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1.
Background: Percutaneous balloon-tipped laparoscopic cannulas designed for preperitoneal hernia repair can be readily used to treat gastric
bleeding laparoscopically.
Methods: Between 1995 and 1997, we successfully used balloon-tipped cannulas to visualize, biopsy, and suture acutely bleeding gastric
lesions in five patients. These case histories are reviewed for this study.
Results: Patients received an average of six units of blood preoperatively (range, 0–15). Operative time averaged 207 min (range,
149–270). At surgery, gastrotomies were made for cannula placement under laparoscopic visualization. Operative findings included:
lesser curve gastric ulcer, Mallory-Weiss tear, prepyloric ulcer, duodenal ulcer, and angiosarcoma. Three patients had successful
percutaneous suture of bleeding gastric lesions. One patient was converted to open surgery. One patient had local resection
of an angiosarcoma.
Conclusion: The laparoscopic use of balloon-tipped cannulas allows the expeditious diagnosis and treatment of acute gastric hemorrhage.
Received: 31 March 1998/Accepted: 26 February 1999 相似文献
2.
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
3.
T. Kohl Z. Szabo K. Suda T. M. Quinn E. Petrossian M. R. Harrison F. L. Hanley 《Surgical endoscopy》1997,11(8):819-824
Background: Maternal morbidity and preterm labor from fetal surgery might be minimized by a percutaneous technique for fetal access and
uterine closure.
Methods: In each of 16 ewes, we inserted three trocars percutaneously into the amniotic cavity using ultrasound and fetoscopic guidance.
In six ewes, percutaneous uterine closure after the procedure was attempted. We assessed feasibility and acute complications
of our technique during surgery and at autopsy.
Results: We achieved percutaneous fetal access in 14 ewes and closed the uterus percutaneously in all six ewes attempted. Fetal injury
was related to amnioinfusion or fixation of chorioamniotic membranes. Other complications were trocar dislodgment and damage
to uterine wall and chorioamniotic membranes. The latter complication was prevented using balloon-tipped trocars.
Conclusions: Percutaneous intraamniotic access and uterine closure for fetoscopic surgery can be achieved reliably with little maternal
and fetal morbidity in sheep. Minor modifications are desired to apply this approach in humans.
Received: 18 September 1996/Accepted: 12 December 1996 相似文献
4.
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
5.
F. Köckerling J. Rose C. Schneider H. Scheidbach H. Scheuerlein M. A. Reymond Th. Reck J. Konradt H. P. Bruch C. Zornig E. Bärlehner A. Kuthe G. Szinicz H. A. Richter W. Hohenberger 《Surgical endoscopy》1999,13(7):639-644
Background: We report on a prospective observational multicenter study of more than 1,000 consecutive patients undergoing laparoscopic
colorectal procedures. The aim of the current study was to investigate the safety of laparoscopic colorectal surgery as reflected
by the anastomotic insufficiency rates in the various sections of the bowel, and to compare these rates with those of open
colorectal surgery.
Methods: The study was begun on August 1, 1995. Twenty-four centers in Germany, Austria, and Switzerland participated in this prospective
multicenter study. All patients undergoing laparoscopic colorectal surgery were included in the study. No selection criteria
were applied, which means that every operation begun as a laparoscopic procedure was included. Data on patient demographics,
surgical indications, surgical course, and patient outcome were recorded prospectively in a computer database. All data were
rendered anonymous.
Results: Between August 1995 and February 1998, the 24 participating centers treated 1,143 patients (male/female ratio, 1:1.36; mean
age, 60.7 years). In all, 626 operations were performed for benign indications and 517 for cancer. Most procedures involved
the sigmoid colon and rectum (80.9%). An anastomosis was performed in 83% of the operations. Most of the anastomoses were
laparoscopically assisted using the stapling technique. We observed an overall leakage rate of 4.25% (colon 2.9%; rectum 12.7%),
and surgical reintervention was required in 1% of the cases. The rate of conversion to open surgery was 5.6%. Intraoperative
complications occurred in 5.9%, and reoperation was necessary in 4.1% of the cases. The overall morbidity rate was 22.3%,
and the 30-day mortality rate was 1.57%.
Conclusions: The feasibility and safety of the laparoscopic colorectal approach is demonstrated clearly. The current study shows that
the laparoscopic or laparoscopically assisted approach to colorectal surgery is not associated with a higher risk of anastomotic
leaks. Morbidity and mortality rates with this method approximate those seen with conventional colorectal surgery.
Received: 24 August 1998/Accepted: 25 November 1998 相似文献
6.
Video-assisted thoracic surgery as a primary therapy for primary spontaneous pneumothorax 总被引:1,自引:0,他引:1
Jhingook Kim Kwhanmien Kim Young M. Shim Woo I. Chang Kay-Hyun Park Tae-Gook Jun Pyo W. Park Hurn Chae Kyung S. Lee 《Surgical endoscopy》1998,12(11):1290-1293
Background: Because blebs are confirmed in most of the patients undergoing thoracotomy, identification of blebs by high-resolution computed
tomography (HRCT) can be proposed as a surgical indication in primary spontaneous pneumothorax (PSP). If an apical bleb is
identified, we treat the patient by video-assisted thoracic surgery (VATS).
Methods: From May 1995 to September 1997, 61 patients (21.9 ± 4.6 years) were seen for initial episodes of PSP. Only seven showed
bullae on simple chest radiography. However, by HRCT, 48 had sizable blebs (>5 mm), and 45 were treated surgically by VATS.
Results: The mean duration of chest tube use after surgery was 3.2 ± 1.9 days, and the mean hospital stay was 4.5 ± 1.9 days. Only
one recurrence developed 5 weeks after VATS.
Conclusions: Our protocol is effective in controlling an initial episode of PSP. It shortens the observation time before definitive surgical
treatment, shortens the hospital stay, and decreases the likelihood of recurrence.
Received: 25 June 1997/Accepted 18 February 1998 相似文献
7.
Background: Direct and capacitive coupling of diathermy current have been reported as causes of occult injury during surgical laparoscopy.
Methods: In order to determine the incidence of electrosurgical injury adjacent to metal and plastic cannulas, skin biopsies at 19
port sites used for monopolar electrosurgery were analyzed for coagulative necrosis. Prior to surgery the cannulas were randomized
to either metal or plastic.
Results: Coagulative necrosis was observed at nine electrosurgery port sites compared to only one control (χ2= 4.872; df= 1; 0.05 > p > 0.02). Plastic cannulas afforded no greater protection from skin burns than metal cannulas.
Conclusions: Burns may be the result of direct or capacitive coupling to metal cannulas or capacitive coupling to the skin edge across
plastic cannulas. The potential exists for burns to other tissues also in close proximity to a cannula used for electrosurgery.
Received: 12 August 1996/Accepted 26 November 1996 相似文献
8.
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
9.
Background: The elderly have prevalence rates and clinical features of gastroesophageal reflux disease (GERD) similar to those in younger
individuals, but the role of laparoscopic antireflux surgery (LARS) in the elderly has not been clearly established. The purpose
of this study was to determine if the results of LARS in the elderly are comparable with those in younger patients.
Methods: All patients undergoing LARS for GERD at the Washington University Medical Center were entered prospectively into a computerized
database. Between May 1992 and June 1998, 339 patients underwent LARS and were divided into two groups based on age: nonelderly
(ages, 18–64 years; n= 303) and elderly (age, ≥65 years; n = 36). Data were expressed as mean ± standard deviation (SD) and statistical analysis
was performed.
Results: Elderly patients had a higher American Society of Anesthesiology (ASA) score (2.3 ± 1.5) and a longer hospital stay (2.1
± 0.2 days) than the younger group (ASA, 1.9 ± 0.5; hospital stay, 1.6 ± 0.9 days; p < 0.001). Operation times averaged 154 ± 68 min in the elderly compared with 134 ± 49 min in the nonelderly (p= NS). Grade I complications occurred significantly more frequently in the elderly (13.9%) than in the nonelderly (2.6%),
but the incidence of grade II complications was similar between the groups (elderly 2.8% vs nonelderly 2.7%). There were no
grade III complications in either group, but there was one death in the nonelderly group. At follow-up ranging to 81 months
(median, 27 months), the two groups had similar low incidences of heartburn and dysphagia. Anatomic failures of LARS developed
in 19 nonelderly patients (6.2%) compared with 2 elderly patients (5.5%; p= NS).
Conclusions: As shown in this study, LARS is safe and effective in elderly patients with GERD. Age older than 65 years should not be a
contraindication to laparoscopic antireflux surgery in properly selected patients.
Received: 3 March 1999/Accepted: 2 April 1999 相似文献
10.
Iatrogenic thoracic migration of the stomach complicating laparoscopic Nissen fundoplication 总被引:1,自引:0,他引:1
Background: Intrathoracic gastric herniation after laparoscopic Nissen fundoplication is an uncommon but potentially life-threatening
complication that may present in the early or late postoperative period.
Methods: A retrospective analysis was performed on all patients undergoing antireflux surgery from December 1991 to June 1999.
Results: Nine cases of gastric herniation occurred after 511 operations (0.17%). Patients presented with the condition 4 days to 29
months after surgery. Eight of these nine patients (89%) had reported vomiting in the immediate postoperative period. Seven
patients (78%) reported persistent odynophagia. A factor common to all patients was that posterior crural repair had not been
performed.
Conclusions: Measures should be undertaken to prevent postoperative vomiting after laparoscopic Nissen fundoplication. Posterior crural
repair is essential after surgery in all cases.
Received: 12 July 1999/Accepted: 22 November 1999/Online publication: 8 May 2000 相似文献
11.
Background: The purpose of this study was to evaluate the results of 138 cases of gastroesophageal reflux disease resolved laparoscopically
with the Rossetti modification of the Nissen fundoplication and to compare them with findings from other studies in an effort
to evaluate the procedure's ability to transfer from an academic setting to a community hospital setting.
Methods: We performed laparoscopic Nissen fundoplication on 138 patients and followed them for up to 45 months. Measures included
postoperative reflux persistence, complications, operating time, length of hospital stay, and others. These findings were
compared, using the Fisher's exact test, chi-square test, and the two-sample t-test, with results from other studies using open and laparoscopic procedures.
Results: No patient undergoing laparoscopic fundoplication experienced gastroesophageal reflux after surgery. Complications, not statistically
significantly different from those in other studies, occurred in 15 (10.9%), and conversion to an open procedure was required
in two (1.5%). The most common postoperative complaint has been dysphagia (21.7%). Operative time averaged 70.6 min, decreasing
from an average of 236 min for the first 10 cases to 40.8 min for the last 10. This measure was statistically significantly
lower than all other operative times to which it was compared, except one to which it was almost identical (69.9 min). Length
of stay (LOS) averaged 2.3 days, ranging from a low of 7 h to a high of 9 days, which made it fall well within limits set
by other studies. Overall, LOS fell from a 3.0-day average for the first 20 cases to a 1.9-day average for the last 20 cases.
Conclusions: Laparoscopic Nissen fundoplication resolved gastroesophageal reflux in all 138 patients, and measures for complications,
operating time, and LOS were well within values reported by other studies, indicating the ability of this procedure to be
successfully transferred from academic medical centers to the community hospital setting.
Received: 7 October 1996/Accepted: 14 May 1997 相似文献
12.
Laparoscopic management of colorectal endometriosis 总被引:5,自引:2,他引:3
Background: In the past, intestinal endometriosis diagnosed at laparoscopy has generally required conversion to conventional surgery.
The purpose of this study was to describe the laparoscopic management of colorectal endometriosis at a tertiary referral center.
Methods: From November 1994 to March 1998, 509 consecutive patients with endometriosis requiring laparoscopic intervention were prospectively
evaluated. Those with colorectal involvement were analyzed for stage of disease, procedure, operative time, conversion rate,
length of hospitalization, and complications.
Results: In 30 of the 509 patients (5.9%), colorectal involvement was identified. Twenty-eight of these 30 had stage IV disease. Intestinal
involvement was suspected preoperatively in 13 of 30. Twelve required superficial excision of colon or rectal endometriomas.
Protectomy/proctosigmoidectomy was done in seven cases, and rectal disc excision was performed in five patients. Four cases
required conversion due to the overall severity of the pelvic disease. For those who did (n= 12) and did not (n= 18) require full-thickness excisions/resections, the median operative time was 180 min (range, 90–390) and 110 min (range,
45–355), respectively; the median length of hospitalization was 4 days (range, 3–7) and 1 day (range, 0–4), respectively.
A major complication occurred in one patient (colovaginal fistula). At a median follow-up of 10 months (range 1–32), 28 patients
were improved, and 24 of these had near or total resolution of preoperative symptoms.
Conclusions: Extensive pelvic endometriosis generally requires rectal disc excision or bowel resection. In our experience, laparoscopic
treatment of colorectal endometriosis, even in advanced stages, is safe, feasible, and effective in nearly all patients.
Received: 1 April 1998/Accepted: 22 March 1999 相似文献
13.
Colocutaneous fistula after percutaneous endoscopic gastrostomy in a remnant stomach 总被引:2,自引:0,他引:2
An 82-year-old woman underwent percutaneous endoscopic gastrostomy (PEG) 5 years after partial gastrectomy for cancer. Four
months after PEG insertion, a colocutaneous fistula was noted at exchange of the PEG tube. Colocutaneous fistula is a rare
and major complication of PEG with 10 reported cases to date. In eight of the 11 reported cases, including this case, fistulas
appeared late (>6 weeks) after PEG insertion. This complication may heal after removal of the PEG alone, if the fistula has
formed completely; otherwise a surgical approach is necessary for the treatment. Since five of the 11 reported patients had
previously undergone abdominal surgery, prior abdominal surgery may increase the risk of a colonic injury after PEG. Open
surgical gastrostomy is a wiser option when performing gastrostomy in patients with prior abdominal surgery.
Received: 26 June 1997/Accepted: 8 May 1998 相似文献
14.
Perforating appendicitis 总被引:1,自引:1,他引:0
Background: This pilot study was performed to reassess the widespread postulate that laparoscopic surgery is contraindicated in cases
of perforating appendicitis.
Methods: A total of 75 children (appendiceal perforation: n= 67; perityphlic abscesses and peritonitis: n= 8) were analyzed in a prospective nonrandomized trial. Ten of them were treated by laparoscopic appendectomy.
Results: In the laparoscopy group, both pain and hospitalization were less time-consuming (i.e., by 50% and 19%, respectively). Antibiotics
use was down from 2.6 over 6 days to 2.2. over 5.5 days, while the duration of surgery was up by 52%. Wound healing disturbances
occurred in 10% (n= 1) and postoperative fever in 50% (n= 5) of patients, compared to 14% (n= 9) and 15% (n= 10) in the group treated by open surgery. All severe complications requiring reintervention (10%; massive subcutaneous abscess,
n= 3; retrocolic abscess, n= 2; adhesion-related ileus, n= 3; appendicular stump, n= 1) were associated with open surgery.
Conclusions: There was not a single major complication in the laparoscopy group. These unexpected results are in contrast to previous
reports and have prompted us to initiate a prospective randomized trial.
Received: 27 August 1998/Accepted: 20 January 1999 相似文献
15.
Early results of a prospective multicenter study on 500 consecutive cases of laparoscopic colorectal surgery 总被引:6,自引:3,他引:3
F. Köckerling C. Schneider M. A. Reymond H. Scheidbach J. Konradt E. Bärlehner H. P. Bruch A. Kuthe H. Troidl W. Hohenberger 《Surgical endoscopy》1998,12(1):37-41
Background: Prospective randomized multicenter studies comparing laparoscopic with open colorectal surgery are not yet available. Reliable
data from prospective multicenter studies involving consecutive patients are also lacking. On the basis of the personal caseloads
of specialized surgeons or of retrospective analyses, it is difficult to judge the true effectiveness of this new technique.
This study aims to investigate the results of laparoscopic colorectal surgery in consecutive patients operated on by unselected
surgeons.
Methods: This observational study was begun August 1, 1995, in the German-speaking part of Europe (Germany and Austria) and 43 centers
initially agreed to participate. All consecutive cases were documented. All data were rendered anonymous. Analysis was performed
on an intention-to-treat basis. The study committee was blinded to the participating center.
Results: By the end of the 1st year, 500 patients (M:F ratio 0.83, mean age 62.9 years) had been treated by 18 centers; 269 operations
were performed for benign indications and 231 for cancer (palliative and curative). Most operations were done on the distal
colon or rectum. An anastomosis was performed in 84%, with an overall leakage rate of 5.3% (colon 3.6% and rectum 11.8%),
which required surgical reintervention in 1.7%. The mean operating time was 176 min and showed a decreasing tendency over
the period under study. The conversion rate was 7.0% and the overall complication rate 21.4%. The reoperation rate was 6.6%;
the most common cause was bleeding. There was one ureteral lesion (0.2%), but urinary tract infections were fairly common
(4.8%). A postoperative pneumonia was diagnosed in 1.6% of the cases. No thromboembolic complications were reported. The 30-day
mortality rate was 1.4% and overall hospital mortality 1.8%.
Conclusions: Laparoscopic colorectal operations are still rare (about 1% of all colorectal operations in Germany). Laparoscopic procedures
are more common on the left colon and rectum than on the right colon. The surgical complication rate is acceptable, comparable
with rates reported by others for open surgery. Cardiopulmonary and thromboembolic complications were rarely seen. Mortality
and surgical morbidity rates do not differ significantly among participating centers. A learning curve, reflected by a shortening
of the operating time and a somewhat lower conversion rate, was observed over the observation period.
Received: 3 February 1997/Accepted: 22 April 1997 相似文献
16.
Laparoscopic surgery preserves monocyte-mediated tumor cell killing in contrast to the conventional approach 总被引:10,自引:2,他引:8
Sietses C Havenith CE Eijsbouts QA van Leeuwen PA Meijer S Beelen RH Cuesta MA 《Surgical endoscopy》2000,14(5):456-460
Background: Experimental animal research shows that immunologic defenses against tumor cells are disturbed by surgical trauma, resulting
in an increased rate of tumor implantation and the growth of subsequent metastases. Minimally invasive surgery is associated
with a preservation of postoperative immunologic functions and, in animal models, with decreased tumor growth. The objective
was to study the influence of several surgical procedures, approached conventionally and laparoscopically, on interleukin-6
(IL-6) and monocyte-mediated cytotoxicity (MMC).
Methods: Five groups of five patients each were included in this prospective study: laparoscopic cholecystectomy (minor trauma) group,
Nissen fundoplication (laparoscopic and conventional as moderate trauma) groups, and sigmoid colectomy (laparoscopic and conventional
as major trauma) groups. Preoperatively, 1 and 4 days after surgery, IL-6 and MMC against SW948 colon cancer cell line were
determined.
Results: The IL-6 levels differed significantly between the three laparoscopic procedures (p= 0.004) and increased according to the degree of trauma. There was no significant difference in MMC between the three laparoscopic
procedures. However, MMC was suppressed after conventional procedures and preserved after laparoscopic procedures (p= 0.001). There was no correlation between IL-6 levels and changes in MMC.
Conclusions: More extensive laparoscopic procedures induce increased levels of IL-6, reflecting higher levels of trauma. Conventional
surgical procedures result in depressed MMC in the postoperative period. After laparoscopic procedures, MMC is preserved.
These findings may be of importance in preventing implantation and growth of cancer cells spread by surgical manipulation.
Received: 10 December 1998/Accepted: 25 March 1999 相似文献
17.
Background: The aim of the study is to evaluate the efficacy of laparoscopic-assisted colon surgery by lifting the abdominal wall with
newly developed lifting bars.
Methods: We have made and used two kinds of lifting bars: type I and type T. Two I-type lifting bars are used in transverse colectomy
and right hemicolectomy. One I-type lifting bar and one T-type bar are used in sigmoid colectomy and low anterior resection.
After the intestine is dissected and the mesenterium is treated under laparoscopy, a small laparotomy wound about 4 to 6 cm
long is made, and the intestine is pulled out of the body for extracorporeal anastomosis.
Results: The mean operating time was 153.8 ± 51.9 min, and no particular complications were noted.
Conclusions: Since postoperative pain is mild and postoperative recovery is rapid, this method is considered to be an effective surgical
procedure.
Received: 18 March 1996/Accepted: 12 December 1996 相似文献
18.
Limited axillary thoracotomy vs video-assisted thoracoscopic surgery for spontaneous pneumothorax 总被引:6,自引:0,他引:6
Background: Video-assisted thoracoscopic surgery (VATS) has been reported to have a higher pneumothorax recurrence rate than limited
axillary thoracotomy (LAT). We investigated the cause of pneumothorax recurrence after VATS by comparing surgical results
for VATS and LAT.
Methods: Ninety-five patients with spontaneous pneumothorax underwent resection of pulmonary bullae by VATS (n= 51) or LAT (n= 44). Operating duration, bleeding during surgery, number of resected bullae, duration of postoperative chest tube drainage,
postoperative hospital stay, postoperative complication, and pneumothorax recurrence were analyzed to compare VATS and LAT
in a retrospective study.
Results: The duration of surgery, postoperative chest tube drainage, and postoperative hospital stay was significantly shorter in
VATS than in LAT cases (p < 0.0005 and p < 0.005). Bleeding during surgery was significantly less in VATS than in LAT cases (p < 0.005). Numbers of resected bullae were significantly lower in VATS (2.7 ± 2.1) than in LAT cases (3.9 ± 2.7) (p < 0.05). Postoperative pneumothorax recurrence was more frequent in VATS (13.7%) than in LAT cases (6.8%), but there was
no significant difference.
Conclusions: VATS has many advantages over LAT in treating spontaneous pneumothorax, although the pneumothorax recurrence rate in VATS
cases was double that in LAT cases. The lower number of resected bullae in VATS than in LAT cases suggests that overlooking
bullae in operation could be responsible for the high recurrence rate in VATS cases. We recommend additional pleurodesis in
VATS for spontaneous pneumothorax to prevent postoperative pneumothorax recurrence.
Received: 13 August 1997/Accepted: 15 December 1997 相似文献
19.
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
20.
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