Combination Of Laparoscopy Research Articles

Total colectomy combined laparoscopy

The advantages of laparoscopic surgery have been reported to result in an earlier recovery of the bowel movement, compared with conventional procedures. We describe 12 prospective cases of total colectomy combined laparoscopy for familial adenomatous polyposis and ulcerative colitis, conducted between July 1994 and December 1998. No intra-operative complications were encountered in this series. The mean operative time was 282 min (range, 169-420 min) and the mean volume of operative blood loss was 321 mL (range, 52-728 mL). Nasogastric tubes were removed after 1.2 postoperative days and the mean time to passage of stool was 1.9 days (range, 1-3 days). Total colectomy combined laparoscopy proved to be a one-stage restorative procedure, without a temporary ileostoma, due to early recovery of the intestine.

Spectrometry supports fluorescence staging laparoscopy after intraperitoneal aminolaevulinic acid lavage for gastrointestinal tumours

Conventional staging laparoscopy in combination with fluorescence diagnosis has proven to be an effective modality in the detection of macroscopically occult intraperitoneal tumours and metastases. Rats with induced peritoneal carcinosis are photosensibilized by intraperitoneal aminolaevulinic acid (ALA) lavage. After visualization of the tumour foci, the emission from the lesions is measured spectrometrically and the fluorescence analysed quantitatively (‘optical biopsy’). There is a considerable accordance between imaging by fluorescence diagnosis laparoscopy and point spectrometry in the detection of peritoneal malignancies. Compared with surrounding healthy peritoneum, tumour-positive areas show significantly higher fluorescence intensities in spectrometry.

Combined endoscopic and laparoscopic management of chronic gastric volvulus

Gastric volvulus may be d efined as an abnormal rotation of one portion of the stomach a round itself.1 It is a rare condition that may lead to an impairment of the vascular supply to the stomach in the a cute setting. Anatomic changes needed for development of volvulus include laxity of the gastrohepatic, gastroduodenal, gastrosplenic, and gastrocolic ligaments. The critical ligaments preventing volvulus are the latter two, as described by Dalgaard 2 in a series of 150 patients. Traditional management of chronic volvulus has been w ith laparotomy and anterior gastropexy. P atients who present with this condition and serious concomitant medical conditions, however, may be at increased risk of anesthetic and postoperative pulmonary complications. We discuss the u se of combined laparoscopy to reduce a volvulus and flexible endoscopy to aid in suture placement in two patients whose volvuli were not able to be reduced by gastroscopy.

Improved combined laparoscopic and minilaparotomy technique to allow for reversal of extensive tubal sterilization

We assessed the efficacy of combined laparoscopic and minilaparotomy for outpatient microsurgical reversal of extensive tubal sterilization in 11 women undergoing the procedure and followed for a mean of 24.7 months. All patients desired reversal of extensive tubal sterilization, and had 4 cm or less of the longer oviduct remaining. The mean operating time was 110 minutes, and the mean total cost was $5067. There were no major complications. Two women were treated for uncomplicated cystitis within 1 month of surgery. Five (45%) of 11 women delivered viable infants; one patient had two ectopic pregnancies. These preliminary data suggest that outpatient combined laparoscopy and minilaparotomy may be effective in patients who desire restoration of fertility after extensive tubal sterilization.

Outpatient tubal renastomosis performed by combined laparoscopy and minilaparotomy

From January 1992 to July 1993, 30 women underwent minilaparotomy for tubal reanastomosis in a surgery center. Laparoscopy was done and if favorable, minilaparotomy with exteriorization of the uterus and microsurgical tubal reanastomosis was performed. Cost was determined from the surgery center and surgeon's bill and compared with hospital costs of inpatient tubal reanastomosis in nearby hospitals. Mean operating time was 1.7 hours, and mean blood loss was 20 ml. Twenty-seven (90%) were discharged the same day, two (6.6%) were 23 hour stay, and one required hospitalization for two nights. There were no immediate or postoperative complications. Early crude pregnancy rate was 50% with 10% ectopic rate. Tubal patency was confirmed in 29 (96%) patients. The average total cost to the patient was $5,200.00. Tubal reanastomosis can be effectively performed as an outpatient, reducing costs, giving comparable pregnancy rates, and accelerating patient recovery.

Laparoscopic assisted vaginal metroplasty

This presentation describes for the first time the successful performance of a laparoscopic-assisted vaginal metroplasty in a habitual aborter patient with a bicornuate uterus. A combined single puncture laparoscopy and operative colpotomy approach was used. Most symptomatic septate uteri can be treated by operative hysteroscopy. However, the correction of a symptomatic bicornuate uterus still requires abdominal metroplasty. The patient was 24 years old with four early midtrimester miscarriages. Habitual abortion work-up was normal except for a bicornuate uterus. A septate uterus with two distinct cavities, one uterine corpus and an indentation in the mid-fundal area was diagnosed by hysterosalpingogram and laparoscopy. The operating time was 2 hours and blood loss 150 ml. The patient was discharged at 48 hours and had an uneventful postoperative period. She is currently 28 weeks pregnant. This case presentation indicates that assisted vaginal metroplasty is an attractive minimally invasive surgical alternative to traditional laparotomy.

Diagnosis and Staging in Pancreatic Cancer: Endoscopic Retrograde Cholangiopancreatography and Endoscopic Ultrasound

Early diagnosis of pancreatic cancer is difficult because of the lack of early symptoms, accurate screening methods, and insensitivity of noninvasive imaging. Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasonography (EUS) are the most sensitive procedures to detect early pancreatic cancer. In patients with biliary obstruction, ERCP is performed as the first invasive procedure to assess morphology of the pancreatic and biliary duct and tissue diagnosis by brush cytology. In patients without biliary obstruction, guided aspiration cytology should be performed either by percutaneous sonography, CT scan or EUS. Staging should be performed if no metastases are present. EUS increases accuracy of T and N staging especially in periampullary tumors. Laparoscopy in combination with CT scan and angiography correctly identifies the majority of unresectable cases. Aggressive diagnostic and staging procedures are justified to identify the prognostically more favorable tumors.

Collection of human oocytes for in vitro fertilization.

By laparoscopy or laparotomy, oocytes were recovered from 42 (90%) of 47 patients. A total of 185 follicles containing 138 oocytes were aspirated by means of a specially constructed aspiration unit. The patients followed two different schemes pre-operatively. In the unstimulated patients an average of 1.3 pre-ovulatory oocytes per patient was collected, while treatment with 600-900 IU human menopausal gonadotropin + 6 000-12 000 IU human chorionic gonadotropin resulted in an average of 2.0 pre-ovulatory oocytes per patient. It is concluded that laparoscopy in combination with the described aspiration technique seems to be a clinically suitable method for collection of human oocytes for in vitro fertilization.

Combined Laparoscopy and Hysteroscopy in the Investigation of the Ovulatory Infertile Female

A previous study had demonstrated the superiority of hysteroscopy over hysterosalpingography for the detection of intrauterine lesions in infertile patients. One hundred and sixty-nine patients were examined by a combined laparoscopic and hysteroscopic technique as the means of detecting tubal, peritubal, peritoneal, or intrauterine causes of infertility. Laparoscopy was successful in 168 and hysteroscopy in 162. The rate of diagnosis by laparoscopy of 49.4% was increased to 66% when the hysteroscopic findings were included. Only one serious complication was recorded, the inadvertent visualization of an intrauterine pregnancy. Arguments are advanced for the replacement of hysterosalpingography with combined laparoscopy and hysteroscopy as the primary means of investigating the ovulatory infertile female.