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1.
TNM staging and assessment of resectability of pancreatic cancer by laparoscopic ultrasonography 总被引:3,自引:0,他引:3
J. Durup Scheel-Hincke M. B. Mortensen N. Qvist C. P. Hovendal 《Surgical endoscopy》1999,13(10):967-971
Background: Laparoscopic ultrasonography (LUS) is an imaging modality that combines laparoscopy and ultrasonography. The purpose of this
prospective blinded study was to evaluate the TNM stage and assessment of resectability by LUS in patients with pancreatic
cancer.
Methods: Of the 71 consecutive patients admitted to our department, 36 were excluded from the study, mainly due to evident signs of
metastatic disease or another condition that would preclude surgery. Thus, a total of 35 patients were enrolled in the study.
All patients underwent abdominal CT scan, ultrasonography, endoscopic ultrasonography (EUS), diagnostic laparoscopy, and LUS.
Histopathologic examination was considered to be the final evaluation for LUS in all but three patients, where EUS was used
as the reference.
Results: The accuracy of LUS in T staging was 29/33 (80%); in N staging it was 22/34 (76%); in M staging, it was 23/34 (68%); and
in overall TNM staging, it was 23/34 (68%). In assessment of nonresectability, distant metastases, and lymph node metastases,
the sensitivity was 0.86, 0.43 and 0.67, respectively, for LUS alone. Combining the information gleaned from laparoscopy and
LUS, the accuracy in finding nonresectable tumors was 89%.
Conclusions: Diagnostic laparoscopy with LUS is highly accurate in TNM staging and assessment of resectability of pancreatic cancer and
should be considered an important modality in the assessment algorithm.
Received: 6 July 1998/Accepted: 13 October 1998 相似文献
2.
An accurate pretherapeutic assessment of resectability in patients with upper gastrointestinal malignancies (UGIM) is mandatory in order to choose the optimal treatment strategy. Endoscopic ultrasonography (EUS) has significantly reduced the need for exploratory laparotomy in patients with UGIM, but the pretherapeutic evaluation in about 10% of the patients is incomplete due to certain limitations of the EUS. We prospectively evaluated the use and results of diagnostic laparoscopy in patients with UGIM selected for this procedure by EUS.In six patients with incomplete EUS, laparoscopy demonstrated nonresectability in five patients and a resectable tumor in one patient, and laparoscopy thus filled the informational gap in all cases. In addition, laparoscopy confirmed nonresectability in ten patients in whom EUS had suggested nonresectability. By employing the combinated use of EUS and laparoscopy it seems possible to avoid a great number of futile laparoscopies, and it should also reduce the need for explorative laparotomies. Larger prospective studies have been initiated and might be able to confirm this. 相似文献
3.
The use of diagnostic laparoscopy supported by laparoscopic ultrasonography in the assessment of pancreatic cancer 总被引:13,自引:0,他引:13
Background: Pancreatic resection with curative intent is possible in a select minority of patients with carcinomas of the pancreatic
head. Diagnostic laparoscopy supported by laparoscopic ultrasonography combines the proven benefits of staging laparoscopy
with high-resolution intraoperative ultrasound, thus allowing the surgeon to perform a detailed assessment of the pancreatic
cancer.
Methods: In a prospective study of 26 patients with obstructive jaundice from a carcinoma of the head of the pancreas, the curative
resectability of tumors was assessed by ultrasound (26 cases), computerized tomography (26 cases), endoscopic ultrasound (16
cases), and a combination of diagnostic laparoscopy and laparoscopic ultrasound (26 cases).
Results: The findings of ultrasound and computerized tomography were comparable: 50% of patients were excluded from curative resection.
Endoscopic ultrasound provided precise information on the primary tumors. The accuracy of the combined diagnostic laparoscopy
and laparoscopic ultrasound, when compared with ultrasound, computerized tomography, and endoscopic ultrasound, was better
with respect to minute peritoneal or hepatic metastasis: 80.7% (or a further 30.7%) of patients did not qualify for curative
resection.
Conclusions: Diagnostic laparoscopy supported by laparoscopic ultrasonography enables detection of previously unsuspected metastases;
thus, needless laparotomy can be avoided. It should therefore be considered the first step in any potentially curative surgical
procedure.
Received: 12 April 1997/Accepted 30 April 1998 相似文献
4.
Is laparoscopic sonography a reliable and sensitive procedure for staging colorectal cancer? 总被引:2,自引:2,他引:0
O. Goletti G. Celona C. Galatioto B. Viaggi P. V. Lippolis L. Pieri E. Cavina 《Surgical endoscopy》1998,12(10):1236-1241
Background: Laparoscopic colectomy has developed rapidly with the explosion of technology. In most cases, laparoscopic resection is performed
for colorectal cancer. Intraoperative staging during laparoscopic procedure is limited. Laparoscopic ultrasonography (LUS)
represents the only real alternative to manual palpation during laparoscopic surgery.
Methods: We evaluated the diagnostic accuracy of LUS in comparison with preoperative staging and laparoscopy in 33 patients with colorectal
cancer. Preoperative staging included abdominal US, CT, and endoscopic US (for rectal cancer). Laparoscopy and LUS were performed
in all cases. Pre- and intraoperative staging were related to definitive histology. Staging was done according to the TNM
classification.
Results: LUS obtained good results in the evaluation of hepatic metastases, with a sensitivity of 100% versus 62.5% and 75% by preoperative
diagnostic means and laparoscopy, respectively. Nodal metastases were diagnosed with a sensitivity of 94% versus 18% with
preoperative staging and 6% with laparoscopy, but the method had a low specificity (53%). The therapeutic program was changed
thanks to laparoscopy and LUS in 11 cases (33%). In four cases (12%), the planned therapeutic approach was changed after LUS
alone.
Conclusions: The results obtained in this study demonstrate that LUS is an accurate and highly sensitive procedure in staging colorectal
cancer, providing a useful and reliable diagnostic tool complementary to laparoscopy.
Received: 2 May 1997/Accepted: 11 February 1998 相似文献
5.
A prospective comparison of laparoscopic ultrasound vs intraoperative cholangiogram during laparoscopic cholecystectomy 总被引:5,自引:2,他引:3
R. A. Falcone Jr. E. J. Fegelman M. S. Nussbaum D. L. Brown T. M. Bebbe G. L. Merhar J. A. Johannigman F. A. Luchette K. Davis Jr. J. M. Hurst 《Surgical endoscopy》1999,13(8):784-788
Background: The laparoscopic ultrasound (US) probe provides a new modality for evaluating biliary anatomy during laparoscopic cholecystectomy
(LC).
Methods: We performed a laparoscopic US examination in 65 patients without suspected common bile duct (CBD) stones prior to the performance
of a laparoscopic cholangiogram (IOC). We then compared the cost, time required, surgeon's assessment of difficulty, and interpretations
of findings.
Results: There was a significant difference in the cost of US versus the cost of IOC ($362 ± 12 versus $665 ± 12; p < 0.05). Surgeons who had performed >10 US (EXP) were compared with those who had performed ≤10 (NOV). There were significant
differences between the EXP and NOV groups in ease of examination, visualization of biliary anatomy, and accuracy of measurement
of the CBD.
Conclusions: The use of laparoscopic US for the accurate evaluation of the CBD and biliary anatomy requires that the surgeon has surpassed
the learning curve, which we have defined as having performed >10 US exams.
Received: 1 May 1998/Accepted: 21 October 1998 相似文献
6.
Background: This prospective study was conducted to evaluate the accuracy and the therapeutic relevance of staging laparoscopy.
Methods: Between June 1993 and February 1997 staging laparoscopy was performed in 389 patients with various neoplasms. Additionally,
144 selected patients of this group were examined with laparoscopic ultrasound using a semiflexible ultrasound probe (7.5
MHz).
Results: Compared to conventional imaging methods, laparoscopy and laparoscopic ultrasound improved the accuracy of staging in 158
of 389 patients (41%). Statistical subgroup analysis of 131 patients with gastric cancer showed that the accuracy of staging
laparoscopy in the detection of distant metastases (68%) was significantly higher (p < 0.01) than that of ultrasound (63%) or computed tomography (58%). In the whole group, laparoscopy alone disclosed intraabdominal
tumor dissemination or nonresectable disease in 111 patients. Laparoscopic ultrasound displayed additional metastases—i.e.,
liver metastases (n = 9), M1 lymph nodes (n = 15), or nonresectable tumors (n = 6) in 30 patients. Although metastastic disease
was suggested by preoperative imaging, benign lesions were found in five patients with laparoscopy and in a further 12 patients
with ultrasonography. The findings of staging laparoscopy changed the treatment strategy in 45% of the patients. Conversion
to open surgery was necessary in 5% of the cases, and complications related to laparoscopy occured in 4% of the patients.
Conclusions: Laparoscopy with laparoscopic ultrasound improves the staging of gastrointestinal tumors and has a significant impact on
a stage-adapted surgical therapy.
Received: 3 April 1997/Accepted: 26 September 1997 相似文献
7.
Long-term results after laparoscopic unroofing of solitary symptomatic congenital liver cysts 总被引:3,自引:0,他引:3
Background: Reports about laparoscopic management of symptomatic nonparasitic liver cysts are increasing, proving the procedure feasible
and safe. However, late results of endoscopic unroofing currently are not available. The primary aim of the study was to offer
long-term results with a follow-up of more than 5 years. Two diagnostic pitfalls are presented.
Methods: Preoperatively, diagnosis was established by sonography, computed tomography (CT) scan, echinococcus serology, and tumor-marker
measurement. The outcome of 12 laparoscopic fenestrations in 11 patients with symptomatic solitary liver cysts is presented.
Nine patients were reexamined after a median observation time of 3.1 years (range, 0.6–6.4 years) by clinical investigation
and ultrasonography, CT scan, or magnetic resonance imaging (MRI), respectively.
Results: All operations could be finished laparoscopically, and no death occurred. Simultaneous cholecystectomy was performed in six
cases. All patients experienced immediate relief of symptoms. Postoperatively, no complications were observed except one patient
with unilateral brachial vein thrombosis. Histologically, we discovered one hydatide cyst and one cystadenoma underlying the
cystic disorder leading to further therapy. At follow-up, one of the remaining seven patients (14.3%) suffered symptomatic
recurrence and successfully underwent reoperation endoscopically.
Conclusions: The results of this study confirm the outcome reported previously after short- and intermediate-term follow-up showing that
laparoscopic management of symptomatic solitary nonparasitic liver cysts is permanently successful in a large majority of
cases when diagnosis is correct.
Received: 16 July 1998/Accepted: 17 December 1998 相似文献
8.
Laparoscopic management of ovarian tumors 总被引:1,自引:0,他引:1
Background: Laparoscopy can be used with minimal operative morbidity to evaluate adnexal masses. We report our experience with the endoscopic
approach to the diagnosis and treatment of ovarian tumors. In particular, we describe 11 patients who incidentally underwent
laparoscopy and in whom the ovarian masses were found to be malignant.
Methods: Between September 1994 and September 1996, 292 patients with 316 ovarian tumors were treated laparoscopically in the Department
of Obstetrics–Gynaecology, University of Ulm. We assessed vaginal ultrasonography, clinical assessment, the tumor marker CA
12-5, and the intraoperative low-power magnification for their value in predicting the final diagnosis in all laparoscopically
treated ovarian tumors.
Results: From a total of 292 patients with ovarian tumors, 11 were diagnosed, intraoperatively or after final histologic examination,
as having a malignant or borderline ovarian tumor. All applied pre- and intraoperative diagnostic procedures were by themselves
too unreliable to exclude early stages of ovarian carcinoma exactly.
Conclusions: On the basis of the present findings, we are tempted to conclude that laparoscopic surgery is justified in the management
of ovarian tumors. Even with an accurate preoperative selection of suitable patients for laparoscopic surgery, the presence
of an undetected ovarian carcinoma cannot be entirely excluded.
Received: 23 September 1997/Accepted: 4 December 1997 相似文献
9.
F. Asencio J. Aguiló J. L. Salvador A. Villar E. De la Morena M. Ahamad J. Escrig J. Puche V. Viciano G. Sanmiguel J. Ruiz 《Surgical endoscopy》1997,11(12):1153-1158
Background: The high proportion of gastric carcinomas present in an unresectable stage, together with the emergence of multimodal treatments,
increases the usefulness of objective staging methods that avoid unnecessary laparotomies.
Methods: A prospective evaluation of the accuracy of laparoscopy in the staging of 71 patients with gastric adenocarcinoma is presented.
Serosal infiltration, retroperitoneal fixation, metastasis to lymph nodes, peritoneal and liver metastasis, and ascites were
determined in the staging workup. Sensitivity, specificity, and predictive values were calculated and compared with those
obtained with ultrasonography (US) and computed tomography (CT).
Results: The diagnostic accuracy of laparoscopy in the determination of resectability was 98.6%. Consequently, over 40% of patients
were spared unnecessary laparotomies. Laparoscopy yielded diagnostic indices superior to US and CT for all the tumoral attributes
studied. Our technique permits accurate assessment and pathologic verification of liver and the peritoneal and retroperitoneal
extent of tumor invasion in the majority of patients.
Conclusions: Laparoscopy in gastric adenocarcinoma is a reliable technique that provides accurate assessment of resectability and stage,
thus avoiding unnecessary laparotomies in patients in whom surgical palliation is not indicated. A stepwise diagnostic workup
combining imaging and minimally invasive techniques is proposed.
Received: 5 May 1996/Accepted: 10 March 1997 相似文献
10.
Minimally invasive surgical staging for esophageal cancer 总被引:9,自引:0,他引:9
Luketich JD Meehan M Nguyen NT Christie N Weigel T Yousem S Keenan RJ Schauer PR 《Surgical endoscopy》2000,14(8):700-702
Background: The incidence of esophageal adenocarcinoma is increasing in the United States, and the 5-year survival rate is dismal. Preliminary
data suggest that conventional imaging is inaccurate in staging esophageal cancer and could limit accurate assessment of new
treatments. The objective of this study was to compare minimally invasive surgical staging (MIS) with conventional imaging
for staging esophageal cancer.
Methods: Patients with potentially resectable esophageal cancer were eligible. Staging by conventional methods used computed tomography
(CT) scan of the chest and abdomen, and endoscopic ultrasound (EUS), whereas MIS used laparoscopy and videothoracoscopy. Conventional
staging results were compared to those from MIS.
Results: In 53 patients, the following stages were assigned by CT scan and EUS: carcinoma in situ (CIS; n= 1), I (n= 1), II (n= 23), III (n= 20), IV (n= 8). In 17 patients (32.1%), MIS demonstrated inaccuracies in the conventional imaging, reassigning a lower stage in 10 patients
and a more advanced stage in 7 patients.
Conclusions: In 32.1% of patients with esophageal cancer, MIS changed the stage originally assigned by CT scan and EUS. Therefore, MIS
should be applied to evaluate the accuracy of new noninvasive imaging methods and to assess new therapies for esophageal cancer.
Received: 5 April 1999/Accepted: 15 March 2000/Online publication: 12 July 2000 相似文献
11.
Role of laparoscopic ultrasonography in intraoperative localization of pancreatic insulinoma 总被引:11,自引:3,他引:8
Background: A combination of digital palpation and ultrasonography plays an important role in locating insulinomas intraoperatively.
Laparoscopic resection of insulinomas has been described recently, but experience in locating insulinomas during laparoscopy
is lacking.
Methods: From January 1998 to January 1999, three patients with pancreatic insulinomas underwent laparoscopy and laparoscopic ultrasonography
aimed at intraoperative localization and potential resection. The role of laparoscopy and laparoscopic ultrasonography in
locating insulinomas is evaluated.
Results: Preoperative localization studies were routinely performed, and two patients had an occult tumor before laparoscopy. None
of the tumors was detected by laparoscopic examination, but laparoscopic ultrasonography identified solitary tumors located
at the body and tail of the pancreas. Conversion to laparotomy was performed in one patient as a planned procedure. One patient
underwent laparoscopic enucleation, whereas the other had a laparoscopic distal pancreatectomy.
Conclusions: Laparoscopic ultrasonography seems to be sensitive in locating insulinomas at the body and tail of the pancreas. It optimizes
and facilitates resection of insulinomas through a minimally invasive approach.
Received: 8 March 1999/Accepted: 10 August 1999/Online publication: 7 September 2000 相似文献
12.
First results of laparoscopic gastrostomy 总被引:2,自引:1,他引:1
Background: Laparoscopic gastrostomy as an alternative to open gastrostomy was introduced with various technical variants 5 years ago.
However, long-term results of these new methods are still lacking.
Methods: From 4/1993 to 2/1996, laparoscopic gastrostomies were performed on 42 patients (50.9 ± 15.6 [24–71] years) with esophageal
stenosis in locally advanced hypopharyngeal (17 patients) or oropharyngeal (nine patients) carcinoma, incurable esophageal
carcinoma (13 patients) and cerebral dyspagia (three patients). Operating time was 38 ± 11 min [15–65 min]. Procedure-related
mortality was 0%. Major complications occurred in 2/42 (4.7%) patients; minor complications were found in 4/42 (9.4%) patients.
During a total usage time of 427 months, 14 stoma infections occurred (0.11 infections/100 days).
Conclusion: Laparoscopic gastrostomy allows a safe, fast, and cheap reestablishment of enteral nutrition. The procedure is minimally
invasive and can also be performed under local anesthesia. It has become our method of choice in patients with malignant,
nonresectable subtotal stenosis of the hypopharynx or esophagus.
Received: 5 March 1996/Accepted: 31 July 1996 相似文献
13.
Background: The aim of this study was to compare the value of endorectal ultrasound (EUS), three-dimensional (3D) EUS, and endorectal
MRI in the preoperative staging of rectal neoplasms.
Methods: Thirty consecutive patients with rectal tumors were assessed by EUS and endorectal MRI. Additionally, three-dimensional ultrasound
was performed in a subgroup of 25 patients. EUS data were obtained with a bifocal multiplane transducer (10 MHz) and processed
on a 3D ultrasound workstation. MR imaging was carried out with a 1.5 T superconducting unit using an endorectal surface coil.
Results: EUS was carried out successfully in all 30 patients, whereas endorectal MRI was not feasible in two patients. Compared with
the histopathological classification, EUS and endorectal MRI correctly determined the tumor infiltration depth in 25 of 30
and 28 patients, respectively. The comparative accuracy of EUS, 3D EUS, and endorectal MRI in predicting tumor invasion was
84%, 88%, and 91%, respectively. EUS, three-dimensional EUS, and endorectal MRI enabled us to assess the lymph node status
correctly in 25, 25, and 24 patients, respectively. Both three-dimensional EUS and endorectal MRI combined high-resolution
imaging and multiplanar display options. Assessment of additional scan planes facilitated the interpretation of the findings
and improved the understanding of the three-dimensional anatomy.
Conclusion: The accuracy of three-dimensional EUS and endorectal MRI in the assessment of the infiltration depth of rectal cancer is
comparable to conventional EUS. One advantage of both methods is the ability to obtain multiplanar images, which may be helpful
for the planning of surgery in the future.
Received: 4 April 2000/Accepted: 25 August 2000/Online publication: 27 October 2000 相似文献
14.
Background: Large adenomas and low-risk rectal carcinomas (T1) that are localized distal of the pelvic peritoneal reflection (PPR) are treated by transanal excision. However, the location
of the PPR varies widely and cannot be detected reliably by preoperative methods. Therefore, we evaluated the value of endorectal
ultrasound (EUS) for the prediction of an intraperitoneal location of rectal tumors.
Methods: Fourteen patients with rectal tumors measuring ≤15 cm from the anal verge were examined by EUS. If peristalsis beyond the
rectal wall or any intraperitoneal fluid was seen at the proximal tumor edge, the lesion was classified as localized above
or in the level of the PPR. During the operation, the surgeon determined whether the upper end of the tumor reached the PPR.
Results: In each of our 14 patients, the prediction by EUS was correct. In two patients, a small rectal tumor was excised with an
electric sling during rectoscopy, but the polyp bases were not free of dysplastic epithelial tissue. The point where these
two polyps were removed could be visualized by endoscopy but not by EUS. Once the relevant area was marked with a titanic
endoclip, EUS was able to predict the resection place in relation to the PPR in these two patients as well.
Conclusions: Although this knowledge would be very important for the therapeutic strategy of small rectal tumors, it is impossible to
determine the location of a rectal tumor with regard to the PPR either clinically or by endoscopy. EUS provides this information
with high reliability. Thus, we recommend EUS as the method of choice for predicting the location of the PPR.
Received: 13 January 1998/Accepted: 14 April 1998 相似文献
15.
A stratified intraoperative surgical strategy is mandatory during laparoscopic common bile duct exploration for common bile duct stones 总被引:3,自引:0,他引:3
J. F. Gigot B. Navez J. Etienne E. Cambier P. Jadoul P. Guiot P. J. Kestens 《Surgical endoscopy》1997,11(7):722-728
Background: Open exploration and endoscopic sphincterotomy (ES) remain the preferred treatment of common bile duct stones (CBDS). The
recent spread of laparoscopy has worsened the dilemna of choosing between surgical and endoscopic treatment of CBDS. The aim
of this study was to critically evaluate the results of our preliminary experience with laparoscopic common bile duct exploration
(CBDE) for CBDS.
Methods: Ninety-two consecutive patients were prospectively submitted to laparoscopic CBDE. Surgical strategy included an initial
transcystic approach or laparoscopic choledochotomy. Failure of stone clearance was managed by conversion to open CBDE or
by postoperative ES. Electrohydraulic lithotripsy and papillary balloon dilatation were selectively used. Stone clearance
was assessed by choledochoscopy and control cholangiography.
Results: The overall laparoscopic stone clearance in this series was 84% (transcystic route 63% and choledochotomy 93%). Conversion
to laparotomy was mandatory in 12% of the patients because of incomplete stone clearance and in 5% because of intraoperative
complications. Postoperative ES was required in 4% of the patients, giving an overall surgical success rate of 96%. When indicated
(small and limited number of stones located below the cysticocholedochal junction, with a dilated and patent cystic duct)
the transcystic route had the lower success rate, the higher complication rate, and the shorter operative time and postoperative
hospital stay. When indicated (accessible and dilated common bile duct over 7 mm), laparoscopic choledochotomy had the higher
success rate, the lower complication rate, the longer operative time, and the longer postoperative hospital stay, which is
related to associated external biliary drainage. The hospital mortality included two high-risk patients (2%) and the complications
rate was 15%.
Conclusions: Laparoscopic CBDE is safe in selected patients. A stratified intraoperative surgical strategy is mandatory in deciding between
a transcystic route and choledochotomy with specific indications for each approach. When feasible, laparoscopic choledochotomy
is more efficient and safe than the transcystic route, but it is associated with a longer postoperative hospital stay, which
is due to external biliary drainage.
Received: 7 May 1996/Accepted: 19 November 1996 相似文献
16.
Background: We performed a prospective randomized comparison of laparoscopic intraoperative ultrasonography (LIOU) and dynamic intraoperative
cholangiography (IOC) during laparoscopic cholecystectomy (LC).
Methods: LIOU and IOC were attempted in 518 consecutive patients scheduled for laparoscopic cholecystectomy. The order in which the
diagnostic procedures were performed was randomly assigned.
Results: LIOU failed in two patients (0.4%), and there were 41 (7.9%) failed IOC. The common bile duct (CBD) was visualized reliably
with both methods. Our patients showed sensitivities of 83.3% and 100% and specificities of 100% and 98.9%, with an overall
accuracy of 99.2% and 98.9% for LIOU as compared to IOC for identifying unsuspected common bile duct stones. The time necessary
for the examination was significantly shorter in LIOU than in IOC (7 versus 16 min).
Conclusion: LIOU performed by experienced surgeons is a good and effective method to assess the CBD, including the neighboring structures
of hepatoduodenal ligament. Using powerful, flexible-tip ultrasound probes, CBD exploration can be done in a longitudinal
fashion, which is necessary for good anatomical clarity. A lack of adverse effects, shorter examination times, and lower costs
are some of the advantages of this method. The most important advantage is the possibility of unlimited repetition, especially
if there is difficulty identifying anatomic structures. In addition, there are some indications that LIOU has the potential
to recognize major iatrogenic bile duct injuries.
Received: 19 December 1996/Accepted: 23 April 1997 相似文献
17.
Background: Whether or not laparoscopic cholecystectomy may be performed safely as an outpatient procedure is controversial. In 1993,
a protocol for outpatient laparoscopic cholecystectomy was instituted to determine the benefits and safety of discharging
patients within several hours of surgery.
Methods: The initial 60 outpatient laparoscopic cholecystectomies performed by one surgeon in a hospital-based outpatient teaching
facility between February 1993 to June 1996 were prospectively studied.
Results: Fifty-eight (97%) patients were discharged successfully after an average stay in the recovery room of 3 h. There were no
deaths. Two patients required overnight observation and three patients required readmission. Two patients (3%) had cystic
duct leak. The average hospital stay for all patients undergoing laparoscopic cholecystectomy at the institution (inpatient
and outpatient) decreased from 3.2 to 1.5 days and the average hospital cost decreased from $7,800 to $4,600 during this period.
Conclusion: Laparoscopic cholecystectomy in an outpatient setting is safe and cost-effective in healthy patients.
Received: 3 April 1997/Accepted: 10 June 1997 相似文献
18.
Background: The laparoscopic approach must be shown to be cost-effective as well as safe and technically effective before being widely
adopted. A review of 54 consecutive patients who underwent open and laparoscopic colposuspension is presented and a cost-analysis
is performed comparing the two approaches.
Methods: This study was a retrospective controlled review of patient records and accounts of in-hospital costs incurred at a private
hospital.
Results: Theater costs were significantly greater in the laparoscopic group but this was balanced by a shorter length of stay and
subsequent reduced accommodation cost. There was no difference in the overall in-hospital costs between the two groups.
Conclusion: The laparoscopic surgical approach is safe and effective and by no means more expensive than the open approach. In the future,
the laparoscopic approach can only become more cost efficient; techniques will improve and there will be earlier returns to
work and, subsequently, greater productivity.
Received: 19 August 1996/Accepted: 20 December 1996 相似文献
19.
Laparoscopic partial adrenalectomy 总被引:2,自引:0,他引:2
Imai T Tanaka Y Kikumori T Ohiwa M Matsuura N Mase T Funahashi H 《Surgical endoscopy》1999,13(4):343-345
Background: Most laparoscopic adrenalectomies involve total removal of the whole adrenal gland, and reports of laparoscopic partial adrenalectomies
have been very few. The criteria for performing a laparoscopic partial adrenalectomy have not been described.
Methods: (a) Patients with functioning adrenal tumors smaller than 3 cm in diameter were selected. (b) The solitary adrenal tumors
were evaluated by preoperative thin-slice computed tomography (CT) scan. (c) Solitary lesions were reconfirmed with intraoperative
ultrasonography. (d) Partial adrenalectomy was performed with at least a 5-mm margin using a vascular stapler.
Results: Laparoscopic partial adrenalectomy was performed in five patients using the vascular stapler. Hemostasis was perfect in all
five patients. The tumor was located in the inferior part of the right adrenal gland in three cases and in the upper pole
of the left adrenal gland in two cases. The postoperation pathologic diagnosis was adrenocortical adenoma in all five patients,
and excessive hormonal levels or symptoms all disappeared.
Conclusions: Laparoscopic partial adrenalectomy can be performed safely using a vascular stapler.
Received: 26 May 1998/Accepted: 30 June 1998 相似文献
20.
A cost and outcome comparison between laparoscopic and Lichtenstein hernia operations in a day-case unit 总被引:8,自引:5,他引:3
Background: Laparoscopic hernia repair has often been criticized for its high costs.
Methods: To compare the costs of laparoscopic and open hernia repair, 40 patients were randomized for either transabdominal laparoscopic
or Lichtenstein mesh repair (under local anesthesia) in a day-case surgery unit.
Results: Median operative times for the laparoscopic and open groups were 62 and 65 min, respectively. Postoperative pain was comparable
for the two groups. The period before return to normal life was 14 days in the laparoscopic group and 21 days in the open
group. The hospital costs were 2051 FIM ($1 US = 4.6 FIM) higher in the laparoscopic group, but the total costs for employed
patients (including expenses due to lost work days) were lower.
Conclusion: Although the Lichtenstein operation is cheaper for the hospital, the total costs for working patients are lower with the
laparoscopic technique, when the cost of lost work days is factored into overall expense.
Received: 5 May 1997/Accepted: 28 October 1997 相似文献