. Patient's counselling is important before hysterectomy with adequate information about potential psychosexual consequences of such procedure. At least, if uterus preservation, patients must be aware of the risk of malignant diseases (cervix or endometrial carcinoma) even if the risk is low in case of a good screening preoperatively. PMID:19969271

Fatton, B; Wagner, L; Delmas, V; Haab, F; Costa, P

2009-12-01

292

Single-Incision Laparoscopic Repair of Spigelian Hernia  

PubMed Central

Introduction: Spigelian hernias represent only 1% to 2% of all abdominal wall hernias. The treatment, however, remains controversial but depends on institutional expertise. This case series reports the first experience with single-incision laparoscopic totally extraperitoneal (SILTEP) repair of Spigelian hernias with telescopic extraperitoneal dissection in combination with inguinal hernia repair. Methods: From February 2013 to April 2014, all patients referred with inguinal or Spigelian hernias, without histories of extraperitoneal intervention, underwent SILTEP repair with telescopic extraperitoneal dissection. A single-port device, 5.5 mm/52 cm/30° angled laparoscope, and conventional straight dissecting instruments were used for all cases. Extraperitoneal dissection was performed under direct vision with preservation of preperitoneal fascia overlying retroperitoneal nerves. Inguinal herniorrhaphy was performed with lightweight mesh that covered low-lying Spigelian defects. High-lying Spigelian defects were repaired with additional mesh. Results: There were 131 patients with 186 (92 direct) inguinal hernias and 7 patients with 8 Spigelian hernias (6 incidental, including 1 bilateral and 2 preoperatively diagnosed), with a mean age of 51.3 years and a mean body mass index of 25.1 kg/m2. An additional piece of mesh was used for 3 hernias. All Spigelian hernias were associated with direct inguinal hernias, and 8 combined inguinal and Spigelian hernias were successfully repaired with SILTEP repair with telescopic extraperitoneal dissection as day cases. There were no clinical recurrences during a mean follow-up period of 6 months (range, 1–15 months). Conclusions: Combined Spigelian and inguinal hernias can be successfully treated with SILTEP herniorrhaphy with telescopic extraperitoneal dissection. The high incidence of Spigelian hernias associated with direct inguinal hernias suggests a high index of suspicion for Spigelian hernias during laparoscopic inguinal herniorrhaphy. PMID:25722629

Tran, Kim; Zajkowska, Marta; Lam, Vincent; Hawthorne, Wayne J.

2015-01-01

293

Evaluation of Current Devices in Single-Incision Laparoscopic Colorectal Surgery: A Preliminary Experience in 32 Consecutive Cases  

Microsoft Academic Search

Background  Single-incision laparoscopic colorectal surgery (SILS) suggests a promising alternative to conventional laparoscopic surgery.\\u000a In this report we describe our initial experience with SILS for both right hemicolectomies and anterior resections.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Between June 2009 and May 2010, SILS was performed for 32 consecutive cases with benign and malignant pathology. Demographic\\u000a data, intraoperative parameters, postoperative data, and pathologic data were assessed.\\u000a \\u000a \\u000a \\u000a \\u000a Results  Twenty-one

Min-Hoe Chew; Mark Te-Ching Wong; Bernard Yon-Kuei Lim; Kheng-Hong Ng; Kong-Weng Eu

2011-01-01

294

Laparoscopic versus open posterior adrenalectomy: A case-control study of 100 patients  

Microsoft Academic Search

Background. Few controlled studies have compared laparoscopic transabdominal adrenalectomy (LA) to conventional open posterior adrenalectomy (PA).Methods. Fifty patients have undergone successful LA at our institution between 1992 and 1996. A matched case-control study of 50 PA patients was performed during a similar time period.Results. Follow-up was complete in 82% of patients with a mean follow-up time of 25 months. There

Geoffrey B Thompson; Clive S Grant; Jon A van Heerden; Richard T Schlinkert; William F Young; David R Farley; Duane M Ilstrup

1997-01-01

295

Laparoscopic extirpation of giant adrenal ganglioneuroma  

PubMed Central

Laparoscopic adrenalectomy is the standard of care for management of adrenal neoplasms. However, large sized adrenal lesions are considered as relative contraindication for laparoscopic extirpation. We report laparoscopic excision of giant ganglioneuroma of adrenal gland in a 33-year-old female patient. Patient was presented with left loin pain of 2 months duration. Computed tomography (CT) scan was suggestive of non-enhancing left suprarenal mass measuring 17 × 10 cm. Preoperative endocrine evaluation ruled out functional adrenal tumor. Patient underwent transperitoneal excision of suprarenal mass. The lesion could be completely extirpated laparoscopically. Duration of surgery was 250 minutes. Estimated blood loss was 230 milliliters. Specimen was extracted through pfannenstiel incision. No significant intraoperative or postoperative happenings were recorded. Microscopic features were suggestive of ganglioneuroma of adrenal gland. PMID:24501511

Abraham, George P; Siddaiah, Avinash T; Das, Krishanu; Krishnamohan, Ramaswami; George, Datson P; Abraham, Jisha J; Chandramathy, Sreerenjini K

2014-01-01

296

Should all distal pancreatectomies be performed laparoscopically?  

PubMed

Despite the relatively slow start of laparoscopic pancreatectomy relative to other laparoscopic resections, an increasing number of these procedures are being performed around the world. Operations that were once considered impossible to perform laparoscopically, such as pancreaticoduodenectomy and central pancreatectomy are gaining momentum. Technology continues to improve, as does surgical experience and prowess. There are both enough experience and data (though retrospective) to confirm that LDP with or without spleen preservation appears to be a safe treatment for benign or noninvasive lesions of the pancreas. Based on the fact that LDP can be performed with similar or shorter operative times, blood loss, complication rates, and length of hospital stay than ODP, it can be recommended as the treatment of choice for benign and noninvasive lesions in experienced hands when clinically indicated. It is very difficult to make clear recommendations with regard to laparoscopic resection of malignant pancreatic tumors due to the lack of conclusive data. As long as margins are negative and lymph node clearance is within accepted standards, LDP appears to have no untoward oncologic effects on outcome. Certainly more data, preferably in the manner of a randomized clinical trial, are needed before additional recommendations can be made. Potential benefits of laparoscopic resection for cancer include the ability to inspect the abdomen and abort the procedure with minimal damage if occult metastases are identified. This does not delay the onset of palliative chemotherapy, which would be the primary treatment in that circumstance. In fact, there is evidence to suggest that there is a greater likelihood of receiving systemic therapy if a laparotomy is avoided in patients who have radiologically occult metastases. Patients may also undergo palliative laparoscopic gastric and biliary bypass if indicated. Faster wound healing may also translate into a shorter waiting time before initiating adjuvant chemotherapy and/or radiation therapy. If the patient develops a wound infection, the infection should be more readily manageable with smaller incisions. Although not proven clinically relevant in humans, the reduction in perioperative stress associated with laparoscopic resection may translate to a cancer benefit for some patients. One report compared markers of systemic inflammatory response in 15 subjects undergoing left pancreatectomy. Eight had hand-access laparoscopic procedures and the rest had standard open surgery. The subjects in the laparoscopic group had statistically lower C-reactive protein levels than the open group on postoperative days one (5.5 mg/dL versus 9.7 mg/dL, P = .006) and three (8.5 mg/dL versus 17.7 mg/dL, P = .003), suggesting that the laparoscopic approach to left pancreatectomy is associated with less inflammation. While this report is underpowered, it supports the notion that MIS cancer surgery may induce less of a systemic insult to the body than standard open cancer surgery. More work in this area is necessary before any firm conclusions can be drawn. An important issue to consider is that of training surgeons to perform these complex procedures laparoscopically. Not all pancreatectomies are amenable to the laparoscopic approach, even in the most skilled hands. As such, only a percentage of cases will be performed this way and expectations to educate surgeons adequately to perform advanced laparoscopic procedures can be unrealistic, resulting in more "on-the-job" training. Another aspect that draws some controversy is that of the totally laparoscopic procedure versus the hand-access approach. No laparoscopic instrument provides the tactile feedback possible to obtain with the hand. The HALS approach allows for this, and the opportunity to control bleeding during the procedure. HALS also provides a way to improve confidence during the learning-curve phase of these operations. Finally, it is important to remember that if the procedure is failing to progress laparoscopically, or if cancer surgery princ

Merchant, Nipun B; Parikh, Alexander A; Kooby, David A

2009-01-01

297

Minimizing knot tying during reconstructive laparoscopic urology  

Microsoft Academic Search

ObjectivesIntracorporeal knot tying during urologic reconstructive surgery is one of the most technically challenging skills of laparoscopic surgery. We describe our experience using the Lapra-Ty clip to substitute for knot tying.

Arieh L. Shalhav; Marcelo A. Orvieto; Gary W. Chien; Albert A. Mikhail; Gregory P. Zagaja; Kevin C. Zorn

2006-01-01

298

Laparoscopic extirpation of giant adrenal ganglioneuroma.  

PubMed

Laparoscopic adrenalectomy is the standard of care for management of adrenal neoplasms. However, large sized adrenal lesions are considered as relative contraindication for laparoscopic extirpation. We report laparoscopic excision of giant ganglioneuroma of adrenal gland in a 33-year-old female patient. Patient was presented with left loin pain of 2 months duration. Computed tomography (CT) scan was suggestive of non-enhancing left suprarenal mass measuring 17 × 10 cm. Preoperative endocrine evaluation ruled out functional adrenal tumor. Patient underwent transperitoneal excision of suprarenal mass. The lesion could be completely extirpated laparoscopically. Duration of surgery was 250 minutes. Estimated blood loss was 230 milliliters. Specimen was extracted through pfannenstiel incision. No significant intraoperative or postoperative happenings were recorded. Microscopic features were suggestive of ganglioneuroma of adrenal gland. PMID:24501511

Abraham, George P; Siddaiah, Avinash T; Das, Krishanu; Krishnamohan, Ramaswami; George, Datson P; Abraham, Jisha J; Chandramathy, Sreerenjini K

2014-01-01

299

MDCT angiography of living laparoscopic renal donors.  

PubMed

Laparoscopic donor nephrectomy has become the accepted method of harvesting the kidney at many institutions because of multiple advantages over open donor nephrectomy. Spiral computed tomographic (CT) angiography provides accurate information of renal vascular anatomy and has become an accepted method of preoperative evaluation of potential laparoscopic renal donors. More recently, multidetector CT (MDCT) provides more detailed datasets compared with single-detector spiral CT and has been used for preoperative evaluation of laparoscopic donor nephrectomy to provide accurate anatomic information. MDCT (especially 16- and 64-slice MDCT) angiography has advantages over single-detector helical CT due to rapid scan time that allows coverage of a large volume of interest with higher spatial and temporal resolutions. In this article, we review the current status of MDCT angiography in the evaluation of laparoscopic renal donors and potential advantages of using this technology. PMID:16447094

Kawamoto, S; Fishman, E K

2006-01-01

300

Laparoscopic correction of intestinal malrotation in adult  

PubMed Central

Intestinal malrotation is rare in adults. Patients may present with acute obstruction or chronic abdominal pain. These symptoms are caused by Ladd's bands and narrow mesentery resulting from incomplete gut rotation. Barium, computed tomography (CT) and magnetic resonance imaging (MRI), angiography and sometimes explorative laparotomy are used for diagnosis. Ladd's procedure is the treatment of choice but data about laparoscopic approach in adult is scarce. We report three cases of laparoscopic correction of adult malrotation presenting with chronic abdominal pain. The diagnosis is made by CT/MRI. Laparoscopic Ladd's procedure (release of bands, broadening of mesentery and appendicectomy) was performed via three ports. Procedure time 25-45 min. All patients were discharged on postoperative day 2. At 6 month follow-up, all are symptom free. Laparoscopic Ladd's procedure is an acceptable alternative to the open technique in treating chronic symptoms of intestinal malrotation in adults. PMID:24761085

Panda, Nilanjan; Bansal, Nitin Kumar; Narasimhan, Mohan; Ardhanari, Ramesh

2014-01-01

301

Peritoneal changes due to laparoscopic surgery  

PubMed Central

Background Laparoscopic surgery has been incorporated into common surgical practice. The peritoneum is an organ with various biologic functions that may be affected in different ways by laparoscopic and open techniques. Clinically, these alterations may be important in issues such as peritoneal metastasis and adhesion formation. Methods A literature search using the Pubmed and Cochrane databases identified articles focusing on the key issues of laparoscopy, peritoneum, inflammation, morphology, immunology, and fibrinolysis. Results Laparoscopic surgery induces alterations in the peritoneal integrity and causes local acidosis, probably due to peritoneal hypoxia. The local immune system and inflammation are modulated by a pneumoperitoneum. Additionally, the peritoneal plasmin system is inhibited, leading to peritoneal hypofibrinolysis. Conclusion Similar to open surgery, laparoscopic surgery affects both the integrity and biology of the peritoneum. These observations may have implications for various clinical conditions. PMID:20552372

Lensvelt, M.; Rinkes, I. H. M. Borel; Klinkenbijl, J. H. G.; Reijnen, M. M. P. J.

2010-01-01

302

Oncological 3-port laparoscopic colectomy by 1 surgeon and 1 camera operator: a preliminary report.  

PubMed

This retrospective study analyzed the short-term outcomes of oncological reduced-port laparoscopic colectomy (RPLC) using 3 ports performed by 1 surgeon and 1 camera operator. Patients who underwent laparoscopic colectomy for colorectal carcinoma in 2010 and 2011 were divided into 2 groups: the CLC group, which included 62 patients who underwent a conventional laparoscopic colectomy and the RPLC group, which included 28 patients who underwent reduced-port laparoscopic colectomy, respectively. There were no significant differences between the groups with regard to TNM stage, estimated blood loss, complications, conversion rate, pain score, the length of postoperative stay, or the number of harvested lymph nodes. However, the prevalence of right-side colectomy was higher and the operative time was significantly shorter in the RPLC group. RPLC was technically feasible, providing that the appropriate patients were selected. Therefore, even though its surgical benefit might be subtle, we believe that RPLC definitively contributes to the reduction of equipment and manpower costs and will be considered as a standard procedure in the near future. PMID:23579514

Hasegawa, Fumi; Kawamura, Yutaka J; Sasaki, Junichi; Tsujinaka, Shingo; Konishi, Fumio

2013-04-01

303

Incidence of complications following laparoscopic hernioplasty  

Microsoft Academic Search

Smaller individual series on the outcome of laparoscopic hernioplasty techniques have been reported. This study reports on the complications of 3,229 laparoscopic hernia repairs performed by the authors in 2,559 patients. The TAPP (transabdominal preperitoneal) technique was the most frequently performed: 1,944 (60%). The totally preperitoneal technique was performed 578 (18%) times. The IPOM (intraperitoneal onlay mesh) repair was performed

E. H. Phillips; M. Arregui; B. J. Carroll; J. Corbitt; W. B. Crafton; M. J. Fallas; C. Filipi; R. J. Fitzgibbons; M. J. Franklin; B. McKernan; D. Olsen; A. Ortega; J. H. Payne; J. Peters; R. Rodriguez; P. Rosette; L. Schultz; A. Seid; R. Sewell; R. Smoot; F. Toy; R. Waddell; S. Watson

1995-01-01

304

Laparoscopic Gastric Banding after Heart Transplantation  

Microsoft Academic Search

Background: Obesity often complicates the postoperative course of heart transplant recipients. Laparoscopic adjustable gastric\\u000a banding (LAGB) represents a minimal invasive therapeutic possibility for weight reduction in non-transplanted patients. Case\\u000a Report: We report a 55-year-old diabetic, morbidly obese male (weight 138 kg, height 173 m, BMI 46 kg\\/m2) in whom 6 years after orthotopic heart transplantation, LAGB and laparoscopic cholecystectomy were

B. Ablassmaier; S. Klaua; C. A. Jacobi; J. M. Müller

2002-01-01

305

Complications of Laparoscopic and Robotic Pyeloplasty  

Microsoft Academic Search

\\u000a Treatment of ureteropelvic junction obstruction has increasingly shifted from open to minimally invasive surgery in the last\\u000a decade. Laparoscopic pyeloplasty in particular has become the standard of care for definitive treatment of this disease process\\u000a based on comparable mid- to long-term outcomes and improved morbidity compared to open surgery. Robotic- assisted laparoscopic\\u000a pyeloplasty has been increasingly performed in lieu of

Elias Hyams; Michael Stifelman

306

Complications of laparoscopic pyeloplasty in children  

Microsoft Academic Search

Introduction  Laparoscopic pyeloplasty in children has been proven to be safe and effective, with comparable results to open surgery. Due\\u000a to the extension of laparoscopic indications from ablative to reconstructive procedures requiring endoscopic suturing, most\\u000a centres have plateaued within their learning curve. Based on our own experience with a little more than 100 cases, we focus\\u000a on the complications and the

Rajendra B. Nerli; Mallikarjun Reddy; Vikram Prabha; Ashish Koura; Praveen Patne; M. K. Ganesh

2009-01-01

307

Laparoscopic renal cryoablation in 32 patients  

Microsoft Academic Search

Objectives. Laparoscopic renal cryoablation is a developmental minimally invasive nephron-sparing treatment alternative for highly select patients with small renal tumors. We present our evolving experience with this procedure.Methods. Thirty-two patients (34 tumors) with a mean tumor size of 2.3 cm on preoperative computed tomography underwent laparoscopic renal cryoablation. As dictated by the tumor location, cryoablation was performed by either the

Inderbir S Gill; Andrew C Novick; Anoop M Meraney; Roland N Chen; Michael G Hobart; Gyung Tak Sung; Jonathan Hale; Dana K Schweizer; Erick M Remer

2000-01-01

308

Laparoscopic liver resection of benign liver tumors  

Microsoft Academic Search

  Objective: The objective of this study was to assess the feasibility, safety, and outcome of laparoscopic liver resection\\u000a for benign liver tumors in a multicenter setting. Background: Despite restrictive, tailored indications for resection in benign\\u000a liver tumors, an increasing number of articles have been published concerning laparoscopic liver resection of these tumors.\\u000a Methods: A retrospective study was performed in 18

B. Descottes; D. Glineur; F. Lachachi; D. Valleix; J. Paineau; A. Hamy; M. Morino; H. Bismuth; D. Castaing; E. Savier; P. Honore; O. Detry; M. Legrand; J. S. Azagra; M. Goergen; M. Ceuterick; J. Marescaux; D. Mutter; B. Hemptinne; R. Troisi; J. Weerts; B. Dallemagne; C. Jehaes; M. Gelin; V. Donckier; R. Aerts; B. Topal; C. Bertrand; B. Mansvelt; L. Krunckelsven; D. Herman; M. Kint; E. Totte; R. Schockmel; J. F. Gigot

2003-01-01

309

Laparoscopic radical nephrectomy for advanced kidney cancer  

Microsoft Academic Search

The management of advanced renal cell carcinoma (RCC) continues to evolve. With the advent of laparoscopic radical nephrectomy\\u000a (LRN), minimally invasive approaches to kidney cancer have developed. Laparoscopic resection of locally advanced RCC yields\\u000a a similar cancer-control rate with the advantage of decreased morbidity. Although cytoreductive LRN is a technically challenging\\u000a procedure, it may be completed safely in selected patients.

Stephen E. Paulter; McClellan M. Walther

2002-01-01

310

Laparoscopic retrieval of intraabdominal foreign bodies  

Microsoft Academic Search

The use of laparoscopy has been described as the means of removing intraabdominal foreign bodies, both intraperitoneal and\\u000a intraluminal, from the stomach or bowel. An early report detailed the laparoscopic removal of translocated intrauterine devices\\u000a from the peritoneal cavity [2]. Laparoscopic removal of a retained surgical sponge also has been reported [1]. For large ingested objects that cannot be retrieved

Edward H. Chin; David Hazzan; Daniel M. Herron; Barry Salky

2007-01-01

311

MDCT angiography of living laparoscopic renal donors  

Microsoft Academic Search

Laparoscopic donor nephrectomy has become the accepted method of harvesting the kidney at many institutions because of multiple\\u000a advantages over open donor nephrectomy. Spiral computed tomographic (CT) angiography provides accurate information of renal\\u000a vascular anatomy and has become an accepted method of preoperative evaluation of potential laparoscopic renal donors. More\\u000a recently, multidetector CT (MDCT) provides more detailed datasets compared with

S. Kawamoto; E. K. Fishman

2006-01-01

312

Laparoscopic renal cryoablation: initial clinical series  

Microsoft Academic Search

Objectives. To present the technique and short-term results of retroperitoneal laparoscopic renal cryoablation.Methods. Ten patients underwent laparoscopic renal cryoablation of 11 exophytic renal tumors ranging in size from 1.5 to 3 cm identified on computed tomography. Tumors were located at the upper (3), middle (5), or lower (3) pole of the kidney. Three patients had a solitary kidney. A 3-port

Inderbir S Gill; Andrew C Novick; Jon J Soble; Gyung Tak Sung; Erick M Remer; Jonathan Hale; Charles M O’Malley

1998-01-01

313

Complications of laparoscopic paraesophageal hernia repair  

Microsoft Academic Search

The complications of laparoscopic paraesophageal hernia repair at two institutions were reviewed to determine the rate and\\u000a type of complications. A total of 76 patients underwent laparoscopic paraesophageal hernia repair between December 1992 and\\u000a April 1996. Seventy-one of them had fundoplication (6 required a Collis-Nissen procedure). Five patients underwent hernia\\u000a reduction and gastropexy only. There was one conversion to laparotomy.

Thadeus L. Trus; Tim Bax; William S. Richardson; Gene D. Branum; Susan J. Mauren; Lee L. Swanstrom; John G. Hunter

1997-01-01

314

Laparoscopic splenectomy in patients with hematologic diseases.  

PubMed Central

OBJECTIVE. The authors review their initial experience with laparoscopic splenectomy in patients with hematologic diseases. Efficacy, morbidity, and mortality of the technique are presented, and other patient recovery parameters are discussed. SUMMARY BACKGROUND DATA. Laparoscopic splenectomy is performed infrequently and data regarding its safety and efficacy are scarce. Factors such as a high level of technical difficulty, the potential for sudden, severe hemorrhage, and slow accrual of operative experience due to a relatively limited number of procedures are responsible. The potential patient benefits from the development of a minimally invasive form of splenectomy are significant. METHODS. Clinical follow-up, a prospective longitudinal database, and review of medical records were analyzed for all patients referred for elective splenectomy for hematologic disease from March 1992 to March 1995. RESULTS. Laparoscopic splenectomy was attempted in 43 patients and successfully completed in 35 (81%). Therapeutic platelet response to splenectomy occurred in 82% of patients with immune thrombocytopenic purpura and hematocrit level increased in 60% of patients with autoimmune hemolytic anemia undergoing successful laparoscopic splenectomy. The morbidity rate was 11.6% (5 of 43 patients), and the mortality rate was 4.7% (2 of 43 patients). Return of gastrointestinal function occurred in patients 23.1 hours after laparoscopic splenectomy and 76 hours after conversion to open splenectomy (p < 0.05). Mean length of stay was 2.7 days after laparoscopic splenectomy and 6.8 days after conversion to open splenectomy (p < 0.05). CONCLUSION. Laparoscopic splenectomy may be performed with efficacy, morbidity, and mortality rates comparable to those of open splenectomy for hematologic diseases, and it appears to retain other patient benefits of laparoscopic surgery. Images Figure 2. Figure 3. Figure 4. Figure 5. Figure 6. PMID:8678613

Flowers, J L; Lefor, A T; Steers, J; Heyman, M; Graham, S M; Imbembo, A L

1996-01-01

315

Laparoscopic Approaches to Pancreatic Endocrine Tumors  

Microsoft Academic Search

\\u000a Pancreatic endocrine tumors (PETs) are rare. Resection is the only curative treatment [1, 2]. A brief overview of the pathophysiology\\u000a and classification of PETs along with epidemiology and survival data is presented. The role of various diagnostic imaging\\u000a modalities is discussed and appropriate patient selection is presented as a guide. Laparoscopic and hand-assisted laparoscopic\\u000a (HALS) approaches to distal pancreatectomy, with

John B. Martinie; Stephen M. Smeaton

316

Update on laparoscopic pancreatectomy in 2010.  

PubMed

Minimally invasive surgery has been proven to be a safe and effective method of surgically managing several gastrointestinal conditions. In the last ten years, increased expertise in laparoscopic surgery and the availability of new surgical devices have contributed to the development of laparoscopic pancreatic surgery. Currently, distal pancreatectomies for benign/low-grade malignant tumors represent the majority of pancreatic resections performed laparoscopically. They are characterized by improved postoperative short-term outcomes compared to open surgery. Pancreaticoduodenectomy still represents a formidable technical challenge for laparoscopy. However, laparoscopic pancreaticoduodenectomy has been proven to be safe and feasible with outcomes comparable to those of open surgery if performed at experienced centers. Robotic surgery, recently introduced in the field of minimally invasive surgery, improves the view and the maneuverability of the instruments compared to standard laparoscopic surgery. The feasibility and safety of robotic pancreatectomy have been recently reported for complex pancreatic resection. This approach has the potential to bridge the gap between minimally invasive surgery and complex pancreatic surgery, allowing the indications for minimally invasive pancreatic surgery to be extended. Almost 15 years after its description, laparoscopic pancreatic surgery is seeing an exponential growth in its applications. The growing experience in laparoscopy and the introduction of robotics will further expand the field of minimally invasive pancreatic surgery in the next several years. PMID:21224799

Addeo, P; Giulianotti, P C

2010-12-01

317

Timing of laparoscopic cholecystectomy in acute cholecystitis.  

PubMed

Laparoscopic 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 the disease. PMID:8173120

Hawasli, A

1994-02-01

318

Automated Instrument Tracking in Robotically-Assisted Laparoscopic Surgery  

E-print Network

Automated Instrument Tracking in Robotically-Assisted Laparoscopic Surgery Darrin R. Uecker automated instrument localization and scope maneuvering in robotically-assisted laparoscopic surgery efficient in performing surgery without requiring additional use of the hands. Key Words: Laparoscopy

Wang, Yuan-Fang

319

Pure Laparoscopic and Robot-Assisted Laparoscopic Reconstructive Surgery in Congenital Megaureter: A Single Institution Experience  

PubMed Central

To report our experience of pure laparoscopic and robot-assisted laparoscopic reconstructive surgery in congenital megaureter, seven patients (one bilateral) with symptomatic congenital megaureter underwent pure laparoscopic or robot-assisted laparoscopic surgery. The megaureter was exposed at the level of the blood vessel and was isolated to the bladder narrow area. Extreme ureter trim and submucosal tunnel encapsulation or papillary implantations and anti-reflux ureter bladder anastomosis were performed intraperitoneally by pure laparoscopic or robot-assisted laparoscopic surgery. The clinical data of seven patients after operation were analyzed, including the operation time, intraoperative complications, intraoperative bleeding volumes, postoperative complications, postoperative hospitalization time and pathological results. All of the patients were followed. The operation was successfully performed in seven patients. The mean operation times for pure laparoscopic surgery and robotic-assistant laparoscopic surgery were 175 (range: 150–220) and 187 (range: 170–205) min, respectively, and the mean operative blood loss volumes were 20 (range: 10–30) and 28.75 (range: 15–20) ml, respectively. There were no intraoperative complications. The postoperative drainage time was 5 (range: 4–6) and 5.75 (range: 5–6) d, respectively, and the indwelling catheter time was 6.33 (range: 4–8) d and 7 (range: 7–7) d, respectively. The postoperative hospitalization time was 7.67 (range: 7–8) d and 8 (range: 7–10) d, respectively. There was no obvious pain, no secondary bleeding and no urine leakage after the operation. Postoperative pathology reports revealed chronic urothelial mucosa inflammation. The follow-up results confirmed that all patients were relieved of their symptoms. Both pure laparoscopic and robot-assisted laparoscopic surgery using different anti-reflux ureter bladder anastomoses are safe and effective approaches in the minimally invasive treatment of congenital megaureter. PMID:24924420

Zhang, Peng; Gao, Jiangping; Dong, Jun; Chen, Guangfu; Xu, Axiang; Ma, Xin; Li, Hongzhao; Shi, Lixin

2014-01-01

320

Pure laparoscopic and robot-assisted laparoscopic reconstructive surgery in congenital megaureter: a single institution experience.  

PubMed

To report our experience of pure laparoscopic and robot-assisted laparoscopic reconstructive surgery in congenital megaureter, seven patients (one bilateral) with symptomatic congenital megaureter underwent pure laparoscopic or robot-assisted laparoscopic surgery. The megaureter was exposed at the level of the blood vessel and was isolated to the bladder narrow area. Extreme ureter trim and submucosal tunnel encapsulation or papillary implantations and anti-reflux ureter bladder anastomosis were performed intraperitoneally by pure laparoscopic or robot-assisted laparoscopic surgery. The clinical data of seven patients after operation were analyzed, including the operation time, intraoperative complications, intraoperative bleeding volumes, postoperative complications, postoperative hospitalization time and pathological results. All of the patients were followed. The operation was successfully performed in seven patients. The mean operation times for pure laparoscopic surgery and robotic-assistant laparoscopic surgery were 175 (range: 150-220) and 187 (range: 170-205) min, respectively, and the mean operative blood loss volumes were 20 (range: 10-30) and 28.75 (range: 15-20) ml, respectively. There were no intraoperative complications. The postoperative drainage time was 5 (range: 4-6) and 5.75 (range: 5-6) d, respectively, and the indwelling catheter time was 6.33 (range: 4-8) d and 7 (range: 7-7) d, respectively. The postoperative hospitalization time was 7.67 (range: 7-8) d and 8 (range: 7-10) d, respectively. There was no obvious pain, no secondary bleeding and no urine leakage after the operation. Postoperative pathology reports revealed chronic urothelial mucosa inflammation. The follow-up results confirmed that all patients were relieved of their symptoms. Both pure laparoscopic and robot-assisted laparoscopic surgery using different anti-reflux ureter bladder anastomoses are safe and effective approaches in the minimally invasive treatment of congenital megaureter. PMID:24924420

Fu, Weijun; Zhang, Xu; Zhang, Xiaoyi; Zhang, Peng; Gao, Jiangping; Dong, Jun; Chen, Guangfu; Xu, Axiang; Ma, Xin; Li, Hongzhao; Shi, Lixin

2014-01-01

321

Laparoscopic training in residency program.  

PubMed

The use of laparoscopy in general surgery has provided surgeons with a new approach to multiple procedures. New techniques are being developed daily. Laparoscopic training for surgical residents must be incorporated into their curriculum. To decrease the risks of training residents on patients and to decrease operative time, a program of videoscopic "bench" training exercises, to improve eye-hand coordination, was instituted for junior residents. Between July and September 1995, nine surgical residents participated in this proficiency videoscopic study. At the end of the study, there was a statistically significant improvement in the residents performance by an average of 37% (P = 0.0109). This program proved to be both effective and economical. It can be reproduced and easily incorporated into any surgical residency program. PMID:8807518

Hawasli, A; Featherstone, R; Lloyd, L; Vorhees, M

1996-06-01

322

Multidetector row computed tomography evaluation of potential living laparoscopic renal donors: the story so far.  

PubMed

Renal transplantation is the treatment of choice for end-stage renal disease. Living related kidney donation is the major source of renal grafts due to limited availability of cadaveric kidneys. Open nephrectomy was used to harvest donor kidneys. However, the laparoscopic approach is associated with less postoperative pain and quick recovery. So, most centers now prefer a laparoscopic approach to explant donor kidneys. Laparoscopic approach is technically challenging due to limited operative visibility. Hence, accurate preoperative detection of renal arterial and venous anomalies is imperative to avoid inadvertent vascular injury and bleeding. The preoperative workup of renal donors includes clinical evaluation, laboratory tests, and imaging. Traditionally, the renal donors were evaluated with conventional imaging techniques, which included renal catheter angiography and intravenous urography. However, conventional imaging is invasive, expensive, and less accurate for evaluation of complex renal venous anomalies, small calculi, and diffuse or focal renal parenchymal lesions. The introduction of multidetector row computed tomography (MDCT) revolutionized the CT technology by enabling isotropic resolution with faster scan coverage in a single, short breath-hold. Consequently, MDCT has now replaced conventional imaging for comprehensive imaging of potential living renal donors. MDCT is a minimally invasive technique that can accurately detect urolithiasis, renal arterial and venous anomalies, renal parenchymal lesions, and urinary tract anomalies. Renal vascular anomalies detected by MDCT can help the surgeon in planning donor nephrectomy. MDCT with three-dimensional CT angiography enables accurate preoperative renal vascular mapping. This article reviews the role of MDCT in preoperative evaluation of potential laparoscopic renal donors. PMID:16701121

Namasivayam, Saravanan; Kalra, Mannudeep K; Small, William C; Torres, William E; Mittal, Pardeep K

2006-01-01

323

Laparoscopic sterilization with the band.  

PubMed

Silastic bands were developed independently by I.B. Yoon at Johns Hopkins Hospital and C.L. Lay at the University of South Florida. The use of bands as a mechanical method of tubal occlusion in laparoscopic tubal sterilization is a response to rare but disastrous thermal complications which have followed the use of electrocautery. Laparoscopy is carried out in the usual fashion with the patient in the lithotomy position with catheterization of the bladder and application of an instrument for uterine manipulation, insufflation of 1-2 liters of carbon dioxide through a Virres needle followed by insertion of the operating laparoscope. Either a double or single puncture technique is used. After the pelvis has been inspected, the fimbriated end of each tube is identified. The applicator is then used to grasp just the tube, about 3 cm from the cornu. The tube is then carefully drawn up into the applicator and the band is applied. Both sides are inspected following application of the bands to be sure that the loop of tube appears avascular. Trocars are removed and the skin incisions are closed. This may be done on an outpatient or inpatient basis. Complications are rare and most are related to trying to bring an edematous or infected tube or one bound down by adhesions into the applicator. The largest series reported so far of 902 patients, with 3,839 woman months following sterilization, shows only 1 pregnancy as a result of method failure. The use of the ring is simple, easy to teach, and avoids the complications of electrocautery. PMID:152344

1978-10-01

324

[Laparoscopic surgery performed for focal liver pathology of various etiology].  

PubMed

The own experience on surgical treatment of more than 400 patients, suffering parasytic and nonparasitic hepatic cysts, benign and malignant hepatic tumors, using laparoscopic technologies, was summarized. Indications for laparoscopic operations, the main technical aspects, immediate and late follow-up results were analyzed. Advantages of laparoscopic operations in comparison to open operative interventions in thoroughly selected patients were noted. PMID:25675778

Nychyta?lo, M Iu; Lytvynenko, O M; Zahri?chuk, M S; Lukecha, I I; Bulyk, I I; Homan, A V; Stokolos, A V; Prysiazhniuk, V V

2014-10-01

325

Trends in utilization and outcomes of laparoscopic versus open appendectomy  

Microsoft Academic Search

BackgroundAlthough a number of trials have analyzed the outcomes of laparoscopic versus open appendectomy, the clinical advantages, and cost-effectiveness of laparoscopic appendectomy in the management of acute and perforated appendicitis are still not clearly defined. The aim of this study was to examine utilization and outcomes of laparoscopic versus open appendectomy using a national administrative database of academic medical centers

Ninh T. Nguyen; Kambiz Zainabadi; Shahrazad Mavandadi; Mahbod Paya; C. Melinda Stevens; Jeffrey Root; Samuel E. Wilson

2004-01-01

326

Total laparoscopic live donor nephrectomy: a 6-year experience  

Microsoft Academic Search

BackgroundSince the introduction of the laparoscopic live donor nephrectomy in 1995, attempts have been made to depart from the total laparoscopic approach to the hand-assisted approach to decrease surgical time and complications. We present our 6-year experience with the total laparoscopic approach.

Abdelkader Hawasli; Richard Berri; Ahmed Meguid; Khoa Le; Henry Oh

2006-01-01

327

Real Time 3D Laparoscopic Ultrasonography Edward D. Light1  

E-print Network

1 Real Time 3D Laparoscopic Ultrasonography Edward D. Light1 , Salim F. Idriss2 , Kathryn F laparoscopic ultrasonography (3D LUS), and real time 3D transesophageal echocardiography (TEE fibrillation. Key Words: Laparoscopic Ultrasonography, Real Time 3D Imaging, 2D Array Transducer, Trocar

Smith, Stephen

328

Full Report The Use of Pneumoperitoneum During Laparoscopic  

E-print Network

Full Report The Use of Pneumoperitoneum During Laparoscopic Surgery as a Model to Study during laparoscopic surgery leads to diverse cardiovascular changes that can be used as a model to study (S1) obtained from the phonocardiogram, during laparoscopic surgery. Patients and Methods: Patients

Intrator, Nathan

329

VIRTUAL ENVIRONMENTS FOR TRAINING CRITICAL SKILLS IN LAPAROSCOPIC SURGERY  

E-print Network

VIRTUAL ENVIRONMENTS FOR TRAINING CRITICAL SKILLS IN LAPAROSCOPIC SURGERY MICHAEL DOWNES (1), M to a particular procedure. We have developed a prototype environment for training laparoscopic cholecystectomy.al., eds., IOS Press, Amsterdam, 1998. #12;Our group has focused on creating a simulation of laparoscopic

Cavusoglu, Cenk

330

SYSTEM FOR LAPAROSCOPIC TISSUE TRACKING Darin Knaus1  

E-print Network

SYSTEM FOR LAPAROSCOPIC TISSUE TRACKING Darin Knaus1 , Eric Friets1 , Jerry Bieszczad1 , Richard.miga@vanderbilt.edu, bob.galloway@vanderbilt.edu ABSTRACT This paper describes the development of a laparoscopic tissue with the actual anatomy encountered during surgery. The laparoscopic tissue tracking system relies on projection

Miga, Michael I.

331

Biomedical Paper Task Decomposition of Laparoscopic Surgery for  

E-print Network

Biomedical Paper Task Decomposition of Laparoscopic Surgery for Objective Evaluation of Surgical of the laparoscopic surgical skills of surgical residents is usually a subjective process carried out in the operating/tissue interactions (types and transitions) per- formed in laparoscopic surgery are skill-dependent, and (2

332

Laparoscopic Surgical Robot for Remote In Vivo Training Brian Allena  

E-print Network

Laparoscopic Surgical Robot for Remote In Vivo Training Brian Allena Brett Jordanb William Pannellb in advanced laparoscopic techniques. The Laparobot allows a student to practice surgery on a remotely located animal. The system uses standard laparoscopic tools for both the student's control interface

Faloutsos, Petros

333

Microline Surgical Articulating Laparoscopic Surgery Device Project Recap  

E-print Network

Microline Surgical Articulating Laparoscopic Surgery Device Project Recap · Due to IP restrictions an articulating laparoscopic surgery device to be manufactured by Microline Surgery. The device is capable. Laparoscopic surgery is a minimally invasive surgery, which is performed by making several small incisions

Demirel, Melik C.

334

Visual Tracking of Laparoscopic Instruments in Standard Training  

E-print Network

Visual Tracking of Laparoscopic Instruments in Standard Training Environments Brian F. ALLEN. We propose a method for accurately tracking the spatial mo- tion of standard laparoscopic instruments requires no modifications to the standard FLS training box, camera or instruments. Keywords. Laparoscopic

Faloutsos, Petros

335

Force Propagation Models in Laparoscopic Tools and Shahram Payandeh  

E-print Network

Force Propagation Models in Laparoscopic Tools and Trainers Shahram Payandeh Experimental Robotics in laparoscopic surgery are graspers and needle drivers. Although the operation of such basic tools are rather are beingfocused on developing a virtual laparoscopic trainers where the sense of touch in manipulating the virtual

336

Force Propagation Models in Laparoscopic Tools and Shahram Payandeh  

E-print Network

Force Propagation Models in Laparoscopic Tools and Trainers Shahram Payandeh Experimental Robotics in laparoscopic surgery are graspers and needle drivers. Although the operation of such basic tools are rather effort are being focused on developing a virtual laparoscopic trainers where the sense of touch

337

LONG-TERM FOLLOWUP AFTER LAPAROSCOPIC RADICAL NEPHRECTOMY  

Microsoft Academic Search

Purpose: Laparoscopic radical nephrectomy has been shown to be less morbid than traditional open radical nephrectomy. The long-term oncological effectiveness of laparoscopic radical ne- phrectomy remains to be established. Materials and Methods: At 3 centers patients undergoing laparoscopic radical nephrectomy before November 1, 1996 with pathologically confirmed renal cell carcinoma were identified. A representative group of patients undergoing open radical

ANDREW J. PORTIS; YAN YAN; JAIME LANDMAN; CATHY CHEN; PETER H. BARRETT; DONALD D. FENTIE; YOSHINARI ONO; ELSPETH M. McDOUGALL; RALPH V. CLAYMAN

2002-01-01

338

Laparoscopic paravaginal repair plus burch colposuspension: review and descriptive technique  

Microsoft Academic Search

The objective of this article was to review the available literature on laparoscopic Burch urethropexy cure rates and describe the authors’ laparoscopic technique and experience with Burch urethropexy and paravaginal repair. A MEDLINE search (1991 to 1999) was performed for articles describing the laparoscopic Burch urethropexy using suture to elevate and stabilize the paraurethral tissue. Also a retrospective chart review

John R Miklos; Neeraj Kohli

2000-01-01

339

LAPAROSCOPIC PARAVAGINAL REPAIR PLUS BURCH COLPOSUSPENSION: REVIEW AND DESCRIPTIVE TECHNIQUE  

Microsoft Academic Search

The objective of this article was to review the available literature on laparoscopic Burch urethropexy cure rates and describe the authors' laparoscopic technique and experience with Burch urethropexy and para- vaginal repair. A MEDLINE search (1991 to 1999) was performed for articles describing the laparoscopic Burch urethropexy using suture to elevate and stabilize the paraurethral tissue. Also a retrospective chart

JOHN R. MIKLOS

340

Development of a safe disposable laparoscope manipulator using hydraulic actuators  

Microsoft Academic Search

This paper describes the development of a novel laparoscope manipulator using the medical hydraulic linear actuators, called P-arm. The manipulator is composed of a Stewart-Gough Platform with six degrees of freedom and six hydraulic linear actuators, and can hold a general laparoscope. In the current prototype, the position of a laparoscope can be controlled through a joystick interface. To evaluate

Kazuhiro Taniguchi; Atsushi Nishikawa; Fumio Miyazaki; Takeharu Kobayashi; Kouhei Kazuhara; Takaharu Ichihara; Mitsugu Sekimoto; Shuji Takiguchi; Morito Monden

2007-01-01

341

Minireview on laparoscopic hepatobiliary and pancreatic surgery  

PubMed Central

The first laparoscopic cholecystectomy was performed in the mid-1980s. Since then, laparoscopic surgery has continued to gain prominence in numerous fields, and has, in some fields, replaced open surgery as the preferred operative technique. The role of laparoscopy in staging cancer is controversial, with regards to gallbladder carcinoma, pancreatic carcinoma, hepatocellular carcinoma and liver metastasis from colorectal carcinoma, laparoscopy in conjunction with intraoperative ultrasound has prevented nontherapeutic operations, and facilitated therapeutic operations. Laparoscopic cholecystectomy is the preferred option in the management of gallbladder disease. Meta-analyses comparing laparoscopic to open distal pancreatectomy show that laparoscopic pancreatectomy is safe and efficacious in the management of benign and malignant disease, and have better patient outcomes. A pancreaticoduodenectomy is a more complex operation and the laparoscopic technique is not feasible for this operation at this time. Robotic assisted pancreaticoduodenectomy has been tried with limited success at this time, but with continuing advancement in this field, this operation would eventually be feasible. Liver resection remains to be the best management for hepatocellular carcinoma, cholangiocarcinoma and colorectal liver metastases. Systematic reviews and meta-analyses have shown that laparoscopic liver resections result in patients with equal or less blood loss and shorter hospital stays, as compared to open surgery. With improving equipment and technique, and the incorporation of robotic surgery, minimally invasive liver resection operative times will improve and be more efficacious. With the incorporation of robotic surgery into hepatobiliary surgery, donor hepatectomies have also been completed with success. The management of benign and malignant disease with minimally invasive hepatobiliary and pancreatic surgery is safe and efficacious. PMID:24634709

Tan-Tam, Clara; Chung, Stephen W

2014-01-01

342

Minireview on laparoscopic hepatobiliary and pancreatic surgery.  

PubMed

The first laparoscopic cholecystectomy was performed in the mid-1980s. Since then, laparoscopic surgery has continued to gain prominence in numerous fields, and has, in some fields, replaced open surgery as the preferred operative technique. The role of laparoscopy in staging cancer is controversial, with regards to gallbladder carcinoma, pancreatic carcinoma, hepatocellular carcinoma and liver metastasis from colorectal carcinoma, laparoscopy in conjunction with intraoperative ultrasound has prevented nontherapeutic operations, and facilitated therapeutic operations. Laparoscopic cholecystectomy is the preferred option in the management of gallbladder disease. Meta-analyses comparing laparoscopic to open distal pancreatectomy show that laparoscopic pancreatectomy is safe and efficacious in the management of benign and malignant disease, and have better patient outcomes. A pancreaticoduodenectomy is a more complex operation and the laparoscopic technique is not feasible for this operation at this time. Robotic assisted pancreaticoduodenectomy has been tried with limited success at this time, but with continuing advancement in this field, this operation would eventually be feasible. Liver resection remains to be the best management for hepatocellular carcinoma, cholangiocarcinoma and colorectal liver metastases. Systematic reviews and meta-analyses have shown that laparoscopic liver resections result in patients with equal or less blood loss and shorter hospital stays, as compared to open surgery. With improving equipment and technique, and the incorporation of robotic surgery, minimally invasive liver resection operative times will improve and be more efficacious. With the incorporation of robotic surgery into hepatobiliary surgery, donor hepatectomies have also been completed with success. The management of benign and malignant disease with minimally invasive hepatobiliary and pancreatic surgery is safe and efficacious. PMID:24634709

Tan-Tam, Clara; Chung, Stephen W

2014-03-16

343

Triple, double- and single-incision laparoscopic cholecystectomy: a prospective study  

PubMed Central

Purpose: Advances in laparoscopic techniques have enabled complicated intra-abdominal surgical procedures to be made with less trauma and a better cosmetic appearance. The techniques have been developed by decreasing the number of incisions in conventional laparoscopic procedures in order to increase patient satisfaction. The aim of this study was to compare the results of cholecystectomies made with 3, 2 or a single incision. Method: A total of 95 cholecystectomy patients from Elbistan State Hospital and Suleyman Demirel University Hospital between 2011 and 2013 were prospectively evaluated. The patients were separated into 3 groups as triple incision laparoscopic cholecystectomy (TILC), double incision laparoscopic cholecystectomy (DILC) and single incision laparoscopic cholecystectomy (SILC). Patients were evaluated in respect of demographic characteristics, operation time, success rate, analgesia requirement, length of hospital stay and patient satisfaction. Results: Successful procedures were completed in 40 TILC, 40 DILC and 15 SILC cases. Transfer to open cholecystectomy was not required in any case. The mean duration of operation was 71 mins (range, 55-120 mins) for SILC cases, 45 mins (range, 32-125 mins) for DILC cases and 42 mins (range, 29-96 mins) for TILC cases. The mean time for the SILC cases was statistically significantly longer than the other two groups (p < 0.000). Conclusions: At a comparable level with DILC and TILC, single incision laparosccopic cholecystectomy is a method which can be used without incurring any extra costs or requiring additional instrumentation or training and which has good cosmetic results and a low requirement for analgesia. PMID:25419372

Sabuncuoglu, Mehmet Zafer; Benzin, Mehmet Fatih; Cakir, Tugrul; Sozen, Isa; Sabuncuoglu, Aylin

2014-01-01

344

Cost and Reimbursement for Three Fibroid Treatments: Abdominal Hysterectomy, Abdominal Myomectomy, and Uterine Fibroid Embolization  

SciTech Connect

Purpose. To compare costs and reimbursements for three different treatments for uterine fibroids. Methods. Costs and reimbursements were collected and analyzed from the Thomas Jefferson University Hospital decision support database from 540 women who underwent abdominal hysterectomy (n 299), abdominal myomectomy (n = 105), or uterine fibroid embolization (UFE) (n = 136) for uterine fibroids during 2000-2002. We used the chi-square test and ANOVA, followed by Fisher's Least Significant Difference test, for statistical analysis. Results. The mean total hospital cost (US$) for UFE was $2,707, which was significantly less than for hysterectomy ($5,707) or myomectomy ($5,676) (p < 0.05). The mean hospital net income (hospital net reimbursement minus total hospital cost) for UFE was $57, which was significantly greater than for hysterectomy (-$572) or myomectomy (-$715) (p < 0.05). The mean professional (physician) reimbursements for UFE, hysterectomy, and myomectomy were $1,306, $979, and $1,078, respectively. Conclusion. UFE has lower hospital costs and greater hospital net income than abdominal hysterectomy or abdominal myomectomy for treating uterine fibroids. UFE may be more financially advantageous than hysterectomy or myomectomy for the insurer, hospital, and health care system. Costs and reimbursements may vary amongst different hospitals and regions.

Goldberg, Jay, E-mail: jaygoldbergmd@yahoo.com; Bussard, Anne [Jefferson Medical College, Department of Obstetrics and Gynecology (United States); McNeil, Jean [Jefferson Medical College, Department of Finance (United States); Diamond, James [Jefferson Medical College, Department of Family Medicine (United States)

2007-02-15

345

Open randomised study of use of levonorgestrel releasing intrauterine system as alternative to hysterectomy  

PubMed Central

Objectives: To assess whether the levonorgestrel intrauterine system could provide a conservative alternative to hysterectomy in the treatment of excessive uterine bleeding. Design: Open randomised multicentre study with two parallel groups: a levonorgestrel intrauterine system group and a control group. Setting: Gynaecology departments of three hospitals in Finland. Subjects: Fifty six women aged 33-49 years scheduled to undergo hysterectomy for treatment of excessive uterine bleeding. Interventions: Women were randomised either to continue with their current medical treatment or to have a levonorgestrel intrauterine system inserted. Main outcome measure: Proportion of women cancelling their decision to undergo hysterectomy. Results: At 6 months, 64.3% (95% confidence interval 44.1 to 81.4%) of the women in the levonorgestrel intrauterine system group and 14.3% (4.0 to 32.7%) in the control group had cancelled their decision to undergo hysterectomy (P<0.001). Conclusions: The use of the levonorgestrel intrauterine system is a good conservative alternative to hysterectomy in the treatment of menorrhagia and should be considered before hysterectomy or other invasive treatments. PMID:9552948

Lähteenmäki, Pekka; Haukkamaa, Maija; Puolakka, Jukka; Riikonen, Ulla; Sainio, Susanna; Suvisaari, Janne; Nilsson, Carl Gustaf

1998-01-01

346

Laparoscopic right hemicolectomy with complete mesocolic excision provides acceptable perioperative outcomes but is lengthy — analysis of learning curves for a novice minimally invasive surgeon  

PubMed Central

Background Associated with reduced trauma, laparoscopic colon surgery is an alternative to open surgery. Furthermore, complete mesocolic excision (CME) has been shown to provide superior nodal yield and offers the prospect of better oncological outcomes. Methods All oncologic laparoscopic right colon resections with CME performed by a single surgeon since the beginning of his surgical practice were retrospectively analyzed for operative duration and perioperative outcomes. Results The study included 81 patients. The average duration of surgery was 220.0 (range 206–233) minutes. The initial durations of about 250 minutes gradually decreased to less than 200 minutes in an inverse linear relationship (y = ?0.58x × 248). The major complication rate was 3.6% ± 4.2% and the average nodal yield was 31.3 ± 4.1. CumulativeSum analysis showed acceptable complication rates and oncological results from the beginning of surgeon’s laparoscopic career. Conclusion Developing laparoscopic skills can provide acceptable outcomes in advanced right hemicolectomy for a surgeon who primarily trained in open colorectal surgery. Operative duration is nearly triple that reported for conventional laparoscopic right hemicolectomy. The slow operative duration learning curve without a plateau reflects complex anatomy and the need for careful dissection around critical structures. Should one wish to adopt this strategy either based on some available evidence of superiority or with intention to participate in research, one has to change the view of right hemicolectomy being a rather simple case to being a complex, lengthy laparoscopic surgery. PMID:25265107

Melich, George; Jeong, Duck Hyoun; Hur, Hyuk; Baik, Seung Hyuk; Faria, Julio; Kim, Nam Kyu; Min, Byung Soh

2014-01-01

347

Treatment of dysfunctional uterine bleeding: patient preferences for endometrial ablation, a levonorgestrel-releasing intrauterine device, or hysterectomy  

Microsoft Academic Search

ObjectiveTo investigate patient preferences for endometrial ablation and a levonorgestrel-releasing intrauterine device (IUD) as alternatives to hysterectomy in the treatment of dysfunctional uterine bleeding.

Petra Bourdrez; Marlies Y Bongers; Ben W. J Mol

2004-01-01

348

Hysterectomy: a medical-legal perspective, 1975 to 1985.  

PubMed

Since 1975 the crisis in professional liability has been the most important problem affecting the future of obstetrics and gynecology. Increasing numbers of physicians have stopped delivering babies and most obstetricians have decreased their high-risk obstetrics. Most of the attention in the specialty has been directed toward the liability problem in obstetrics as opposed to gynecology. The liability problem in gynecology is not insignificant, however, and has increased in importance in the last several years. This is particularly true in the areas of failure to diagnose and complications of surgery. This study reports on the closed cases involving hysterectomy from Norcal Mutual Insurance Company, a physician-owned mutual company founded in Northern California in 1975. A number of factors are analyzed in comparing those cases involving payment of money because of a settlement or loss at trial with those cases in which no money was paid. PMID:2360577

Whitelaw, J M

1990-06-01

349

Image acquisition in laparoscopic and endoscopic surgery  

NASA Astrophysics Data System (ADS)

Laparoscopic and endoscopic surgery rely uniquely on high quality display of acquired images, but a multitude of problems plague the researcher who attempts to reproduce such images for educational purposes. Some of these are intrinsic limitations of current laparoscopic/endoscopic visualization systems, while others are artifacts solely of the process used to acquire and reproduce such images. Whatever the genesis of these problems, a glance at current literature will reveal the extent to which endoscopy suffers from an inability to reproduce what the surgeon sees during a procedure. The major intrinsic limitation to the acquisition of high-quality still images from laparoscopic procedures lies in the inability to couple directly a camera to the laparoscope. While many systems have this capability, this is useful mostly for otolaryngologists, who do not maintain a sterile field around their scopes. For procedures in which a sterile field must be maintained, one trial method has been to use a beam splitter to send light both to the still camera and the digital video camera. This is no solution, however, since this results in low quality still images as well as a degradation of the image that the surgeon must use to operate, something no surgeon tolerates lightly. Researchers thus must currently rely on other methods for producing images from a laparoscopic procedure. Most manufacturers provide an optional slide or print maker that provides a hardcopy output from the processed composite video signal. The results achieved from such devices are marginal, to say the least. This leaves only one avenue for possible image production, the videotape record of an endoscopic or laparoscopic operation. Video frame grabbing is at least a problem to which industry has applied considerable time and effort to solving. Our own experience with computerized enhancement of videotape frames has been very promising. Computer enhancement allows the researcher to correct several of the shortcomings of both laparoscopic video systems and videotapes, namely color imperfections, scanline problems, and lack of image resolution for later display. We present a history of laparoscopic imaging, the current state of the art, and future prospects for high-resolution images from laparoscopic and endoscopic systems.

Gill, Brijesh S.; Georgeson, Keith E.; Hardin, William D., Jr.

1995-04-01

350

A fast stereo matching algorithm for 3D reconstruction of internal organs in laparoscopic surgery  

NASA Astrophysics Data System (ADS)

We propose a fast stereo matching algorithm for 3D reconstruction of internal organs using a stereoscopic laparoscope. Stoyanov et al. have proposed a technique for recovering the 3D depth of internal organs from images taken by a stereoscopic laparoscope. In their technique, the dense stereo correspondence is solved by registration of the entire image. However, the computational cost is very high because registration of the entire image requires multidimensional optimization. In this paper, we propose a new algorithm based on a local area registration method that requires only low-dimensional optimization for reduction of computational cost. We evaluated the computational cost of the proposed algorithm using a stereoscopic laparoscope. We also evaluated the accuracy of the proposed algorithm using three types of images of abdominal models taken by a 3D laser scanner. In the matching step, the size of the template used to calculate the correlation coefficient, on which the computational cost is strongly dependent, was reduced by a factor of 16 as compared with the conventional algorithm. On the other hand, the average depth errors were 4.68 mm, 7.18 mm, and 7.44 mm respectively, and accuracy was approximately as same as the conventional algorithm.

Okada, Yoshimichi; Koishi, Takeshi; Ushiki, Suguru; Nakaguchi, Toshiya; Tsumura, Norimichi; Miyake, Yoichi

2008-03-01

351

Visual search behaviour during laparoscopic cadaveric procedures  

NASA Astrophysics Data System (ADS)

Laparoscopic surgery provides a very complex example of medical image interpretation. The task entails: visually examining a display that portrays the laparoscopic procedure from a varying viewpoint; eye-hand coordination; complex 3D interpretation of the 2D display imagery; efficient and safe usage of appropriate surgical tools, as well as other factors. Training in laparoscopic surgery typically entails practice using surgical simulators. Another approach is to use cadavers. Viewing previously recorded laparoscopic operations is also a viable additional approach and to examine this a study was undertaken to determine what differences exist between where surgeons look during actual operations and where they look when simply viewing the same pre-recorded operations. It was hypothesised that there would be differences related to the different experimental conditions; however the relative nature of such differences was unknown. The visual search behaviour of two experienced surgeons was recorded as they performed three types of laparoscopic operations on a cadaver. The operations were also digitally recorded. Subsequently they viewed the recording of their operations, again whilst their eye movements were monitored. Differences were found in various eye movement parameters when the two surgeons performed the operations and where they looked when they simply watched the recordings of the operations. It is argued that this reflects the different perceptual motor skills pertinent to the different situations. The relevance of this for surgical training is explored.

Dong, Leng; Chen, Yan; Gale, Alastair G.; Rees, Benjamin; Maxwell-Armstrong, Charles

2014-03-01

352

Efficacy and oncologic safety of nerve-sparing radical hysterectomy for cervical cancer: a randomized controlled trial  

PubMed Central

Objective A prospective, randomized controlled trial was conducted to evaluate the efficacy of nerve-sparing radical hysterectomy (NSRH) in preserving bladder function and its oncologic safety in the treatment of cervical cancer. Methods From March 2003 to November 2005, 92 patients with cervical cancer stage IA2 to IIA were randomly assigned for surgical treatment with conventional radical hysterectomy (CRH) or NSRH, and 86 patients finally included in the analysis. Adequacy of nerve sparing, radicality, bladder function, and oncologic safety were assessed by quantifying the nerve fibers in the paracervix, measuring the extent of paracervix and harvested lymph nodes (LNs), urodynamic study (UDS) with International Prostate Symptom Score (IPSS), and 10-year disease-free survival (DFS), respectively. Results There were no differences in clinicopathologic characteristics between two groups. The median number of nerve fiber was 12 (range, 6 to 21) and 30 (range, 17 to 45) in the NSRH and CRH, respectively (p<0.001). The extent of resected paracervix and number of LNs were not different between the two groups. Volume of residual urine and bladder compliance were significantly deteriorated at 12 months after CRH. On the contrary, all parameters of UDS were recovered no later than 3 months after NSRH. Evaluation of the IPSS showed that the frequency of long-term urinary symptom was higher in CRH than in the NSRH group. The median duration before the postvoid residual urine volume became less than 50 mL was 11 days (range, 7 to 26 days) in NSRH group and was 18 days (range, 10 to 85 days) in CRH group (p<0.001). No significant difference was observed in the 10-year DFS between two groups. Conclusion NSRH appears to be effective in preserving bladder function without sacrificing oncologic safety. PMID:25872890

Roh, Ju-Won; Lee, Dong Ock; Lim, Myong Cheol; Seo, Sang-Soo; Chung, Jinsoo; Lee, Sun

2015-01-01

353

Robotic-assisted laparoscopic approaches to the ureter: Pyeloplasty and ureteral reimplantation  

PubMed Central

Introduction and Objectives: The benefits of robotic surgery when compared to standard laparoscopy have been well established, especially when it comes to reconstructive procedures. The application of robotic technology to laparoscopic pyeloplasty has reduced the steep learning curve associated with the procedure. Consequently, this has allowed surgeons who are less experienced with laparoscopy to offer this treatment to their patients, instead of referring them to centers of excellence. Robotic pyeloplasty has also proved useful for repairing secondary UPJO, a procedure which is considered extremely difficult using a conventional laparoscopic approach. Finally, the pursuit of scarless surgery has seen the development of laparoendoscopic single site (LESS) procedures. The application of robotics to LESS (R-LESS) has also reduced the difficulty in performing conventional LESS pyeloplasty. Herein we present a literature review with regards to robotic-assisted laparoscopic pyeloplasty. We also discuss the benefits of robotic surgery with regards to reconstruction of the lower urinary tract. Materials and Methods: A systematic literature review was performed using PubMed to identify relevant studies. There were no time restrictions applied to the search, but only studies in English were included. We utilized the following search terms: Ureteropelvic junction obstruction and laparoscopy; laparoscopic pyeloplasty; robotic pyeloplasty; robotic ureteric reimplantation; robotic ureteroneocystostomy; robotic boari flap; robotic psoas hitch. Results: There has been considerable experience in the literature with robotic pyeloplasty. Unfortunately, no prospective randomized studies have been conducted, however there are a number of meta analyses and systematic reviews. While there are no clear benefits when it comes to surgical and functional outcomes when compared to standard laparoscopic pyeloplasty, it is clear that robotics makes the operation easier to perform. There is also a benefit to the robotic approach when performing a redo-pyeloplasty. Robotic pyeloplasty has also been applied to the pediatric population, and there may be a benefit in older children while in very young patients, retroperitoneal open pyeloplasty is still the gold standard. In the field of single incision surgery R-LESS is technically easier to perform than conventional LESS. However, the design of the current robotic platform is not completely suited for this application, limiting its utility and often requiring a larger incision. Optimized R-LESS specific technology is awaited. What is clear, from a number of analyses, is that robotic pyeloplasty is considerably more expensive than the laparoscopic approach, largely due to costs of instrumentation and the capital expense of the robot. Until cheaper robotic technology is available, this technique will continue to be expensive, and a cost-benefit analysis must be undertaken by each hospital planning to undertake this surgery. Finally, the benefits of upper tract reconstruction apply equally to the lower tract although there is considerably less experience. However, there have been a number of studies demonstrating the technical feasibility of ureteral reimplantation. Conclusions: Robotic-assisted laparoscopic pyeloplasty is gaining popularity, likely due to the shorter learning curve, greater surgeon comfort, and easier intracorporeal suturing. This has allowed more surgeons to perform the procedure, improving accessibility. Robotic technology is also beneficial in the field of LESS. Nevertheless, the procedure still is not as cost-effective as the conventional laparoscopic approach, and until more affordable robotic technology is available, it will not be universally offered. PMID:25097316

Samarasekera, Dinesh; Stein, Robert J.

2014-01-01

354

Controlling difficult pelvic bleeding with argon beam coagulator during laparoscopic ultra low anterior resection.  

PubMed

In recent years, the standard of care for lower rectal tumors has developed to include a total mesorectal excision, which provides optimal long-term results. There has been debate with regard to the best approach for lower rectal tumors, conventional open versus less invasive procedures. As the trend toward less invasive surgical procedures progresses, similar complications, which are seen in open cases, are being encountered, such as the notorious presacral fascia bleed. These are small vessels, which are difficult to locate and control. Surgical literature suggests different methods during laparoscopic procedures. These include: placing lap pads and holding pressure, placing saline bag, placing tacks, using bone wax, and electrocautry at different settings. We present a case of a 57-year-old male, positive for lymph node disease, who underwent laparoscopic ultra low anterior resection with total mesorectal excision and protective loop ileostomy. PMID:21304367

Kandeel, Ahmed; Meguid, Ahmed; Hawasli, Abdelkader

2011-02-01

355

2002 IEEE Systems and Information Design SymposiumUniversity of Virginia VIDEO-BASED TRAINING FOR LAPAROSCOPIC SURGERY  

E-print Network

FOR LAPAROSCOPIC SURGERY Student team: K. Brook Green, Maranda S. Luniewski, Todd C. Mersch, Brian A. Mitchell, G, laparoscopic, video-based training ABSTRACT Current laparoscopic cholecystectomy surgical training programs training skillful surgeons. Laparoscopic cholecystectomy is the noninvasive surgical removal

Virginia, University of

356

Fluidic lens laparoscopic zoom camera for minimally invasive surgery  

NASA Astrophysics Data System (ADS)

This work reports a miniaturized laparoscopic zoom camera that can significantly improve vision for minimally invasive surgery (MIS), also known as laparoscopic surgery. The laparoscopic zoom camera contains bioinspired fluidic lenses that can change curvature and focal length in a manner similar to the crystalline lenses in human eyes. The traditional laparoscope is long, rigid, and made of fixed glass lenses with a fixed field of view. The constricted vision of a laparoscope is often an inconvenience and plays a role in many surgical injuries. To further advance MIS technology, we developed a new type of laparoscopic camera that has a total length of less than 17 mm, greater than 4× optical zoom, and 100 times higher sensitivity than today's laparoscope allowing it to work under illumination as low as 300 lux. All these unique features are enabled by the technology of bioinspired fluidic lenses having a dynamic range over 100 diopters and being convertible between a convex and concave shape.

Tsai, Frank S.; Johnson, Daniel; Francis, Cameron S.; Cho, Sung Hwan; Qiao, Wen; Arianpour, Ashkan; Mintz, Yoav; Horgan, Santiago; Talamini, Mark; Lo, Yu-Hwa

2010-05-01

357

Verification of Ultrasonic Image Fusion Technique for Laparoscopic Surgery  

NASA Astrophysics Data System (ADS)

Laparoscopic surgery is one of the most challenging surgical operations, because inside information about the target organ cannot be fully understood from the laparoscopic image. Therefore, a fusion technique of laparoscopic and ultrasonic images is proposed for guidance during laparoscopic surgery. The proposed technique can display the internal organ structure by overlaying a three-dimensional (3D) ultrasonic image over a 3D laparoscopic image, which is acquired using a stereo laparoscope. The registration of the 3D images is performed by registering the surface of the target organ, which is found in the two 3D images without requiring the use of an external position detecting device. The proposed technique was evaluated experimentally using a tissue-mimicking phantom. Results obtained led to registration accuracy better than 2 cm. The total computation time was 3.1 min on a personal computer (Xeon processor, 3 GHz CPU). The structural information permits the visualization of target organs during laparoscopic surgery.

Zenbutsu, Satoki; Igarashi, Tatsuo; Mamou, Jonathan; Yamaguchi, Tadashi

2012-07-01

358

The first total laparoscopic pancreatoduodenectomy in Poland  

PubMed Central

We present a case of a 55-year-old female patient with pancreatic head cancer who was treated with total laparoscopic pylorus-preserving pancreatoduodenectomy (TLPD) on 13.12.2013. The procedure as well as the postoperative course was uncomplicated. The patient was mobilized on the day of surgery; a liquid diet was introduced on day 1 and a full hospital diet on day 2 postoperatively. Drains were removed on the 3rd day after the procedure. Length of hospital stay was 6 days. The final pathology report confirmed the diagnosis of cancer. According to our knowledge this is the first report on total laparoscopic pancreatoduodenectomy in Poland performed by an entirely Polish team of surgeons. In our opinion, TLPD is feasible and similarly to other laparoscopic operations may improve postoperative recovery. PMID:25337173

Budzy?ski, Andrzej; Zub-Pokrowiecka, Anna; Zychowicz, Anna; Wierdak, Mateusz; Mat?ok, Maciej; Zaj?c, Ma?gorzata

2014-01-01

359

The technique of laparoscopic cholecystectomy in children.  

PubMed Central

Twelve children underwent elective laparoscopic cholecystectomy for symptomatic cholelithiasis during a 10-month period in one institution. The operative technique that has been described for adults was modified because of the smaller dimensions of pediatric patients. These modifications are discussed in this report, as are new alternatives for evaluating the common duct. No operative complications or conversions to open cholecystectomy occurred, and no complications after surgery were seen during an average follow-up period of 4.5 months. The benefits of laparoscopic cholecystectomy include decreased pain and ileus after surgery, shortened hospitalization, and improved cosmesis. Laparoscopic cholecystectomy is safe and efficacious in children, and it compares favorably with traditional cholecystectomy in the pediatric age group. Images FIG. 3. PMID:1532120

Davidoff, A M; Branum, G D; Murray, E A; Chong, W K; Ware, R E; Kinney, T R; Pappas, T N; Meyers, W C

1992-01-01

360

[Laparoscopic cholecystectomy: a prospective study of 1,775 unselected patients].  

PubMed

1775 patients with symptomatic cholecystolithiasis were treated by laparoscopic cholecystectomy without selection or contraindications. Complications should be compared with those of conventional cholecystectomy. 73.5% of our patients were female, the median age was 62 years (min. 9, max. 91 years). They presented uncomplicated cholecystolithiasis in 85%, acute cholecystitis in 11% and cirrhotic gallbladder in 4.5%. The rate of conversion to laparotomy was 2.9% for uncomplicated cholecystolithiasis and 11% for each cholecystitis and cirrhotic gallbladders. In general 4.4% were converted. These conversions were due to complications in 0.9% (bile duct lesions 0.7%, bowel perforation 0.2%), due to adhesions or inflammatory alterations in 3%. Perioperative letality was 0.3%, but only 0.15% were related directly to the operation. Other complications were bile duct strictures 0.3%, postoperative hemorrhage 0.3%, ileus 0.2%, perforation of diaphragm/pneumothorax 0.1%. Suspected bile duct stones were proved and treated by preoperative ERCP in 5.6%. Routinely performed intraoperative cholangiography detected unsuspected stones in 4%. These were removed mostly by postoperative ERCP. We consider laparoscopic cholecystectomy a safe method for the treatment of every stage of symptomatic cholecystolithiasis. There are no contraindications, if the operation is performed by an experienced team. Intraoperative cholangiography should remain standard. Complications in unselected patients are comparable to those of conventional cholecystectomy. The rate of bile duct lesions is equal (0.7%), a further decrease is expected (learning curve). According to this data, it is no longer justified, to perform cholecystectomy primarily by laparotomy, if there is experience with the laparoscopic method. Laparotomy by itself is no complication, it should be applied only, if the surgeon considers the operation inadequate to be continued laparoscopically. PMID:7610721

Morlang, T; Umscheid, T; Stelter, W J

1995-01-01

361

Massive Splenomegaly in Children: Laparoscopic Versus Open Splenectomy  

PubMed Central

Background and Objectives: Laparoscopic splenectomy for massive splenomegaly is still a controversial procedure as compared with open splenectomy. We aimed to compare the feasibility of laparoscopic splenectomy versus open splenectomy for massive splenomegaly from different surgical aspects in children. Methods: The data of children aged <12 years with massive splenomegaly who underwent splenectomy for hematologic disorders were retrospectively reviewed in 2 pediatric surgery centers from June 2004 until July 2012. Results: The study included 32 patients, 12 who underwent laparoscopic splenectomy versus 20 who underwent open splenectomy. The mean ages were 8.5 years and 8 years in the laparoscopic splenectomy group and open splenectomy group, respectively. The mean operative time was 180 minutes for laparoscopic splenectomy and 120 minutes for open splenectomy. The conversion rate was 8%. The mean amount of intraoperative blood loss was 60 mL in the laparoscopic splenectomy group versus 110 mL in the open splenectomy group. Postoperative atelectasis developed in 2 cases in the open splenectomy group (10%) and 1 case in the laparoscopic splenectomy group (8%). Oral feeding postoperatively resumed at a mean of 7.5 hours in the laparoscopic splenectomy group versus 30 hours in the open splenectomy group. The mean hospital stay was 36 hours in the laparoscopic splenectomy group versus 96 hours in the open splenectomy group. Postoperative pain was less in the laparoscopic splenectomy group. Conclusion: Laparoscopic splenectomy for massive splenomegaly in children is safe and feasible. Although the operative time was significantly greater in the laparoscopic splenectomy group, laparoscopic splenectomy was associated with statistically significantly less pain, less blood loss, better recovery, and shorter hospital stay. Laparoscopic splenectomy for pediatric hematologic disorders should be the gold-standard approach regardless of the size of the spleen. PMID:25392624

Al Ali, Khalid

2014-01-01

362

Ureteral Injury After Laparoscopic Versus Open Colectomy  

PubMed Central

Background and Objectives: Ureteral injury is an infrequent but potentially lethal complication of colectomy. We aimed to determine the incidence of intraoperative ureteral injury after laparoscopic and open colectomy and to determine the independent morbidity and mortality rates associated with ureteral injury. Methods: We analyzed data from the National Surgical Quality Improvement Program for the years 2005–2010. All patients undergoing colectomy for benign, neoplastic, or inflammatory conditions were selected. Patients undergoing laparoscopic colectomy versus open colectomy were matched on disease severity and clinical and demographic characteristics. Multivariate logistic regression analyses and coarsened exact matching were used to determine the independent difference in the incidence of ureteral injury between the 2 groups. Multivariate models were also used to determine the independent association between postoperative complications associated with ureteral injury. Results: Of a total of 94 526 colectomies, 33 092 (35%) were completed laparoscopically. Ureteral injury occurred in a total of 585 patients (0.6%). The crude incidence in the open group was higher than that in the laparoscopic group (0.66% versus 0.53%, P = .016). CEM produced 14 630 matching pairs. Matched analysis showed the likelihood of ureteral injury after laparoscopic colectomy to be 30% less than after open colectomy (odds ratio, 0.70; 95% confidence interval, 0.51–0.96). Patients with ureteral injury were independently more likely to have septic complications and have longer lengths of hospital stay than those without ureteral injury. Conclusion: Laparoscopic colectomy is associated with a lower incidence of intraoperative ureteral injury when compared with open procedures. Ureteral injury leads to significant postoperative morbidity even if identified and repaired during the colectomy. PMID:25392666

Ahaghotu, Chiledum A.; Libuit, Laura; Ortega, Gezzer; Coleman, Pamela W.; Cornwell, Edward E.; Tran, Daniel D.; Fullum, Terrence M.

2014-01-01

363

Psychological outcomes after hysterectomy for benign conditions: a systematic review and meta-analysis.  

PubMed

Hysterectomy is one of the commonest operative procedures in the developed world, mostly occurring among premenopausal women, with contradictory results regarding post-operative psychological wellbeing. This review aims to inform practice by examining whether hysterectomy predicts depression or anxiety outcomes. We searched PubMed, EMBASE, and PsycINFO electronic databases for articles published before November 2012. Reference lists of relevant articles were hand searched, and expert opinions were sought. Refereed studies investigating an association between hysterectomy for benign (non-cancerous) conditions and post-operative symptoms of depression or anxiety were chosen for this review. Two authors independently abstracted data from original articles. Authors of relevant studies were contacted for data that could not be extracted from the published articles. Review Manager 5.1 was used throughout the meta-analysis to calculate the summary relative risks (RRs), and the weighted standardized mean difference (WstdMD), and their corresponding 95% confidence intervals (CI). A random effects model was used in data analysis and verified using a fixed effect model. Overall, hysterectomy was associated with a decreased risk of clinically relevant depression (RR=1.69, 95% CI 1.19-2.38). Additionally, hysterectomy was associated with a decrease in standardized depression outcomes (standardized mean difference (SMD) 0.38 (95% CI 0.27-0.49)). Conversely, there was no significant association between hysterectomy and risk of clinically relevant anxiety (RR=1.41, 95% CI 0.72-2.75). In conclusion, data from before and after studies suggest that hysterectomy for benign gynecological conditions is not adversely associated with anxiety and may be positively rather than adversely associated with depression. PMID:24398028

Darwish, Maram; Atlantis, Evan; Mohamed-Taysir, Tamara

2014-03-01

364

Laparoscopic colorectal anastomosis: risk of postoperative leakage  

Microsoft Academic Search

Background: We report on a prospective observational multicenter study of more than 1,000 consecutive patients undergoing laparoscopic\\u000a colorectal procedures. The aim of the current study was to investigate the safety of laparoscopic colorectal surgery as reflected\\u000a by the anastomotic insufficiency rates in the various sections of the bowel, and to compare these rates with those of open\\u000a colorectal surgery.\\u000a \\u000a \\u000a \\u000a \\u000a Methods:

F. Köckerling; J. Rose; C. Schneider; H. Scheuerlein; M. A. Reymond; Th. Reck; J. Konradt; H. P. Bruch; C. Zornig; E. Bärlehner; A. Kuthe; G. Szinicz; H. A. Richter; W. Hohenberger

1999-01-01

365

Ergonomic problems associated with laparoscopic surgery  

Microsoft Academic Search

Background: The Society of American Gastrointestinal Endoscopic Surgeons (SAGES) Task Force on Ergonomics conducted a subjective and\\u000a objective assessment of ergonomic problems associated with laparoscopic instrument use. The goal was to assess the prevalence,\\u000a causes, and consequences of operational difficulties associated with the use of laparoscopic instruments.\\u000a \\u000a \\u000a \\u000a \\u000a Methods: A questionnaire was distributed asking respondents to rate the frequency with which

R. Berguer; D. L. Forkey; W. D. Smith

1999-01-01

366

[Laparoscopic burch colposuspensio--our experience].  

PubMed

Stress incontinence is involuntary loss of urine that occurs during periods of increased intraabdominal pressure, such as sneezing, coughing or exercise. Retropubic Burch colposuspension has been considered by many to be the "gold standard" procedure for treatment of female stress urinary incontinence for almost 50 years. The firs reported retropubic surgery performed via the laparoscopic approach was described by Vancaillie and Schuessler in 1991. We present a clinical case of a female patient with stress incontinence who has been operated by laparoscopic approach by our team. PMID:24919345

Bechev, B; Kornovski, J; Kostov, I; Lazarov, I

2014-01-01

367

Is right laparoscopic donor nephrectomy right?  

Microsoft Academic Search

Introduction  Laparoscopic donor nephrectomy has become the standard of care in many renal transplant centers. Many centers are reluctant\\u000a to perform right laparoscopic donor nephrectomies, primarily due to concerns about transplanting a kidney with a short renal\\u000a vein.\\u000a \\u000a \\u000a \\u000a Methods  A retrospective review of 26 right and 24 left consecutive donor nephrectomies and their recipients was performed. Patient\\u000a demographics, preoperative, perioperative, and postoperative

Mark Sawatzky; Abdulmalik Altaf; James Ellsmere; Dennis Klassen; Mark Walsh; Michele Molinari; Björn Nashan; Jaap Bonjer

2009-01-01

368

Laparoscopic resection of pancreatic neuroendocrine tumors  

PubMed Central

Pancreatic neuroendocrine tumors (PNETs) are a rare heterogeneous group of endocrine neoplasms. Surgery remains the best curative option for this type of tumor. Over the past two decades, with the development of laparoscopic pancreatic surgery, an increasingly larger number of PNET resections are being performed by these minimally-invasive techniques. In this review article, the various laparoscopic surgical options for the excision of PNETs are discussed. In addition, a summary of the literature describing the outcome of these treatment modalities is presented. PMID:24803802

Al-Kurd, Abbas; Chapchay, Katya; Grozinsky-Glasberg, Simona; Mazeh, Haggi

2014-01-01

369

Laparoscopic Fertility Sparing Management of Cervical Cancer  

PubMed Central

Fertility can be preserved after conservative cervical surgery. We report on a 29-year-old woman who was obese, para 0, and diagnosed with cervical insufficiency at the first trimester of current pregnancy due to a previous trachelectomy. She underwent laparoscopic transabdominal cervical cerclage (LTCC) for cervical cancer. The surgery was successful and she was discharged two days later. The patient underwent a caesarean section at 38 weeks of gestation. Laparoscopic surgery is a minimally invasive approach associated with less pain and faster recovery, feasible even in obese women. PMID:24696772

Facchini, Chiara; Rapacchia, Giuseppina; Montanari, Giulia; Casadio, Paolo; Pilu, Gianluigi; Seracchioli, Renato

2014-01-01

370

Sterile and economic instrumentation in laparoscopic surgery  

Microsoft Academic Search

Background: Because so many common surgical problems can now be addressed by the laparoscopic approach, the issue of sterile processing\\u000a has to be reconsidered.\\u000a \\u000a \\u000a \\u000a \\u000a Methods: Selected laparoscopic instrumentation was analyzed regarding wear and tear and decontamination after sterile processing following\\u000a 6,000 surgical laparoscopies carried out between 1990 and 1996 at the Academic Hospital Moabit, Berlin.\\u000a \\u000a \\u000a \\u000a \\u000a Results: Fewer than 7.9 (parts

T. W. Fengler; H. Pahlke; E. Kraas

1998-01-01

371

Total and subtotal laparoscopic gastrectomy for adenocarcinoma  

Microsoft Academic Search

Background  Laparoscopic gastrectomies are currently performed in many centers, but compliance with oncologic requirements still represents\\u000a a subject open to debate. The aim of this work was to compare the short-term and oncologic outcomes after laparoscopic and\\u000a open surgery in gastric adenocarcinoma.\\u000a \\u000a \\u000a \\u000a Methods  From June 2000 through June 2005, 147 patients in our institution underwent gastrectomy by open or mininvasive approach for

R. Pugliese; D. Maggioni; F. Sansonna; I. Scandroglio; G. C. Ferrari; S. Di Lernia; A. Costanzi; J. Pauna; P. de Martini

2007-01-01

372

Laparoscopic revolution in bariatric surgery  

PubMed Central

The history of bariatric surgery is investigational. Dedicated surgeons have continuously sought for an ideal procedure to relieve morbidly obese patients from their burden of comorbid conditions, reduced life expectancy and low quality of life. The ideal procedure must have low complication risk, both in short- and long term, as well as minimal impact on daily life. The revolution of laparoscopic techniques in bariatric surgery is described in this summary. Advances in minimal invasive techniques have contributed to reduced operative time, length of stay, and complications. The development in bariatric surgery has been exceptional, resulting in a dramatic increase of the number of procedures performed world wide during the last decades. Although, a complex bariatric procedure can be performed with operative mortality no greater than cholecystectomy, specific procedure-related complications and other drawbacks must be taken into account. The evolution of laparoscopy will be the legacy of the 21st century and at present, day-care surgery and further reduction of the operative trauma is in focus. The impressive effects on comorbid conditions have prompted the adoption of minimal invasive bariatric procedures into the field of metabolic surgery. PMID:25386062

Sundbom, Magnus

2014-01-01

373

Perforation of missed double gallbladder after primary laparoscopic cholecystectomy: endoscopic and laparoscopic management.  

PubMed

Gallbladder congenital duplication is a rare disease difficultly diagnosed preoperatively. Eight days after a laparoscopic cholecystectomy a 72-year-old man, complaining of abdominal pain and vomiting, presented to our emergency department. Ultrasound and computer tomography (CT) scans demonstrated a gallbladder-like structure with a 12-mm diameter stone and a subhepatic fluid collection. During an endoscopic retrograde cholangiopancreatography, a probably second gallbladder with a fistula of the posterior wall was filled with contrast. Laparoscopic exploration confirmed a missed gallbladder, which was successfully removed. Histologic diagnosis of cholecystolithiasis and chronic cholecystitis was made. The postoperative course was uneventful. Symptomatic double gallbladder should be considered also during the complicated postoperative course after the laparoscopic cholecystectomy and laparoscopic reoperation is feasible. PMID:18503379

Borghi, Felice; Giraudo, Giorgio; Geretto, Paolo; Ghezzo, Luigi

2008-06-01

374

Development of a collapsible guard component for a novel surgical instrument  

E-print Network

The Endoblend is a novel surgical device for use in laparoscopic hysterectomy surgery. Laparoscopic hysterectomy surgery requires that the uterus be removed through a laparoscopic port. To achieve this, the Endoblend ...

Buckley, Darragh

2007-01-01

375

Laparoscopic management of impalpable undescended testes: 20 years’ experience  

PubMed Central

BACKGROUND: Laparoscopy is the best available method to manage impalpable undescended testes. We performed our first laparoscopic orchiopexy in June 1992 and found good results in consecutive cases with laparoscopic orchiopexy over last 20 years. MATERIALS AND METHODS: From June 1992 to May 2012, 241 patients with 296 impalpable testes were operated upon by laparoscopic approach. One-stage laparoscopic orchiopexy was performed in 152 cases, while two-stage Fowler — Stephens laparoscopic orchiopexy was performed in 55 cases. Laparoscopic orchiectomy was required in 20, and in 21 patients testes were absent. One-sided laparoscopic orchiopexy was performed in a male pseudo hermaphrodite. RESULTS: None of the testis atrophied after two-stage Fowler — Stephens laparoscopic orchiopexy, while in 152 cases of single-stage orchiopexies one testes atrophied. One patient developed malignant change in the testis, 6 years after orchiopexy. CONCLUSIONS: Laparoscopy is the best way to diagnose impalpable undescended testes. No other imaging investigation was required. Single-stage laparoscopic orchiopexy for low level undescended testis has very good results. For high-level undescended testis and when one-stage mobilisation is difficult, two-stage Fowler — Stephens orchiopexy has excellent results. Minimum 4 months should separate first and second stage of laparoscopic Fowler — Stephens procedure. Even when open orchiopexy is being done for intra-canalicular testes in a child, it is advisable to be ready with laparoscopy if necessary, at the same time, in case open surgery fails to mobilise the testicular vessels adequately. PMID:24250059

Mehendale, Vinay G; Shenoy, Sharad N; Shah, Rupin S; Chaudhari, Namita C; Mehendale, Alap V

2013-01-01

376

Laparoscopic Revision of Failed Fundoplication and Hiatal Herniorraphy  

PubMed Central

Abstract Objective The aim of this study was to evaluate the mechanisms of failure after laparoscopic fundoplication and the results of revision laparoscopic fundoplication. Background Laparoscopic Nissen fundoplication has become the most commonly performed antireflux procedure for the treatment of gastroesophageal reflux disease, with success rates from 90 to 95%. Persistent or new symptoms often warrant endoscopic and radiographic studies to find the cause of surgical failure. In experienced hands, reoperative antireflux surgery can be done laparoscopically. We performed a retrospective analysis of all laparoscopic revision of failed fundoplications done by the principle author and the respective fellow within the laparoscopic fellowship from 1992 to 2006. Methods A review was performed on patients who underwent laparoscopic revision of a failed primary laparoscopic fundoplication. Results Laparoscopic revision of failed fundoplication was performed on 68 patients between 1992 and 2006. The success rate of the laparoscopic redo Nissen fundoplication was 86%. Symptoms prior to the revision procedure included heartburn (69%), dysphagia (8.8%), or both (11.7%). Preoperative evaluation revealed esophagitis in 41%, hiatal hernia with esophagitis in 36%, hiatal hernia without esophagitis in 7.3%, stenosis in 11.74%, and dysmotility in 2.4%. The main laparoscopic revisions included fundoplication alone (41%) or fundoplication with hiatal hernia repair (50%). Four gastric perforations occurred; these were repaired primarily without further incident. An open conversion was performed in 1 patient. Length of stay was 2.5?±?1.0 days. Mean follow-up was 22 months (range, 6–42), during which failure of the redo procedure was noted in 9 patients (13.23%). Conclusion Laparoscopic redo antireflux surgery, performed in a laparoscopic fellowship program, produces excellent results that approach the success rates of primary operations. PMID:19216692

Madan, Atul K.; Carlson, Mark A.; Zeni, Tallal M.; Zografakis, John G.; Moore, Ronald M.; Meiselman, Mick; Luu, Minh; Ayiomamitis, Georgios D.

2009-01-01

377

Postoperative Immunosuppression After Open and Laparoscopic Liver Resection: Assessment of Cellular Immune Function and Monocytic HLA-DR Expression  

PubMed Central

Background and Objectives: Major abdominal procedures are strongly associated with postoperative immunosuppression and subsequent increased patient morbidity. It is believed that laparoscopic surgery causes less depletion of the systemic immune function because of the reduced tissue trauma. Various cytokines and monocytic HLA-DR expression have been successfully implemented to assess postoperative immune function. The aim of our study was to show the difference in immunologic profiles after minimally invasive versus conventional liver resection. Methods: Ten animals underwent either laparoscopic or conventional open left lateral liver resection. Flow cytometric characteristics of HLA-DR expression on monocytes and lipopolysaccharide-stimulated cellular secretion of tumor necrosis factor ?, interferon ?, interleukin 6, and interleukin 8 were measured and analyzed in ex vivo whole blood samples. Intraoperative and postoperative clinical outcome parameters were also documented and evaluated. Results: All animals survived the procedures. Postoperative complications were fever (n = 3), wound infections (n = 2), and biloma (n = 1). Open surgery showed a morbidity rate of 80% compared with 40% after laparoscopic surgery. Laparoscopic liver resection showed no postoperative immunoparalysis. Major histocompatibility complex class II expression in this group was elevated, whereas the open surgery group showed decreased major histocompatibility complex class II expression on postoperative day 1. Postoperative secretion of tumor necrosis factor ?, interleukin 6, and interferon ? was lower in the open surgery group. Elevated transaminase levels after laparoscopy might have resulted from an ischemia/reperfusion injury caused by the capnoperitoneum. Conclusion: Major immunoparalysis depression was not observed in either group. Laparoscopic surgery shows a tendency to improve immunologic recovery after liver resection. PMID:24398205

Haacke, Nadine; Meisel, Christian; Unterwalder, Nadine; Fikatas, Panagiotis; Schmidt, Sven C.

2013-01-01

378

Postprandial bloating after laparoscopic Nissen fundoplication  

PubMed Central

Objective To evaluate the prevalence and possible contributing factors to postprandial bloating in patients having chronic gastroesophageal reflux disease (GERD) before and after laparoscopic Nissen fundoplication. Design A prospective cohort study. Setting A tertiary care teaching hospital. Patients Five hundred and seventy-eight patients with proven GERD. Intervention Laparoscopic Nissen fundoplication. Outcome measures Symptom severity scores for postprandial bloating and dysphagia, esophageal motility and 24-hour pH measurement before and at 6 months, 2 years and 5 years after laparoscopic Nissen fundoplication. Results Of the 598 patients, 436 (73%) reported some postprandial bloating before the procedure. The symptom score for bloating significantly improved after surgery (p < 0.0001). There were no significant differences in the lower esophageal sphincter basal pressures or 24-hour pH scores between those who reported improvement or worsening of their postprandial bloating. At 6 months after surgery, 54% of patients experienced postprandial bloating; of these, 49% reported improvement, 21% reported worsening and 30% reported no change in bloating symptoms compared with the preoperative state. Of the patients who reported worsening of postprandial bloating 6 months after surgery, 86 were reassessed 2 years after surgery and 71% reported improvement of this symptom over this time interval. Conclusions Bloating is a common symptom in patients who suffer from chronic GERD. Laparoscopic Nissen fundoplication lessens the severity of this symptom in most patients. In a small subgroup of patients, antireflux surgery may exacerbate the bloating, but this improves over time. PMID:11764878

Anvari, Mehran; Allen, Christopher

2001-01-01

379

Laparoscopic approach to benign esophageal disorders  

Microsoft Academic Search

Background: The technique of laparoscopic surgery (LS) has taken rapid strides over the past decade. Though the biliary tract has been the main focus of LS, the surgical treatment of benign esophageal disease is an area of growing interest. In this article we outline our experience using LS in the treatment of benign esophageal diseases. Material and Methods: From March

K. P. Balsara; C. R. Shah; N. H. Patell; H. Shah; B. Jamaiwar; P. Gupta

380

Ambidexterity in laparoscopic surgical skills training.  

PubMed

Understanding the way in which specialized medical skills are acquired is critical for developing effective training curricula, as well as effective metrics and methodologies for assessing skill acquisition, proficiency, and retention. Currently, a need exists for novel, objective metrics to support training and assessment of specialized surgical skills, such as those involved in laparoscopy, and to support a deeper understanding of the way in which these skills are acquired and decay during periods of nonuse. Ambidexterity has been identified by expert surgeons as a critical factor in the achievement of laparoscopic psychomotor surgical skill proficiency; however, the current standardized training and assessment protocols do not measure or account for differential performance between the dominant and non-dominant hands. Two experiments compared performance with the left and right hands during training of laparoscopic psychomotor surgical skills using the Fundamentals of Laparoscopic Surgery (FLS) platform, examining the role of ambidexterity in skill acquisition and proficiency. The results of these investigations indicate that degree of ambidexterity in task performance increases with overall task performance improvement and may be related to achievement of task proficiency. Measures that account for degree of task-related ambidexterity may provide useful metrics for assessing laparoscopic surgical skill acquisition, proficiency, and decay. PMID:23400194

Skinner, Anna; Auner, Gregory; Meadors, Margaret; Sebrechts, Marc

2013-01-01

381

Laparoscopic surgery and the systemic immune response.  

PubMed Central

OBJECTIVE: The authors review studies relating to the immune responses evoked by laparoscopic surgery. SUMMARY BACKGROUND DATA: Laparoscopic surgery has gained rapid acceptance based on clinical grounds. Patients benefit from faster recovery, decreased pain, and quicker return to normal activities. Only more recently have attempts been made to identify the metabolic and immune responses that may underlie this clinical success. The immune responses to laparoscopy are now being evaluated in relation to the present knowledge of immune responses to traditional laparotomy and surgery in general. METHODS: A review of the published literature of the immune and metabolic responses to laparoscopy was performed. Laparoscopic surgery is compared with the traditional laparotomy on the basis of local and systemic immune responses and patterns of tumor growth. The impact of pneumoperitoneum and insufflation gases on the immune response is also reviewed. CONCLUSIONS: The systemic immune responses for surgery in general may not apply to laparoscopic surgery. The body's response to laparoscopy is one of lesser immune activation as opposed to immunosuppression. PMID:9527054

Vittimberga, F J; Foley, D P; Meyers, W C; Callery, M P

1998-01-01

382

Increased transperitoneal bacterial translocation in laparoscopic surgery  

Microsoft Academic Search

Background: The indications for laparoscopic surgery have expanded to include diseases possibly associated with peritonitis such as appendicitis, perforated peptic ulcers, and diverticulitis. The safety of carbon dioxide (CO 2) pneumoperitoneum in the presence of peritonitis has not been proved. Our previous investigations demonstrated increased bacteremia associated with CO 2 insufflation. In effort to clarify the relative effects of intraabdominal

M. C. Horattas; N. Haller; D. Ricchiutti

2003-01-01

383

Major venous resection during total laparoscopic pancreaticoduodenectomy  

PubMed Central

Background The feasibility of total laparoscopic pancreaticoduodenectomy (TLPD) has been established. Laparoscopic major venous resection during TLPD has not been reported. The aim of the present study was to describe the technique and outcomes of patients undergoing TLPD with major venous resection. Methods Retrospective review of all consecutive patients undergoing TLPD and major venous resection from July 2007 to December 2010 was performed. Patient demographics and peri-operative outcomes were retrieved. Data are presented as mean ± standard deviation (SD) or median with range. Results Out of 129 patients undergoing TLPD, major venous resection was performed in 11 patients with a mean age of 71 years. Median operative time and blood loss was 413 (301–666) min and 500 (75–2800) ml, respectively. Venous resection included tangential (n = 10) and segmental resection (n = 1). Venous reconstruction included patch (n = 4), suture (n = 4), stapled (n = 2) and a left renal vein interposition graft (n = 1). Median mesoportal clamp time was 35 (10–82) min. There was no 30-day or in-hospital mortality. Post-operative imaging was available in 10 patients with 100% patency at the venous reconstruction site. Conclusions Laparoscopic major venous resection during TLPD is feasible in selected patients. Extensive experience with complex laparoscopic pancreatic resection and reconstruction is advocated before attempting this procedure. PMID:21689228

Kendrick, Michael L; Sclabas, Guido M

2011-01-01

384

Laparoscopic and robotic resection for pancreatic cancer.  

PubMed

Minimally invasive surgical approaches for pancreatic resection have been established as feasible and safe. Whereas widespread application of laparoscopic distal pancreatectomy is in progress, the utilization of laparoscopic pancreaticoduodenectomy is still localized to a few centers because of the added complexity and advanced laparoscopic skills required. Comparative studies have demonstrated the typical advantages of minimally invasive approaches for pancreatic resection, namely, less blood loss and shorter hospital stay. Robotic assistance for laparoscopic approaches is gaining interest, but the true value added is still undefined. Significant discussion revolves around the appropriateness of minimally invasive approaches in pancreatic cancer. Although limited data and only short-term follow-up engender ongoing skepticism, the technical feasibility, existing reports in pancreatic cancer, and the lack of negative outcomes in other gastrointestinal cancers spark ongoing clinical evaluation. Minimally invasive surgical approaches have significant potential to improve the outcomes of pancreatic resection especially in pancreatic cancer patients in whom an optimal recovery is important for adjuvant treatment options. Larger experiences are forthcoming, and controlled trials are eagerly awaited; however, the feasibility of such is questionable because of the low incidence of resectable pancreatic cancer and the small number of centers performing minimally invasive pancreatectomy for malignancy. PMID:23187844

Kendrick, Michael L

2012-01-01

385

Laparoscopic splenectomy for atraumatic splenic rupture.  

PubMed

A traumatic splenic rupture (ASR) is a rare clinical entity. Several underlying benign and malignant conditions have been described as a leading cause. We report on a case of ASR in a 41-year-old man treated with laparoscopic splenectomy. Considering ASR as a life-threatening condition, a prompt diagnosis can be life saving. PMID:21675627

Grossi, Ugo; Crucitti, Antonio; D'Amato, Gerardo; Mazzari, Andrea; Tomaiuolo, Pasquina M C; Cavicchioni, Camillo; Bellantone, Rocco

2011-01-01

386

Laparoscopic urology: Past, present, and future  

Microsoft Academic Search

Laparoscopy has begun to have a significant impact on the management of urologic problems. Although initially limited to diagnostic pediatric problems, it has more recently been used to resolve myriad adult urologic conditions. Indeed, during the past year laparoscopic urology has moved well beyond the diagnosis of the undescended testicle and has been successfully used for pelvic lymphadenectomy, varicocelectomy, ureterolysis,

Ralph V. Clayman; Louis R. Kavoussi

1993-01-01

387

Laparoscopic Radical Cystectomy and Urinary Diversion  

Microsoft Academic Search

Most reported publications regarding laparoscopic radical cystectomy (LRC) have focused on technical feasibility and perioperative outcomes of the institutions’ initial experiences. Subsequent construction of urinary diversion remains a challenging procedure. Recent increasing experience from major medical centers worldwide indicates rising interest and expertise in LRC. We describe the histological and experimental background, surgical technique, surgical outcomes, and future directions of

Osamu Ukimura; Inderbir S. Gill

388

Pediatric laparoscopic splenectomy using the lateral approach  

Microsoft Academic Search

Laparoscopic splenectomy in children has been shown to be safe, to reduce postoperative pain and hospital stay, and to accelerate return to full activities. We describe our experience with a four-port “lateral” approach in 18 patients. Patients were placed in the lateral decubitus position and the table was flexed to separate the left subcostal margin and iliac crest. The camera

P. G. Fitzgerald; J. C. Langer; B. H. Cameron; A. E. Park; M. J. Marcaccio; J. M. Walton; M. A. Skinner

1996-01-01

389

Laparoscopic TME: Better Vision, Better Results?  

Microsoft Academic Search

One of the most controversial discussions on laparoscopic surgery deals with the question of whether to apply this technique to malignant disease and specifically to rectal cancer. The four major issues are the adequacy of oncologic resection, recurrence rates and patterns, long-term survival and quality of life. There is evidence, from nonrandomized studies, suggesting that margins of excision and lymph

T. H. K. Schiedeck; F. Fischer; C. Gondeck; U. J. Roblick; H. P. Bruch

390

Augmented Reality Visualization for Laparoscopic Surgery  

E-print Network

Augmented Reality Visualization for Laparoscopic Surgery Henry Fuchs1 , Mark A. Livingston1 Reality Augmented reality (AR) refers to systems that attempt to merge computer graphics and real imagery experience and hand-eye coordination for a surgeon to adjust to this disparity. 1.2 Benefits of Augmented

State, Andrei

391

Post-cholecystectomy symptoms after laparoscopic cholecystectomy.  

PubMed Central

Abdominal symptoms persist in up to 40% of patients after laparotomy cholecystectomy and biliary lithotripsy. Laparoscopic cholecystectomy is now the treatment of choice for symptomatic gallstone disease. However, no data exist as to the influence of laparoscopic cholecystectomy on symptoms. We analysed 100 patients who had undergone laparoscopic cholecystectomy at a median of 12 months (range 10-19 months) previously. Pre- and postoperative symptoms were compared and patient satisfaction was graded from 1 (best) to 5 (worst). Time to resumption of full activity (mean +/- SD) was recorded. All patients had more than two symptoms preoperatively. Postoperatively, 61 patients had complete absence of symptoms, 14 patients complained of only one symptom during the postoperative period and 25 patients continued to have at least two symptoms. The mean time taken to return to full activity was 2.4 +/- 1.7 weeks. In patients without any symptoms postoperatively, time taken to return to full activity was 2.3 +/- 1.5 weeks, 2.7 +/- 1.4 weeks for patients with one symptom postoperatively, while patients with two or more symptoms returned to full activity in 2.3 +/- 1.3 weeks and 2.6 +/- 1.7 weeks, respectively. Notwithstanding that 25% of patients reported two or more symptoms postoperatively, most patients (n = 84) considered the procedure to be a complete success. A further 10 patients had significant improvement after laparoscopic cholecystectomy. Five patients considered themselves only slightly improved, while a single patient was no better off postoperatively. These data indicate that after laparoscopic cholecystectomy most patients return to full activity within 3 weeks.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8215152

Qureshi, M. A.; Burke, P. E.; Brindley, N. M.; Leahy, A. L.; Osborne, D. H.; Broe, P. J.; Bouchier-Hayes, D. J.; Grace, P. A.

1993-01-01

392

[Laparoscopic repair of incisional and ventral hernia].  

PubMed

The application of laparoscopic principles to ventral or incisional hernia repair has recently been shown to be a safe and effective alternative to open procedures. In this study we analyzed our recent experience with laparoscopic incisional-ventral hernia repair. The outcomes of 75 consecutive patients (January 2002 to July 2006) who underwent laparoscopic repair for incisional-ventral hernia were reviewed. Patient's demographics, hernia parameters, and intraoperative and postoperative data were collected. Of the 75 patients, 44 were females and 31 males. Mean age was 59.1 yrs (range 29-80 yrs). Mean BMI was 25.9 (range 19.4-36.7). Twenty-one patients had primary ventral hernias while 54 patients had an incisional hernia. Fifty-three patients had a single defect and 22 patients multiple defects. In 45 cases the incisional hernia was a primary hernia; in 4 cases it was a first recurrence; in 2 cases a 2nd recurrence; and in 3 cases a 3rd recurrence. The mean defect size was 52,7 cm2 (range 4-432). Laparoscopic hernia repair was successfully performed in 71 cases (94.7%). The mean mesh size was 211 cm2 (range 63-694). Mean operating time was 101 min (range 50-220 min). The mean hospital stay was 4.7 days. The postoperative morbidity rate was 14%. After a mean follow-up of 24.6 months (range 7-56) the recurrence rate was 7% (5/71). Laparoscopic repair of incisional-ventral hernias seems to be safe and effective. Medium-term outcomes were promising with a relatively low rate of conversion to open surgery, a low complication rate and a low risk of recurrence. PMID:18709780

Antinori, Armando; Moschella, Francesca; Tomaiuolo, Pasquina M C; Crucitti, Antonio; La Greca, Antonio; Maci, Eliana; Magistrelli, Paolo

2008-01-01

393

Laparoscopic adrenalectomy – ten-year experience  

PubMed Central

Objectives The objective of the study is to summarize the authors’ 10-year experience with laparoscopic adrenalectomy and to analyze the intra- and postoperative complications of the procedure. Material and methods The records of 80 patients who had undergone laparoscopic adrenalectomy from January 2002 to January 2012 were reviewed retrospectively. There were 51 female and 29 male patients. The average age was 52. In 33 cases the right adrenal gland was affected, in 47 it was the left adrenal gland. Nineteen operations were performed with the retroperitoneal approach, in 61 a transperitoneal access was used. The average size of the tumor was 5 cm. The diagnosis was based on ultrasonography (USG) and computed tomography (CT). The biochemical tests were performed in all cases to assess hormonal activity of the tumor. Pheochromocytoma was diagnosed in 16 cases, Cushing syndrome in 3 cases, and Conn syndrome in 4 cases. All other tumors were hormonally inactive. Six patients were operated on because of adrenal metastases – from renal carcinoma in five cases and from lung carcinoma in one case. Results There were three open conversions. The mean operative time was 158 minutes. The mean hospital stay was 5.5 days Blood transfusion was necessary in three patients. Postoperative complications were observed in 11 patients (13.7%). Conclusions Laparoscopic adrenalectomy is a safe and effective procedure and should be considered the first – line treatment of benign adrenal masses. Our experience indicates that patients with adrenal metastases are suitable candidates for laparoscopic adrenalectomy, providing a skilled laparoscopic surgeon is involved in operation. PMID:24578932

Lewandowski, Jaros?aw; Panek, Wojciech; Tupikowski, Krzysztof; Dembowski, Janusz; Zdrojowy, Romuald

2012-01-01

394

Laparoscopic surgery for colorectal cancer in China: an overview  

PubMed Central

Since its introduction into China in 2001, laparoscopic techniques have been extensively used for the surgical management of colorectal cancer during the last two decades in China. Like all the pioneers of the technique, Chinese gastrointestinal surgeons claim that laparoscopic surgery for colorectal cancer led to faster recovery, shorter hospital stay and more rapid return to daily activities respect to open surgery while offering the same functional and oncological results. There has been booming interest in laparoscopic surgery for colorectal cancer since 2006 in China. The last decade has witnessed national growth in the application of laparoscopic surgery for colorectal cancer and yielded a significant amount of scientific data to support its clinical merits and advantages. However, few prospective randomized controlled trials have investigated the benefits of laparoscopic surgery for colorectal cancer in China. In this article, we make an overview of the current data and state of the art of laparoscopic surgery for colorectal cancer in China. PMID:25663960

Jin, Ketao; Wang, Jun; Lan, Huanrong; Zhang, Ruili

2014-01-01

395

Single-incision laparoscopic cholecystectomy: a systematic review  

Microsoft Academic Search

Background  Laparoscopic techniques induced a tremendous revolution in surgery of the biliary tract, mainly due to improved results compared\\u000a with the open approach and secondary because of their cosmetic advantage. A trend toward even more minimally invasive approaches\\u000a has led to techniques of single-incision and natural orifice laparoscopic surgery. Because the evaluation of single-incision\\u000a laparoscopic cholecystectomy (SILC) is rather fragmentary by

Stavros A. Antoniou; Rudolph Pointner; Frank A. Granderath

2011-01-01

396

Comparison of laparoscopic cholecystectomy versus elective open cholecystectomy.  

PubMed

Laparoscopic cholecystectomy has essentially replaced open cholecystectomy as the procedure of choice for gallbladder disease. This rapid shift to laparoscopic cholecystectomy, however, has resulted more from marketing forces than from prospective clinical trials. To evaluate the safety and efficacy of laparoscopic cholecystectomy, the first 486 laparoscopic cholecystectomies at two institutions were studied. These results were then compared to the results of the last 6 months of elective open cholecystectomy cases prior to the introduction of laparoscopic surgery. The age, sex, height, and weight were similar in both groups. The mean operative time was 78.8 +/- 1.8 min for laparoscopic cholecystectomy and 62.7 +/- 2.6 min for open cholecystectomy (p < 0.01). The mean time for tolerating a regular diet was 1.23 +/- 0.04 days in the laparoscopic group versus 2.44 +/- 0.07 days in the open group (p < 0.01). Laparoscopic cholecystectomy patients required only oral pain medications by a mean of 1.22 +/- 0.03 days postoperatively compared to 2.55 +/- 0.07 days postoperatively for those undergoing open cholecystectomy (p < 0.01). The mean length of hospitalization was 1.58 +/- 0.07 days for laparoscopic patients and 3.55 +/- 0.11 days for open patients (p < 0.01). Thirty-one patients undergoing laparoscopic cholecystectomy were converted to open cholecystectomy (6.4%). The most common reasons for conversion to open cholecystectomy were acute inflammation, adhesions, and bleeding. For the laparoscopic patients, the morbidity rate was 8.4% and the mortality rate 0.2% (1 death). In the open cholecystectomy group the morbidity rate was 8.0% and there were no deaths. The most troublesome complication in laparoscopic cholecystectomies continues to be bile leaks and bile duct injuries.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1489996

Smith, J F; Boysen, D; Tschirhart, J; Williams, T; Vasilenko, P

1992-12-01

397

Hand assisted laparoscopic radical cystectomy for cancer bladder  

Microsoft Academic Search

Aim: To evaluate the efficacy, safety and feasibility of hand assistance in performing laparoscopic radical cystectomy and to\\u000a describe our point of technique of hand assisted laparoscopic radical cystectomy (HALRC) with extra-corporeal ileal conduit\\u000a reconstruction for muscle invasive bladder cancer. This is the second case report of HALRC in the world literature. Methods: A five-port transperitoneal laparoscopic approach with an

A. K. Hemal; Iqbal Singh

2004-01-01

398

Laparoscopic Approach for Metachronous Cecal and Sigmoid Volvulus  

PubMed Central

Background: Metachronous colonic volvulus is a rare event that has never been approached laparoscopically. Methods: Here we discuss the case of a 63-year-old female with a metachronous sigmoid and cecal volvulus. Results: The patient underwent 2 separate successful laparoscopic resections. Discussion and Conclusion: The following is a discussion of the case and the laparoscopic technique, accompanied by a brief review of colonic volvulus. In experienced hands, laparoscopy is a safe approach for acute colonic volvulus. PMID:21605523

Greenstein, Alexander J.; Zisman, Sharon R.

2010-01-01

399

Nonrestoration of pneumoperitoneum in laparoscopic-assisted left colon resection  

Microsoft Academic Search

Laparoscopic-assisted left colon resection entails reestablishing pneumoperitoneum and laparoscopic colorectal anastomosing, if performed through a left lower-quadrant incision. A horizontal suprapubic incision allows direct view of the colorectal anastomosis obviating the need for reestablishing pneumoperitoneum. Performing colorectal anastomoses in an open fashion via a suprapubic incision and with nonrestoration of pneumoperitoneum will contain operating time in laparoscopic-assisted left colectomy.

Roberto Bergamaschi

2000-01-01

400

Clinical Significance of Central Obesity in Laparoscopic Bariatric Surgery  

Microsoft Academic Search

Background: Laparoscopic surgery had increased the interest and growth of bariatric surgery. Whether central obesity has any\\u000a adverse effect in laparoscopic bariatric surgery is not clear. Methods: 612 morbidly obese patients received laparoscopic\\u000a bariatric surgery,in a prospectively controlled clinical trial of the outcome of the bariatric surgery. For comparison, subjects\\u000a were dichotomized into either a central obesity group or peripheral

Wei-Jei Lee; Weu Wang; Tai-Chi Chen; Po-Li Wei; Ching-Mei Lin; Ming-Te Huang

2003-01-01

401

Four zoom lens design for 3D laparoscope by using liquid lens  

NASA Astrophysics Data System (ADS)

Laparoscopic lens module that is capable of zooming is presented. The lens module has a high magnification and a high resolution such as four zoom and 2M pixels full HD image. The lens module consists of two lens sets to get 3-D images. Each lens module has several lenses less than conventional laparoscope but has 8 lenses and two liquid lenses. The total length of module is 19 mm long and the diameter is less than 5 mm. The separated distance of two lens center is 5 mm and two lens modules are inserted into the 11mm diameter laparoscope. The lens module is designed by Code V™ by using the 2M pixels CMOS sensor that the pixel size is 1.75 ?m. The merit of this fluidic lens design is being convertible between a convex and concave shape. The effective focal length of zoom-out and zoom-in modes is 3.24 mm and 12.94 mm respectively. The modulation transfer function of zoom-out and zoom-in modes is 40% and 30% at 140 lp/mm frequency. We have a diffraction of element at near stop to improve image resolution. Also the resolution of zoom-in mode is improved by using liquid iris. The F-number of a two modes is 4.4 and 5.8 and the optical distortion is 10% and 0.5%. It is expected that the z-direction resolution by this laparoscope is less than 2 mm

Lee, Seungwan; Choi, Minseog; Lee, Eunsung; Jung, Kyu-Dong; Chang, Jong-Hyeon; Kim, Woonbae

2012-10-01

402

Robotic-Assisted Laparoscopic Donor Nephrectomy: Decreasing Length of Stay  

PubMed Central

Background The number of robotic operations performed with the da Vinci Surgical System has increased during the past decade. This system allows for greater maneuverability and control than hand-assisted laparoscopic procedures, resulting in less tissue manipulation and irritation. Methods We retrospectively analyzed the results of 100 consecutive robotic-assisted laparoscopic donor nephrectomies and compared them to our most recent 20 hand-assisted laparoscopic donor nephrectomies. Results Between May 2008 and June 2012, 120 laparoscopic donor nephrectomies were performed at Ochsner Clinic Foundation. Of those, 100 live kidney donors underwent robotic-assisted laparoscopic donor nephrectomies. Surgical time and hospital length of stay improved after the first 20 patients receiving robotic-assisted laparoscopic nephrectomies, which was considered the learning curve. Sixty percent of patients who underwent robotic-assisted laparoscopic donor nephrectomies were released on postoperative day 1 compared to 45% of patients who underwent hand-assisted laparoscopic techniques. Conclusion In our experience, robotic-assisted laparoscopic donor nephrectomy resulted in decreased postoperative length of stay that decreased the global cost of the procedure and allowed our institution to admit more patients.

Cohen, Ari J.; Williams, Darin S.; Bohorquez, Humberto; Bruce, David S.; Carmody, Ian C.; Reichman, Trevor; Loss, George E.

2015-01-01

403

A System to Support Laparoscopic Surgery by Augmented Reality Visualization  

Microsoft Academic Search

This paper describes the development of an augmented reality system for intra-operative laparoscopic surgery support.\\u000a \\u000a The goal of this system is to reveal structures, otherwise hidden within the laparoscope view. To allow flexible movement\\u000a of the laparoscope we use optical tracking to track both patient and laparoscope.\\u000a \\u000a \\u000a \\u000a The necessary calibration and registration procedures were developed and bundled where possible in

Stijn De Buck; Johan Van Cleynenbreugel; Indra Geys; Thomas P. Koninckx; Philippe R. Koninck; Paul Suetens

2001-01-01

404

Superior mesenteric vein thrombosis after laparoscopic sleeve gastrectomy.  

PubMed

Laparoscopic procedures for morbid obesity are becoming standard of care which, in experienced hands, has a very low mortality and morbidity. Superior mesenteric vein thrombosis has been reported in the literature after different bariatric and nonbariatric laparoscopic procedures. Laparoscopic sleeve gastrectomy is a relatively new procedure in the treatment of morbid obesity; its complications being well-known including staple line leak, bleeding, and stricture among others. We present a case of superior mesenteric vein thrombosis after laparoscopic sleeve gastrectomy successfully managed conservatively with therapeutic anticoagulation, and propose a different hypothesis for the development of such a complication. PMID:23917607

Pineda, Lucas; Sarhan, Mohammad; Ahmed, Leaque

2013-08-01

405

Improved outcome after laparoscopic cholecystectomy with ultrasonic dissection: a randomized multicenter trial  

Microsoft Academic Search

Background  In conventional laparoscopic cholecystectomy, dissection with electrocautery starts at the triangle of Calot. In a randomized\\u000a single-center trial, the fundus-first method (dome down) using ultrasonic dissection was faster, involved less pain or nausea,\\u000a and had a shorter postoperative sick leave. This may relate to the fundus-first method or to the ultrasonic dissection.\\u000a \\u000a \\u000a \\u000a Methods  In a multicenter trial, 243 elective patients were

Yucel Cengiz; Jan Dalenbäck; Gunnar Edlund; Leif A. Israelsson; Arthur Jänes; Mats Möller; Anders Thorell

2010-01-01

406

[3D Virtual Reality Laparoscopic Simulation in Surgical Education - Results of a Pilot Study.  

PubMed

Background: The use of three-dimensional imaging in laparoscopy is a growing issue and has led to 3D systems in laparoscopic simulation. Studies on box trainers have shown differing results concerning the benefit of 3D imaging. There are currently no studies analysing 3D imaging in virtual reality laparoscopy (VRL). Materials and Methods: Five surgical fellows, 10 surgical residents and 29 undergraduate medical students performed abstract and procedural tasks on a VRL simulator using conventional 2D and 3D imaging in a randomised order. Results: No significant differences between the two imaging systems were shown for students or medical professionals. Participants who preferred three-dimensional imaging showed significantly better results in 2D as wells as in 3D imaging. Discussion: First results on three-dimensional imaging on box trainers showed different results. Some studies resulted in an advantage of 3D imaging for laparoscopic novices. This study did not confirm the superiority of 3D imaging over conventional 2D imaging in a VRL simulator. Conclusion: In the present study on 3D imaging on a VRL simulator there was no significant advantage for 3D imaging compared to conventional 2D imaging. PMID:23918724

Kneist, W; Huber, T; Paschold, M; Lang, H

2013-08-01

407

Perforated diverticulitis sigmoidei after laparoscopic cholecystectomy.  

PubMed

We present a case of 47-year-old healthy man who underwent an uneventful elective laparoscopic cholecystectomy. Despite the postoperative analgesia with non-steroidal anti-inflammatory drugs (NSAIDs), the patient developed diffuse abdominal pain culminating on the second postoperative day when the patient also had rebound tenderness. A diagnostic laparoscopy showed diverticular perforation, which was treated with laparoscopic lavage and drain. The patient's condition continued to deteriorate and the drain output resembled faecal material necessitating an emergency sigmoidium resection. The histopathological examination confirmed inflammation and perforation in the diverticulosis-bearing segment. The use of NSAID can be a reason for perforation, and may be for diverticulitis. NSAID should be used with caution in patients with a previous history or endoscopic-verified diverticulosis. PMID:25770142

Eljaja, Salameh; Hadi, Sabah; El-Hussuna, Alaa

2015-01-01

408

Perforated diverticulitis sigmoidei after laparoscopic cholecystectomy  

PubMed Central

We present a case of 47-year-old healthy man who underwent an uneventful elective laparoscopic cholecystectomy. Despite the postoperative analgesia with non-steroidal anti-inflammatory drugs (NSAIDs), the patient developed diffuse abdominal pain culminating on the second postoperative day when the patient also had rebound tenderness. A diagnostic laparoscopy showed diverticular perforation, which was treated with laparoscopic lavage and drain. The patient's condition continued to deteriorate and the drain output resembled faecal material necessitating an emergency sigmoidium resection. The histopathological examination confirmed inflammation and perforation in the diverticulosis-bearing segment. The use of NSAID can be a reason for perforation, and may be for diverticulitis. NSAID should be used with caution in patients with a previous history or endoscopic-verified diverticulosis. PMID:25770142

Eljaja, Salameh; Hadi, Sabah; El-Hussuna, Alaa

2015-01-01

409

Laparoscopic cholecystectomy using 2-mm instruments.  

PubMed

Today, laparoscopic cholecystectomy is the method of choice for treatment of symptomatic gallbladder disorders. It minimizes effects of the operation that are independent of the gallbladder, such as trauma to the abdominal wall and other soft tissue. The surgical wounds were even smaller when 2-mm trocars were used. Laparoscopic cholecystectomy using 2-mm instruments was performed in a consecutive series of 14 patients with symptomatic gallstones. The procedure was completed in 12 cases, with conversion to open surgery in two cases. Intraoperative cholangiography was always performed. The postoperative course was always uneventful. The cosmetic effect was highly satisfactory. The procedure using 2-mm instruments could be indicated in selected patients with uncomplicated gallstone disease. PMID:9820716

Uranüs, S; Peng, Z; Kronberger, L; Pfeifer, J; Salehi, B

1998-10-01

410

Laparoscopic treatment of rectal prolapse: experience gained in a prospective multicenter study  

Microsoft Academic Search

Background. We report the findings of a prospective multicenter observational study carried out by the Study Group for Laparoscopic Colorectal Surgery on patients undergoing laparoscopic or laparoscopic-assisted surgery for rectal prolapse. The study investigated the safety of various laparoscopic techniques in terms of perioperative and postoperative general and technique-specific complications and compared the results with those reported for open surgery

J. Rose; C. Schneider; H. Scheidbach; C. Yildirim; H. Bruch; J. Konradt; E. Bärlehner; F. Köckerling

2002-01-01

411

Laparoscopic versus Open Appendectomy: Time to Decide  

Microsoft Academic Search

.   Although widely practiced, laparoscopic appendectomy (LA) has not met with universal approval. Several controlled trials\\u000a have been conducted, some in favor, others not. The goal of this review was to ascertain (1) if laparoscopy was capable of\\u000a improving the diagnostic and therapeutic difficulties encountered during open appendectomy (OA) and (2) if the introduction\\u000a of laparoscopy in the overall management

Abe Fingerhut; Bertrand Millat; Fredéric Borrie

1999-01-01

412

Local epinephrine facilitates laparoscopic Heller myotomy  

Microsoft Academic Search

.   Incomplete myotomy and mucosal perforation are the most common technical complications of laparoscopic esophageal myotomy.\\u000a The muscle layers of the lower esophagus are infiltrated with a 1:100,000 epinephrine solution using a thin needle. Gentle\\u000a pressure is applied with a peanut sponge to diminish the edema produced by the injections. The longitudinal fibers are separated\\u000a with a dissector and the

G. G. R. Kuster

1998-01-01

413

Durability of laparoscopic repair of paraesophageal hernia.  

PubMed Central

OBJECTIVES: To define a method of primary repair that would minimize hernia recurrence and to report medium-term follow-up of patients who underwent laparoscopic repair of paraesophageal hernia to verify durability of the repair and to assess the effect of inclusion of an antireflux procedure. SUMMARY BACKGROUND DATA: Primary paraesophageal hernia repair was completed laparoscopically in 55 patients. There were five recurrences within 6 months when the sac was not excised (20%). After institution of a technique of total sac excision in 30 subsequent repairs, no early recurrences were observed. METHODS: Inclusion of an antireflux procedure, incidence of subsequent hernia recurrence, dysphagia, and gastroesophageal reflux symptoms were recorded in clinical follow-up of patients who underwent a laparoscopic procedure. RESULTS: Mean length of follow-up was 29 months. Forty-nine patients were available for follow-up, and one patient had died of lung cancer. Mean age at surgery was 68 years. The surgical morbidity rate in elderly patients was no greater than in younger patients. Eleven patients (22%) had symptoms of mild to moderate reflux, and 15 were taking acid-reduction medication for a variety of dyspeptic complaints. All but 2 of these 15 had undergone 360 degrees fundoplication at initial repair. Two patients (4%) had late recurrent hernia, each small, demonstrated by esophagram or endoscopy. CONCLUSIONS: Laparoscopic repair in the medium term appeared durable. The incidence of postsurgical reflux symptoms was unrelated to inclusion of an antireflux procedure. In the absence of motility data, partial fundoplication was preferred, although dysphagia after floppy 360 degrees wrap was rare. With the low morbidity rate of this procedure, correction of symptomatic paraesophageal hernia appears indicated in patients regardless of age. Images Figure 1. PMID:9790342

Edye, M B; Canin-Endres, J; Gattorno, F; Salky, B A

1998-01-01

414

Laparoscopic appendectomy for mucocele of the appendix  

PubMed Central

Mucocele of the appendix is an aseptic dilatation secondary to obstruction. The preoperative clinical diagnosis of appendiceal mucoceles can therefore be difficult because of this lack of clinical symptomotology. Surgical excision is the treatment of choice in benign mucocele. We report a case presenting to the surgeons where initial clinical findings and investigations suggested a cyst in the right adnexa. Diagnostic laparoscopy revealed mucocele of the appendix and laparoscopic appendicectomy was done. PMID:24678230

Singh, Manish Kumar; Kumar, Mani Kant; Singh, Ramanuj

2014-01-01

415

Revisional surgery after laparoscopic sleeve gastrectomy.  

PubMed

The recent increase in the frequency of bariatric surgery, especially laparoscopic sleeve gastrectomy, is associated with an increase in the frequency of revisional bariatric surgery. The causes of this are numerous but can be summarized as: (1) late fistulae (2) stenosis; (3) gastroesophageal reflux; and (4) weight regain (by increasing or not increasing the gastric volume). We present below a review of the clinical features, diagnosis, and treatment of them. PMID:25318535

Ferrer-Márquez, Manuel; Belda-Lozano, Ricardo; Solvas-Salmerón, Ma José; Ferrer-Ayza, Manuel

2015-02-01

416

Laparoscopic repair of paraesophageal hiatal hernia.  

PubMed

Twenty-seven patients underwent consecutive elective laparoscopic repair of paraesophageal hiatal hernia between October 1992 and June 1997. There were 24 females and 3 males. The average age was 68 years (range, 46-86) and average weight was 173 pounds (range, 122-243 lb.). Presenting symptoms were: postprandial epigastric pain or pressure in 19 patients, postprandial dyspnea in 7 patients, anemia in 5 patients, postprandial vomiting of food in 5 patients, and 1 patient had postprandial palpitation. Heartburn was present in 9 patients. Five patients had a history of symptoms of intermittent volvulus. History of hiatal hernia was present in 19 patients ranging from 6 months to 38 years in duration. The operative procedure included a laparoscopic reduction of the herniated stomach, excision of the hernia sac, and closure of the diaphragmatic defect with placement of mesh graft. Anterior gastropexy was performed on all patients except two who had a Nissen fundoplication due to severe reflux symptoms. Seven patients had laparoscopic cholecystectomy at the same time and one patient had an excision of a small benign gastric leiomyoma of the fundus. The average operative time was 2:54 hours (range, 1:35-4:05 hrs.). The average hospital stay was 3.8 days (range, 2-8 days). One patient had a postoperative stroke and recovered quickly. Follow-up of 1 to 56 months showed no recurrence of the hernia. Two patients complained of some epigastric pain and six patients had occasional mild reflux that was easily controlled medically. Laparoscopic repair of paraesophageal hernia is a safe procedure with a short hospital stay and recovery time. Using mesh graft decreases the risk of developing an iatrogenic parahiatal hernia. The addition of Nissen fundoplication is not necessary unless the patient has objective findings of reflux. PMID:9697897

Hawasli, A; Zonca, S

1998-08-01

417

Laparoscopic Radical Trachelectomy: Technique, Feasibility, and Outcomes  

PubMed Central

Background and Objectives: Our objectives are to describe our surgical technique for laparoscopic radical trachelectomy, to evaluate its feasibility, and to present the perioperative results at Hospital Italiano de Buenos Aires, Argentina. Methods: We analyzed 4 patients who underwent laparoscopic radical trachelectomy for early-stage cervical cancer between December 2011 and May 2013. Results: Four patients were included in this study. Total laparoscopic radical trachelectomy was performed in all cases. The mean age was 26 years (range, 19–32 years), the mean body mass index was 21 (range, 18–23), and the mean length of hospital stay was 33 hours (range, 24–36 hours). The mean operative time was 225 minutes (range, 210–240 minutes), and no complications were reported. During the postoperative period, only 1 patient presented with left vulvar edema, which resolved spontaneously. The pelvic and parametrial lymph nodes, as well as the vaginal cuff and cervical resection margins, were negative for malignancy in all cases. On average, 18 pelvic lymph nodes (range, 15–20) were removed. The tumor stage was IB in all 4 patients, and the mean tumor size was 17 mm (range, 12–31 mm). No patient required conversion to laparotomy. Conclusion: We consider laparoscopic radical trachelectomy, performed by trained surgeons, a feasible and safe therapeutic option as a fertility-sparing surgical technique, with good perioperative outcomes for women with early-stage cervical cancer with a desire to preserve their fertility. Minimally invasive surgery provides the widely known benefits of this type of approach.

Saadi, José Martín; Perrotta, Myriam; Orti, Roberto; Salvo, Gloria; Gogorza, Sebastían; Testa, Roberto

2015-01-01

418

Venous air embolism during laparoscopic cholecystectomy.  

PubMed

Vascular air embolism is a rare and potentially life-threatening event. In this study, a case of venous air embolism during laparoscopic cholecystectomy due to an injured inferior vena cava is presented. Anesthesiologists and surgeons must be aware of this dangerous complication. Emphasis is given to the prevention and prompt recognition of this event and to the use of all available tools in the management of cardiovascular complications. PMID:19929300

Abut, Yesim Cokay; Eryilmaz, Ramazan; Okan, Ismail; Erkalp, Kerem

2009-01-01

419

[Laparoscopic management of median arcuate ligament syndrome].  

PubMed

Median arcuate ligament syndrome is a rare disorder resulting from luminal narrowing of the celiac trunk. The classic management of median arcuate ligament syndrome involves the surgical division of the median arcuate ligament fibers in order to decompress the celiac trunk. This has traditionally required an upper midline incision. A few authors have described a successful laparoscopic release of celiac artery compression syndrome. Laparoscopy provides a less invasive, but equally effective method for decompressing the celiac trunk. PMID:18313874

Jarry, J; Berard, X; Ducasse, E; Biscay, D; Pailler, A; Sassoust, G; Midy, D; Baste, J-C

2008-02-01

420

Laparoscopic diverted resleeve with ileal transposition for failed laparoscopic sleeve gastrectomy: a case report.  

PubMed

Laparoscopic sleeve gastrectomy (LSG) recently gained popularity for the treatment of obesity and related co-morbidities. With the increasing number of bariatric operations, the requirement for redo or revision bariatric surgery seems to be increasing. In the present case, a 50-year-old female patient with failed LSG who underwent laparoscopic resleeve, duodenal diversion, and ileal transposition is presented. Her metabolic and biochemical parameters were found to be improved significantly after 18 months. To the best of our knowledge, this is the first report of a case treated with this method in the literature. PMID:25578286

Çelik, Alper; Ugale, Surendra; Ofluo?lu, Hasan

2015-01-01

421

Laparoscopic fundoplication for gastroesophageal reflux disease  

PubMed Central

Gastroesophageal reflux disease (GERD) is a condition that develops when the reflux of gastric contents into the esophagus leads to troublesome symptoms and/or complications. Heartburn is the cardinal symptom, often associated with regurgitation. In patients with endoscopy-negative heartburn refractory to proton pump inhibitor (PPI) therapy and when the diagnosis of GERD is in question, direct reflux testing by impedance-pH monitoring is warranted. Laparoscopic fundoplication is the standard surgical treatment for GERD. It is highly effective in curing GERD with a 80% success rate at 20-year follow-up. The Nissen fundoplication, consisting of a total (360°) wrap, is the most commonly performed antireflux operation. To reduce postoperative dysphagia and gas bloating, partial fundoplications are also used, including the posterior (Toupet) fundoplication, and the anterior (Dor) fundoplication. Currently, there is consensus to advise laparoscopic fundoplication in PPI-responsive GERD only for those patients who develop untoward side-effects or complications from PPI therapy. PPI resistance is the real challenge in GERD. There is consensus that carefully selected GERD patients refractory to PPI therapy are eligible for laparoscopic fundoplication, provided that objective evidence of reflux as the cause of ongoing symptoms has been obtained. For this purpose, impedance-pH monitoring is regarded as the diagnostic gold standard. PMID:25339814

Frazzoni, Marzio; Piccoli, Micaela; Conigliaro, Rita; Frazzoni, Leonardo; Melotti, Gianluigi

2014-01-01

422

Laparoscopic excision of a familial paraganglioma.  

PubMed

Pheochromocytomas are rare neuroendocrine tumors that secrete catecholamines and usually arise from the adrenal medulla. Catecholamine-producing tumors that arise from extra-adrenal chromaffin tissue are referred to as paragangliomas, or extra-adrenal pheochromocytomas. Contrary to the traditional "Rule of Tens," as many as 25% of pheochromocytomas occur in hereditary tumor syndromes, such as multiple endocrine neoplasia-2, von Hippel-Lindau disease, neurofibromatosis-1, or hereditary or familial paraganglioma syndrome. Surgical resection remains the only curative therapy for pheochromocytomas, and advances in minimally invasive techniques have shown laparoscopic adrenalectomy to be safe and effective. Paragangliomas are extremely rare tumors, especially in children, and the role of laparoscopy in their treatment is evolving. This case report and the accompanying video demonstrate that the laparoscopic approach to retroperitoneal paraganglioma resection provides excellent exposure of the tumor and surrounding structures. Given proper patient preparation and perioperative monitoring, laparoscopic exploration and resection of paragangliomas can be safely and successfully accomplished in children. In addition, genetic analysis should be considered for all patients presenting with these tumors. PMID:19260793

Kelliher, Kristine; Santiago, Angela; Estrada, D Elizabeth; Campbell, Brendan T

2009-04-01

423

Laparoscopic appendectomy with hand-made loop  

PubMed Central

Introduction Acute appendicitis is the most common abdominal pathology requiring emergent surgical procedure. For treatment, laparoscopic surgery is commonly performed. For appendix stump closure different procedures are used. Aim Evaluation of the results of patients in whom the stump of the appendix was closed with a hand-made loop during laparoscopic appendectomy (LA). Material and methods Patients in whom the stump of the appendix was closed with a hand-made loop during LA were included in the study. Reports of patients were collected from patient files retrospectively. Laparoscopic appendectomy was applied through 3 ports. Two loops were placed in the stump of the appendix. Loop was a modification of the Roeder loop that has been described in the literature and has been shown to be safe. Results Sixty-one patients were included in the study. Twenty-four of them (39%) were female, 37 of them (61%) were male. The age range is from 13 to 60 (average age is 30) years. During the postoperative period, one surgical wound infection and two intraabdominal abscesses were detected. There was no leakage from the stump of the appendix in any patients. Conclusions One of the most important components of cost of LA is the technique of closure of the stump. Stapler, endoloop, various clips or a hand-made loop could be used for closure. We recommend using a hand-made loop for closure as an easy, safe and cheap method. PMID:25097680

Bilecik, Tuna; Ensari, Cemal Ozben; Oruc, Mehmet Tahir

2014-01-01

424

Laparoscopically assisted resection of the lower rectum.  

PubMed

We report a new laparoscopic approach to the resection of the lower rectum which has been successfully used in the treatment of a patient with a small rectal carcinoid tumor. Under general anesthesia a pneumo-peritoneum was established with CO2 gas insufflation and the rectum was mobilized from the sacrum including division of the lateral ligaments under the direct view of the laparoscope. The bowel was divided between the sigmoid colon and the rectum using an endoscopic linear stapler, and the rectum was everted through the anal canal. The lower rectum was transected extracorporeally using a linear stapler and the rectal stump was then returned to the anatomical position. An anvil of a circular stapling device into the oral colon stump through a small skin incision on the left lower abdomen was introduced and the shaft of the device through the rectal stump via anus was inserted. The device was then re-approximated under laparoscopic view and fired. Our procedure described here is applicable to the lower rectal lesion as a minimally invasive, safe, and useful therapeutic tool. PMID:8779073

Tanaka, J; Ito, M; Shindo, Y; Kotanagi, H; Koyama, K

1996-03-01

425

Adjuvant radiotherapy following radical hysterectomy for patients with stage IB and IIA cervical cancer  

Microsoft Academic Search

From 1971 through 1984, 320 women underwent radical hysterectomy as primary therapy of stage IB and IIA cervical cancer. Two hundred forty-eight patients (78%) were treated with surgery alone and 72 patients (22%) received adjuvant postoperative external-beam radiotherapy. Presence of lymph node metastasis, large lesion (greater than 4 cm in diameter), histologic grade, race (noncaucasian), and age (greater than 40

Andrew P. Soisson; John T. Soper; Daniel L. Clarke-Pearson; Andrew Berchuck; Gustavo Montana; William T. Creasman

1990-01-01