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1.
Asoglu O Igci A Karanlik H Parlak M Kecer M Ozmen V Muslumanoglu M 《Surgical endoscopy》2003,17(5):832
Mesenteric cysts are rare intraabdominal tumors. We review the diagnosis, laparoscopic management, patients outcome and follow-up of evaluation for three cases of mesenteric cyst that presented to Istanbul University, Istanbul Medical School, Department of Surgery, from 1999 to 2002. All of the patients presented with nonspecific abdominal symptoms such as constipation, abdominal discomfort, and anorexia. Preoperative evaluation for differentiating mesenteric cyst from malignancy is made by abdominal ultrasound and computed tomography. The procedure was completed laparoscopically using three trocars in three patients. In one patient retroperitoneal resection was performed. There were no intraoperative or postoperative complications. The follow-up periods ranged from 6 to 36 months, and there were no recurrences. Currently, the surgical treatment of mesenteric cyst should be performed by laparoscopy, which offers significant advantages in terms of reduced morbidity and hospital stay. For appropriate cases in which cyst arises from mesenterium of colon, the retroperitoneal approach should be applied.
Presented at the 5th National Endoscopic Laparoscopic Surgery Congress, Istanbul, Turkey, 22 April 2002 相似文献
2.
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
3.
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
4.
Ergonomic problems associated with laparoscopic surgery 总被引:6,自引:16,他引:6
Background: The Society of American Gastrointestinal Endoscopic Surgeons (SAGES) Task Force on Ergonomics conducted a subjective and objective assessment of ergonomic problems associated with laparoscopic instrument use. The goal was to assess the prevalence, causes, and consequences of operational difficulties associated with the use of laparoscopic instruments. Methods: A questionnaire was distributed asking respondents to rate the frequency with which they experienced pain, stiffness, or numbness in several body areas after laparoscopic operations. An ergonomics station was assembled to quantify forearm and thumb muscle workload. Processed electromyogram (EMG) signals were acquired from 27 volunteer surgeon subjects while they completed simulated surgical tasks using a hemostat and an Ethicon® laparoscopic grasper, with the aid of an endoscopic trainer and video monitoring system. Results: Of 149 surgeons responding to the questionnaire, 8% to 12% reported frequent pain in the neck and upper extremities associated with laparoscopic surgery. The ergonomics station demonstrated that the peak and total muscle effort of forearm and thumb muscles were significantly greater (p < 0.01) when the grasping task was performed using the laparoscopic instrument rather than the hemostat. Conclusion: These findings indicate that laparoscopic surgical technique is more taxing on the surgeon. 相似文献
5.
Background: Because so many common surgical problems can now be addressed by the laparoscopic approach, the issue of sterile processing
has to be reconsidered.
Methods: Selected laparoscopic instrumentation was analyzed regarding wear and tear and decontamination after sterile processing following
6,000 surgical laparoscopies carried out between 1990 and 1996 at the Academic Hospital Moabit, Berlin.
Results: Fewer than 7.9 (parts of) instruments failed per 100 laparoscopies. Most of the repairs involved scissors. The main problems
were blunting, burnt or disconnected electromechanical components, defective insulation, and damaged or lost parts of dismantable
instruments. Residues of human blood proteins were detected on a few instruments. The effect of intraluminal rinsing was documented
by measuring the iron content (as an indicator for blood contamination). A comparison of costs showed that it was >10 times
cheaper to use instrumentation with reusable components.
Conclusions: The sterile processing of economic reusable instrumentation for laparoscopies needs staff well trained in sterile supply.
Instrument design should allow easy dismantling and rinsing of internal parts. Insulating compounds present a problem for
decontamination. Disinfection with aldehydes before cleaning the lumina of instruments must be avoided because protein coagulation
will occur. A tube-in-tube concept for tubular instruments offering compatibility should be favored.
Received: 26 August 1997/Accepted: 9 January 1998 相似文献
6.
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
7.
Incidence and significance of pneumomediastinum after laparoscopic esophageal surgery 总被引:1,自引:0,他引:1
Clements RH Reddy S Holzman MD Sharp KW Olsen D Holcomb GW Richards WO 《Surgical endoscopy》2000,14(6):553-555
Background: Pneumomediastinum can be a sign of esophageal perforation. During laparoscopic esophageal surgery, the mediastinum is exposed
to carbon dioxide gas under pressure that can cause pneumomediastinum.
Methods: Forty-five patients undergoing laparoscopic esophageal procedures had erect, inspiratory, single-view chest radiographs (CXR)
performed in the recovery room (RR). Patients with extraabdominal gas underwent daily erect, inspiratory, single-view CXR
until resorption of the gas or discharge from the hospital. Insufflation time and pressure were recorded, and morbidity was
evaluated. Results are expressed as mean ± SEM.
Results: Twenty-five mens (56%)and 20 women (44%) aged 33.0 ± 2.9 years underwent 10 Heller myotomies (22.2%), 27 Nissen fundoplications
(60.0%), six Toupet fundoplications (13.3%), and two paraesophageal hernia repairs (4.4%). Twenty-four patients (53.3%) had
normal CXR in RR, and 21 (46.7%) had extraabdominal gas. Eighteen (85.7%) of the 21 had pneumomediastinum, three (14.3%) had
pneumothorax, and 12 (57.1%) had subcutaneous emphysema in RR. Sixteen of these 21 remained hospitalized and had repeat CXR
on postoperative day 1. Of these 16, five (31.3%) had normal CXR, 11 (68.8%) had pneumomediastinum, and seven (43.8%) had
subcutaneous emphysema. There were no esophageal perforations and no chest tube insertions, and there was no morbidity related
to pneumomediastinum.
Conclusion: Pneumomediastinum is observed frequently following laparoscopic esophageal operations and often persists past 24 h. After
these operations, pneumomediastinum is not necessarily indicative of esophageal perforation. In this group, it caused no clinically
significant events that altered the course of the patients.
Received: 30 April 1999/Accepted: 24 February 2000/Online publication: 8 May 2000 相似文献
8.
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
9.
R. Rosati U. Fumagalli S. Bona L. Bonavina M. Pagani A. Peracchia 《Surgical endoscopy》1998,12(3):270-273
Background: Extramucosal myotomy of the lower esophagus and cardia, combined with anterior fundoplication, is, in our opinion, the procedure
of choice to treat stage I–III esophageal achalasia.
Methods: After a successful experience with open surgery in over 280 patients, from January 1992 through February 1997, 61 patients
underwent laparoscopic Heller-Dor for stage I–III achalasia. Conversion to laparotomy was done in three cases. All procedures
were performed under intraoperative endoscopic control. Intraoperative complications were seven mucosal tears, which were
sutured laparoscopically in five cases. The sole postoperative complication was bleeding from an acute gastric ulcer (conservative
treatment).
Results: Follow-up consisted of clinical and radiographic study 1 month after surgery, and endoscopy and manometry within 1 year.
After a mean follow-up (F.U.) of 21 months (1–62), clinical results range from excellent to good in 98.2%. One patient (1.7%)
complaining of recurrent dysphagia improved after endoscopic dilation. Esophageal diameter reduced from 52 to 27 mm. LES pressure
reduced from 30.3 ± 12.4 to 10.7 ± 3.5 mmHg (basal) and from 14.8 ± 9.3 to 2.9 ± 2.1 mmHg (residual).
Conclusions: Laparoscopic Heller-Dor operation is feasible, safe, and effective. Special care should be taken in patients with previous
endoscopic dilations.
Received: 3 April 1997/Accepted: 28 July 1997 相似文献
10.
Determinants of outcomes in laparoscopic colorectal surgery 总被引:3,自引:3,他引:0
11.
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
12.
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
13.
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
14.
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
15.
Is laparoscopic pyloromyotomy superior to open surgery? 总被引:1,自引:1,他引:0
Background: We set out to determine whether laparoscopic pyloromyotomy (LPM) is superior to open pyloromyotomy (OPM) in babies with hypertrophic
pyloric stenosis (HPS).
Methods: We performed a retrospective study of 36 LPM and 36 OPM. Both groups were comparable in terms of sex, age and weight on admission,
and blood pH on admission and prior to surgery. In the LPM group, three trocars were used; in the OPM group, a small right
upper quadrant transverse muscle-cutting laparotomy was carried out.
Results: LPM produces a better cosmetic result, seems to produce less postoperative discomfort, and results in the absence of conversion
in a shorter hospital stay. However, the duration of the operation was significantly longer (32 versus 18 min). Moreover,
LPM clearly entailed more complications (three mucosal perforations against two, and two reoperations against none in the
open group).
Conclusions: The actual series does not favor the laparoscopic approach over the open one, in view of the relatively high complication
rate. Babies who are operated laparoscopically, however, seem to have less postoperative discomfort, a shorter hospital stay,
and a better cosmetic result. As we are confident that the complication rate and duration of the operation will drop with
further experience, we will continue to do LPM. LPM is not easy and should only be carried out when substantial experience
has been gained in the field of pediatric laparoscopic surgery.
Received: 6 September 1997/Accepted: 28 October 1997 相似文献
16.
Background: Peritonitis continues to be an important cause of morbidity and mortality and often an etiologic diagnosis is unclear. To
evaluate the efficacy and safety of laparoscopy the authors analyzed their 5-year experience with this modality of treatment.
Methods: A review was made of 107 consecutive nonselected laparoscopic procedures performed between October 1990 and November 1995.
The diagnosis was established by clinical, laboratory, and imaging findings and confirmed by laparoscopy and/or laparotomy.
Results: An etiologic diagnosis was unclear in 35% of the cases and was established in all by laparoscopy; 94 patients (87.9%) were
successfully treated by laparoscopy while 13 (12.1%) required conversion. Mortality was 4.6%; 14% had postoperative complications
and 7.4% had reoperations.
Conclusions: Laparoscopic surgery is safe and very efficient in the diagnosis and treatment of patients with peritonitis. In most instances
a definitive treatment can be carried out without conversion and has the additional and well-known advantages of minimally
invasive surgery.
Received: 15 March 1996/Accepted: 29 August 1996 相似文献
17.
Pneumoperitoneum risk prognosis and correction of venous circulation disturbances in laparoscopic surgery 总被引:1,自引:0,他引:1
S. I. Emeljanov V. V. Fedenko E. M. Levite S. A. Panfilov I. G. Bobrinskaya A. V. Fedorov N. L. Matveev V. V. Evdoshenko S. V. Luosev V. V. Bokarev S. R. Musaeva 《Surgical endoscopy》1998,12(10):1224-1231
Background: This study was initiated to find a method of determining the prognosis for possible changes in hemodynamic and respiratory
parameters in patients with pneumoperitoneum (PP).
Methods: We devised a model for a pseudopneumoperitoneum (PPP), which is created by encircling the wide pneumochamber on the entire
abdomen and inflating it to a preset pressure. To verify the prognostic possibilities of the proposed model, we studied the
pneumotachygraphy parameters, noninvasive and invasive monitoring parameters of PPP after induction of anaesthesia, and venous
circulation disturbances, as well as the medical effect of the intermittent sequential compression device.
Results: In healthy patients, the restrictive lung syndrome did not approach the risky limit. In patients ≥60 years old, this syndrome
was very close to the limit. In a number of patients with serious cardiovascular and pulmonary pathology, the pressure of
>10 mmHg was considered to be intolerable. Lung compliance, which was the parameter most sensitive to the increased intraabdominal
pressure, was 47 ± 10 at baseline, and 29 ± 4 (p > 0.05) at both PPP and real PP (14 mmHg).
Conclusions: The PPP model is quite similar to the real PP and can be used for preoperative prognosis in laparoscopic surgery. The elevated
intraabdominal pressure results in a significant disturbance of venous blood flow in the lower extremities. The use of the
device for peristaltic pneumomassage of the lower limbs is effective in correcting negative changes in venous hemodynamics
in laparoscopic surgery.
Received: 28 July 1997/Accepted: 12 January 1998 相似文献
18.
Laparoscopic management of ovarian cysts in newborns 总被引:3,自引:0,他引:3
Background: Cysts are the most common ovarian masses found in newborn girls. Spontaneous regression, which occurs in ∼25–50% of cases,
is more frequent with smaller cysts. Pre- or postnatal complications are common; these complications may consist of intracystic
bleeding, torsion of the cyst or corresponding annex, or self-amputation of the cyst. When the cyst is <4 cm it is possible
to perform a simple echographic monitoring to check for the possibility of spontaneous involution; all other cases require
surgery.
Methods: Between February 1985 and June 1997, we treated 22 neonatal ovarian cysts laparoscopically. In 14 cases, the right side was
involved; in eight cases, it was the left. The patients' ages ranged between 7 days and 5 months (median, 45 days). In all
cases, we used three trocars. An intraperitoneal cystectomy was done in eight cases, a transparietal cystectomy in four cases,
an ovariectomy in seven cases, and the simple removal of the cyst in one case where self-amputation had occurred. In two cases
of bilateral pathology, the cysts, which were <1 cm, were left untreated.
Results: Average operating time was 40 min (range, 25–60 min). Intraabdominal pressure never exceeded 6–8 mmHg during the intervention.
The postoperative course was always under 3 days. No intra- or postsurgical complications were recorded, and long-term ultrasonographic
follow-ups were all normal.
Conclusion: Our experience indicates that the laparoscopic approach is a reliable and safe technique in the treatment of neonatal ovarian
cysts.
Received: 30 July 1997/Accepted: 24 October 1997 相似文献
19.
The insufflation of carbon dioxide into the peritoneal cavity is a routine technique of abdominal exposure in laparoscopic
surgery. Because of adverse physiological effects and technical disadvantages of the pneumoperitoneum, alternative methods
of abdominal wall lifting have been explored recently. Two groups of retraction systems exist: intraabdominal lifting and
subcutaneous lifting of the abdominal wall. Some systems require additional pneumoperitoneum, because the extent of intraabdominal
exposure is not sufficient. Other systems are working completely without gas insufflation. Two systems combine abdominal wall
lifting with pressure on the internal organs. Every method allows the use of standard laparoscopic instruments, which originally
were designed for a regular pneumoperitoneum. The use of a low-pressure pneumoperitoneum in combination with mechanical augmentation
of the peritoneal cavity reduces physiological disadvantages of laparoscopy. But technical advantages, such as combination
of laparoscopic and open techniques, can be realized only without gas insufflation. Conventional instruments have been designed
to fit the ergonomical needs of isopneumic laparoscopy and to be employed with simple valveless cannulae.
Received: 19 November 1996/Accepted: 30 December 1997 相似文献
20.
Background: We performed a consecutive series of unilateral laparoscopic adrenalectomies (LA) with the expectation of short (less than
24 h) hospital stay. Results were compared with those from laparoscopic cholecystectomy (LC) and unilateral open adrenalectomy
(OA).
Methods: A combination of chart review and patient questionnaires was used to compare LA (n= 19) to LC (n= 20) regarding length of stay (LOS), narcotic requirements, and time to full recovery. Chart reviews also were used to compare
LA to OA (n= 48) regarding operating room time (OR time), LOS, and surgical morbidity.
Results: All of the LC patients as compared with 47% of the LA patients were discharged within 24 h. The reason for additional hospitalization
in the LA group was pain control. After discharge, the narcotic requirement lasted 6.6 days in the LA group as compared with
3.4 days in the LC group (p < 0.01), but the times until full recovery were not significantly different (12.2 vs 11.3 days respectively). Operating room
times did not differ significantly between the LA and OA groups (3.3 and 3.8 h, respectively), but there were fewer postoperative
complications and much shorter LOS in the LA group (1.5 vs 6.3 days; p < 0.001), a difference that remained significant even when cases from the same time period were compared.
Conclusions: Increased pain in LA as compared with LC patients may result in a slightly longer LOS and higher narcotic requirement during
the early postoperative period, but time to full recovery between the two groups is the same. As compared with its open counterpart,
LA offers a significant reduction in LOS and morbidity with no increase in OR time.
Received: 12 February 1999/Accepted: 24 October 1999/Online publication: 28 April 2000 相似文献