Use Of Laparoscopic Techniques Research Articles

Laparoscopic Billroth-II gastrectomy.

Although the use of laparoscopic techniques in gastric surgery had become a focus in upper gastrointestinal surgery, standardized procedures have not yet been developed. The purpose of the study was to develop a standardized technique for laparoscopic Billroth-II resection in a cadaver model. End points were intraoperative complications and patency of the gastro jejunostomy. Laparoscopic partial stomach resection was performed in seven cadavers. The specimen was removed through an enlarged trocar incision. The first part of the jejunum was temporarily taken out through the same incision and a side-to-side jejuno-jejunostomy created. The gastrojejunostomy was stapled intracorporally. After surgery, all cadavers underwent autopsy. No lesions of intraabdominal organs were found, and the gastrojejunostomy was patent with correct stapling. No major intraoperative complications were recorded. Using the described technique, a laparoscopic Billroth-II operation can safely be accomplished. The technique has been successfully performed in three patients in the last month.

Laparoscopic procedures for treatment of infertility related to polycystic ovarian syndrome

The use of laparoscopic techniques for the treatment of polycystic ovarian syndrome (PCOS) has included many different approaches in the 1980s and 90s. Broadly similiar results have been obtained using biopsy, cauterization, multi-electrocoagulation and laser surgery; i.e. > 50% ovulation and a mean pregnancy rate of 50%. Evaluation of the data is complicated by the lack of uniformity in these clinical studies and the variation in diagnostic criteria. None of the studies included a treatment-independent control group. Endocrine changes following laparoscopy have been identified in many studies, but the mode of action of these treatments remains a mystery. In conclusion, laparoscopic techniques have the advantage over surgical wedge resection of cost saving and a lower risk of post-operative adhesions. For clomiphene resistant patients, laparoscopic techniques have many advantages over gonadotrophin therapy including serial repetitive ovulation events, no increased risk of ovarian hyperstimulation or multiple pregnancies and a lower incidence of spontaneous abortion, but these procedures must not be considered as the first line treatment for the anovulatory patient with PCOS, for whom clomiphene citrate remains the first choice mode of therapy.

The emergency laparoscopy

Summary.In 1991, after a suitable elective laparoscopic training, we pursued the use of laparoscopic technique to increase applications of minimally invasive surgery in many emergencies. Emergency minimally invasive procedures have been performed in 149 patients, without intra- or postoperative major drawbacks, Laparoscopic conversions occurred in 10 patients (6.7%). Three patients (2%) developed postoperative complications which needed re-operation for residual pelvic abscess. Indications for the laparoscopic approach included acute cholecystitis, unknown acute abdominal pain, questionable acute appendicitis or gynaecological diseases, adhesions with small bowel obstruction, perforated peptic ulcers, abdominal trauma with good haemodynamic conditions. In addition, small bowel resection, excision of Meckel's diverticulum and colostomy have been achieved in a laparoscopically assisted manner. In poorly characterized abdominal disease laparoscopy helps to define the correct diagnosis, avoiding unnecessary o...

Laparoscopic Techniques for Inflammatory Bowel Disease.

Very little has been written concerning the use of laparoscopic techniques in inflammatory bowel disease. Its most useful indications appear to be in Crohn's disease, especially for intestinal diversions when severe perineal/perianal sepsis occurs. In this instance, avoidance of a laparotomy is a major advantage, and the simplicity of a laparoscopic stoma formation makes this a procedure that most surgeons may perform, even with minimal laparoscopic experience. Laparoscopic techniques may also be used for the limited resections required in Crohn's ileal or ileocolonic disease and for diagnostic purposes when indicated. The laparoscopic approach to the surgical treatment of ulcerative colitis (total abdominal colectomy, possibly with proctectomy and ileoanal pouch formation) remains to be evaluated before it can be contemplated as an alternative to conventional procedures.

Laparoscopic Resection for Colorectal Cancer: A European Perspective.

The increasing use of laparoscopic techniques in colorectal surgery is controversial. The technical feasibility of such methods is now beyond doubt; however, their clinical evaluation is at an early stage. The expectation that the laparoscopic approach would confer benefit to patients in terms of reduced postoperative pain and other morbidity has been questioned. The safety of these methods in neoplasia is unproven. This article presents those laparoscopic resectional techniques available to the colorectal surgeon. The authors' personal experience with these procedures is review and those issues of controversy are discussed, with particular reference to the question of the suitability of these techniques for the treatment of malignancy.

Laparoscopic Techniques for Inflammatory Bowel Disease

Very little has been written concerning the use of laparoscopic techniques in inflammatory bowel disease. Its most useful indications appear to be in Crohn's disease, especially for intestinal diversions when severe perineal/perianal sepsis occurs. In this instance, avoidance of a laparotomy is a major advantage, and the simplicity of a laparoscopic stoma formation makes this a procedure that most surgeons may perform, even with minimal laparoscopic experience. Laparoscopic techniques may also be used for the limited resections required in Crohn's ileal or ileocolonic disease and for diagnostic purposes when indicated. The laparoscopic approach to the surgical treatment of ulcerative colitis (total abdominal colectomy, possibly with proctectomy and ileoanal pouch formation) remains to be evaluated before it can be contemplated as an alternative to conventional procedures.

Laparoscopic Resection for Colorectal Cancer: A European Perspective

The increasing use of laparoscopic techniques in colorectal surgery is controversial. The technical feasibility of such methods is now beyond doubt; however, their clinical evaluation is at an early stage. The expectation that the laparoscopic approach would confer benefit to patients in terms of reduced postoperative pain and other morbidity has been questioned. The safety of these methods in neoplasia is unproven. This article presents those laparoscopic resectional techniques available to the colorectal surgeon. The authors' personal experience with these procedures is review and those issues of controversy are discussed, with particular reference to the question of the suitability of these techniques for the treatment of malignancy.

Cancer recurrence following laparoscopic colectomy

Use of laparoscopic techniques for resection of colon and rectal cancer has raised considerable controversy. There is increasing concern that wound recurrence and peritoneal dissemination may represent a potentially fatal complication of this technique. The surgical literature was reviewed, and clinical course of two patients is presented. Our two patients had tumor recurrence in the laparoscopy port sites within one year after laparoscopic assisted colectomy for Dukes B adenocarcinoma of the colon. At laparotomy, diffuse peritoneal carcinomatosis without lymph node or liver metastases were found in both patients. They were treated by surgical resection of recurrent disease combined with heated intraoperative intraperitoneal mitomycin C chemotherapy and five days of early postoperative intraperitoneal 5-fluorouracil. These patients are clinically free of disease at 1.5 years after treatment of peritoneal implants. Cancer recurrence in abdominal wall incisions after laparoscopic colectomy has been reported in an increasing number of patients. It is possible that this technique should be abandoned. Cytoreductive surgery combined with intraperitoneal chemotherapy may represent the most adequate treatment of recurrent cancer that occurs following laparoscopic colectomy.

Laparoscopic hysterectomy

We describe the use of laparoscopic techniques in hysterectomy, and the epidemiology of hysterectomy. We review the advantages and complications of total laparoscopic hysterectomy and subtotal laparoscopic hysterectomy. Finally, we discuss long-term outcomes and the cost of these techniques.

Use of laparoscopic techniques in oncologic right colectomy in a canine model.

The purpose of this study was to evaluate the feasibility of laparoscopic oncologic righ colectomy (RC) with intraperitoneal ileocolic anastomosis (ICA) in a canine model. In 21 dogs a laparoscopic RC with transection of the main right colic artery and removal of adjacent lymph nodes (LN) was carried out using an Nd:YAG contact laser and endoscopic stapler. Two weeks after surgery, all animals were killed. The number of remaining right colon mesenteric LN, length of remaining right colic artery, bursting pressure (BP) of ICA, and postoperative morbidity were evaluated. No major intraoperative complications were recorded. One dog died of pneumonia and heartworms. There were no postoperative septic or anastomotic complications. All dogs passed feces within the first 24 h postoperatively. Median operative time was 135 min (range 105-180 min). Length of remaining right colic artery after oncologic resection was 4.5 mm (range 3-7 mm), the number of remaining LN was 0, and the median anastomotic BP was 232 mm Hg (range 132-312 mm Hg). Oncologic resection of the right colon with high vascular ligation, wide mesenteric clearance of LN, and intraperitoneal anastomosis is feasible and safe in a canine model.

Interleukin-6 response to laparoscopic and open colectomy

It has been postulated that cortisol and interleukin-6 play a significant role in the modulation of the early inflammatory response following surgical intervention. There are no available data on the normal responses of these mediators following major laparoscopic procedures. The purpose of this study was to assess changes in cortisol (by fluorescence polarization immunoassay), interleukin-6 (by enzyme-linked immunoassay), and interleukin-1 (by enzyme-linked immunoassay) after elective laparoscopic colon resections. All patients undergoing colon resection between February 1, 1992 and April 30, 1992 were eligible for study. Selection of laparoscopic (N = 12) vs. open (N = 41) resection was determined by the attending surgeon. All patients received a standard general anesthetic with endotracheal intubation. Cortisol, interleukin-6, and interleukin-1 were measured at preinduction, 1 hour, 2 hours, 3 hours, 4 hours, and 5 hours after the induction. Interleukin-6 and interleukin-1 were additionally measured at 12 hours, 24 hours, and 72 hours after induction. Comparisons were made between the laparoscopic patients (N = 12) and age, sex, and operation-matched open patients (N = 12). Cortisol levels rose in the early postoperative period in both open and laparoscopic groups with no significant differences occurring between the cohorts at any of the measured time intervals. The interleukin-6 levels of the laparoscopic cohort (N = 12) were significantly lower than those of the open cohort (N = 12) between 3 and 24 hours postinduction (P < 0.05). Interleukin-1 levels remained undetectable in virtually all patients irrespective of operative technique or postoperative interval. There was no correlation between peak interleukin-6 levels and operative times (laparoscopic, r = 0.31; open, r = 0.36) or blood loss (laparoscopic, r = 0.10; open, r = 0.20). The results indicate that laparoscopic colon resections do not appear to alter cortisol or interleukin-1 responses when compared with open colon resection. There is, however, a significant blunting of the interleukin-6 response associated with the use of laparoscopic techniques for colectomy compared with standard laparotomy.

Laparoscopic Surgical Procedures

Therapeutic laparoscopic surgical procedures have rapidly become well established. Two commonly stated advantages are decreased postoperative pain and shortened hospitalization and recovery times in comparison with an open surgical procedure. Currently, laparoscopic cholecystectomy is the procedure of choice for most patients with symptomatic gallstones, and many stones in the common bile duct can be retrieved by laparoscopic techniques. Laparoscopic appendectomy is a reasonable alternative with improved diagnostic capabilities in comparison with open appendectomy. Laparoscopic antireflux procedures, bowel resections, and repair of inguinal hernias are being performed in ever-increasing numbers; however, long-term results for these procedures are needed and are unavailable at the present time. Various diagnostic and palliative procedures can be done with use of laparoscopic techniques; they provide effective management with minimal perioperative morbidity. Solid organ resections can be safely undertaken laparoscopically in selected patients in whom the target organ is not massively enlarged. Currently, the indications for laparoscopic operations continue to broaden; however, long-term evaluation of laparoscopic surgical results and further improvements in technique and instrumentation are necessary before the appropriate and complete spectrum of laparoscopic surgical procedures will be realized.

Laparoscopic oncologic abdominoperineal resection

Although the use of laparoscopic techniques in colorectal surgery has recently become a focus of major interest in intestinal surgery, there is no proof that an oncologic abdominoperineal resection can be accomplished using laparoscopic techniques. The hypothesis of this study is that a standardized technique for laparoscopic oncologic abdominoperineal resection according to accepted oncologic surgical principles can be developed in a cadaver model. The end points of this study were intraoperative complications, success in performance of proximal vascular ligation of the inferior mesenteric artery, complete removal of the mesorectum including all lymph nodes adjacent to the named rectal arteries, and wide clearance of pelvic side walls. Laparoscopic abdominoperineal resection was performed in 11 fresh cadavers (1 female and 10 males). After surgery, all cadavers underwent autopsy. The number of removed and remaining mesenteric lymph nodes, length of remaining inferior mesenteric artery, and mesorectal and the pelvic side wall soft tissue were evaluated. No major intraoperative complications were recorded. The median number of removed lymph nodes in the mesorectum was 12 (range, 6-22) and no remaining lymph nodes were found at the base of the inferior mesenteric artery. The median length of remaining inferior mesenteric artery was 5 (range, 1-15) mm. Wide lateral clearance of pelvic side walls was noted in all patients. A laparoscopic technique of abdominoperineal resection can be performed according to oncologic principles with proximal vascular ligation of inferior mesenteric artery, wide clearance of pelvic side walls, and complete removal of mesorectum using our described technique.

Use of laparoscopic techniques in colorectal surgery. Preliminary study.

This study evaluated the feasibility and safety of laparoscopic bowel surgery performed by colorectal surgeons not previously experienced in laparoscopic biliary or appendiceal surgery. Thirty-two patients underwent ileocolic resection/anastomosis (n = 12), loop ileostomy (n = 7), colostomy (n = 4), ileostomy takedown/ileorectal anastomosis (n = 3), subtotal colectomy/ileorectal anastomosis (n = 2), sigmoid resection (n = 2), or other procedures (n = 2). No curative cancer surgery was undertaken. Time to first bowel movement was one to eight (median, four) days. Length of stay ranged from 4 to 11 (median, 6) days. There were no major complications seen in follow-up from 6 to 15 (median, 7) months after surgery. Large intestinal and distal ileal surgery using laparoscopic techniques, performed by surgeons with training only in laparoscopic intestinal surgery, is feasible and safe. Faster recovery and need for less postoperative analgesia in laparoscopic surgery compared with conventional surgery cannot be surmised from this study. A randomized study design is needed to evaluate many of the differences between conventional and laparoscopic intestinal surgery.

An analysis of the factors leading to crossed gas lines causing profound hypercarbia during general anesthesia

With increasing use of laparoscopic techniques to facilitate surgical procedures in closed cavities, our institution has installed piped-in carbon dioxide (CO 2) in most of our operating rooms. This case report describes an occurrence of a nitrous oxide hose being connected to a CO 2 outlet, resulting in profound hypercarbia. The factors, human and mechanical, leading to this error are discussed, as well as the process of diagnosis and the subsequent treatment.

Current Surgical Management Of Duodenal Ulcers

The optimal treatment of duodenal ulcer disease today requires familiarity with a variety of operative approaches. Experience and judgment are needed to select the best procedure for the individual patient presenting with a specific ulcer complication. Improved medical therapy has relegated surgery largely to the role of emergency life-saving intervention. Nonetheless, the goal of surgery remains cure of the ulcer diathesis with avoidance of postoperative side effects. Toward this end, proximal gastric vagotomy has proved itself to be the operation of choice, not only for intractable pain, but also for perforation and perhaps for bleeding in selected good-risk patients. Its efficacy in the treatment of obstructing duodenal ulcer has not been demonstrated. Modifications of proximal gastric vagotomy, including the use of laparoscopic techniques, are currently being evaluated in patients with intractable duodenal ulcer pain.