A Prospective Comparison of Laparoscopy and Imaging in the Staging of Esophagogastric Cancer Before Surgery

Objective: To carry out a prospective comparison of laparoscopy and combined imaging (CT and ultrasound) in the preoperative staging of distal esophageal and gastric cancer in patients who were selected for surgery.
Methods: Patients with clinically overt metastases or a contraindication to major surgery were excluded. One hundred and forty-five patients underwent chest radiography, CT of mediastinum and abdomen, and ultra-sonography of abdomen and laparoscopy. The primary diagnoses were adenocarcinoma of the esophagogastric region in 110 cases, squamous cell carcinoma of the distal esophagus in 30 patients, and five miscellaneous.
Results: Thirty nine (27%) patients had metastatic disease outside the potential field of resection. Metastases were detected preoperatively by laparoscopy in 30 patients (sensitivity 77%) and by combined imaging in 15 (sensitivity 38%) ( p < 0.01). Twenty four patients with adenocarcinoma had metastases to the peritoneal cavity, which were detected preoperatively by laparoscopy in 23 (sensitivity 96%) and by combined imaging in five (sensitivity 21%) ( p < 0.01). Peritoneal metastases were not seen in patients with squamous cell carcinoma. Fifteen patients had hepatic metastases, which were detected preoperatively by laparoscopy in nine (sensitivity 60%) and by combined imaging in seven (sensitivity 47%). Laparoscopy was more sensitive than combined imaging in detecting metastases in patients with adenocarcinoma [laparoscopy 28, combined imaging 10 ( p < 0.01)].
Conclusion: Addition of laparoscopy to the staging protocol prevented unbeneficial thoraco-abdominal exploration in 20 patients with adenocarcinoma. Thus, laparoscopy should be used in the assessment of patients with adenocarcinoma of the esophagogastric region before performing excisional surgery.     

A comparison study of computed tomography and laparoscopy in the staging of abdominal neoplasms

Summary Thirty patients who underwent both computed tomography and laparoscopy were viewed retrospectively to evaluate the usefulness of each modality in the staging of abdominal neoplasms. In 20 of the cases, identical diagnostic information was obtained by each procedure. Eight patients had significant findings detected by computed tomography that were not detected at laparoscopy. Two patients had small peritoneal implants detected by laparoscopy alone. In our limited series, computed tomography with directed skinny needle biopsy appeared to have significant advantages over laparoscopy because it was less invasive, permitted imaging of areas not seen at laparoscopy, and was capable of whole-body imaging. Nevertheless, laparoscopy appeared useful in staging neoplasms which characteristically seed via peritoneal implants.     

Photographic Monitoring under Intravenous Sedation

Abstract: To reduce the time and patient discomfort associated with laparoscopy, intravenous administration of a hypnotic sedative and photographic monitoring were used. The time needed to complete laparoscopy was reduced from 39 ±7 to 35 ±6 min with use of the monitoring equipment. Questionnaires completed by 66 patients revealed 64 (97.0%) to have virtually no memory of pain caused by the intravenous anesthesia during laparoscopy, and 54 (81.8%) requested intravenous anesthesia for the next laparoscopy. The photographs taken were of excellent quality. Intravenous anesthesia and the use of photographic monitoring were found to be useful means of reducing patient discomfort and facilitating performance of the procedure.     

Pelvic examination versus fiberoptic laparoscopy. A fictional study of patient preference in 1,534 women

A fictional study of patient preference was conducted in 1,534 women who received both laparoscopy and a pelvic examination plus pelvic ultrasonography. The overwhelming majority of women (87%) preferred laparoscopy, with most patients (78%) indicating they would undergo a repeat examination if requested. Hospital occupancy rose 24% while gynecologists' incomes rose 58%. Radiologists' incomes declined 14%. Seven deaths occurring in conjunction with laparoscopy were determined to be statistically insignificant. Based on these findings, it is suggested that the pelvic examination be replaced by routine laparoscopy.     

The diagnosis of liver cirrhosis: a comparative evaluation of standard laparoscopy, mini-laparoscopy and histology

BACKGROUND: The superiority of laparoscopy with guided biopsy over biopsy alone is established. It is still uncertain if this is also true for midi-/ and mini-laparoscopy. AIM: The aim of this study was to determine the diagnostic gain of laparoscopic-guided biopsy for standard laparoscopy and the use of midi-/mini-laparoscopies. Characteristics of the liver biopsies were investigated with regard to a missed diagnosis of cirrhosis. METHODS: In a consecutive series of 425 patients clinical, laparoscopic and histological findings were investigated. The length and fragmentation of the liver biopsies were investigated with regard to a missed diagnosis of cirrhosis. RESULTS: The sensitivity of laparoscopy in the diagnosis of cirrhosis was 96 %, that of histology 68 %. The sensitivity of histology alone was especially low in macronodular cirrhosis. The sensitivity of both laparoscopy and histology improved from Child A to C. When cirrhosis was apparent, liver biopsies were shorter and more frequently fragmented. However, the diagnosis of cirrhosis was independent of these parameters. CONCLUSION: Mini-laparoscopy may replace standard laparoscopy and appears to be superior compared with histology alone.     

Bacteremia after diagnostic conventional laparoscopy and minilaparoscopy: a prospective study in 100 patients

BACKGROUND/GOALS: Diagnostic laparoscopy under sedoanalgesia is a valuable tool in the work-up of liver diseases and is helpful as a staging procedure. The rate of bacteremia caused by this procedure is unknown, in particular when performed as minilaparoscopy. STUDY: A 100 consecutive patients having undergone diagnostic laparoscopy carried out either conventionally (group I, n=50) or as minilaparoscopy (group II, n=50) were prospectively enrolled in this study. Blood cultures were drawn before and within 5 minutes after the procedure. Risk factors for bacteremia were evaluated. RESULTS: Bacterial growth occurred in 4 blood cultures drawn immediately after laparoscopy. No patient developed fever or other signs of infection in the follow-up. Risk factors predisposing to bacteremia could not be identified. CONCLUSIONS: Conventional diagnostic laparoscopy under sedoanalgesia and minilaparoscopy are associated with a low rate of bacteremia as in diagnostic upper endoscopy.     

Is laparoscopy equal to laparotomy in detecting and treating small bowel injuries in a porcine model?

AIM: To evaluate the safety and effectiveness of laparoscopy compared with laparotomy for diagnosing and treating small bowel injuries (SBIs) in a porcine model.METHODS: Twenty-eight female pigs were anesthetized and laid in the left recumbent position. The SBI model was established by shooting at the right lower quadrant of the abdomen. The pigs were then randomized into either the laparotomy group or the laparoscopy group. All pigs underwent routine exploratory laparotomy or laparoscopy to evaluate the abdominal injuries, particularly the types, sites, and numbers of SBIs. Traditional open surgery or therapeutic laparoscopy was then performed. All pigs were kept alive within the observational period (postoperative 72 h). The postoperative recovery of each pig was carefully observed.RESULTS: The vital signs of all pigs were stable within 1-2 h after shooting and none of the pigs died from gunshot wounds or SBIs immediately. The SBI model was successfully established in all pigs and definitively diagnosed with single or multiple SBIs either by exploratory laparotomy or laparoscopy. Compared with exploratory laparotomy, laparoscopy took a significantly longer time for diagnosis (41.27 ± 12.04 min vs 27.64 ± 13.32 min, P = 0.02), but the time for therapeutic laparoscopy was similar to that of open surgery. The length of incision was significantly reduced in the laparoscopy group compared with the laparotomy group (5.27 ± 1.86 cm vs 15.73 ± 1.06 cm, P < 0.01). In the final post-mortem examination 72 h after surgery, both laparotomy and laparoscopy offered a definitive diagnosis with no missed injuries. Postoperative complications occurred in four cases (three following laparotomy and one following laparoscopy, P = 0.326). The average recovery period for bowel function, vital appearance, and food re-intake after laparoscopy was 10.36 ± 4.72 h, 14.91 ± 3.14 h, and 15.00 ± 7.11 h, respectively. All of these were significantly shorter than after laparotomy (21.27 ± 10.17 h, P = 0.004; 27.82 ± 9.61 h, P < 0.001; and 24.55 ± 9.72 h, respectively, P = 0.016).CONCLUSION: Compared with laparotomy, laparoscopy offers equivalent efficacy for diagnosing and treating SBIs, and reduces postoperative complications as well as recovery period.     

Diagnostic laparoscopy: a prospective review of 100 cases

The perceived role of laparoscopy in the management of liver disease has changed because of the widespread use of image-guided biopsy. Laparoscopy, however, permits direct inspection of the liver surface and the abdominal cavity, as well as tissue sampling. In order to assess the utility of laparoscopy, and specifically, the diagnostic value of direct visualization of the liver surface, we prospectively collected information on 100 consecutive patients undergoing laparoscopy. The contribution of the laparoscopic findings to patient management and the predictive value of the laparoscopic diagnosis compared to histology were assessed. Laparoscopy had a 95% diagnostic yield. Liver surface characteristic consistent with malignancy, cirrhosis, or fibrosis were sensitive and specific predictors of histologic findings. We conclude that laparoscopy continues to be a valuable diagnostic procedure, especially in cases where accurate assessment of the liver architecture is required.     

Management of advanced pancreatic cancer: staging laparoscopy and immunochemotherapy--a new treatment strategy

BACKGROUND/AIMS: Pancreatic cancer remains a challenging disease with a dismal prognosis. This study investigated the effect of two-route immunochemotherapy via artery (2-ICA) and usefulness of staging laparoscopy in the management of advanced cases. METHODOLOGY: Fifty-five patients admitted to our Department between April 1993 and April 2000 for resection of pancreatic cancer were the subjects of this study. Staging laparoscopy was performed in 16 of the patients, and 2-ICA was used to treat three of 16 because they were found to have small liver metastases during staging laparoscopy. RESULTS: According to the TNM staging system (UICC), 9 (56%) in the 16 patients who underwent staging laparoscopy were found to have Stage IVb disease, 4 (25%) to have Stage IVa disease and only 3 (19%) to have Stage III disease. The three patients with small liver metastases received 2-ICA therapy. The metastatic lesions in the liver had completely disappeared in one patient, and decreased to about half the size in the other two cases. CONCLUSIONS: Staging laparoscopy is useful for correctly diagnosing tumor stage in pancreatic cancer patients and selecting appropriate treatment. The 2-ICA therapy is a new and effective method of treatment for advanced cases.     

腹腔镜辅助内镜检查对小肠出血性疾病的诊断价值

目的：探讨腹腔镜辅助内镜检查对小肠出血性疾病的诊断价值。方法：选择1994年--2002年间常规检查难以明确病因的16例小肠出血性疾病患者，行腹腔镜辅助内镜检查，病理学检查。结果：16例患者均完成腹腔镜辅助内镜检查。腹腔镜下直接发现病灶5例，联合应用内镜检查发现病灶11例；病理检查显示平滑肌肉瘤l例，平滑肌瘤4例，小肠腺瘤4例，黏膜下血管瘤2例，血管畸形和毛细血管扩张症2例，Meckel憩室炎伴出血3例。结论：腹腔镜辅助内镜检查对常规检查无法明确病因的小肠出血有较好的诊断价值。该技术方法简单、创伤小、病变阳性检出率高，有较好的临床推广价值。     

腹腔镜检查对腹膜病变的诊断价值

目的 研究腹腔镜检查及直视下腹膜活检对腹膜病变的诊断价值。方法 应用MachidaFLA-8腹腔镜及直视下腹膜活检诊断腹膜病变。结果 腹腔镜检查及直视下腹膜活检131例中，122例（93.1%)活检病理诊断阳性，其中结核性腹膜炎（TBP）63例，腹膜癌（PC）56例，腹膜恶性间皮瘤2例，腹膜恶性淋巴瘤1例，TBP临床误诊率为58.8%。而PC为91.1%。TBP的腹腔镜性间皮瘤2例，腹膜恶性淋巴瘤1例，TBP临床误诊率为58.8%，而PC为91.1%，TBP的腹腔镜所见主要为腹膜与邻近脏器表面有比较均匀一致的粟粒样白色结节，常散在或成群地分布于腹膜上活检时组织较软。而PC的所见主要是腹膜与邻近脏器表面有大小不一的灰白色斑块和结节，活检时有明显的坚硬感。结论 腹膜病变临床诊断困难，误诊率高，腹腔镜检查及直视下腹膜活检是最有效的诊断方法，可以确定诊断。     

Value of laparoscopy and laparoscopic ultrasonography in determining resectability of colorectal hepatic metastases

BackgroundThe aim was to assess the value of laparoscopy and laparoscopic ultrasonography (LUS) in selecting patients for resection of colorectal hepatic metastases.MethodsSixty patients with potentially resectable colorectal hepatic metastases after helical computer tomography (CT) and scheduled to undergo laparoscopy and LUS were studied retrospectively. Primary outcome measurement was the number of cases in which laparoscopy and LUS resulted in a change of therapeutic approach.ResultsOf the 60 patients, 59 patients were examined by LUS and/or laparoscopy. The small intestine was perforated due to adhesions in two patients, necessitating open exploration in one of them. In 17 patients (29%) the combined laparoscopic procedure yielded results prohibiting resection; another 6 patients were denied resection on other grounds. Of the 36 patients who underwent open exploration, 31 underwent resection. Combined laparoscopy and LUS predicted resectability correctly in 86% of the patient group. Compared with resection, the sensitivity of both CT and LUS to detect lesions was 91%.DiscussionLaparoscopy and LUS can avoid open exploration without resection in a substantial number of patients considered eligible for resection of colorectal hepatic metastases based on CT. LUS does not seem to detect more metastases than CT.     

Usefulness of laparoscopy as a second-look method in neoplasms of the ovary

The usefulness of second-look laparoscopy in the follow-up of ovarian cancer is evaluated. This procedure has been included in the protocol for the treatment of these tumors. During the period 1980-1987 a total of 3038 laparoscopies were performed; 205 (7%) were for ovarian cancer. We present the results of 72 explorations in 52 patients; after surgery and chemotherapy all of them were in complete remission. 44 explorations were second-look laparoscopy and 28 third-look laparoscopy. All the examinations were done under local anesthesia. There were two failures due to the presence of adhesions secondary to the previous surgery which prevented the pneumoperitoneum. In 35 (48.6%) explorations a neoplasia was found and a laparotomy was avoided. There were 31% (4/13) false negative in second-look laparotomy post-laparoscopy. The correlation between gross and microscopic findings was excellent. There were no complications in spite of the previous abdominal surgery. We recommend second-look laparoscopy in patients under treatment of ovarian cancer which in our experience avoided laparotomy almost in half of the cases; no complications were observed and the procedure was well-tolerated.     

The Robotic-Assisted Laparoscopy,Isthmusectomy, and Pyeloplasty in a Patient With Horseshoe Kidney: A Case Report

The aim of this case report was to evaluate the results of isthmusectomy and pyeloplasty of horseshoe kidney with the da Vinci robotic-assisted laparoscopy system.This case presented 1 patient with left back pain, associated with lower abdominal pain, and then she underwent the isthmusectomy and dismembered pyeloplasty using robotic-assisted laparoscopy simultaneously. The operation was performed by a transperitoneal approach using 5 ports.We cut the renal isthmus by means of bipolar scissors and then closed the renal parenchyma with 3–0 absorbed stitches. The total operation time was 123 min including simultaneous dismembered pyeloplasty. Blood loss was <50 mL. There were no complications either during or after the procedure. The oral nutrition and mobilization were included on the second day after surgery. The peritoneal drainage was removed on the eighth day. Long-term follow-up after treatment showed good results.The da Vinci robotic-assisted laparoscopy is an alternative to open surgery and laparoscopy, particularly in the correction of congenital defects of the urinary tract. Furthermore, the da Vinci robotic-assisted laparoscopy technique in isthmusectomy and pyeloplasty is safe for patient as shown by our results.     

Complications of diagnostic laparoscopy in Dallas: a 7-year prospective study

The complication rate for diagnostic laparoscopy reported in the literature is very low (1.07%, 0.3%, and 0.03% for minor and major complications, and deaths, respectively). A prospective study of the complications of diagnostic laparoscopy by 17 gastroenterologists in the Dallas-Fort Worth metropolitan area is reported. In 603 laparoscopies performed during a 7-year period, there were 31 (5.1%) minor complications and 14 (2.3%) major complications requiring surgery or transfusion. These rates are five- and sevenfold higher (p less than 0.01) than are reported in retrospective series in the literature. There were three (0.49%) deaths in this series. It is concluded that retrospective studies have underestimated the complication rate of laparoscopy. However, despite the higher complication rate found in this prospective study, laparoscopy appears to be as safe or safer than other methods of establishing a tissue diagnosis under direct vision in intraabdominal diseases.     

Diagnostic laparoscopy in the evaluation of the viral hepatitis patient with potentially resectable hepatocellular carcinoma

Background. Despite significant recent improvements in liver imaging, preoperative evaluation of the potentially resectable patient with viral Hepatitis and Hepatocellular Carcinoma (HCC) is often inaccurate. Diagnostic laparoscopy may change management for patients with under-appreciated nodular cirrhosis or intrahepatic metastases, preventing unnecessary open exploration. The purpose of this study is to determine the effectiveness of routine laparoscopy as a separate procedure prior to resection in the evaluation of patients with potentially resectable HCC. Methods. Patients with potentially resectable HCC were evaluated preoperatively with routine blood tests and axial imaging. All study patients also underwent diagnostic laparoscopy with laparoscopic ultrasonography. Laparoscopy was performed in an inpatient hospital setting, with 23 hour stays in most cases. Results. Among 65 patients evaluated with Hepatocellular Carcinoma between July 2001 and November 2003, 20 patients with potentially resectable disease were evaluated by diagnostic laparoscopy. All patients had viral Hepatitis: 16 with Hepatitis B and 4 with Hepatitis C. All study patients had cirrhosis; 18 classified as Child''s-Pugh A and 2 as Child''s-Pugh B. Diagnostic laparoscopy changed the management in 9/20 (45%) cases. Management was changed because of severe nodular cirrhosis in 4 cases, inaccurate assessment of intrahepatic metastases in 2 cases, inability to identify an HCC in 1 case, peritoneal carcinomatosis in 1 case, and inability to tolerate induction to general anesthesia in 1 case. Discussion. Diagnostic laparoscopy is useful in the evaluation of the potentially resectable patient with HCC. Information obtained from laparoscopy may change the clinical management in up to 45% of cases.     

Complication of laparoscopy in Japan

Trends of examinees and complications of laparoscopy were examined by a questionaire sent to all representative institutions in Japan. As a conclusion, the rate of complication by this examination was 10 times higher, while its mortality was 25 times higher, as compared with gastroenterological endoscopic examination. This article may indicate the present status of laparoscopy in Japan.     

Laparoscopy compared with ultrasonography in the diagnosis of hepatocellular carcinoma

In recent years, various newer imaging procedures have superseded laparoscopy in the detection of many diseases. The role of laparoscopy in the diagnosis of hepatocellular carcinoma is still subject to debate. To assess the value of laparoscopy compared with that of ultrasonography, we compared data obtained from a series of 54 patients with hepatocellular carcinoma, all of whom had both procedures performed at nearly the same time. In our study, ultrasonography proved superior to laparoscopy in detecting the presence and extent of the hepatocellular carcinoma. Supplemental findings attributable to laparoscopy did not alter management, whereas additional information obtained by ultrasonography often did influence the choice of treatment. We conclude that ultrasonography is the primary diagnostic method of choice in the assessment of hepatocellular carcinoma and that laparoscopy should be reserved for only selected cases.     

Experimental pain in gastroenterology: a reappraisal of human studies

Background: Even though endoscopic ultrasonography (EUS) has improved the pretherapeutic staging and assessment of resectability in patients with upper gastrointestinal (GI) tract malignancies, a considerable number of patients still have to undergo unnecessary explorative laparotomy to obtain the final assessment of resectability. The aim of the present study was to evaluate laparoscopic ultrasonography (LUS) and the combination of EUS and LUS in the pretherapeutic study of these patients with special reference to resectability. Methods: Each of 44 patients with esophageal, gastric, or pancreatic cancer was assigned to a treatment-related resectability group based on five different imaging modalities: computer tomography (CT) + ultrasonography (US), EUS, laparoscopy, LUS, and EUS + LUS. The findings with these imaging modalities were compared with intraoperative findings. Results: Overall group assignment accuracy showed significantly better results for EUS, LUS, and EUS + LUS than for CT + US and laparoscopy. EUS + LUS identified all non-resectable patients, whereas the sensitivity of CT + US, laparoscopy, and EUS were 14%, 36%, and 79%, respectively. Median time consumption for each EUS, laparoscopy, or LUS procedure was less than 25 min, and no complications were seen during or after the EUS, laparoscopy, or LUS procedures. Conclusion: Preliminary experience with the combination of EUS and LUS for pretherapeutic assessment of upper GI tract malignancies showed that this combination was superior to CT + US, laparoscopy, and EUS. EUS + LUS correctly identified all non-resectable patients, but two overstaged patients also indicated the need for larger prospective studies to identify the indications and the limitations of this new approach.     

Total Laparoscopic Versus Laparotomic Radical Hysterectomy and Lymphadenectomy in Cervical Cancer: An Observational Study of 13-Year Experience

This article aims to review our 13-year experience in the treatment of patients with cervical cancer by comparing total laparoscopic radical hysterectomy and lymphadenectomy with laparotomy.We reviewed all patients undergoing total laparoscopic or laparotomic radical hysterectomy and lymphadenectomy because of cervical cancer between 2001 and 2014 in our hospital.In total, 154 eligible patients with International Federation of Gynecology and Obstetrics Ia–IIb were enrolled, including 106 patients undergoing total laparoscopic procedure and 48 patients undergoing laparotomic procedure. In the present study, patients in total laparoscopy group were associated with superior surgical outcomes, such as significantly lower blood transfusion compared to those in laparotomy group. Furthermore, patients had significantly lower postoperative complication rate in total laparoscopy group compared with that in laparotomy group (24.5% vs 52.1%) (P = 0.001). Three patients (2.8%) in total laparoscopy group had unplanned conversion to laparotomy. Disease-free survival rates were 89.7% and 88.9% in total laparoscopy and laparotomy groups (P = 0.39), respectively, and overall survival rates were 90.2% in total laparoscopy group and 91.3% in laparotomy group (P = 0.40).Total laparoscopic procedure is a surgically and oncologically safe and reliable alternative to laparotomic procedure in the treatment for cervical cancer.