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1.
Laparoscopic colectomy 总被引:4,自引:1,他引:3
G. A. Fielding J. Lumley L. Nathanson P. Hewitt M. Rhodes R. Stitz 《Surgical endoscopy》1997,11(7):745-749
Background: Laparoscopic colectomy has developed with the explosion of technology that has followed laparoscopic cholecystectomy. Accumulation
of skills in general laparoscopic surgery has made complex surgery, such as colectomy, feasible.
Methods: Three hundred fifty-nine laparoscopic cases were prospectively studied. Data has been kept on benign and malignant cases,
operative results, hospital stay, and morbidity. Special care has been taken to follow malignant cases, looking for recurrence
of disease.
Results: There were 359 cases (206 females, 153 male) average age 58.8 years (18–94), and 149 patients had malignancy. All types of
resections were performed, including 151 anterior resections, 66 right hemicolectomies (RHC), 36 total colectomies, and 22
rectopexies. Operating times fell with experience—the last 20 cases of anterior resection took 150 min (110–240) and of RHC
took 130 min (65–210). Twenty-six (7%) cases were converted to open surgery. Hospital stays for anterior resection lasted
5–7 days (2–33); in the last 20 cases the average stay was 4 days. Morbidity included seven leaks (2.7%), four strictures
(1.2%), 12 wound infections (3.3%), and nine ileus (2.5%). There were six deaths within 30 days—sepsis, myocardial infarction,
aspiration pneumonia, and disseminated liver metastases. One hundred forty-nine cancer cases have had ten recurrences: one
pelvic recurrence, six liver metastases, two para-aortic nodal, and one case of disseminated disease. Average time of recurrence
was 33 months (15–46 months).
Conclusions: Laparoscopy in the hands of experienced laparoscopic surgeons is a safe, efficient procedure. All types of procedures are
possible. Early results in 149 malignancies are encouraging and recurrence rates are low. Prospective studies, now that skills
are developed to a level comparable to that of open surgery, are now being performed to further assess laparoscopy's possible
role in treating cancer.
Received: 26 March 1996/Accepted: 15 October 1996 相似文献
2.
Postoperative complications of laparoscopic-assisted colectomy 总被引:4,自引:2,他引:2
A. M. Lacy J. C. García-Valdecasas S. Delgado L. Grande J. Fuster J. Tabet C. Ramos J. M. Piqué A. Cifuentes J. Visa 《Surgical endoscopy》1997,11(2):119-122
Background: This study was performed to prospectively assess the complications of 118 consecutive patients who underwent laparoscopic
assisted colorectal resections.
Methods: The variables included were: indication for surgery, type of resection, duration of operation, duration of postoperative
ileus, length of hospital stay, port-site recurrence, and complications in relation to the laparoscopic technique.
Results: 118 Laparoscopic-assisted procedures were performed between July 1992 and October 1995. Surgical indications were: 106 patients
for colonic malignancy, six for diverticulitis, two for Crohn's disease, two for benign polyps, one for endometriosis, and
one for ischemic colitis. Fifteen patients required conversion to open techniques for completion of the operations (12.7%).
The mean operating time was 168.8 min. The amount of operative blood loss was 98 ml. The mean time for passing flatus was
36 ± 16 h. Mean postoperative stay was 5.4 (range 3–13) days. Eight patients (6.8%) sustained complications: four unrelated
to laparoscopy (three wound infection, one anastomotic leak); and four complications related to the laparoscopic approach:
one small-bowel obstruction, one trocar injury, one rotation of the anastomosis, and one misdiagnosed synchronous adenocarcinoma.
Conclusions: We suggest that with the development of improved technical devices and more experience, the indications for laparoscopic
colectomy should continue to expand. The low incidence of infectious complications suggests an important role for the laparoscopic
approach to colorectal surgery.
Received: 25 March 1996/Accepted: 8 July 1996 相似文献
3.
Telementoring 总被引:1,自引:0,他引:1
J. C. Rosser M. Wood J. H. Payne T. M. Fullum G. B. Lisehora L. E. Rosser P. J. Barcia R. S. Savalgi 《Surgical endoscopy》1997,11(8):852-855
Background: Telemedicine offers significant advantages in bringing consulting support to distant colleagues. There is a shortage of surgeons
trained in performing advanced laparoscopic operations.
Aim: Our aim was to evaluate the role of telementoring in the training of advanced laparoscopic surgical procedures.
Methods: Student surgeons received a uniform training format to enhance their laparoscopic skills and intracorporeal suturing techniques
and specific procedural training in laparoscopic colonic resections and Nissen fundoplication. Subsequently, operating rooms
were equipped with three cameras. Telestrator (teleguidance device), instant replay (to critique errors), and CD-ROM programs
(to provide information of reference) were used as intraoperative educational assistance tools. In phase I, four colonic resections
were performed with the mentor in the operating room (group A) and four colonic resections were performed with the mentor
on the hospital grounds, but not in the operating room (group B). The voice and video signals were received at the mentor's
location, using coaxial cable. In phase II, two Nissen fundoplications were performed with the mentors in the operating room
(group C) and two Nissen fundoplications were performed with the mentors positioned five miles away from the operating room
(group D), using currently existing land lines at the T-1 level.
Results: There were no differences in the performances of the surgeons and outcome of the operations between groups A & B and C &
D. It was possible to tackle the intraoperative problems effectively.
Conclusions: The telementoring concept is potentially a safe and cost-effective option for advanced training in laparoscopic operations.
Further investigation is necessary before routine transcontinental patient applications are attempted.
Received: 17 May 1996/Accepted: 19 August 1996 相似文献
4.
A. Emmermann C. Zornig D. M. Lloyd M. Peiper C. Bloechle C. E. Broelsch 《Surgical endoscopy》1997,11(7):734-736
Background: Between 1991 and November 1994, 18 patients with large, solitary, nonparasitic liver cysts underwent laparoscopic deroofing;
the last 13 of them also received an omental transposition flap in addition.
Methods: Using three to four trocars, the cystic contents were first aspirated, and the cyst derooted widely using diathermia. An
omental transposition flap was fashioned and stapled into the cyst cavity itself.
Results: Postoperative complications included one case of pulmonary atelectasis. Another patient developed a subhepatic bile collection
which was aspirated percutaneously. On average, patients were discharged on the 4th (2–14) postoperative day. Follow-up was
performed with abdominal ultrasound for 2–43 months (mean 19 months). There were two early cyst recurrences, both in cases
without an omental transposition flap (overall recurrence rate, 11%; in patients with omental flap, 0).
Conclusions: Deroofing in combination with an omental transposition flap is a safe and effective therapy for symptomatic solitary liver
cysts and can be performed using minimal-access surgical techniques.
Received: 19 January 1996/Accepted: 26 August 1996 相似文献
5.
Laparoscopic vs conventional Nissen fundoplication 总被引:18,自引:6,他引:12
Background: Laparoscopic Nissen fundoplication has gained wide acceptance among surgeons, but the results of the laparoscopic procedure
have not been compared to the results of an open fundoplication in a randomized study.
Methods: Some 110 consecutive patients with prolonged symptoms of grade II–IV esophagitis were randomized, 55 to laparoscopic (LAP)
and 55 to an open (OPEN) Nissen fundoplication. Postoperative recovery, complications, and outcome at 3- and 12-month follow-up
were compared in the two groups.
Results: Five LAP operations were converted to open laparotomy due to esophageal perforation (two), technical difficulties (two),
and bleeding (one). In the OPEN group (two) patients underwent splenectomy. There was no mortality. The mean hospital stay
was 3.2 days in the LAP group and 6.4 in the OPEN group. Dysphagia and gas bloating were the most common complaints 3 months
after the operation in both groups. These symptoms had disappeared at the 12-month follow-up examination. All patients in
the LAP group and 86% in the OPEN group were satisfied with the result.
Conclusions: Laparoscopic Nissen fundoplication is a safe and feasible procedure. Complications are few and functional results are good
if not better than those of conventional open surgery.
Received: 15 May 1996/Accepted: 10 September 1996 相似文献
6.
Laparoscopic creation of stomas 总被引:5,自引:0,他引:5
Background: Some indications for laparoscopic bowel surgery are still controversial. However, the use of laparoscopic techniques for
the treatment of benign disorders is less often challenged. Moreover, the morbidity of nonresectional procedures is less than
that encountered with resectional cases. Therefore, stoma creation seems ideally suited to laparoscopy. The aim of our study
was to assess the outcome of laparoscopic stoma creation.
Methods: All patients who underwent laparoscopic intestinal diversion were evaluated; parameters included age, gender, indication
for the procedure, history of previous surgery, operative time, length of hospitalization, recovery of bowel function, and
postoperative complications.
Results: Between March 1993 and January 1996, 32 patients of a mean age of 42.2 (range 19–72) years (14 males, 18 females) underwent
elective laparoscopic fecal diversion (25 loop ileostomy, four loop colostomy, three end colostomy). Indications for fecal
diversion were fecal incontinence (n= 11), Crohn's disease (n= 6), unresectable rectal cancer (n= 4), pouch vaginal fistula (n= 3), rectovaginal fistula (n= 2), colonic inertia (n= 2), radiation proctitis (n= 1), anal stenosis (n= 1), Kaposi's sarcoma of the rectum (n= 1), and tuberculous fistula (n= 1). Conversion was required in five patients (15.6%) due to the presence of adhesions (three), enterotomy (one), or colotomy
(one). All of these five patients had undergone previous abdominal surgery and were operated on early in our experience. Major
postoperative complications occurred in two patients (6%) and in both cases consisted of stoma outlet obstruction after construction
of a loop ileostomy. One of the two patients had undergone prior surgery. This patient required reoperation, at which time
a rotation of the terminal ileum at the stoma site was found. The other patient had a narrow fascial opening which was successfully
managed with 2 weeks of self-intubation of the stoma. The mean operative time was 76 (range 30–210) min; mean length of hospitalization
was 6.2 (range 2–13) days; stoma function started after a mean of 3.1 (range 1–6) days. Patients with previous abdominal surgery
had a longer mean operative time (14/32; 117 min) compared to patients who had no previous surgery (18/32; 55 min) (p < 0.0002). These longer operative times and hospital stay were attributable to extensive enterolysis, which was required
in some cases.
Conclusion: In conclusion, laparoscopic creation of intestinal stomas is safe, feasible, and effective. Although the length of the procedure
is longer in patients who have had prior surgery, previous surgery is not a contraindication, and even in these cases, a laparotomy
can be avoided in the majority of patients. Lastly, care must be taken to ensure adequate fascial opening and correct limb
orientation.
Received: 25 March 1996/Accepted: 21 May 1996 相似文献
7.
W. J. H. J. Meijerink Q. A. J. Eijsbouts M. A. Cuesta R. A. van Hogezand J. Ringers S. G. M. Meuwissen G. Griffioen W. A. Bemelman 《Surgical endoscopy》1999,13(9):882-886
Background: Laparoscopic bowel surgery was evaluated in 44 consecutive patients who underwent surgery for inflammatory bowel disease
(IBD). We studied feasibility, results, and final outcome.
Methods: At two academic institutes, 44 laparoscopically assisted colectomies and laparoscopic ileostomies or colostomies were attempted.
All patients had histologically proven IBD and no prior surgery for IBD. Loop ileostomy (n= 4), end colostomy (n= 1), ileocecal resection (n= 26) and (procto)colectomy (n= 13) were performed. All resections were laparoscopically assisted with extracorporal resection and anastomosis.
Results: Only in two patients (ileocecal resection in both) was conversion to open surgery necessary. Two patients with laparoscopic
ileocolic resection had intra-abdominal abscesses, which were drained percutaneously in both. One patient in the laparoscopically
assisted colectomy group had a subphrenic abscess that was drained percutaneously, and one patient had a generalized candidiasis.
Conclusions: Laparoscopically assisted colectomies can be performed safely in treating IBD. The laparoscopic method with use of a small
vertical umbilical or Pfannenstiel's incision seems acceptable with regard to operating time and overall costs, also allowing
superior cosmesis to be maintained.
Received: 12 August 1998/Accepted: 13 January 1999 相似文献
8.
Background: Experience with 94 resections in 88 patients with Crohn's disease using advanced laparoscopic techniques is reported. Records
of patients who underwent intestinal resection for Crohn's disease between August, 1993 and November, 1998 were reviewed.
Indications, operative findings, clinicopathologic, and postoperative data were recorded.
Methods: In this study, the mean age was 37 years (range, 16–70 years), and 55% of the participants were women. Indications for surgery
included obstruction (64 cases), pain (22 cases), peritonitis (1 case) and abscess (1 case). Seventy patients underwent ileocolic
resection, 28 of whom had a previous history of one or two ileocolic resections. Eight of these patients had additional procedures
including tubal ligation (1), sigmoidectomy (1), cholecystectomy (3 cases), and enterectomy (3 cases). Small bowel resection
(13 cases), right hemicolectomy (3 cases), subtotal colectomy (3 cases), anterior rectal resection (2 cases), and sigmoid
resection (3 cases) were performed in the remaining patients. All but one procedure were completed laparoscopically with extracorporeal
anastomosis. The average length of intestine resected was 33 cm (range, 10–92 cm). Forty-one patients had 58 fistulae between
ileum, jejunum, mesentery, colon, abdominal wall, skin, or bladder. Mean blood loss was 168 ml (range, 30–800 ml) and mean
operative time was 183 min (range, 96–400 min).
Results: More than 85% of the patients were tolerating a liquid diet on the first postoperative day. Average length of hospital stay
was 4.2 days (range, 3–11 days). Complications included anastomotic leak necessitating reoperation, stricture requiring endoscopic
dilation, hemorrhage treated expectantly, urinary tract infection, pulmonary embolus, line sepsis, and early postoperative
intestinal obstruction (7 cases) requiring reoperation in three cases.
Conclusions: Experience with both advanced laparoscopic techniques and conventional surgery for inflammatory bowel disease allowed successful
laparoscopic management of patients with complicated Crohn's disease.
Received: 29 August 1998/Accepted: 22 January 1999 相似文献
9.
Postoperative pain and fatigue after laparoscopic or conventional colorectal resections 总被引:16,自引:0,他引:16
Background: Conventional colorectal resections are associated with severe postoperative pain and prolonged fatigue. The laparoscopic
approach to colorectal tumors may result in less pain as well as less fatigue, and may improve postoperative recovery after
colorectal resections.
Methods: Sixty patients were included into a prospective randomized trial to determine the influence of laparoscopic (n= 30) or conventional (n= 30) resection of colorectal tumors on postoperative pain and fatigue. Major endpoints of the study were dose of morphine
sulfate during patient-controlled analgesia (PCA), visual analog scale for pain while coughing (VASC), and visual analogue
scale for fatigue (VASF). Efficacy of pain medication was assessed by visual analogue score at rest (VASR).
Results: Preoperative age, sex, stage, and localization of tumors were comparable in both groups. The PCA dose of morphine given immediately
after surgery until postoperative day 4 was higher in the conventional group (median, 1.37 mg/kg; 5–95 percentile 0.71–2.46
mg/kg) than the laparoscopic group (0.78 mg/kg; 0.24–2.38 mg/kg, p < 0.01). Postoperative VASR was comparable between both groups, but VASC was higher from the first to the seventh postoperative
day (p < 0.01). Postoperative fatigue was higher after conventional than after laparoscopic surgery from the second to the seventh
day (p < 0.05).
Conclusions: This study confirms that analgetic requirements are lower and pain is less intense after laparoscopic than after conventional
colorectal resection. Patients also experience less fatigue after minimal invasive surgery. Because of these differences,
the duration of recovery is shortened, and the postoperative quality of life is improved after laparoscopic colorectal resections.
Received: 4 July 1997/Accepted: 16 November 1997 相似文献
10.
Laparoscopic vs conventional bowel resection in the rat 总被引:2,自引:0,他引:2
N. D. Bouvy R. L. Marquet L. N. L. Tseng E. W. Steyerberg S. W. J. Lamberts H. Jeekel H. J. Bonjer 《Surgical endoscopy》1998,12(5):412-415
Background: The role of laparoscopic surgery in the treatment of colorectal disease is still controversial. To assess the metabolic consequences
of laparoscopic and open bowel surgery, we studied serum levels of insulin-like growth factor 1 (IGF-1), an anabolic and mitogeneic
peptide, in rats.
Materials and methods: In experiment 1, the serum IGF-1 levels of 10 rats undergoing laparoscopic small bowel resections (group I) and 10 rats undergoing
conventional small bowel resections (group II) were determined before surgery and on days 1, 2, and 7. Experiment 2 compared
five rats that had CO2 pneumoperitoneum (group III), five rats that underwent laparotomy (group IV), and five rats that received anesthesia only
(group V). Differences in IGF-1 levels were tested with analysis of covariance.
Results: In experiment 1, preoperative IGF-1 levels were similar in groups I and II (87.9 ± 6.1 nmol/L versus 90.5 ± 8.1 nmol/L).
One day after surgery IGF-1 was 54.6 ± 10.5 in group I versus 41.6 ± 8.3 in group II (p= 0.006). Two days after surgery, IGF-1 was 79.4 ± 9.2 in group I versus 59.0 ± 10.5 in group II (p < 0.001). Seven days after both types of surgery, IGF-1 levels had returned to almost normal levels. In experiment 2, no
significant differences were found between the rats with CO2 pneumoperitoneum (group III) and those with laparotomy only (group IV). Rats that had anaesthesia only showed a significant
decrease in IGF-1 levels between days 0 and 1 (p < 0.018).
Conclusion: Our study indicates that laparoscopic bowel surgery is associated with a better postoperative anabolic state (i.e., less
catabolism) than conventional surgery. This finding reflects a potential benefit of laparoscopy in bowel surgery.
Received: 22 May 1996/Accepted: 10 July 1997 相似文献
11.
Needle and trocar injury during laparoscopic surgery in Japan 总被引:12,自引:3,他引:9
Background: With the growth and sophistication of laparoscopic surgery, increased attention is now being focused on safety and complications.
Methods: In an attempt to address questions regarding the safety of laparoscopic surgery, a retrospective study of the time period
from January 1991 to December 1995 was conducted by the Study Group of Endoscopic Surgery in Kyushu, Japan.
Results: The response rate was 84.4% (152 of 180 hospitals). During the last 5 years 17,626 patients underwent endoscopic operations
and 87.5% (15,422 patients) had laparoscopic surgery while 12.5% (2,204 patients) underwent thoracoscopic surgery. In 96.6%
of the hospitals a minimal open laparotomy was used. Among the various operations, a cholecystectomy was performed in the
largest number of patients (13,787). The total number of complications was 415 (2.7%), of which 156 (37.6%) were related to
needle or trocar insertion. Visceral injury was found in 22 patients (0.14%): major vessel injury in 10, gastrointestinal
tract injury in 11, and liver injury in one patient. Abdominal wall injury was seen in 79 patients (0.52%), bleeding in 70
(0.46%), and a hernia in 9 (0.06%). Extraperitoneal insufflation occurred in 55 patients (0.36%). There was no mortality.
The complication rate significantly decreased year by year after the use of laparoscopic surgery began.
Conclusions: The most common complications of laparoscopic surgery are related to needle and trocar insertion. These are preventable by
placement under direct vision with verification of the intraperitoneal location of the needle and trocar.
Received: 10 February 1997/Accepted: 22 May 1997 相似文献
12.
Background: Despite the reduced rate of occurrence, the hydatidosis of the liver is still taking an important place in surgical practice
in Asia Minor and the Middle East. Traditional techniques for performing liver cyst surgery seem to be comparatively traumatic.
In this clinical study, we present our experience with laparoscopic treatment of hydatid cyst of the liver and discuss the
validity of the gasless technique as a solution to carbon dioxide (CO2) ensufflation problems.
Methods: All patients were prepared by administrating albendazole for 21 days preoperatively. Surgery was performed on 87 patients
under general anesthesia. Working space was obtained in 51 operations by using an abdominal wall lifting device, Laparolift™
(Origin Med Systems, Menlo Park, California, USA) (group 1). In 36 patients, the abdominal cavity was insufflated with CO2 gas (group 2). In all cases, hydatid cysts were identified, and gauses soaked in germicide solution were placed around them.
The cysts were punctured and aspirated. Then germisid solution was injected into the cysts. The cysts walls were opened, and
germinative membranes were evacuated.
Results: The median operation time was 50.49 ± 10.9 min (range, 30–75 min) in group 1 and 70.8 ± 16 min (ranges 40–120 min) in group
2. The difference in the operative times of the two groups was significant (p < 0.01). There was no significant difference between the minor complications of the two groups. There were no deaths and
no major complications or conversions to open surgery in any of the groups. There were no recurrences during follow-up time.
Conclusions: The use of gasless technique for the laparoscopic treatment of liver cyst is a safe, time-saving, and promising procedure
that can be applied in selected cases.
Received: 1 March 1999/Accepted: 1 July 1999 相似文献
13.
Complications of laparoscopic antireflux surgery in childhood 总被引:6,自引:2,他引:4
Background: The aim of this study was to assess the complications associated with the laparoscopic treatment of gastroesophageal reflux
disease (GERD) in children.
Methods: From March 1992 to March 1998, we used the laparoscopic approach to treat 289 children affected by gastroesophageal reflux
disease. The patients' ages ranged between 4 months and 17 years (median, 4.3 years), and their body weight ranged between
5 and 52 kg. In 148 children (51.3%), we adopted a Nissen-Rossetti procedure and in 141 (48.7%) a Toupet technique.
Results: The duration of surgery ranged between 40 and 180 min (median, 70). There were no deaths and no anesthesiological complications
in our series. We recorded 15 (5.1%) intraoperative complications: six pleural perforations, four lesions of the posterior
vagus nerve, two esophageal perforations, two gastric perforations, and one pericardiac perforation. Conversion to open surgery
was necessary in only four cases (1.3%). We recorded 10 (3.4%) postoperative complications: one peritonitis due to an esophageal
perforation not detected during the intervention that required a reoperation, five cases of herniation of the epiploon through
a trocar orifice, three cases of dysphagia that disappeared spontaneously after a few months, and one case of delayed gastric
emptying that subsequently required a pyloroplasty. We had six recurrences of GERD (2.1%). In two cases, a new fundoplication
was performed using the laparoscopic approach; in the other four, the GERD was controlled with medical therapy.
Conclusion: Our results show that laparoscopic fundoplication is an adequate treatment for children with GERD that has a low rate of
complications. When severe complications do occur, they can be treated effectively via the laparoscopic approach.
Received: 16 November 1999/Accepted: 16 December 1999/Online publication: 5 June 2000 相似文献
14.
Morbidity in laparoscopic gynecological surgery 总被引:16,自引:0,他引:16
C. Mac Cordick F. Lécuru E. Rizk F. Robin V. Boucaya R. Taurelle 《Surgical endoscopy》1999,13(1):57-61
Background: We set out to investigate prospectively the morbidity rate for gynecological laparoscopy patients at a tertiary care center.
Methods: We prospectively recorded data on 743 laparoscopic procedures performed between January 1, 1992 and December 31, 1996. The
procedures included 36 diagnostic laparoscopies (4.8%), 115 laparoscopies carried out for minor surgical acts (15.4%), 523
for major surgical acts (70.4%), and 69 for advanced surgical acts (9.4%). A total of 127 patients had a history of prior
laparotomy (17%). All those procedures were performed by young senior surgeons. We defined a complication as an event that
had modified the usual course of the procedure or of the postoperative period. For statistical analysis, we used the chi-squared
test or Fisher's exact test.
Results: Complications occurred in 22 cases; the overall complication rate was 2.9% when all events were considered. One complication
(injury of the left primitive iliac artery) was related to insertion of the Veress needle (0.13%). A total of 2,578 trocars
were inserted, giving rise to 10 complications (1.3%). Three unintended laparotomies were required for bowel or bladder injuries
(0.4%). Finally, the introduction of the laparoscope was responsible for 11 complications (1.4%); this figure represents 50%
of all the complications of this series. Eight intraoperative complications (1%) occurred during the laparoscopic surgery
(seven severe bleedings and one ureter injury, but no intestinal lesions); laparotomy was required in six of these cases.
Three complications occurred during the postoperative stage: one granulomatous peritonitis after intraabdominal rupture of
a dermoid cyst, one incisional hernia, and a fast-resolving cardiac arrhythmia.
Conclusions: In our experience, operative gynecological laparoscopy is associated with an acceptable morbidity rate. Moreover, about half
of the complications occur during the installation of the laparoscopic procedure, underscoring the usefulness of safety rules.
Received: 25 November 1997/Accepted: 8 May 1998 相似文献
15.
Background: Colonic perforations associated with colonoscopy are rare but major complications. Conservative treatment is less invasive
than major surgery, but any case of failure leads to more extensive surgical procedures with a higher morbidity and mortality
than the immediate operative repair. To reduce the invasiveness of major surgery and avoid the risk of failure, we introduced
laparoscopic techniques to deal with iatrogenic colonic perforations.
Methods: Each colonic perforation was identified by diagnostic laparoscopy. The perforation was then characterized by size and extent
of thermal damage into one of three types, followed by type-dependent treatment (suture, tangential resection, segmental resection,
or open procedure). Operative time, complications, clinical outcome, and patient satisfaction were recorded.
Results: Seven patients underwent diagnostic laparoscopy for colonic perforations. Laparoscopic treatment was performed on five patients
(one simple closure by suture, three tangential resections, and one segmental resection). Two cases required open procedures.
There was one intraoperative complication that necessitated conversion. There were no postoperative complications. All laparoscopically
treated patients were satisfied with their clinical outcome and cosmetic results.
Conclusions: Laparoscopic treatment seems to reduce the invasiveness and morbidity of major surgery. At the same time, it is more definitive
than conservative treatment, so that we now prefer to use laparoscopic techniques to treat colonic perforations related to
colonoscopy.
Received: 25 February 1998/Accepted: 22 June 1998 相似文献
16.
Laparoscopic renal surgery usually involves the use of five or six trocars. This report concerns the authors' technique for
performing such surgery through only three trocars. Semilateral patient positioning, along with additional table rotation,
is utilized to facilitate visceral rotation and optimize exposure of the kidney. Four laparoscopic renal procedures were performed:
one renal cyst decortication and three upper pole partial nephrectomies with ureterectomies for duplications of the collecting
system. Mean operative time was 148 min with no conversions; there were no intra- or postoperative complications. All patients
tolerated a liquid diet on postoperative day 1, and the median hospital stay was 2 days. In selected cases laparoscopic renal
surgery may be approached safety through three trocars.
Received: 29 March 1996/Accepted: 1 July 1996 相似文献
17.
Background: Minimally invasive techniques offer theoretical advantages for treating resectable periampullary neoplasms. Laparoscopic
pancreaticoduodenectomy (LPD) was first reported in 1992 and has been performed clinically despite lack of animal data to
support the operation. The purpose of this study was to develop LPD in an acute porcine model and to assess safety and efficacy
before considering clinical trials.
Methods: LPD was initiated in six domestic pigs under general anesthesia. Once pneumoperitoneum was created, five 10-mm access ports
were placed (one central and two in each flank). After cholecystectomy, the duodenum was mobilized and the proximal jejunum
was divided distal to the ligament of Treitz. The neck of the pancreas was separated from the superior mesenteric vein, and
the midstomach was divided by a stapler. Pancreaticojejunostomy (PJ), choledochojejunostomy (CDJ), and gastrojejunostomy (GJ)
were performed using interrupted sutures. The animals were immediately sacrificed and the operative site was examined.
Results: LPD was aborted in three animals due to complications: intestinal perforation with fecal contamination (one) and prolonged
resection time ≥ 2.5 h (two). LPD was completed in three animals (operative time ranged from 5.0 to 7.5 h, blood loss < 200
cc); however, at sacrifice one PJ and two CDJs had small posterior leaks. The efferent loop of the GJ was narrowed by the
staple line in one pig. All animals had extensive ecchymosis of the jejunal serosa due to excessive manipulation.
Conclusion: Despite a significant number of anastomotic leaks in the immediate postoperative period, laparoscopic pancreaticoduodenectomy
is feasible in a porcine model. Further studies and technical development are necessary before laparoscopic pancreatic resection
can be performed on a more widespread basis.
Received: 22 April 1996/Accepted: 10 July 1996 相似文献
18.
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
19.
Duration of postlaparoscopic pneumoperitoneum 总被引:4,自引:0,他引:4
Background: Patients who present with abdominal pain after recent laparoscopic surgery present a diagnostic dilemma when pneumoperitoneum
is present. Previous studies do not define the duration of postlaparoscopic pneumoperitoneum. In this study, we attempted
to define the duration of laparoscopic pneumoperitoneum and to identify factors which affect resolution time.
Methods: We followed 57 patients who underwent laparoscopic cholecystectomy (34), inguinal herniorraphy (20), or appendectomy (three).
Serial abdominal films were taken until all residual gas was resolved.
Results: Thirty patients resolved their pneumoperitoneum within 24 h; 16 patients resolved between 24 h and 3 days; nine patients
resolved between 3 and 7 days; two patients resolved between 7 and 9 days. Mean resolution time for all patients was 2.6 ±
2.1 days. There was no apparent difference in resolution time between the three types of procedures; however, the sample size
may be insufficient. Duration of the pneumoperitoneum did not correlate with gender, age, weight, initial volume of CO2 used, length of time for the procedure, or postoperative complications. Sixteen patients had bile spillage during cholecystectomy
which significantly reduced the duration of postoperative pneumoperitoneum (p < 0.008), resulting in a mean resolution time of 1.3 ± 0.9 days. While 14 patients reported postoperative shoulder pain,
no correlation was found between the presence or duration of shoulder pain and the extent or duration of pneumoperitoneum.
Conclusions: We conclude that the residual pneumoperitoneum following laparoscopic surgery resolves within 3 days in 81% of patients and
within 7 days in 96% of patients. The resolution time was significantly less in patients sustaining intraoperative bile spillage
during cholecystectomy. There was no correlation found between postoperative shoulder pain and the presence or duration of
the pneumoperitoneum.
Received: 22 March 1996/Accepted: 12 July 1996 相似文献
20.
Conversions and complications in 185 laparoscopic adjustable silicone gastric banding cases 总被引:9,自引:3,他引:6
E. Chelala G. B. Cadiére F. Favretti J. Himpens M. Vertruyen J. Bruyns L. Maroquin M. Lise 《Surgical endoscopy》1997,11(3):268-271
Background: Kuzmak's gastric silicone banding technique is the least invasive operation for morbid obesity. The purpose of this study
was to analyze the complications of this approach.
Methods: Between September 1992 and March 1996, 185 patients underwent laparoscopic gastroplasty by the adjustable silicone band technique.
A minimally invasive procedure using five trocars was performed.
Results: In 11 patients exposure of the hiatus was impeded because of hypertrophy of the left liver lobe which led to conversion in
eight patients and abortion of the procedure in three other patients. Anatomical complications: We observed two gastric perforations
and one band slippage at the early stage, one infection and three rotations of the access port. Functional complications:
There were eight (4%) cases of irreversible total food intolerance resulting in pouch dilation and eight cases (4%) of esophagitis.
One fatality on the 45th day in a patient with a Prader-Willi syndrome.
Conclusion: The most disturbing complications of gastric banding technique are gastric perforation and pouch dilation. Their incidence
may be reduced by improving the technique and by considering pitfalls of the procedure.
Received: 28 May 1996/Accepted: 25 July 1996 相似文献