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1.
Alterations in hepatic function during laparoscopic surgery 总被引:15,自引:4,他引:11
Background: Very few studies have been done on the consequences of pneumoperitoneum on hepatic function. At present, there is no consensus
on the physiopathological hepatic implications of pneumoperitoneum. The purpose of this clinical study was to evaluate the
effects of pneumoperitoneum on hepatic function in 52 patients treated with laparoscopic procedures.
Methods: Thirty-two laparoscopic cholecystectomies and 20 nonhepatobiliary laparoscopic procedures were performed in 52 patients (12
men and 40 women) with a mean age of 44 years (range, 15–74). All patients had normal values on preoperative liver function
tests. The anesthesiologic protocol was uniform, with drugs at low hepatic metabolism. The 32 cholecystectomies were randomized
into 22 performed with pneumoperitoneum at 14 mmHg and 10 performed at 10 mmHg. All nonhepatobiliary laparoscopic procedures
were performed with a pneumoperitoneum of 14 mmHg. The postoperative serologic levels of AST, ALT, bilirubin, and prothrombin
time were measured at 6, 24, 48, and 72 h. The serologic changes were related to the procedure, the duration, and the level
of pneumoperitoneum.
Results: Mortality and morbidity were nil. All 52 patients had a postoperative increase in AST, ALT, bilirubin, and lengthening in
prothrombin time. Slow return to normality occurred 48 or 72 h after operation. The increase of AST and ALT was statistically
significant and correlated both to the level (10 versus 14 mmHg) and the duration of pneumoperitoneum.
Conclusions: The duration and level of intraabdominal pressure are responsible for changes of hepatic function during laparoscopic procedures.
Although no symptom appears in patients with normal hepatic function, patients with severe hepatic failure should probably
not be subjected to prolonged laparoscopic procedures.
Received: 23 May 1997/Accepted: 28 October 1997 相似文献
2.
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
3.
D. S. Seidman F. Nasserbakht F. Nezhat C. Nezhat C. Nezhat 《Surgical endoscopy》1996,10(11):1099-1101
Vascular injury is one of the major complications of laparoscopic surgery. Prompt diagnosis is crucial for proper management
of this potentially life-threatening complication. Two cases of iliac artery puncture occurred during operative laparoscopy.
The injuries were not diagnosed immediately, probably due to the initial accumulation of blood in the retroperitoneum. Significant
damage to large blood vessels may not be readily apparent during laparoscopic surgery.
Received: 6 December 1995/Accepted: 19 January 1996 相似文献
4.
Complications of pediatric laparoscopic surgery 总被引:2,自引:2,他引:0
C. Esposito G. Ascione V. Garipoli G. De Bernardo G. Esposito 《Surgical endoscopy》1997,11(6):655-657
Background: Surgical complications of laparoscopy most often occur during Veress needle or primary trocar placement. Veress needle punctures
are insignificant and require no further treatment, whereas trocar-induced vascular injuries can be catastrophic. The frequency
of vascular and viscus injuries is difficult to calculate because several complications are not reported in the literature.
Methods: During a 10-year-period (1984–1995), at the Division of Pediatric Surgery at ``Federico II' University of Naples, 430 laparoscopic
procedures were performed in 395 children with a mean age of 5 years. The incidence of complications related to laparoscopy
was 1.8% with eight complications, one of which was rather severe. The complications included one abdominal wall hematoma,
two perforations of abdominal viscus (stomach, ovary), one umbilical scar complication, one postoperative hydrocele, one subcutaneous
emphysema, and one pneumothorax during a Nissen procedure. The only severe complication occurred in a young girl with neurologic
problems and a kyphoscoliosis operated on via laparoscopy for a gastroesophageal reflux. She suffered injuries of both right
common iliac vessels and several intestinal perforations due to blind introduction of the first umbilical trocar.
Results: In this case rapid conversion, complex vascular reconstruction, and multiple intestinal sutures were performed. The Nissen
fundoplication with pyloroplasty was performed traditionally and the patient left the hospital free of symptoms after 20 days.
The other seven complications were resolved without any problem intra- or postoperatively.
Conclusions: The authors believe that the open approach with a blunt trocar is most important in helping to avoid complications in pediatric
laparoscopy.
Received: 5 July 1996/Accepted: 19 November 1996 相似文献
5.
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
6.
Takiguchi S Matsuura N Hamada Y Taniguchi E Sekimoto M Tsujinaka M Shiozaki H Monden M Ohashi S 《Surgical endoscopy》2000,14(1):41-44
Background: CO2 pneumoperitoneum provides a new surgical environment to treat malignant disease. The purpose of this study was to investigate
the influence of CO2 pneumoperitoneum during laparoscopic surgery on cancer cell growth.
Methods: WiDr human colon cancer cells were incubated for 3 h under the following two conditions: 100% CO2 at 10 mmHg, and 95% air/5% CO2 (control). Cell proliferation was assessed by the WST-1 assay and BrdU assay. Tumor growth was assessed by subcutaneous injection
into 20 nude mice. Cellular damage was measured by lactate dehydrogenase (LDH) assay.
Results: The number of WiDr cells under pneumoperitoneal conditions decreased in the first 24 h. However, no significant difference
was observed in the proliferation rate and tumor growth of the viable cells. LDH release of the CO2 pneumoperitoneal group was higher than that of the controls.
Conclusions: Our data indicate that CO2 pneumoperitoneum does not promote cancer cell proliferation but instead has a toxic effect on cancer cells.
Received: 19 March 1999/Accepted: 15 June 1999 相似文献
7.
S. H. Kim J. W. Milsom J. M. Church K. A. Ludwig A. Garcia-Ruiz J. Okuda V. W. Fazio 《Surgical endoscopy》1997,11(10):1013-1016
Background: Because of the inability to palpate colonic tumors during laparoscopy, their location must be precisely identified before
resection is undertaken.
Method: A retrospective study was performed of 58 patients in order to be able to describe our methods of tumor localization for
laparoscopic colorectal operations and to review their effectiveness.
Results: In all patients, the entire colon was examined preoperatively by colonoscopy. In one patient, preoperative colonoscopic localization
was inaccurate. In 31 patients, tumors were easily detectable at surgery. In five patients with the tumor in the right colon,
even though the lesion was not detectable at surgery, right colectomy was performed without marking because preoperative colonoscopy
reliably identified the lesion adjacent to the ileocecal valve. Twenty-two patients required some type of procedure to localize
the tumor. The procedures and their problems were as follows: preoperative tattoo (five)—tattoo not visualized (one); intraoperative
colonoscopy alone (six), combined with intraoperative tattoo (four) or clip (three)—poor operative exposure due to bowel distension
(nine), hard to see the clip (three), dislodged clip (two), inadequate resection margin (one); intraoperative proctoscopy
alone (two), combined with laparoscopic stitch (two)—no problems. In no patient was tumor present at a resection line and
in no patient was the wrong segment resected.
Conclusions: Reliable preoperative identification of the tumor adjacent to the ileocecal valve can permit right colectomy without marking.
Lesions in the upper rectum can be approached via intraoperative proctoscopy ± suture placement. If the surgeon anticipates
intraoperative localization may be difficult, lesions other than rectal or cecal ones should probably be marked by preoperative
tattooing. Further studies regarding the technique of tattooing are warranted.
Received: 18 July 1996/Accepted: 10 March 1997 相似文献
8.
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
9.
Production and systemic absorption of toxic byproducts of tissue combustion during laparoscopic surgery 总被引:3,自引:0,他引:3
Background: Among the potential hazards of laparoscopic surgery using electrocautery is the intraperitoneal release and subsequent absorption
of byproducts of tissue combustion. In a porcine model of laparoscopic surgery with smoke production, our aims were to assess
(1) the relationship between levels of intraperitoneal carbon monoxide (CO) and systemic carboxyhemoglobin (COHb) and methemoglobin
(MetHb), and (2) intraperitoneal concentrations of other noxious gases, including hydrogen cyanide (HCN), acrylonitrile (Acr),
and benzene (Bzn).
Methods: Seven pigs underwent laparoscopic resection of three hepatic wedges using monopolar electrocautery in a CO2 pneumoperitoneum. Sequential arterial samples were drawn to measure [COHb] and [MetHb] perioperatively, while gaseous intraabdominal
[CO], [HCN], [Acr], and [Bzn] were assayed intraoperatively.
Results: The mean ± SEM duration of operation was 90 ± 2 min, and electrocautery was used for 68 ± 4 min. Intraabdominal [CO] rose
from 0 to 814 ± 200 ppm (p < 0.01) while [COHb] increased from 2.9 ± 0.1% to 3.5 ± 0.1% (p < 0.001). Systemic [MetHb] remained unchanged intra- and postoperatively, ranging from 0.3 to 0.7%. Intraperitoneal [HCN]
rose from 0 to 5.7 ± 0.7 ppm (p < 0.001). [Acr], however, did not change significantly from preoperative values, ranging from 0 to 1.6 ± 1.0 ppm, and [Bzn]
was undetectable.
Conclusions: Laparoscopic tissue combustion increases intraabdominal [CO] to ``hazardous' levels leading to minimal, yet significant,
elevations of [COHb]. Systemic [MetHb] and intraabdominal [HCN], [Acr], and [Bzn] are not elevated to toxic levels. Production
of intraperitoneal smoke during laparoscopic electrosurgery therefore may not pose a significant threat to the patient.
Received: 3 April 1997/Accepted: 22 May 1997 相似文献
10.
P. M. Hewitt K. H. Kwong W. Y. Lau S. C. S. Chung A. K. C. Li 《Surgical endoscopy》1997,11(10):1032-1033
We report two cases of necrotizing fasciitis following laparoscopic surgery and discuss contributing factors, as well as
treatment of this rare complication.
Received: 26 August 1996/Accepted: 31 December 1996 相似文献
11.
We have developed a new device which enables rapid sealing of a minilaparotomy during laparoscopic assisted surgery to recreate
an airtight condition. This device consists of a center rod and two discs (7 cm in diameter) which form an airtight condition
by compressing the inner and outer surfaces of the abdominal wall. Advanced laparoscopic procedures requiring both pneumoperitoneum
and minilaparotomy are facilitated with the use of this device. This new device is called the Sandwich-disc: Takasago Medical
Industry Co., Ltd.
Received: 11 January 1996/Accepted: 22 March 1996 相似文献
12.
Effect of temperature of insufflated CO2 during and after prolonged laparoscopic surgery 总被引:2,自引:2,他引:0
M. Bäcklund I. Kellokumpu T. Scheinin K. von Smitten I. Tikkanen L. Lindgren 《Surgical endoscopy》1998,12(9):1126-1130
Background: Pneumoperitoneum with room temperature carbon dioxide (CO2) has been shown to decrease core temperature and urine output.
Methods: The effect of 37°C (warm) and room temperature (cool) CO2 pneumoperitoneum on core temperature, urine output, and central hemodynamics was compared in 26 randomized patients undergoing
prolonged laparoscopic surgery (>90 min).
Results: The core temperature (p < 0.05) and cardiac index (p < 0.05) were significantly higher after warm than after cool pneumoperitoneum. Urine output was significantly higher during
warm (2.3 ± 1.6 ml/kg/h) than during cool (0.9 ± 0.7 ml/kg/h) insufflation (p < 0.05). Two of 13 patients with warm and 11 of 13 patients with cool pneumoperitoneum needed mannitol to maintain adequate
diuresis (p < 0.05).
Conclusions: Warm insufflation probably causes a local vasodilation in the kidneys and may be beneficial to patients with borderline renal
function.
Received: 23 June 1997/Accepted: 16 November 1997 相似文献
13.
A. S. Lowham C. J. Filipi R. A. Hinder L. L. Swanstrom K. Stalter A. dePaula J. G. Hunter T. G. Buglewicz K. Haake 《Surgical endoscopy》1996,10(10):979-982
Background: This study retrospectively assesses the mechanisms of 13 esophageal or gastric injuries resulting from dilator or nasogastric
tube placement during laparoscopic foregut surgery and is intended to assist in determining methods of prevention.
Methods: Information regarding esophageal or gastric injury during laparoscopic foregut surgery was obtained from six experienced
laparoscopic surgeons. The specific mechanisms of injury were determined by discussion with the operating surgeon and review
of the operative reports.
Results: Eleven cases of esophageal or gastric perforation occurred during bougie insertion and two perforations occurred secondary
to nasogastric tube placement during Nissen fundoplication or Heller myotomy. Five perforations required conversion to open
operation for repair including two delayed thoracotomies. The 13 injuries occurred during the performance of 1,620 laparoscopic
foregut operations for an overall incidence of 0.8%.
Conclusion: Foregut injury resulting from esophagogastric intubation during laparoscopic surgery is more common than expected. Risk factors
include esophageal anatomy, intrinsic pathologic changes of the esophagus, and inexperience. Prevention must focus on close
communication between the surgeon and anethesiologist and safe techniques of dilator insertion. 相似文献
14.
Determinants of outcomes in laparoscopic colorectal surgery 总被引:3,自引:3,他引:0
15.
Intraperitoneal thermal variations during laparoscopic surgery 总被引:3,自引:1,他引:2
Background: The aim of this study was to measure thermal variations during laparoscopy in the vicinity of heat sources such as monopolar
(MC) and bipolar coagulation (BC) and to evaluate their possible negative consequences for the patient.
Methods: This study included 43 patients who underwent laparoscopic cholecystectomy. The temperature measurements were taken with
a sterile thermal probe (Mallinkrot Medical) introduced through a 5-mm trocar coupled with a recording monitor reading variations
between 20 and 80°C. The variation in temperature was measured as a function of the power applied to the electrodes (20 or
30 W) and in relation to the distance (1, 2, 3, 4, and 5 cm) from the electrodes.
Results: The temperature varied by 3° for BC and 29° for MC when the distance increased from 1 to 5 cm. With respect to the power
delivered, 20 or 30 W, the variations were 1° for BC and 17° for MC.
Conclusions: The minimal temperature variations associated with the use of BC makes it the option of choice for operating near structures
such as the common bile duct or the gastrointestinal tract.
Received: 7 January 1998/Accepted: 27 April 1998 相似文献
16.
Background: Laparoscopic surgery has not been widely established in developing countries due to the lack of access to training and lack
of money. We describe our experience using on-site training programs to efficiently teach and propagate laparoscopic surgery
in Leon, Nicaragua; La Paz, Bolivia; and Santa Cruz, Bolivia.
Methods: A group of well-trained and motivated local surgeons was identified in each country as the initial target for teaching. Participants
were taught basic and advanced laparoscopic surgery during on-site didactics, animal laboratories, and proctoring sessions.
Follow-up courses were held until the target group of surgeons was capable of independently teaching and supervising laparoscopic
surgery among other surgeons in each country.
Results: Multiple technical and logistic difficulties were encountered. In Leon, Nicaragua, and La Paz, Bolivia, a total of eight
surgeons were fully trained and proctored in laparoscopic cholecystectomy. In La Paz and Santa Cruz, Bolivia, a total of seven
surgeons were instructed in advanced laparoscopic procedures. To date, over 180 patients have undergone laparoscopic cholecystectomy
or advanced procedures with a morbidity similar to that reported in literature series in the United States.
Conclusions: Our experience demonstrates that in spite of numerous limitations, basic and laparoscopic surgery can be efficiently and
safely taught in developing countries. Many lessons were learned in how to safely and efficiently use laparoscopic equipment
and instruments within strict financial constraints.
Received: 20 March 1996/Accepted: 15 May 1996 相似文献
17.
Background: Bile duct injuries during laparoscopic cholecystectomy (LC) are thought to occur because surgeons tend to confuse the common
bile duct (CBD) with the cystic duct. Among reasons for this misidentification, the difference in the way the operating field
is exposed in LC compared to open cholecystectomy should be noticed. Using Dr. Reddick's technique, which is commonly practiced,
the upward and the lateral traction of the gallbladder results in a narrower Calot's triangle and angulation of the CBD. These
anatomical distortions are thought to contribute to ductal injuries during LC.
Methods: We propose a new method to expose Calot's triangle during LC. The principle of this technique is to expose the hepatic hilus
by retracting the caudal surfaces of the quadrate and lateral lobes of the liver using an atraumatic curved instrument.
Results: The advantages of this technique are that one gains wide exposure of the hepatic hilus, leaves Calot's triangle undistorted,
and avoids tenting the CBD.
Conclusions: This new technique may make LC safer and decrease the number of bile duct injuries associated with the misidentification
of the anatomy.
Received: 28 May 1996/Accepted: 2 December 1996 相似文献
18.
Totally laparoscopic abdominal aortic aneurysm repair 总被引:1,自引:0,他引:1
On the basis of our previous animal and clinical experience with laparoscopic intra-abdominal vascular reconstructions, and
due to the prevalence of abdominal aortic aneurysms (AAA), we have recently broadened our scope to tackle more difficult aortic
surgery laparoscopically. We present a case report of our first clinical experience with laparoscopic AAA repair using specialized
laparoscopic vascular instrumentation. The patient was an 84-year-old hypertensive male with a 7-cm asymptomatic infrarenal
abdominal aortic aneurysm that was discovered incidentally. He presented with postcoronary artery bypass grafting and had
moderate chronic obstructive pulmonary disease (COPD). A spiral computed tomograph (CT) angiogram revealed an adequate infrarenal
neck and aneurysmal involvement of the proximal iliac arteries. An eight-port transabdominal technique was used with the patient
in the supine position. Proximal and distal control was achieved without difficulty. The aneurysm was excluded using endoscopic
stapling devices, and an aortobiiliac reconstruction was performed with a 16 × 9-mm bifurcated dacron graft. Estimated blood
loss was 1000 ml, and the operative time was approximately 7 hours. The patient was ambulating without assistance on postoperative
day 3. Total hospitalization was 7 days (delayed secondarily to postoperative ileus). Minimal quantities of narcotics were
required for analgesia. At 6-months follow-up, the patient has palpable peripheral pulses and no complications related to
surgery. This case report shows that a completely laparoscopic approach to the abdominal aortic aneurysm is possible using
instrumentation specifically designed for laparoscopic vascular surgery. The exact role that laparoscopic techniques will
hold in vascular surgery remains to be determined because these procedures are time consuming and technically difficult.
Received: 2 December 1997/Accepted: 4 March 1998 相似文献
19.
It is recommended that tumor surface should be covered before resection in endoscopic surgery, but this is difficult to do,
and no satisfactory method for this purpose has been reported. Therefore, we developed a polymer sheet to cover the wet surfaces
of tumors. The sheet we developed is composed mainly of a cellulose derivative, ethyl citrate, and polyacrylic acid. Experimental
and clinical study was performed to investigate the usefulness of the sheet. The sheet became attached to the organ surface
by absorbing fluid secreted by tissues, and remained fixed for a period of 2 to 3 hours. No foreign body or allergic reaction
was observed, and no postoperative infection occurred. The polymer sheet can be used safely for the purpose of covering tumors
during endoscopic surgery.
Received: 8 March 1999/Accepted: 13 September 1999 相似文献
20.
Background: Between November 1991 and May 1995, a series of laparoscopic colectomies were performed in our hospital.
Methods: Our main aim was to define more specifically the indications for laparoscopic colectomy.
Results: A total of 69 patients underwent laparoscopic surgery for benign polypoid colorectal disease (n = 10), inflammatory bowel
disease (n = 24), and colorectal malignancy (n = 35). Of the latter group, four patients underwent a palliative procedure.
The conversion rate of the whole group was 29%. The main reason to convert was infiltrative growth in inflammatory disease
or cancer. Respectively, seven (10%) and 12 (17%) patients sustained complications in the perioperative and early postoperative
phase. Two patients died perioperatively (3%). The mean hospital stay was 12 days. On follow-up, 11 patients had developed
a stenotic anastomosis, which was successfully dilated in all cases. After 3 years, the survival rate according to Kaplan-Meier
is 86%, 66%, 68%, and 0% for Dukes' A, B, C, and D color carcinoma, respectively. In one patient with a Dukes B carcinoma,
port site metastases were found.
Conclusions: Justifiable indications for laparoscopic colorectal surgery include (a) a benign polyp 20–50 cm from the anal ring; (b) mobile,
inflammatory large bowel disease; (c) palliation in case of malignant disease, preferably of the left hemicolon. It remains
to be proven that laparoscopic colectomy is superior and not just equivalent to open colectomy. This is especially true for
resections of colorectal carcinoma with curative intent. Therefore a cost/benefit analysis should be performed in a prospective,
randomized setting.
Received: 1 November 1996/Accepted: 1 July 1997 相似文献