Sample records for hand-assisted laparoscopy hal

  1. Hand-Assisted Laparoscopic (HAL) Multiple Segmental Colorectal Resections: Are They Feasible and Safe?

    Taggarshe, Deepa; Attuwaybi, Bashir O; Matier, Brian; Visco, Jeffrey J; Butler, Bryan N


    The objective of this study was to evaluate the short-term outcomes of synchronous hand-assisted laparoscopic (HAL) segmental colorectal resections. The surgical options for synchronous colonic pathology include extensive colonic resection with single anastomosis, multiple synchronous segmental resections with multiple anastomoses, or staged resections. Traditionally, multiple open, synchronous, segmental resections have been performed. There is a lack of data on HAL multiple segmental colorectal resections. A retrospective chart review was compiled on all patients who underwent HAL synchronous segmental colorectal resections by all the colorectal surgeons from our Group during the period of 1999 to 2014. Demographics, operative details, and short-term outcomes are reported. During the period, 9 patients underwent HAL synchronous multiple segmental colorectal resections. There were 5 women and 4 men, with median age of 54 (24-83) years and median BMI of 24 (19.8-38.7) kg/m(2). Two patients were on long-term corticosteroid therapy. The median operative time was 210 (120-330) minutes and median operative blood loss was 200 (75-300) mLs. The median duration for return of bowel function was 2 days and the median length of stay was 3.5 days. We had 2 minor wound infections. There were no deaths. Synchronous segmental colorectal resections with anastomoses using the hand-assisted laparoscopic technique are safe. Early conversion to open and use of stomas are advisable in challenging cases.

  2. Radical nephrectomy performed by open, laparoscopy with or without hand-assistance or robotic methods by the same surgeon produces comparable perioperative results

    Tanya Nazemi


    Full Text Available PURPOSE: Radical nephrectomy can be performed using open or laparoscopic (with or without hand assistance methods, and most recently using the da Vinci Surgical Robotic System. We evaluated the perioperative outcomes using a contemporary cohort of patients undergoing radical nephrectomy by one of the above 4 methods performed by the same surgeon. MATERIALS AND METHODS: The relevant clinical information on 57 consecutive patients undergoing radical nephrectomy from September 2000 until July 2004 by a single surgeon was entered in a Microsoft Access DatabaseTM and queried. Following appropriate statistical analysis, p values < 0.05 were considered significant. RESULTS: Of 57 patients, the open, robotic, laparoscopy with or without hand assistance radical nephrectomy were performed in 18, 6, 21, and 12 patients, respectively. The age, sex, body mass index (BMI, incidence of malignancy, specimen and tumor size, tumor stage, Fuhrman grade, hospital stay, change in postoperative creatinine, drop in hemoglobin, and perioperative complications were not significantly different between the methods. While the estimated median blood loss, postoperative narcotic use for pain control, and hospital stay were significantly higher in the open surgery method (p < 0.05, the median operative time was significantly shorter compared to the robotic method (p = 0.02. Operating room costs were significantly higher in the robotic and laparoscopic groups; however, there was no significant difference in total hospital costs between the 4 groups. CONCLUSIONS: The study demonstrates that radical nephrectomy can be safely performed either by open, robotic, or laparoscopic with or without hand assistance methods without significant difference in perioperative complication rates. A larger cohort and longer follow up are needed to validate our findings and establish oncological outcomes.



    Nephroureterectomy with removal of a bladder cuff was performed successfully on a 47-year -old man for transitional cell carcinoma of the right renal pelvis using hand-assisted laparoscopy. The results showed that hand-assisted laparoscopic nephroureterectomy is an efficacious altemative to open surgery and provides the urologist new to laparoscopy a shorter learning curve compared with standard laparoscopy.

  4. Radical nephrectomy performed by open, laparoscopy with or without hand-assistance or robotic methods by the same surgeon produces comparable perioperative results

    Tanya Nazemi; Anton Galich; Samuel Sterrett; Douglas Klingler; Lynette Smith; Balaji, K. C.


    PURPOSE: Radical nephrectomy can be performed using open or laparoscopic (with or without hand assistance) methods, and most recently using the da Vinci Surgical Robotic System. We evaluated the perioperative outcomes using a contemporary cohort of patients undergoing radical nephrectomy by one of the above 4 methods performed by the same surgeon. MATERIALS AND METHODS: The relevant clinical information on 57 consecutive patients undergoing radical nephrectomy from September 2000 until July 2...

  5. Diverticulite aguda complicada tratada por cirurgia laparoscópica assistida com a mão (Hals: descrição da técnica e revisão da literatura Complicated diverticulitis operated with the hand assisted approach (Hals: description and literature review

    Guines Antunes Alvarez


    Full Text Available INTRODUÇÃO: A doença diverticular é freqüente em nosso meio e o tratamento clínico é suficiente para a grande maioria dos casos. No entanto, o tratamento cirúrgico fica reservado para as formas complicadas da doença, para o insucesso da terapia clínica e nos casos de imunossupressão. A cirurgia laparoscópica vem ganhando espaço como modalidade terapêutica na doença diverticular, diminuindo o tempo de internação e melhorando o resultado cosmético e funcional apesar de algumas dificuldades inerentes ao método. OBJETIVO: O objetivo dos autores é descrever a técnica de cirurgia laparoscópica assistida com a mão em dois casos de diverticulite complicada (um caso de fístula colo-vesical e outro de abscesso e rever a literatura mundial. RESULTADOS: Um paciente apresentando fístula colo-vesical foi submetido ao tratamento laparoscópico assistido com a mão (HALS. O tempo operatório foi de 183 minutos e a alta se deu no 4º. dia pós-operatório. Outro paciente, portador de abscesso diverticular, submetido ao mesmo método, com tempo operatório de 145 minutos, recebeu alta no 5º. dia pós-operatório. Não houve morbidade nem mortalidade. CONCLUSÃO: A técnica (Hals alia vantagens de ambos os métodos, parece ser mais rápida e segura permitindo o tratamento de diverticulite complicada. Mais estudos são necessários.The laparoscopic surgery for diverticular disease has become a very good alternative. The hand-assisted allows combining the advantages of conventional surgery such as tactile perception, masses mobilization without trauma, vascular control with the magnifying laparoscopic view. Difficult cases of diverticulitis can be treated with the hand-assisted approach. The authors revised the literature and describe the technique utilized in 2 cases of complicated diverticulitis. RESULTS: Two patients were operated on a hand-assisted approach. One had fistula with the bladder. The operative time was 183 minutes and

  6. Hand-assisted laparoscopy in urology: recent advances%泌尿外科手助腹腔镜手术的进展

    谢立平; 秦杰


    外科手术发展至今可分为三代:第一代为开放手术(open surgery);第二代为腹腔镜手术(1aparoseopic surgery),其又可分为三个技术平台,包括标准腹腔镜手术(pure laparoseopic surgery或standard laparoscopie surgery)、手助腹腔镜手术(hand—assisted laparoscopic surgery)和针式腹腔镜手术(needlescopic surgery);第三代为机器人手术(robotic surgery)。

  7. Hand-assisted laparoscopic surgery using Gelport

    Gupta Puneet


    Full Text Available Introduction: Minimally invasive surgery has revolutionized general surgery during the past 10 years. However, for more advanced surgical procedures, the acceptance of the minimally invasive approach has been slower than expected. Advanced laparoscopic surgery is complex and time-consuming. The major drawbacks of laparoscopic surgery are two-dimensional view, lack of depth perception and loss of tactile sensation. This has led to the innovation of hand-assisted laparoscopic surgery (HALS. The objective of the present study was to determine that safety of HALS. Materials and Methods: We preformed 18 HALS procedures in our department between July 2003 and January 2005 on patients who had given their informed consent for the use of Gelport. Out of these, 15 were colectomy, 2 nephrectomy and 1 splenectomy. Out of the 18 patients, 13 were males and 5 were females with the age group ranging from 44 to 72 years. Results: Hand-assisted laparoscopic surgery could be completed in 17 patients maintaining all the oncological principals of surgery. The mean operating times were 120 min for right haemicolectomy, 135 min for left colectomy, 150 min for splenectomy, and 150 min for nephrectomy. The patient undergoing radical nephrectomy by HALS had to be converted to open surgery. As the tumour was large and adherent to the spleen and posterior peritoneal wall. Postoperative recovery was excellent with an average hospital stay of 5 days. Histopathology report showed wide clearance and till date we have a good follow up of 30-380 days. Conclusion: Hand-assisted laparoscopic surgery allows tactile sensation and depth perception thereby may simplify the complex procedures. This may result in reduction of operating time and conversion rates at the same time maintaining all the oncological principles. Hand-assisted laparoscopic surgery strikes a perfect balance between an extended open laparotomy incision and an excessively tedious laparoscopic exercise. Hand

  8. Effects of Hand-assisted Laparoscopy vs.Modified Open Sugiura Procedure on Perioperative Neuroendocrine Stress Response: A Prospective Controlled Study%手助腹腔镜与开腹改良Sugiura术对围术期机体神经内分泌反应的前瞻性对照研究

    刘佳; 张绍庚; 肖朝辉; 刘虎; 赵德希


    目的 探讨手助腹腔镜与开腹改良Sugiura术对机体神经内分泌反应的影响. 方法 2011年1月~2012年3月,将我科需要行改良Sugiura术的56例门静脉高压症按医生手术习惯和患者意愿分为手助腹腔镜组和开腹组,每组28例.于术前1d,手术开始1h,术后即刻,术后1、2、4d抽取静脉血,检测肾上腺素(E)、去甲肾上腺素(NE)、促肾上腺皮质激素(ACTH)、皮质醇(Cor)水平,并进行双因素重复测量资料方差分析. 结果 2组患者E、NE、ACTH、Cor比较F值分别为7.592、15.612、87.821、34.513,P值均<0.05;组内不同时间点比较F值分别为867.084、979.812、2189.563、1897.142,P值均=0.000;组别一时间F值分别为39.471,75.556、54.472、297.623,P值均=0.000,表明4个指标2组间存在显著差异,不同时间点不全相同,在不同时间点的变化趋势也不全相同. 结论 手助腹腔镜改良Sugiura术较开腹改良Sugiura术对机体神经内分泌反应影响小,有利于患者的恢复.%Objective To compare prospectively the effects of hand-assisted laparoscopy (HALS) on neuroendocrine stress response in patients with portal hypertension with that of modified open Sugiura procedure. Methods From January 2011 to March 2012, we divided 56 patients with portal hypertension into HALS and open groups with 28 in each according to doctors' habits and patients' wishes. We collected venous blood sample one day before the operation, immediately after the operation, and 1,2, and 4 days after the operation to determine the level of epinephrine ( E) , norepinephrine (NE) , adrenocorticotropic hormone ( ACTH) and cortisol (Cor) which were then analyzed by the ANOVA of two-factor repeated measures. Results The F value of E, NE, ACTH and Cor between the two groups was 7. 592, 15. 612, 87. 821, and 34. 513, respectively (all P <0. 05). The F value of E, NE, ACTH and Cor within groups (time) was 867. 084, 979. 812, 2189.563, and 1897. 142 (all P =0.000) . And

  9. Hand-assisted versus straight laparoscopic sigmoid colectomy on a training simulator: what is the difference? A stepwise comparison of hand-assisted versus straight laparoscopic sigmoid colectomy performance on an augmented reality simulator.

    Leblanc, Fabien


    We hypothesized that simulator-generated metrics and intraoperative errors may be able to differentiate the technical differences between hand-assisted laparoscopic (HAL) and straight laparoscopic (SL) approaches.

  10. Hand-assisted laparoscopic nephrectomy as a minimally invasive option in the treatment of large renal specimens

    M. Tobias-Machado


    Full Text Available INTRODUCTION: We describe our experience with hand-assisted laparoscopy (HAL as an option for the treatment of large renal specimens. MATERIALS AND METHODS: Between March 2000 and August 2004, 13 patients candidate to nephrectomies due to benign renal conditions with kidneys larger than 20 cm were included in a prospective protocol. Unilateral nephrectomy was performed in cases of hydronephrosis (6 patients or giant pyonephrosis (4 patients. Bilateral nephrectomy was performed in 3 patients with adult polycystic kidney disease (APKD with low back pain refractory to clinical treatment previous to kidney transplant. The technique included the introduction of 2 to 3 10 mm ports, manual incision to allow enough space for the surgeon's wrist without a commercial device to keep the pneumoperitoneum. The kidney was empty, preferably extracorporeally, enough to be removed through manual incision. We have assessed operative times, transfusions, complications, conversions, hospital stay and convalescence. RESULTS: The patients mean age (9 women and 4 men was 58 years. Mean operating time was 120 ± 10 min (hydronephrosis, 160 ± 28 min (pyonephrosis and 190 ± 13 min (bilateral surgery for APKD. There was a need for a conversion in 1 case and another patient needed a transfusion due to a lesion in the renal vein; 2 patients had minor complications. CONCLUSION: HAL surgery is a minimally invasive alternative in the treatment of large renal specimens, with or without significant inflammation.

  11. Hand-assisted laparoscopic surgery for complex gallstone disease: A report of five cases

    Qi Wei; Lai-Gen Shen; He-Ming Zheng


    AIM: To describe the use of hand-assisted laparoscopic surg-ery (HALS) as an alternative to open conversion for complex gall-stone diseases, including Mirizzi syndrome (MS) and mimic MS.METHODS: Five patients with MS and mimic MS of 232 consecutive patients undergoing laparoscopic cholecystectomies were analyzed. HALS without a hand-port device was performed as an alternative to open conversion if the anatomy was still unclear after the neck of the gallbladder was reached.RESULTS: HALS was performed on three patients with MS type Ⅰ and 2 with mimic MS owing to an undear or abnormal anatomy, or an unusual circumstance in which an impacted stone was squeezed out from the infundibulum or the aberrant cystic duct impossible with laparoscopic approach. The median operative time was 165 min (range, 115-190 min). The median hand-assisted time was 75 min (range, 65-100 min). The median postoperative stay was 4 d (range, 3-5 d). The postoperative course was uneventful, except for 1 patient complicated with a minor incision infection. CONCLUSION: HALS for MS type Ⅰ and mimic MS is safe and feasible. It simplifies laparoscopic procedure, and can be used as an alternative to open conversion for complex gallstone diseases.

  12. HAL/S-360 compiler system specification

    Johnson, A. E.; Newbold, P. N.; Schulenberg, C. W.; Avakian, A. E.; Varga, S.; Helmers, P. H.; Helmers, C. T., Jr.; Hotz, R. L.


    A three phase language compiler is described which produces IBM 360/370 compatible object modules and a set of simulation tables to aid in run time verification. A link edit step augments the standard OS linkage editor. A comprehensive run time system and library provide the HAL/S operating environment, error handling, a pseudo real time executive, and an extensive set of mathematical, conversion, I/O, and diagnostic routines. The specifications of the information flow and content for this system are also considered.

  13. A randomized clinical trial of living donor nephrectomy : a plea for a differentiated appraisal of mini-open muscle splitting incision and hand-assisted laparoscopic donor nephrectomy

    Hofker, H.S.; Nijboer, W.N.; Niesing, J.; Krikke, C.; Seelen, M.A.; van Son, W.J.; van Wijhe, M.; Groen, H.; Van der Heide, J.J.; Ploeg, R.J.

    A randomized controlled trial was designed to compare various outcome variables of the retroperitoneal mini-open muscle splitting incision (MSI) technique and the transperitoneal hand-assisted laparoscopic technique (HAL) in performing living donor nephrectomies. Fifty living kidney donors were

  14. Complete mesocolic excision in right hemicolectomy: comparison between hand-assisted laparoscopic and open approaches

    Sheng, Qin-Song; Pan, Zhe; Chai, Jin; Cheng, Xiao-Bin; Liu, Fan-Long; Wang, Jin-Hai; Chen, Wen-Bin


    Purpose To demonstrate the feasibility, safety, and technical strategies of hand-assisted laparoscopic complete mesocolic excision (HAL-CME) and to compare oncological outcomes between HAL-CME and the open approach (O-CME) for right colon cancers. Methods Patients who were scheduled to undergo a right hemicolectomy were divided into HAL-CME and O-CME groups. Measured outcomes included demographic variables, perioperative parameters, and follow-up data. Demographic variables included age, sex distribution, body mass index (BMI), American Society of Anesthesiologists (ASA) physical status classification, previous abdominal surgery, tumor localization, and potential comorbidities. Perioperative parameters included incision length, operative time, blood loss, conversion rate, postoperative pain score, postoperative first passage of flatus, duration of hospital stay, total cost, number of lymph nodes retrieved, TNM classification, and postoperative complications. Follow-up data included follow-up time, use of chemotherapy, local recurrence rate, distant metastasis rate, and short-term survival rate. Results In total, 150 patients (HAL-CME, 78; O-CME, 72) were included. The groups were similar in age, sex distribution, BMI, ASA classification, history of previous abdominal surgeries, tumor localization, and potential comorbidities. Patients in the HAL-CME group had shorter incision lengths, longer operative times, less operative blood loss, lower pain scores, earlier first passage of flatus, shorter hospital stay, higher total costs, similar numbers of lymph nodes retrieved, similar TNM classifications, and a comparable incidence of postoperative complications. The 2 groups were also similar in local recurrence rate, distant metastasis rate, and short-term survival rate. Conclusion The results demonstrate that the HAL-CME procedure is a safe, valid, and feasible surgical method for right hemicolon cancers. PMID:28203556

  15. Pelvic laparoscopy

    ... nearby lymph nodes or tissue Chronic (long-term) pelvic pain, if no other cause has been found Ectopic ( ... pregnant or having a baby (infertility) Sudden, severe pelvic pain A pelvic laparoscopy may also be done to: ...

  16. TransStats_HALS90

    Vermont Center for Geographic Information — Each arc of this coverage corresponds to a high accident location (HAL), based on a VTrans database with the location of each HAL given by milemarkers along named...

  17. HAL/S-360 compiler test activity report

    Helmers, C. T.


    The levels of testing employed in verifying the HAL/S-360 compiler were as follows: (1) typical applications program case testing; (2) functional testing of the compiler system and its generated code; and (3) machine oriented testing of compiler implementation on operational computers. Details of the initial test plan and subsequent adaptation are reported, along with complete test results for each phase which examined the production of object codes for every possible source statement.


    Klumpp, A. R.


    This package extends the Ada programming language to include linear algebra capabilities similar to those of the HAL/S programming language. The package is designed for avionics applications such as Space Station flight software. In addition to the HAL/S built-in functions, the package incorporates the quaternion functions used in the Shuttle and Galileo projects, and routines from LINPAK that solve systems of equations involving general square matrices. Language conventions in this package follow those of HAL/S to the maximum extent practical and minimize the effort required for writing new avionics software and translating existent software into Ada. Valid numeric types in this package include scalar, vector, matrix, and quaternion declarations. (Quaternions are fourcomponent vectors used in representing motion between two coordinate frames). Single precision and double precision floating point arithmetic is available in addition to the standard double precision integer manipulation. Infix operators are used instead of function calls to define dot products, cross products, quaternion products, and mixed scalar-vector, scalar-matrix, and vector-matrix products. The package contains two generic programs: one for floating point, and one for integer. The actual component type is passed as a formal parameter to the generic linear algebra package. The procedures for solving systems of linear equations defined by general matrices include GEFA, GECO, GESL, and GIDI. The HAL/S functions include ABVAL, UNIT, TRACE, DET, INVERSE, TRANSPOSE, GET, PUT, FETCH, PLACE, and IDENTITY. This package is written in Ada (Version 1.2) for batch execution and is machine independent. The linear algebra software depends on nothing outside the Ada language except for a call to a square root function for floating point scalars (such as SQRT in the DEC VAX MATHLIB library). This program was developed in 1989, and is a copyrighted work with all copyright vested in NASA.


    Klumpp, A. R.


    This package extends the Ada programming language to include linear algebra capabilities similar to those of the HAL/S programming language. The package is designed for avionics applications such as Space Station flight software. In addition to the HAL/S built-in functions, the package incorporates the quaternion functions used in the Shuttle and Galileo projects, and routines from LINPAK that solve systems of equations involving general square matrices. Language conventions in this package follow those of HAL/S to the maximum extent practical and minimize the effort required for writing new avionics software and translating existent software into Ada. Valid numeric types in this package include scalar, vector, matrix, and quaternion declarations. (Quaternions are fourcomponent vectors used in representing motion between two coordinate frames). Single precision and double precision floating point arithmetic is available in addition to the standard double precision integer manipulation. Infix operators are used instead of function calls to define dot products, cross products, quaternion products, and mixed scalar-vector, scalar-matrix, and vector-matrix products. The package contains two generic programs: one for floating point, and one for integer. The actual component type is passed as a formal parameter to the generic linear algebra package. The procedures for solving systems of linear equations defined by general matrices include GEFA, GECO, GESL, and GIDI. The HAL/S functions include ABVAL, UNIT, TRACE, DET, INVERSE, TRANSPOSE, GET, PUT, FETCH, PLACE, and IDENTITY. This package is written in Ada (Version 1.2) for batch execution and is machine independent. The linear algebra software depends on nothing outside the Ada language except for a call to a square root function for floating point scalars (such as SQRT in the DEC VAX MATHLIB library). This program was developed in 1989, and is a copyrighted work with all copyright vested in NASA.

  20. HAL/S-FC compiler system specifications


    This document specifies the informational interfaces within the HAL/S-FC compiler, and between the compiler and the external environment. This Compiler System Specification is for the HAL/S-FC compiler and its associated run time facilities which implement the full HAL/S language. The HAL/S-FC compiler is designed to operate stand-alone on any compatible IBM 360/370 computer and within the Software Development Laboratory (SDL) at NASA/JSC, Houston, Texas.


    S. V. Gautier


    Full Text Available The first experience of hand-assisted laparoscopic donor nephrectomy is described in the article. A new technique of the operation and it’s results are discussed in details. Advantages of this type of the operation in comparison with open and full laparoscopic techniques are presented. 

  2. Evaluation of verifiability in HAL/S. [programming language for aerospace computers

    Young, W. D.; Tripathi, A. R.; Good, D. I.; Browne, J. C.


    The ability of HAL/S to write verifiable programs, a characteristic which is highly desirable in aerospace applications, is lacking since many of the features of HAL/S do not lend themselves to existing verification techniques. The methods of language evaluation are described along with the means in which language features are evaluated for verifiability. These methods are applied in this study to various features of HAL/S to identify specific areas in which the language fails with respect to verifiability. Some conclusions are drawn for the design of programming languages for aerospace applications and ongoing work to identify a verifiable subset of HAL/S is described.

  3. Hand-assisted laparoscopic nephrectomy in living donor

    Luiz S. Santos


    Full Text Available OBJECTIVE: Report the authors’ initial experience with hand-assisted laparoscopic nephrectomy technique in renal donors for transplantation. MATERIALS AND METHODS: Twenty-seven donors submitted to hand-assisted laparoscopic nephrectomy were retrospectively analyzed from February 2001 to June 2002. Technical aspects of the donor surgery, results, and complications, are discussed, as well as recipient’s complications and outcomes. RESULTS: Among 27 hand-assisted laparoscopic nephrectomies, left kidney was withdrew in 18 donors (66.6%, and right kidney in 9 (33.3%. The operative time ranged from 55 to 210 minutes (mean 132.7 ± 37.6 min, and the time of hot ischemia ranged from 2 to 11 minutes (mean 4.7 ± 2.5 min, with an estimated mean blood loss during the intraoperative period of 133.3 mL. Conversion to open surgery was necessary for 1 (3.7% patient due to vascular lesion. In graft evaluation, immediate diuresis was observed in 26 (96.3% cases, and mean serum creatinine in PO day 7 was 1.5 ± 1.1 mg/dL. Renal vein thrombosis occurred in 1 (3.7% patient requiring graft removal. Lymphocele was observed in 3 recipients (11.1%, and urinary leakage due to ureteral necrosis in 1 case (3.7%. CONCLUSION: Hand-assisted laparoscopic nephrectomy in living donors is a safe procedure and an effective alternative to open nephrectomy. In this series, the procedure presented low morbidity after surgery providing to the recipient a good morphological and functional quality of the graft.

  4. Hand-assisted right laparoscopic nephrectomy in living donor

    Fernando Meyer


    Full Text Available OBJECTIVE: To assess results obtained with the authors' technique of right hand-assisted laparoscopic nephrectomy in living kidney donors. MATERIALS AND METHODS: We retrospectively analyzed 16 kidney donors who underwent hand-assisted right laparoscopic nephrectomy from February 2001 to July 2004. Among these patients, 7 were male and 9 were female, with mean age ranging between 22 and 58 years (mean 35.75. RESULTS: Surgical time ranged from 55 to 210 minutes (mean 127.81 min and warm ischemia time from 2 to 6 minutes (mean 3.78 min with mean intra-operative blood loss estimated at 90.62 mL. There was no need for conversion in any case. Discharge from hospital occurred between the 3rd and 6th days (mean 3.81. On the graft assessment, immediate diuresis was seen in 15 cases (93.75% and serum creatinine on the 7th post-operative day was 1.60 mg/dL on average. Renal vein thrombosis occurred in 1 patient (6.25% who required graft removal, and lymphocele was seen in 1 recipient (6.25%. CONCLUSION: Hand-assisted right laparoscopic nephrectomy in living donors is a safe and effective alternative to open nephrectomy. Despite a greater technical difficulty, the procedure presented low postoperative morbidity providing good morphological and functional quality of the graft on the recipient.

  5. Exotic Mammal Laparoscopy.

    Sladakovic, Izidora; Divers, Stephen J


    Laparoscopy is an evolving field in veterinary medicine, and there is an increased interest in using laparoscopic techniques in nondomestic mammals, including zoo animals, wildlife, and exotic pets. The aim of this article is to summarize the approach to laparoscopic procedures, including instrumentation, patient selection and preparation, and surgical approaches, and to review the current literature on laparoscopy in exotic mammals. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Hand-assisted laparoscopic surgery of abdominal large visceral organs

    Li-Hua Dai; Bo Xu; Guang-Hui Zhu


    AIM: To design a hand-assisted laparoscopic approach in an attempt to provide an option for laparoscopic resection of abdominal large viscera.METHODS: A 5-6 cm incision (for HandPort) and 2 trocars were employed. The main vessel of the target organ was taken as a "core", and all tissues around the core were taken as peripheral structures. The peripheral structures were dissected first, and the core vessels were treated last. Twenty-six patients underwent laparoscopic deroofing of the hepatic huge cysts, resection of the segments lying at the outer edge of the liver (segments 2 to 6), splenectomy, hemicolectomy, ileocecectomy and subtotal gastrectomy with HandPort device, harmonic scalpel, or Ligasure.RESULTS: The duration of the procedure was within 2 hours. Blood loss amounted to 8-120 mL. The conversion rate was 3.8% (1/26). All patients had uneventful postoperative courses with less pain, earlier oral intake,and faster recovery, compared with conventional surgery.CONCLUSION: This method combines the advantages of both open and laparoscopic techniques, achieving better hemostasis effect, shortening the operative time,and is beneficial to the patients.

  7. Development and assessment of a hand assist device: GRIPIT.

    Kim, Byungchul; In, Hyunki; Lee, Dae-Young; Cho, Kyu-Jin


    Although various hand assist devices have been commercialized for people with paralysis, they are somewhat limited in terms of tool fixation and device attachment method. Hand exoskeleton robots allow users to grasp a wider range of tools but are heavy, complicated, and bulky owing to the presence of numerous actuators and controllers. The GRIPIT hand assist device overcomes the limitations of both conventional devices and exoskeleton robots by providing improved tool fixation and device attachment in a lightweight and compact device. GRIPIT has been designed to assist tripod grasp for people with spinal cord injury because this grasp posture is frequently used in school and offices for such activities as writing and grasping small objects. The main development objective of GRIPIT is to assist users to grasp tools with their own hand using a lightweight, compact assistive device that is manually operated via a single wire. GRIPIT consists of only a glove, a wire, and a small structure that maintains tendon tension to permit a stable grasp. The tendon routing points are designed to apply force to the thumb, index finger, and middle finger to form a tripod grasp. A tension-maintenance structure sustains the grasp posture with appropriate tension. Following device development, four people with spinal cord injury were recruited to verify the writing performance of GRIPIT compared to the performance of a conventional penholder and handwriting. Writing was chosen as the assessment task because it requires a tripod grasp, which is one of the main performance objectives of GRIPIT. New assessment, which includes six different writing tasks, was devised to measure writing ability from various viewpoints including both qualitative and quantitative methods, while most conventional assessments include only qualitative methods or simple time measuring assessments. Appearance, portability, difficulty of wearing, difficulty of grasping the subject, writing sensation, fatigability

  8. An Ada Linear-Algebra Software Package Modeled After HAL/S

    Klumpp, Allan R.; Lawson, Charles L.


    New avionics software written more easily. Software package extends Ada programming language to include linear-algebra capabilities similar to those of HAL/S programming language. Designed for such avionics applications as Space Station flight software. In addition to built-in functions of HAL/S, package incorporates quaternion functions used in Space Shuttle and Galileo projects and routines from LINPAK solving systems of equations involving general square matrices. Contains two generic programs: one for floating-point computations and one for integer computations. Written on IBM/AT personal computer running under PC DOS, v.3.1.

  9. An Ada Linear-Algebra Software Package Modeled After HAL/S

    Klumpp, Allan R.; Lawson, Charles L.


    New avionics software written more easily. Software package extends Ada programming language to include linear-algebra capabilities similar to those of HAL/S programming language. Designed for such avionics applications as Space Station flight software. In addition to built-in functions of HAL/S, package incorporates quaternion functions used in Space Shuttle and Galileo projects and routines from LINPAK solving systems of equations involving general square matrices. Contains two generic programs: one for floating-point computations and one for integer computations. Written on IBM/AT personal computer running under PC DOS, v.3.1.

  10. Hand-Assisted Laparoscopic Hepatectomy for Primary Clear Cell Hepatocellular Carcinoma of the Liver

    Kazutoshi Kida


    Full Text Available We report a case of primary clear cell hepatocellular carcinoma of the liver (PCCCL for which we performed hand-assisted laparoscopic hepatectomy. A 71-year-old female with hepatitis C infection and diabetes mellitus was admitted to our department for a hepatic tumor with gallstone. Abdominal computed tomography revealed a tumor 25 mm in diameter on the surface in segment 5 of the liver. The imaging results suggested small hepatocellular carcinoma located on the surface in segment 5 of the liver, and we performed laparoscopic surgery aiming at a minimally invasive procedure. We performed laparoscopic cholecystectomy and hand-assisted laparoscopic hepatectomy. Histopathological findings showed moderately differentiated hepatocellular carcinoma, and as the proportion of clear cells was 75%, the tumor was diagnosed as PCCCL. This is the first report of hand-assisted laparoscopic hepatectomy for PCCCL. Laparoscopic hepatectomy is a useful minimally invasive surgical procedure when the tumor is located on the surface of the liver.

  11. [Comparative research of traumatic injury of open hand-assisted laparoscopic anterior resection of the rectum].

    Khitar'yan, A G; Glumov, E E; Veliev, K S


    The article made a comparative assessment of traumatic injury of open hand-assisted laparoscopic anterior resection of the rectum in lateral and spinal positions. The presented technique of hand-assisted laparoscopic colon and rectal surgery is simple. There are advantages in case of obesity presence (IMT more than 30 kg/m2), in significant shortening of the mesocolon and mesentery, high fixation of splenic flexure and intimate fixation of the spleen, in case of bad preparation of the bowels in partial intestinal obstruction or in case of emergency operation, big cancer size, expressed perifocal inflammation. A comparative analysis of dynamics of hormone stress content and metabolism (cortisol, adrenaline, thyrothrophic hormone) showed their expressed increase in blood during operation after traditional surgery. Less stressed reaction was noted after hand-assisted surgery, especially in overweight patients. An application of low invasive method allowed reduction of hemorrhage, pain syndrome, terms of patient's activation and restoration of intestinal motility after operation.

  12. Hand-assisted retroperitoneoscopic versus standard laparoscopic donor nephrectomy: HARP-trial

    Alwayn Ian PJ


    Full Text Available Abstract Background Transplantation is the only treatment offering long-term benefit to patients with chronic kidney failure. Live donor nephrectomy is performed on healthy individuals who do not receive direct therapeutic benefit of the procedure themselves. In order to guarantee the donor's safety, it is important to optimise the surgical approach. Recently we demonstrated the benefit of laparoscopic nephrectomy experienced by the donor. However, this method is characterised by higher in hospital costs, longer operating times and it requires a well-trained surgeon. The hand-assisted retroperitoneoscopic technique may be an alternative to a complete laparoscopic, transperitoneal approach. The peritoneum remains intact and the risk of visceral injuries is reduced. Hand-assistance results in a faster procedure and a significantly reduced operating time. The feasibility of this method has been demonstrated recently, but as to date there are no data available advocating the use of one technique above the other. Methods/design The HARP-trial is a multi-centre randomised controlled, single-blind trial. The study compares the hand-assisted retroperitoneoscopic approach with standard laparoscopic donor nephrectomy. The objective is to determine the best approach for live donor nephrectomy to optimise donor's safety and comfort while reducing donation related costs. Discussion This study will contribute to the evidence on any benefits of hand-assisted retroperitoneoscopic versus standard laparoscopic donor nephrectomy. Trial Registration Dutch Trial Register NTR1433

  13. Promising early results after hand-assisted laparoscopic partial nephrectomy in carefully selected patients

    Azawi, Nessn H; Christensen, Tom


    was dissected using hand-assisted laparoscopic technique, the gerotic fascia was dissected and a complete exploration of the kidney was achieved. A vascular bulldog clamp was removed from the renal artery immediately after the tumour resection bed had been closed with a running suture with Hem-o-Lok clips...

  14. A comparison of hand-assisted and pure laparoscopic techniques in live donor nephrectomy

    Anibal Wood Branco


    Full Text Available PURPOSE: To compare hand-assisted laparoscopic donor nephrectomy and pure laparoscopic live donor nephrectomy techniques in live donor nephrectomy. METHODS: In this retrospective study, we included all patients submitted to hand-assisted laparoscopic donor nephrectomy and pure laparoscopic live donor nephrectomy between May 2002 and December 2007. The operative data and post-operative courses were reviewed. Information was collected on the operative time, warm ischemia time, estimated blood loss, intra-operative complications, time to first oral intake, length of hospital stay, and post-operative complications. The data were analyzed using Student's t -tests and Fisher exact tests as appropriate, with statistical significance defined as p < 0.05. RESULTS: The means of the operative duration, warm ischemia time and intra-operative bleeding were 83 min, 3.6 min and 130.9 cc, respectively, for hand-assisted laparoscopic donor nephrectomy, and 78.4 min, 2.5 min and 98.9 cc, respectively, for pure laparoscopic live donor nephrectomy (p=0.29, p<0.0001 and p=0.08, respectively. Intra-operative complications occurred in 6% of patients submitted to hand-assisted laparoscopic donor nephrectomy and in 4.5% of those submitted to pure laparoscopic live donor nephrectomy (p=0.68. Only one patient from each group required conversion to open surgery; one person receiving hand-assisted laparoscopic donor nephrectomy had bleeding and one person receiving pure laparoscopic live donor nephrectomy had low carbon dioxide levels during the warm ischemia period. Compared with patients receiving hand-assisted laparoscopic donor nephrectomy, patients submitted to pure laparoscopic live donor nephrectomy were able to take their first meal earlier (12.5 vs. 9.2 hours, p=0.046, were discharged home sooner (2.8 vs. 1.4 days, p<0.0001 and had fewer post-operative complications (7.5% vs. 0.6%, p=0.04. CONCLUSIONS: Pure laparoscopic live donor nephrectomy had some advantages

  15. Hand-assisted partial nephrectomy with early arterial clamp removal: Impact of the learning curve

    Azawi, Nessn H; Norus, Thomas P; Wittendorff, Hans-Erik;


    OBJECTIVE: The aims of this study were to present the results of hand-assisted laparoscopic partial nephrectomy according to the margin, ischaemia and complications system; to assess the role of the learning curve; and to compare this approach with other approaches. MATERIAL AND METHODS: Data from...... nephrectomy for complex tumours with a relatively high success rate according to the margin, ischaemia and complications system. Warm ischaemia time could be obtained within 5 min after 40 procedures....

  16. Hand-assisted laparoscopic sigmoid colectomy skills acquisition: augmented reality simulator versus human cadaver training models.

    Leblanc, Fabien; Senagore, Anthony J; Ellis, Clyde N; Champagne, Bradley J; Augestad, Knut M; Neary, Paul C; Delaney, Conor P


    The aim of this study was to compare a simulator with the human cadaver model for hand-assisted laparoscopic colorectal skills acquisition training. An observational prospective comparative study was conducted to compare the laparoscopic surgery training models. The study took place during the laparoscopic colectomy training course performed at the annual scientific meeting of the American Society of Colon and Rectal Surgeons. Thirty four practicing surgeons performed hand-assisted laparoscopic sigmoid colectomy on human cadavers (n = 7) and on an augmented reality simulator (n = 27). Prior laparoscopic colorectal experience was assessed. Trainers and trainees completed independently objective structured assessment forms. Training models were compared by trainees' technical skills scores, events scores, and satisfaction. Prior laparoscopic experience was similar in both surgeon groups. Generic and specific skills scores were similar on both training models. Generic events scores were significantly better on the cadaver model. The 2 most frequent generic events occurring on the simulator were poor hand-eye coordination and inefficient use of retraction. Specific events were scored better on the simulator and reached the significance limit (p = 0.051) for trainers. The specific events occurring on the cadaver were intestinal perforation and left ureter identification difficulties. Overall satisfaction was better for the cadaver than for the simulator model (p = 0.009). With regard to skills scores, the augmented reality simulator had adequate qualities for the hand-assisted laparoscopic colectomy training. Nevertheless, events scores highlighted weaknesses of the anatomical replication on the simulator. Although improvements likely will be required to incorporate the simulator more routinely into the colorectal training, it may be useful in its current form for more junior trainees or those early on their learning curve. Copyright 2010 Association of Program

  17. Adrenal Leiomyoma Treated by Hand-Assisted Laparoscopic Adrenalectomy: A Case Report

    Tu-Hao Chang


    Full Text Available A left adrenal incidentaloma was found by abdominal ultrasound and computed tomography (CT in a 53-year-old woman who had a history of non-insulin dependent diabetes mellitus. Abdominal CT showed a well-circumscribed adrenal mass (5.5 × 4.5 × 3.5 cm with low density (32 HU on precontrast scan and heterogeneous enhancement on postcontrast scan. Laboratory examinations revealed a nonfunctional adrenal tumor. As the malignant potential of the tumor could not be ruled out, the patient underwent hand-assisted laparoscopic adrenalectomy. Postoperative recovery was uneventful, and pathologic examination revealed leiomyoma.

  18. Hand-assisted bilateral nephrectomy in a patient with adult polycystic kidney disease

    Marcello Alves Pinto

    Full Text Available CONTEXT: Dominantly autosomal polycystic disease is characterized by multiple bilateral and non-functional cysts, which lead to progressive kidney failure. OBJECTIVE: Our objective was to report on a case of hand-assisted bilateral nephrectomy in a 28-year-old female patient with adult polycystic disease and recurring pyelonephritis in a kidney transplant program. CASE REPORT: A hand-assisted bilateral nephrectomy was performed through a supra-umbilical median incision of approximately 6 cm, and with 3 ports of 10 mm. The length of the surgery was 3 hours and 15 minutes. The kidneys were removed after the aspiration of some cysts through the supra-umbilical incision. Pain control was achieved via the use of analgesics. The blood loss during surgery was 160 ml. During the postoperative period, the patient developed right-side pneumothorax, which was drained with no further occurrence. This drain was kept in place for 48 hours. The length of hospitalization was 4 days.

  19. The GOAL-to-HAL/S translator specification. [for space shuttle

    Stanten, S. F.; Flanders, J. H.


    The specification sets forth a technical framework within which to deal with the transfer of specific GOAL features to HAL/S. Key technical features of the translator are described which communicate with the data bank, handle repeat statements, and deal with software interrupts. GOAL programs, databank information, and GOAL system subroutines are integrated into one GOAL in HAL/S. This output is fully compatible HAL/S source ready for insertion into the HAL/S compiler. The Translator uses a PASS1 to establish all the global data needed for the HAL/S output program. Individual GOAL statements are translated in PASS2. The specification document makes extensive use of flowcharts to specify exactly how each variation of each GOAL statement is to be translated. The specification also deals with definitions and assumptions, executive support structure and implementation. An appendix, entitled GOAL-to-HAL Mapping, provides examples of translated GOAL statements.

  20. Hand-assisted laparoscopic colectomy for colovesical fistula associated with diverticular disease.

    Spector, Rona; Bard, Vyacheslav; Zmora, Oded; Avital, Shmuel; Wasserberg, Nir


    To evaluate the feasibility and short-term outcome of hand-assisted laparoscopic colectomy (HALC) for the treatment of colovesical fistula complicating diverticulitis, we reviewed the files of all 34 patients who underwent surgery for diverticular colovesical fistula in 1999 to 2010 at a major tertiary medical center. Twenty-one were treated with HALC and 13 with open colectomy. There were no differences in demographic parameters among the groups. HALC and open colectomy had similar operating time. HALC was associated with a significantly shorter hospital stay compared with open colectomy (5 vs. 8 d, P=0.001). HALC proved to be technically feasible and safe in this setting. It provided benefits of tactile feedback and manual manipulation as in open colectomy while maintaining the advantages of a minimal invasive approach.

  1. Left Hand-assisted Laparoscopic Nephrectomy With Renal Vein Thrombectomy for Stage T3b Renal Cell Carcinoma.

    Ghareeb, George M; Kenleigh, Dorian A; Brown, James A


    A 60-year-old male was found to have an 8.0 cm left renal mass and associated renal vein thrombus on computed tomography. The thrombus extended 3 mm beyond the right aortic border to within 1.6 cm of the left border of the inferior vena cava. The patient underwent left nephrectomy with renal vein thrombectomy using a hand-assisted laparoscopic approach. The tumor thrombus was "milked" proximally back into left renal vein, which was then divided with an endovascular stapler. Left renal vein thrombi extending to right margin of the aorta can be managed with hand-assisted laparoscopic approach.

  2. Hand-Assisted Laparoscopic Nephrectomy and Auto-Transplantation for a Hilar Renal Artery Aneurysm: A Case Report.

    Kim, Min Jung; Lee, Kyo Won; Park, Jae Berm; Kim, Sung Joo


    A 52-year-old man was admitted with an incidentally detected right renal artery aneurysm (RAA). Computed tomographic angiography with three-dimensional reconstruction revealed that the aneurysm was 2.2 cm in diameter and located at the renal hilum. We performed hand-assisted laparoscopic nephrectomy with ex vivo repair of the RAA and auto-transplantation with minimal elongation of Gibson incision. The operation and postoperative course were uneventful. At last follow-up, the patient was alive with a well-functioning auto-transplant. Hand-assisted laparoscopic nephrectomy and auto-transplantation is a useful treatment option for hilar RAA.

  3. Obesity: physiologic changes and challenges during laparoscopy.

    Lamvu, Georgine; Zolnoun, Denniz; Boggess, John; Steege, John F


    The purpose of this report was to describe the evidence for the benefits of laparoscopic surgery in obese patients, to review the physiologic abnormalities that are associated with obesity, and to explore surgical techniques that will enable surgeons to perform laparoscopy successfully in obese patients. This article is a review of the available literature on obesity, the physiologic changes that occur in obese patients, and the impact of these changes on laparoscopy outcomes. Obesity is associated with sudden death and a wide range of morbid conditions such as hypertension, atherosclerosis, angina, chronic obstructive disease, and diabetes mellitus. Recent studies have demonstrated that obese patients who undergo laparoscopy have shorter hospital stays, less postoperative pain, and fewer wound infections when compared with obese patients who undergo laparotomy. Laparoscopy patients also have fewer postoperative ileus and fevers. With thorough preparation and careful preoperative evaluation, laparoscopy can be performed safely and is the preferred surgical method in obese patients.

  4. Laparoscopy

    ... used to look for the cause of chronic pelvic pain , infertility , or a pelvic mass. If a problem ... uterus at the top of the vagina. Chronic Pelvic Pain: Persistent pain in the pelvic region that has ...

  5. Laparoscopy

    ... 2 inch long). Laparoscopic surgery sometimes is called “minimally invasive surgery.” How is laparoscopic surgery done? Laparoscopic surgery ... incisions may be made in the abdomen for surgical instruments. Another instrument, called a uterine manipulator, may be inserted through the vagina and cervix ...

  6. Clipless management of the renal vein during hand-assist laparoscopic donor nephrectomy

    Rosenblatt Gregory S


    Full Text Available Abstract Background Laparoscopic live donor nephrectomy has become the preferred method of donor nephrectomy at many transplant centers. The laparoscopic stapling device is commonly used for division of the renal vessels. Malfunction of the stapling device can occur, and is often due to interference from previously placed clips. We report our experience with a clipless technique in which no vascular clips are placed on tributaries of the renal vein at or near the renal hilum in order to avoid laparoscopic stapling device misfires. Methods From December 20, 2002 to April 12, 2005, 50 patients underwent hand-assisted laparoscopic left donor nephrectomy (LDN at our institution. Clipless management of the renal vein tributaries was used in all patients, and these vessels were divided using either a laparoscopic stapling device or the LigaSureTM device (Valleylab, Boulder, CO. The medical and operative records of the donors and recipients were reviewed to evaluate patient outcomes. Results The mean follow-up time was 14 months. Of the 50 LDN procedures, there were no laparoscopic stapling device malfunctions and no vascular complications. All renal allografts were functioning at the time of follow-up. Conclusion Laparoscopic stapling device failure due to deployment across previously placed surgical clips during laparoscopic live donor nephrectomy can be prevented by not placing clips on the tributaries of the renal vein. In our series, there were no vascular complications and no device misfires. We believe this clipless technique improves the safety of laparoscopic donor nephrectomy.

  7. Advances in Pediatric Urologic Laparoscopy

    M. C. Smaldone


    Full Text Available The spectrum of laparoscopic surgery in children has undergone a dramatic evolution. Initially used as a diagnostic modality for many pediatric urologists, complex as well as reconstructive procedures are now being performed laparoscopically. Laparoscopic orchiopexy and nephrectomy are well established and are being performed at many centers. Laparoscopic partial nephrectomy, adrenalectomy, and dismembered pyeloplasty series have reported shortened hospital stays and operative times that are comparable to that of open techniques or are decreasing with experience. The initial experiences with laparoscopic ureteral reimplantation and laparoscopic-assisted bladder reconstructive surgery have been described, reporting encouraging results with regards to feasibility, hospital stay, and cosmetic outcome. This report will provide a directed review of the literature to establish the current indications for laparoscopy in pediatric urologic surgery.

  8. HAL/S-FC compiler system functional specification


    Compiler organization is discussed, including overall compiler structure, internal data transfer, compiler development, and code optimization. The user, system, and SDL interfaces are described, along with compiler system requirements. Run-time software support package and restrictions and dependencies are also considered of the HAL/S-FC system.

  9. HAL1 mediate salt adaptation in Arabidopsis thaliana


    The yeast HAL1 gene was introduced into Arabidopsis thaliana by Agrobacterium tumefaciens-mediated transformation with vacuum infiltration under the control of CaMV 35S promoter.Thirty-three individual kanamycin resistant plants were obtained from 75,000 seeds.Southern blotting analysis indicated that HAL1 gene had been integrated into all of the transgenic plants' genomes.The copy number of HAL1 gene in transgenic plants was mostly 1 to 3 by Southern analysis.Phenotypes of transgenic plants have no differences with wild type plants.Several samples of transformants were self-pollinated,and progenies from transformed and non-transformed plants(controls)were evaluated for salt tolerance and gene expression.Measurement of concentrations of intracellular K+ and Na+ showed that transgenic lines were able to retain less Na+ than that of the control under salt stress.Results from different tests indicated the expression of HAL1 gene promotes a higher level of salt tolerance in vivo in the transgenic Arabidopsis plants.

  10. Current status of robotics in urologic laparoscopy.

    Gettman, Matthew T; Blute, Michael L; Peschel, Reinhard; Bartsch, Georg


    Urology has continuously embraced novel technologies like laparoscopy that reduce patient morbidity yet maintain an excellent standard of care. Because of limitations on maneuverability, operative vision, manual dexterity, and tactile sense, laparoscopy can be more difficult to perform than corresponding tasks in open surgery. To potentially increase clinical applicability of laparoscopy, robots that enhance operative performance have recently been introduced for a variety of laparoscopic procedures such as laparoscopic radical prostatectomy, pyeloplasty, and even laparoscopic cystectomy and neobladder construction. While these robots have generated excitement and many robotic applications have been described, the benefit of the advanced technology in expanded series of patients remains largely unknown. In addition, the ability of telerobotics to be used by surgeons inexperienced in conventional laparoscopy is also poorly understood. This review compares current features of available robots, advantages and limitations of robots, the emerging clinical applications, and the future potential of robotics in urology.

  11. Experience with diagnostic laparoscopy for gynecological indications


    Feb 27, 2012 ... complaints like chronic pelvic pain. ... on full recovery from the anesthesia. ... had an uneventful recovery and was discharged home on. Table 1: .... Ten‑year experience with laparoscopy on a gynecologic oncology service:.

  12. Advancing frontiers in anaesthesiology with laparoscopy

    Sood, Jayashree


    The introduction of laparoscopy in the surgeon’s armamentarium was in fact a “revolution in the history of surgery”. Since this technique involves insufflation of carbon dioxide it produces several pathophysiological changes which have to be understood by the anaesthesiologist who can modify the anaesthesia technique accordingly. Advantages of laparoscopy include reduced pain, small scars and early return to work. Certain complications specific to laparoscopic surgery are due to carboperitone...

  13. Three-dimensional laparoscopy vs 2-dimensional laparoscopy with high-definition technology for abdominal surgery

    Fergo, Charlotte; Burcharth, Jakob; Pommergaard, Hans-Christian;


    SOURCES: This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomized controlled trials (RCTs) comparing newer generation 3D-laparoscopy with 2D-laparoscopy were included through searches in Pubmed, EMBASE, and Cochrane...

  14. The Health Archetype Language (HAL-42): interface considerations.

    Elkin, Peter L; Froehling, David; Wahner-Roedler, Dietlind; Trusko, Brett; Welsh, Gail; Rosenbloom, S Trent; Speroff, Theodore; Brown, Steven H


    In this manuscript we report an evaluation of the reliability of clinical research rules creation by multiple clinicians using the Health Archetype Language (HAL-42) and user interface. HAL-42 is a language which allows real time epidemiological inquiry using automatically derived clinical encodings with any health Ontology. This evaluation used SNOMED CT as the underlying Ontology. The inquiries were performed on a population of 17,731 patients whose 50,000 clinical records have all been fully encoded in SNOMED CT. Four subject matter experts (SMEs) were asked independently to encode and run 10 rules/studies. The inter-rater agreement was 74.8% (p=0.6526) with a Kappa statistic of 0.49217 (p=0.5722). The ten rules were divided into three easy rules, four moderate and three complex rules. There was no significant difference in the SME's agreement when representing easy and complex rules (p=0.6243). We conclude that although the usability of the HAL-42 language is usable enough to achieve reasonable inter-rater reliability, some training will be necessary to reach high levels of reliability for ad hoc queries. We also conclude that SMEs are just as competent to perform complex queries as easy queries of ontologically indexed clinical data.

  15. [Anesthesia for laparoscopy in sterile patients].

    Schönrath, B; Borgwardt, D; Langanke, D; Alexander, H; Baier, D; Haake, K W


    During 5 years 382 laparoscopies were carried through in female patients with sterility in different kinds of anaesthesia (Intubation anaesthesia, spinal anaesthesia, and i.v. anaesthesia). We found the most advantageous results in the cases of i.v. anaesthesia with Ketamin and Diazepam.

  16. Advancing frontiers in anaesthesiology with laparoscopy.

    Sood, Jayashree


    The introduction of laparoscopy in the surgeon's armamentarium was in fact a "revolution in the history of surgery". Since this technique involves insufflation of carbon dioxide it produces several pathophysiological changes which have to be understood by the anaesthesiologist who can modify the anaesthesia technique accordingly. Advantages of laparoscopy include reduced pain, small scars and early return to work. Certain complications specific to laparoscopic surgery are due to carboperitoneum and increased intra-abdominal pressure. Venous air embolism, although very rare, can be lethal if not managed promptly. Other complications include subcutaneous emphysema, haemodynamic compromise and arrhythmias. Although associated with minimal postoperative morbidity, postoperative pain, nausea and vomiting can be quite problematic. The limitations of laparoscopy have been overcome by the introduction of robotic surgery. There are important implications for the anaesthesiologist during robotic surgeries which have to be practiced accordingly. Robotic surgery has a learning curve for both the surgeon and the anaesthesiologist. The robot is bulky, and cannot be disengaged after docking. Therefore it is important that the anaesthetized patient remains immobile throughout surgery and anaesthesia is reversed only after the robot has been disengaged at the end of surgery. Advances in laparoscopy and robotic surgery have modified anaesthetic techniques too.

  17. Pediatric laparoscopy: Facts and factitious claims

    Raveenthiran V


    Full Text Available Background: Pediatric laparoscopy (LS is claimed to be superior to open surgery (OS. This review questions the scientific veracity of this assertion by systematic analysis of published evidences comparing LS versus OS in infants and children. Materials and Methods: Search of PubMed data base and the available literature on pediatric LS is analyzed. Results: One hundred and eight articles out of a total of 426 papers were studied in detail. Conclusions: High quality evidences indicate that LS is, at the best, as invasive as OS; and is at the worst, more invasive than conventional surgery. There are no high quality evidences to suggest that LS is minimally invasive, economically profitable and is associated with fewer complications than OS. Evidences are equally distributed for and against the benefits of LS regarding postoperative pain. Proof of cosmetic superiority of LS or otherwise is not available. The author concludes that pediatric laparoscopy, at the best, is simply comparable to laparotomy and its superiority over the latter could not be sustained on the basis of available scientific evidences. Benefits of laparoscopy appear to recede with younger age. Concerns are raised on the quick adoption, undue promotion and frequent misuse of laparoscopy in children.

  18. Hal Foster (Ed., L’antiestetica. Saggi sulla cultura postmoderna

    Francesca Agamennoni


    Full Text Available La notevole distanza temporale che separa la prima edizione, nel 1983, della raccolta di saggi curata da Hal Foster e intitolata The Anti-Aesthetics e la recentissima pubblicazione di quest'ultima nella sua traduzione italiana, L'antiestetica, da parte di Postmedia Books costituisce una circostanza singolare per un'opera di così ampia e diffusa risonanza internazionale da essere definita da Ester Coen, nella sua postfazione, come il «vademecum di un'intera generazione» (187. A poco più di trent'anni di distanza questo testo ci appare per molti versi come un documento postumo, manifesto di un progetto – il postmodernismo – già esauritosi, riproposto «quando ormai la discussione si volge piuttosto altrove, alla consunzione di questo termine e, in definitiva, all'epilogo di una fase» (ibid..

  19. Modelling, Simulation, and Analysis of HAL BangaloreInternational Airport

    P. Lathasree


    Full Text Available Air traffic density in India and the world at large is growing fast and posing challengingproblems. The problems encountered can be parameterized as flight delay, workload of air trafficcontrollers and noise levels in and around aerodromes. Prediction and quantification of theseparameters aid in developing strategies for efficient air traffic management. In this study, themethod used for quantifying is by simulation and analysis of the selected aerodrome and airspace. This paper presents the results of simulation of HAL Bangalore International Airport,which is used by civil as well as military aircraft. With the test flying of unscheduled militaryaircraft and the increase in the civil air traffic, this airport is hitting the limit of acceptable delay.The workload on air traffic controllers is pushed to high during peak times. The noise contourprediction, especially for the test flying military aircraft is sounding a wake up call to thecommunities living in the vicinity of the Airport.

  20. Key Role for Intracellular K+ and Protein Kinases Sat4/Hal4 and Hal5 in the Plasma Membrane Stabilization of Yeast Nutrient Transporters▿

    Pérez-Valle, Jorge; Jenkins, Huw; Merchan, Stephanie; Montiel, Vera; Ramos, José; Sharma, Sukesh; Serrano, Ramón; Yenush, Lynne


    K+ transport in living cells must be tightly controlled because it affects basic physiological parameters such as turgor, membrane potential, ionic strength, and pH. In yeast, the major high-affinity K+ transporter, Trk1, is inhibited by high intracellular K+ levels and positively regulated by two redundant “halotolerance” protein kinases, Sat4/Hal4 and Hal5. Here we show that these kinases are not required for Trk1 activity; rather, they stabilize the transporter at the plasma membrane under low K+ conditions, preventing its endocytosis and vacuolar degradation. High concentrations (0.2 M) of K+, but not Na+ or sorbitol, transported by undefined low-affinity systems, maintain Trk1 at the plasma membrane in the hal4 hal5 mutant. Other nutrient transporters, such as Can1 (arginine permease), Fur4 (uracil permease), and Hxt1 (low-affinity glucose permease), are also destabilized in the hal4 hal5 mutant under low K+ conditions and, in the case of Can1, are stabilized by high K+ concentrations. Other plasma membrane proteins such as Pma1 (H+-pumping ATPase) and Sur7 (an eisosomal protein) are not regulated by halotolerance kinases or by high K+ levels. This novel regulatory mechanism of nutrient transporters may participate in the quiescence/growth transition and could result from effects of intracellular K+ and halotolerance kinases on membrane trafficking and/or on the transporters themselves. PMID:17548466

  1. Effect on Negative Laparoscopy Rate in Chronic Pelvic Pain Patients Using Patient Assisted Laparoscopy


    Objective: To determine the value of Patient Assisted Laparoscopy (PAL) in the diagnosis of pelvic pain. Methods: One hundred patients with pelvic pain were assessed by the procedure of Patient Assisted Laparoscopy to determine the cause of chronic pelvic pain. Results: Of the 100 patients with pelvic pain, 12 patients were not assessed due to technique failure, which included reaction to the carbon dioxide gas, inadequate visualization due to abdominal adhesions or failure to enter peritoneum. Of the remaining 88 patients, 61 had endometriosis; 16 had adhesions not associated with endometriosis; five had hernias; one had occult bowel cancer; one pseudo-stone from previous cholecystectomy; one had pain as a result of staples used at hysterectomy and one patient had chronic Crohn's disease. Two patients had no demonstrated interabdominal cause for their symptoms. Conclusion: In contrast to the well published rate of 35% negative laparoscopy in those patients with pelvic pain when examined under general anesthetic, Patient Assisted Laparoscopy decreased the negative laparoscopy rate to less than 3%. This methodology was also of benefit in giving the patient a better understanding of the cause of her pain and the need for therapy. PMID:9876695

  2. [Gynecologic laparoscopy at the ABC Hospital. Analysis of 882 cases].

    Díaz Argüello, D; Barrón Vallejo, J; Rojas Poceros, G; Kably Ambe, A


    The objective was to evaluate the indications and clinical evolution of patients treated with laparoscopy. Eight hundred eighty two women undergoing conventional laparoscopy for gynecological pathology, patients were not preselected, preoperative and postoperative data were registered retrospectively. Main indications to perform laparoscopy were dismenorrhea and infertility. Endometriosis and pelvic adhesions were the most frequent findings detected in the study subjects. Endoscopic treatment resulted in minimal complications and short postoperative stay. As conclusion classic laparoscopy is a safe and efficacious technique for treatment gynecological pathology.

  3. Analysis the related risk factors of incisional hernia after hand-assisted laparoscopic surgery for colorectal cancer%手辅助腹腔镜结直肠癌术后切口疝的发生危险因素分析

    王松松; 苏艳华; 谭晓杰; 张建立


    Objective;The aim of this study is to identify the predictive risk factors related to incisional hernia after hand-assisted laparoscopic surgery (HALS) for colorectal cancer. Additionally, this analysis has provided the necessary basis for the prevention of incisional hernia. Methods; The clinical data of 142 patients with colorectal cancer treated with HALS were analyzed retrospectively during a period from Aug. 2009 to Aug. 2012. Patients were divided into two groups according to whether a hernia developed at the hand-assist port site. Risk factors such as age,gender,body mass index (BMI) ,tobacco abuse,concomitant diseases,position and length of the incisions, wound infection were analyzed. Results;A total of 142 eligible patients were followed up?13 patients developed an incisional hernia for an incidence of 9. 2 percent. The incisional hernia incidence of patients with diabetes mellitus were significantly higher in the hernia-forming group than the non-hernia group (P<0. 01). Mean BMI and tobacco use were also higher in the heraia-forming group. A low transverse incision was associated with the lower rate of incisional hernia compared with midline vertical incision. Conclusions : Diabetes mellitus, BMI, tobacco use and position of the incision are closely related risk factors of hernia development. Adequate perioperative preparation can effectively reduce the incidence of incisional hernia.%目的:探讨手辅助腹腔镜(hand-assisted laparoscopic surgery,HALS)结直肠癌术后切口疝发生的相关危险因素,为预防术后切口疝的发生提供证据.方法:回顾分析2009年8月至2012年8月为142例患者行HALS结直肠癌切除术的临床资料,至随访结束时,根据手辅助口位置是否发生切口疝将患者分为切口疝组及无切口疝组,分析两组患者年龄、性别、体质指数(body mass index,BMI)、吸烟、伴随疾病、辅助切口位置、切口长度、是否感染等与切口疝发生相关

  4. Feasibility of laparoscopy for small bowel obstruction

    De Sol Angelo A


    Full Text Available Abstract Background Adherential pathology is the most common cause of small bowel obstruction. Laparoscopy in small bowel obstruction does not have a clear role yet; surely it doesn't always represent only a therapeutic act, but it is always a diagnostic act, which doesn't interfere with abdominal wall integrity. Methods We performed a review without any language restrictions considering international literature indexed from 1980 to 2007 in Medline, Embase and Cochrane Library. We analyzed the reference lists of the key manuscripts. We also added a review based on international non-indexed sources. Results The feasibility of diagnostic laparoscopy is high (60–100%, while that of therapeutic laparoscopy is low (40–88%. The frequency of laparotomic conversions is variable ranging from 0 to 52%, depending on patient selection and surgical skill. The first cause of laparotomic conversion is a difficult exposition and treatment of band adhesions. The incidence of laparotomic conversions is major in patients with anterior peritoneal band adhesions. Other main causes for laparotomic conversion are the presence of bowel necrosis and accidental enterotomies. The predictive factors for successful laparoscopic adhesiolysis are: number of previous laparotomies ≤ 2, non-median previous laparotomy, appendectomy as previous surgical treatment causing adherences, unique band adhesion as phatogenetic mechanism of small bowel obstruction, early laparoscopic management within 24 hours from the onset of symptoms, no signs of peritonitis on physical examination, experience of the surgeon. Conclusion Laparoscopic adhesiolysis in small bowel obstruction is feasible but can be convenient only if performed by skilled surgeons in selected patients. The laparoscopic adhesiolysis for small bowel obstruction is satisfactorily carried out when early indicated in patients with a low number of laparotomies resulting in a short hospital stay and a lower postoperative

  5. Femoral hernia sac laparoscopy: a case report.

    Ramirez Valderrama, Alexander; Ruiz, Dan; Malik, Manmeet; Tiszenkel, Howard


    We present the case of a 64-year-old female with an incarcerated right femoral hernia, associated with a small bowel obstruction that was successfully treated with an open femoral hernia repair with plug. At the same time we performed a hernia sac laparoscopy to evaluate the viability of the previously reduced small bowel. The hernioscopy was performed with a 0° 5 mm scope with reliable evaluation of the peritoneal cavity. We confirm that hernioscopy is a safe and feasible procedure and provides useful information for the appropriate management of acute incarcerated femoral/inguinal hernias.

  6. Evaluation of three laparoscopic modalities: robotics versus three-dimensional vision laparoscopy versus standard laparoscopy.

    LaGrange, Chad A; Clark, Curtis J; Gerber, Eric W; Strup, Stephen E


    Standard laparoscopy has undergone many recent advances with the advent of three-dimensional visual systems and robotic surgical systems. In evaluating the usefulness of these new systems, it is difficult to objectively measure their advantages in the operating room. Therefore, we designed a trial using three different laparoscopic modalities to evaluate the strengths and weaknesses of each modality. Twenty-seven subjects were entered into the study. Three different laparoscopic modalities were tested. These included standard laparoscopy with two-dimensional cameras, the 3Di Endosite visual system, and the daVinci Robotic Surgical System. A standard laparoscopic trainer was utilized and testing consisted of three different tasks: peg transfer, ring manipulation, and cannulation. Of the 27 subjects, 16 (60%) reported some degree of laparoscopic experience. The number of pegs transferred with standard laparoscopy and the Endosite 3Di system was significantly greater than with the robot. The number of errors committed during the peg transfer test and the amount of time required was significantly lower with the Endosite 3Di system compared to the robot. Subjects completed the ring manipulation task significantly faster with the robot, but the number of errors committed was no different among the three modalities. Subjects were able to complete the cannulation task with their dominant hand significantly faster with the robot compared to the Endosite 3Di system or standard laparoscopy, and committed fewer errors using the robot compared to standard laparoscopy. This study showed improved performance using three-dimensional optics on some tasks, but not a significant improvement in overall results. Three-dimensional vision does appear beneficial during performance of some complex tasks. The wrist-like action of the robot improved performance on some tasks, while the lack of tactile feedback likely was a source of errors on other tasks.

  7. Comparison of surgical outcome and the systemic inflammatory response syndrome score between retroperitoneoscopic hand-assisted nephroureterectomy and open nephroureterectomy.

    Sato, Yoshikazu; Nanbu, Akihito; Tanda, Hitoshi; Kato, Shuji; Onishi, Shigeki; Nakajima, Hisao; Nitta, Toshikazu; Koroku, Mikio; Akagashi, Keigo; Hanzawa, Tatsuo


    The goal of this study is to compare surgical and oncological outcomes of laparoscopic nephroureterectomy and the open surgery using the concept of systemic inflammatory response syndrome (SIRS) in addition to common variables. Thirty-six and 23 patients having upper urinary tract urothelial cancer who were operated on with retroperitoneoscopic hand-assisted nephroureterectomy (RHANU) or standard open nephroureterectomy (ONU) retrospectively, were analyzed. Median operation time was 140 (range 70-200) and 60 (range 45-85) minutes, respectively in the RHANU group and the ONU group. The median days to ambulation and hospital stay of the RHANU group were significantly shorter than those of the ONU group. There was no significant difference in the incidence of SIRS and other surgical results between the two groups. In oncological outcome, no significant difference was found in the bladder recurrence rate (RHANU vs. ONU; 52% vs. 45%), local recurrence (0% vs. 0%), distant metastasis (11% vs. 13%) or survival rate (94% vs. 91%) between the RHANU group and the ONU group at 2-year follow-up. There was no port site recurrence in the RHANU group. Although the RHANU may have an advantage in terms of earlier recovery, there were no significant differences in the incidence of SIRS and oncological outcomes between the RHANU group and the ONU group.

  8. Donor Complications Following Laparoscopic Compared to Hand-Assisted Living Donor Nephrectomy: An Analysis of the Literature

    Whitney R. Halgrimson


    Full Text Available There are two approaches to laparoscopic donor nephrectomy: standard laparoscopic donor nephrectomy (LDN and hand-assisted laparoscopic donor nephrectomy (HALDN. In this study we report the operative statistics and donor complications associated with LDN and HALDN from large-center peer-reviewed publications. Methods. We conducted PubMed and Ovid searches to identify LDN and HALDN outcome studies that were published after 2004. Results. There were 37 peer-reviewed studies, each with more than 150 patients. Cumulatively, over 9000 patients were included in this study. LDN donors experienced a higher rate of intraoperative complications than HALDN donors (5.2% versus. 2.0%, <.001. Investigators did not report a significant difference in the rate of major postoperative complications between the two groups (LDN 0.5% versus HALDN 0.7%, =.111. However, conversion to open procedures from vascular injury was reported more frequently in LDN procedures (0.8% versus 0.4%, =.047. Conclusion. At present there is no evidence to support the use of one laparoscopic approach in preference to the other. There are trends in the data suggesting that intraoperative injuries are more common in LDN while minor postoperative complications are more common in HALDN.

  9. Khush Hal Nameh: dal teatro all’emozione etnografica - Khush Hal Nameh: from theatre to ethnographic emotion

    Veronica Boldrin


    Full Text Available During the summer of 2011 the theatre company of an Italian High School puts on “Khush Hal Nameh”, an ethnographic drama by Ariane Baghaï, which through the tale of the rivalry between two Pashtun brothers projects both actors and spectators in the heart of Afghan society and in its kinship structures and dynamics of power. The article concentrates on the protagonists of this initiative, above all on the young actors, in order to understand what their “structure of experience” was like. It therefore follows the various phases of the staging process starting with the motivations of the students to take part to the experiment and the assessment of additional knowledge and competence; it also analyzes a wide range of relationships such as between actors and characters, between the theatre company and outside world and also between students and schoolinstitution. The theatre laboratory reveals itself as an ideal space to reflect about social relations and ethnographic drama as in Victor Turner’s performing ethnography: a valid instrument reach to an emotional and cognitive comprehension of the Other.

  10. Laparoscopy in the Treatment of Early Cervical Carcinoma

    Alton V. Hallum, III; Childers, Joel M.


    Recent investigators have used several indications to incorporate laparoscopy in the management of patients with cervical cancer. This manuscript reviews the current literature on the role of modern operative laparoscopy in early cervical cancer and recommends a simple approach for its use in these patients.

  11. Monitoring and lessons PV-projects in Amersfoort and the HAL-area (Netherlands). Summary; Monitoring en lessen PV-projecten Amersfoort en HAL-gebied. Samenvatting

    Westerhuis, R.; Verhoef, L. [New-Energy-Works, Utrecht (Netherlands); Van Sark, W. [Copernicus Instituut voor Duurzame Ontwikkeling en Innovatie, Faculteit Natuurwetenschap en Samenleving, Universiteit Utrecht, Utrecht (Netherlands); Koppen, W. [Koppen vastGoed, Bergen (Netherlands)


    Two new Dutch housing estate areas that apply PV systems on a large scale are the districts Nieuwland in Amersfoort and in the HAL area (Heerhugowaard-Alkmaar-Langedijk). By request of SenterNovem a report has been written on the experiences with these projects. [mk]. [Dutch] Twee nieuwbouwgebieden waar PV-systemen op grote schaal zijn toegepast zijn de wijk Nieuwland in Amersfoort en in het HAL-gebied (Heerhugowaard-Alkmaar-Langedijk). In opdracht van SenterNovem is een rapportage opgesteld met de ervaringen die met deze projecten zijn opgedaan.

  12. A Health Technology Assessment: laparoscopy versus colpoceliotomy.

    Damonti, A; Ferrario, L; Morelli, P; Mussi, M; Patregnani, C; Garagiola, E; Foglia, E; Pagani, R; Carminati, R; Porazzi, E


    The objective of this paper is the comparison between two different technologies used for the removal of a uterine myoma, a frequent benign tumor: the standard technology currently used, laparoscopy, and an innovative one, colpoceliotomy. It was considered relevant to evaluate the real and the potential effects of the two technologies implementation and, in addition, the consequences that the introduction or exclusion of the innovative technology would have for both the National Health System (NHS) and the entire community. The comparison between these two different technologies, the standard and the innovative one, was conducted using a Health Technology Assessment (HTA). In particular, in order to analyse their differences, a multi-dimensional approach was considered: effectiveness, costs and budget impact analysis data were collected, applying different instruments, such as the Activity Based Costing methodology (ABC), the Cost-Effectiveness Analysis (CEA) and the Budget Impact Analysis (BIA). Organisational, equity and social impact were also evaluated. The results showed that the introduction of colpoceliotomy would provide significant economic savings to the Regional and National Health Service; in particular, a saving of € 453.27 for each surgical procedure. The introduction of the innovative technology, colpoceliotomy, could be considered a valuable tool; one offering many advantages related to less invasiveness and a shorter surgical procedure than the standard technology currently used (laparoscopy).

  13. Fluorescense laparoscopy in patients with gastric cancer

    V. A. Lukin


    Full Text Available The results of fluorescence laparoscopy in 60 patients with gastric cancer in P.A.Herzen MCRI are represented in the article. All patients had gastric cancer stage III. Undifferentiated cancer was diagnosed in 3 (5% patients, signet ring cell carcinoma – in 42 (70%, low differentiated adenocarcinoma – in 15 (25%. Fluorescence diagnosis was performed using fluorescence laparoscope by Carl Storz (Germany with wavelengths 380-460 nm and alasens given per os at a dose of 30 mg/kg body weight 3 h before study. During the investigation the examination of parietal and visceral peritoneum, great omentum with instrumental revision of pelvic organs was made. The technique of fluorescence diagnosis and assessment of its results are described. According to results of the study occult tumor microdissemination over peritoneum was detected in 10 (16.7% patients. The sensitivity of fluorescence laparoscopy in patients with gastric cancer accounted for 87.5%, specificity – 76%. The data of fluorescence diagnosis allowed to perform staging of tumor process and influenced on following management. 

  14. Molecular Simulation of Solubility and Diffusion of Hindered-Amine Light Stabilizers (HALS) in Polyethylene

    Nath, Shyamal K.; de Pablo, Juan J.; Debellis, Anthony


    Hindered-amine light stabilizers (HALS) are some of the most common additives employed for prevention of photooxidation in polymers. One of the major problems encountered in polymer stabilization is that of physical loss of the additives. Such loss limits the life of the polymer and, more importantly, it can have serious consequences when the polymer is to be used for food packaging and other toxicity-sensitive applications. The loss of additives is related to their solubility and diffusion coefficient in polymers. In this work, a novel Monte Carlo formalism is proposed to determine the solubility of commercially available HALS (Tinuvin 770) in polyethylene. Diffusion coefficients is also determined by conventional molecular dynamics simulations. We report results for the solubility and diffusion of HALS in polyethylene as a function of temperature, pressure and density. We also examine the effects of branching on these quantities, and we use our findings to propose HALS structures with attractive compatibility and diffusive characteristics.

  15. Maury Nussbaum reappointed as Hal G. Prillaman Professor Fellow in Industrial and Systems Engineering

    Owczarski, Mark


    Maury Nussbaum, professor of industrial and systems engineering in the College of Engineering at Virginia Tech, has been reappointed as the Hal G. Prillaman Professor Fellow in Industrial and Systems Engineering by the Virginia Tech Board of Visitors.

  16. Structure and Stability of Endohedral Complexes X@(HAlNH)12 (X = He, Ne, Ar, Kr)

    ZHANG Cai-Yun; WU Hai-Shun


    The structures of closo-hedral cluster (HAlNH)12 and endohedral complexes X@(HAlNH)12 (X = He, Ne, Ar, Kr) have been studied by using density functional theory (DFT) at the B3LYP/6-31G(d) level. The geometries, natural bond orbital (NBO), vibrational frequency, energetic parameters, magnetic shielding constants and nucleus independent chemical shifts (NICS) were discussed. The potential surface of guest X shifting from the cage center to a face of six- membered ring was calculated at the same level. The exit transition state was demonstrated with IRC calculations. It is found that X@(HAlNH)12 complexes are dynamically stable, and Ne@(HAlNH)12 is more energetically favorable than the other complexes in thermodynamics.

  17. Hal Foster e a crítica ao primitivismo vanguardista

    Mata,Larissa Costa da


    The following text presents some concepts applied on the work of Hal Foster, American art critic and art historian, which has been translated to Portuguese only in some scattered texts and in a single whole book. Nowadays, Hal Foster is the chair holder of Art and Anthropology at Princeton University and co-editor of OCTOBER. This introduction is followed by the translation of "Blinded insights", which is one chapter of Prosthetic Gods, 2004, about the aesthetic relation of artists as Jean Du...

  18. The inhibitory mechanism of Hal3 on the yeast Ppz1 phosphatase: A mutagenesis analysis.

    Molero, Cristina; Casado, Carlos; Ariño, Joaquín


    The Ser/Thr protein phosphatase (PPase) Ppz1 is an enzyme related to the ubiquitous type-1 PPases (PP1c) but found only in fungi. It is regulated by an inhibitory subunit, Hal3, which binds to its catalytic domain. Overexpression of Ppz1 is highly toxic for yeast cells, so its de-regulation has been proposed as a target for novel antifungal therapies. While modulation of PP1c by its many regulatory subunits has been extensively characterized, the manner by which Hal3 controls Ppz1 remains unknown. We have used error-prone PCR mutagenesis to construct a library of Ppz1 variants and developed a functional assay to identify mutations affecting the binding or/and the inhibitory capacity of Hal3. We have characterized diverse Ppz1 mutated versions in vivo and in vitro and found that, although they were clearly refractory to Hal3 inhibition, none of them exhibited significant reduction in Hal3 binding. Mapping the mutations strengthened the notion that Hal3 does not interact with Ppz1 through its RVxF-like motif (found in most PP1c regulators). In contrast, the most relevant mutations mapped to a conserved α-helix region used by mammalian Inhibitor-2 to regulate PP1c. Therefore, modulation of PP1c and Ppz1 by their subunits likely differs, but could share some structural features.

  19. Long-term outcome of hand-assisted laparoscopic nephroureterectomy for pathologic T3 upper urinary tract urothelial carcinoma.

    Chung, Shiu-Dong; Chen, Shyh-Chyan; Wang, Shuo-Meng; Chueh, Shih-Chieh; Lai, Ming-Kuen; Huang, Chao-Yuan; Pu, Yeong-Shiau; Huang, Kuo-How; Yu, Hong-Jeng


    To determine the feasibility and long-term outcomes of hand-assisted laparoscopic nephroureterectomy (HALNU) compared with open nephroureterectomy (ONU) in the management of pT(3)N0 upper urinary tract urothelial carcinoma (UUT-UC). Between January 1994 and December 2005, 21 patients who underwent HALNU for stage pT(3)N0 UTT-UC were matched and compared with 31 patients who underwent ONU. The oncologic out-comes, including bladder recurrence, recurrence-free survival, cancer-specific survival, and overall survival, were statistically analyzed. The median follow-up period in the HALNU group was 72 months (range 33-111 months) and 115 months in the ONU group (range 24-161 months). Patient age, sex, body mass index, tumor size, specimen weight, and American Society of Anesthesiologists classification showed no significant difference between the two groups. The HALNU group had statistically less blood loss than the ONU group (113 mL versus 487 mL; P = 0.02). The average hospital stay and doses of narcotic analgesics were significantly less in the HALNU group than the ONU group. The complication and bladder recurrence rates were similar between the two groups. The 5-year recurrence-free survival, cancer-specific survival, and overall survival were also comparable in both groups. HALNU is a safe and efficacious procedure with comparable long-term oncologic outcomes in comparison with ONU in treating patients with locally advanced pT(3)N0UUT-UC.

  20. Intravenous lidocaine for post-operative pain relief after hand-assisted laparoscopic colon surgery: a randomized, placebo-controlled clinical trial

    Tikuišis, R.; Miliauskas, P.; Samalavičius, N. E.; Žurauskas, A.; Samalavičius, R.; Zabulis, V.


    Background Perioperative intravenous (IV) infusion of lidocaine has been shown to decrease post-operative pain, shorten time to return of bowel function, and reduce the length of hospital stay. This randomized, prospective, double-blinded, placebo-controlled clinical trial evaluated the impact of IV lidocaine on the quality of post-operative analgesia and other outcomes after hand-assisted laparoscopic colon surgery. Methods Sixty four patients with colon cancer scheduled for elective colon r...

  1. A three-arm (laparoscopic, hand-assisted, and robotic) matched-case analysis of intraoperative and postoperative outcomes in minimally invasive colorectal surgery.

    Patel, Chirag B; Ragupathi, Madhu; Ramos-Valadez, Diego I; Haas, Eric M


    Robotic-assisted laparoscopic surgery is an emerging modality in the field of minimally invasive colorectal surgery. However, there is a dearth of data comparing outcomes with other minimally invasive techniques. We present a 3-arm (conventional, hand-assisted, and robotic) matched-case analysis of intraoperative and short-term outcomes in patients undergoing minimally invasive colorectal procedures. Between August 2008 and October 2009, 70 robotic cases of the rectum and rectosigmoid were performed. Thirty of these were organized into triplets with conventional and hand-assisted cases based on the following 6 matching criteria: 1) surgeon; 2) sex; 3) body mass index; 4) operative procedure; 5) pathology; and 6) history of neoadjuvant therapy in malignant cases. Demographics, intraoperative parameters, and postoperative outcomes were assessed. Pathological outcomes were analyzed in malignant cases. Data were stratified by postoperative diagnosis and operative procedure. There was no significant difference in intraoperative complications, estimated blood loss (126.1 ± 98.5 mL overall), or postoperative morbidity and mortality among the groups. Robotic technique required longer operative time compared with conventional laparoscopic (P arm case-matched series, the robotic approach results in short-term outcomes comparable to conventional and hand-assisted laparoscopic approaches for benign and malignant diseases of the rectum and rectosigmoid. With 3-dimensional visualization, additional freedom of motion, and improved ergonomics, this enabling technology may play an important role when performing colorectal procedures involving the pelvic anatomy.

  2. A structured four-step curriculum in basic laparoscopy

    Strandbygaard, Jeanett; Bjerrum, Flemming; Maagaard, Mathilde


    The objective of this study was to develop a 4-step curriculum in basic laparoscopy consisting of validated modules integrating a cognitive component, a practical component and a procedural component....

  3. Laparoscopy in 100 consecutive patients with 128 impalpable testes

    Cortes, Dina; Thorup, J M; Lenz, K


    To investigate the value of laparoscopy in boys with impalpable testes, to carry out a histological examination of testicular biopsies or orchidectomy specimens, and to present a clinical description of boys with impalpable testes....

  4. [The role of laparoscopy in emergency abdominal surgery].

    Balén, E; Herrera, J; Miranda, C; Tarifa, A; Zazpe, C; Lera, J M


    Abdominal emergencies can also be operated on through the laparoscopic approach: the approach can be diagnostic laparoscopy, surgery assisted by laparoscopy or laparotomy directed according to the findings of the laparoscopy. The general contraindications refer above all to the state of haemodynamic instability of the patient and to seriously ill patients (ASA IV). In the absence of any specific counter-indications for the specific laparoscopic procedure to be carried out, many abdominal diseases requiring emergency surgery can be performed with the laparoscopic approach. The most frequent indications are appendicitis, acute colecistitis, gastroduodenal perforation, occlusion of the small intestine, and some abdominal traumas. With a correct selection of patients and the appropriate experience of the surgeon, the results are excellent and better than open surgery (less infection of the wound, complications, hospital stay and postoperative pain). A detailed explanation is given of the basic aspects of the surgical technique in the most frequent procedures of emergency laparoscopy.

  5. Simultaneous laparoscopy-assisted resection for rectal and gastric cancer.

    Wei, Hongbo; Master, Jiafeng Fang; Chen, Tufeng; Zheng, Zongheng; Wei, Bo; Huang, Yong; Huang, Jianglong; Master, Haozhong Xu


    Laparoscopy-assisted surgery for either rectal or gastric cancer has been increasingly performed. However, simultaneous laparoscopy-assisted resection for synchronous rectal and gastric cancer is rarely reported in the literature. In our study, 3 cases of patients who received simultaneous laparoscopy-assisted resection for synchronous rectal and gastric cancer were recorded. The results showed that all 3 patients recovered well, with only 253 minutes of mean operation time, 57 mL of intraoperative blood loss, 5 cm of assisted operation incision, 4 days to resume oral intake, 12 days' postoperative hospital stay, and no complication or mortality. No recurrence or metastasis was found within the follow-up period of 22 months. When performed by surgeons with plentiful experience in laparoscopic technology, simultaneous laparoscopy-assisted resection for synchronous rectal and gastric cancer is safe and feasible, with the benefits of minimal trauma, fast recovery, and better cosmetic results, compared with open surgery.

  6. The efficacy of virtual reality simulation training in laparoscopy

    Larsen, Christian Rifbjerg; Oestergaard, Jeanett; Ottesen, Bent S


    Background. Virtual reality (VR) simulators for surgical training might possess the properties needed for basic training in laparoscopy. Evidence for training efficacy of VR has been investigated by research of varying quality over the past decade. Objective. To review randomized controlled trials...... medical subject headings (MeSh) terms: Laparoscopy/standards, Computing methodologies, Programmed instruction, Surgical procedures, Operative, and the following free text terms: Virtual real* OR simulat* AND Laparoscop* OR train* Limits: Controlled trials. Study eligibility criteria. All randomized...

  7. Diagnostic Laparoscopy for Small Intestinal Intussusception in a Horse

    P. Holak, M. Jałyński, Z. Peczyński, Z. Adamiak, M. Jaskólska and W. Pesta*


    Laparoscopy is a low-invasive diagnostic and surgical technique for examining and performing surgical procedures in the equine peritoneal cavity. This article is a case study of a horse with weakly expressed, irregular symptoms of colic occurring over a period of four weeks. Diagnostic laparoscopy was performed, and liver and spleen tissue samples were collected for a histopathological analysis. An endoscopic examination of the abdominal cavity ruled out small intestinal intussusception, and ...

  8. Building HAL: computers that sense, recognize, and respond to human emotion

    Picard, Rosalind W.


    The HAL 9000 computer, the inimitable star of the classic Kubrick and Clarke film '2001: A Space Odyssey,' displayed image understanding capabilities vastly beyond today's computer systems. HAL could not only instantly recognize who he was interacting with, but also he could lip read, judge aesthetics of visual sketches, recognize emotions subtly expressed by scientists on board the ship, and respond to these emotions in an adaptive personalized way. Of course, HAL also had capabilities that we might not want to give to machines, like the ability to terminate life support or otherwise take lives of people. This presentation highlights recent research in giving machines certain affective abilities that aim to make them ore intelligent, shows examples of some of these systems, and describes the role that affective abilities may play in future human-computer interaction.

  9. The impact of elective diagnostic laparoscopy in chronic abominal disorders

    Al-Akeely Mohammed


    Full Text Available Objectives: Diagnostic laparoscopy has become an integral part of general surgical procedures with the recent advancements in laparoscopic technology. Since surgeons are more oriented in viewing and dissection of different intra-abdominal areas and are proficient in the definitive management of complications in the procedures, diagnostic laparoscopy may be better off in the hands of surgeons. Laparoscopy has proved to be an important tool in final minimally invasive exploration for selected medical patients with chronic abdominal disorders, the diagnosis of which remains uncertain despite employing the requisite laboratory and non-invasive imaging investigations. This retrospective study was done to evaluate the accuracy of elective diagnostic laparoscopy in patients with chronic abdominal disorders and its impact on the management of these patients. Methods: The records of 35 patients, admitted to Riyadh Medical Complex with chronic abdominal disorders and referred to the author by physicians for elective diagnostic laparoscopy from 1999 through 2004, were evaluated for the accuracy and impact of this procedure in the further management of these patients. All 35 patients were investigated by the referring physician. Investigations included hematology, biochemistry, radiology, ascitic fluid analysis, endoscopic and imaging studies and the Mantoux test. These investigations suggested abdominal tuberculosis in 22 patients and intra-abdominal malignancy in 13 patients. They were referred for elective diagnostic laparoscopy and tissue biopsy. Results: Diagnostic laparoscopy confirmed the diagnosis in all patients suspected of malignancy. In patients with suspected abdominal tuberculosis, the laparoscopic diagnosis and biopsy revealed tuberculosis (16 patients, liver cirrhosis (2 patients, Crohn′s disease (1 patient, and metastatic carcinoma of terminal ileum (1 patient. In 2 patients the procedure did not reveal any specific pathology. The

  10. Los microorganismos halófilos y su potencial aplicado en biotecnología

    Meseguer Soria, Inmaculada; Dpto., de producción vegetal y microbiología. Universidad Miguel Hernández de Elche. Avda de la Universidad S/N, Edificio Torregaitán, 03202 ELCHE (Alicante) España.


    La sal común (NaCl), en elevadas concentraciones, es considerada generalmente como un inhibidor del crecimiento microbiano, por lo que ha sido ampliamente utilizada como un aditivo para la conservación de alimentos, curtido de pieles, etc. Sin embargo, existe gran cantidad de microorganismos, llamados halófilos, que son capaces de vivir en presencia de altas concentraciones de sal es decir en ambientes hipersalinos. Esto es posible porque a lo largo de su evolución, los microorganismos halófi...

  11. Adenoidzystische Karzinome (AdzK) im Kopf-Hals-Bereich: Retrospektive Analyse eines Therapiekonzepts

    Wegent, L; Münscher, A; Möckelmann, N; Knecht, R.


    Einleitung: AdzK stellen als seltene Entität ca 1% aller Kopf-Hals-Malignome dar. Die häufigste Lokalisation sind die Speicheldrüsen, gefolgt von den Nasennebenhöhlen sowie exkretorischen Drüsen in anderen Lokalisationen. Klinisch präsentiert sich das AdzK durch ein langsames Wachstum mit meist perineuraler Invasion. Der Therapie-"Gold-Standard" ist die radikale Tumorresektion, gefolgt von einer Radiotherapie.Methoden: In die Analyse wurden Patienten mit einem AdzK im Kopf-Hals-Bereich des ...

  12. A wireless robot for networked laparoscopy.

    Castro, Cristian A; Alqassis, Adham; Smith, Sara; Ketterl, Thomas; Sun, Yu; Ross, Sharona; Rosemurgy, Alexander; Savage, Peter P; Gitlin, Richard D


    State-of-the-art laparoscopes for minimally invasive abdominal surgery are encumbered by cabling for power, video, and light sources. Although these laparoscopes provide good image quality, they interfere with surgical instruments, occupy a trocar port, require an assistant in the operating room to control the scope, have a very limited field of view, and are expensive. MARVEL is a wireless Miniature Anchored Robotic Videoscope for Expedited Laparoscopy that addresses these limitations by providing an inexpensive in vivo wireless camera module (CM) that eliminates the surgical-tool bottleneck experienced by surgeons in current laparoscopic endoscopic single-site (LESS) procedures. The MARVEL system includes 1) multiple CMs that feature a wirelessly controlled pan/tilt camera platform, which enable a full hemisphere field of view inside the abdominal cavity, wirelessly adjustable focus, and a multiwavelength illumination control system; 2) a master control module that provides a near-zero latency video wireless communications link, independent wireless control for multiple MARVEL CMs, digital zoom; and 3) a wireless human-machine interface that gives the surgeon full control over CM functionality. The research reported in this paper is the first step in developing a suite of semiautonomous wirelessly controlled and networked robotic cyber-physical devices to enable a paradigm shift in minimally invasive surgery and other domains such as wireless body area networks.

  13. The history and future of operative laparoscopy.

    Rock, J A; Warshaw, J R


    Laparoscopic sterilization was first performed in the United States in 1941. During the 1950s and 1960s hospitals procured the relatively inexpensive basic laparoscopic instrumentation, and education for physicians learning the techniques was provided mostly by academic centers during residency training. Interest in expansion of laparoscopic procedures was slight until the mid-1980s when operative laparoscopic management of ectopic pregnancies began to spread from academic centers to the private sector. Major technologic developments in instrumentation greatly simplified the endoscopic procedures and provided the first impetus for an explosive growth of operative laparoscopic applications in surgery. The great financial resources of private hospitals enabled them to adapt and retool quickly for operative endoscopy. Lacking these resources, academic institutions lagged behind; thus a growing divergence began between academic and private institutions in their influence on the development, use, and acceptance of the new technology. The development of expensive disposable instruments, with costs passed on to patients by private hospitals, further priced academic institutions out of the market. Two concerns today are paramount regarding operative laparoscopy: (1) The majority of laparoscopic techniques and procedures being performed by surgeons in this country have not been taught in the controlled setting of a residency or fellowship training program; (2) the legitimacy of the procedures themselves is questionable because of lack of sufficient data in the literature to support them. Academic institutions, working in tandem with the private sector, must assume the responsibility for answering these concerns.

  14. HIV-1/HAART-Related Lipodystrophy Syndrome (HALS Is Associated with Decreased Circulating sTWEAK Levels.

    Miguel López-Dupla

    Full Text Available Obesity and HIV-1/HAART-associated lipodystrophy syndrome (HALS share clinical, pathological and mechanistic features. Tumor necrosis factor-like weak inducer of apoptosis (TWEAK is a multifunctional cytokine that plays an important role in obesity and related diseases. We sought to explore the relationship between HALS and circulating levels of soluble (s TWEAK and its scavenger receptor sCD163.This was a cross-sectional multicenter study of 120 HIV-1-infected patients treated with a stable HAART regimen; 56 with overt HALS and 64 without HALS. Epidemiological and clinical variables were determined. Serum levels of sTWEAK and sCD163 levels were measured by ELISA. Results were analyzed with Student's t-test, Mann-Whitney U and χ2 test. Pearson and Spearman correlation were used to estimate the strength of association between variables.Circulating sTWEAK was significantly decreased in HALS patients compared with non-HALS patients (2.81±0.2 vs. 2.94±0.28 pg/mL, p = 0.018. No changes were observed in sCD163 levels in the studied cohorts. On multivariate analysis, a lower log sTWEAK concentration was independently associated with the presence of HALS (OR 0.027, 95% CI 0.001-0.521, p = 0.027.HALS is associated with decreased sTWEAK levels.

  15. Laser laparoscopy in the treatment of polycystic ovarian disease

    Mutrynowski, Andrzej; Zabielska, Renata


    A polycystic ovaries disease occurs in the case of women with anovulatory cycles as the result of neurohormonal disorders. Patients with this disease suffer from infertility and many symptoms, such as: irregular menstrual bleeding, hirsutism, obesity. The paper presents a method of the carbon dioxide laser laparoscopy in the polycystic ovary disease treatment. The study included 96 women operated on (carbon dioxide laser laparoscopy) in the II Clinic Of Obstetric and Gynecology in Warsaw. Each woman measured her body temperature in order to evaluate her menstrual cycle and had vaginal USG examination or a cytohormonal one before laparoscopy and within 6 months after the surgery. Performing the laparoscopy the operator punctured each ovary in at least 15 points using the carbon dioxide laser. The patients were followed-up for 6 months. The Chi test was used to make the statistic analysis. Comparing the percent of ovulatory cycles and regular ones before and after surgery we noticed that the differences were statistically relevant. Eighty-five patients (88%) had regular cycles and in 88 cases (92%) there was a diphasic curve of the body temperature after the laparoscopy. Fourteen percent of infertile women with polycystic ovary disease conceived.

  16. Exploratory rigid laparoscopy in an African elephant (Loxodonta africana).

    Sweet, Julia; Hendrickson, Dean A; Stetter, Mark; Neiffer, Donald L


    In March 2009, a 25-yr-old captive female African elephant (Loxodonta africana) underwent an exploratory laparoscopy after several weeks of diarrhea, submandibular and ventral edema, and swelling on medial and lateral aspects of all feet. Although there have been recent advances in laparoscopic vasectomies in free-ranging African elephants in South Africa utilizing specially designed rigid laparoscopes and insufflation devices, this was the first attempt at using these same techniques for an exploratory purpose. The elephant was sedated in a static restraint chute and remained standing for the duration of the procedure. Laparoscopy provided visibility of the dorsal abdomen, enabled collection of reproductive tract biopsies and peritoneal fluid samples, and allowed for instillation of antibiotics and crystalloid fluids directly into the abdominal cavity. Abdominal exploration, collection of tissue samples, and local therapy is possible via standing laparoscopy in megavertebrates.

  17. Hand-assisted laparoscopic radical nephrectomy in the treatment of a renal cell carcinoma with a level ii vena cava thrombus

    Jason R. Kovac


    Full Text Available Excision of renal cell carcinoma (RCC with corresponding vena cava thrombus is a technical challenge requiring open resection and vascular clamping. A 58 year old male with a right kidney tumor presented with a thrombus extending 1 cm into the vena cava. Using a hand-assisted transperitoneal approach through a 7 cm gel-port, the right kidney was dissected and the multiple vascular collaterals supplying the tumor were identified and isolated. The inferior vena cava was mobilized 4 cm cephalad and 4 cm caudal to the right renal vein. Lateral manual traction was applied to the right kidney allowing the tumor thrombus to be retracted into the renal vein, clear of the vena cava. After laparoscopic ultrasonographic confirmation of the location of the tip of the tumor thrombus, an articulating laparoscopic vascular stapler was used to staple the vena cava at the ostium of the right renal vein. This allowed removal of the tumor thrombus without the need for a Satinsky clamp. The surgery was completed in 243 minutes with no intra-operative complications. The entire kidney and tumor thrombus was removed with negative surgical margins. Estimated blood loss was 300 cc. We present a laparoscopic resection of a renal mass with associated level II thrombus using a hand-assisted approach. In patients with minimal caval involvement, our surgical approach presents an option to the traditional open resection of a renal mass.

  18. Role of laparoscopy in evaluation of chronic pelvic pain

    Hebbar Shripad


    Full Text Available Introduction: Chronic pelvic pain (CPP is a common medical problem affecting women. Too often the physical signs are not specific. This study aims at determining the accuracy of diagnostic laparoscopy over clinical pelvic examination. Settings and Design: A retrospective study of patients who underwent diagnostic laparoscopy for CPP. Materials and Methods: The medical records of 86 women who underwent laparoscopic evaluation for CPP of at least 6-month duration were reviewed for presentation of symptoms, pelvic examination findings at the admission, operative findings and follow up when available. Statistical analysis used: McNemar Chi-square test for frequencies in a 2 x 2 table. Results: The most common presentation was acyclic lower abdominal pain (79.1%, followed by congestive dysmenorrhoea (26.7%. 61.6% of women did not reveal any significant signs on pelvic examination. Pelvic tenderness was elicited in 27.9%. Diagnostic laparoscopy revealed significant pelvic pathology in 58% of those who essentially had normal pervaginal findings. The most common pelvic pathology by laparoscopy was pelvic adhesions (20.9%, followed by pelvic congestion (18.6%. Laparoscopic adhesiolyis achieved pain relief only in one-third of the women. Conclusion: The study revealed very low incidence of endometriosis (4.7%. Overall clinical examination could detect abnormality in only 38% of women, where as laparoscopy could detect significant pathology in 66% of women with CPP. This shows superiority of diagnostic laparoscopy over clinical examination in detection of aetiology in women with CPP (P < 0.001. Adhesiolysis helps only small proportion of women in achieving pain control.

  19. Role of laparoscopy in evaluation of chronic pelvic pain

    Hebbar, Shripad; Chawla, Chander


    Introduction: Chronic pelvic pain (CPP) is a common medical problem affecting women. Too often the physical signs are not specific. This study aims at determining the accuracy of diagnostic laparoscopy over clinical pelvic examination. Settings and Design: A retrospective study of patients who underwent diagnostic laparoscopy for CPP. Materials and Methods: The medical records of 86 women who underwent laparoscopic evaluation for CPP of at least 6-month duration were reviewed for presentation of symptoms, pelvic examination findings at the admission, operative findings and follow up when available. Statistical analysis used: McNemar Chi-square test for frequencies in a 2 × 2 table. Results: The most common presentation was acyclic lower abdominal pain (79.1%), followed by congestive dysmenorrhoea (26.7%). 61.6% of women did not reveal any significant signs on pelvic examination. Pelvic tenderness was elicited in 27.9%. Diagnostic laparoscopy revealed significant pelvic pathology in 58% of those who essentially had normal pervaginal findings. The most common pelvic pathology by laparoscopy was pelvic adhesions (20.9%), followed by pelvic congestion (18.6%). Laparoscopic adhesiolyis achieved pain relief only in one-third of the women. Conclusion: The study revealed very low incidence of endometriosis (4.7%). Overall clinical examination could detect abnormality in only 38% of women, where as laparoscopy could detect significant pathology in 66% of women with CPP. This shows superiority of diagnostic laparoscopy over clinical examination in detection of aetiology in women with CPP (P < 0.001). Adhesiolysis helps only small proportion of women in achieving pain control. PMID:21188008

  20. Three-dimensional versus two-dimensional vision in laparoscopy

    Sørensen, Stine Maya Dreier; Savran, Mona M; Konge, Lars;


    BACKGROUND: Laparoscopic surgery is widely used, and results in accelerated patient recovery time and hospital stay were compared with laparotomy. However, laparoscopic surgery is more challenging compared with open surgery, in part because surgeons must operate in a three-dimensional (3D) space...... through a two-dimensional (2D) projection on a monitor, which results in loss of depth perception. To counter this problem, 3D imaging for laparoscopy was developed. A systematic review of the literature was performed to assess the effect of 3D laparoscopy. METHODS: A systematic search of the literature...

  1. Diagnostic Laparoscopy for Small Intestinal Intussusception in a Horse

    P. Holak, M. Jałyński, Z. Peczyński, Z. Adamiak, M. Jaskólska and W. Pesta*


    Full Text Available Laparoscopy is a low-invasive diagnostic and surgical technique for examining and performing surgical procedures in the equine peritoneal cavity. This article is a case study of a horse with weakly expressed, irregular symptoms of colic occurring over a period of four weeks. Diagnostic laparoscopy was performed, and liver and spleen tissue samples were collected for a histopathological analysis. An endoscopic examination of the abdominal cavity ruled out small intestinal intussusception, and a histopathological analysis supported the identification of the causes of colic.

  2. Take-Home Training in Laparoscopy.

    Thinggaard, Ebbe


    When laparoscopy was first introduced, skills were primarily taught using the apprenticeship model. A limitation of this method when compared to open surgery, was that it requires more time to practise and more frequent learning opportunities in clinical practice. The unique set of skills required in laparoscopy highlighted the need for new training methods that reduce the need for supervision and do not put the patient at risk. Simulation training was developed to meet this need. The overall purpose of this thesis was to explore simulation-based laparoscopic training at home. The thesis consists of five papers: a review, a validation study, a study of methodology, a randomised controlled trial and a mixed-methods study. Our aims were to review the current knowledge on training off-site, to develop and explore validity for a training and assessment system, to investigate the effect of take-home training in a simulation-based laparoscopic training programme, and to explore the use of take-home training. The first paper in this thesis is a scoping review. The aim of the review was to explore the current knowledge on off-site laparoscopic skills training. We found that off-site training was feasible but that changes were required in order for it to become an effective method of training. Furthermore, the select-ed instructional design varied and training programmes were designed using a variety of educational theories. Based on our findings, we recommended that courses and training curricula should follow established education theories such as proficiency-based learning and deliberate practice. Principles of directed self-regulated learning could be used to improve off-site laparoscopic training programmes. In the second study, we set out to develop and explore validity evidence of the TABLT test. The TABLT test was developed for basic laparoscopic skills training in a cross-specialty curriculum. We found validity evidence to support the TABLT test as a summative test

  3. Laparoscopy for ventriculoperitoneal shunt implantation and revision surgery

    Fernando; Campos; Gomes; Pinto; Matheus; Fernandes; de; Oliveira


    Ventriculoperitoneal shunting(VPS) is a widely accepted technique for the treatment of hydrocephalus. The probability of shunt dysfunction is pretty high throughout life. Laparoscopy has become a valuable tool to perform VPS and treat abdominal complications. An electronic literature search was performed to reveal the published data relating laparoscopy and ventriculoperitoneal shunt in Medline, Embase, Scielo and Lilacs databases. The keywords employed were “laparoscopy” OR “laparoscopic surgery” AND “ventriculoperitoneal shunt” OR “shunt” AND “surgery” OR “implantation” OR “revision” OR “complication”. No high quality trials were developed comparing conventional laparotomic incision vs laparoscopic approach. Both approaches have evolved and currently there are less invasive options for laparotomy, like periumbilical small incisions; and for laparoscopy, like smaller and less incisions. Operating room time, blood loss and hospital stay may be potentially smaller in laparoscopic surgery and complications are probably the same as laparotomy. In revision surgery for abdominal complications after VPS,visualization of whole abdominal cavity is fundamental to address properly the problem and laparoscopic approach is valuable once it is safe, fast and much less invasive than laparotomy. Ventriculoperitoneal shunting is a widely accepted technique for the treatment of hydrocephalus. Laparoscopy assisted shunt surgery in selected cases might be a less invasive and more effective option for intrabdominal manipulation. The laparoscopic approach allows a better catheter positioning, lysis of fibrotic bundles and peritoneal inspection as well, without any additional complication.

  4. Role of diagnostic laparoscopy in the management of female infertility

    Rajshree Dayanand Katke


    Conclusions: We concluded that Laparoscopy has important role in the diagnosis and treatment of unexplained infertility. It also helps in Prediction and improvement of success rate of assisted reproductive technologies like IUI and IVF. [Int J Reprod Contracept Obstet Gynecol 2016; 5(8.000: 2592-2595

  5. Laser visual guidance versus two-dimensional vision in laparoscopy

    Sørensen, Stine Maya Dreier; Mahmood, Oria; Konge, Lars;


    BACKGROUND: During laparoscopy, the surgeon's loss of depth perception and spatial orientation is problematic. Laser visual guidance (LVG) is an innovative technology that improves depth perception to enhance the visual field. In this trial, we examined the effect of LVG on surgical novices' moto...

  6. Laparoscopy in the diagnosis of tuberculosis in chronic pelvic pain

    Shalini Rajarama


    Full Text Available Background: To estimate the prevalence of genital tuberculosis in women with idiopathic chronic pelvic pain on laparoscopy, correlate laparoscopic findings with microbiological and histological diagnosis of tuberculosis and assess the response to anti tubercular treatment (ATT in these cases. Method: In a prospective cohort study, fifty women with idiopathic chronic pelvic pain were enrolled. Diagnostic laparoscopy was done in all women and fluid from pouch of Douglas and/or saline washings were sent for acid fast bacilli (AFB smear, conventional and rapid culture and DNA polymerase chain reaction (PCR analysis for diagnosis of genital TB. The results of these tests were analyzed and agreement with laparoscopy was assessed using Kappa statistics. Pain scores using visual analogue scale were compared before and after treatment. Results: Pelvic pathology was present in 44 (88% women of idiopathic chronic pelvic pain, with a 34% prevalence rate of genital tuberculosis. Pelvic inflammation was associated with positive peritoneal fluid PCR (n = 4 and AFB culture (n = 3. Acid fast bacilli PCR had substantial agreement (kappa statistics = 0.716 with visual findings at laparoscopy. There was a significant reduction in pain scores after treatment. Conclusion: Genital tuberculosis contributes to one-third cases of chronic pelvic pain. Pelvic inflammation is an early feature of genital TB and peritoneal fluid PCR has the best co-relation with laparoscopic findings of genital tuberculosis.

  7. Optimising abdominal space with deep neuromuscular blockade in gynaecologic laparoscopy

    Madsen, Matias Vested; Gätke, M R; Springborg, H H


    neuromuscular blockade (NMB) would enlarge surgical space, measured as the distance from the sacral promontory to the trocar in patients undergoing gynaecologic laparoscopy. METHODS: Fourteen patients were randomised in an assessor-blinded crossover design. The distance from the sacral promontory to the trocar...

  8. Technique of open laparoscopy for supramesocolic surgery in obese patients.

    Deguines, Jean Baptiste; Qassemyar, Quentin; Dhahri, Abdennaceur; Brehant, Olivier; Fuks, David; Verhaeghe, Pierre; Regimbeau, Jean-Marc


    Incidence of obesity and related diseases are increasing in the world. Visceral surgeons are more often confronted with laparoscopic surgery in obese patients. Besides validated surgery procedures, such as cholecystectomy and gastroesophageal reflux surgery, bariatric procedures are increasingly performed. In obese patients, the thickness of adipose panicle makes open laparoscopy hazardous. In our department, we use systematically a technique of open laparoscopy in obese patients for supramesocolic surgery, which is safe, reproducible, and permits good closure of the abdominal wall. The surgical technique consists of opening the abdominal wall through the rectus abdominis. Helped by specific retractors called Descottes (Medtronic Laboratory), both fascias are charged by sutures separately. Incision in the fascias is made safely by pooling on sutures. Introduction of port-site is made under view control. At the end of laparoscopy, closure of both fascias is easily done. We present a technique of open laparoscopy in obese patients, systematically used, for supramesocolic surgery. This technique is safe, reproducible, and permits an efficient closure of the abdominal wall.

  9. Successful resuscitation after carbon dioxide embolism during laparoscopy

    Burcharth, Jakob; Burgdorf, Stefan; Lolle, Ida


    to another hospital, where she received hyperbaric oxygen treatment. The patient was discharged 14 days after surgery without any sequelae. It is important that the general surgeon suspects VAE during laparoscopy whenever the patient develops sudden and unexplained severe hypotension or cardiac arrest during...

  10. Laparoscopy can be used to diagnose peritoneal tuberculosis

    Ferløv Schwensen, Jakob; Bulut, Mustafa; Nordholm-Carstensen, Andreas


    and widespread pale nodules were found throughout the peritoneum. Consequently, the patient was diagnosed with peritoneal tuberculosis. This case demonstrates that atypical manifestations of tuberculosis exist in Denmark and that laparoscopy with biopsy can be performed to obtain the diagnosis when suspecting...... peritoneal tuberculosis....

  11. Role of Diagnostic Laparoscopy in Chronic Abdominal Conditions ...

    Laparoscopy, one such achievement developed in the twentieth century, offers a simple, rapid .... (CT scan), out of which, sixty ‑ three (52.5%) patients had a change in findings when .... or visceral tubercles, varying in size from 2 mm to 1 cm.[12]. Small bowel ... diagnosis and management of chronic abdominal pain. J Minim.

  12. LIGHT SOURCE: Conceptual design of Hefei Advanced Light Source (HALS) injection system

    Zhang, Shan-Cai; Wang, Lin; Feng, Guang-Yao; Wu, Cong-Feng; Li, Wei-Min; Xu, Hong-Liang; Liu, Zu-Ping


    The Hefei Advanced Light Source(HALS) is a super low emittance storage ring and has a very short beam life time. In order to run the ring stablely, top-up injection will be necessary. The injection system will greatly affect the quality of beam. This article first gives a physics design of the injecting system. Then the injecting system is tracked under different errors. The responses of storage beam and injecting beam are given in the article.

  13. Baryon interactions in lattice QCD: the direct method vs. the HAL QCD potential method

    Iritani, Takumi


    We make a detailed comparison between the direct method and the HAL QCD potential method for the baryon-baryon interactions, taking the $\\Xi\\Xi$ system at $m_\\pi= 0.51$ GeV in 2+1 flavor QCD and using both smeared and wall quark sources. The energy shift $\\Delta E_\\mathrm{eff}(t)$ in the direct method shows the strong dependence on the choice of quark source operators, which means that the results with either (or both) source are false. The time-dependent HAL QCD method, on the other hand, gives the quark source independent $\\Xi\\Xi$ potential, thanks to the derivative expansion of the potential, which absorbs the source dependence to the next leading order correction. The HAL QCD potential predicts the absence of the bound state in the $\\Xi\\Xi$($^1$S$_0$) channel at $m_\\pi= 0.51$ GeV, which is also confirmed by the volume dependence of finite volume energy from the potential. We also demonstrate that the origin of the fake plateau in the effective energy shift $\\Delta E_\\mathrm{eff}(t)$ at $t \\sim 1$ fm can b...

  14. Single-incision laparoscopy surgery: a systematic review

    far, Sasan Saeed; Miraj, Sepide


    Background Laparoscopic surgery is a modern surgical technique in which operations are performed far from their location through small incisions elsewhere in the body. Objective This systematic review is aimed to overview single-incision laparoscopy surgery. Methods This systematic review was carried out by searching studies in PubMed, Medline, Web of Science, and IranMedex databases. The initial search strategy identified about 87 references. In this study, 54 studies were accepted for further screening and met all our inclusion criteria [in English, full text, therapeutic effects of single-incision laparoscopy surgery and dated mainly from the year 1990 to 2016]. The search terms were “single-incision,” “surgery,” and “laparoscopy.” Results Single-incision laparoscopy surgery is widely used for surgical operations in cholecystectomy, sleeve gastrectomy, cholecystoduodenostomy, hepatobiliary disease, colon cancer, obesity, appendectomy, liver surgery, rectosigmoid cancer, vaginal hysterectomy, vaginoplasty, colorectal lung metastases, pyloroplasty, endoscopic surgery, hernia repair, nephrectomy, rectal cancer, colectomy and uterus-preserving repair, bile duct exploration, ileo-ileal resection, lymphadenectomy, incarcerated inguinal hernia, anastomosis, congenital anomaly, colectomy for cancer. Conclusion Based on the findings, single-incision laparoscopy surgery is a scarless surgery with minimal access. Although it possesses lots of benefits, including less incisional pain and scars, cosmesis, and the ability to convert to standard multiport laparoscopic surgery, it has some disadvantages, for example, less freedom of movement, fewer number of ports that can be used, and the proximity of the instruments to each other during the operation. PMID:27957308

  15. Development and validation of a theoretical test in basic laparoscopy

    Strandbygaard, Jeanett; Maagaard, Mathilde; Larsen, Christian Rifbjerg;


    for first-year residents in obstetrics and gynecology. This study therefore aimed to develop and validate a framework for a theoretical knowledge test, a multiple-choice test, in basic theory related to laparoscopy. METHODS: The content of the multiple-choice test was determined by conducting informal...... levels: senior medical students, first-year residents, and chief physicians. RESULTS: The four conversational interviews resulted in the development of 47 test questions, which were narrowed down to 37 test questions after two Delphi rounds involving 12 chief physicians. Significant differences were.......001). Internal consistency (Cronbach's alpha) was 0.82. There was no evidence of differential item functioning between the three groups tested. CONCLUSIONS: A newly developed knowledge test in basic laparoscopy proved to have content and construct validity. The formula for the development and validation...

  16. [3D in laparoscopy: state of the art].

    Kunert, W; Storz, P; Müller, S; Axt, S; Kirschniak, A


    High definition stereoscopic (3D) vision has been introduced into the operation theatre. This review exposes the optical and physiological background as well as the state of the art of 3D in laparoscopy. The distinguishing marks of 3D laparoscopes and monitors are listed and characteristics of stereoscopy, such as comfort zones and ghosting are explained. Suggestions for the practical use in the clinical routine should help to extract the best benefit possible from the new technology.

  17. Torsion of the greater omentum: treatment by laparoscopy.

    Sánchez, Javier; Rosado, Rafael; Ramírez, Diego; Medina, Pedro; Mezquita, Susana; Gallardo, Andrés


    Four new cases of necrosis of the omentum secondary to torsion are reported. We review the associated signs and symptoms, which are usually those of an acute inflammatory condition in the right lower quadrant (RLQ), very similar to acute appendicitis. Because of acute abdominal pain in the RLQ, along with an uncertain diagnosis, laparoscopic surgery was performed in these cases. Laparoscopy demonstrated the existence of the omental infarction and allowed for complete treatment of the condition without the need for laparotomy.

  18. Evaluation of stress patterns during simulated laparoscopy in residency.

    Ghazali, Daniel A; Faure, Jean P; Breque, Cyril; Oriot, Denis


    Laparoscopy simulation offers realistic complexity of tasks and required skills, and helps to develop competencies. However the relationship of stress to the experience has not been comprehensively explored. Objectives were: 1) to evaluate stress level before and during laparoscopy in surgery interns (PGY-1) and surgery residents (PGY-2); 2) to evaluate performance in simulated laparoscopy in both groups; 3) to study the correlation between stress pathways themselves and to study which factors mediate the relationship between stress and performance. Seven PGY-1 (didactic course plus 2-hour hands-on session) and 6 PGY-2 who usually operate by laparoscopy were included. Performance assessment used the MISTELS scale. Salivary cortisol (SC) was measured the day prior (T0) to simulation, and immediately before (T1), and after the session (T2). Electrophysiological indicators of stress were assessed by Holter: heart rate (HR) and its variability (pNN50) at the same time. Perceived stress was determined at T1. All parameters were similar at T0. Regarding the whole study population, simulation induced stress. However response varied by subgroups. For PGY-1, levels of SC, HR and pNN50 were similar between T0 and T1. Afterwards, SC and HR significantly increased with a parallel decrease in pNN50 at T2. For PGY-2, a significant increase in HR and decrease in pNN50 were observed from T0 to T1, and remained stable at T2. No change in SC level or perceived stress was noted. Performance score was significantly higher in PGY-2. Stress patterns were not correlated between each other but a correlation was found between electrophysiological parameters and performance. Two stress patterns were identified: PGY-1 exhibited an increase in stress level during the procedure, whereas in PGY-2 it occurred prior to the procedure. This suggests that the impact of simulation on stress parameters might be different according to the experience of the learners.

  19. Venous hemodynamic changes of lower extremity during gynecological laparoscopy

    YIN Shan-de; LIU Yan; HE Sheng


    To study the effect of CO2 pneumoperitoneum and the special 30 degree head-down tilt positionon the venous hemodynamics in the lower extremity. Methods: Color doplex ultrasound was adopted to evaluate the diameterand blood flow velocity of the right femoral vein of 18 patients undergoing gynecologic laparoscopy under the same pressure ofpneumoperitoneum of 12 mmHg. The diameter of femoral vein and the flow velocity were measured; the blood flow volumewas calculated based on the equation of Q = vπr2 . Result: After establishment of pneumoperitoneum, the dilation of the fem-oral vein and the decrease in the velocity and volume can be observed (P < 0.05). And the 30 degree head-down positioncould increase the flow velocity and volume of the femoral vein and decrease the diameter of the vessel ( P < 0.05). At 30minutes of the 30 degree head-down tilt position, the blood flow ameliorated compared with that in prone position after theestablishment of pneumoperitoneum. After deflation of pneumoperitoneum, the femoral vein remained dilated( P < 0.05 ).Conclusion: During laparoscopy, CO2 pneumoperitoneum may result in the dilation of the vein in lower extremity and retar-dance of blood flow. The 30 degree Trendlenburg position can ameliorate the blood flow in the lower extremity. The deflationof the pneumoperitoneum cannot eliminate the effect of CO2 pneumoperitoneum on the lower extremity veins, which may pre-dispose deep venous thrombosis after laparoscopy.

  20. Multiple huge epiphrenic esophageal diverticula with motility disease treated with video-assisted thoracoscopic and hand-assisted laparoscopic esophagectomy: a case report.

    Taniguchi, Yoshiki; Takahashi, Tsuyoshi; Nakajima, Kiyokazu; Higashi, Shigeyoshi; Tanaka, Koji; Miyazaki, Yasuhiro; Makino, Tomoki; Kurokawa, Yukinori; Yamasaki, Makoto; Takiguchi, Shuji; Mori, Masaki; Doki, Yuichiro


    Epiphrenic esophageal diverticulum is a rare condition that is often associated with a concomitant esophageal motor disorder. Some patients have the chief complaints of swallowing difficulty and gastroesophageal reflux; traditionally, such diverticula have been resected via right thoracotomy. Here, we describe a case with huge multiple epiphrenic diverticula with motility disorder, which were successfully resected using a video-assisted thoracic and laparoscopic procedure. A 63-year-old man was admitted due to dysphagia, heartburn, and vomiting. An esophagogram demonstrated an S-shaped lower esophagus with multiple epiphrenic diverticula (75 × 55 mm and 30 × 30 mm) and obstruction by the lower esophageal sphincter (LES). Esophageal manometry showed normal peristaltic contractions in the esophageal body, whereas the LES pressure was high (98.6 mmHg). The pressure vector volume of LES was 23,972 mmHg(2) cm. Based on these findings, we diagnosed huge multiple epiphrenic diverticula with a hypertensive lower esophageal sphincter and judged that resection might be required. We performed lower esophagectomy with gastric conduit reconstruction using a video-assisted thoracic and hand-assisted laparoscopic procedure. The postoperative course was uneventful, and the esophagogram demonstrated good passage, with no leakage, stenosis, or diverticula. The most common causes of mid-esophageal and epiphrenic diverticula are motility disorders of the esophageal body; appropriate treatment should be considered based on the morphological and motility findings.




    Full Text Available : Infertility is not only a medical, but a serious social problem as well, especially in our country. Use of diagnostic and therapeutic laparoscopy in infertility has been a focus of attention in recent years and is found to be very effective method in evaluating these cases. Traditional way to assess the uterine cavity, tubal structures and tubal patency was hysterosalpingography, but it has now largely been superseded by hysteroscopy and laparoscopy. It is concluded that laparoscopy is useful in diagnosing cases with endometriosis, tubal factor infertility and exclusion of bilateral anatomical tubal pathology by diagnostic laparoscopy could avoid IVF treatment in these cases.

  2. Clinical application of the Hybrid Assistive Limb (HAL for gait training - a systematic review.

    Anneli eWall


    Full Text Available Objective: The aim of this study was to review the literature on clinical applications of the Hybrid Assistive Limb system for gait training.Methods: A systematic literature search was conducted using Web of Science, PubMed, CINAHL and and additional search was made using reference lists in identified reports. Abstracts were screened, relevant articles were reviewed and subject to quality assessment. Results: Out of 37 studies, 7 studies fulfilled inclusion criteria. Six studies were single group studies and 1 was an explorative randomized controlled trial. In total, these studies involved 140 participants of whom 118 completed the interventions and 107 used HAL for gait training. Five studies concerned gait training after stroke, 1 after spinal cord injury (SCI and 1 study after stroke, SCI or other diseases affecting walking ability. Minor and transient side effects occurred but no serious adverse events were reported in the studies. Beneficial effects on gait function variables and independence in walking were observed.Conclusions: The accumulated findings demonstrate that the HAL system is feasible when used for gait training of patients with lower extremity paresis in a professional setting. Beneficial effects on gait function and independence in walking were observed but data do not allow conclusions. Further controlled studies are recommended.

  3. Hysterectomy for obese women with endometrial cancer: laparoscopy or laparotomy?

    Eltabbakh, G H; Shamonki, M I; Moody, J M; Garafano, L L


    The aim of this study was to investigate the feasibility and safety of laparoscopic management of obese women with early stage endometrial cancer and to compare the surgical outcome, cost, hospital stay, recall of postoperative pain control, time to return to full activity and to work, and overall satisfaction among these women and those managed by laparotomy. We conducted a prospective study over 2 years applying laparoscopic surgery to all women with clinical stage I endometrial cancer and body mass indices (BMIs) between 28.0 and 60.0 who can tolerate such surgery. As a control, we used women with clinical stage I endometrial cancer and similar BMIs who underwent laparotomy in the previous 2 years. Both groups were compared in their characteristics, surgical outcome, cost, and hospital stay, and interviewed regarding time to recovery, recall of postoperative pain control, and overall satisfaction with their management. Forty of 42 obese women who presented with clinical stage I endometrial cancer during the study period were offered laparoscopic surgery. The procedure was converted to laparotomy in 3 (7.5%) patients. Laparoscopic surgery was thus successful in 88.1% of all obese women. There was no significant difference between women who underwent laparoscopy and those who underwent laparotomy in patient characteristics, proportion of women who underwent lymphadenectomy, complications, total cost, patients' recall of postoperative pain, and patients' satisfaction with management. Women who underwent laparoscopy had a significantly longer operative time, more pelvic lymph nodes removed, a smaller drop in postoperative hematocrit, less pain medication, and a shorter hospital stay (194.8 versus 137.7 min, P obese women with early stage endometrial cancer can be safely managed through laparoscopy with excellent surgical outcome, shorter hospitalization, and less postoperative pain than those managed through laparotomy. Copyright 2000 Academic Press.

  4. Intraperitoneal lidocaine & tenoxicam for pain relief after gynaecological laparoscopy

    Ibrahim A Abdelazim; Mohammed Al-Kadi; Maged Mahmoud El Shourbagy; Ahmed Abdelazim Mohamed; Mohannad Lutfi Abu faza


    Objective: To detect the effect of intra-peritoneal instillation of local anesthetic with or without NSAIDs on pain relief after gynecological laparoscopy. Methods: Seventy five patients scheduled for laparoscopy were included in the study and randomly divided into three groups. At the end of the laparoscopic procedure, 100 mL normal saline in the first group, or 100 mL normal saline contains 200 mg lidocaine in the second group, or 100 mL normal slaine containing 200 mg lidocaine and 20 mg tenoxicam in the third group were splashed into the pelvis by the surgeon. Post-operative pain were monitored and compared. Results: The incidence and severity of immediate postoperative shoulder pain reduced from 44% of patients scoring 2-5 in saline group to 16% scoring 2-3 in lidocaine group and 8% scoring 2-3 in lidocaine-tenoxicam group. Compared with saline group, abdominal pain scores were significantly lower in lidocaine group and lidocaine-tenoxicam group over 24 hours after surgery. At 12 and 24 hours after surgery, abdominal pain scores were significantly reduced in lidocaine-tenoxicam group compared with lidocaine group. No pain on deep respiration was reported in 84%, and 68% in lidocaine-tenoxicam and lidocaine groups respectively compared to 12% in those in the saline group. The mean time to first request for analgesia was increased from (2.3 ±1.9) hours in saline group to (4.4 ± 2.4) hours in lidocaine group and to (8.3 ± 10.2) hours in lidocaine-tenoxicam group. Conclusion: Intraperitoneal balanced analgesia (local anesthetics ± NSAIDS) is a simple and safe technique for analgesia following gynaecological Laparoscopy.

  5. Role of laparoscopy in the management of impalpable testes

    El-Gohary M


    Full Text Available Both diagnostic and operative laparoscopy was used in the management of 189 impalpable testes. 66 were either vanishing or atrophied, 17 were found in the inguinal canal, 19 in the groin, and 87 intra-abdominal. Four of the latter group were associated with persistent Mullerian duct syndrome and one with splenogonad fusion. Four atrophied abdominal testes were excised laparoscopically, 47 were treated with one stage laparoscopic orchidopexy and 34 with laparoscopic Fowler Stephen (FS procedure. A good scrotal position was achieved in 63% of the one stage procedure and 69% with the two stage FS approach.

  6. Occasional finding of mesenteric lipodystrophy during laparoscopy: A difficult diagnosis


    Mesenteric lipodystrophy is a rare pathological condition affecting the mesentery. Its initial presentation is typically asymptomatic. Pathological characteristics are unspecific, and generally attributed to inflammation, unless the diagnosis is suspected. Laparoscopy done for other reasons has been, as in this case, unsuccessful in providing evidence for the correct diagnosis, thus requiring laparotomy due to lack of diagnostic tissue. After 6 mo no further medical therapy is required, as the patient remains asymptomatic. Discussion of this case and a brief review of the literature are presented in the following paragraphs.

  7. Intravenous lidocaine for post-operative pain relief after hand-assisted laparoscopic colon surgery: a randomized, placebo-controlled clinical trial.

    Tikuišis, R; Miliauskas, P; Samalavičius, N E; Žurauskas, A; Samalavičius, R; Zabulis, V


    Perioperative intravenous (IV) infusion of lidocaine has been shown to decrease post-operative pain, shorten time to return of bowel function, and reduce the length of hospital stay. This randomized, prospective, double-blinded, placebo-controlled clinical trial evaluated the impact of IV lidocaine on the quality of post-operative analgesia and other outcomes after hand-assisted laparoscopic colon surgery. Sixty four patients with colon cancer scheduled for elective colon resection were involved in this study. Patients were randomized to receive either lidocaine infusion [lidocaine group (LG)] or normal 0.9 % saline infusion [placebo group (PG)] for a period of 24 h. Anaesthetic and surgical techniques were standardized. Twenty-four-hour post-operative analgesia in the recovery area was maintained by continuous infusion of 0.1 μg/kg/h fentanyl. The primary outcome of the study was post-operative pain control. Pain was assessed using visual analogue scale (VAS) scores at 2, 4, 8, 12, and 24 h after surgery. Patients with a VAS score >3 were treated with ketorolac 30 mg as needed. Secondary outcomes included time to resumption of bowel function and length of hospital stay. Data in the two groups were compared using the two-tailed Student's t test. All statistical tests were two-tailed at a significance level of 0.05. Demographic characteristics and clinical features of both groups were similar. Intensity of pain at rest in LG compared with PG was significantly lower during the first 24 h post-operatively. LG patients reported significantly less pain during movements at 2-, 12-, and 24-h post-surgery than PG patients. The study showed that ketorolac consumption was significantly higher in PG: mean ketorolac consumption in LG was 43.77 ± 13.86 mg and in PG 51.67 ± 13.16 mg (p = 0.047). Compared with placebo, lidocaine infusion produced a 32 % reduction in time to the first drink (Cohen's d = 3.85), 16 % reduction in time to the first full diet

  8. Gynecologic laparoscopy and reproductive failure: Review of 4103 infertile Egyptian women

    Soha Siam


    Conclusion: The high prevalence of pelvic pathology found during laparoscopy confirms its role in the investigation and management of infertile women. While not all infertile women will need IVF, they will still benefit from laparoscopy either to assist natural conception, to direct them to IVF-ET, or to enhance IVF results.

  9. Vascular injuries during gynecological laparoscopy: the vascular surgeon's advice

    Marcello Barbosa Barros

    Full Text Available CONTEXT: Iatrogenic vascular problems due to laparoscopy are a well recognized problem and lead to significant repercussions. In this context, a ten-year review of cases topic is presented, based on experience gained while heading two important vascular surgery services. CASES: Five patients with vascular injuries during elective laparoscopy are described. These patients presented with seven lesions of iliac vessels. All cases were evaluated immediately and required laparotomy, provisional hemostasis and urgent attendance by a vascular surgeon. Direct suturing was performed in three cases. One aortoiliac bypass and one ilioiliac reversed venous graft were made. Venous lesions were sutured. One case of a point-like perforation of the small bowel was found. There were no deaths and no complications during the postoperative period. DISCUSSION: Important points on this subject are made, and advice is given. There needs to be immediate recognition of the vascular injury, and expert repair by a vascular surgeon is recommended, in order to significantly reduce the degree of complications.

  10. Reoperation of biliary tract by laparoscopy: experiences with 39 cases.

    Li, Li-Bo; Cai, Xiu-Jun; Mou, Yi-Ping; Wei, Qi


    To evaluate the safety and feasibility of biliary tract reoperation by laparoscopy for the patients with retained or recurrent stones who failed in endoscopic sphincterotomy. A retrospective analysis of data obtained from attempted laparoscopic reoperation for 39 patients in a single institution was performed, examining open conversion rates, operative times, complications, and hospital stay. Out of the 39 cases, 38 (97%) completed laparoscopy, 1 required conversion to open operation because of difficulty in exposing the common bile duct. The mean operative time was 135 min. The mean post-operative hospital stay was 4 d. Procedures included laparoscopic residual gallbladder resection in 3 cases, laparoscopic common bile duct exploration and primary duct closure at choledochotomy in 13 cases, and laparoscopic common bile duct exploration and choledochotomy with T tube drainage in 22 cases. Duodenal perforation occurred in 1 case during dissection and was repaired laparoscopically. Retained stones were found in 2 cases. Postoperative asymptomatic hyperamlasemia occurred in 3 cases. There were no complications due to port placement, postoperative bleeding, bile or bowel leakage and mortality. No recurrence or formation of duct stricture was observed during a mean follow-up period of 18 mo. Laparoscopic biliary tract reoperation is safe and feasible if it is performed by experienced laparoscopic surgeons, and is an alternative choice for patients with choledocholithiasis who fail in endoscopic sphincterectomy.

  11. Comparison of two minimal invasive techniques of splenectomy: Standard laparoscopy versus transumbilical multiport single-site laparoscopy with conventional instruments

    Baris Bayraktar


    Full Text Available Background: Laparoendoscopic single-site (LESS splenectomy which is performed on small number of patients, has been introduced with better cosmetic outcome, less postoperative pain, greater patient satisfaction and faster recovery compared to standard laparoscopy. Materials and Methods : Thirty six patients were included in the study comparing standard laparoscopic splenectomy (LS, 17 patients transumbilical multiport splenectomy performed with conventional laparoscopic instruments (TUMP-LS, 19 patients. Two groups of patients were compared retrospectively by means of operation time, intra- and postoperative blood loss, perioperative complications, packed red cell and platelet requirements, lenght of hospitalization, pain scores and patient satisfaction. Results: There was no mortality in any of the groups, and no significant differences determined in operative time (P = 0,069, intraoperative blood loss (P = 0,641, patient satisfaction (P = 0,506, pain scores (P = 0,173 and the average length of hospital stay (P = 0,257. Umbilical incisions healed uneventfully and no hernia formation or wound infection was observed during follow-up period (2-34 months. There were no conversions to open surgery. Conclusions: Transumbilical multiport splenectomy performed with the conventional laparoscopic instruments is feasible and could be a logical alternative to classical laparoscopic splenectomy by combining the advantages of single access techniques and standard laparoscopy.

  12. The expression of the Saccharomyces cerevisiae HAL1 gene increases salt tolerance in transgenic watermelon [Citrullus lanatus (Thunb.) Matsun. & Nakai.].

    Ellul, P; Ríos, G; Atarés, A; Roig, L A; Serrano, R; Moreno, V


    An optimised Agrobacterium-mediated gene transfer protocol was developed in order to obtain watermelon transgenic plants [Citrullus lanatus (Thunb.) Matsun. & Nakai.]. Transformation efficiencies ranged from 2.8% to 5.3%, depending on the cultivar. The method was applied to obtain genetically engineered watermelon plants expressing the Saccharomyces cerevisiae HAL1 gene related to salt tolerance. In order to enhance its constitutive expression in plants, the HAL1 gene was cloned in a pBiN19 plasmid under control of the 35S promoter with a double enhancer sequence from the cauliflower mosaic virus and the RNA4 leader sequence of the alfalfa mosaic virus. This vector was introduced into Agrobacterium tumefaciens strain LBA4404 for further inoculation of watermelon half-cotyledon explants. The introduction of both the neomycin phosphotransferase II and HAL1 genes was assessed in primary transformants (TG1) by polymerase chain reaction analysis and Southern hybridisation. The expression of the HAL1 gene was determined by Northern analysis, and the diploid level of transgenic plants was confirmed by flow cytometry. The presence of the selectable marker gene in the expected Mendelian ratios was demonstrated in TG2 progenies. The TG2 kanamycin-resistant plantlets elongated better and produced new roots and leaves in culture media supplemented with NaCl compared with the control. Salt tolerance was confirmed in a semi-hydroponic system (EC=6 dS m(-1)) on the basis of the higher growth performance of homozygous TG3 lines with respect to their respective azygous control lines without the transgene. The halotolerance observed confirmed the inheritance of the trait and supports the potential usefulness of the HAL1 gene of S. cerevisiae as a molecular tool for genetic engineering of salt-stress protection in other crop species.

  13. Reassessment of the laparoscopy role in the investigation of infertility and treatment plan determination

    Sebastio F de Medeiros; Mrcia MW Yamamoto; Bianca B Galera; Matheus AS de Medeiros; Jacklyne S Barbosa


    Objective:To reassess the importance of laparoscopy in infertility investigation treatment plan determination.Methods:The study enrolled237 patients with infertility duration >1 year.A complete investigation was performed in all patients and male factor was evaluated by medical history and semen analysis.In the case of normal semen or mild-to-moderate oligozoospermia, the female evaluation included screening for infection diseases, transvaginal ultrasound, hormone parameter, hysterosalpingography, and laparoscopy.The final treatment plan was decided according to laparoscopy findings and any modification of the initial proposal was taken as treatment change. Results:At laparoscopy, normal pelvic cavity was found in5.5%, endometriosis in76.4%, pelvic adhesion in17.2%, ovarian adhesion in24.8%, peritubal adhesion 15.2%, unilateral tubal occlusion in21.1%, bilateral tubal occlusion in5.5%, and tubal sacculation, kinking, constriction, or fibrosis in46.3%.Operative interventions during laparoscopy were endometriosis ablation/excision(74.6%), adhesiolysis(27.4%), and endometrioma cystectomy(4.6%). Laparoscopy determined to switch the initial treatment plan in85(35.8%) patients.Conclusions:Pelvic cavity abnormalities, primarily endometriosis, have high prevalence in infertileBrazilian women.Laparoscopy provides a precise diagnosis of tuboperitoneal factor and may switch the initial treatment plan in at least one third of patients.

  14. Laparoscopy and ultrasound examination in women with acute pelvic pain

    Mikkelsen, A L; Felding, C


    The results of preoperative pelvic examination and eventual ultrasound examination were correlated with the laparoscopic findings in 316 women with acute pelvic pain. The predictive values of normal and abnormal findings at pelvic examination were 46.9 and 82.1%, respectively. 42.1% of the women...... had ultrasound examination performed. This investigation showed to be helpful especially in patients with normal findings at pelvic examination. If ultrasonic findings were abnormal the results at laparoscopy were also abnormal in 90%. On the contrary, normal findings at ultrasound examination did...... not exclude abnormal pelvic findings. The predictive value of normal results at ultrasound examination was 50.0%. This discrepancy between ultrasonic and pelvic findings can be explained by the size of the pelvic masses. Ultrasound examination is a valuable tool in the evaluation of patients with acute pelvic...

  15. Surgical effects of obesity on laparoscopy-assisted distal gastrectomy.

    Kawamura, Hideki; Tanioka, Toshiro; Funakoshi, Tohru; Takahashi, Masahiro


    To compare the effects of obesity on laparoscopy-assisted distal gastrectomy (LADG) and open distal gastrectomy (ODG). A retrospective study was conducted on 249 patients, who underwent LADG and 224 patients who underwent ODG. The regression coefficient of the primary regression equation between operative time and body mass index (BMI) for LADG was greater than ODG; and between blood loss and BMI for LADG was almost the same as ODG. In overweight patients (BMI ≥25), no significant difference was seen between LADG and ODG regarding postoperative complications, and the benefits of the less-invasive nature of LADG were also seen in some parameters. Obesity-associated difficulties are more while performing LADG than during ODG; however, the influence of obesity on LADG decreases with surgical experience. Moreover, even in overweight patients, the benefits of the less-invasive nature of LADG still remain, but the degree of the benefits is smaller than that in nonobese patients.

  16. Unexpected motor weakness following quadratus lumborum block for gynaecological laparoscopy.

    Wikner, M


    Quadratus lumborum block has recently been described as an effective and long-lasting analgesic strategy for various abdominal operations, including gynaecological laparoscopy. Despite evidence that the analgesic effect is mediated by indirect paravertebral block and that local anaesthetic spreads to the lumbar paravertebral space, there have been no reports to date of lower limb motor weakness. We present a patient with unilateral hip flexion and knee extension weakness leading to unplanned overnight admission following lateral quadratus lumborum block with 20 ml levobupivacaine 0.25%. The L2 dermatomal sensory loss and hip flexion weakness suggested spread to either the L2 paravertebral space or to the lumbar plexus, causing weakness of the psoas and iliacus muscles and possibly the quadriceps. The duration of motor block was approximately 18 h. This complication should be considered when performing the block, especially in the setting of day-case surgery.

  17. Designing a Standardized Laparoscopy Curriculum for Gynecology Residents

    Shore, Eliane M; Lefebvre, Guylaine G; Husslein, Heinrich


    surgery, and asked 39 experts in gynecologic education to rate the items on a Likert scale (1-5) for inclusion in the curriculum. Consensus was predefined as Cronbach α of ≥0.80. We then conducted another Delphi survey with 9 experienced users of laparoscopic virtual reality simulators to delineate...... of the curriculum Delphi, and after 2 rounds (Cronbach α=0.80) in the virtual reality curriculum Delphi. Consensus was reached for cognitive, technical, and nontechnical skills as well as for 6 virtual reality tasks. Median time and economy of movement scores defined benchmarks for all tasks. CONCLUSIONS......: This study used Delphi consensus to develop a comprehensive curriculum for teaching gynecologic laparoscopy. The curriculum conforms to current educational standards of proficiency-based training, and is suggested as a standard in residency programs....

  18. Association between intraabdominal pressure during gynaecologic laparoscopy and postoperative pain.

    Kundu, Sudip; Weiss, Clara; Hertel, Hermann; Hillemanns, Peter; Klapdor, Rüdiger; Soergel, Philipp


    Laparoscopy is nowadays a well-established surgical method and plays a main role in an ever-increasing range of indications in gynaecology. High-quality studies of surgical techniques are necessary to improve the quality of patient care. The present study aims at evaluating postoperative pain after gynaecological laparoscopy depending on the intraoperative CO2 pressure. In a prospective, monocentric, randomized single-blind study at the Department of Gynaecology and Obstetrics at the Hannover Medical School, we include patients scheduled for different laparoscopic procedures. Randomization of the intraoperative CO2 pressure was carried out in six groups. Pain was assessed the day after surgery by the blinded nurse using a visual analogue scale. 550 patients were included in the period from May 2013 to January 2016. The analysis of the per protocol population PPP (n = 360) showed no statistically significant difference between the six intervention groups with regard to mean postoperative pain perception. In direct comparison between two groups, an intraoperative CO2 pressure of 15 mmHg was associated with a significant higher pain score than a pressure of 12 mmHg. The difference was 7.46 mm on a 10 cm VAS. The results of our study indicate that a CO2 pressure of 12 versus 15 mmHg can be advantageous. However, the clinical relevance remains unclear due to the low difference in pain. The additional benefit of an even lower pressure of 10 or 8 mmHg cannot be reliably assessed; we found signs of poor visibility conditions in these low pressure groups.

  19. Diagnostic laparoscopy and laparoscopic ultrasonography with local anesthesia in hepatocellular carcinoma

    Mariano Gómez-Rubio; Mercedes Moya-Valdés; Jesús García


    Diagnosis of hepatocellular carcinoma (HCC), a common digestive malignancy, remains a challenge. The aim of this study was to evaluate the feasibility of performing laparoscopy and laparoscopic ultrasound with local anesthesia as a diagnostic procedure in HCC. Laparoscopy and laparoscopic ultrasound with local anesthesia was performed in the gastrointestinal endoscopy unit in three patients diagnosed of HCC. Endoscopy staged diffuse liver disease. Laparoscopic ultrasonography identified all liver tumors not visible during endoscopy and guided needle biopsy in one case. No complications happened. In conclusion, laparoscopy and laparoscopic ultrasound,performed as a minimally invasive diagnostic procedure can be a safe and very promising tool in planning therapy of HCC.

  20. A Potentiometric, Spectrophotometric and Pitzer Ion-Interaction Study of Reaction Equilibria in the Aqueous H+-Al3+, H+-Oxalate and H+-Al3+-Oxalate Systems up to 5 mol*dm-3 NaCl

    Boily, Jean F.; Qafoku, Odeta; Felmy, Andrew R.


    Aluminium-oxalate complexation was determined in acidic media of aqueous NaCl solutions ranging from 0.1-5.0 mol•dm-3. Complexation in the H+-Al3+ and H+-Oxalate systems was also studied to provide a set of internally consistent thermodynamic data. The ionic strength dependent formation constants describing the stabilities of the Al3+, AlOH2+, Al3(OH)45+, Al13O4(OH)247+, H2L, HL-, L2-, AlL+, AlL2- and AlL33- species (where L is the oxalate ion) was also described using a Pitzer ion interaction model. The derived parameters can be used to predict chemical speciation in the H+-Al3+-Oxalate system in the 0.1-5.0 mol•dm-3 NaCl range.

  1. Metodologi Hukum Islam ‘Abd al-Halîm Mahmûd

    M. Lathoif Ghozali


    Full Text Available This article discusses the concept of ijtihâd (legal reasoning and the typology of legal thought of ‘Abd al-Halîm Mahmûd. According to Mahmûd, ijtihad is devoting all abilities of a mujtahid to arrive at the essence and substance of a problem intended by the Prophet Muhammad. This definition is supported by the division of ijtihâd into two: ijtihâd istinbâtî, the object of which is the texts of the Qur’ân or the Sunnah, and ijtihâd tatbîqî, the object of which is legal problems of the time. Mahmud maintains that a mujtahid should meet certain qualifications such as the abilities of understanding Arabic language, memorizing the Qur’ân, understanding asbâb al-nuzûl (causes of revelation, memorizing the Traditions of the Prophet related to legal matters, and the brilliance in making legal reasoning and conclusions. Mahmûd belongs to moderate group that agrees with the formalization of private laws, while public laws in his view serve only as materials for national laws. Mahmûd also gives an emphasis on the integration between nass (text and maqâsid al-sharî‘ah (the objectives of law.

  2. Modification of hemiplegic compensatory gait pattern by symmetry-based motion controller of HAL.

    Kawamoto, Hiroaki; Kadone, Hideki; Sakurai, Takeru; Sankai, Yoshiyuki


    As one of several characteristics of hemiplegic patients after stroke, compensatory gait caused by affected limb is often seen. The purpose of this research is to apply a symmetry-based controller of a wearable type lower limb robot, Hybrid Assistive Limb (HAL) to hemiplegic patients with compensatory gait, and to investigate improvement of gait symmetry. The controller is designed respectively for swing phase and support phase according to characteristics of hemiplegic gait pattern. The controller during swing phase stores the motion of the unaffected limb and then provides motion support on the affected limb during the subsequent swing using the stored pattern to realize symmetric gait based on spontaneous limb swing. Moreover, the controller during support phase provides motion to extend hip and knee joints to support wearer's body. Clinical tests were conducted in order to assess the modification of gait symmetry. Our case study involved participation of one chronic stroke patient who performs abnormally-compensatory gait for both of the affected and unaffected limbs. As a result, the patient's gait symmetry was improved by providing motion support during the swing phase on the affected side and motion constraint during the support phase on the unaffected side. The study showed promising basis for the effectiveness of the controller for the future clinical study.

  3. The HAL 9000 Space Operating System Real-Time Planning Engine Design and Operations Requirements

    Stetson, Howard; Watson, Michael D.; Shaughnessy, Ray


    In support of future deep space manned missions, an autonomous/automated vehicle, providing crew autonomy and an autonomous response planning system, will be required due to the light time delays in communication. Vehicle capabilities as a whole must provide for tactical response to vehicle system failures and space environmental effects induced failures, for risk mitigation of permanent loss of communication with Earth, and for assured crew return capabilities. The complexity of human rated space systems and the limited crew sizes and crew skills mix drive the need for a robust autonomous capability on-board the vehicle. The HAL 9000 Space Operating System[2] designed for such missions and space craft includes the first distributed real-time planning / re-planning system. This paper will detail the software architecture of the multiple planning engine system, and the interface design for plan changes, approval and implementation that is performed autonomously. Operations scenarios will be defined for analysis of the planning engines operations and its requirements for nominal / off nominal activities. An assessment of the distributed realtime re-planning system, in the defined operations environment, will be provided as well as findings as it pertains to the vehicle, crew, and mission control requirements needed for implementation.

  4. Diagnostic laparoscopy for pneumatosis intestinalis in a very elderly patient: A case report

    Shuhei Ito


    Conclusion: Diagnostic laparoscopy may be a useful option for definitively ruling out the lethal conditions associated with pneumatosis intestinalis in frail elderly patients with severe conditions in the emergency setting.

  5. Pulmonary function and pain after gastroplasty performed via laparotomy or laparoscopy in morbidly obese patients

    Joris, J L; Hinque, V L; Laurent, P E; Desaive, C J; Lamy, M L


    ...) to determine if laparoscopy results in any benefit in the obese. Postoperative pain, measured on a 100-mm visual analogue scale, and opioid consumption were recorded during the first two days after operation...

  6. Excision of the urachal remnant using the abdominal wall-lift laparoscopy: A case report

    Kosuke Kobayashi


    Discussion and conclusion: Urachal sinus excision using the abdominal wall-lift laparoscopy seems to surpass the previously reported methods in term of safety, cosmetics, and adequacy of surgical procedures.

  7. Re-laparoscopy in the diagnosis and treatment of postoperative complications following laparoscopic colorectal surgery.

    O'Riordan, J M


    Laparoscopic colorectal surgery has increasingly become the standard of care in the management of both benign and malignant colorectal disease. We herein describe our experience with laparoscopy in the management of complications following laparoscopic colorectal surgery.

  8. Comparison between total laparoscopy and laparoscopy-assisted distal gastrectomy for gastric cancer. A meta-analysis based on Japanese and Korean articles.

    Xiao, Shuo-Meng; Gao, Xiao-Jin; Zhao, Ping


    To assess the safety and feasibility of total laparoscopy distal gastrectomy (TLDG). This meta-analysis was conducted between April and July 2013 in Sichuan Cancer Hospital, Chengdu, China. We searched PubMed, EMBASE and China Knowledge Resource Integrated Database updated until May 2013. Eight retrospective studies and one prospective study involving 2,046 total patients were included. The results showed that TLDG was associated with lower blood loss (mean difference=-22.39, p=0.04). and a greater number of harvested lymph nodes (mean difference=2.74, p=0.02). There was no significant difference between the 2 groups in operation time, time to first flatus, length of postoperative hospital stay, and postoperative complications. Compared with laparoscopy-assisted distal gastrectomy, TLDG resulted in reduced blood loss, and a greater number of harvested lymph nodes. Total laparoscopy distal gastrectomy is safe and feasible for gastric cancer. 

  9. Development of an assist controller with robot suit HAL for hemiplegic patients using motion data on the unaffected side.

    Kawamoto, Hiroaki; Kandone, Hideki; Sakurai, Takeru; Ariyasu, Ryohei; Ueno, Yukiko; Eguchi, Kiyoshi; Sankai, Yoshiyuki


    Among several characteristics seen in gait of hemiplegic patients after stroke, symmetry is known to be an indicator of the degree of impairment of walking ability. This paper proposes a control method for a wearable type lower limb motion assist robot to realize spontaneous symmetric gait for these individuals. This control method stores the motion of the unaffected limb during swing and then provides motion support on the affected limb during the subsequent swing using the stored pattern to realize symmetric gait based on spontaneous limb swing. This method is implemented on the robot suit HAL (Hybrid Assistive Limbs). Clinical tests were conducted in order to assess the feasibility of the control method. Our case study involved participation of one chronic stroke patient who was not able to flex his right knee. As a result, the walking support for hemiplegic leg provided by the HAL improved the subject's gait symmetry. The feasibility study showed promising basis for the future clinical study.

  10. Perioperative Outcomes of Robotic Assisted Laparoscopic Surgery Versus Conventional Laparoscopy Surgery for Advanced-Stage Endometriosis

    Sirota, Ido


    Background and Objectives: To determine perioperative outcome differences in patients undergoing robotic-assisted laparoscopic surgery (RALS) versus conventional laparoscopic surgery (CLS) for advanced-stage endometriosis. Methods: This retrospective cohort study at a minimally invasive gynecologic surgery center at 2 academically affiliated, urban, nonprofit hospitals included all patients treated by either robotic-assisted or conventional laparoscopic surgery for stage III or IV endometriosis (American Society for Reproductive Medicine criteria) between July 2009 and October 2012 by 1 surgeon experienced in both techniques. The main outcome measures were extent of surgery, estimated blood loss, operating room time, intraoperative and postoperative complications, and length of stay, with medians for continuous measures and distributions for categorical measures, stratified by body mass index values. Robotically assisted laparoscopy and conventional laparoscopy were then compared by use of the Wilcoxon rank sum, χ2, or Fisher exact test, as appropriate. Results: Among 86 conventional laparoscopic and 32 robotically assisted cases, the latter had a higher body mass index (27.36 kg/m2 [range, 23.90–34.09 kg/m2] versus 24.53 kg/m2 [range, 22.27–26.96 kg/m2]; P laparoscopy patients. After body mass index stratification, obese patients varied in operating room time (282.5 minutes [range, 224–342 minutes] for robotic-assisted laparoscopy versus 174 minutes [range, 130–270 minutes] for conventional laparoscopy; P laparoscopy groups. Conclusion: Despite a higher operating room time, robotic-assisted laparoscopy appears to be a safe minimally invasive approach for patients, with all other perioperative outcomes, including intraoperative and postoperative complications, comparable with those in patients undergoing conventional laparoscopy. PMID:25489208

  11. The Robotic-Assisted Laparoscopy, Isthmusectomy, and Pyeloplasty in a Patient With Horseshoe Kidney

    Tai, Sheng; Wang, Jianzhong; Zhou, Jun; Hao, Zongyao; Shi, Haoqiang; Zhang, Yifei; Liang, Chaozhao


    Abstract 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 bipol...

  12. Implementation of a Cross-specialty Training Program in Basic Laparoscopy

    Bjerrum, Flemming; Sorensen, Jette Led; Thinggaard, Jette


    BACKGROUND AND OBJECTIVES: Several surgical specialties use laparoscopy and share many of the same techniques and challenges, such as entry approaches, equipment, and complications. However, most basic training programs focus on a single specialty. The objective of this study was to describe the ...... laparoscopy is feasible. There are several logistic benefits of using a cross-specialty approach; however, it is important that local departments include specialty-specific components, together with clinical departmental follow-up....

  13. Transcription factors Asg1p and Hal9p regulate pH homeostasis in Candida glabrata

    Jing eWu


    Full Text Available Candida glabrata is an important microorganism used in commercial fermentation to produce pyruvate, but very little is known about its mechanisms for surviving acid stress in culture. In this study, it was shown that transcription factors Asg1p and Hal9p play essential roles in C. glabrata in the tolerance of acid stress, as the deletion of CgASG1 or CgHAL9 resulted in the inability to survive in an acidic environment. Cgasg1 and Cghal9 mutant strains are unable to maintain pH homeostasis, as evidenced by a decrease in intracellular pH and an increase in reactive oxygen species production, which results in metabolic disorders. The results showed that intracellular acidification was partly due to the diminished activity of the plasma membrane proton pump, CgPma1p. In addition, transcriptome sequencing revealed that Cgasg1 and Cghal9 mutant strains displayed a variety of changes in gene expression under acidic conditions, including genes in the MAPK signaling pathway, plasma membrane or cell wall organization, trehalose accumulation, and the RIM101 signaling pathway. Lastly, quantitative reverse-transcribed PCR and cellular localization showed that CgAsg1p and CgHal9p played independent roles in response to acid stress.

  14. Application of laparoscopy in diagnosis and treatment of massive small intestinal bleeding: Report of 22 cases

    Ming-Chen Ba; San-Hua Qing; Xiang-Cheng Huang; Ying Wen; Guo-Xin Li; Jiang Yu


    AIM: To investigate the diagnostic and therapeutic value of laparoscopy in patients with massive small intestinal bleeding.METHODS: Twenty-two patients with massive small intestinal bleeding and hemodynamic alteration underwent laparoscopic laparotomy in our unit from December 2002 to April 2005. Post pathologic sites were found, laparoscopy- or laparoscopy-assisted part small intestinal resection including pathologic intestinal site and enteroanastomosis was performed in all these patients.RESULTS: The bleeding sites were successfully detected by laparoscopy in all these 22 patients. Massive small intestinal bleeding was caused by jejunum benign stromal tumor in 8 cases, by jejunum potential malignant stromal tumor in 5 cases, by jejunum malignant stromal tumor in 1 case, by Mechel's diverticulum in 5 cases,by small intestinal vascular deformity in 2 cases, and by ectopic pancreas in 1 case. A total of 16 patients underwent laparoscopy-assisted enterectomy and enteroanastomosis of small intestine covering the of the diseased segment under laparoscope. No surgical complications occurred and the outcome was satisfactory.CONCLUSION: Laparoscopy in diagnosis and treatment of massive small intestinal bleeding is noninvasive with less pain, short recovery time and definite therapeutic efficacy.


    Jadranka Domazet Fink


    Full Text Available Background. The aim of this study was to assess the share of organic changes in patients with chronic pelvic pain (CPP as well as evaluate the need for invasive CPP diagnostics – laparoscopy.Methods. The data for the analysis were gathered retrospectively from the descriptions of 287 CPP patients who were treated at the Clinic of Gynaecology in Ljubljana from 1993 to 1999. In this analysis the share of laparoscopically established organic causes of CPP was assessed and the findings of invasive (laparoscopy and non-invasive diagnostics (clinical status and ultrasound were compared.Results. Out of 287 patients, 272 underwent laparoscopy, 7 underwent laparotomy while 8 were only observed. As regards organic CPP causes, an organic cause was established in 70.7% patients through laparoscopy. The most frequently observed phenomena were adhesions, namely in 97 (35.7% patients, endometriosis in 68 (25.0% and pelvic varices in 29 (10% patients.By comparing the results of invasive and non-invasive diagnostics it was established that up to three times more organic changes – a possible cause of CPP – can be discovered through laparoscopy than through the use of non-invasive diagnostics methods.Conclusions. Laparoscopy is considered to be the most reliable method of diagnostics and detection of organic causes of CPP. An adequate psychological treatment within a multidisciplinary approach is necessary in patients in whom an organic cause of CPP can not be discovered in their genital tract.

  16. Laparoscopy in the morbidly obese: physiologic considerations and surgical techniques to optimize success.

    Scheib, Stacey A; Tanner, Edward; Green, Isabel C; Fader, Amanda N


    The objectives of this review were to analyze the literature describing the benefits of minimally invasive gynecologic surgery in obese women, to examine the physiologic considerations associated with obesity, and to describe surgical techniques that will enable surgeons to perform laparoscopy and robotic surgery successfully in obese patients. The Medline database was reviewed for all articles published in the English language between 1993 and 2013 containing the search terms "gynecologic laparoscopy" "laparoscopy," "minimally invasive surgery and obesity," "obesity," and "robotic surgery." The incidence of obesity is increasing in the United States, and in particular morbid obesity in women. Obesity is associated with a wide range of comorbid conditions that may affect perioperative outcomes including hypertension, atherosclerosis, angina, obstructive sleep apnea, and diabetes mellitus. In obese patients, laparoscopy or robotic surgery, compared with laparotomy, is associated with a shorter hospital stay, less postoperative pain, and fewer wound complications. Specific intra-abdominal access and trocar positioning techniques, as well as anesthetic maneuvers, improve the likelihood of success of laparoscopy in women with central adiposity. Performing gynecologic laparoscopy in the morbidly obese is no longer rare. Increases in the heaviest weight categories involve changes in clinical practice patterns. With comprehensive and thoughtful preoperative and surgical planning, minimally invasive gynecologic surgery may be performed safely and is of particular benefit in obese patients. Copyright © 2014 AAGL. Published by Elsevier Inc. All rights reserved.

  17. Management of Ovarian Dermoid Cysts by Laparoscopy Compared With Laparotomy

    Pang Liyi


    Full Text Available Thirty patients with ovarian dermoid cysts removed by laparoscopic surgery were compared with 42 patients with ovarian dermoid cysts removed by laparotomy, with respect to the selection criteria, surgical procedures, operating time, intraoperative and postoperative complications, blood loss, and hospital stay. Although the operating time for unilateral cystectomy, unilateral salpingo-oophorectomy, and bilateral cystectomy performed by laparoscopic surgery was longer (120.3 ± 43.7 min, mean ± SD than those for the same procedures performed by laparotomy (73.9 ± 21.6 min, p < 0.01, we observed a learning curve with a remarkable declining tendency (linear regression model, p < 0.01. At the end of this study, the times taken for laparoscopic procedures were almost the same as those for laparotomy. Less blood loss (18.2 ± 1.7 ml versus 105.9 ± 84.3 ml, p < 0.01 and shorter hospital stay (5.9 ± 1.9 days versus 12.0 ± 2.9 days, p < 0.01 were also found to be advantages of laparoscopic surgery. This article discusses the technical procedures of laparoscopic surgery. The efficiency and safety of operative laparoscopy as an alternative access route for the management of ovarian dermoid cysts were recognized. We stress that strict criteria for selection of patients should always be followed and the necessity of retraining schedules for gynecologists and nursing staff in the speciality of laparoscopic surgery.

  18. Laparoscopy in the management of pediatric vesicoureteral reflux

    Atul A Thakre


    Full Text Available The prevalence of vesicoureteral reflux (VUR has been estimated as. 4 to 1.8% among the pediatric population. In children with urinary tract infection the prevalence is typically from 30-50% with higher incidence occurring in infancy. When correction of VUR is determined to be necessary, traditionally open ureteral reimplantation by a variety of techniques has been the mainstay of treatment. This approach is justified because surgical correction affords a very high success rate of 99% in experienced hands and a low complication rate. In that context the purpose of this review article is to highlight the use of laparoscopy and robot-assisted techniques to perform ureteric reimplantation for the management of pediatric VUR. A detailed review of recent literature on the subject is performed to find out various aspects of minimally invasive surgery in the treatment of VUR, highlighting evolution of management approaches, operative steps, complications, results and the current status in clinical practice. We also share our experience on the subject.

  19. Training of basic laparoscopy skills on SimSurgery SEP.

    Buzink, Sonja N; Goossens, Richard H M; De Ridder, Huib; Jakimowicz, Jack J


    The aim of this study was to assess the performance curve for novices training in bimanual tissue manipulation and angled laparoscope navigation, and compare those performances with the performances of experienced laparoscopic surgeons. The Camera Navigation task with a 30 degrees angled laparoscope and the Place Arrow task of the new SimSurgery SEP virtual reality simulator were used. Fourteen medical trainees (no laparoscopy experience) performed four training sessions within one week, including 15 repetitions of each task in total. The experienced participants (>50 procedures & familiar with angled laparoscope) performed each task twice. The performance on both tasks by the novices improved significantly over the training sessions. The experienced participants performed both tasks significantly better than the novices in repetition 3. After repetition 15, the performances of the novices on both tasks were of the same level as the performances of the experienced participants. By training on SimSurgery SEP, medical trainees can extensively improve their skills in navigation with 30 degrees angled laparoscope and bimanual tissue manipulation. Further research should focus on the transfer of skills acquired on the simulator to the clinical setting. Knowledge on proficiency thresholds and training end-points for pre-clinical criterion-based training of different laparoscopic tasks also needs to be extended.

  20. Open, intraperitoneal, ventral hernia repair: lessons learned from laparoscopy.

    Ponsky, Todd A; Nam, Arthur; Orkin, Bruce A; Lin, Paul P


    Recent literature suggests that laparoscopic repair of ventral hernias may have very low recurrence rates. However, laparoscopy may not be feasible in certain situations. We describe an open technique that uses the tension-free retrofascial principles of laparoscopic repair without the need for subcutaneous flaps. Through an incision in the hernia, the peritoneum is entered and adhesions are taken down. A piece of DualMesh (W.L. Gore & Associates, Inc, Newark, Del) is trimmed to fit with a 5-cm circumferential overlap. A vertical incision is made in the mid portion of the mesh. The mesh is fixed in an intraperitoneal retrofascial position using GORE-TEX sutures (W.L. Gore & Associates, Inc). The sutures are brought through the abdominal wall using a laparoscopic suture passer and tied into place on one side of the mesh. That side is then tacked to the posterior fascia with a spiral tacking device. The other side is sutured into place in a similar fashion and then tacked to the fascia by passing the spiral tacking device through the incision in the mesh. The mesh incision is closed with a running GORE-TEX suture. The overlying tissues are closed in layers.

  1. Transumbilical videolaparoscopic (single site liver biopsy with laparoscopy equipment

    Jorge Ricardo Góise Cunha


    Full Text Available Introduction: Liver diseases have a high incidence in the whole world. In order to diagnose, stage and follow these diseases it is often necessary the execution of liver biopsy. There are many possible ways to perform the procedure and the rise of transumbilical endoscopic surgery (TUES brings to the medical practice an additional good option. Materials and Methods: The study is prospective, nonrandomised and cohort type. It involves 42 patients who underwent liver biopsy through TUES using conventional video laparoscopic material. Results: Among the patients 18 (42.86% underwent isolated liver biopsy and 24 (57.14% to liver biopsy associated with umbilical hernia repair. Within those, 27 (64.28% were male and 15 (35.71% female. The average body mass index (BMI was of 27.26 kg/m2, 10 were in the normal BMI range, 24 (57.14% were in the overweight range, 6 (14.28% had class I obesity and 2 (4.76% had class II obesity. In none of the cases the procedure was converted to regular video laparoscopy, all the patients were discharged in the day after the procedure and reported a satisfactory aesthetic result. Conclusions: The study shows that liver biopsy using TUES has applicability and good results, including in obese patients that would have a contraindication to other methods.

  2. Reducing the Cost of Laparoscopy: Reusable versus Disposable Laparoscopic Instruments

    Dimitrios K. Manatakis


    Full Text Available Cost-effectiveness in health care management is critical. The situation in debt-stricken Greece is further aggravated by the financial crisis and constant National Health System expense cut-downs. In an effort to minimize the cost of laparoscopy, our department introduced reusable laparoscopic instruments in December 2011. The aim of this study was to assess potential cost reduction of laparoscopic operations in the field of general surgery. Hospital records, invoice lists, and operative notes between January 2012 and December 2013, were retrospectively reviewed and data were collected on laparoscopic procedures, instrument failures, and replacement needs. Initial acquisition cost of 5 basic instrument sets was €21,422. Over the following 24 months, they were used in 623 operations, with a total maintenance cost of €11,487. Based on an average retail price of €490 per set, projected cost with disposable instruments would amount to €305,270, creating savings of €272,361 over the two-year period under study. Despite the seemingly high purchase price, each set amortized its acquisition cost after only 9 procedures and instrument cost depreciated to less than €55 per case. Disposable instruments cost 9 times more than reusable ones, and their high price would almost equal the total hospital reimbursement by social security funds for many common laparoscopic procedures.

  3. "Spaghetti Maneuver": A useful tool in pediatric laparoscopy - Our experience

    Antonio Marte


    Full Text Available Aims: The laparoscopic "Spaghetti Maneuver" consists in holding an organ by its extremity with a grasper and rolling it up around the tool to keep the organ stable and facilitate its traction within a small space. We describe our experience with the "Spaghetti Maneuver" in some minimally invasive procedures. Materials and Methods: We successfully adopted this technique in 13 patients (5F : 8M aged between 6 and 14 years (average age, 10 on whom we performed 7 appendectomies, 2 ureteral reimplantation and 4 cholecystectomies. In all cases, after the first steps, the appendix, the gallbladder and the ureter were rolled around the grasper and easily isolated; hemostasis was thus induced and the organ was mobilized until removal during cholecystectomy and appendectomy, and before the reimplantation in case of ureteral reimplantation. Results: We found that this technique facilitated significantly the acts of holding, isolating and removing, when necessary, the structures involved, which remained constantly within the visual field of the operator. This allowed a very ergonomic work setting, overcoming the problem of the "blind" zone, which represents a dangerous and invisible area out of the operator′s control during laparoscopy. Moreover the isolation maneuvers resulted easier and reduced operating time. Conclusion: We think that this technique is easy to perform and very useful, because it facilitates the dissection of these organs, by harmonizing and stabilizing the force of traction exercised.

  4. Gasless laparoscopy-assisted distal gastrectomy is feasible and useful for non-obese patients with early gastric cancer.

    Hyodo, Masanobu; Hosoya, Yoshinori; Kurashina, Kentarou; Saitoh, Shin; Hirashima, Yuuki; Yokoyama, Taku; Arai, Wataru; Yasuda, Yoshikazu; Nagai, Hideo; Sekiguchi, Chuuji


    To evaluate the feasibility and usefulness of gasless laparoscopy-assisted distal gastrectomy except when treating obese patients compared with open distal gastrectomy for early cancer. We treated 92 patients with distal gastrectomy for early gastric cancer consecutively. Patients with massive submucosal invasion and/or LN swelling were allocated for the open method, and patients with slightly invasive submucosal cancer were allocated for gasless laparoscopy-assisted surgery. As exceptions we employed open surgery for overweight patients and gasless laparoscopy for elderly and/or feeble patients. We attempted to perform open and laparoscopy-assisted surgery on 52 and 40 patients, respectively. Three cases in the laparoscopy-assisted group were converted to open surgery because of obesity. The age was older and BMI was lower in the laparoscopy-assisted group. In terms of operative time and blood loss as well as postoperative recovery, the results for the laparoscopy-assisted group were superior to those of the open surgery group. There were no cases of cardiopulmonary complications for the laparoscopy-assisted group. Gasless laparoscopy-assisted distal gastrectomy is feasible and useful for early gastric cancer except when treating obese patients.


    Ramesh Maturi


    Full Text Available BACKGROUND Laparoscopy has been a new entry in the field of surgery with an active history of around just two decades. Today, it is in a position to challenge the conventional surgery which is in use since ages. It is making rapid inroads into various disciplines of surgery. Rapid improvements in optics, along with improvements in energy devices and mechanical stapling devices gave a fillip to acceptance of laparoscopy by the majority of surgeons. Also accumulating data and evidence has started influencing the sceptical, mobilising them to jump into the bandwagon. Barriers to adoption of new techniques, resistance to learning are common to human nature and it is necessary to have a systematic overview of the issues that might crop, so as to be prepared to overcome the problems of accepting laparoscopy into established centres of surgery. AIMS This publication is a reflection of our experience, our trials and tribulations in taking forward the laparoscopy program at our institution. This publication will give an overview of the steps involved in initiation of laparoscopy and aspires to be a source of answers, for day-to-day issues that crop during the process of learning laparoscopy. METHODS AND MATERIALS Just the way, executing laparoscopic surgery is a team effort, incorporating laparoscopy program in an institution is also a team effort where the members of team extend beyond the operating room. Involvement and co-operation of individuals across departments is a must along with benevolent seniors and a proactive administration. So we collated data by interviewing all the stakeholders of laparoscopy program, analysed observations of the faculty from the operating room and reviewed literature on the world wide web. Opinions of the administrators about their perceptions and the issues faced by the junior staff of the department were taken into consideration. Patients were interviewed before and after laparoscopic surgery. CONCLUSIONS Success at

  6. Laparoscopy decreases complications for obese patients undergoing elective rectal surgery.

    Vargas, Gabriela M; Sieloff, Eric P; Parmar, Abhishek D; Tamirisa, Nina P; Mehta, Hemalkumar B; Riall, Taylor S


    While there are many reported advantages to laparoscopic surgery compared to open surgery, the impact of a laparoscopic approach on postoperative morbidity in obese patients undergoing rectal surgery has not been studied. Our goal was to determine whether obese patients undergoing laparoscopic rectal surgery experienced the same benefits as non-obese patients. We identified patients undergoing rectal resections using the National Surgical Quality Improvement Project Participant Use Data File. We performed multivariable analyses to determine the independent association between laparoscopy and postoperative complications. A total of 26,437 patients underwent rectal resection. The mean age was 58.5 years, 32.6 % were obese, and 47.2 % had cancer. Laparoscopic procedures were slightly less common in obese patients compared to non-obese patients (36.0 vs. 38.2 %, p = 0.0006). In unadjusted analyses, complications were lower with the laparoscopic approach in both obese (18.9 vs. 32.4 %, p obese (15.6 vs. 25.3 %, p obesity worsened. The likelihood of experiencing a postoperative complication increased by 25, 45, and 75 % for obese class I, obese class II, and obese class III patients, respectively. A laparoscopic approach was associated with a 40 % decreased odds of a postoperative complication for all patients (OR 0.60, 95 % CI 0.56-0.64). Laparoscopic rectal surgery is associated with fewer complications when compared to open rectal surgery in both obese and non-obese patients. Obesity was an independent risk factor for postoperative complications. In appropriately selected patients, rectal surgery outcomes may be improved with a minimally invasive approach.

  7. Surgery for inflammatory bowel disease in the era of laparoscopy

    Sica, Giuseppe S; Biancone, Livia


    During the course of inflammatory bowel disease (IBD), surgery may be needed. Approximately 20% of patients with ulcerative colitis (UC) will require surgery, whereas up to 80% of Crohn’s disease (CD) patients will undergo an operation during their lifetime. For UC patients requiring surgery, total proctocolectomy and ileoanal pouch anastomosis (IPAA) is the operation of choice as it provides a permanent cure and good quality of life. Nevertheless a permanent stoma is a good option in selected patients, especially the elderly. Minimally invasive surgery has replaced the conventional open approach in many specialized centres worldwide. Laparoscopic colectomy and restorative IPAA is rapidly becoming the standard of care in the treatment of UC requiring surgery, whilst laparoscopic ileo-cecal resection is already the new gold standard in the treatment of complicated CD of terminal ileum. Short term advantages of laparoscopic surgery includes faster recovery time and reduced requirement for analgesics. It is, however, in the long term that minimally invasive surgery has demonstrated its superiority over the open approach. A better cosmesis, a reduced number of incisional hernias and fewer adhesions are the long term advantages of laparoscopy in IBD surgery. A reduction in abdominal adhesions is of great benefit when a second operation is needed in CD and this influences positively the pregnancy rate in young women undergoing restorative IPAA. In developing the therapeutic plan for IBD patients it should be recognized that the surgical approach to the abdomen has changed and that surgical treatment of complicated IBD can be safely performed with a true minimally invasive approach with great patient satisfaction. PMID:23674844

  8. Laparoscopy or laparotomy? A comparison of 240 patients with early-stage endometrial cancer.

    Santi, Alessandro; Kuhn, Annette; Gyr, Thomas; Eberhard, Markus; Johann, Silke; Günthert, Andreas R; Mueller, Michael D


    This study aimed to compare the safety and efficacy of laparoscopy and laparotomy in the surgical treatment of early endometrial cancer, especially in obese women. The results obtained after laparoscopic surgical treatment of early endometrial cancer (International Federation of Gynecology and Obstetrics (FIGO) stage 1 or 2) in patients between 1996 and 2007 were compared with an age- and tumour-matched historical group of patients treated with laparotomy between 1988 and 1996. All the patients underwent hysterectomy, bilateral salpingo-oophorectomy, and pelvic + or - paraaortic lymphadenectomy. Both groups included 120 patients with a preoperative diagnosis of early endometrial cancer. The postoperative diagnosis was endometrial cancer stage 1 or 2 for 89% of the cases in both groups. The mean operating time was 170 min for the laparotomy group compared with 178 min for the laparoscopy group (nonsignificant difference). The estimated intraoperative blood loss was significantly greater in the laparotomy group, and the hospital stay was significantly shorter in the laparoscopy group. The results show that early endometrial cancer can be treated effectively by laparoscopy. Because of this study's retrospective design, the results should be interpreted with caution. However, the advantages of this method for obese patients are evident. The age and weight of these patients should not be used as a contraindication for laparoscopy.


    Paula Marcela Vilela CASTRO


    Full Text Available Objective To compare the laparotomy and laparoscopy techniques for correction of ventral hernia when related to perioperative complications, length of hospitalization, surgical time, and recurrence of hernia. Methods This was a systematic review of randomized controlled trials, which included studies retrieved from four databases (MEDLINE, Embase, Cochrane and LILACS, using a combination of the terms (Hernia, Ventral and (Laparoscopy and (Laparotomy. Results Six randomized trials were included, totaling 566 patients, 283 in the Laparoscopy group and 283 in the Laparotomy group. Laparoscopy reduced the risk of infection of the surgical wound (NNT = 5 and seroma formation (NNT = 13 and less length hospitalization (P = 0.02 compared to laparotomy in the correction of ventral hernias. Furthermore, laparoscopy increased the incidence of enterotomy (NNH = 25 and post operative pain (NNH = 8 and longer surgical time (P = 0.0009 when compared with laparotomy. There was no difference related to abscess (P = 0.79, hematoma (P = 0.43 and recurrency of ventral hernias (P = 0.25. Conclusions In the correction of ventral hernias, the use of laparoscopic technique is effective to reduce infections of the surgical wound and seroma formation, as well as, decrease the length hospitalization.

  10. Quality of life in patients affected by endometrial cancer: comparison among laparotomy, laparoscopy and vaginal approach.

    Berretta, Roberto; Gizzo, Salvatore; Noventa, Marco; Marrazzo, Vivienne; Franchi, Laura; Migliavacca, Costanza; Michela, Monica; Merisio, Carla; Modena, Alberto Bacchi; Patrelli, Tito Silvio


    The aim of this study is to verify if the surgical approach (laparoscopy/laparotomy/vaginal) in stage-I endometrial cancer treatment, may have effects on intra- and post-operative outcomes and on the patient's quality of life. The study group consisted of patients with histological diagnosis of type-I endometrial adenocarcinoma, stage-I. They were divided into three groups according to surgical approach chosen (laparotomic/laparoscopic/vaginal). Every patient answered a telephone health survey (SF-36) at 30 and 180 days post-surgery. Surgical-operating times, hospitalization length and short/long-term complications after surgery were also compared. The SF-36 survey revealed a better performance status in patients who underwent laparoscopy as compared to those who received laparotomy or vaginal surgery. We found significantly better results considering General Health, Physical Functioning, Role-Physical and Bodily Pain in the laparoscopy group after 30 and 180 days. Patients who underwent laparoscopy had significantly shorter hospitalization and less post-operative complications even if laparoscopy required significantly longer surgical-operating times compared to vaginal surgery. Our data confirm the superiority of the laparoscopic approach respect to the laparotomic and vaginal ones both in term of hospitalization length and post-operative complications.

  11. OsHAL3, a Blue Light-Responsive Protein, Interacts with the Floral Regulator Hd1 to Activate Flowering in Rice.

    Su, Lei; Shan, Jun-Xiang; Gao, Ji-Ping; Lin, Hong-Xuan


    In flowering plants, photoperiodic flowering is controlled by a complicated network. Light is one of the most important environmental stimuli that control the timing of the transition from vegetative growth to reproductive development. Several photoreceptors, including PHYA, PHYB, CRY2, and FKF1 in Arabidopsis and their homologs (OsPHYA, OsPHYB, OsPHYC, and OsCRY2) in rice, have been identified to be related to flowering. Our previous study suggests that OsHAL3, a flavin mononucleotide-binding protein, may function as a blue-light sensor. Here, we report the identification of OsHAL3 as a positive regulator of flowering in rice. OsHAL3 overexpression lines exhibited an early flowering phenotype, whereas downregulation of OsHAL3 expression by RNA interference delayed flowering under an inductive photoperiod (short-day conditions). The change in flowering time was not accompanied by altered Hd1 expression but rather by reduced accumulation of Hd3a and MADS14 transcripts. OsHAL3 and Hd1 colocalized in the nucleus and physically interacted in vivo under the dark, whereas their interaction was inhibited by white or blue light. Moreover, OsHAL3 directly bound to the promoter of Hd3a, especially before dawn. We conclude that OsHAL3, a novel light-responsive protein, plays an essential role in photoperiodic control of flowering time in rice, which is probably mediated by forming a complex with Hd1. Our findings open up new perspectives on the photoperiodic flowering pathway.

  12. The preoperative and postoperative nursing of forty cases of hand-assisted laparocopic resection of colorectal cancer%40例手助腹腔镜结直肠癌根治术术前及术后的护理

    储霞飞; 马瑟琴; 张鹏年


    Objective:To summarize the preoperative and postoperative nursing experience for hand-assisted la-parocopic resection of colorectal cancer.Methods:The clinical nursing data of forty patients with hand-assisted la-parocopic resection of colorectal cancer were analyzed retrospectively.Results:All patients were received successful hand-assisted laparocopic resection.In the preoperative,to strengthen psychological care,nutritional support,bowel preparation,positioning abdominal stoma and skin preparations.In the postoperative,to notice vital signs monitoring,diet and activity guide,pain care,drainage tube care,and ostomy care.Discovered and disposed of intestinal obstruc-tion,pulmonary infection,wound infection and other complications timely,and all patients were recovery.Conclusion:To strengthen preoperative and postoperative care,discovery and dispose complications timely,it was in favour of pa-tient recovery speedy.%目的:总结手助腹腔镜结直肠癌根治术的护理.方法:分析40例手助腹腔镜结直肠癌根治术患者的临床资料.结果:40例患者均成功实施手助腹腔镜结直肠癌根治术,术前加强心理护理、营养支持、肠道准备、肠造口腹部定位及皮肤准备;术后注意生命体征监测、饮食活动指导、疼痛、引流管及造口护理;及时发现并处理肠梗阻、肺部感染、切口感染等并发症,患者均痊愈出院.结论:加强术前及术后护理,早期发现及时处理并发症,有利于患者早日康复.

  13. Cesarean scar pregnancy treated by curettage and aspiration guided by laparoscopy

    Shu S


    Full Text Available Shan-rong Shu, Xin Luo, Zhi-xin Wang, Yu-hong Yao Department of Obstetrics and Gynecology, The First Affiliated Hospital of JiNan University, HuangPu Road West, Guangzhou, People’s Republic of China Abstract: Pregnancy in a cesarean scar is the rarest form of an ectopic pregnancy. The treatment for cesarean scar pregnancy mainly includes systemic methotrexate and uterine artery embolization. Here, we reported a case of cesarean scar pregnancy treated by curettage and aspiration guided by laparoscopy. The treatment plan included two phases. Three days after a combination of methotrexate and mifepristone was administered, the gestational sac was removed under laparoscopy, which enabled a successful treatment for the unruptured ectopic pregnancy in a previous cesarean scar and made it possible to preserve the reproductive capability of the patient. Keywords: cesarean scar pregnancy, laparoscopy, curettage and aspiration 

  14. Total extraperitoneal (TEP) hernioplasty with intestinal resection assisted by laparoscopy for a strangulated Richter femoral hernia.

    Ginestà, Cesar; Saavedra-Perez, David; Valentini, Mauro; Vidal, Oscar; Benarroch, Guerson; García-Valdecasas, Juan Carlos


    We describe the first clinical case of a total extraperitoneal hernioplasty combined with intestinal resection assisted by laparoscopy for a strangulated Richter femoral hernia. The patient was a 94-year-old woman admitted to the emergency room with signs and symptoms of acute small bowel obstruction. Diagnosis of a strangulated left Richter femoral hernia was only possible during the initial exploratory laparoscopy. The extraperitoneal approach for mesh positioning was performed gaining access through an infraumbilical 12 mm trocar incision, and assistance of two 5 mm laparoscopic ports at the hipogastrium and right flank. Laparoscopy was resumed and segmental intestinal resection with primary anastomosis was performed. The patient recovered without complications and was discharged home at the fourth postoperative day. The total extraperitoneal approach for acute hernia repair was successful in our particular case. However, factors such as laparoscopic surgical experience, careful patient selection, and correct preoperative diagnosis must be considered before studies in the emergency setting.

  15. Laparoscopy is safe among patients with congestive heart failure undergoing general surgery procedures

    Speicher, Paul J.; Ganapathi, Asvin M.; Englum, Brian R.; Vaslef, Steven N.


    Background Over the past 2 decades, laparoscopy has been established as a superior technique in many general surgery procedures. Few studies, however, have examined the impact of the use of a laparoscopic approach in patients with symptomatic congestive heart failure (CHF). Because pneumoperitoneum has known effects on cardiopulmonary physiology, patients with CHF may be at increased risk. This study examines current trends in approaches to patients with CHF and effects on perioperative outcomes. Methods The 2005–2011 National Surgical Quality Improvement Program Participant User File was used to identify patients who underwent the following general surgery procedures: Appendectomy, segmental colectomy, small bowel resection, ventral hernia repair, and splenectomy. Included for analysis were those with newly diagnosed CHF or chronic CHF with new signs or symptoms. Trends of use of laparoscopy were assessed across procedure types. The primary endpoint was 30-day mortality. The independent effect of laparoscopy in CHF was estimated with a multiple logistic regression model. Results A total of 265,198 patients were included for analysis, of whom 2,219 were identified as having new or recently worsened CHF. Of these patients, there were 1,300 (58.6%) colectomies, 486 (21.9%) small bowel resections, 216 (9.7%) ventral hernia repairs, 141 (6.4%) appendectomies, and 76 (3.4%) splenectomies. Laparoscopy was used less frequently in patients with CHF compared with their non-CHF counterparts, particularly for nonelective procedures. Baseline characteristics were similar for laparoscopy versus open procedures with the notable exception of urgent/emergent case status (36.4% vs 71.3%; P surgery procedures, particularly in urgent/emergent cases. Despite these patterns and apparent preferences, laparoscopy seems to offer a safe alternative in appropriately selected patients. Because morbidity and mortality were considerable regardless of approach, further understanding of

  16. Moonlighting proteins Hal3 and Vhs3 form a heteromeric PPCDC with Ykl088w in yeast CoA biosynthesis.

    Ruiz, Amparo; González, Asier; Muñoz, Ivan; Serrano, Raquel; Abrie, J Albert; Strauss, Erick; Ariño, Joaquín


    Unlike most other organisms, the essential five-step coenzyme A biosynthetic pathway has not been fully resolved in yeast. Specifically, the genes encoding the phosphopantothenoylcysteine decarboxylase (PPCDC) activity still remain unidentified. Sequence homology analyses suggest three candidates-Ykl088w, Hal3 and Vhs3-as putative PPCDC enzymes in Saccharomyces cerevisiae. Notably, Hal3 and Vhs3 have been characterized as negative regulatory subunits of the Ppz1 protein phosphatase. Here we show that YKL088w does not encode a third Ppz1 regulatory subunit, and that the essential roles of Ykl088w and the Hal3 and Vhs3 pair are complementary, cannot be interchanged and can be attributed to PPCDC-related functions. We demonstrate that while known eukaryotic PPCDCs are homotrimers, the active yeast enzyme is a heterotrimer that consists of Ykl088w and Hal3/Vhs3 monomers that separately provides two essential catalytic residues. Our results unveil Hal3 and Vhs3 as moonlighting proteins involved in both CoA biosynthesis and protein phosphatase regulation.

  17. Magnetic resonance urography and laparoscopy in paediatric urology: a case series.

    Damasio, Maria Beatrice; Costanzo, Sara; Podestà, Emilio; Ghiggeri, Gianmarco; Piaggio, Giorgio; Faranda, Fabio; Degl'Innocenti, Maria Ludovica; Jasonni, Vincenzo; Magnano, Gian Michele; Buffa, Piero; Montobbio, Giovanni; Mattioli, Girolamo


    Paediatric urology often presents challenging scenarios. Magnetic resonance urography (MRU) and laparoscopy are increasingly used. We retrospectively studied children affected by a disease of the upper urinary tract who after MRU were elected for laparoscopic treatment. This pictorial essay draws on our experience; it illustrates some specific MRU findings and highlights the usefulness of MRU for the diagnosis of upper urinary tract pathology in children. It also offers some examples of the potential additional diagnostic information provided by laparoscopy as well as its therapeutic role.

  18. Role of laparoscopy in the diagnosis and treatment of adnexal masses


    Background Laparoscopy has been accepted for years as a management of benign ovarian tumors. The aim of this study was to estimate the feasibility and safety of laparoscopy in diagnosis and management of adnexal masses.Methods A total of 2083 patients with benign adnexal mass were treated by laparoscopy at Peking Union Medical College Hospital from January 2000 to December 2003. Their clinical data were reviewed retrospectively. All the adnexal masses suspicious of malignancy at the time of laparoscopy were sent for frozen section evaluation intraoperatively. The rates of unexpected intracystic vegetation and low malignant potential (LMP) tumor or malignancy were investigated. The sensitivity, specificity, positive predictive value, and negative predictive value of laparoscopic diagnosis for LMP or ovarian malignancies were calculated. The ratios were compared by Chi-square test and the continuous variables were tested using two-tailed t test. Results Of the 2083 patients, 16 had LMP or invasive tumors (0.77%), among which 14 were diagnosed histologically intraoperatively and 2 postoperatively. Fifty-five (2.6%) of the 2083 patients had unexpected intracystic vegetations. Their frozen sections showed benign tumors in 41 (74.5%), LMP tumors in 8 (14.5%), and focal invasive ovarian cancers (stage Ic) in 6 (10.9%). The final pathological diagnosis were benign tumors in 41 (74.5%), LMP tumors 7 (12.7%), and focal invasive ovarian cancers (stage Ic) in 7 (12.7%). Laparoscopy achieved a sensitivity of 87.5%, specificity of 98%, positive predictive value of 25.5%, and negative predictive value of 99.9% in the diagnosis of ovarian malignancies. 2067 cases with benign adnexal masses underwent laparoscopy successfully. No conversion to laparotomy, or intra- and postoperative complications in this series. Of the 16 patients with LMP or invasive ovarian cancer, seven underwent laparoscopic surgery including immediate staging laparoscopy in 3. The mean follow-up was 17.3 months




    Full Text Available ABSTRACT: Chronic abdominal pain is a FREQUENTLY ENCOUNTERED pr oblem and abdominal tuberculosis is a very common cause of the same. Di agnostic laparoscopy is a highly sensitive, specific, and safe procedure for the early diagnosis of abdominal tuberculosis. The procedure is beneficial because it is minimally invasive and prov ides diagnostic benefit in terms of both visual appearances and tissue yield for histopathologi cal and cytological confirmation. We have performed an extensive retrospective study with 250 s ubjects and were able to justify the safety, sensitivity & early selection of laparoscopy as a procedure of choice to confirm tuberculosis in chronic abdominal pain.

  20. An unusual case of intra-abdominal testicular torsion: Role of laparoscopy

    Alfonso Papparella


    Full Text Available The authors report a case of intra-abdominal testicular torsion, where laparoscopy has been useful for diagnosis and surgical management. A boy was presented with a left impalpable testis. Laparoscopy revealed a twisted spermatic cord at the inlet pelvis, which ended in a testicular remnant located in the sub-umbilical area. After orchiectomy, the pathologist confirmed testicular atrophy. Diagnosis of intra-abdominal testicular torsion should be considered in patients with impalpable testis and abdominal pain, but could not be excluded in those with no symptoms.

  1. 3-dimensional versus conventional laparoscopy for benign hysterectomy: protocol for a randomized clinical trial.

    Hoffmann, Elise; Bennich, Gitte; Larsen, Christian Rifbjerg; Lindschou, Jannie; Jakobsen, Janus Christian; Lassen, Pernille Danneskiold


    Hysterectomy is one of the most common surgical procedures for women of reproductive age. Laparoscopy was introduced in the 1990es and is today one of the recommended routes of surgery. A recent observational study showed that operative time for hysterectomy was significantly lower for 3-dimensional compared to conventional laparoscopy. Complication rates were similar for the two groups. No other observational studies or randomized clinical trials have compared 3-dimensional to conventional laparoscopy in patients undergoing total hysterectomy for benign disease. The objective of the study is to determine if 3D laparoscopy gives better quality of life, less postoperative pain, less per- and postoperative complications, shorter operative time, or a shorter stay in hospital and a faster return to work or normal life, compared to conventional laparoscopy for benign hysterectomy. The design is a randomised multicentre clinical trial. Participants will be 400 women referred for laparoscopic hysterectomy for benign indications. Patients will be randomized to 3-dimensional or conventional laparoscopic hysterectomy. Operative procedures will follow the same principles and the same standard whether the surgeon's vision is 3-dimensional or conventional laparoscopy. Primary outcomes will be the impact of surgery on quality of life, assessed by the SF 36 questionnaire, and postoperative pain, assessed by a Visual Analogue scale for pain measurement. With a standard deviation of 12 points on SF 36 questionnaire, a risk of type I error of 3.3% and a risk of type II error of 10% a sample size of 190 patients in each arm of the trial is needed. Secondarily, we will investigate operative time, time to return to work, length of hospital stay, and - and postoperative complications. This trial will be the first randomized clinical trial investigating the potential clinical benefits and harms of 3-dimensional compared to conventional laparoscopy. The results may provide more evidence

  2. Lattice QCD studies on baryon interactions from L\\"uscher's finite volume method and HAL QCD method

    Iritani, Takumi


    A comparative study between the L\\"uscher's finite volume method and the time-dependent HAL QCD method is given for the $\\Xi\\Xi$($^1\\mathrm{S}_0$) interaction as an illustrative example. By employing the smeared source and the wall source for the interpolating operators, we show that the effective energy shifts $\\Delta E_{\\rm eff} (t)$ in L\\"uscher's method do not agree between different sources, yet both exhibit fake plateaux. On the other hand, the interaction kernels $V(\\vec{r})$ obtained from the two sources in the HAL QCD method agree with each other already for modest values of $t$. We show that the energy eigenvalues $\\Delta E(L)$ in finite lattice volumes ($L^3$) calculated by $V(\\vec{r})$ indicate that there is no bound state in the $\\Xi\\Xi(^1\\mathrm{S}_0)$ channel at $m_{\\pi}=0.51$ GeV in 2+1 flavor QCD.

  3. Role of laparoscopy and ultrasound in the management of “impalpable testis” in children

    Iskandar Rahardjo Budianto


    Conclusions: Laparoscopy is superior to ultrasound in the management of impalpable testes when high-resolution ultrasound is not available during the diagnostic process, with respect to both the sensitivity of localizing the testis and being more time and cost effective.

  4. Performance Variables and Professional Experience in Simulated Laparoscopy: A Two-Group Learning Curve Study

    Luursema, J.M.; Rovers, Maroeska M.; Groenier, Marleen; van Goor, Harry


    Objective Virtual reality simulators are increasingly used in laparoscopy training. Such simulators allow objective assessment of performance. However, both low-level variables and overall scores generated by the simulator can be hard to interpret. We present a method to generate intermediate

  5. Evaluation of the appendix during diagnostic laparoscopy, the laparoscopic appendicitis score : a pilot study

    Hamminga, Jenneke T. H.; Hofker, H. Sijbrand; Broens, Paul M. A.; Kluin, Philip M.; Heineman, Erik; Haveman, Jan Willem


    Diagnostic laparoscopy is the ultimate diagnostic tool to evaluate the appendix. Still, according to the literature, this strategy results in a negative appendectomy rate of approximately 12-18 % and associated morbidity. Laparoscopic criteria for determining appendicitis are lacking. The goal of th

  6. Analysis of secondary cytoreduction for recurrent ovarian cancer by robotics, laparoscopy and laparotomy.

    Magrina, Javier F; Cetta, Rachel L; Chang, Yu-Hui; Guevara, Gregory; Magtibay, Paul M


    Analysis of perioperative outcomes and survival of patients with recurrent ovarian cancer undergoing secondary cytoreduction by robotics, laparoscopy, or laparotomy. Retrospective analysis of 52 selected patients with recurrent ovarian cancer undergoing secondary cytoreduction by laparoscopy (9), laparotomy (33) or robotics (10) between January 2006 and December 2010. Comparison was made by a total of 21 factors including age, BMI, number of previous surgeries, tumor type and grade, number of procedures, and 15 types of procedures performed at secondary cytoreduction. For all patients, the mean operating time was 213.8 min, mean blood loss 657.4 ml; and mean hospital stay 7.5 days. Complete debulking was achieved in 75% of patients. Postoperative complications were noted in 36.5% of patients. Overall and progression-free survival at 3-years were 58.8% and 34.1%, respectively. Laparoscopy and robotics had reduced blood loss and hospital stay, while no differences were observed among the three groups for operating time, complications, complete debulking, and survival. Selected patients with recurrent ovarian cancer benefit from a laparoscopic or robotic secondary cytoreduction without compromising survival. Robotics and laparoscopy provide similar perioperative outcomes, and reduced blood loss and shorter hospital stay as compared to laparotomy. Laparotomy seems preferable for patients with widespread peritoneal implants, multiple sites of recurrence, and/or extensive adhesions. Copyright © 2013 Elsevier Inc. All rights reserved.

  7. Diverticulitis of the sigmoid colon. A comparison of CT, colonic enema and laparoscopy

    Stefansson, T. [Univ. Hospital, Uppsala (Sweden). Dept. of Surgery]|[Univ. Hospital, Uppsala (Sweden). Dept. of Epidemiology; Nyman, R. [Univ. Hospital, Uppsala (Sweden). Dept. of Diagnostic Radiology; Nilsson, S. [Univ. Hospital, Uppsala (Sweden). Dept. of Diagnostic Radiology; Ekbom, A. [Univ. Hospital, Uppsala (Sweden). Dept. of Surgery]|[Univ. Hospital, Uppsala (Sweden). Dept. of Epidemiology; Paahlman, L. [Univ. Hospital, Uppsala (Sweden). Dept. of Surgery


    Purpose: To evaluate the use of laparoscopy, CT, colonic enema (CE), and laboratory tests (white blood cell count (WBC), sedimentation rate (SR), and C-reactive protein (CRP)) in diagnosing diverticulitis of the sigmoid colon. Material and Methods: The diagnostic methods were prospectively evaluated in 88 patients, 30 of whom were referred for laparoscopy. Results: Fity-two patients were found to have sigmoid diverticulitis: 20 patients by lanparoscopy, 21 by CT, and 11 by CE combined with one positive laboratory test. Laparoscopy proved to be superior to the other diagnostic methods in diagnosing diverticulitis of the sigmoid colon. CT had a high specificity (1.0; 95% CI: 0.92-1.0) but low sensitivity (0.69; 95% CI: 0.56-0.79) in detecting diverticulitis. CE had a higher sensitivity (0.82; 95% CI: 0.71-0.90) but a lower specificity (0.81; 95% CI: 0.67-0.91) than CT. Conclusion: CT was the best method for diagnosing abdominal pathology outside the colon. CT can be recommended as the first examination in seriously ill patients where abscesses and other causes of the symptoms than diverticulitis must first be rule out. Laparoscopy is probably the most accurate method in diagnosing diverticulitis. (orig.).

  8. Laparoscopy for the management of early-stage endometrial cancer: from experimental to standard of care.

    Acholonu, Uchenna C; Chang-Jackson, Shao-Chun R; Radjabi, A Reza; Nezhat, Farr R


    We performed a search of PUBMED and MEDLINE for articles concerning surgical management of early stage endometrial cancer from 1950 to 2011. From the articles collected we extracted data such as estimated blood loss, operating room time, complications, conversion to laparotomy, and length of hospital stay. Forty-seven relevant sources were analyzed. The patients in the laparoscopy group had less blood loss, fewer complications, longer operating room times, and a shorter length of stay. Lymph node count was similar in both groups. Although obesity is not a contraindication to laparoscopy, it does lead to a higher conversion rate. Route of surgical treatment had no impact on recurrence or survival. Robotic surgery has significant advantages over laparotomy, but advantages over laparoscopy are not as distinct. Laparoscopic hysterectomy offers several advantages over laparotomy. These advantages relate to improvements in patient care with comparable clinical outcome. After careful analysis we believe laparoscopy should be the standard of care for surgical management of early stage endometrial cancer. Copyright © 2012 AAGL. Published by Elsevier Inc. All rights reserved.


    SUSSENBACH, Samanta; SILVA, Everton N; PUFAL, Milene Amarante; ROSSONI, Carina; CASAGRANDE, Daniela Schaan; PADOIN, Alexandre Vontobel; MOTTIN, Cláudio Corá


    Background Although Brazilian National Public Health System (BNPHS) has presented advances regarding the treatment for obesity in the last years, there is a repressed demand for bariatric surgeries in the country. Despite favorable evidences to laparoscopy, the BNPHS only performs this procedure via laparotomy. Aim 1) Estimate whether bariatric surgeons would support the idea of incorporating laparoscopic surgery in the BNPHS; 2) If there would be an increase in the total number of surgeries performed; 3) As well as how BNPHS would redistribute both procedures. Methods A panel of bariatric surgeons was built. Two rounds to answer the structured Delphi questionnaire were performed. Results From the 45 bariatric surgeons recruited, 30 (66.7%) participated in the first round. For the second (the last) round, from the 30 surgeons who answered the first round, 22 (48.9%) answered the questionnaire. Considering the possibility that BNPHS incorporated laparoscopic surgery, 95% of surgeons were interested in performing it. Therefore, in case laparoscopic surgery was incorporated by the BNPHS there would be an average increase of 25% in the number of surgeries and they would be distributed as follows: 62.5% via laparoscopy and 37.5% via laparotomy. Conclusion 1) There was a preference by laparoscopy; 2) would increase the number of operations compared to the current model in which only the laparotomy is available to users of the public system; and 3) the distribution in relation to the type of procedure would be 62.5% and 37.5% for laparoscopy laparotomy. PMID:25409964

  10. Improving standard of care through introduction of laparoscopy for the surgical management of gynecological malignancies.

    Bogani, Giorgio; Cromi, Antonella; Serati, Maurizio; Di Naro, Edoardo; Casarin, Jvan; Pinelli, Ciro; Candeloro, Ilario; Sturla, Davide; Ghezzi, Fabio


    This study aimed to evaluate the impact on perioperative and medium-term oncologic outcomes of the implementation of laparoscopy into a preexisting oncologic setting. Data from consecutive 736 patients undergoing surgery for apparent early stage gynecological malignancies (endometrial, cervical, and adnexal cancers) between 2000 and 2011 were reviewed. Complications were graded per the Accordion classification. Survival outcomes within the first 5 years were analyzed using Kaplan-Meier method. Overall, 493 (67%), 162 (22%), and 81 (11%) had surgery for apparent early stage endometrial, cervical, and adnexal cancer. We assisted at an increase of the number of patients undergoing surgery via laparoscopy through the years (from 10% in the years 2000-2003 to 82% in years 2008-2011; P introduction of laparoscopic approach (P > 0.05). The introduction of laparoscopy did not adversely affect medium-term (within 5 years) survival outcomes of patients undergoing surgery for apparent early stage cancers of the endometrium, uterine cervix, and adnexa (P > 0.05 log-rank test). The introduction of laparoscopy into a preexisting oncologic service allows an improvement of standard of care due to a gain in perioperative results, without detriments of medium-term oncologic outcomes.

  11. Robotics versus laparoscopy - an experimental study of the transfer effect in maiden users

    Kockum Christina C


    Full Text Available Abstract Background Robot-assisted laparoscopy (RL is used in a wide range of operative interventions, but the advantage of this technique over conventional laparoscopy (CL remains unclear. Studies comparing RL and CL are scarce. The present study was performed to test the hypothesis that maiden users master surgical tasks quicker with the robot-assisted laparoscopy technique than with the conventional laparoscopy technique. Methods 20 subjects, with no prior surgical experience, performed three different surgical tasks in a standardized experimental setting, repeated four times with each of the RL and CL techniques. Speed and accuracy were measured. A cross-over technique was used to eliminate gender bias and the experience gained by carrying out the first part of the study. Results The task "tie a knot" was performed faster with the RL technique than with CL. Furthermore, shorter operating times were observed when changing from CL to RL. There were no time differences for the tasks of grabbing the needle and continuous suturing between the two operating techniques. Gender did not influence the results. Conclusion The more advanced task of tying a knot was performed faster using the RL technique than with CL. Simpler surgical interventions were performed equally fast with either technique. Technical skills acquired during the use of CL were transferred to the RL technique. The lack of tactile feedback in RL seemed to matter. There were no differences between males and females.

  12. Evaluation of the appendix during diagnostic laparoscopy, the laparoscopic appendicitis score : a pilot study

    Hamminga, Jenneke T. H.; Hofker, H. Sijbrand; Broens, Paul M. A.; Kluin, Philip M.; Heineman, Erik; Haveman, Jan Willem

    Diagnostic laparoscopy is the ultimate diagnostic tool to evaluate the appendix. Still, according to the literature, this strategy results in a negative appendectomy rate of approximately 12-18 % and associated morbidity. Laparoscopic criteria for determining appendicitis are lacking. The goal of

  13. A Sense of Touch in Laparoscopy: Using Augmented Haptic Feedback to Improve Grasp Control

    Westebring-van der Putten, E.P.


    Laparoscopy is Minimally Invasive Surgery (MIS) that is conducted in the belly alcove and which enables instruments, which enter the body through small incisions, to manipulate tissue. The possible complications arising during laparoscopic surgery are partly caused by improper grasp control on the p

  14. The efficacy of laparoscopy in the diagnosis and management of chronic abdominal pain

    El-labban Gouda


    Full Text Available Background : Chronic abdominal pain is a difficult complaint. It leads to evident suffering and disability, both physically and psychologically. Many diagnostic and therapeutic procedures have been described in literature, but with little proof or evidence of success. Laparoscopy is one of the modalities that could be of benefit in such cases. We aim to evaluate the diagnostic and therapeutic value of laparoscopy in cases with chronic abdominal pain. Materials and Methods : Thirty patients with chronic abdominal pain were included in this prospective descriptive cross-sectional study. The pain in all patients was of unclear etiology despite all the investigative procedures. All patients were subjected to laparoscopic evaluation for their conditions. The findings and outcomes of the laparoscopy were recorded and analyzed. Results : The most common site of pain was the periumbilical region (30%. A definitive diagnosis was made in 25 patients (83.3%, while five patients (16.7% had no obvious pathology. Adhesions were the most common laparoscopic findings (63.3% followed by appendiceal pathology (10%, hernia (3.3%, gall bladder pathology (3.3%, and mesenteric lymphadenopathy (3.3%. Postoperatively, pain relief was achieved in 24 patients (80% after two months. Conclusion : Laparoscopy is an effective diagnostic and therapeutic modality in the management of patients with chronic abdominal pain.

  15. Performance variables and professional experience in simulated laparoscopy: a two-group learning curve study

    Luursema, J.M.; Rovers, M.M.; Groenier, M.; Goor, H. van


    OBJECTIVE: Virtual reality simulators are increasingly used in laparoscopy training. Such simulators allow objective assessment of performance. However, both low-level variables and overall scores generated by the simulator can be hard to interpret. We present a method to generate intermediate perfo

  16. Laparoscopy-promising tool for improvement of reproductive efficiency of small ruminants

    Dovenski Toni


    Full Text Available Assisted reproductive technologies are used to accelerate genetic gain and improve reproductive performances in farm animals, including small ruminants. This technologies include estrous synchronization, artifi cial insemination (AI using fresh, frozen or sexed semen, embryo transfer (ET using in vivo or in vitro produced embryos, and more advanced - cloning and production of transgenic animals. Diagnostic procedures, such as ultrasonography and laparoscopy, have been used as additional tools for monitoring the ovarian response to superovulatory treatment in donor animals as well as for AI and collection and transfer of embryos. The use of laparoscopy for assisted reproduction techniques in Macedonia commenced in the early 90’s, with the acquisition of a set of ,,Karl Storz” equipment. After the adoption of the required routine, our group has completed several scientifi c projects where laparoscopy was used for intrauterine inseminations as well as for recovery and transfer of embryos in both sheep andgoats. In the following period our group endeavored into introduction of laparoscopic insemination in the routine farm practice. Ovine intrauterine/intracornual insemination by frozen-thawed semen resulted with pregnancy rates of 45% and 60%, when AI was performed out of season and during the breeding season, respectively. In goats, this percentage occasionally peaked at 85%. The aim of this article is to review the status of implementation of laparoscopy in Assisted Reproduction Technologies (ART of small ruminants and to present our experience in this field.

  17. Comparison of H/Al stoichiometry of mineral and organic soils in Brazil Comparação da estequiometria H/Al em solos minerais e orgânicos brasileiros

    Daniel Vidal Perez


    Full Text Available Exchangeable Al has been used as a criterion for the calculation of lime requirement in several Brazilian States. However, the laboratory method with extraction by a 1 mol L-1 KCl solution followed by indirect alkaline titration is not accurate for some Brazilian soils, mainly in the case of soils with high organic matter content. The objective of this study was therefore to evaluate the stoichiometry of H+/Al3+ in KCl soil extracts. The results suggested that organically complexed Al is the main contributor to exchangeable acidity in soils enriched with organic matter. Liming recommendations for organic soils based exclusively on exchangeable Al determined by the NaOH titration method should therefore be revised.A determinação de alumínio trocável é utilizada como critério para cálculo de calagem em vários estados brasileiros. Contudo, a determinação indireta pela titulação com NaOH, após extração com solução de KCl 1 mol L-1, pode não ser adequada para certos tipos de solos brasileiros, notadamente aqueles que apresentem altos teores de carbono orgânico. Dessa forma, o principal objetivo deste trabalho foi avaliar a estequiometria da relação H+/Al3+ em extratos de KCl. Os resultados obtidos sugerem que o Al complexado pela matéria orgânica, em solos orgânicos, é o principal contribuinte para a acidez trocável obtida por titulação. Dessa forma, a recomendação de calagem em solos orgânicos baseado somente na determinação de alumínio trocável por titulação com NaOH deve ser revista.

  18. Preserving Different Pasts: The American National Monuments, by Hal Rothman, University of Illinois Press, Urbana and Chicago, 1989

    Terry A. Barnhart


    Full Text Available The national monuments that exist today within our national parks are often perceived as icons of a romantic or even a mythic past Seldom, however, do very personal crusades that were waged to preserve these natural and culture resources intrude upon the public consciousness? Even less frequently are the preservation efforts of the past valued for what they tell us about American culture and how the values of that culture have changed over time. But the archaeological, historic, and natural history sites that comprise our national monuments have layered meanings. Quite apart from their intrinsic value as heritage sites, our effort to preserve perceptions of the past. It is somewhat surprising, therefore, that scholarship on the national monuments proper remained an historiographical backwater. This situation has been rectified, however, with the publication of Hal Rothman's Preserving Different Pasts: The American National Monuments. These national treasurers have at last found an able historian to tell their story.

  19. Comparison of robotic surgery with laparoscopy and laparotomy for treatment of endometrial cancer: a meta-analysis.

    Longke Ran

    Full Text Available To compare the relative merits among robotic surgery, laparoscopy, and laparotomy for patients with endometrial cancer by conducting a meta-analysis.The MEDLINE, Embase, PubMed, Web of Science, and Cochrane Library databases were searched. Studies clearly documenting a comparison between robotic surgery and laparoscopy or between robotic surgery and laparotomy for endometrial cancer were selected. The outcome measures included operating time (OT, number of complications, length of hospital stay (LOHS, estimated blood loss (EBL, number of transfusions, total lymph nodes harvested (TLNH, and number of conversions. Pooled odds ratios and weighted mean differences with 95% confidence intervals were calculated using either a fixed-effects or random-effects model.Twenty-two studies were included in the meta-analysis. These studies involved a total of 4420 patients, 3403 of whom underwent both robotic surgery and laparoscopy and 1017 of whom underwent both robotic surgery and laparotomy. The EBL (p = 0.01 and number of conversions (p = 0.0008 were significantly lower and the number of complications (p<0.0001 was significantly higher in robotic surgery than in laparoscopy. The OT, LOHS, number of transfusions, and TLNH showed no significant differences between robotic surgery and laparoscopy. The number of complications (p<0.00001, LOHS (p<0.00001, EBL (p<0.00001, and number of transfusions (p = 0.03 were significantly lower and the OT (p<0.00001 was significantly longer in robotic surgery than in laparotomy. The TLNH showed no significant difference between robotic surgery and laparotomy.Robotic surgery is generally safer and more reliable than laparoscopy and laparotomy for patients with endometrial cancer. Robotic surgery is associated with significantly lower EBL than both laparoscopy and laparotomy; fewer conversions but more complications than laparoscopy; and shorter LOHS, fewer complications, and fewer transfusions but a longer OT

  20. Vegetación halófila de tres localidades andinas en la vertiente pácifica del sur de perú

    Montesinos, D.B.


    Se describen las comunidades vegetales halófilas halladas en tres ecosistemas andinos en los departamentos de Arequipa y Moquegua (sur de Perú) en campos con influencia de pastoreo, fuego, abandono de agricultura o ocupando suelos inundados en las márgenes de los ríos. Se aplicó la metodología fitos

  1. Vegetación halófila de tres localidades andinas en la vertiente pácifica del sur de perú

    Montesinos, D.B.


    Se describen las comunidades vegetales halófilas halladas en tres ecosistemas andinos en los departamentos de Arequipa y Moquegua (sur de Perú) en campos con influencia de pastoreo, fuego, abandono de agricultura o ocupando suelos inundados en las márgenes de los ríos. Se aplicó la metodología

  2. Vegetación halófila de tres localidades andinas en la vertiente pácifica del sur de perú

    Montesinos, D.B.


    Se describen las comunidades vegetales halófilas halladas en tres ecosistemas andinos en los departamentos de Arequipa y Moquegua (sur de Perú) en campos con influencia de pastoreo, fuego, abandono de agricultura o ocupando suelos inundados en las márgenes de los ríos. Se aplicó la metodología fitos

  3. Differences in clinical features between laparoscopy and open resection for primary tumor in patients with stage IV colorectal cancer

    Kim IY


    Full Text Available Ik Yong Kim,1,* Bo Ra Kim,2,* Hyun Soo Kim,2 Young Wan Kim1 1Department of Surgery, Division of Colorectal Surgery, 2Department of Internal Medicine, Division of Gastroenterology, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do, Korea *These authors contributed equally to this work Purpose: To identify differences in clinical features between laparoscopy and open resection for primary tumor in patients with stage IV colorectal cancer. We also evaluated short-term and oncologic outcomes after laparoscopy and open surgery.Methods: A total of 100 consecutive stage IV patients undergoing open (n=61 or laparoscopic (n=39 major resection were analyzed. There were four cases (10% of conversion to laparotomy in the laparoscopy group.Results: Pathological T4 tumors (56% vs 26%, primary colon cancers (74% vs 51%, and larger tumor diameter (6 vs 5 cm were more commonly managed with open surgery. Right colectomy was more common in the open surgery group (39% and low anterior resection was more common in the laparoscopy group (39%, P=0.002. Hepatic metastases in segments II, III, IVb, V, and VI were more frequently resected with laparoscopy (100% than with open surgery (56%, although the difference was not statistically significant. In colon and rectal cancers, mean operative time and 30-day complication rates of laparoscopy and open surgery did not differ. In both cancers, mean time to soft diet and length of hospital stay were shorter in the laparoscopy group. Mean time from surgery to chemotherapy commencement was significantly shorter with laparoscopy than with open surgery. In colon and rectal cancers, 2-year cancer-specific and progression-free survival rates were similar between the laparoscopy and open surgery groups.Conclusion: Based on our findings, laparoscopy can be selected as an initial approach in patients with a primary tumor without adjacent organ invasion and patients without primary tumor-related symptoms. In selected stage

  4. 手助腹腔镜胃癌 D2根治术的团队配合%Teamwork Cooperation in Hand-assisted Laparoscopic D2 Radical Gastrectomy

    周均; 曹永宽; 宋亚宁; 王永华; 张国虎; 王培红; 李旭


    目的:探讨手助腹腔镜胃癌D2根治术的团队配合技巧及重要性。方法对我中心2010年12月~2013年6月180例手助腹腔镜胃癌D2根治术的临床资料进行回顾性总结。术者及助手相对固定,只需术者及扶镜手两人相互配合,就能完成肿瘤的根治性切除及淋巴结清扫。结果180例均在手助腹腔镜下完成手术,全胃切除术84例,远端胃切除术81例,近端胃切除术15例。手术切口长度(6.9±0.5)cm;术中出血量(226.1±127.0)ml;手术时间(172.2±34.1)min;病检获淋巴结数(17.3±5.0)枚;术后住院时间(9.3±2.0) d。围手术期死亡1例,手术残端癌残留2例。手术相关并发症率6%(11/180)。术后随访1~24个月,失访12例(失访率7%),同时性肝转移4例,异时性淋巴结转移2例,局部复发1例,未发生切口和穿刺口种植。结论良好的团队配合是保证手助腹腔镜胃癌D2根治术的必备条件,对肿瘤的根治程度、手术时间及术后并发症的发生起着至关重要的作用。%Objective To discuss the importance of teamwork coorperation in hand-assisted laparoscopic D2 radical gastrectomy. Methods Clinical materials of 180 patients with gastric cancer undergoing hand-assisted laparoscopic D2 radical gastrectomy from December 2010 to June 2013 were summarized retrospectively.The lymph nodes dissection and radical tumor excision were performed by two persons of cooperation that the operator surgeon worked with camera assistant in a relatively fixed mode in the operation. Results The hand-assisted laparoscopic D2 radical gastrectomy was accomplished in all the patients.Among the 180 patients, gastrectomy was performed in 84 cases, distal gastrectomy in 81 cases, and proximal gastrectomy in 15 cases.The average length of incision was (6.9 ±0.5) cm, the blood loss was (226.1 ±127.0) ml, the operative time was (172.2 ±34.1) min, the number

  5. Comparison of Robotic Surgery with Laparoscopy and Laparotomy for Treatment of Endometrial Cancer: A Meta-Analysis

    Longke Ran; Jing Jin; Yan Xu; Youquan Bu; Fangzhou Song


    Purpose To compare the relative merits among robotic surgery, laparoscopy, and laparotomy for patients with endometrial cancer by conducting a meta-analysis. Methods The MEDLINE, Embase, PubMed, Web of Science, and Cochrane Library databases were searched. Studies clearly documenting a comparison between robotic surgery and laparoscopy or between robotic surgery and laparotomy for endometrial cancer were selected. The outcome measures included operating time (OT), number of complications, len...

  6. Modified esophagogastrostomy in laparoscopy-assisted proximal gastrectomy: A reverse-Tornado anastomosis.

    Kubota, Keisuke; Suzuki, Akihiro; Fujikawa, Aoi; Watanabe, Takayuki; Sekido, Yuki; Shiozaki, Hironori; Taketa, Takashi; Shimada, Gen; Ohigashi, Seiji; Sakurai, Shintaro; Kishida, Akihiro


    The aim of this study was to introduce and examine a modified mechanical end-to-side esophagogastrostomy method ("reverse-Tornado" anastomosis) in laparoscopy-assisted proximal gastrectomy. Five patients with gastric cancer who underwent laparoscopy-assisted proximal gastrectomy were analyzed retrospectively. Esophagogastrostomy in the anterior wall was performed in three patients, and esophagogastrostomy in the posterior wall was performed in two patients. Clinicopathological features, operative outcomes (operative time, operative blood loss), and postoperative outcomes (complications, postoperative hospital stay, reflux esophagitis) were evaluated. Operative time was normal (278 min). There was no marked operative blood loss, postoperative complications, prolonged hospital stay, or reflux esophagitis. Esophagogastrostomy was completed in a normal time with reverse-Tornado anastomosis. This method can be safe and can enable good postoperative quality of life. © 2016 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and John Wiley & Sons Australia, Ltd.

  7. Surgical Treatment of Endometrial Cancer and Atypical Hyperplasia: A Trend Shift from Laparotomy to Laparoscopy

    Erik Qvigstad


    Full Text Available Background. Laparoscopic hysterectomy has proved to be a safe alternative to open surgery in women with benign indications. Few studies compare laparotomy and laparoscopy in gynecologic oncology, and the objective of this study was to analyze the feasibility and development of laparoscopic surgery in endometrial cancer patients. Material and Methods. Records from all women having a hysterectomy due to premalignant or malignant endometrial changes during the years 2002–2009 were examined retrospectively. Results. A total of 521 hysterectomies were performed during the study period. Laparoscopy was performed in about 20% of the cases in the first two years, increasing to 83% in the last year of the period. Moreover, the laparoscopic technique was increasingly applied in older women, more obese women and in women with high-risk preoperative diagnosis, without increasing the complication rate. Conclusions. As for benign indications, laparoscopic hysterectomy in endometrial cancer patients should be preferred whenever possible.

  8. Use of laparoscopy for the evaluation of the reproductive status of tench (Tinca tinca).

    Macrì, F; Rapisarda, G; Marino, G; De Majo, M; Aiudi, G


    The aim of the study was to evaluate the use of laparoscopy for the assessment of the reproductive tract and stage of gonadal development of the tench (Tinca tinca). Laparoscopy was carried out from February to March 2009, on 30 anesthetized tenchs, 15 males and 15 females, of approximately 250 g bodyweight and 30 cm length, using a 1.9-mm rigid cystoscope. Male and female gonads, attached to the swim bladder, were visualized. Testes were orange with a striped appearance. Mature ovaries were cluster-shaped and whitish. Histological samples were collected, from the reproductive organs of both the sexes, with a forceps and showed the presence of gametes at different stages of maturity. The application of this minimally invasive diagnostic imaging technique could clinically be used as a powerful tool to evaluate the gender and to establish the reproductive status of tench and other fish.

  9. PET/CT imaging in head and neck tumors; PET-CT-Bildgebung bei Kopf-Hals-Tumoren

    Roedel, R.; Palmedo, H.; Reichmann, K.; Reinhardt, M.J.; Biersack, H.J. [Universitaetsklinikum Bonn, Klinik und Poliklinik fuer Nuklearmedizin (Germany); Straehler-Pohl, H.J. [Universitaetsklinikum Bonn, Klinik und Poliklinik fuer Hals-, Nasen- und Ohrenheilkunde (Germany); Jaeger, U. [Universitaetsklinikum Bonn, Radiologische Klinik (Germany)


    To evaluate the usefulness of combined PET/CT examinations for detection of malignant tumors and their metastases in head and neck oncology. 51 patients received whole body scans on a dual modality PET/CT system. CT was performed without i.v. contrast. The results were compared concerning the diagnostic impact of native CT scan on FDG-PET images and the additional value of fused imaging. From 153 lesions were 97 classified as malignant on CT and 136 on FDG/PET images, as suspicious for malignancy in 33 on CT and 7 on FDG-PET and as benign in 23 on CT and 10 on FDG-PET. With combined PET/CT all primary and recurrent tumors could be found, the detection rate in patients with unknown primary tumors was 45%. Compared to PET or CT alone the sensitivity, specifity and accuracy could be significantly improved by means of combined PET/CT. Fused PET/CT imaging with [F18]-FDG and native CT-scanning enables accurate diagnosis in 93% of lesions and 90% of patients with head and neck oncology. (orig.) [German] Die Bestimmung der Wertigkeit der kombinierten PET-CT-Untersuchung zum Nachweis maligner Kopf-Hals-Tumoren und ihrer Metastasen. Bei 51 Patienten wurden Ganzkoerperuntersuchungen mit dem kombiniertem PET-CT-System durchgefuehrt. Die CT erfolgte ohne i.v. Kontrastmittelgabe. Die Ergebnisse wurden in ihrer diagnostischen Aussage einerseits getrennt fuer native CT- und FDG-PET-Bildgebung und andererseits fuer das fusionierte Bild verglichen. Von 153 Laesionen wurden 97 im CT und 136 im FDG-PET als maligne, 33 im CT und 7 im FDG-PET als malignitaetsverdaechtig, 23 im CT und 10 in der FDG-PET als benigne beurteilt. Die Anzahl der konkordanten Ergebnisse betrug 94 (61%), die der diskordanten 59 (39 %). Mit der PET-CT konnten alle Primaertumoren und Rezidive entdeckt werden, die Nachweisrate eines unbekannten Primaertumors betrug 45%. Im Vergleich zur alleinigen PET- oder CT-Untersuchung erhoehen sich bei der kombinierten PET-CT Sensitivitaet, Spezifitaet sowie die




    Full Text Available ABSTRACT: BACKGROUND : Chronic idiopathic pain syndromes are among the most challeng ing and demanding conditions to treat across the whole age spectrum. Potentially it can be unrewarding for both the patients and the medical team. Patients with chronic abdominal pain (CAP can undergo numerous diagnostic tests with failure to detect any s tructural or biochemical abnormality. This study was undertaken to assess the diagnostic and therapeutic role of laparoscopy in patients with unexplained chronic abdominal pain (UCAP. PATIENTS AND METHODS: Diagnostic laparoscopy was performed for 100 pati ents with UCAP not diagnosed by usual clinical examination and investigations . The pain in all patients was of unclear etiology despite all the investigative procedures. All patients were subjected to laparoscopic evaluation for their conditions. The findi ngs and outcomes of the laparoscopy were recorded and analyzed. RESULTS: UCAP is common in females (62% than in males. The most frequent laparoscopic findings detected were abdominal adhesions ( 30% , followed by pelvic inflammatory disease ( 25%, abdomina l tuberculosis (12%, chronic appendicitis (8%, mesenteric lymphadenitis (5% and diverticulosis (2%. In 18% of cases no identifiable cause could be found. Follow after 2 months revealed pain relief in 84% irrespective of cause of pain. CONCLUSION: Lapa r oscopy is an effective diagnostic and therapeutic modality in the management of patients with chronic abdominal pain.

  11. Effect of different pneumoperitoneum pressure on stress state in patients underwent gynecological laparoscopy

    Ai-Yun Shen


    Objective:To observe the effect of different CO2 pneumoperitoneum pressure on the stress state in patients underwent gynecological laparoscopy.Methods:A total of 90 patients who were admitted in our hospital from February, 2015 to October, 2015 for gynecological laparoscopy were included in the study and divided into groups A, B, and C according to different CO2 pneumoperitoneum pressure. The changes of HR, BP, and PetCO2 during the operation process in the three groups were recorded. The changes of stress indicators before operation (T0), 30 min during operation (T1), and 12 h after operation (T2) were compared. Results: The difference of HR, BP, and PetCO2 levels before operation among the three groups was not statistically significant (P>0.05). HR, BP, and PetCO2 levels 30 min after pneumoperitoneum were significantly elevated when compared with before operation (P0.05). PetCO2 level 30 min after pneumoperitoneum in group B was significantly higher than that in group A (P0.05).Conclusions:Low pneumoperitoneum pressure has a small effect on the stress state in patients underwent gynecological laparoscopy, will not affect the surgical operation, and can obtain a preferable muscular relaxation and vision field; therefore, it can be selected in preference.

  12. Total intravenous anesthesia using propofol and ketamine for ambulatory gynecologic laparoscopy.

    Cheng, K I; Chu, K S; Fang, Y R; Su, K C; Lai, T W; Chen, Y S; Tang, C S


    Laparoscopy under total intravenous anesthesia (TIVA) with spontaneous respiration is a commonly encountered procedure in ambulatory gynecologic surgery. The purpose of this study was to evaluate the efficacy of TIVA using propofol and ketamine, compared with endotracheal inhalational general anesthesia (EIGA) for ambulatory gynecologic laparoscopy. Fifty-eight female patients, aged 17-48 years, were randomly allocated into two groups. Group 1 (TIVA) (n = 28) received propofol at the induction of anesthesia followed by propofol infusion for maintenance. Intravenous ketamine 0.5 mg/kg was administered before operation for anesthetic effect. Natural airway and spontaneous breathing were then maintained in patients. Group 2 (n = 30) received EIGA with isoflurane under controlled ventilation. We found that the two groups demonstrated similar trend characters of pH and PaCO2 during operation and in recovery room. The incidence of postoperative vomiting was higher in group 2 than in group 1 (30% vs. 7%; p sore throat was higher in group 2 than in group 1 (47% vs. 7%; p < 0.001). We conclude that TIVA with spontaneous respiration is suitable for ambulatory gynecologic laparoscopy.

  13. [Efficacy evaluation of laparoscopy-assisted radical gastrectomy in obese patients with gastric cancer].

    Yang, Hong; Xing, Jiadi; Cui, Ming; Zhang, Chenghai; Yao, Zhendan; Zhang, Nan; Su, Xiangqian


    To investigate the influence of obesity on short-term outcomes after laparoscopy-assisted radical gastrectomy. Clinical data of 214 patients with gastric cancer, who underwent laparoscopy-assisted radical gastrectomy between May 2009 and December 2012 were analyzed retrospectively. Patients were divided into two groups, consisting of obese and non-obese patients. In the obese group, the BMI was ≥ 25.0 kg/m² (n=66), and in the non-obese group was obese group than that in non-obese group [(271.5 ± 51.2) min vs. (252.1 ± 53.6) min, Pobese group was less than that in non-obese group (26.2 ± 10.3 vs. 30.3 ± 12.4, P0.05). There were no significant differences between the two groups with respect to postoperative complications rate (25.8% vs. 20.9%, P>0.05) and perioperative mortality (1.5% vs. 0.7%, P>0.05). However, minor surgery-related complication rate was higher in obese group(16.7% vs. 6.8%, Pgastric emptying. There was no difference in perioperative mortality between the two groups (1.5% vs. 0.7%, P>0.05). Although obesity prolongs the duration of laparoscopy-assisted radical gastrectomy, and increases the risk of minor surgery-related complications, it has no influence on the surgical safety.

  14. [Should a laparoscopy be necessary in case of infertility with normal tubes at hysterosalpingography?].

    Merviel, P; Lourdel, E; Brzakowski, M; Garriot, B; Mamy, L; Gagneur, O; Nasreddine, A


    The aetiological assessment of an infertile couple includes several complementary biological and morphological examinations. Initial exploration of the female genital tract requires the performance of pelvic ultrasound and hysterosalpingography. The value of systematic laparoscopy in infertility assessment is still subject to debate. The aim of the present review is to evaluate arguments against the systematic use of laparoscopy and to define the place of the other tests as Chlamydia Trachomatis serology, hysterosalpingosonography and MR-IRM. In our opinion, laparoscopy is of course indicated in infertility assessments not only when anomalies are revealed by hysterosalpingography but also in the following circumstances: past history of infection (especially a positive Chlamydia antibody blood test) and/or pelvic surgery (a significant risk of adhesions), unexplained secondary infertility, unexplained infertility after the age of 38 (when choosing between artificial insemination and direct enrolment in an IVF programme) and failure of 3 cycles of good-quality intra-uterine inseminations (with ovarian stimulation and a sufficient number of spermatozoids). Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  15. Laparoscopy in the Diagnosis and the Treatment of Infertility (Analysis of 340 consecutive cases)

    葛春晓; 刘梦梅; 丁慧娟; 曹雪芬


    Three hundred and forty patients suffering from primary and secondary infertility were investigated by laparoscopy with the following results. 1. The substantial and most common causes of infertility were related to chronic pelvic inflammatory disease and pelvic endometriosis. 2. Comparison of the result of chromopertubation under direct vision during laparoscopy with the preoperative results with hysterosalpingography and phenolphthaline tubal instillation test showed significant difference (P<0.01). In the tubal patent group the compatibility of the results was 90.2% and 79% respectively whereas in the obstructed tubal group the discrepancy between the results was 50.5% and 59% respectively. 3. With the aid of laparoscopic investigation, the underlying cause of infertility could be verified in 97.6% of the patients. In 53.2% of the cases 14 different kinds of operations were performed directly under the laparascope,while 12.9% of the cases required laparotomy. In 58.5% of the patients laparoscopy was performed in combination with hysteroscopy and 26 operations,consisting of uterine septum resection and intrauterine adhesiolysi8 were completed undder the monitoring of the laparoscope.

  16. Clinical Study on Endometrial Ovarian Cyst Treated by Combined Laparoscopy and Chinese Herbal Medicine


    Objective: To investigate a new method of combined laparoscopy edici ne (CHM) in treating endometrial ovarian cyst. Methods: One hundre d and fifty-two patients with endometrial ovarian cyst three therapies: combined laparoscopy with CHM (combination group), CHM (TCM group) and To compare the clinical efficacy and side-effects shown by the three groups and to elucidate the therapeutic mechanism by ne hormone, plasma prostaglandin F 2α , prostaglandin E 2 etc. Results: The shrinking rate, ate of the cysts and markedly effective rate in the combination group were obviously higher than those in the TCM group and WM bination group was also higher than that of the WM group (P<0.05). Few side-effects constituted age for the combination g roup and TCM group. After treatment, the plasm a prostaglandin F 1α lowered remarkably, serum obviously (P<0. 01, P<0.05). Conclusion: The laparoscopy and CHM combination therapy is a new method in cyst which has signifi cant efficacy, minimal adverse effect and maximal preservation of reproductive function.

  17. Emergency diagnostic laparoscopy in abdominal trauma: a study of 41 patients

    Marcos Félix Osorio Pagola


    Full Text Available Background: laparoscopy is a test used in the patients with abdominal trauma with suspicion of intra-abdominal organic damage and an imminent surgical behavior. Objectives: to expose the results of the urgency laparoscopic diagnosis in the traumatic acute abdomen. Methods: an descriptive and retrospective study in patient with diagnosis of abdominal trauma to which were carried out urgency laparoscopy at the Hospital Dr. Gustavo Aldereguía Lima", from january 2001 to december 2008, when not being possible to define injury of intra-abdominal viscera performing other tests. Inclusion and exclusion criterion were applied. Results: we study 41 patients with average of 39, 2 ± 7, 7 years. Most of the studied patients were in the age range from 31 to 40 years with 21 patients (51, 2 % the open abdominal trauma with 26 patients prevailed (63, 4 %. The masculine sex prevailed with 38 patients (92,7 % and as much the open trauma as the closed one were more frequent in this sex with 25 patients (96,2 % and 13 patients (86,7 % respectively. They didn't show visceral damage during the laparoscopy 93, 3 % of the patients with closed abdominal trauma by what the surgical treatment was avoided, the same as in the patients with open abdominal trauma which had a non penetrating damage in abdominal cavity (80, 8 %. Conclusion: laparoscopic diagnosis is a useful test in patients with abdominal trauma and it avoids a considerable number of unnecessary conventional surgical treatment.

  18. Is laparoscopy an advantage in the diagnosis of cirrhosis in chronic hepatitis C virus infection?

    Perdita Wietzke-Braun; Felix Braun; Peter Schott; Giuliano Ramadori


    AIM: To evaluate the potential of laparoscopy in the diagnosis of cirrhosis and outcome of interferon treatment in HCV-infected patients.METHODS: In this retrospective study, diagnostic laparoscopy with laparoscopic liver biopsy was performed in 72 consecutive patients with chronic HCV infection. The presence or absence of cirrhosis was analyzed macroscopically by laparoscopy and microscopically by liver biopsy specimens. Clinical and laboratory data and outcome of interferon-alfa treatment were compared between cirrhotic and noncirrhotic patients.RESULTS: Laparoscopically, cirrhosis was seen in 29.2%(21/72) and non-cirrhosis in 70.8% (51/72) of patients.Cirrhotic patients were significantly older with a significant longer duration of HCV infection than noncirrhotic patients.Laboratory parameters (AST, y-GT, y-globulin fraction) were measured significantly higher as well as significantly lower (prothrombin index, platelet count) in cirrhotic patients than in non-cirrhotic patients. Histologically, cirrhosis was confirmed in 11.1% (8/72) and non cirrhosis in 88.9% (64/72). Patients with macroscopically confirmed cirrhosis (n=21) showed histologically cirrhosis in 38.1% (8/21) and histologically noncirrhosis in 61.9% (13/21). In contrast, patients with macroscopically non-cirrhosis (n=51) showed histologically non cirrhosis in all cases (51/51). Thirty-nine of 72 patients were treated with interferon-alfa, resulting in 35.9% (14/39)patients with sustained response and 64.1% (25/39) with non response. Non-responders showed significantly more macroscopically cirrhosis than sustained responders. In contrast, there were no significant histological differences between non-responders and sustained responders.CONCLUSION: Diagnostic laparoscopy is more accurate than liver biopsy in recognizing cirrhosis in patients with chronic HCV infection. Liver biopsy is the best way to assess inflammatory grade and fibrotic stage. The invasive marker for staging, prognosis and

  19. Cytochrome c-554 from Methylosinus trichosporium OB3b; a protein that belongs to the cytochrome c2 family and exhibits a HALS-Type EPR signal.

    Espen Harbitz

    Full Text Available A small soluble cytochrome c-554 purified from Methylosinus trichosporium OB3b has been purified and analyzed by amino acid sequencing, mass spectrometry, visible, CD and EPR spectroscopies. It is found to be a mono heme protein with a characteristic cytochrome c fold, thus fitting into the class of cytochrome c(2, which is the bacterial homologue of mitochondrial cytochrome c. The heme iron has a Histidine/Methionine axial ligation and exhibits a highly anisotropic/axial low spin (HALS EPR signal, with a g(max at 3.40, and ligand field parameters V/ξ = 0.99, Δ/ξ = 4.57. This gives the rhombicity V/Δ = 0.22. The structural basis for this HALS EPR signal in Histidine/Methionine ligated hemes is not resolved. The ligand field parameters observed for cytochrome c-554 fits the observed pattern for other cytochromes with similar ligation and EPR behaviour.

  20. Anti-corrosion film formed on HAl77-2 copper alloy surface by aliphatic polyamine in 3 wt.% NaCl solution

    Yu, Yinzhe; Yang, Dong; Zhang, Daquan; Wang, Yizhen; Gao, Lixin


    The corrosion inhibition of a polyamine compound, N-(4-amino-2, 3-dimethylbutyl)-2, 3-dimethylbutane-1, 4-diamine (ADDD), was investigated for HAl77-2 copper alloy in 3 wt.% NaCl solution. Electrochemical measurements, scanning electron microscopy (SEM), atomic force microscope (AFM) and Fourier transform infrared spectroscopy (FT-IR) techniques were employed for this research. The results show that ADDD strongly suppresses the corrosion of HAl77-2 alloy. The inhibition efficiency of ADDD is 98.6% at 0.5 mM, which is better than benzotriazole (BTAH) at the same concentration. Polarization curves indicate that ADDD is an anodic type inhibitor. Surface analysis suggests that a protective film is formed via the interaction of ADDD and copper. FT-IR reveals that the inhibition mechanism of ADDD is dominated by chemisorption onto the copper alloy surface to form an inhibition film. Furthermore, quantum chemical calculation and molecular dynamics (MD) simulations methods show that ADDD adsorbs on HAl77-2 surface via amino group in its molecule.

  1. Results of the surgical treatment of non-advanced megaesophagus using Heller-Pinotti's surgery: Laparotomy vs. Laparoscopy

    Luiz Roberto Lopes


    Full Text Available INTRODUCTION: Dysphagia is the important symptom in achalasia, and surgery is the most common treatment. The Heller-Pinotti technique is the method preferred by Brazilian surgeons. For many years, this technique was performed by laparotomy, and now the laparoscopic method has been introduced. The objective was to evaluate the immediate and long-term results of patients submitted to surgery by either laparotomy or laparoscopy. MATERIALS AND METHODS: A total of 67 patients submitted to surgery between 1994 and 2001 with at least 5 years of follow-up were evaluated retrospectively and divided into two groups: laparotomy (41 patients and laparoscopy (26 patients. Chagas was the etiology in 76.12% of cases. Dysphagia was evaluated according to the classification defined by Saeed et al. RESULTS: There were no cases of conversion to open surgery. The mean duration of hospitalization was 3.32 days for laparotomy and 2.54 days for laparoscopy (p<0.05. An improvement in dysphagia occurred with both groups reporting good or excellent results (laparotomy: 73.17% and laparoscopy: 73.08%. Mean duration of follow-up was 8 years. CONCLUSIONS: There was no difference between the two groups with respect to relief from dysphagia, thereby confirming the safety and effectiveness of the Heller-Pinotti technique, which can be performed by laparotomy or laparoscopy, depending on the surgeon's experience.

  2. Effects of the deletion and over-expression of Fusarium graminearum gene FgHal2 on host response to mycovirus Fusarium graminearum virus 1.

    Yu, Jisuk; Lee, Kyung-Mi; Son, Moonil; Kim, Kook-Hyung


    The mycovirus Fusarium graminearum virus 1 (FgV1) is associated with reduced virulence (hypovirulence) of Fusarium graminearum. Transcriptomic and proteomic expression profiling have shown that many F. graminearum genes are differentially expressed as a consequence of FgV1 infection. Several of these genes may be related to the maintenance of the virus life cycle. The host gene, FgHal2, which has a highly conserved 3'-phosphoadenosine 5'-phosphatase (PAP phosphatase-like) domain or inositol monophosphatase (IMPase) superfamily domain, shows reduced expression in response to FgV1 infection. We generated targeted gene deletion and over-expression mutants to clarify the possible function(s) of FgHal2 and its relationship to FgV1. The gene deletion mutant showed retarded growth, reduced aerial mycelia formation and reduced pigmentation, whereas over-expression mutants were morphologically similar to the wild-type (WT). Furthermore, compared with the WT, the gene deletion mutant produced fewer conidia and these showed abnormal morphology. The FgHal2 expression level was decreased by FgV1 infection at 120 h post-inoculation (hpi), whereas the levels were nine-fold greater for both the virus-free and virus-infected over-expression mutant than for the WT. FgV1 RNA accumulation was decreased in the deletion mutant at 48, 72 and 120 hpi. FgV1 RNA accumulation in the over-expression mutant was reduced relative to that of the WT at 48 and 120 hpi, but was similar to that of the WT at 72 hpi. The vertical transmission rate of FgV1 in the gene deletion mutant was low, suggesting that FgHal2 may be required for the maintenance of FgV1 in the host cell. Together, these results indicate that the putative 3'(2'),5'-bisphosphate nucleotidase gene, FgHal2, has diverse biological functions in the host fungus and may affect the viral RNA accumulation and transmission of FgV1.

  3. Management of Peritonitis After Minimally Invasive Colorectal Surgery: Can We Stick to Laparoscopy?

    Marano, Alessandra; Giuffrida, Maria Carmela; Giraudo, Giorgio; Pellegrino, Luca; Borghi, Felice


    Although laparoscopy is becoming the standard of care for the treatment of colorectal disease, its application in case of postoperative peritonitis is still not widespread. The objective of this article is to evaluate the role of laparoscopy in the management of postoperative peritonitis after elective minimally invasive colorectal resection for malignant and benign diseases. Between April 2010 and May 2016, 536 patients received primary minimally invasive colorectal surgery at our Department. Among this series, we carried out a retrospective study of those patients who, having developed signs of peritonitis, were treated with a laparoscopic reintervention. Patient demographics, type of complication and of the main relaparoscopic treatment, and main outcomes of reoperation were recorded. A total of 20 patients (3.7%) underwent relaparoscopy for the management of postoperative peritonitis, of which exact causes were detected by laparoscopy in 75% as follows: anastomotic leakage (n = 8, 40%), colonic ischemia (n = 2, 10%), iatrogenic bowel tear (n = 4, 20%), and other (n = 1, 5%). The median time between operations was 3.5 days (range, 2-8). The laparoscopic reintervention was tailored case by case and ranged from lavage and drainage to redo anastomosis with ostomy fashioning. Conversion rate was 10% and overall morbidity was 50%. No cases required additional surgery and 30-day mortality was nil. Three patients (15%) were admitted to intensive care unit for 24-hour surveillance. Our experience suggests that in experienced hands and in hemodynamically stable patients, a prompt laparoscopic reoperation appears as an accurate diagnostic tool and an effective and safe option for the treatment of postoperative peritonitis after primary colorectal minimally invasive surgery.

  4. The efficacy of virtual reality simulation training in laparoscopy: a systematic review of randomized trials.

    Larsen, Christian Rifbjerg; Oestergaard, Jeanett; Ottesen, Bent S; Soerensen, Jette Led


    Virtual reality (VR) simulators for surgical training might possess the properties needed for basic training in laparoscopy. Evidence for training efficacy of VR has been investigated by research of varying quality over the past decade. To review randomized controlled trials regarding VR training efficacy compared with traditional or no training, with outcome measured as surgical performance in humans or animals. In June 2011 Medline, Embase, the Cochrane Central Register of Controlled Trials, Web of Science and Google Scholar were searched using the following medical subject headings (MeSh) terms: Laparoscopy/standards, Computing methodologies, Programmed instruction, Surgical procedures, Operative, and the following free text terms: Virtual real* OR simulat* AND Laparoscop* OR train* Controlled trials. All randomized controlled trials investigating the effect of VR training in laparoscopy, with outcome measured as surgical performance. A total of 98 studies were screened, 26 selected and 12 included, with a total of 241 participants. Operation time was reduced by 17-50% by VR training, depending on simulator type and training principles. Proficiency-based training appeared superior to training based on fixed time or fixed numbers of repetition. Simulators offering training for complete operative procedures came out as more efficient than simulators offering only basic skills training. Skills in laparoscopic surgery can be increased by proficiency-based procedural VR simulator training. There is substantial evidence (grade IA - IIB) to support the use of VR simulators in laparoscopic training. © 2012 The Authors  Acta Obstetricia et Gynecologica Scandinavica© 2012 Nordic Federation of Societies of Obstetrics and Gynecology.

  5. 5-millimeter Trocar-site Hernias After Laparoscopy Requiring Surgical Repair.

    Pereira, Nigel; Hutchinson, Anne P; Irani, Mohamad; Chung, Eric R; Lekovich, Jovana P; Chung, Pak H; Zarnegar, Rasa; Rosenwaks, Zev


    Trocar-site hernias are rare complications of laparoscopic surgery. Although trocar-site hernias occur more often at >10-mm sites, hernias can still develop at 5-mm sites after laparoscopy and can lead to serious complications. The primary objective of this review is to summarize the current medical literature pertaining to the clinical presentation and predisposing risk factors of trocar-site hernias at 5-mm sites after laparoscopy. A total of 295 publications were identified, 17 (5.76%) of which met the inclusion criteria. Twenty-seven patients with trocar-site hernias were identified after laparoscopic cases. The median age (interquartile range) for all adult patients with trocar-site hernias was 63 years (interquartile range, 39.5-66.5 years). Eight of the 18 patients (44.4%) undergoing gynecologic laparoscopy were parous although details of parity were not reported in most publications. Simple manual reduction or laparoscopic reduction with fascial closure (21 patients [84%]) was used more often compared with exploratory laparotomy (4 patients [16%], p manipulation can extend 5-mm fascial incisions, thereby increasing the risk of trocar-site hernias. Parous women older than 60 years may have unrecognized fascial defects, which confer a higher risk of trocar-site hernias after laparoscopic surgery, even in the absence of incision manipulation or prolonged surgical duration. Such patients may benefit from closure of 5-mm fascial incisions although prospective data are required to validate the overall generalizability of this management strategy.

  6. Validating a standardized laparoscopy curriculum for gynecology residents: a randomized controlled trial.

    Shore, Eliane M; Grantcharov, Teodor P; Husslein, Heinrich; Shirreff, Lindsay; Dedy, Nicolas J; McDermott, Colleen D; Lefebvre, Guylaine G


    Residency programs struggle with integrating simulation training into curricula, despite evidence that simulation leads to improved operating room performance and patient outcomes. Currently, there is no standardized laparoscopic training program available for gynecology residents. The purpose of this study was to develop and validate a comprehensive ex vivo training curriculum for gynecologic laparoscopy. In a prospective, single-blinded randomized controlled trial (Canadian Task Force Classification I) postgraduate year 1 and 2 gynecology residents were allocated randomly to receive either conventional residency training or an evidence-based laparoscopy curriculum. The 7-week curriculum consisted of cognitive didactic and interactive sessions, low-fidelity box trainer and high-fidelity virtual reality simulator technical skills, and high-fidelity team simulation. The primary outcome measure was the technical procedure score at laparoscopic salpingectomy with the use of the objective structured assessment of laparoscopic salpingectomy tool. Secondary outcome measures related to performance in multiple-choice questions and technical performance at box trainer and virtual reality simulator tasks. A sample size of 10 residents per group was planned (n = 20). Results are reported as medians (interquartile ranges), and data were compared between groups with the Mann-Whitney U, chi-square, and Fisher's exact tests (P ≤ .05). In July 2013, 27 residents were assigned randomly (14 curriculum, 13 conventional). Both groups were similar at baseline. Twenty-one residents (10 curriculum, 11 conventional) completed the surgical procedure-based assessment in the operating room (September to December 2013). Our primary outcome indicated that curriculum-trained residents displayed superior performance at laparoscopic salpingectomy (P = .043). Secondary outcomes demonstrated that curriculum-trained residents had higher performance scores on the cognitive multiple

  7. A lithium-sensitive and sodium-tolerant 3'-phosphoadenosine-5'-phosphatase encoded by halA from the cyanobacterium Arthrospira platensis is closely related to its counterparts from yeasts and plants.

    Zhang, Ju-Yuan; Zou, Jie; Bao, Qiyu; Chen, Wen-Li; Wang, Li; Yang, Huanming; Zhang, Cheng-Cai


    3'-Phosphoadenosine-5'-phosphatase (PAPase) is required for the removal of toxic 3'-phosphoadenosine-5'-phosphate (PAP) produced during sulfur assimilation in various eukaryotic organisms. This enzyme is a well-known target of lithium and sodium toxicity and has been used for the production of salt-resistant transgenic plants. In addition, PAPase has also been proposed as a target in the treatment of manic-depressive patients. One gene, halA, which could encode a protein closely related to the PAPases of yeasts and plants, was identified from the cyanobacterium Arthrospira (Spirulina) platensis. Phylogenic analysis indicated that proteins related to PAPases from several cyanobacteria were found in different clades, suggesting multiple origins of PAPases in cyanobacteria. The HalA polypeptide from A. platensis was overproduced in Escherichia coli and used for the characterization of its biochemical properties. HalA was dependent on Mg2+ for its activity and could use PAP or 3'-phosphoadenosine-5'-phosphosulfate as a substrate. HalA is sensitive to Li+ (50% inhibitory concentration [IC50] = 3.6 mM) but only slightly sensitive to Na+ (IC50 = 600 mM). The salt sensitivity of HalA was thus different from that of most of its eukaryotic counterparts, which are much more sensitive to both Li+ and Na+, but was comparable to the PAPase AtAHL (Hal2p-like protein) from Arabidopsis thaliana. The properties of HalA could help us to understand the structure-function relationship underlying the salt sensitivity of PAPases. The expression of halA improved the Li+ tolerance of E. coli, suggesting that the sulfur-assimilating pathway is a likely target of salt toxicity in bacteria as well.

  8. The impact of a high body mass index on laparoscopy assisted gastrectomy for gastric cancer.

    Lee, Hyuk-Joon; Kim, Hyung-Ho; Kim, Min-Chan; Ryu, Seong-Yeob; Kim, Wook; Song, Kyo-Young; Cho, Gyu-Seok; Han, Sang-Uk; Hyung, Woo Jin; Ryu, Seung-Wan


    Obesity is known to be associated with postoperative morbidity in gastric cancer surgery, but its impact on laparoscopy assisted gastrectomy (LAG) for gastric cancer has rarely been evaluated. The clinical data for 1,485 LAG procedures for gastric cancer in 10 institutions were reviewed. The patients were divided into high body mass index (BMI) (BMI > or = 25 kg/m(2); n = 432) and low BMI (BMI gastric cancer. However, when a surgeon is relatively inexperienced with LAG, a careful approach is required for male patients with a high BMI.

  9. Early colon cancer within a diverticulum treated by magnifying chromoendoscopy and laparoscopy

    Kuang; I; Fu; Yukihiro; Hamahata; Yasunobu; Tsujinaka


    We report a unique case of intramucosal carcinoma in a tubulovillous adenoma arising from a single diverticulum.Endoscopic mucosal resection(EMR)was carried out successfully and completely with the assistance of laparoscopy.A 71-year-old man was admitted to our hospital because of melena and anemia.Emergent colonoscopy showed diverticulosis in the right-sided colon.However,endoscopy could not exactly detect the bleeding site.A flat elevated polyp was found within a single diverticulum located in the descend...

  10. The role of laparoscopy in the identification and management of missing accessory spleens after primary splenectomy: A case report and literature review

    Vaos, George; Mantadakis, Elpis; Gardikis, Stefanos; Pitiakoudis, Michael


    We present a 7-year-old boy with recurrent thrombocytopenia after primary laparoscopic splenectomy for immune thrombocytopenia (ITP). Imaging modalities (ultrasound, computed tomography scan, and scintigraphy) revealed two accessory spleens while the subsequent second laparoscopy revealed 11, which were successfully removed. The relevant medical literature is reviewed, and the value of laparoscopy for chronic ITP is highlighted. PMID:27695216

  11. Comparing surgical outcomes in obese women undergoing laparotomy, laparoscopy, or laparotomy with panniculectomy for the staging of uterine malignancy.

    Eisenhauer, Eric L; Wypych, Kelly A; Mehrara, Babak J; Lawson, Carrie; Chi, Dennis S; Barakat, Richard R; Abu-Rustum, Nadeem R


    Limiting surgical morbidity while maintaining staging adequacy is a primary concern in obese patients with uterine malignancy. The goal of this study was to compare the surgical adequacy and postoperative morbidity of three surgical approaches to staging the disease of obese women with uterine cancer. The records of all patients with a body mass index (BMI) of >or=35 undergoing primary surgery for uterine corpus cancer at our institution from January 1993 to May 2006 were reviewed. Patients were assigned to three groups on the basis of planned surgical approach-standard laparotomy, laparoscopy, or laparotomy with panniculectomy. Standard statistical tests appropriate to group size were used to compare the three groups. In all, 206 patients with a BMI of >or=35 were grouped as follows: laparotomy, 154 patients; laparoscopy, 25 patients; and laparotomy with panniculectomy, 27 patients. Median BMI was 41 (range, 35-84). Regional lymph nodes were removed in 45% of the laparotomy patients, 40% of the laparoscopy patients, and 70% of the panniculectomy patients (P = .04). Compared with laparotomy, both laparoscopy and panniculectomy yielded higher median pelvic and total lymph node counts (P = .001). Operative time was shortest after standard laparotomy, and blood loss was greatest after panniculectomy. The incidence of all incisional complications was lower for panniculectomy (11%) and laparoscopy (8%) compared with standard laparotomy (35%) (P = .002). On multivariate analysis, a significantly lower risk of total incisional complications was seen for patients undergoing panniculectomy (risk ratio, .25; 95% confidence interval, .071-.88) and laparoscopy (risk ratio, .19; 95% confidence interval, .04-.94). Both laparoscopic staging and panniculectomy in a standardized fashion were associated with an improved lymph node count and a lower rate of incisional complications than laparotomy alone. Although definitive conclusions are limited by low patient numbers, the

  12. [Laparoscopy as a method of final diagnosis of acute adhesive small bowel obstruction in a previously unoperated patients].

    Timofeev, M E; Shapoval'iants, S G; Fedorov, E D; Polushkin, V G


    The article presents the use of laparoscopic interventions in 38 patients with Acute Adhesive Small Bowel Obstruction (AASBO) in patients without previous history of abdominal surgery. Clinical, radiological and ultrasound patterns of disease are analyzed. The use of laparoscopy has proved itself the most effective and relatively safe diagnostic procedure. In 14 (36.8%) patients convertion to laparotomy was made due to contraindications for laparoscopy. In 24 (63.2%) patients laparosopic adhesyolisis was performed and AASBO subsequently treated with complications rate of 4.2%.

  13. 'Money for nothing'. The role of robotic-assisted laparoscopy for the treatment of endometriosis.

    Berlanda, Nicola; Frattaruolo, Maria Pina; Aimi, Giorgio; Farella, Marilena; Barbara, Giussy; Buggio, Laura; Vercellini, Paolo


    Despite higher costs for robotic-assisted laparoscopy (RAL) than standard laparoscopy (SL), RAL treatment of endometriosis is performed without established indications. PubMed/MEDLINE was searched for 'robotic surgery' and 'endometriosis' or 'gynaecological benign disease' from January 2000 to December 2016. Full-length studies in English reporting original data were considered. Among 178 articles retrieved, 17 were eligible: 11 non-comparative (RAL only) and six comparative (RAL versus SL). Non-comparative studies included 445 patients. Mean operating time, blood loss and hospital stay were 226 min, 168 ml and 4 days. Major complications and laparotomy conversions were 3.1% and 1.3%. Eight studies reported pain improvement at 15-month follow-up. Comparative studies were all retrospective; 749 women underwent RAL and 705 SL. Operating time was longer for RAL in five studies. Major complications and laparotomy conversions for RAL and SL were 1.5% versus 0.3% and 0.3% versus 0.5%. One study reported pain reduction for RAL at 6-month follow-up. RAL treatment of endometriosis did not provide benefits over SL, overall and among subgroups of women with severe endometriosis, peritoneal endometriosis and obesity. Available evidence is low-quality, and data regarding long-term pain relief and pregnancy rates are lacking. RAL treatment of endometriosis should be performed only within controlled studies. Copyright © 2017 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  14. Systematic review of robotic surgery in gynecology: robotic techniques compared with laparoscopy and laparotomy.

    Gala, Rajiv B; Margulies, Rebecca; Steinberg, Adam; Murphy, Miles; Lukban, James; Jeppson, Peter; Aschkenazi, Sarit; Olivera, Cedric; South, Mary; Lowenstein, Lior; Schaffer, Joseph; Balk, Ethan M; Sung, Vivian


    The Society of Gynecologic Surgeons Systematic Review Group performed a systematic review of both randomized and observational studies to compare robotic vs nonrobotic surgical approaches (laparoscopic, abdominal, and vaginal) for treatment of both benign and malignant gynecologic indications to compare surgical and patient-centered outcomes, costs, and adverse events associated with the various surgical approaches. MEDLINE and the Cochrane Central Register of Controlled Trials were searched from inception to May 15, 2012, for English-language studies with terms related to robotic surgery and gynecology. Studies of any design that included at least 30 women who had undergone robotic-assisted laparoscopic gynecologic surgery were included for review. The literature yielded 1213 citations, of which 97 full-text articles were reviewed. Forty-four studies (30 comparative and 14 noncomparative) met eligibility criteria. Study data were extracted into structured electronic forms and reconciled by a second, independent reviewer. Our analysis revealed that, compared with open surgery, robotic surgery consistently confers shorter hospital stay. The proficiency plateau seems to be lower for robotic surgery than for conventional laparoscopy. Of the various gynecologic applications, there seems to be evidence that renders robotic techniques advantageous over traditional open surgery for management of endometrial cancer. However, insofar as superiority, conflicting data are obtained when comparing robotics vs laparoscopic techniques. Therefore, the specific method of minimally invasive surgery, whether conventional laparoscopy or robotic surgery, should be tailored to patient selection, surgeon ability, and equipment availability.

  15. Varied Practice in Laparoscopy Training: Beneficial Learning Stimulation or Cognitive Overload?

    Edward N. eSpruit


    Full Text Available AbstractDetermining the optimal design for surgical skills training is an ongoing research endeavor. In education literature, varied practice is listed as a positive intervention to improve acquisition of knowledge and motor skills. In the current study we tested the effectiveness of a varied practice intervention during laparoscopy training. 24 trainees (control group without prior experience received a three week laparoscopic skills training utilizing four basic and one advanced training task. 28 trainees (experimental group received the same training with a random training task schedule, more frequent task switching and inverted viewing conditions on the four basic training tasks, but not the advanced task. Results showed inferior performance of the experimental group on the four basic laparoscopy tasks during training, at the end of training and at a two month retention session. We assume the inverted viewing conditions have led to the deterioration of learning in the experimental group because no significant differences were found between groups on the only task that had not been practiced under inverted viewing conditions; the advanced laparoscopic task. Potential moderating effects of inter-task similarity, task complexity and trainee characteristics are discussed.

  16. Laparoscopy:As a First Line Diagnostic Tool for Infertility Evaluation

    Khatuja, Ritu; Juneja, Atul; Mehta, Sumita


    Introduction: The role of diagnostic and therapeutic hystero-laparoscopy in women with infertility is well established. It is helpful not only in the identification of the cause but also in the management of the same at that time. Materials and Methods: In this study, the aim was to analyse the results of 203 women on whom laparoscopy for the evaluation of infertility was done. This study was carried out at a tertiary level hospital from 2005 to 2012. The study group included 121 women with primary infertility and 82 women with secondary infertility. Women with incomplete medical records and isolated male factor infertility were excluded from the study. Results: It was observed that tubal disease was the responsible factor in 62.8% women with primary infertility and 54.8% women with secondary infertility followed by pelvic adhesions in 33% and 31.5%, ovarian factor in 14% and 8.5%, pelvic endometriosis in 9.9% and 6.1% women respectively. Thus tubal factor infertility is still a major cause of infertility in developing countries and its management at an early stage is important to prevent an irreversible damage. At the same time, it also directs which couples would be benefited from assisted reproductive technologies (ART). PMID:25478408

  17. Laparoscopy-assisted cutaneous ureterostomy at suprapubic creaseline facilitates subsequent reimplantation

    Md. Jafrul Hannan


    Full Text Available Background: Cutaneous ureterostomy is still practiced despite a trend towards primary surgical correction for obstructive or refluxive uropathy. For future open reimplantation, ureterostomy can be created by minimal invasive technique at the end(s of the suprapubic creaseline. Materials and Methods: From 1 January 2009 to 31 July 2012, seven children were treated with laparoscopy-assisted cutaneous ureterostomy followed by ureteric reimplantation. Indications were primary obstructive megaureter 3, hugely dilated ureters with reflux 3 and posterior urethral valve with poor general health 1. The distal manoeuverable part of tortuous ureter was pulled to the surface at either end of suprapubic creaseline to create the stoma. During reimplantation, this stoma was dismembered and brought inside urinary bladder obviating the need for stoma-site repair. Results: Mean age was 4.6 ± 2.8 years with six males. There were three bilateral cases with total 10 lesions. Mean operating time was 39.8 ± 12.5 minutes. Mean follow-up was 1.7 ± 0.8 years and except for peri-stomal excoriations no major complication occurred. All these were reimplanted 6-12 months after ureterostomy and faring well except in one case. Conclusions: Laparoscopy-assisted cutaneous ureterostomy can be fashioned at suprapubic creaseline to facilitate future reimplantation without much jeopardy and extra scar.

  18. Robert's uterus: modern imaging techniques and ultrasound-guided hysteroscopic treatment without laparoscopy or laparotomy.

    Ludwin, A; Ludwin, I; Martins, W P


    Robert's uterus is a unique malformation, described as a septate uterus with a non-communicating hemicavity, consisting of a blind uterine horn usually with unilateral hematometra, a contralateral unicornuate uterine cavity and a normally shaped external uterine fundus. The main symptom in affected young women is pelvic pain that becomes intensified near menses. We describe the case of a 22-year-old woman who was referred for diagnostic assessment and treatment of a congenital uterine anomaly. We used three-dimensional sonohysterography with volume-contrast imaging, HDLive rendering mode and automatic volume calculation (SonoHysteroAVC) for the diagnosis, surgical planning and postoperative evaluation. These imaging techniques provided a complete understanding of the internal and external uterine structures, enabling us to perform a minimally invasive hysteroscopic metroplasty, guided by transrectal ultrasound, and therefore avoiding the need for laparotomy/laparoscopy. The outcome of treatment was considered satisfactory; menstruation ceased to be painful and, after two hysteroscopic procedures, the communicating 0.3-cm(3) hemicavity was visualized as a 3.6-cm(3) normalized uterine cavity using the same imaging techniques. The findings of this case report raise questions about the embryological origin of Robert's uterus, the suitability of current classification systems, and the role of more invasive approaches (laparoscopy/laparotomy) and surgical procedures (horn resection/endometrectomy) that do not aim to improve uterine cavity shape and volume in women with this condition. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

  19. Laparoscopy versus laparotomy for the management of endometrial carcinoma in morbidly obese patients: a prospective study.

    Bige, Özgür; Demir, Ahmet; Saatli, Bahadır; Koyuncuoğlu, Meral; Saygılı, Uğur


    To compare the results of total laparoscopic hysterectomy and total abdominal hysterectomy in morbidly obese women with early stage endometrial cancer. This prospective study was conducted on 140 morbidly obese women with body mass indices ≥35 kg/m(2) and presenting with clinical stage 1 endometrial cancer. The patients underwent total laparoscopic hysterectomy (n=70) or total abdominal hysterectomy (n=70), bilateral salpingo-oophorectomy, pelvic lymphadenectomy, and peritoneal washing. Age, parity, menopausal status, weight, height, medical problems, history of previous laparotomy, surgical procedure, operative time, estimated amount of blood loss, preoperative hematocrit, postoperative hematocrit, operative complications, conversion to laparotomy, need for intraoperative or postoperative blood transfusion, intraoperative and postoperative complications, secondary surgery, tumor stage, grade, histology, number of recovered lymph nodes, and visual pain scores of the patients were recorded. Postoperative complications were significantly higher in the laparotomy group. Hospital stay in the laparoscopy group was significantly lower than that in the laparotomy group. The visual pain scores were significantly higher in the laparotomy group on the first, second, and third postoperative days and on the day of discharge from the hospital. Resuming activity took a significantly longer time in the laparotomy group (34.70 days) than in the laparoscopic group (17.89 days). With the availability of skilled endoscopic surgeons, most obese women with early stage endometrial cancer can be safely managed by performing laparoscopy with an excellent surgical outcome, shorter hospitalization, less postoperative pain, and faster resumption of full activity.

  20. The effect of patient body mass index on surgical difficulty in gynaecological laparoscopy.

    McIlwaine, Kate; Manwaring, Janine; Ellett, Lenore; Cameron, Melissa; Readman, Emma; Villegas, Rocio; Maher, Peter


    Over the past three decades, rates of overweight and obesity internationally have risen to epidemic proportions. There are currently no published prospective studies examining the effect of obesity on gynaecologic laparoscopy for benign indications within a population with obesity rates comparable to Australian women. To assess and quantify whether increasing patient body mass index negatively impacted upon the ability to successfully complete planned laparoscopic surgery. From January 2009 until October 2012, 307 women undergoing laparoscopic gynaecological surgery for benign pathology were recruited. Intra-operative variables included the following: ease of identification of anatomical landmarks, entry technique and number of attempts, conversion to laparotomy and any complications encountered. Any post-operative complications were recorded at the six week post-operative review. 94.46% of operations were completed as planned. As BMI increased, the ease of identification of important anatomical landmarks significantly decreased. There was no correlation between increasing BMI and surgical complication rates. Planned gynaecological laparoscopy can be performed in obese patients with a high likelihood of completion. In this study, obesity was not associated with a significant increase in complication rates or failure to complete the surgery as planned. © 2014 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  1. Laparoscopy versus laparotomy for the management of endometrial carcinoma in morbidly obese patients: a prospective study

    Bige, Özgür; Demir, Ahmet; Saatli, Bahadır; Koyuncuoğlu, Meral; Saygılı, Uğur


    Objective To compare the results of total laparoscopic hysterectomy and total abdominal hysterectomy in morbidly obese women with early stage endometrial cancer. Material and Methods This prospective study was conducted on 140 morbidly obese women with body mass indices ≥35 kg/m2 and presenting with clinical stage 1 endometrial cancer. The patients underwent total laparoscopic hysterectomy (n=70) or total abdominal hysterectomy (n=70), bilateral salpingo-oophorectomy, pelvic lymphadenectomy, and peritoneal washing. Age, parity, menopausal status, weight, height, medical problems, history of previous laparotomy, surgical procedure, operative time, estimated amount of blood loss, preoperative hematocrit, postoperative hematocrit, operative complications, conversion to laparotomy, need for intraoperative or postoperative blood transfusion, intraoperative and postoperative complications, secondary surgery, tumor stage, grade, histology, number of recovered lymph nodes, and visual pain scores of the patients were recorded. Results Postoperative complications were significantly higher in the laparotomy group. Hospital stay in the laparoscopy group was significantly lower than that in the laparotomy group. The visual pain scores were significantly higher in the laparotomy group on the first, second, and third postoperative days and on the day of discharge from the hospital. Resuming activity took a significantly longer time in the laparotomy group (34.70 days) than in the laparoscopic group (17.89 days). Conclusion With the availability of skilled endoscopic surgeons, most obese women with early stage endometrial cancer can be safely managed by performing laparoscopy with an excellent surgical outcome, shorter hospitalization, less postoperative pain, and faster resumption of full activity. PMID:26401110

  2. Spontaneous Bilateral Tubal Ectopic Pregnancy: Incidental Finding During Laparoscopy - Brief Report and Review of Literature.

    Hoffmann, S; Abele, H; Bachmann, C


    Objective: Bilateral tubal ectopic pregnancies are rare; the reported incidence is only 1 in 200 000 pregnancies. Detecting bilateral tubal ectopic pregnancy is urgent because of the associated morbidity and mortality. The appropriate fertility-preserving surgery must also be considered, as preservation of both tubes is presumed to offer better fertility prospects. Case Report: A 39-year-old gravida 2, para 1 presented with vaginal bleeding at 8 + 4 weeks of gestation. An approximately 18 mm adnexal mass in the right fallopian tube was detected on ultrasound. Laparoscopy was performed because ectopic pregnancy was suspected. This suspicion was confirmed during laparoscopy; the right fallopian tube was found to contain a mass measuring 20 mm in the isthmic part. Ultrasound of the left fallopian tube also showed a mass in the ampullary region (diameter: 10 mm), also suspicious for ectopic pregnancy. Bilateral salpingotomy was performed laparoscopically. Pathological examination confirmed the diagnosis. Conclusions for Practice: Although ectopic tubal pregnancy is seen more often after assisted reproductive techniques, bilateral spontaneous ectopic pregnancies must also be considered in other cases. Laparoscopic surgery is effective to confirm the diagnosis and treat heterotopic pregnancies. Further studies will be needed to confirm whether unilateral or bilateral conservative fertility-preserving surgery is more appropriate.

  3. Effect of preemptive analgesia with parecoxib sodium on the postoperative pain for gynecological laparoscopy

    Yu-Jing Zhou


    Objective:To observe the effect of preemptive analgesia with parecoxib sodium on the postoperative pain and complications for patients undergoing gynecological laparoscopy. Methods:A total of 100 patients with ASA I-II grade who were admitted in our hospital from January, 2013 to February, 2014 and were undergoing gynecological laparoscopy were included in the study and randomized into the observation group and the control group. The patients in the observation group were given parecoxib sodium injection (40 mg) 30 min before operation and fentanyl citrate injection (1.0μg/kg) 30 min before the end of the surgery, while the patients in the control group were givens injections of parecoxib sodium injection (40 mg) and fentanyl citrate injection (1.0μg/kg) 30 min before the end of the surgery. The analgesia and sedation effects 4, 8, 12 h after the operation in the two groups were observed, and the postoperative additional fentanyl dosage and the adverse reactions were recorded.Results: The postoperative VAS score in each timing point and the total dosage of fentanyl in the observation group were significantly lower than those in the control group (P0.05).Conclusions: The preemptive analgesia with parecoxib sodium can reduce the dosage of postoperative analgesia medications with an accurate analgesic effect; therefore, it deserves to be widely recommended in the clinic.

  4. Spontaneous Bilateral Tubal Ectopic Pregnancy: Incidental Finding During Laparoscopy – Brief Report and Review of Literature

    Hoffmann, S.; Abele, H.; Bachmann, C.


    Objective: Bilateral tubal ectopic pregnancies are rare; the reported incidence is only 1 in 200 000 pregnancies. Detecting bilateral tubal ectopic pregnancy is urgent because of the associated morbidity and mortality. The appropriate fertility-preserving surgery must also be considered, as preservation of both tubes is presumed to offer better fertility prospects. Case Report: A 39-year-old gravida 2, para 1 presented with vaginal bleeding at 8 + 4 weeks of gestation. An approximately 18 mm adnexal mass in the right fallopian tube was detected on ultrasound. Laparoscopy was performed because ectopic pregnancy was suspected. This suspicion was confirmed during laparoscopy; the right fallopian tube was found to contain a mass measuring 20 mm in the isthmic part. Ultrasound of the left fallopian tube also showed a mass in the ampullary region (diameter: 10 mm), also suspicious for ectopic pregnancy. Bilateral salpingotomy was performed laparoscopically. Pathological examination confirmed the diagnosis. Conclusions for Practice: Although ectopic tubal pregnancy is seen more often after assisted reproductive techniques, bilateral spontaneous ectopic pregnancies must also be considered in other cases. Laparoscopic surgery is effective to confirm the diagnosis and treat heterotopic pregnancies. Further studies will be needed to confirm whether unilateral or bilateral conservative fertility-preserving surgery is more appropriate. PMID:27134298

  5. Laparoscopy-assisted combined resection for synchronous gastric and colorectal cancer: report of three cases.

    Matsui, Hideo; Okamoto, Yuichi; Ishii, Akiko; Ishizu, Kazuhiro; Kondoh, Yasumasa; Igarashi, Naoki; Ogoshi, Kyoji; Makuuchi, Hiroyasu


    In gastric cancer patients, the most common form of synchronous cancer is colorectal cancer. To reduce the invasiveness of the resection, a laparoscopy-assisted combined resection was performed in three patients with synchronous gastric and colorectal cancer. Although all gastric lesions were in the early stages, two colorectal lesions were advanced cases. In all cases, the laparoscopic gastric resection and reconstruction was performed first, followed by the colorectal resection. In the case of right-side colon cancer in addition to gastric cancer, it was relatively easy to perform the combined resection with lymph node dissection sharing the same ports used for the gastrectomy, although we needed an additional port. In one case, in which rectal cancer was present in addition to gastric cancer located in the upper portion of the stomach, a totally laparoscopic proximal gastrectomy was combined with a laparoscopy-assisted low anterior resection, leaving only a lower abdominal minilaparotomy wound. All patients quickly returned to normal activity without remarkable complications, with the exception of a wound infection in one patient. With a mean follow-up of 30.7 months, all patients survived without any sign of recurrence. This procedure represents a feasible option for minimally invasive treatment of synchronous gastric and colorectal cancer.

  6. Comparison of the TINTARA uterine manipulator with the Cohen cannula in gynecologic laparoscopy.

    Choksuchat, Chainarong; Getpook, Chatpavit; Watthanagamthornkul, Saranya; Choobun, Thanapan; Dhanaworavibul, Kriengsak; Tintara, Hatern


    To assess the efficacy of the TINTARA uterine manipulator and the Cohen cannula for gynecologic laparoscopy. Sixty women scheduled for laparoscopy were randomized for use of TINTARA (n = 30) or Cohen (n = 30) as a uterine manipulator. The degree of anterior and lateral deviation of the uterus, operative time, surgical complications and ease of use were recorded and compared between the two groups. The mean ranges of anterior and lateral deviation of the uterus in TINTARA and Cohen groups were 61.17 +/- 19.37 vs. 49.33 +/- 22.58 degrees (p = 0.033) and 107.03 +/- 39.68 vs. 85.5 +/- 37.52 degrees (p = 0.035) respectively. The percentage of patients having dye leakage from the cervix in the Cohen group was greater than in the TINTARA group, but the difference was not statistically significant. Both instruments provided similar ease of use. Complications were not found in either group. TINTARA was found to have more advantages than the Cohen in moving the uterus in both anterior and lateral directions.

  7. Papel da laparoscopia no trauma abdominal penetrante The role of laparoscopy in penetrating abdominal trauma

    Luiz Carlos Von Bahten


    Full Text Available OBJETIVO: O papel da laparoscopia na redução da taxa de laparotomias não-terapêuticas e da morbidade em pacientes vítimas de trauma abdominal penetrante tem sido amplamente discutido durante os últimos anos. O objetivo do presente estudo é relatar a experiência inicial de um hospital universitário no manejo laparoscópico de pacientes com trauma abdominal penetrante. MÉTODO: Durante um período de três anos, a laparoscopia foi realizada em 37 pacientes vítimas de trauma abdominal penetrante, hemodinamicamente estáveis. Os prontuários médicos foram revisados e os parâmetros analisados foram as indicações do procedimento, lesões associadas, necessidade de conversão, tempo de permanência hospitalar e complicações. RESULTADOS: Houve 18 (48,6% casos de laparoscopias diagnósticas (LD positivas e 19 (51,4% negativas. Dos pacientes com LD positiva, oito (44,4% foram submetidos à laparotomia exploradora com finalidade terapêutica ou para melhor delineamento da lesão. Houve 10 (55,6% LD positivas nas quais não foi realizada conversão para cirurgia aberta. Quatro pacientes apresentaram lesões reparáveis laparoscopicamente, sendo realizado hepatorrafia (n=2 e frenorrafia (n=2. Os outros seis pacientes apresentavam lesões isoladas sem sangramento ativo, e a laparotomia não-terapêutica foi evitada. Os pacientes receberam dieta no primeiro dia de pós-operatório e o tempo médio de hospitalização foi de 3,8 dias. CONCLUSÕES: Nossa experiência inicial confirma que a laparoscopia é um bom método de avaliação e tratamento no trauma penetrante. A morbidade relacionada à laparotomias desnecessárias pode ser minimizada quando o procedimento é bem indicado, e o tratamento pode ser realizado com sucesso em casos selecionados.BACKGROUND: The role of laparoscopy in reducing the rate of non-therapeutic laparotomies and the morbidity in patients sustaining penetrating abdominal trauma has been widely discussed over the last

  8. Diagnostic Laparoscopy

    ... Courses Endorsed Courses MIS Fellows Course Free Webinars SMART Enhanced Recovery Program SAGES Quality Initiative SAGES OR ... may discover a mass inside or on the surface of the liver. If non-invasive imaging cannot ...

  9. Diagnostic laparoscopy

    ... in other areas ( endometriosis ) Inflammation of the gallbladder (cholecystitis) Ovarian cysts or cancer of the ovary Infection ... Elsevier Saunders; 2014:1403-1405. Read More Acute cholecystitis Appendicitis Cancer Ectopic pregnancy Endometriosis Ovarian cysts Pelvic ...

  10. Molecular imaging of head and neck cancers. Perspectives of PET/MRI; Molekulare Bildgebung bei Kopf-ï]¿Hals-Tumoren. Perspektive der PET-MRT

    Stumpp, P.; Kahn, T. [Universitaetsklinikum Leipzig AoeR, Klinik und Poliklinik fuer Diagnostische und Interventionelle Radiologie, Leipzig (Germany); Purz, S.; Sabri, O. [Universitaetsklinikum Leipzig, Klinik und Poliklinik fuer Nuklearmedizin, Leipzig (Germany)


    The {sup 18}F-fluorodeoxyglucose positron emission tomography-computed tomography ({sup 18}F-FDG-PET/CT) procedure is a cornerstone in the diagnostics of head and neck cancers. Several years ago PET-magnetic resonance imaging (PET/MRI) also became available as an alternative hybrid multimodal imaging method. Does PET/MRI have advantages over PET/CT in the diagnostics of head and neck cancers ?The diagnostic accuracy of the standard imaging methods CT, MRI and PET/CT is depicted according to currently available meta-analyses and studies concerning the use of PET/MRI for these indications are summarized. In all studies published up to now PET/MRI did not show superiority regarding the diagnostic accuracy in head and neck cancers; however, there is some evidence that in the future PET/MRI can contribute to tumor characterization and possibly be used to predict tumor response to therapy with the use of multiparametric imaging. Currently, {sup 18}F-FDG-PET/CT is not outperformed by PET/MRI in the diagnostics of head and neck cancers. The additive value of PET/MRI due to the use of multiparametric imaging needs to be investigated in future research. (orig.) [German] Die {sup 18}F-Fluordesoxyglukose-Positronenemissionstomographie-Computertomographie ({sup 18}F-FDG-PET-CT) hat ihren festen Stellenwert in der Diagnostik von Kopf-Hals-Tumoren. Seit einigen Jahren ist die PET-MRT als weitere hybride Bildgebungsmodalitaet verfuegbar. Bringt die PET-MRT Fortschritte bei der Diagnostik von Kopf-Hals-Tumoren ?Darstellung der diagnostischen Genauigkeit der bisherigen Bildgebungsmethoden CT, MRT und PET-CT anhand von Metaanalysen und Zusammenfassung der bisherigen Publikationen zur PET-MRT auf diesem Gebiet. Die PET-MRT zeigt in allen bisherigen Studien keine Ueberlegenheit bzgl. der diagnostischen Genauigkeit von Kopf-Hals-Tumoren. Sie kann jedoch durch die multiparametrische Diagnostik perspektivisch Beitraege zur Tumorcharakterisierung und damit moeglicherweise Voraussagen zum

  11. Aislamiento y caracterización de microalgas formadoras de tapetes microbianos asociados a un cultivo hidropónico de plantas halófitas

    Giraldo-Silva, Ana María


    Programa de Doctorado Ecología y Gestión de los Recursos Vivos Marinos [ES]Los tapetes microbianos, formados principalmente por microalgas, generan una matriz de polisacáridos que contribuye a la fertilización, estabilización y retención de agua en el suelo. Los tapetes microbianos pueden ser empleados como herramienta en el acondicionamiento de suelos y estimuladores del crecimiento en plantas superiores (como las halófitas), en regiones áridas o semiáridas. Se plantea la agrobiotecnologí...

  12. Anesthetic management for laparoscopy surgery in a patient with residual coarctation of aorta and mild aortic stenosis

    Renu Sinha


    Full Text Available Perioperative management of patients with congenital heart disease is a challenge for the anesthesiologist. We present successful anesthetic management for diagnostic laparoscopy and cystectomy for tubo-ovarian mass in a case of residual coarctation of the aorta along with bicuspid aortic valve and mild aortic stenosis.

  13. Does Training of the Nondominant Upper Extremity Reduce the Surgeon's Muscular Strain During Laparoscopy?: Results From a Randomized Controlled Trial

    Nieboer, T.E.; Massa, M.; Weinans, M.J.; Vierhout, M.E.; Kluivers, K.B.; Stegeman, D.F.


    Introduction. In laparoscopy, suboptimal ergonomics frequently lead to morbidity for surgeons. Physical complaints are more commonly reported on the dominant upper extremity. This may be the consequence of challenging laparoscopic tasks being easier to perform with the dominant side. The authors hyp

  14. Efficacy evaluation of laparoscopy assisted ultrasound guided radiofrequency ablation in the treatment of hepatocellular carcinoma beneath the diaphragm

    Song WANG


    Full Text Available Objective To explore the feasibility, safety and efficacy of laparoscopy assisted ultrasound guided radiofrequency ablation (RFA in the treatment of hepatocellular carcinoma (HCC beneath the diaphragm. Methods Twenty- three consecutive patients with solitary HCC beneath the diaphragm were treated by laparoscopy assisted ultrasound guided RFA in the Chinese PLA General Hospital from January 2013 to March 2016. We observed the perioperative complications and followed- up long-term effect. Results All the 23 patients successfully underwent laparoscopy assisted ultrasound guided radiofrequency ablation. No serious complications such as massive hemorrhage, biliary fistula and severe pleural effusion, hemopneumothorax occurred in the patients during perioperative period. CT examination 2-3 days after the operation revealed that the tumor was completely covered by the ablation area. Besides, the survival condition was satisfactory during follow-up period of 9-38 months. Conclusion Laparoscopy-assisted ultrasound-guided radiofrequency ablation is effective and safe for HCC beneath the diaphragm. DOI: 10.11855/j.issn.0577-7402.2017.05.16

  15. Defining the Pros and Cons of Open, Conventional Laparoscopy, and Robot-Assisted Pyeloplasty in a Developing Nation

    Mrinal Pahwa


    Full Text Available Introduction. Congenital pelviureteric junction obstruction (PUJO is one of the most common causes of hydronephrosis. Historically, open dismembered pyeloplasty has been considered the gold standard intervention for correcting PUJO. The aim of this study was to compare the surgical and functional outcomes of three different approaches, namely, open, conventional laparoscopy, and robotic pyeloplasty. Material and Methods. 60 patients underwent minimally invasive pyeloplasty (30 conventional laparoscopies and 30 robotics for congenital PUJO at a tertiary health center in India. Demographic, perioperative, and postoperative data were prospectively collected and analyzed. The data of these patients were retrospectively compared with another cohort of 30 patients who had undergone open pyeloplasty. Results. There was significant difference in operative time, time to drain removal, hospital stay, pain score, and complications rate between open and minimally invasive pyeloplasty (P<0.05. SFI was considerably lesser in robotic as compared to conventional laparoscopy. The success rate in OP, CLP, and RP was 93.33, 96.67, and 96.67%. Conclusion. Robotic pyeloplasty is safe, effective, and feasible. It is associated with significantly lesser operative time, lesser blood loss, less pain, shorter hospital stay, and fewer complications. It is also associated with considerably lesser surgeon fatigue as compared to conventional laparoscopy pyeloplasty.

  16. Laparoscopy in the morbidly obese pregnant patient using a modified foley lap-lift technique: case report.

    Chohan, Lubna; Ramirez, Mildred M; Martinez, Carla A; Kilpatrick, Charlie C


    Obesity in women of reproductive age is increasing. Gynecologic laparoscopy in the morbidly obese pregnant patient presents challenges, and is not often attempted. Herein is reported a successful case using a modified Foley lap-lift technique, which improved visualization and facilitated mechanical ventilation. Copyright © 2011 AAGL. Published by Elsevier Inc. All rights reserved.

  17. Advantages of laparoscopy versus laparotomy in extremely obese women (BMI>35) with early-stage endometrial cancer: a multicenter study.

    Tinelli, Raffaele; Litta, Pietro; Meir, Yoram; Surico, Daniela; Leo, Livio; Fusco, Annarita; Angioni, Stefano; Cicinelli, Ettore


    The aim of the present study was to demonstrate the advantages of laparoscopy versus laparotomy for treatment of extremely obese women with early-stage endometrial cancer. Seventy-five extremely obese patients with Body Mass Index >35 kg/m(2) and clinical stage I endometrial cancer underwent hysterectomy and bilateral salpingo-oophorectomy, and in all cases we performed systematic pelvic lymphadenectomy by laparoscopy (mean BMI of 38±7.3 kg/m(2)) or laparotomy (mean BMI of 39±8.1 kg/m(2)). In two (4.4%) patients of the laparoscopy group we observed a port site haematoma that was resolved without a second surgery. In three patients of the laparotomy-group, we observed dehiscence of the abdominal suture with surgical site infection that was re-sutured. Laparoscopy can be considered a safe and effective therapeutic procedure for managing early-stage endometrial cancer in extremely obese women with a lower complication rate, lower surgical site infection and postoperative hospitalization.

  18. Current laparoscopy training in urology: a comparison of fellowships governed by the Society of Urologic Oncology and the Endourological Society.

    Yap, Stanley A; Ellison, Lars M; Low, Roger K


    Laparoscopic surgery is now an integral technique in the practice of urology, particularly in the management of certain urologic malignancies. Advanced laparoscopy training in urology is primarily reserved for those pursuing fellowship training and is offered both by traditional endourology fellowships and increasingly in urologic oncology fellowships. The purpose of our study was to evaluate and compare current laparoscopy training at the fellowship level. A 17-item questionnaire was developed with support from both the Endourological Society (EUS) and Society of Urologic Oncology (SUO). Surveys were sent to program directors of fellowships recognized by the EUS and SUO. Directors were surveyed on the laparoscopic case volume, degree of oncology training, and career choice of their graduates. Data were analyzed with Wilcoxon rank-sum and Student t tests. Our survey had an overall response rate of 60%. Fellows performed more than 100 laparoscopies during their training period in 57% of EUS and 25% of SUO fellowship programs. Similar trends are demonstrated when analyzing robotic procedures, with 73% of EUS fellows performing more than 50 procedures compared with 43% of SUO fellows. The majority (59%) of EUS programs provide oncologic training. Between 44% and 100% of graduates from EUS and SUO fellowships obtain academic positions. The majority of SUO directors (63%) believe that fellowship training in laparoscopy should be provided in fellowships governed solely by the SUO, while 41% of EUS directors believe this training should be governed solely by the EUS. Endourology fellowships currently provide a greater exposure to laparoscopy and robotics than SUO fellowships. The percentage of fellows seeking academic positions is similar for EUS and SUO fellowship programs and has remained stable for several years. Directors of fellowship programs that offer advanced laparoscopic training have divergent views as to which administrative body should govern its future.

  19. Laparoscopy in major abdominal emergency surgery seems to be a safe procedure

    Nielsen, Liv Bjerre Juul; Tengberg, Line Toft; Bay-Nielsen, Morten


    INTRODUCTION: Laparoscopy is well established in the majority of elective procedures in abdominal surgery. In contrast, it is primarily used in minor surgery such as appendectomy or cholecystectomy in the emergent setting. This study aimed to analyze the safety and effectiveness of a laparoscopic...... approach in a large cohort of major abdominal emergencies. METHODS: A population-based cohort from the Region of Copenhagen, Denmark, including n = 1,139 patients undergoing major abdominal emergency surgery in 2012. RESULTS: A total of 313 patients were operated with an initial laparoscopic approach; 37......% were laparoscopically completed and 63% of the operations were converted to a laparotomy. Most conversions (40%) were for performing a bowel resection, 35% were due to inadequate exposure, 2% were converted due to accidental bleeding and 7% due to iatrogenic injuries. The reoperation rate was 17...

  20. A case of a glomus tumor of the stomach resected by laparoscopy endoscopy cooperative surgery.

    Nakajo, Keiichiro; Chonan, Akimichi; Tsuboi, Rumiko; Nihei, Kousuke; Iwaki, Tomoyuki; Yamaoka, Hajime; Sato, Shun; Matsuda, Tomomi; Nakahori, Masato; Endo, Mareyuki


    A 56-year-old woman who was found to have a submucosal tumor (SMT) of the stomach in a medical check-up was admitted to our hospital for a detailed investigation of the SMT. Upper gastrointestinal endoscopy revealed an SMT of 20mm at the anterior wall of the antrum of the stomach. Endoscopic ultrasonography showed a hyperechoic tumor in the fourth layer of the stomach wall. CT examination showed a strongly enhancing tumor on arterial phase images and persistent enhancement on portal venous phase images. Laparoscopy endoscopy cooperative surgery was performed with a diagnosis of SMT of the stomach highly suspicious of a glomus tumor. Immunohistochemistry revealed expression of α-SMA but no expression of desmin, c-kit, CD34, or S-100. The tumor was finally diagnosed as a glomus tumor of the stomach.

  1. Stomach arteriovenous malformation resected by laparoscopy-assisted surgery: A case report.

    Hotta, Masahiro; Yamamoto, Kazuhito; Cho, Kazumitsu; Takao, Yoshimune; Fukuoka, Takeshi; Uchida, Eiji


    Arteriovenous malformations of the stomach are an uncommon cause of upper GI bleeding. We report a case of stomach arteriovenous malformation in an 85-year-old Asian man who presented with massive hematemesis. Initial esophagogastroduodenoscopy did not detect this lesion, but contrast multi-detector CT confirmed GI bleeding. Multi-detector CT revealed a mass of blood vessels underlying the submucosa that arose from the right gastroepiploic artery. Repeat esophagogastroduodenoscopy showed that the lesion was a submucosal tumor with erosion and without active bleeding in the lower body of the stomach on the greater curvature. We performed partial gastrectomy via laparoscopy-assisted surgery. The histopathological diagnosis was arteriovenous malformation. © 2016 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and John Wiley & Sons Australia, Ltd.

  2. Sigmoid colon endometriosis treated with laparoscopy-assisted sigmoidectomy: Significance of preoperative diagnosis


    We present a female patient with sigmoid colon endometriosis who was diagnosed correctly preoperatively and underwent minimally invasive surgery. She was admitted to our hospital with rectal bleeding and constipation. We performed several workups. Colonoscopy and endoscopic ultrasonography showed sigmoid colon stenosis caused by submucosal tumor, and magnetic resonance imaging revealed a sigmoid colon tumor displaying signal hypointensity on both T1- and T2-weighted imaging. However, colonoscopic ultrasonography-assisted needle aspiration biopsy could not specify tumor characteristics. From these examinations, the lesion was diagnosed as sigmoid colon endometriosis and laparoscopy-assisted sigmoidectomy was performed. Pathological diagnosis from the resected specimen was identical to preoperative diagnosis, i.e., colonic endometriosis. Since differential diagnosis of intestinal endometriosis seems difficult, a cautious preoperative diagnosis is required to select treatments including minimally invasive surgery.

  3. Gastric carcinoma originating from the heterotopicsubmucosal gastric gland treated by laparoscopy andendoscopy cooperative surgery


    Gastric carcinoma is derived from epithelial cells inthe gastric mucosa. We reported an extremely rarecase of submucosal gastric carcinoma originating fromthe heterotopic submucosal gastric gland (HSG) thatwas safely diagnosed by laparoscopy and endoscopycooperative surgery (LECS). A 66-year-old manunderwent gastrointestinal endoscopy, which detected asubmucosal tumor (SMT) of 1.5 cm in diameter on thelesser-anterior wall of the upper gastric body. The tumorcould not be diagnosed histologically, even by endoscopicultrasound-guided fine-needle aspiration biopsy. Localresection by LECS was performed to confirm a diagnosis.Pathologically, the tumor was an intra-submucosal welldifferentiated adenocarcinoma invading 5000 μm into the submucosal layer. The resected tumor had negativelateral and vertical margins. Based on the Japanesetreatment guidelines, additional laparoscopic proximalgastrectomy was curatively performed. LECS is a lessinvasive and safer approach for the diagnosis of SMT,even in submucosal gastric carcinoma originating fromthe HSG.

  4. Laparoscopy-Assisted Billroth I Gastrectomy for Ectopic Pancreas in the Prepyloric Region

    Yueh-Tsung Lee


    Full Text Available Ectopic pancreatic tissue is an uncommon developmental anomaly. The condition mostly occurs in the gastrointestinal tract and is usually asymptomatic. It rarely causes symptoms of inflammation, bleeding and perforation, and has potential for malignant change. Though it is an uncommon condition, cases of ectopic pancreas have been reported worldwide. Preoperative diagnosis of ectopic pancreas is challenging because of its nonspecific symptoms and signs. Owing to the revolution of minimally invasive surgery, submucosal tumors of the stomach can be resected by laparoscopic techniques. We have earlier reported on a case of ectopic pancreas in the stomach treated by robotics-assisted laparoscopic wedge resection. Herein, we report a case of ectopic pancreas in the prepyloric region of the stomach. A 44-year-old female presented with a two-week history of epigastralgia with radiation to the back. She received endoscopy check-up which disclosed a mass in the stomach. By endoscopic findings, a submucosal lesion in the prepyloric region with umbilical folding on the mucosa was identified. The umbilical folding on the mucosa hint the orifice of the duct of ectopic pancreas into the gastric mucosa suggestive of ectopic pancreas. Contrast-enhanced abdominal computed tomography showed a 5 cm cystic mass with heterogeneous content. To sum it up, the patient was diagnosed as ectopic pancreas in the stomach. She underwent laparoscopy-assisted antrectomy with Billroth I anastomosis (excision of the antrum and prepyloric region with reconstruction of gastrointestinal continuity by gastroduodenostomy and had an uneventful hospitalization course. The histopathology of the resected tumor demonstrated ectopic pancreatic tissue in the gastric wall. To the best of our knowledge, excision of gastric ectopic pancreas using laparoscopy-assisted antrectomy with Billroth I anastomosis has never been reported in the literature.

  5. Laparoscopy in children and its impact on brain oxygenation during routine inguinal hernia repair

    Pelizzo, Gloria; Bernardi, Luciano; Carlini, Veronica; Pasqua, Noemi; Mencherini, Simonetta; Maggio, Giuseppe; De Silvestri, Annalisa; Bianchi, Lucio; Calcaterra, Valeria


    BACKGROUND: The systemic impact of intra-abdominal pressure (IAP) and/or changes in carbon dioxide (CO2) during laparoscopy are not yet well defined. Changes in brain oxygenation have been reported as a possible cause of cerebral hypotension and perfusion. The side effects of anaesthesia could also be involved in these changes, especially in children. To date, no data have been reported on brain oxygenation during routine laparoscopy in paediatric patients. PATIENTS AND METHODS: Brain and peripheral oxygenation were investigated in 10 children (8 male, 2 female) who underwent elective minimally invasive surgery for inguinal hernia repair. Intraoperative transcranial near-infrared spectroscopy to assess regional cerebral oxygen saturation (rScO2), peripheral oxygen saturation using pulse oximetry and heart rate (HR) were monitored at five surgical intervals: Induction of anaesthesia (baseline T1); before CO2 insufflation induced pneumoperitoneum (PP) (T2); CO2 PP insufflation (T3); cessation of CO2 PP (T4); before extubation (T5). RESULTS: rScO2 decreases were recorded immediately after T1 and became significant after insufflation (P = 0.006; rScO2 decreased 3.6 ± 0.38%); restoration of rScO2 was achieved after PP cessation (P = 0.007). The changes in rScO2 were primarily due to IAP increases (P = 0.06). The HR changes were correlated to PP pressure (P < 0.001) and CO2 flow rate (P = 0.001). No significant peripheral effects were noted. CONCLUSIONS: The increase in IAP is a critical determinant in cerebral oxygenation stability during laparoscopic procedures. However, the impact of anaesthesia on adaptive changes should not be underestimated. Close monitoring and close collaboration between the members of the multidisciplinary paediatric team are essential to guarantee the patient's safety during minimally invasive surgical procedures. PMID:27251842

  6. Postoperative pain after cholecystectomy: Conventional laparoscopy versus single-incision laparoscopic surgery

    Prasad A


    Full Text Available Background: This study was undertaken to compare the postoperative pain after cholecystectomy done by single-incision laparoscopic surgery (SILS versus conventional four-port laparoscopy [conventional laparoscopic surgery (CLS]. SILS is a feasible and a promising method for cholecystectomy. It is possible to do this procedure without the use of special equipments. While there are cosmetic advantages to SILS, it is not clear whether or not the pain is also reduced. Methods: Patients undergoing cholecystectomy for symptomatic gallstones were offered the choice of the two methods and the first 100 consecutive patients from each group were included in this observational study. Only conventional instruments were used to keep the cost of surgery comparable. Pain scores were checked 8 hours after the surgery using visual analogue score. Student′s t test was done to check the statistical significance. Results: We observed no significant difference in the pain score between the CLS and SILS (2.78 versus 2.62. The operative time (OT was significantly lower in the CLS group (28 versus 67 minutes. Comparing the OTs of the first 50 patients undergoing SILS with the second 50 patients showed a significantly lower OT (79 versus 54 minutes. We also compared the pain score between these three groups. The second half of SILS group had a significantly lower pain score compared to the first half (2.58 versus 2.84. This group also had a lower pain score compared to conventional laparoscopy group but the difference was not statistically significant (2.58 versus 2.78. Conclusion: Although there was no significant difference in the overall postoperative pain as OT decreases with surgeon′s experience in single-incision laparoscopic cholecystectomy, postoperative pain at 8 hours appears to favour this method over conventional laparoscopic cholecystectomy.

  7. Multifocal intraportal invasion of breast carcinoma diagnosed by laparoscopy-assisted liver biopsy

    Tomoki Nakajima; Takeshi Mazaki; Akio Yanagisawa; Takeshi Okanoue; Satoru Sekoguchi; Taichirou Nishikawa; Hidetaka Takashima; Tadashi Watanabe; Masahito Minami; Yoshito Itoh; Naruhiko Mizuta; Hiroo Nakajima


    Hepar lobatum carcinomatosum (HLC) is defined as an acquired hepatic deformity consisting of an irregularly lobulated hepatic contour caused by intravascular infiltration of metastatic carcinoma. To date, only nine cases of HLC have been reported in the literature. We report a case of a 68-year-old woman showing hepatic metastasis of breast carcinoma in radiologically unidentified form. Initially, she received left partial mastectomy for breast cancer but solid hepatic metastases were identified in S2 and S6, 9 mo after surgery. Then, they responded to chemotherapy and radiologically disappeared. After radiological disappearance of the liver tumors, the patient's blood chemistry showed abnormal liver function. A CT scan demonstrated heterogeneous enhancement effect in the liver in the late phase,suggesting uneven hepatic blood supply. Hepatic deformity was not obvious. Laparoscopy revealed a slightly deformed liver surface with multiple indentations and shallow linear depressions. Furthermore, a wide scar was observed on the surface of S2 possibly at the site where the metastatic tumor existed before chemotherapy. Liver biopsy from the wide scar lesion showed intraportal tumor thrombi with desmoplastic change. Because of its similarity to the histology of the original breast cancer, we concluded that the hepatic functional abnormalities and slightly deformed liver surface were derived from the circulatory disturbance caused by microscopic tumor thrombi. Besides, since the wide scar was located at the site of the pre-existing tumor,it is probable that chemotherapy was an important cause of fibrous scarring as a result of tumor regression. These morphologic findings are compatible with those of HLC.Laparoscopy-assisted liver biopsy was useful to make definite diagnosis, even though the hepatic deformity was radiologically undetectable.

  8. On Response Characteristics Analysis of HAL Tool in Thin Inter-beds and Deviated Hole Formation%薄互层和倾斜地层阵列侧向测井响应计算分析

    冯琳伟; 汪德刚; 贺飞; 张昊; 王普海; 关照星; 张兴


    为分析HAL阵列侧向测井在薄互层和斜井的响应特性,根据HAL仪器工作原理,采用三维有限元算法,建立不同地层模型,进行薄互层响应特性对比,并计算分析直井和斜井的正演响应特性.该仪器受围岩影响小,对薄层分辨效果好,薄互层响应特征明显;在斜井中仪器响应曲线使地层真实层厚变厚,并且曲线关系由于受围岩影响而呈现幅度差异.%The HAL tool has high resolution and multiple radial investigation depths. To study the responses of HAL tool in thin inter-beds and deviated well, a three-dimensional finite element method (3-D FEM) is worked out in this paper. Different formation models are simulated to study the tool responses in the thin inter-beds in vertical and deviated wells. Comparison results show that HAL reduces shoulder beds sensitivity than traditional laterolog measurements and enhances thin-bed definition with actively focused arrays and the response can separate different thin inter-beds easily. Therefore, the HAL tool has a good resolution for the thin inter-beds. For deviated borehole, the tool response shows that the apparent thickness of formation is increased and the responses are different because of the shoulder effect. The simulation and analysis of HAL electrode array characteristics are presented and beneficial to the evaluation of HAL logs in the thin inter-beds and deviated wells.

  9. Combining of ETHOS Operating Ergonomic Platform, Three-dimensional Laparoscopic Camera, and Radius Surgical System Manipulators Improves Ergonomy in Urologic Laparoscopy: Comparison with Conventional Laparoscopy and da Vinci in a Pelvi Trainer.

    Tokas, Theodoros; Gözen, Ali Serdar; Avgeris, Margaritis; Tschada, Alexandra; Fiedler, Marcel; Klein, Jan; Rassweiler, Jens


    Posture, vision, and instrumentation limitations are the main predicaments of conventional laparoscopy. To combine the ETHOS surgical chair, the three-dimensional laparoscope, and the Radius Surgical System manipulators, and compare the system with conventional laparoscopy and da Vinci in terms of task completion times and discomfort. Fifteen trainees performed the three main laparoscopic suturing tasks of the Heilbronn training program (IV: simulation of dorsal venous complex suturing; V: circular suturing of tubular structure; and VI: urethrovesical anastomosis) in a pelvi trainer. The tasks were performed conventionally, utilizing the three devices, and robotically. Task completion times were recorded and the surgeon discomfort was evaluated using questionnaires. Task completion times were compared using nonparametric Wilcoxon signed rank test and ergonomic scores were compared using Pearson chi-square test. The use of the full laparoscopic set (ETHOS chair, three-dimensional laparoscopic camera, Radius Surgical System needle holders), resulted in a significant improvement of the completion time of the three tested tasks compared with conventional laparoscopy (psystem nullified heavy discomfort for Tasks IV and V and minimized it (6.7%) for the most demanding Task VI. Especially for Task VI, all trainees gained benefit, by using the system, in terms of task completion times and discomfort. The limited trainee robotic experience and the questionnaire subjectivity could be a potential limitation. The ergonomic laparoscopic system offers significantly improved task completion times and ergonomy than conventional laparoscopy. Furthermore, it demonstrates comparable results to robotic surgery. The study was conducted in a pelvi trainer and no patients were recruited. Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  10. For 3D laparoscopy: a step toward advanced surgical navigation: how to get maximum benefit from 3D vision.

    Kunert, Wolfgang; Storz, Pirmin; Kirschniak, Andreas


    The authors are grateful for the interesting perspectives given by Buchs and colleagues in their letter to the editor entitled "3D Laparoscopy: A Step Toward Advanced Surgical Navigation." Shutter-based 3D video systems failed to become established in the operating room in the late 1990s. To strengthen the starting conditions of the new 3D technology using better monitors and high definition, the authors give suggestions for its practical use in the clinical routine. But first they list the characteristics of single-channeled and bichanneled 3D laparoscopes and describe stereoscopic terms such as "comfort zone," "stereoscopic window," and "near-point distance." The authors believe it would be helpful to have the 3D pioneers assemble and share their experiences with these suggestions. Although this letter discusses "laparoscopy," it would also be interesting to collect experiences from other surgical disciplines, especially when one is considering whether to opt for bi- or single-channeled optics.

  11. Simultaneous laparoscopy-assisted low anterior resection and distal gastrectomy for synchronous carcinoma of rectum and stomach.

    Zhu, Qian-Lin; Zheng, Min-Hua; Feng, Bo; Lu, Ai-Guo; Wang, Min-Liang; Li, Jian-Wen; Hu, Wei-Guo; Zang, Lu; Mao, Zhi-Hai; Dong, Feng; Ma, Jun-Jun; Zong, Ya-Ping


    Laparoscopic resection of rectal cancer or gastric cancer has been advocated for the benefits of a reduced morbidity, a shorter treatment time, and similar outcomes. However, simultaneous laparoscopy-assisted low anterior resection and distal gastrectomy for synchronous carcinoma of rectum and stomach are rarely documented in literature. Endoscopic examination revealed a synchronous carcinoma of rectum and stomach in a 55-year-old male patient with rectal bleeding and epigastric discomfort. He underwent a simultaneous laparoscopy-assisted low anterior resection and distal gastrectomy with regional lymph nodes dissected. The operation time was 270 min and the estimated blood loss was 120 mL. The patient required parenteral analgesia for less than 24 h. Flatus was passed on postoperative day 3, and a solid diet was resumed on postoperative day 7. He was discharged on postoperative day 13. With the advances in laparoscopic technology and experience, simultaneous resection is an attractive alternative to a synchronous gastrointestinal cancer.


    Suzana Peternelj-Marinšek


    Full Text Available Background. The aim of this retrospective study was to find the incidence and type of adnexal masses in pregnancy, reliability of preoperative ultrasound examination and the effect of the surgical approach used, duration of pregnancy at the time of surgery, and the effect of emergency or planned surgery on the outcome of pregnancy. The obtained results and the data from literature were to provide the basis of the guidelines for the management of pregnant women with adnexal masses.Methods. In the study we enrolled 42 women, who underwent a surgery in pregnancy for adnexal masses. All surgeries were performed at the Department of Obstetrics and Gynecology in the period 1 January 1993–31 August 2000. The course of pregnancy was followed by 28 February 2001. The data were obtained from the records kept at the Department and from the questionnaire sent to the women. Statistical analysis was done using Chi-square test. Statistical significance was set at P ≤ 0.05.Results. We found the incidence of adnexal masses in pregnancy, requiring surgical treatment, to be 1/1034 deliveries. There were 6 (14.3% borderline malignant and malignant ovarian tumours, the incidence being 1/7239 deliveries. Preoperative ultrasound examination was not reliable enough to differentiate neither between benign and malignant adnexal masses, nor between adnexal masses and leiomyomas. Forty-two surgeries were made, 21 by laparoscopy and 21 by laparotomy. The size of removed tumours ranged between 4 and 30 cm (mean 9.4 cm, the most frequent type was mature cystic teratoma (n = 12. There were no differences in the outcome of pregnancy between the laparoscopy and laparotomy approach, between emergency and planned surgery, and between laparotomy performed by the 23rd and after the 23rd gestational week. Hemorrhagic shock due to heterotopic pregnancy lead to 1 spontaneous abortion. There were 2 preterm deliveries in the 37th week, 2 babies had intrauterine growth retardation

  13. Comparison between lignocaine hydrochloride and ropivacaine hydrochloride as lumbosacral epidural anaesthetic agents in goats undergoing laparoscopy assisted embryo transfer

    Anubhav Khajuria


    Full Text Available Goats (n=12 undergoing laparoscopy assisted embryo transfer were randomly allotted to two groups (I and II and injected lignocaine hydrochloride (4mg/kg or ropivacaine hydrochloride (1mg/kg at the lumbosacral epidural space. The animals were held with raised hind quarters for first three minutes following injection. Immediately after induction of regional anaesthesia, they were restrained in dorsal recumbency in Trendelenburg position in a cradle. Laparoscopy was performed after creating pneumoperitoneum using filtered room air. The mean (± S.E induction time in animals of group I was significantly shorter (5.33 ± 0.61 min than those belonging to group II (12.66 ±1.99 min. Complete analgesia developed throughout the hind quarters and abdomen for 30 min and 60 min in group I and II animal’s respectively. Unlike animals of group I, group II goats continued to show moderate analgesia for 180 minutes. The motor activity returned after a lapse of 130.00 ± 12.64 min and 405.00 ± 46.31 min respectively. Occasional vocalization and struggling was noticed in two goats one from each group irrespective of the surgical manipulations during laparoscopy. The rectal temperature and respiration rates showed only non-significant increase, but the heart rate values were significantly higher (P < 0.5 up to 150 min in animals of both the groups when compared to their baseline values. From this study, it was concluded that both anaesthetic agents produced satisfactory regional anaesthesia in goats undergoing laparoscopy. However, considering the very long delay in regaining the hind limb motor activity, the use of ropivacaine may not be recommended for this purpose. Supplementation of sedative/tranquilizer with lumbosacral epidural anaesthesia needs evaluation.

  14. 3D straight-stick laparoscopy versus 3D robotics for task performance in novice surgeons: a randomised crossover trial.

    Shakir, Fevzi; Jan, Haider; Kent, Andrew


    The advent of three-dimensional passive stereoscopic imaging has led to the development of 3D laparoscopy. In simulation tasks, a reduction in error rate and performance time is seen with 3D compared to two-dimensional (2D) laparoscopy with both novice and expert surgeons. Robotics utilises 3D and instrument articulation through a console interface. Robotic trials have demonstrated that tasks performed in 3D produced fewer errors and quicker performance times compared with those in 2D. It was therefore perceived that the main advantage of robotic surgery was in fact 3D. Our aim was to compare 3D straight-stick laparoscopic task performance (3D) with robotic 3D (Robot), to determine whether robotic surgery confers additional benefit over and above 3D visualisation. We randomised 20 novice surgeons to perform four validated surgical tasks, either with straight-stick 3D laparoscopy followed by 3D robotic surgery or in the reverse order. The trial was conducted in two fully functional operating theatres. The primary outcome of the study was the error rate as defined for each task, and the secondary outcome was the time taken to complete each task. The participants were asked to perform the tasks as quickly and as accurately as possible. Data were analysed using SPSS version 21. The median error rate for completion of all four tasks with the robot was 2.75 and 5.25 for 3D with a P value robot was 157.1 and 342.5 s for 3D with a P value robotic systems over 3D straight-stick laparoscopy, in terms of reduced error rate and quicker task performance time.

  15. Single-port laparoscopic colorectal resections in obese patients are as safe and effective as conventional laparoscopy.

    Aytac, Erman; Turina, Matthias; Gorgun, Emre; Stocchi, Luca; Remzi, Feza H; Costedio, Meagan M


    Obese patients pose additional operative technical difficulties, and it is unclear if the outcomes of single-port colorectal surgery are equivalent to those of conventional laparoscopy in such patients. The aim of this study was to compare perioperative variables and short-term outcomes of single-port versus conventional laparoscopy in obese patients undergoing colorectal surgery. Obese patients (BMI ≥ 30 kg/m(2)) undergoing single-port laparoscopic colorectal resections between March 2009 and September 2012 were case matched 1:1 with obese counterparts undergoing conventional (multi-port) laparoscopic surgery based on diagnosis and operation type. Thirty-seven patients who underwent single-port surgery were matched with 37 conventional laparoscopic counterparts. Male gender predominated in the single-port group (26 vs 15, p = 0.02). The number of patients with a history of previous abdominal operations (17 vs 13, p = 0.48) and ASA score (3 vs 2, p = 0.6) were similar between the groups. No differences were observed with respect to conversion rate (2 vs 5, p = 0.43), operative time (146 vs 150 min, p = 0.48), estimated blood loss (159 vs 183 ml, p = 0.99), time to first flatus (3 vs 3 days, p = 0.91), time to first bowel movement (3 vs 4 days, p = 0.62), length of hospital stay (7 vs 6 days, p = 0.37), or reoperation (2 vs 1, p > 0.99), and readmission rates (2 vs 2, p > 0.99). There were no deaths. For obese patients undergoing colorectal resections, single-port laparoscopy appears to be as safe and effective as conventional laparoscopy.

  16. Rodent laparoscopy: refinement for rodent drug studies and model development, and monitoring of neoplastic, inflammatory and metabolic diseases.

    Baran, Szczepan W; Perret-Gentil, Marcel I; Johnson, Elizabeth J; Miedel, Emily L; Kehler, James


    The refinement of surgical techniques represents a key opportunity to improve the welfare of laboratory rodents, while meeting legal and ethical obligations. Current methods used for monitoring intra-abdominal disease progression in rodents usually involve euthanasia at various time-points for end of study, one-time individual tissue collections. Most rodent organ tumour models are developed by the introduction of tumour cells via laparotomy or via ultrasound-guided indirect visualization. Ischaemic rodent models are often generated using laparotomies. This approach requires a high number of rodents, and in some instances introduces high degrees of morbidity and mortality, thereby increasing study variability and expense. Most importantly, most laparotomies do not promote the highest level of rodent welfare. Recent improvements in laparoscopic equipment and techniques have enabled the adaptation of laparoscopy for rodent procedures. Laparoscopy, which is considered the gold standard for many human abdominal procedures, allows for serial biopsy collections from the same animal, results in decreased pain and tissue trauma as well as quicker postsurgical recovery, and preserves immune function in comparison to the same procedures performed by laparotomy. Laparoscopy improves rodent welfare, decreases inter-animal variability, thereby reducing the number of required animals, allows for the replacement of larger species, decreases expense and improves data yield. This review article compares rodent laparotomy and laparoscopic surgical methods, and describes the utilization of laparoscopy for the development of cancer models and assessment of disease progression to improve data collection and animal welfare. In addition, currently available rodent laparoscopic equipment and instrumentation are presented.

  17. Diagnosis and management of choledocholithiasis in the golden age of imaging, endoscopy and laparoscopy.

    Costi, Renato; Gnocchi, Alessandro; Di Mario, Francesco; Sarli, Leopoldo


    Biliary lithiasis is an endemic condition in both Western and Eastern countries, in some studies affecting 20% of the general population. In up to 20% of cases, gallbladder stones are associated with common bile duct stones (CBDS), which are asymptomatic in up to one half of cases. Despite the wide variety of examinations and techniques available nowadays, two main open issues remain without a clear answer: how to cost-effectively diagnose CBDS and, when they are finally found, how to deal with them. CBDS diagnosis and management has radically changed over the last 30 years, following the dramatic diffusion of imaging, including endoscopic ultrasound (EUS) and magnetic resonance cholangiography (MRC), endoscopy and laparoscopy. Since accuracy, invasiveness, potential therapeutic use and cost-effectiveness of imaging techniques used to identify CBDS increase together in a parallel way, the concept of "risk of carrying CBDS" has become pivotal to identifying the most appropriate management of a specific patient in order to avoid the risk of "under-studying" by poor diagnostic work up or "over-studying" by excessively invasive examinations. The risk of carrying CBDS is deduced by symptoms, liver/pancreas serology and ultrasound. "Low risk" patients do not require further examination before laparoscopic cholecystectomy. Two main "philosophical approaches" face each other for patients with an "intermediate to high risk" of carrying CBDS: on one hand, the "laparoscopy-first" approach, which mainly relies on intraoperative cholangiography for diagnosis and laparoscopic common bile duct exploration for treatment, and, on the other hand, the "endoscopy-first" attitude, variously referring to MRC, EUS and/or endoscopic retrograde cholangiography for diagnosis and endoscopic sphincterotomy for management. Concerning CBDS diagnosis, intraoperative cholangiography, EUS and MRC are reported to have similar results. Regarding management, the recent literature seems to show better

  18. Sterile and economic instrumentation in laparoscopic surgery. Experiences with 6,000 surgical laparoscopies, 1990-1996.

    Fengler, T W; Pahlke, H; Kraas, E


    Because so many common surgical problems can now be addressed by the laparoscopic approach, the issue of sterile processing has to be reconsidered. 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. 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. 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.

  19. Systematic Review of Economic Evaluation of Laparotomy versus Laparoscopy for Patients Submitted to Roux-en-Y Gastric Bypass

    Sussenbach, Samanta Pereira; Silva, Everton Nunes; Pufal, Milene Amarante; Casagrande, Daniela Shan; Padoin, Alexandre Vontobel; Mottin, Cláudio Corá


    Background Because of the high prevalence of obesity, there is a growing demand for bariatric surgery worldwide. The objective of this systematic review was to analyze the difference in relation to cost-effectiveness of access route by laparoscopy versus laparotomy of Roux en-Y gastric bypass (RYGB). Methods A systematic review was conducted in the electronic databases MEDLINE, Embase, Scopus, Cochrane and Lilacs in order to identify economic evaluation studies that compare the cost-effectiveness of laparoscopic and laparotomic routes in RYGB. Results In a total of 494 articles, only 6 fulfilled the eligibility criteria. All studies were published between 2001 and 2008 in the United States (USA). Three studies fulfilled less than half of the items that evaluated the results quality; two satisfied 5 of the required items, and only 1 study fulfilled 7 of 10 items. The economic evaluation of studies alternated between cost-effectiveness and cost-consequence. Five studies considered the surgery by laparoscopy the dominant strategy, because it showed greater clinical benefit (less probability of post-surgical complications, less hospitalization time) and lower total cost. Conclusion This review indicates that laparoscopy is a safe and well-tolerated technique, despite the costs of surgery being higher when compared with laparotomy. However, the additional costs are compensated by the lower probability of complications after surgery and, consequently, avoiding their costs. PMID:24945704

  20. Comparative study of multiport laparoscopy and umbilical laparoendoscopic single-site surgery with reusable platform for treating renal masses.

    Chantada, C; García-Tello, A; Esquinas, C; Moraga, A; Redondo, C; Angulo, J C

    Umbilical laparoendoscopic single-site (LESS) surgery is an increasingly used modality for treating renal masses. We present a prospective comparison between LESS renal surgery and conventional laparoscopy. A comparative paired study was conducted that evaluated the surgical results and complications of patients with renal neoplasia treated with LESS surgery (n=49) or multiport laparoscopy (n=53). The LESS approach was performed with reusable material placed in the navel and double-rotation curved instruments. An additional 3.5-mm port was employed in 69.4% of the cases. We assessed demographic data, the type of technique (nephrectomy, partial nephrectomy and nephroureterectomy), surgical time, blood loss, haemoglobin, need for transfusion, number and severity of complications (Clavien-Dindo), hospital stay, histological data and prognosis. There were no differences in follow-up, age, sex, body mass index, preoperative haemoglobin levels or type of surgery. Conversion occurred in 2 cases (1 in each group). The surgical time was equivalent (P=.6). Intraoperative transfusion (P=.03) and blood loss (Pmasses, with time consumption and safety comparable to conventional laparoscopy. The LESS approach is advantageous in terms of blood loss and hospital stay. Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  1. MMW radar enhanced vision systems: the Helicopter Autonomous Landing System (HALS) and Radar-Enhanced Vision System (REVS) are rotary and fixed wing enhanced flight vision systems that enable safe flight operations in degraded visual environments

    Cross, Jack; Schneider, John; Cariani, Pete


    Sierra Nevada Corporation (SNC) has developed rotary and fixed wing millimeter wave radar enhanced vision systems. The Helicopter Autonomous Landing System (HALS) is a rotary-wing enhanced vision system that enables multi-ship landing, takeoff, and enroute flight in Degraded Visual Environments (DVE). HALS has been successfully flight tested in a variety of scenarios, from brown-out DVE landings, to enroute flight over mountainous terrain, to wire/cable detection during low-level flight. The Radar Enhanced Vision Systems (REVS) is a fixed-wing Enhanced Flight Vision System (EFVS) undergoing prototype development testing. Both systems are based on a fast-scanning, threedimensional 94 GHz radar that produces real-time terrain and obstacle imagery. The radar imagery is fused with synthetic imagery of the surrounding terrain to form a long-range, wide field-of-view display. A symbology overlay is added to provide aircraft state information and, for HALS, approach and landing command guidance cuing. The combination of see-through imagery and symbology provides the key information a pilot needs to perform safe flight operations in DVE conditions. This paper discusses the HALS and REVS systems and technology, presents imagery, and summarizes the recent flight test results.

  2. Laparoscopy-assisted hydrostatic in situ reduction of intussusception: A reasonable alternative?

    V. V. S. S. Chandrasekharam


    Full Text Available Aim: To evaluate an alternative way of reducing intussusceptions under laparoscopic guidance. Materials and Methods: This is a retrospective observational study of children who underwent laparoscopy-assisted hydrostatic in situ reduction of intussusceptions (LAHIRI. Under general anesthesia with laparoscopic vision, warm saline was infused into the rectum with a 16-18 F Foley catheter and a drip set till the intussusception was reduced. Results: Eleven patients [age 7.8 (±2.8 months] were operated over a period of 1 year. Ten (90.9% patients had ileocolic intussusception, which got completely reduced, but one (9% had ileo-ileocolic intusussception, in whom manual reduction by extending the subumbilical incision was required to reduce the ileoileal part. The mean duration of surgery was 38.5 (±6.6 min. No patient had bowel ischemia and there were no intra- or postoperative complications. Conclusions: LAHIRI appears to be an effective and safe technique in children. Specific advantages are that it is performed in a controlled environment in the operating room, avoids patient apprehension and discomfort, avoids bowel handling, provides a safe opportunity to create higher intraluminal pressure, ensures visual assessment of bowel vascularity and completeness of reduction.

  3. Right intercostal insertion of a Veress needle for laparoscopy in dogs.

    Fiorbianco, Valentina; Skalicky, Monika; Doerner, Judith; Findik, Murat; Dupré, Gilles


    To evaluate right intercostal Veress needle (VN) insertion for laparoscopy in dogs. Longitudinal cohort study. Female dogs (n = 56). The VN was inserted in the last palpable right intercostal space, either 1/3 (Group T; 28 dogs) or mid distance (Group H; 28 dogs) from the xiphoid cartilage to the most caudal extent of the costal arch. Problems encountered during VN insertion and injuries were recorded, graded, and compared between groups, and also between the first and last 20 insertions. Pneumoperitoneum was successfully achieved by VN insertion in 49 (88%) dogs after a single (45 dogs) or 2nd attempt (4 dogs). Frequency of complications was as follows: 20 grade 1 (subcutaneous emphysema, omentum, or falciform injuries); 6 grade 2 (liver or spleen injury), and 1 grade 3 complication (pneumothorax occurred). No significant difference was found between the 2 groups or between the first and last 20 dogs. Right intercostal VN insertion facilitates pneumoperitoneum in dogs with few consequential complications. No significant difference was found between entry sites; however, the mid distance insertion site in the last palpable intercostal space with dog positioned in dorsal recumbency is likely to result in less complications. © Copyright 2012 by The American College of Veterinary Surgeons.

  4. Three-dimensional Laparoscopy: Does Improved Visualization Decrease the Learning Curve Among Trainees in Advanced Procedures?

    Cologne, Kyle G; Zehetner, Joerg; Liwanag, Loriel; Cash, Christian; Senagore, Anthony J; Lipham, John C


    Complex laparoscopy is difficult to master because it involves 3-dimensional (3D) interpretation on a 2-dimensional (2D) viewing screen. The use of 3D technology has an uncertain effect on training surgeons. We aim to evaluate the effectiveness of 3D on learning and performing laparoscopic tasks. Medical students without laparoscopic experience (novices) were evaluated doing inanimate object transfer and laparoscopic suturing. Tasks were repeated using 2D and 3D cameras with standard instruments. Time and error rates (missed attempts, dropped objects, and failure to complete the task) were recorded. Twenty-nine novice medical students experienced a 45.5% decrease in the time to complete PEG transfer using 3D (mean 207 s with 2D vs. 113 s with 3D). Error rate was reduced to 50% (2D, 4 errors vs. 3D, 2 errors) and mean drop rate was reduced to 0. Similar decreases in suture time (46.5%) were seen (mean 403 s with 2D vs. 220 s with 3D). Our results indicate that 3D significantly improved visualization and ability to perform complex tasks in the skills laboratory setting. This technology may be very effective in teaching advanced laparoscopic skills in the era of work-hour restrictions.

  5. Evaluation of Basic Skills Improvement for Laparoscopy by Training with a Video Game

    María Fernanda Gómez-Ramírez


    Full Text Available Introduction: Due to the growing economical and ethical limitations in surgeons training for minimally invasive surgery (mis, e.g. laparoscopy, this study aims at evaluating the effect of a continuous practice of a particular videogame on the development of the fundamental and specific skills needed to perform this type of procedure successfully. Materials and methods: To evaluate the effectiveness of video game practicing, three essential and common activities were chosen (cutting, suturing, and eye-hand coordination to be performed in laparoscopic simulators. Eight different indexes or variables of performance were measured in the three activities. Fourteen voluntaries without previous experience in surgery were divided in two groups (intervention and control and their performance was evaluated before and after a one-month standardized training program with the video game Marble Mania®. Results: A general improvement of all the performance variables was observed after one month training in the intervention group. This improvement was significant with respect to the control group in three of the eight variables: suturing errors (p = 0.003, and the execution and number of errors in the eye-hand coordination (p = 0.025 and 0.001, respectively.

  6. Comparison between two portal laparoscopy and open surgery for ovariectomy in dogs.

    Shariati, Elnaz; Bakhtiari, Jalal; Khalaj, Alireza; Niasari-Naslaji, Amir


    Ovariectomy (OVE) is a routine surgical procedure for neutering in small animal practice. Laparoscopy is a new surgical technique which contains advantages such as less trauma, smaller incision and excellent visualization than traditional open surgery. The present study was conducted to examine the feasibility and safety of laparoscopic procedure through two portal comparing with the conventional open surgery for OVE in healthy female bitches (n=16). Dogs were divided in two equal groups. In laparoscopic group, two 5 and 10 mm portals were inserted; First in the umbilicus for introducing the camera and the second, caudal to the umbilicus for inserting the forceps. Laparoscopic procedure involved grasping and tacking the ovary to the abdominal wall, followed by electrocautery, resection and removal of the ovary. In open surgery, routine OVE was conducted through an incision from umbilicus to caudal midline. Mean operative time, total length of scar, blood loss, clinical and blood parameters and all intra and post-operative complications were recorded in both groups. Mean operative time, total length of scar, blood loss and post-operative adhesions were significantly less in laparoscopic group compared with open surgery. In conclusion, laparoscopic OVE is an acceptable procedure due to more advantages in comparison with traditional OVE.

  7. Proficiency assessment of gesture analysis in laparoscopy by means of the surgeon's musculo-skeleton model.

    Cavallo, Filippo; Pietrabissa, Andrea; Megali, Giuseppe; Troia, Elena; Sinigaglia, Stefano; Dario, Paolo; Mosca, Franco; Cuschieri, Alfred


    This article presents the implementation of surgeon's musculo-skeletal model for gesture analysis in laparoscopy, thereby providing a complete account of the objective metrics needed to evaluate surgical performance and to improve the design of new surgical instruments including robotic instrumentation for surgical procedures. Previous published work has been based exclusively on the kinematics involved whereas, this study is focused on the dynamics and muscle contraction analysis to assess loads on bones and muscle fatigue during simulation of surgical interventions. Nine medical students and 2 fully trained surgeons participated in the experimental sessions using a virtual laparoscopic simulator. Movement was acquired by means of an Optical Localization System and processed by means of the biomechanical software platform ADAMS-LifeMOD. The musculo-skeletal analysis allows calculation of how the muscles are used and their respective mean work during the exercises. Results, relative to biceps and trapezius for left and right arm, clearly demonstrate different proficiencies between surgeons and medical students and highlight differences in using different surgical instruments and assumption of different postures. The model provides data on the evaluation of biomechanical parameters of surgical gesture not only in kinematic terms but also includes analysis of the dynamics of muscle contraction analysis during surgical manipulations.

  8. [Endometrial cancer by laparoscopy and vaginal approach in the obese patient].

    Caquant, Frédéric; Mas-Calvet, Marie; Turbelin, Caroline; Lesoin, Anne; Lefebvre, Daniele; Narducci, Fabrice; Querleu, Denis; Leblanc, Eric


    To prove feasibility of laparoscopic and vaginal surgical approach in obese patients with endometrial cancer, 81 patients were included retrospectively in 2 Cancer Centres : 41 obese and 40 non obese. We performed hysterectomy with oophorectomy and pelvic lymphadenectomy by laparoscopic and vaginal approach. Operative time was higher for obese patients vs non obese (150 vs 121 minutes, p = 0.01) but pelvic nodes (16.3 vs 16.2), postoperative stay (3.8 [2-8] vs 3.6 days [2-7]), complications and disease-free survival (93 % vs 83 %) were similar. Matching 41 obese patients treated by laparoscopy with 29 obese patients with endometrial cancer treated by laparotomy, hospital stay was shorter in the laparoscopic group (3.8 [2-8] vs 7.4 days [5-10] p obese patients with stage I endometrial adenocarcinoma, laparoscopic approach should be first choice because of similar operative complications and pelvic nodes, shorter hospital stay and less abdominal wall morbidity associated with lower risk to delay adjuvant radiotherapy.

  9. Consideration for safe and effective gynaecological laparoscopy in the obese patient.

    Hackethal, A; Brennan, D; Rao, A; Land, R; Obermair, A; Nicklin, J; Garrett, A; Nascimento, M; Crandon, A; Perrin, L; Chetty, N


    The number of obese and morbidly obese patients within the developed world is dramatically increasing within the last 20 years. Apart from demographical changes, obese patients are especially prone to have oestrogen-dependent morbidities and neoplasias, of which laparoscopic treatment should be the standard of care. The increasing number of patients with BMI >40 is concerning, making it necessary to summarise considerations for safe and effective Gynaecological Laparoscopic Surgery. The sequel to successful laparoscopic surgery in obese patients comprises an interdisciplinary appreciation of laparoscopy. Preoperatively, anaesthetics and medical review are suggested to optimise treatment of comorbidities (i.e. infections and blood sugar levels). Positioning of the patient should consider anti-slip options and pannus fixation to ease laparoscopic access and decrease pressure to the chest. There is no standard port placement in obese patients and landmarks have to be the bony structures of the pelvis and ribs. Retraction of the bowel is essential and mobilisation of the sigmoid with fan retractors or endoloops can accomplish adequate vision. 30° scopes can be considered for vision "around the obstacle". An experienced assistant with anticipation of surgical steps is favourable for successful surgery completion. Intra-operatively, good surgical techniques are essential. Vessel sealing systems reduce the need for instrument changes and may be helpful in following visualised tissue planes. A transvaginal vault closure may be advantageous compared to laparoscopic closure and Endostiches may be preferred to close the fascia of large trocar sites under vision.

  10. Learning curve of laparoscopy-assisted distal gastrectomy with systemic lymphadenectomy for early gastric cancer

    Min-Chan Kim; Ghap-Joong Jung; Hyung-Ho Kim


    AIM: To evaluate the nature of the "learning curve" for laparoscopy-assisted distal gastrectomy (LADG) with systemic lymphadenectomy for early gastric cancer. METHODS: The data of 90 consecutive patients with early gastric cancer who underwent LADG with systemic lymphadenectomy between April 2003 and November 2004 were reviewed. The 90 patients were divided into 9 sequential groups of 10 cases in each group and the average operative time of these 9 groups were determined. Other learning indicators, such as transfusion requirements, conversion rates to open surgery, postoperative complication, time to first flatus, and postoperative hospital stay, were evaluated. RESULTS: After the first 10 LADGs, the operative time reached its first plateau (230-240 min/operation) and then reached a second plateau (<200 min/operation) for the final 30 cases. Although a significant improvement in the operative time was noted after the first 50 cases, there were no significant differences in transfusion requirements, conversion rates to open surgery, postoperative complications, time to first flatus, or postoperative hospital stay between the groups. CONCLUSION: Based on operative time analysis, this study show that experience of 50 cases of LADG with systemic lymphadenectomy for early gastric cancer is required to achieve optimum proficiency.

  11. Intravenous ketamine compared with diclofenac suppository in suppressing acute postoperative pain in women undergoing gynecologic laparoscopy.

    Vosoughin, Maryam; Mohammadi, Shabnam; Dabbagh, Ali


    We aimed to compare the analgesic effects of low-dose intravenous ketamine with the effects of diclofenac suppositories in acute postoperative pain management in women undergoing gynecologic laparoscopic surgery under general anesthesia. In a double-blind, randomized clinical trial, 80 patients were selected and entered the study. After the induction of general anesthesia, one group received 0.15 mg/kg intravenous ketamine and the other group received a 100-mg rectal diclofenac suppository. The two groups were compared regarding acute pain scores, postoperative morphine requirements, and untoward complications. Pain scores and morphine requirements were lower in the rectal diclofenac suppository group at the 1st, 3rd, and 6th postoperative hours. Higher incidences of postoperative nausea and vomiting (PONV), delusions, and oral secretions were observed in the ketamine group. Diclofenac 100-mg suppositories were more effective in suppressing acute pain than 0.15 mg/kg intravenous ketamine in women undergoing elective gynecologic laparoscopy, with fewer untoward complications.

  12. Echinococcus multilocularis Detection in Live Eurasian Beavers (Castor fiber Using a Combination of Laparoscopy and Abdominal Ultrasound under Field Conditions.

    Róisín Campbell-Palmer

    Full Text Available Echinococcus multilocularis is an important pathogenic zoonotic parasite of health concern, though absent in the United Kingdom. Eurasian beavers (Castor fiber may act as a rare intermediate host, and so unscreened wild caught individuals may pose a potential risk of introducing this parasite to disease-free countries through translocation programs. There is currently no single definitive ante-mortem diagnostic test in intermediate hosts. An effective non-lethal diagnostic, feasible under field condition would be helpful to minimise parasite establishment risk, where indiscriminate culling is to be avoided. This study screened live beavers (captive, n = 18 or wild-trapped in Scotland, n = 12 and beaver cadavers (wild Scotland, n = 4 or Bavaria, n = 11, for the presence of E. multilocularis. Ultrasonography in combination with minimally invasive surgical examination of the abdomen by laparoscopy was viable under field conditions for real-time evaluation in beavers. Laparoscopy alone does not allow the operator to visualize the parenchyma of organs such as the liver, or inside the lumen of the gastrointestinal tract, hence the advantage of its combination with abdominal ultrasonography. All live beavers and Scottish cadavers were largely unremarkable in their haematology and serum biochemistry with no values suspicious for liver pathology or potentially indicative of E. multilocularis infection. This correlated well with ultrasound, laparoscopy, and immunoblotting, which were unremarkable in these individuals. Two wild Bavarian individuals were suspected E. multilocularis positive at post-mortem, through the presence of hepatic cysts. Sensitivity and specificity of a combination of laparoscopy and abdominal ultrasonography in the detection of parasitic liver cyst lesions was 100% in the subset of cadavers (95%Confidence Intervals 34.24-100%, and 86.7-100% respectively. For abdominal ultrasonography alone sensitivity was only 50% (95%CI 9

  13. [Per os early nutrition for colorectal pathology susceptible of laparoscopy-assisted surgery].

    Fernández de Bustos, A; Creus Costas, G; Pujol Gebelli, J; Virgili Casas, N; Pita Mercé, A M


    Current less invasive surgical techniques, the use of new analgesic and anesthetic drugs, and early mobilization ("multimodal surgical strategies") reduce the occurrence of post-surgery paralytic ileus and vomiting, making possible early nutrition by the digestive route. With these premises, a nutrition protocol was designed for its implementation in colorectal pathology susceptible of laparoscopy-assisted surgery. to assess the efficacy of this protocol that comprises 3 phases. Phase I: home preparation with 7 days duration; low-residues and insoluble fiber diet, supplemented with 400 mL of hyperproteic polymeric formula with no lactose or fiber, bowel cleansing 2 days prior to surgery and hydration with water, sugared infusions, and vegetable broth. Phase II: immediate post-surgical period with watery diet for 3 days with polymeric diet with no fiber. Phase III: semi-solid diet with no residues, nutritional formula and progressive reintroduction of food intake in four stages of varying duration according to surgery and digestive tolerance. prospective study performed at our hospital with patients from our influence area, from February 2003 to May 2004, including 25 patients, 19 men and 6 women, with mean age of 63.3 years (range = 33-79) and mean body mass index of 26.25 kg/m2 (range = 20.84-31.3), all of them suffering from colorectal pathology susceptible of laparoscopy-assisted surgery, and to which the study protocol was applied. Fourteen left hemicolectomies, 5 right hemicolectomies, 4 low anterior resections with protective colostomy, and subtotal colectomies and lateral ileostomy were done. Final diagnoses were: 3 diverticular diseases; 3 adenomas; 7 rectosigmoidal neoplasms; and 12 large bowel neoplasms in other locations. The pathology study confirmed: pT3N0 (n = 7), pT3N1 (n = 3), pT3N2 (n = 1), and pT3N1M1 (n = 1), pT1N0 (n = 4), pT1N1 (n = 2), pTis (n = 1). Twelve patients were started on adjuvant therapy of which 3 had received an initial treatment

  14. Virtual laparoscopy: Initial experience with three-dimensional ultrasonography to characterize hepatic surface features

    Sekimoto, Tadashi, E-mail: [Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670 (Japan); Maruyama, Hitoshi, E-mail: [Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670 (Japan); Kondo, Takayuki, E-mail: [Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670 (Japan); Shimada, Taro, E-mail: [Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670 (Japan); Takahashi, Masanori, E-mail: [Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670 (Japan); Yokosuka, Osamu, E-mail: [Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670 (Japan); Otsuka, Masayuki, E-mail: [Department of General Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670 (Japan); Miyazaki, Masaru, E-mail: [Department of General Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670 (Japan); Mine, Yoshitaka, E-mail: [Toshiba Medical Systems Corporation, Ultrasound Systems Division, Ultrasound Systems Development Department, Otawara, Tochigi (Japan)


    Objective: To examine the potential utility of 3D-reconstructed sonograms to distinguish cirrhotic from non-cirrhotic livers by demonstrating hepatic surface characteristics. Materials and methods: A preliminary phantom study was performed to examine the potential resolution of 3D images, recognizing surface irregularities as a difference in height. In a prospective clinical study of 31 consecutive patients with ascites (21 cirrhosis, 10 non-cirrhosis), liver volume data were acquired by transabdominal mechanical scanning. The hepatic surface features of cirrhotic and non-cirrhotic patients were compared by 2 independent reviewers. Intra- and inter-operator/reviewer agreements were also examined. Results: The phantom study revealed that 0.4 mm was the minimum recognizable difference in height on the 3D sonograms. The hepatic surface image was successfully visualized in 74% patients (23/31). Success depended on the amount of ascites; visualization was 100% with ascites of 10 mm or more between the hepatic surface and abdominal wall. The images showed irregularity of the hepatic surface in all cirrhotic patients. The surface appearance was confirmed as being very similar in 3 patients who had both 3D sonogram and liver resection for transplantation. The ability to distinguish cirrhotic liver from non-cirrhotic liver improved with the use of combination of 2D- and 3D-imaging versus 2D-imaging alone (sensitivity, p = 0.02; accuracy, p = 0.02) or 3D-imaging alone (sensitivity, p = 0.03). Intra-/inter-operator and inter-reviewer agreement were excellent (κ = 1.0). Conclusion: 3D-based sonographic visualization of the hepatic surface showed high reliability and reproducibility, acting as a virtual laparoscopy method, and the technique has the potential to improve the diagnosis of cirrhosis.

  15. Training models in laparoscopy: a systematic review comparing their effectiveness in learning surgical skills.

    Willaert, W; Van De Putte, D; Van Renterghem, K; Van Nieuwenhove, Y; Ceelen, W; Pattyn, P


    Surgery has traditionally been learned on patients in the operating room, which is time-consuming, can have an impact on the patient outcomes, and is of variable effectiveness. As a result, surgical training models have been developed, which are compared in this systematic review. We searched Pubmed, CENTRAL, and Science Citation index expanded for randomised clinical trials and randomised cross-over studies comparing laparoscopic training models. Studies comparing one model with no training were also included. The reference list of identified trials was searched for further relevant studies. Fifty-eight trials evaluating several training forms and involving 1591 participants were included (four studies with a low risk of bias). Training (virtual reality (VR) or video trainer (VT)) versus no training improves surgical skills in the majority of trials. Both VR and VT are as effective in most studies. VR training is superior to traditional laparoscopic training in the operating room. Outcome results for VR robotic simulations versus robot training show no clear difference in effectiveness for either model. Only one trial included human cadavers and observed better results versus VR for one out of four scores. Contrasting results are observed when robotic technology is compared with manual laparoscopy. VR training and VT training are valid teaching models. Practicing on these models similarly improves surgical skills. A combination of both methods is recommended in a surgical curriculum. VR training is superior to unstructured traditional training in the operating room. The reciprocal effectiveness of the other models to learn surgical skills has not yet been established.

  16. Effect of different warm-up strategies on simulated laparoscopy performance: a randomized controlled trial.

    Brönnimann, Enrico; Hoffmann, Henry; Schäfer, Juliane; Hahnloser, Dieter; Rosenthal, Rachel


    The objective of this trial was to assess which type of warm-up has the highest effect on virtual reality (VR) laparoscopy performance. The following warm-up strategies were applied: a hands-on exercise (group 1), a cognitive exercise (group 2), and no warm-up (control, group 3). This is a 3-arm randomized controlled trial. The trial was conducted at the department of surgery of the University Hospital Basel in Switzerland. A total of 94 participants, all laypersons without any surgical or VR experience, completed the study. A total of 96 participants were randomized, 31 to group 1, 31 to group 2, and 32 to group 3. There were 2 postrandomization exclusions. In the multivariate analysis, we found no evidence that the intervention had an effect on VR performance as represented by 6 calculated subscores of accuracy, time, and path length for (1) camera manipulation and (2) hand-eye coordination combined with 2-handed maneuvers (p = 0.795). Neither the comparison of the average of the intervention groups (groups 1 and 2) vs control (group 3) nor the pairwise comparisons revealed any significant differences in VR performance, neither multivariate nor univariate. VR performance improved with increasing performance score in the cognitive exercise warm-up (iPad 3D puzzle) for accuracy, time, and path length in the camera navigation task. We were unable to show an effect of the 2 tested warm-up strategies on VR performance in laypersons. We are currently designing a follow-up study including surgeons rather than laypersons with a longer warm-up exercise, which is more closely related to the final task. Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  17. Quality control and educational value of laparoscopy-assisted gastrectomy in a high-volume center.

    Tokunaga, Masanori; Hiki, Naoki; Fukunaga, Tetsu; Miki, Akira; Nunobe, Souya; Ohyama, Shigekazu; Seto, Yasuyuki; Yamaguchi, Toshiharu


    Laparoscopy-assisted gastrectomy (LAG) is increasingly performed in Japan by a number of surgeons. As this is a relatively new technique, a training system is important, however there has been little discussion about an educational system for teaching trainees to perform LAG and the ideal training system has not yet been established. Two hundred and sixty-three patients who underwent LAG at the Cancer Institute Hospital were included in this study. In all cases there was standardization of LAG (the way in which the surgical field was formed by the assistant and the way the operator dissected the lymph nodes was determined and all cases were performed using the same laparoscopic procedures) and a step-by-step training system was completed. Specialists performed the surgery in 213 patients (S group) while the remaining 50 patients had their surgery performed by trainees (T group). Early surgical outcomes were compared between specialists and trainees to clarify whether the standardization and our educational system are useful in maintaining the quality of LAG. T-group patients had significantly longer operation times than those of S-group (262.3 +/- 7.3 versus 233.3 +/- 3.7 min), however, the trainees reached the plateau of their learning curve earlier than previously reported. All other early surgical outcomes examined, including intraoperative blood loss (76.7 +/- 35.1 versus 64.9 +/- 7.7 ml), number of retrieved lymph nodes (33.4 +/- 1.4 versus 35.7 +/- 0.8), morbidity (8 versus 14%), and mortality (0% in both groups), were not significantly different between the two groups. The surgical results of T-group were almost equal to those of S-group, showing that our educational system is effective and surgical quality is maintained. Standardized laparoscopic procedures and sufficient intensive experience in the short term are requisites for effectively learning how to perform LAG.

  18. Patient and surgeon factors are associated with the use of laparoscopy in appendicitis.

    McCartan, D P


    Aim The use of a minimally invasive approach to treat appendicitis has yet to be universally accepted. The objective of this study was to examine recent trends in Ireland in the surgical management of acute appendicitis. Method Data were obtained from the Irish Hospital In-Patient Enquiry system for patients discharged with a diagnosis of appendicitis between 1999 and 2007. An anonymous postal survey was sent to all general surgeons of consultant and registrar level in Ireland to assess current attitudes to the use of laparoscopic appendectomy. Results The use of laparoscopic appendectomy increased throughout the study and was the most common approach for appendectomy in 2007. Multivariate analysis revealed age under 50 years (OR = 1.51), female sex (OR = 2.84) and residence in high-density population areas (OR = 4.15) as predictive factors for undergoing laparoscopic appendectomy in the most recent year of the study. While 97% of surgeons reported current use of laparoscopy in patients with acute right iliac fossa pain, in most cases it was selective. Surgeons in university teaching hospitals (42 of 77; 55%) were more likely to report using laparoscopic appendectomy for all cases of appendicitis than those in regional (six of 23; 26%) or general (13 of 53; 25%) hospitals (P = 0.048). Conclusion This study has demonstrated a significant increase in laparoscopic appendectomy, yet a variety of patient and surgeon factors contribute to the choice of procedure. Differences in the perception of benefit of the laparoscopic approach amongst surgeons appears to be an important factor in determining the operative approach for appendectomy.

  19. Cystoscopy-assisted laparoscopy for bladder endometriosis: modified light-to-light technique for bladder preservation

    Stopiglia, Rafael Mamprin; Ferreira, Ubirajara; Faundes, Daniel Gustavo; Petta, Carlos Alberto


    ABSTRACT Introduction Endometriosis is a disease with causes still unclear, affecting approximately 15% of women of reproductive age, and in 1%-2% of whom it may involve the urinary tract. The bladder is the organ most frequently affected by endometriosis, observed around 85% of the cases. In such cases, the most effective treatment is partial cystectomy, especially via videolaparoscopy. Study Objective, Design, Size and Duration In order to identify and delimit the extent of the intravesical endometriosis lesion, to determine the resection limits, as well as to perform an optimal reconstruction of the organ aiming for its maximum preservation, we performed a cystoscopy simultaneously with the surgery, employing a modified light-to-light technique in 25 consecutive patients, from September 2006 to May 2012. Setting Study performed at Campinas Medical Center – Campinas – Sao Paulo – Brazil.Participants/materials, setting and methods: Patients aged 27 to 47 (average age: 33.4 years) with deep endometriosis with total bladder involvement were selected for the study. The technique used was conventional laparoscopy with a transvaginal uterine manipulator and simultaneous cystoscopy (the light-to-light technique). A partial videolaparoscopic cystectomy was performed with cystoscopy-assisted vesical reconstruction throughout the entire surgical time. The lesions had an average size of 2.75cm (ranging from 1.5 to 5.5cm). The average surgical time was 137.7 minutes, ranging from 110 to 180 minutes. Main Results Postoperative follow-up time was 32.4 months (12-78 months), with clinical evaluation and a control cystoscopy performed every six months. No relapse was observed during the follow-up period. Conclusions A cystoscopy-assisted partial laparoscopic cystectomy with a modified light-to-light technique is a method that provides adequate identification of the lesion limits, intra or extravesically. It also allows a safe reconstruction of the organ aiming for its

  20. Influencing factors for port-site hernias after single-incision laparoscopy.

    Buckley, F P; Vassaur, H E; Jupiter, D C; Crosby, J H; Wheeless, C J; Vassaur, J L


    Single-incision laparoscopic surgery (SILS) has been demonstrated to be a feasible alternative to multiport laparoscopy, but concerns over port-site incisional hernias have not been well addressed. A retrospective study was performed to determine the rate of port-site hernias as well as influencing risk factors for developing this complication. A review of all consecutive patients who underwent SILS over 4 years was conducted using electronic medical records in a multi-specialty integrated healthcare system. Statistical evaluation included descriptive analysis of demographics in addition to bivariate and multivariate analyses of potential risk factors, which were age, gender, BMI, procedure, existing insertion-site hernia, wound infection, tobacco use, steroid use, and diabetes. 787 patients who underwent SILS without conversion to open were reviewed. There were 454 cholecystectomies, 189 appendectomies, 72 colectomies, 21 fundoplications, 15 transabdominal inguinal herniorrhaphies, and 36 other surgeries. Cases included 532 (67.6 %) women, and among all patients mean age was 44.65 (±19.05) years and mean BMI of 28.04 (±6). Of these, 50 (6.35 %) patients were documented as developing port-site incisional hernias by a health care provider or by incidental imaging. Of the risk factors analyzed, insertion-site hernia, age, and BMI were significant. Multivariate analysis indicated that both preexisting hernia and BMI were significant risk factors (p value = 0.00212; p value = 0.0307). Morbidly obese patients had the highest incidence of incisional hernias at 18.18 % (p value = 0.02). When selecting patients for SILS, surgeons should consider the presence of an umbilical hernia, increased age and obesity as risk factors for developing a port-site hernia.

  1. Safety and efficacy of laparoscopy-assisted gastrectomy for advanced gastric cancer in the elderly.

    Qiu, Jiang-Feng; Yang, Bing; Fang, Lei; Li, Yi-Ping; Shi, Yi-Jiu; Yu, Xiu-Chong; Zhang, Mou-Cheng


    To evaluate safety and efficacy of laparoscopy-assisted radical gastrectomy (LARG) for advanced gastric cancer patients aged 70 years or older. Clinical data were retrospectively collected from patients with IIA-IIIC gastric cancer who underwent LARG (n = 30) and open radical gastrectomy (ORG, n = 34) in Department of Gastrointestinal Surgery in the Ningbo First Hospital from January 2012 to December 2013. The mean operative time was longer in the LARG group than in the ORG group but there was no statistical difference between the two groups. The intraoperative blood loss (120 ± 52.7 ml vs 227.3 ± 146.9 ml), incidence of postoperative complication (23.0% vs 47%) were lower in the LARG group than those in the ORG group. In addition, the time to first flatus (2.9 ± 0.8 d vs 4.6 ± 1.2 d), time to first ambulation (1.2 ± 0.4 vs 4.1 ± 1.0 d), time of nasogastric intubation (2.5 ± 1.0 d vs 3.5 ± 1.4 d), and postoperative hospital stay (13.0 ± 4.2 d vs 16.9 ± 4.1 d) were significantly shorter in the LARG group than in the ORG group, respectively. No statistical difference in the number of harvested lymph nodes was noted between the two groups (30.2 ± 12.0 vs 28.1 ± 11.8, P > 0.05). LARG is safer, more effective and less invasive for the elderly patients with advanced gastric cancer.

  2. Laparoscopy mitigates adverse oncological effects of delayed adjuvant chemotherapy for colon cancer.

    Gantt, Gerald A; Ashburn, Jean; Kiran, Ravi P; Khorana, Alok A; Kalady, Matthew F


    Delaying initiation of adjuvant chemotherapy more than 8 weeks after surgical resection for colorectal cancer adversely affects overall patient survival. The effect of a laparoscopic surgical approach on initiation of chemotherapy has not been studied. The goal of this study was to determine if a laparoscopic approach to colon cancer resection affects the timing of adjuvant chemotherapy and outcomes. Patients who underwent curative surgery for stage II or III colon cancer and received adjuvant chemotherapy between 2003 and 2010 were identified from a prospectively maintained database. Patients were categorized according to surgical approach: open or laparoscopic. Patient demographics, clinicopathologic variables, postoperative complications, time from surgery to initiation of chemotherapy, and long-term oncologic outcomes were compared. Age, gender, ASA class, BMI, tumor stage, and postoperative complications were similar for laparoscopic and open cases, while length of stay was 2 days shorter for laparoscopic cases (5.4 vs 7.6 days, p < 0.01). The proportion of patients who received adjuvant chemotherapy more than 8 weeks after surgery did not differ between the groups (35.6 % open vs 38.7 % laparoscopic, p = 0.77). In the open group, delay in chemotherapy after surgery was associated with decreased disease-free and overall survival (p = 0.01, 0.01, respectively). However, delay in chemotherapy more than 8 weeks did not affect disease-free or overall survival in the laparoscopy group (p = 0.93, 0.51, respectively). The benefits of quicker recovery after laparoscopic surgery did not translate into earlier initiation of adjuvant chemotherapy in this retrospective study. However, a laparoscopic approach negated the inferior oncologic outcomes of patients who received delayed initiation of chemotherapy.

  3. Comparison of robotic surgery and laparoscopy to perform total hysterectomy with pelvic adhesions or large uterus

    Li-Hsuan Chiu


    Full Text Available Background: Currently, benefits of robotic surgery in patients with benign gynecological conditions remain unclear. In this study, we compared the surgical outcome of robotic and laparoscopic total hysterectomies and evaluated the feasibility of robotic surgery in cases with pelvic adhesions or large uterus. Materials and Methods: A total of 216 patients receiving total hysterectomy via robotic or laparoscopic approach were included in this study. Of all 216 patients, 88 underwent robotic total hysterectomy and 128 underwent laparoscopic total hysterectomy. All cases were grouped by surgical type, adhesion score, and uterine weight to evaluate the interaction or individual effect to the surgical outcomes. The perioperative parameters, including operation time, blood loss, postoperative pain score, time to full diet resumption, length of hospital stay, conversion rate, and surgery-related complications were compared between the groups. Results: Operation time and blood loss were affected by both surgical type and adhesion score. For cases with severe adhesions (adhesion score greater than 4, robotic surgery was associated with a shortened operation time (113.9 ± 38.4 min versus 164.3 ± 81.4 min, P = 0.007 and reduced blood loss (187.5 ± 148.7 mL versus 385.7 ± 482.6, P=0.044 compared with laparoscopy. Moreover, robotic group showed a lower postoperative pain score than laparoscopic group, as the effect was found to be independent of adhesion score or uterine weight. The grade-II complication rate was also found to be lower in the robotic group. Conclusions: Comparing to laparoscopic approach, robotic surgery is a feasible and potential alternative for performing total hysterectomy with severe adhesions.

  4. Effectiveness of a team participation training course for laparoscopy-assisted gastrectomy.

    Kinoshita, Takahiro; Kanehira, Eiji; Matsuda, Minoru; Okazumi, Shinichi; Katoh, Ryoji


    Laparoscopy-assisted distal gastrectomy (LADG) for stomach cancer is increasingly performed in Japan and Korea. However, the procedure still is considered to be complicated, and the optimal education system for trainees has not been established to date. The authors organized a 1-day professional training course termed the LADG Basic Lab Course for LADG beginners. The participants were required to apply as a team of two surgeons and two operating nurses. The training course consisted of lectures and a live porcine lab emphasizing use of the ultrasonically activated device and the flexible laparoscope as well as team cooperation. The quality and effectiveness of the course were evaluated 6-10 months (mean, 8.2 +/- 2.2 months) after the course using a survey form sent to a representative surgeon of each institution. From May 2007 to July 2008, a total of 80 colleagues (47 surgeons and 33 nurses) from 20 different centers in Japan participated in the training course. These surgeons represented 12.4 +/- 6.2 postgraduate years of education and had performed 2.7 +/- 4.9 LADGs before taking the course. In the follow-up evaluation, 12 institutions (60%) completed the survey forms. The mean operation time was reduced for eight respondents (66.7%). The number of LADGs performed per month increased in 50% of the respondents' institutions. The degree of lymph node dissection in LADG was extended for 66.7% of the respondents. The respondents answered that 100% of the first operators showed improvement in skills, as did 59.5% of the scope operators and 59.5% of the nurses. The training course was an effective means of introducing LADG to each institution. Training courses emphasizing explanations of key devices and teamwork may be effective for the introduction of advanced laparoscopic surgeries.

  5. Internal inguinal ring closure by laparoscopy using homologous pericardium grafts in horses

    Julio David Spagnolo


    Full Text Available ABSTRACT: The occlusion of inguinal ring is the treatment to avoid the inguinal hernia in horses. The aim of this study is evaluate the efficacy of homologous pericardium grafts for internal inguinal ring closure in horses, comparing mechanical or manual laparoscopic suture. Cross over study, using six healthy intact male Mangalarga breed horses aged between 3 and 12 years. Horses were operated under general anesthesia in 25º Trendelenburg position. Five laparoscopic portals were employed. Pericardium grafts measuring 4x5cm were anchored covering the left and right internal inguinal rings using either manual intracorporeal suture or laparoscopic stapler. Horses were followed-up during 11 weeks when were submitted to a laparoscopic control. Surgical time, trans and postoperative complications and effectiveness of internal inguinal closure were evaluated and statistically analyzed. The level of significance was set at 5% P<0.05. The procedures were realized without complications and the mean time required for manual and mechanical suture procedures differed significantly (67.8±15.3 and 14.1±2.1 min respectively; P<0.05. All manually sutured grafts remained in place and partial suture dehiscence with incomplete occlusion of the internal inguinal ring was observed in two stapled grafts. Non-severe complications were observed trans or postoperatively. One synechiae and three omental adhesions were observed by laparoscopic control on day 77, but without clinical relevance in the evaluated period. The use of homologous pericardium grafts was effectiveness to internal inguinal ring closure by laparoscopy. Mechanical suture was faster to perform than manual, but provided less satisfactory results concerning safety of graft fixation.

  6. Cystoscopy-assisted laparoscopy for bladder endometriosis: modified light-to-light technique for bladder preservation

    Rafael Mamprin Stopiglia

    Full Text Available ABSTRACT Introduction Endometriosis is a disease with causes still unclear, affecting approximately 15% of women of reproductive age, and in 1%-2% of whom it may involve the urinary tract. The bladder is the organ most frequently affected by endometriosis, observed around 85% of the cases. In such cases, the most effective treatment is partial cystectomy, especially via videolaparoscopy. Study Objective, Design, Size and Duration In order to identify and delimit the extent of the intravesical endometriosis lesion, to determine the resection limits, as well as to perform an optimal reconstruction of the organ aiming for its maximum preservation, we performed a cystoscopy simultaneously with the surgery, employing a modified light-to-light technique in 25 consecutive patients, from September 2006 to May 2012. Setting Study performed at Campinas Medical Center – Campinas – Sao Paulo – Brazil.Participants/materials, setting and methods: Patients aged 27 to 47 (average age: 33.4 years with deep endometriosis with total bladder involvement were selected for the study. The technique used was conventional laparoscopy with a transvaginal uterine manipulator and simultaneous cystoscopy (the light-to-light technique. A partial videolaparoscopic cystectomy was performed with cystoscopy-assisted vesical reconstruction throughout the entire surgical time. The lesions had an average size of 2.75cm (ranging from 1.5 to 5.5cm. The average surgical time was 137.7 minutes, ranging from 110 to 180 minutes. Main Results Postoperative follow-up time was 32.4 months (12-78 months, with clinical evaluation and a control cystoscopy performed every six months. No relapse was observed during the follow-up period. Conclusions A cystoscopy-assisted partial laparoscopic cystectomy with a modified light-to-light technique is a method that provides adequate identification of the lesion limits, intra or extravesically. It also allows a safe reconstruction of the organ

  7. Laparoscopy versus mini-laparotomy peritoneal catheter insertion of ventriculoperitoneal shunts: a systematic review and meta-analysis.

    He, Mingliang; Ouyang, Leping; Wang, Shengwen; Zheng, Meiguang; Liu, Anmin


    OBJECTIVE Ventriculoperitoneal (VP) shunt treatment is the main treatment method for hydrocephalus. The traditional operative approach for peritoneal catheter insertion is mini-laparotomy. In recent years, laparoscopy-assisted insertion has become increasingly popular. It seems likely that use of an endoscope could lower the incidence of shunt malfunction. However, there is no consensus about the benefits of laparoscopy-assisted peritoneal catheter insertion. METHODS A systematic search was performed using the PubMed, Embase, ScienceDirect, and Cochrane Library databases. A manual search for reference lists was conducted. The protocol was prepared according to the interventional systematic reviews of the Cochrane Handbook, and the article was written on the basis of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. RESULTS Eleven observational trials and 2 randomized controlled trials were included. Seven operation-related outcome measures were analyzed, and 3 of these showed no difference between operative techniques. The results of the meta-analysis are as follows: in the laparoscopy group, the rate of distal shunt failure was lower (OR 0.41, 95% CI 0.25-0.67; p = 0.0003), the absolute effect is 7.11% for distal shunt failure, the number needed to treat is 14 (95% CI 8-23), operative time was shorter (mean difference [MD], -12.84; 95% CI -20.68 to -5.00; p = 0.001), and blood loss was less (MD -9.93, 95% CI -17.56 to -2.31; p = 0.01). In addition, a borderline statistically significant difference tending to laparoscopic technique was observed in terms of hospital stay (MD -1.77, 95% CI -3.67 to 0.13; p = 0.07). CONCLUSIONS To some extent, a laparoscopic insertion technique could yield a better prognosis, mainly because it is associated with a lower distal failure rate and shorter operative time, which would be clinically relevant.

  8. The Multidisciplinary Team Conference's Decision on M-Staging in Patients with Gastric- and Gastroesophageal Cancer is not Accurate without Staging Laparoscopy

    Strandby, Rune Broni; Svendsen, Lars Bo; Fallentin, E.


    in the period 2010-2012 were retrospectively reviewed. Patient data were retrieved by searching for specific diagnosis and operation codes in the in-house system. The inclusion criteria were as follows: biopsy-verified cancer of the esophagus, gastroesophageal junction or stomach, and no suspicion of peritoneal......BACKGROUND: The implementation of the multidisciplinary team conference has been shown to improve treatment outcome for patients with gastric- and gastroesophageal cancer. Likewise, the staging laparoscopy has increased the detection of patients with disseminated disease, that is, patients who do...... carcinomatosis or liver metastases on multidisciplinary team conference before staging laparoscopy. Furthermore, an evaluation with staging laparoscopy was required. RESULTS: In total, 222 patients met the inclusion criteria. Most cancers were located in the gastroesophageal junction, n = 171 (77.0%), and most...

  9. The HubBLe Trial: haemorrhoidal artery ligation (HAL) versus rubber band ligation (RBL) for symptomatic second- and third-degree haemorrhoids: a multicentre randomised controlled trial and health-economic evaluation.

    Brown, Steven; Tiernan, Jim; Biggs, Katie; Hind, Daniel; Shephard, Neil; Bradburn, Mike; Wailoo, Allan; Alshreef, Abualbishr; Swaby, Lizzie; Watson, Angus; Radley, Simon; Jones, Oliver; Skaife, Paul; Agarwal, Anil; Giordano, Pasquale; Lamah, Marc; Cartmell, Mark; Davies, Justin; Faiz, Omar; Nugent, Karen; Clarke, Andrew; MacDonald, Angus; Conaghan, Phillip; Ziprin, Paul; Makhija, Rohit


    Optimal surgical intervention for low-grade haemorrhoids is unknown. Rubber band ligation (RBL) is probably the most common intervention. Haemorrhoidal artery ligation (HAL) is a novel alternative that may be more efficacious. The comparison of HAL with RBL for the treatment of grade II/III haemorrhoids. A multicentre, parallel-group randomised controlled trial. UK NHS and Personal Social Services. 17 NHS Trusts. Patients aged ≥ 18 years presenting with grade II/III (second- and third-degree) haemorrhoids, including those who have undergone previous RBL. HAL with Doppler probe compared with RBL. Primary outcome - recurrence at 1 year post procedure; secondary outcomes - recurrence at 6 weeks; haemorrhoid severity score; European Quality of Life-5 Dimensions, 5-level version (EQ-5D-5L); Vaizey incontinence score; pain assessment; complications; and cost-effectiveness. A total of 370 participants entered the trial. At 1 year post procedure, 30% of the HAL group had evidence of recurrence compared with 49% after RBL [adjusted odds ratio (OR) = 2.23, 95% confidence interval (CI) 1.42 to 3.51; p = 0.0005]. The main reason for the difference was the number of extra procedures required to achieve improvement/cure. If a single HAL is compared with multiple RBLs then only 37.5% recurred in the RBL arm (adjusted OR 1.35, 95% CI 0.85 to 2.15; p = 0.20). Persistence of significant symptoms at 6 weeks was lower in both arms than at 1 year (9% HAL and 29% RBL), suggesting significant deterioration in both groups over the year. Symptom score, EQ-5D-5L and Vaizey score improved in both groups compared with baseline, but there was no difference between interventions. Pain was less severe and of shorter duration in the RBL group; most of the HAL group who had pain had mild to moderate pain, resolving by 3 weeks. Complications were low frequency and not significantly different between groups. It appeared that HAL was not cost-effective compared with RBL. In the base

  10. Laparoscopy-assisted gastrectomy with D2 lymph node dissection for advanced gastric cancer without serosa invasion: a matched cohort study from South China

    Lin Jian-Xian


    Full Text Available Abstract Background Gastric cancer is a common malignancy worldwide and a common cause of death from cancer. Despite recent advances in multimodality treatment and targeted therapy, complete resection remains the only treatment that can lead to cure. This study was devised to investigate the technical feasibility, safety and oncologic efficacy of laparoscopy-assisted gastrectomy for advanced gastric cancer without serosa invasion. Methods A retrospective matched cohort study was performed in south China comparing laparoscopy-assisted gastrectomy and open gastrectomy for advanced gastric cancer without serosa invasion. Eighty-three patients with advanced gastric cancer undergoing laparoscopy-assisted gastrectomy between January 2008 and December 2010 were enrolled. These patients were compared with 83 patients with advanced gastric cancer undergoing open gastrectomy during the same period. Results There was no significant difference in clinicopathologic characteristics between the two groups. Regarding perioperative characteristics, the operation time and time to ground activities did not differ between the two groups, whereas the blood loss, transfused patient number, time to first flatus, time to resumption of diet, and postoperative hospital stay were significantly less in laparoscopy-assisted gastrectomy than in open gastrectomy (P Conclusion Laparoscopy-assisted gastrectomy with D2 lymphadenectomy is a safe and feasible procedure for advanced gastric cancer without serosa invasion. To be accepted as a choice treatment for advanced gastric cancer, well-designed randomized controlled trials comparing short-term and long-term outcomes between laparoscopy-assisted gastrectomy and open gastrectomy in a larger number of patients are necessary.

  11. Hybrid approach of retractor-based and conventional laparoscopy enabling minimally invasive hysterectomy in a morbidly obese patient: case report and review of the literature.

    Hoellen, Friederike; Rody, Achim; Ros, Andrea; Bruns, Angela; Cirkel, Christoph; Bohlmann, Michael K


    Minimally invasive hysterectomy in obese patients may be limited by laparoscopic sight on the one hand and by intraoperative complications related to reduced ventilation due to pneumoperitoneum on the other. Retractor-based laparoscopy offers an operative technique reducing anesthesia risks. We report the case of laparoscopic hysterectomy in an obese patient of short stature. Laparoscopic supracervical hysterectomy was performed by a hybrid approach of a retractor system exerting its effects on lifting the abdominal wall through gravity and conventional laparoscopy, thus bypassing the adverse effects of pneumoperitoneum on ventilation.

  12. Laparoscopy assisted percutaneous stone surgery can be performed in multiple ways for pelvic ectopic kidneys.

    Soylemez, Haluk; Penbegül, Necmettin; Utangac, Mehmet Mazhar; Dede, Onur; Çakmakçı, Süleyman; Hatipoglu, Namık Kemal


    Pelvic kidney stones remain a unique challenge to the endourologists. Treatment options include open surgery, extracorporeal shockwave lithotripsy, percutaneous nephrolithotomy (PNL), retrograde intrarenal surgery, and laparoscopy assisted PNL (LA-PNL). As a minimal invasive option, LA-PNL can decrease the risk for bowel and major vessel injury. Here, we describe our experience using the LA-PNL procedures with different combinations, to treat kidney stones in multiple patients with a pelvic ectopic kidney (PEK). Eight patients, with PEK, kidney stones, and no other treatment choice, but open surgery, were included in the study. Two different laparoscopic techniques such as mesocolon dissection and transmesocolic, and four different percutaneous procedures such as standard-PNL, mini-PNL, micro-PNL, and a PNL through the renal pelvis were used for stone extraction in these patients. The mean age of patients was 25.6 ± 12.9 years and mean stone size was 524.1 ± 430.3 mm(2). Mean operation time was 150.5 ± 40.0 (77-210) min which was composed of retrograde catheterization (14.8 ± 2.9 min), laparoscopic procedure (48.7 ± 20.6 min) and PNL procedure (86.8 ± 31.1 min). Residual stones were seen in two patients (no additional treatment was need), while a 'stone-free' procedure was achieved in six patients (75.0 %). On the post-operative first month visit, a stone was observed on radiological examinations in only one patient (87.5 % stone-free). Mean hospitalization time was 2.8 ± 0.9 days. No perioperative or post-operative complication was observed in all patients. LA-PNL surgery is a safe and effective option for treatment of PEK stones, and has several alternative approaches.

  13. Die Analyse der Inhibition des Monozyten chemotaktischen Proteins-1 (MCP-1) und der Stimulation durch MCP-1 auf die Koloniebildung und die Zytokinexpression von Plattenepithelkarzinomen der Kopf-Hals-Region im FLAVINO-Assay

    Körner, Carolin


    Das Monozyten chemotaktische Protein-1 (MCP-1) ist ein CC-Chemokin, das in seiner Rolle als Chemoattraktor auf Monozyten in der Genese von Malignomen eine wesentliche Rolle spielt. Dabei kann es sowohl zur lokalen Tumorabwehr als auch zur Tumorgenese, Tumor-angiogenese und Metastasierung beitragen. Die vorliegende Arbeit untersucht die MCP-1-Inhibition und die Stimulation durch MCP-1 auf die Koloniebildung und die Zytokinexpression von Plattenepithelkarzinomen der Kopf-Hals-Region (HNSCC) im ...

  14. Simultaneous laparoscopy-assisted low anterior resection and distal gastrectomy for synchronous carcinoma of rectum and stomach

    Qian-Lin Zhu; Feng Dong; Jun-Jun Ma; Ya-Ping Zong; Min-Hua Zheng; Bo Feng; Ai-Guo Lu; Min-Liang Wang; Jian-Wen Li; Wei-Guo Hu; Lu Zang; Zhi-Hai Mao


    Laparoscopic resection of rectal cancer or gastric cancer has been advocated for the benefits of a reduced morbidity,a shorter treatment time,and similar outcomes.However,simultaneous laparoscopy-assisted low anterior resection and distal gastrectomy for synchronous carcinoma of rectum and stomach are rarely documented in literature.Endoscopic examination revealed a synchronous carcinoma of rectum and stomach in a 55-year-old male patient with rectal bleeding and epigastric discomfort.He underwent a simultaneous laparoscopy-assisted low anterior resection and distal gastrectomy with regional lymph nodes dissected.The operation time was 270min and the estimated blood loss was 120mL.The patient required parenteral analgesia for less than 24h.Flatus was passed on postoperative day 3,and a solid diet was resumed on postoperative day 7.He was discharged on postoperative day 13.With the advances in laparoscopic technology and experience,simultaneous resection is an attractive alternative to a synchronous gastrointestinal cancer.

  15. Operative outcomes of single-port-access laparoscopy-assisted vaginal hysterectomy compared with single-port-access total laparoscopic hysterectomy

    Bo Sung Yoon


    Conclusion: SPA-TLH with laparoscopic vaginal suture required the longest operating time, and hemoglobin changes were smaller in the SPA-LAVH group than in the other groups. In patients undergoing SPA laparoscopy, we recommend the SPA-LAVH procedure.

  16. Comparison of Tubal Sterilization Procedures Performed by Keyless Abdominal Rope-Lifting Surgery and Conventional CO2 Laparoscopy: A Case Controlled Clinical Study

    Kahraman Ülker


    Full Text Available Objective. To evaluate the safety and efficacy of Keyless Abdominal Rope-Lifting Surgery (KARS, for tubal sterilization procedures in comparison with the conventional CO2 laparoscopy. Material and Methods. During a one-year period, 71 women underwent tubal ligation surgery. Conventional laparoscopy (N=38 and KARS (N=33 were used for tubal sterilization. In KARS, an abdominal access pathway through a single intra-abdominal incision was used to place transabdominal sutures that elevated the abdominal wall, and the operations were performed through the intraumbilical entry without the use of trocars. In CO2 laparoscopy, following the creation of the CO2 pneumoperitoneum a 10 mm trocar and two 5 mm trocars were introduced into the abdominal cavity. Tubal sterilizations were performed following the creation of the abdominal access pathways in both groups. The groups were compared with each other. Results. All operations could be performed by KARS without conversion to CO2 laparoscopy or laparotomy. The mean operative time of the two groups was not significantly different (P>0.05. Intra- and postoperative findings including complications, bleeding, and hospital stay time did not differ between groups (P>0.05. Conclusion. KARS for tubal sterilization seems safe and effective in terms of cosmesis, postoperative pain, and early hospital discharge.

  17. Is the aptitude of manual skills enough for assessing the training effect of students using a laparoscopy simulator?

    Zielke, Andreas


    Full Text Available Background: The aim of this study was to determine if students are suitable candidates to assess the learning effect through a virtual reality laparoscopy simulator (LapSim®. Materials and methods: 14 medical students in their final year without any previous experience with a virtual reality simulator were recruited as subjects. In order to establish a "base line" all subjects were instructed into the "clip application" task - a basis module of the laparoscopy simulator - at the beginning of the study. They were then randomized into two groups. Group A (n=7 had parameter adjusted to an easy level of performance, while group B (n=7 was adjusted to a difficult level. In both levels, errors simulated clinically relevant situations such as vessel rupture and subsequent bleeding. Each participant had to repeat the clip application task ten times consecutively. Results: The mean time for completion ten repetitions was 15 min pro participant in group A and 20 min in group B. From the first to the fifth repetition group A improved significantly the task completion time from 238.9 s to 103.3 s (p<0.007 consecutively and also improved the error score from 312 to 177 (p<0.07. At the tenth repetition they increased the task completion time from 103.3 s to 152.2 s (p<0.09 and increased their error score from 177 to 202 (p=0.25. From the first to the fifth repetition group B also improved the task completion time from 131.6 s to 104.5 s (p<0.31 consecutively and improved the error score from 235 to 208 (p<0.32 but at the tenth repetition they increased the task completion time from 104.5 s to 142.4 s (p<0.45 and clearly increased their error score from 208 to 244 (p<0.38. Conclusion: These results suggest that medical students, who lack clinical background, may be not suitable candidates for assessing the efficiency of a training model using a laparoscopy simulator. If medical students are appointed for such studies, they should receive didactic sessions in

  18. Sexual Function and Body Image are Similar after Laparoscopy-Assisted and Open Ileal Pouch-Anal Anastomosis

    Kjaer, Mie Dilling; Laursen, Stig Borbjerg; Qvist, Niels


    postoperative sexual function and body image compared to those after open surgery IPAA. METHODS: Patients treated with IPAA in the period from October 2008 to March 2012 were included. Evaluation of sexual function, body image, and quality of life was performed using the Female Sexual Function Index (FSFI......, quality of life (SIBDQ score: 53 vs. 53), or time of follow-up (637 vs. 803 days). All women and men showed scores above the cutoff line of normal sexual function. There was no significant difference in sexual function between the laparoscopic and open groups. We found no differences in BIQ between open...... better body image among laparoscopy-treated women, the two surgical techniques seem equal with respect to postoperative sexual function....

  19. Large Mucocele of the Appendix at Laparoscopy Presenting as an Adnexal Mass in a Postmenopausal Woman: A Case Report

    Elvira Paladino


    Full Text Available A 79-year-old female was referred to our Gynecologic Department presenting with a pelvic magnetic resonance imaging (MRI, showing an adnexal mass, later confirmed at the pelvic examination. The patient’s routine laboratory tests were normal. A sonographic examination was performed with inconclusive results. Although the ultrasonography excluded the presence of vascularization and malignant degeneration, the adnexal localization appeared to be dubious. The laparoscopy and the subsequent histologic examination revealed the presence of a mucocele of the appendix. The following case report focuses the attention on a misdiagnosis of appendiceal mucocele. The misdiagnosis caused no negative impact on the treatment that in this case was adequate and successful.

  20. Carbon dioxide pneumothorax occurring during laparoscopy-assisted gastrectomy due to a congenital diaphragmatic defect: a case report.

    Park, Hye-Jin; Kim, Duk-Kyung; Yang, Mi-Kyung; Seo, Jeong-Eun; Kwon, Ji-Hye


    During laparoscopic surgery, carbon dioxide (CO2) pneumothorax can develop due to a congenital defect in the diaphragm. We present a case of a spontaneous massive left-sided pneumothorax that occurred during laparoscopy-assisted gastrectomy, because of an escape of intraperitoneal CO2 gas, under pressure, into the pleural cavity through a congenital defect in the esophageal hiatus of the left diaphragm. This was confirmed on intraoperative chest radiography and laparoscopic inspection. This CO2 pneumothorax caused tolerable hemodynamic and respiratory consequences, and was rapidly reversible after release of the pneumoperitoneum. Thus, a conservative approach was adopted, and the remainder of the surgery was completed, laparoscopically. Due to the high solubility of CO2 gas and the extra-pulmonary mechanism, CO2 pneumothorax with otherwise hemodynamically stable conditions can be managed by conservative modalities, avoiding unnecessary chest tube insertion or conversion to an open procedure.

  1. Surgical technique for single-port laparoscopy in huge ovarian tumors: SW Kim's technique and comparison to laparotomy.

    Kim, Jeong Sook; Lee, In Ok; Eoh, Kyung Jin; Chung, Young Shin; Lee, Inha; Lee, Jung-Yun; Nam, Eun Ji; Kim, Sunghoon; Kim, Young Tae; Kim, Sang Wun


    This study aimed to introduce a method to remove huge ovarian tumors (≥15 cm) intact with single-port laparoscopic surgery (SPLS) using SW Kim's technique and to compare the surgical outcomes with those of laparotomy. Medical records were retrospectively reviewed for patients who underwent either SPLS (n=21) with SW Kim's technique using a specially designed 30×30-cm(2)-sized 3XL LapBag or laparotomy (n=22) for a huge ovarian tumor from December 2008 to May 2016. Perioperative surgical outcomes were compared. In 19/21 (90.5%) patients, SPLS was successfully performed without any tumor spillage or conversion to multi-port laparoscopy or laparotomy. There was no significant difference in patient characteristics, including tumor diameter and total operation time, between both groups. The postoperative hospital stay was significantly shorter for the SPLS group than for the laparotomy group (median, 2 [1 to 5] vs. 4 [3 to 17] days; Phuge ovarian tumors.

  2. Hand-assisted right laparoscopic live donor nephrectomy

    Anibal W. Branco


    Full Text Available PURPOSE: Laparoscopic live donor nephrectomy has acquired an important role in the era of minimally invasive surgery. Laparoscopic harvesting of the right kidney is technically more challenging than that of the left kidney because of the short right renal vein and the need to retract the liver away from the right kidney. The aim of this article is to report our experience with right laparoscopic live donor nephrectomies. MATERIALS AND METHODS: We performed a retrospective review of 28 patients who underwent right laparoscopic donor nephrectomies at our service. Operative data and postoperative outcomes were collected, including surgical time, estimated blood loss, warm ischemia time, length of hospital stay, conversion to laparotomy and complications. RESULTS: The procedure was performed successfully in all 28 patients. The mean operative time was 83.8 minutes (range 45 to 180 minutes, with an estimated blood loss of 111.4 mL (range 40 to 350 mL and warm ischemia time of 3 minutes (range 1.5 to 8 minutes. No donor needed conversion to open surgery and all kidneys showed immediate function after implantation. The average time to initial fluid intake was 12 hours (range 8 to 24 hours. Two cases of postoperative ileus and a case of hematoma on the hand-port site were observed. The mean postoperative hospital stay was 3 days (range 1 to 7 days. CONCLUSIONS: Our data confirm the safety and feasibility of right laparoscopic donor nephrectomy and we believe that the right kidney should not be avoided for laparoscopic donor nephrectomy when indicated.

  3. Laparoscopy Using Room Air Insufflation in a Rural African Jungle Hospital: The Bongolo Hospital Experience, January 2006 to December 2013.

    O'Connor, Zachary; Faniriko, Marco; Thelander, Keir; O'Connor, Jennifer; Thompson, David; Park, Adrian


    Carbon dioxide is the standard insufflation gas for laparoscopy. However, in many areas of the world, bottled carbon dioxide is not available. Laparoscopy offers advantages over open surgery and has been practiced using filtered room air insufflation since 2006 at Bongolo Hospital in Gabon, Africa. Our primary goal was to evaluate the safety of room air insufflation related to intraoperative and postoperative complications. Our secondary aim was to review the types of cases performed laparoscopically at our institution. This retrospective review evaluates laparoscopic cases performed at Bongolo Hospital between January 2006 and December 2013. Demographic and perioperative information for patients undergoing laparoscopic procedures was collected. Insufflation was achieved using a standard, oil-free air compressor using filtered air and a standard insufflation regulator. A total of 368 laparoscopic procedures were identified within the time period. The majority of cases were gynecologic (43%). There was a 2% (8/368) complication rate with one perioperative death. The 2 complications related to insufflation were episodes of hypotension responsive to standard corrective measures. No intracorporeal combustion events were observed in any cases in which the use of diathermy and room air insufflation were combined. The other complications and the death were unrelated to the use of insufflation with air. Insufflation complications with room air occurred in our study. However, the complications related to insufflation with room air in our study were no different than those described in the literature using carbon dioxide. As room air is less costly than carbon dioxide and readily available, confirming the safety of room air insufflation in prospective studies is warranted. Room air appears to be safe for establishing and maintaining pneumoperitoneum, making laparoscopic surgery more accessible to patients in low-resource settings.

  4. Gastric tube reconstruction by laparoscopy-assisted surgery attenuates postoperative systemic inflammatory response after esophagectomy for esophageal cancer.

    Tsujimoto, Hironori; Ono, Satoshi; Sugasawa, Hidekazu; Ichikura, Takashi; Yamamoto, Junji; Hase, Kazuo


    Conventional open procedures have been supplanted in part by less invasive approaches, such as laparoscopic surgery developed for treating gastrointestinal malignancies. However, it is unclear whether laparoscopy-assisted gastric tube reconstruction (LAGT) can attenuate the postoperative systemic inflammatory response after esophagectomy for esophageal cancer. We investigated the postoperative clinical course of the systemic inflammatory response syndrome (SIRS) in patients who underwent an esophagectomy for esophageal cancer by LAGT (LAGT group) and gastric tube reconstruction by conventional open surgery (Open group). Compared with the Open group, the LAGT group had a significantly shorter operative time (539.6 min vs. 639.8 min), shorter duration of postoperative mechanical ventilation (1.1 days vs. 2.8 days), and shorter length of stay in the intensive care unit (2.1 days vs. 4.4 days). The LAGT group also had a significantly shorter SIRS duration (1.4 days vs. 2.7 days), a significantly lower incidence of SIRS, and a smaller number of positive SIRS criteria. Throughout the investigation period, the postoperative white blood cell count was lower in the LAGT group than in the Open group. Additionally, in the LAGT group, the heart rate was lower on each postoperative day (POD), and the respiratory rate was significantly lower on postoperative days (PODs) 1 and 4. There was no difference in postoperative oxygenation, morbidity, and mortality between the groups. The C-reactive protein level on PODs 3 and 4 was significantly lower in the LAGT group than in the Open group. Laparoscopy-assisted gastric tube reconstruction significantly attenuates postoperative SIRS, and it is therefore a potentially less invasive surgical procedure.

  5. Désaturation peropératoire lors d'une laparoscopie-hystéroscopie gynécologique: une étiologie méconnue, l'épanchement pleural

    Pendeville, Philippe; Boufroukh, D; Aunac, S; Donnez, Jacques; Lengelé, Benoît


    A 41-year-old patient presented several episodes of desaturation during a gynaecological laparoscopy. The major complication of this procedure is the venous air embolism. Several other side-effects have been reported: heart rate disorders, subcutaneous emphysema or pneumothorax. Pleural effusions during gynaecologic laparoscopy are apparently rare and the volume of effusion must be important to induce clinical symptoms. This fact can probably explain the frequent difficulty of diagnosis. The ...

  6. Microdureza de resinas em função da cor e luz halógena Microhardness of resins as a function of color and halogen light

    Fábio Martins


    Full Text Available O objetivo desse trabalho foi avaliar a influência da intensidade da luz e cor de uma resina composta no grau de dureza Knoop. Corpos-de-prova foram confeccionados utilizando-se matrizes de poliéster envoltas por um anel de cobre, contendo uma cavidade padronizada de 6 mm de diâmetro por 2 mm de espessura. Estas cavidades foram preenchidas com resina composta selecionada, Fill Magic - Vigodent, com as cores A3, B3, C3, D3 e I, fotopolimerizadas através de um fotopolimerizador Elipar, calibrado para produzir 3 intensidades de luz diferentes: 450 mW/cm², 800 mW/cm² e uma intensidade de luz crescente de 100 a 800 mW/cm². Foram confeccionados 90 corpos-de-prova em que o tempo de exposição da resina à luz halógena foi de 40 s. As amostras foram armazenadas em tubos de ensaio com água destilada a 37 ± 1ºC. Após este período, foram realizados os testes de dureza Knoop na região de superfície e fundo. Os resultados mostraram que houve diferença estatística em relação a intensidade de luz, entretanto em relação a cor, não houve diferença estatística. Os autores concluíram que a cor do compósito não influencia a dureza Knoop e que a intensidade progressiva promoveu os melhores resultados de dureza Knoop.The aim of this study was to evaluate the influence of light intensity and the influence of the color of a composite resin on Knoop hardness. Samples were confected utilizing polyester matrices with 6 mm of diameter and 2 mm of depth. The matrices were filled with composite resin (Fill Magic - Vigodent, colors A3, B3, C3, D3 and I, and light-cured by means of an Elipar light-curing unit in three different light intensities: 450 mW/cm2, 800 mW/cm² and an increasing intensity setup of 100 mW/cm² to 800 mW/cm². Ninety test specimens were confected, with the standard curing time of 40 seconds. The specimens were stored at 37 ± 1ºC and immersed in distillate water. The Knoop test was carried out in superficial and deep areas

  7. Laparoscopy hepatic biopsy through cauterization Biópsia hepática laparoscopica por cauterização

    Alexandra Pinheiro Fantinatti


    Full Text Available Hepatic biopsy was realized through laparoscopy with simultaneous cauterization in the present study, whose principal aim was to evaluate the efficacy of the applied method and to study its effects in the liver of healthy dogs. Furthermore, we tried to verify the main hematological and chemistry profile alterations related to the hepatic function, and to investigate the viability of the fragments collected by histopathology. To attain this objective, 21 clinically healthy dogs, weighing between 10 and 15kg were submitted to hepatic biopsy with forceps connected to the cautery. Cautery was performed by applying radiofrequency energy at 45 watts. Forty-two hepatic biopsies through laparoscopy were conducted in the animals. At group I one hepatic fragment per animal was collected, at group II two hepatic fragments per animal were collected, and at group III three fragments were collected. Hematocrit and alanine-aminotransferase measurements were employed to evaluate the animals at the pre-operative period, at four and six hour post-operative, and at day 30 post-operative. The results revealed that the procedure was safe and effective for hepatic biopsy in dogs. There were no clinical alterations related to the technique. The fragments collected were viable for histopathology. Hepatic biopsy through laparoscopy with simultaneous cauterization is an effective and usefull method in dogs.Este estudo visou avaliar a eficácia do método de biópsia hepática laparoscópica por cauterização e estudar os seus efeitos no fígado de cães sadios. Além disso, procurou-se verificar as principais alterações hematológicas e bioquímicas-séricas relacionadas às funções hepáticas e averiguar a viabilidade dos fragmentos colhidos por exame de histopatologia. Para tanto, 21 cães clinicamente sadios pesando entre 10 e 15kg, foram separados em três grupos de sete animais cada grupo. As amostras foram retiradas da borda no lobo lateral esquerdo

  8. Impact of Obesity on Surgical Treatment for Endometrial Cancer: A Multicenter Study Comparing Laparoscopy vs Open Surgery, with Propensity-Matched Analysis.

    Uccella, Stefano; Bonzini, Matteo; Palomba, Stefano; Fanfani, Francesco; Ceccaroni, Marcello; Seracchioli, Renato; Vizza, Enrico; Ferrero, Annamaria; Roviglione, Giovanni; Casadio, Paolo; Corrado, Giacomo; Scambia, Giovanni; Ghezzi, Fabio


    To evaluate the impact of obesity on the outcomes of surgical treatment for endometrial cancer in general and also comparing laparoscopic and open abdominal approach. Retrospective case-control study (Canadian Task Force classification II-1). Obstetrics and Gynecology Department, University of Insubria, Varese, Catholic University of the Sacred Heart, Rome, International School of Surgical Anatomy, Sacred Heart Hospital, Negrar, and Sant'Orsola-Malpighi Hospital, Bologna, Italy. Data of consecutive patients who underwent surgery for endometrial cancer in 4 centers were reviewed. Univariate and multivariable analyses were performed. Adjustment for potential selection bias in surgical approach was made using propensity score (PS) matching. Laparoscopic or open surgical treatment for endometrial cancer. A total of 1266 patients were included, including 764 in the laparoscopy group and 502 in the open surgery group. A total of 391 patients (30.9%) were obese, including 238 (18.8%) with class I obesity, 89 (7%) with class II obesity, and 64 (5.1%) with class III obesity. The total number of complications, risk of wound complications, and venous thromboembolic events were higher in obese women compared with nonobese women. Blood transfusions, incidence/severity of postoperative complications, and postoperative hospital stay were significantly higher in the open surgery group compared with the laparoscopy group, irrespective of obesity. These differences remained significant in both multivariable analysis and PS-matched analysis. The percentage of patients who received lymphadenectomy declined significantly in patients with BMI ≥40 in both the laparoscopy and open surgery groups. Conversions from the initially intended minimally invasive approach to open surgery were 1.1% to 2.2% for women with BMI obese women in the laparoscopic group. Laparoscopy for endometrial cancer retains its advantages over open surgery, even in obese patients. However, operating on obese

  9. The effects of inverse ratio ventilation on cardiopulmonary function and inflammatory cytokine of bronchoaveolar lavage in obese patients undergoing gynecological laparoscopy.

    Zhang, W P; Zhu, S M


    High peak airway pressure (Ppeak) and high end-tidal carbon dioxide tension (PETCO2) are the common problems encountered in the obese patients undergoing gynecological laparoscopy with conventional volume-controlled ventilation. This study was designed to investigate whether volume-controlled inverse ratio ventilation (IRV) with inspiratory to expiratory (I:E) ratio of 2:1 could reduce Ppeak or the plateau pressure (Pplat), improve oxygenation, and alleviate lung injury in patients with normal lungs. Sixty obese patients undergoing gynecological laparoscopy were enrolled in this study. After tracheal intubation, the patients were randomly divided into the IRV group (n = 30) and control group (n = 30). They were ventilated with an actual tidal volume of 8 mL/kg, respiratory rate of 12 breaths/min, zero positive end-expiratory pressure and I:E of 1:2 or 2:1. Arterial blood samples, hemodynamic parameters, and respiratory mechanics were recorded before and during pneumoperitoneum. The concentrations of tumor necrosis factor-α, and interleukins 6 and 8 in bronchoalveolar lavage fluid were measured immediately before and 60 minutes after onset of CO2 pneumoperitoneum. IRV significantly increased arterial partial pressure of oxygen, mean airway pressure, and dynamic compliance of respiratory system with concomitant significant decreases in Ppeak and Pplat compared to conventional ventilation with I:E of 1:2 (p obese patients undergoing gynecologic laparoscopy without adverse respiratory and hemodynamic effects. It is superior to conventional ratio ventilation in terms of oxygenation, respiratory mechanics and inflammatory cytokine in obese patients undergoing gynecologic laparoscopy. Copyright © 2015. Published by Elsevier B.V.


    Cornel Igna


    Full Text Available SURGICAL MANAGEMENT BY STANDING LAPAROSCOPY AND INGUINAL CELIOTOMY APPROACH OF THE CRYPTORCHID CANADIAN PONY STALLION – CASE REPORT   Cornel IGNA1*, Roxana DASCALU1, Daniel BUMB1, Bogdan Sicoe1, Larisa SCHUSZLER1 1 Banat’s University of Agricultural Science and Veterinary Medicine, “King Michael I of Romania” from Timisoara, Romania *Corresponding author, e-mail: Keywords: cryptorchidectomy, inguinal celiotomy, laparoscopic, stallion pony Introduction: Laparoscopic surgery has become an accepted method of identification and removal of intra-abdominal testes in the horse. Wilson and Madison – 1989 describe the use of laparoscopy to diagnose an abdominal retained testes. Since then numerous laparoscopic cryptorchidectomy techniques have been described. Aims: In the encountered specialty literature there are few reports in which standing laparoscopic cryptorchidectomy could not be performed in stallions including miniature horse too. Because there are no informations regarding laparoscopic surgery in large animals in romanian literature this report describes the surgical management of a Canadian pony diagnosed with partial abdominal unilaterally cryptorchidism at which laparoscopic castration has failed and the removal of the retained testicle has been made through inguinal celiotomy. Materials and Methods: A 4-year-old unilaterally cryptorchid Canadian pony was admitted for castration. The left testis was in the scrotum, but neither the right testis nor the right epididymis could be located by external palpation of the right inguinal canal. The proposed treatment was laparoscopic cryptorchidectomy with pony standing in stock. With a long-handled forceps inserted into the abdominal cavity, the testis cord is gently grasped and moderate traction without success in bringing the testicle into the abdomen - retained testis. After the failure of laparascopic cryptorchidectomy but having an exact diagnosis - partial

  11. Combined incisional ropivacaine infiltration and pulmonary recruitment manoeuvre for postoperative pain relief after diagnostic hysteroscopy and laparoscopy

    Liu Huili; Ma Caihong; Zhang Xiaoqing; Yu Chen; Yang Yan; Song Xueling; Tang Yi


    Background Preoperative incisional local anaesthesia with ropivacaine is a common method of providing postlaparoscopy pain relief.The pulmonary recruitment manoeuvre also provides pain relief,but the combined effect of these two methods on pain following laparoscopic procedures has not been reported.We investigated the efficacy of combining local anaesthetic infiltration of ropivacaine with pulmonary recruitment manoeuvre on postoperative pain following diagnostic hysteroscopy and laparoscopy.Methods This prospective,randomized,controlled study involved 60 patients divided into two groups (n=30,each).Group 1 received 20 ml of 0.5% ropivacaine injected peri-incisionally preoperatively,with intra-abdominal carbon dioxide removed by passive deflation.Group 2 received 20 ml of 0.5% ropivacaine injected peri-incisionally with five manual inflations of the lungs with a positive-pressure ventilation of 40 cmH2O at the end of surgery.The last inflation was held for 5 seconds.The intensity of postoperative incisional and shoulder pain was evaluated using a numerical rating scale at 0,2,4,8,12,24 and 48 hours postoperatively by an independent blinded anaesthesiologist.Tramadol was given postoperatively for analgesia.Results Compared with group 1,incisional ropivacaine infiltration combined with pulmonary recruitment manoeuvre significantly reduced dynamic pain at 0 hour,4 hours,and 24 hours postoperatively (4.1 ± 2.2 vs.2.1 ± 1.9,P=0.002;2.7 ± 2.7 vs.1.2 ± 1.3,P=0.035; and 3.5 ± 2.1 vs.2.1 ± 1.8,P=0.03,respectively).Static incisional pain was significantly relieved at 0 hour,2 hours,and 24 hours postoperatively (3.1 ± 1.7 vs.1.6 ± 1.3,P=0.001; 1.4 ± 1.3 vs.0.5 ± 0.8,P=0.012;and 2.3 ± 1.9 vs.1.0 ± 1.5,P=0.038,respectively).Group 2 had more patients without shoulder pain (P<0.05) and fewer requiring tramadol (P<0.05).Conclusion Ropivacaine with pulmonary recruitment manoeuvre provided simple and effective pain relief after diagnostic hysteroscopy and

  12. Laparoscopy-assisted versus open D2 radical gastrectomy for advanced gastric cancer without serosal invasion: a case control study

    Chen Qi-Yue


    Full Text Available Abstract Background The application of laparoscopic surgery for advanced gastric cancer (AGC remains questionable on account of technical difficulty of D2 lymphadenectomy, and there has been few large-scale follow-up results regarding the oncological adequacy of laparoscopic surgery compared with that of open surgeries for AGC. The aim of this study is to evaluate technical feasibility and oncological efficacy of laparoscopy-assisted gastrectomy (LAG for advanced gastric cancer without serosal invasion. Methods From January 2008 to December 2012, 1114 patients with gastric cancer underwent D2 gastrectomy, including 336 T2 and T3 patients in term of depth of invasion. Of all 336 patients, 224 underwent LAG, while open gastrectomy (OG performed on the other 112 patients. The comparison was based on the clinicopathologic characteristics, surgical outcome, and follow-up results. Results There are not significant differences in clinicopathological characteristics between the two groups (P > 0.05. The operation time and first ambulation time was similar in the two groups. However, estimated blood loss, bowel function recovery time and duration of hospital stay were significantly less in the LAG group. No significant difference in morbidity and mortality was found between the LAG group and OG group (11.1% vs. 15.3%, P = 0.266; 0.9% vs. 1.8%, P = 0.859. The mean number of resected lymph nodes (LNS between the LAG group and OG group was similar (30.6 ± 10.1 vs. 30.3 ± 8.6, P = 0.786. Furthermore, the mean number of removed LNS in each station was not significantly different in the distal gastrectomy and total gastrectomy (P > 0.05. No statistical difference was seen in 1 year survival rate (91.5% vs. 89.8% P > 0.05 and the survival curve after surgery between the LAG group and OG group. Conclusion Laparoscopy-assisted D2 radical gastrectomy is feasible, effective and has comparative oncological efficacy compared with

  13. Diagnostic Laparoscopy with Ultrasound Still Has a Role in the Staging of Pancreatic Cancer: A Systematic Review of the Literature

    Jordan Levy


    Full Text Available Background. The reported incidence of noncurative laparotomies for pancreatic cancer using standard imaging (SI techniques for staging remains high. The objectives of this study are to determine the diagnostic accuracy of diagnostic laparoscopy with ultrasound (DLUS in assessing resectability of pancreatic tumors. Study Design. We systematically searched the literature for prospective studies investigating the accuracy of DLUS in determining resectability of pancreatic tumors. Results. 104 studies were initially identified and 19 prospective studies (1,573 patients were included. DLUS correctly predicted resectability in 79% compared to 55% for SI. DLUS prevented noncurative laparotomies in 33%. Of those, the most frequent DLUS findings precluding resection were liver metastases, vascular involvement, and peritoneal metastases. DLUS had a morbidity rate of 0.8% with no mortalities. DLUS remained superior to SI when analyzing studies published only in the last five years (100% versus 81%, enrolling patients after the year 2000 (74% versus 58%, or comparing DLUS to modern multidimensional CT (100% versus 78%. Conclusion. DLUS seems to still have a role in the preoperative staging of pancreatic cancer. With its ability to detect liver metastases, vascular involvement, and peritoneal metastases, the use of DLUS leads to less noncurative laparotomies.

  14. Effects of taurolidine and octreotide on tumor growth and lipid peroxidation after staging-laparoscopy in ductal pancreatic cancer.

    Kilian, M; Mautsch, I; Braumann, C; Schimke, I; Guski, H; Jacobi, C A; Wenger, F A


    Irrigation with taurolidine after laparoscopy decreases tumor growth in colon carcinoma. In pancreatic cancer subcutaneous therapy with octreotide decreases oxidative stress and carcinogenesis as well. However, it is still unclear, whether irrigation with taurolidine or octreotide after laparoscopic pancreatic biopsy reduces tumor growth in pancreatic cancer as well. In 60 Syrian hamsters ductal pancreatic adenocarcinoma was induced by weekly injection of 10mg/kg body weight N-nitrosobis-2-oxopropylamine s.c. for 10 weeks. In week 16 laparoscopic pancreatic biopsy by use of carbon dioxide was performed (gr. 1, n = 20) with subsequent laparoscopic irrigation with taurolidine (gr. 2, n = 20) or octreotide (gr. 3, n = 20). In week 25 hamsters were sacrificed. Our results show that macroscopic visible primary tumors were found in only one animal of the taurolidine group (5.9%), compared to 42.1% in the saline and 62.5% in the octreotide group (Ptaurolidine after pancreatic biopsy inhibited tumor growth in ductal pancreatic adenocarcinoma.

  15. Effect of obesity on laparoscopy-assisted distal gastrectomy compared with open distal gastrectomy for gastric cancer.

    Makino, Hirochika; Kunisaki, Chikara; Izumisawa, Yusuke; Tokuhisa, Motohiko; Oshima, Takashi; Nagano, Yasuhiko; Fujii, Shoichi; Kimura, Jun; Takagawa, Ryo; Kosaka, Takashi; Ono, Hidetaka A; Akiyama, Hirotoshi; Endo, Itaru


    This study compared surgical outcomes between patients undergoing laparoscopy-assisted distal gastrectomy (LADG) and those undergoing open distal gastrectomy (ODG) from the viewpoint of obesity. Between June 2002 and May 2008, 146 patients with preoperatively diagnosed early gastric cancer who underwent LADG (n = 90) or ODG (n = 56) were enrolled in this study and compared in terms of clinicopathological findings and operative outcome. The visceral fat area (VFA) and subcutaneous fat area (SFA) were assessed as identifiers of obesity using FatScan software. The relationship between obesity and operative outcomes after LADG and ODG was evaluated. There were no significant correlations between intraoperative blood loss (IBL) and any obesity-related factors, or between operation time (OT) and any obesity-related factors in the LADG group. There was a significant correlation between IBL and BMI (r = 0.486, P = 0.0001), IBL and VFA (r = 0.456, P = 0.0003), IBL and SFA (r = 0.311, P = 0.0193), OT and BMI (r = 0.406, P = 0.0017), OT and VFA (r = 0.314, P = 0.0178), and between OT and SFA (r = 0.382, P = 0.0034) in the ODG group. LADG may be a useful operative manipulation that is not influenced by obesity, whereas ODG may be influenced by obesity even after reaching the surgical plateau. (c) 2010 Wiley-Liss, Inc.

  16. Short-term outcomes for laparoscopy-assisted distal gastrectomy for body mass index ≥30 patients with gastric cancer.

    Wang, Zheng; Zhang, Xingmao; Liang, Jianwei; Hu, Junjie; Zeng, Weigen; Zhou, Zhixiang


    Obesity is known to be a preoperative risk factor for gastric cancer surgery. This study aimed to investigate the influence of obesity on the surgical outcomes of laparoscopy-assisted distal gastrectomy (LADG) for gastric cancer. The clinical data of 131 patients with gastric cancer from January 2010-December 2013 were analyzed retrospectively. Perioperative outcomes were compared between 43 patients with a body mass index (BMI) ≥30 kg/m(2) (obese group) and 88 patients with a BMI obese group than for the nonobese group (234.1 ± 57.2 min versus 212.2 ± 43.5 min, P = 0.026). There were no statistically significant differences between two groups in terms of intraoperative blood loss, the number of retrieved lymph nodes, postoperative recovery, and postoperative complications (P > 0.05). During the follow-up period of 5 mo-49 mo (average, 36 mo), the overall survival rates were not significantly different between the two groups (80.0% [32/40] versus 81.9% [68/83], P > 0.05). The differences in recurrence and metastasis between the two groups were not statistically significant. Our analysis revealed that LADG can be safely performed in patients with BMI ≥30. The procedure was considered to be difficult but sufficiently feasible. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. Role of diagnostic hystero-laparoscopy in the evaluation of infertility: A retrospective study of 300 patients

    Prasanta K Nayak


    Full Text Available Objective: To determine the role of diagnostic hysterolaparoscopy in the evaluation of infertility in tertiary care centres. Materials and Methods: This retrospective study was conducted at two tertiary care centres (the infertility clinics of Sriram Chandra Bhanj Medical College and Prachi hospital at Cuttack, Odisha throughout the year in 2008. Women aged 20-40 years with normal hormone profile without male factor infertility were included. Results: Out of 300 cases, 206 (69% patients had primary infertility. While laparoscopy detected abnormalities in 34% of the cases, significant hysteroscopy findings were noted in 18% of cases. Together, diagnostic hysterolaparoscopy detected abnormalities in 26% of the infertile patients in both groups. While the most common laparoscopic abnormality was endometriosis (14% and adnexal adhesion (12% in primary and secondary infertile patients, respectively, hysteroscopy found intrauterine septum as the most common abnormality in both groups. Conclusions: Hysterolaparoscopy is an effective diagnostic tool for evaluation of certain significant and correctable tubo-peritoneal and intrauterine pathologies like peritoneal endometriosis, adnexal adhesions, and subseptate uterus, which are usually missed by other imaging modalities.

  18. Reexpansion Pulmonary Edema following Laparoscopy-Assisted Distal Gastrectomy for a Patient with Early Gastric Cancer: A Case Report

    Kazuhito Yajima


    Full Text Available We report here a case of reexpansion pulmonary edema following laparoscopy-assisted distal gastrectomy (LADG for early gastric cancer. A 57-year-old Japanese woman with no preoperative comorbidity was diagnosed with early gastric cancer. The patient underwent LADG using the pneumoperitoneum method. During surgery, the patient was unintentionally subjected to single-lung ventilation for approximately 247 minutes due to intratracheal tube dislocation. One hour after surgery, she developed severe dyspnea and produced a large amount of pink frothy sputum. Chest radiography results showed diffuse ground-glass attenuation and alveolar consolidation in both lungs without cardiomegaly. A diagnosis of pulmonary edema was made, and the patient was immediately intubated and received ventilatory support with high positive end-expiratory pressure. The patient gradually recovered and was weaned from the ventilatory support on the third postoperative day. This case shows that single-lung ventilation may be a risk factor for reexpansion pulmonary edema during laparoscopic surgery with pneumoperitoneum.

  19. Quality of life and sexuality in disease-free survivors of cervical cancer after radical hysterectomy alone: A comparison between total laparoscopy and laparotomy.

    Xiao, Meizhu; Gao, Huiqiao; Bai, Huimin; Zhang, Zhenyu


    The aim of the present study was to evaluate the possible differences between total laparoscopy and laparotomy regarding their impact on postoperative quality of life and sexuality in disease-free cervical cancer survivors who received radical hysterectomy (RH) and/or lymphadenectomy alone and were followed for >1 year.We reviewed all patients with cervical cancer who had received surgical treatment in our hospital between January 2001 and March 2014. Consecutive sexually active survivors who received RH and/or lymphadenectomy for early stage cervical cancer were enrolled and divided into 2 groups based on surgical approach. Survivors were interviewed and completed validated questionnaires, including the European Organization for Research Treatment of Cancer Quality-of-Life Core Questionnaire including 30 items, the Cervical Cancer-Specific Module of European Organization for Research Treatment of Cancer Quality-of-Life Questionnaire including 24 items (EORTC QLQ-CX24), and the Female Sexual Function Index (FSFI).In total, 273 patients with histologically confirmed cervical cancer were retrospectively reviewed. However, only 64 patients had received RH and/or lymphadenectomy alone; 58 survivors meeting the inclusion criteria were enrolled, including 42 total laparoscopy cases and 16 laparotomy cases, with an average follow-up of 46.1 and 51.2 months, respectively. The survivors in the 2 groups obtained good and similar scores on all items of the European Organization for Research Treatment of Cancer Quality-of-Life Core Questionnaire including 30 items and Cervical Cancer-Specific Module of European Organization for Research Treatment of Cancer Quality-of-Life Questionnaire including 24 items, without significant differences after controlling for covariate background characteristics. To the date of submission, 21.4% (9/42) of cases in the total laparoscopy group and 31.2% (5/16) of cases in the laparotomy group had not resumed sexual behavior after RH. Additionally

  20. Impact of locomotion training with a neurologic controlled hybrid assistive limb (HAL) exoskeleton on neuropathic pain and health related quality of life (HRQoL) in chronic SCI: a case study (.).

    Cruciger, Oliver; Schildhauer, Thomas A; Meindl, Renate C; Tegenthoff, Martin; Schwenkreis, Peter; Citak, Mustafa; Aach, Mirko


    Chronic neuropathic pain (CNP) is a common condition associated with spinal cord injury (SCI) and has been reported to be severe, disabling and often treatment-resistant and therefore remains a clinical challenge for the attending physicians. The treatment usually includes pharmacological and/or nonpharmacological approaches. Body weight supported treadmill training (BWSTT) and locomotion training with driven gait orthosis (DGO) have evolved over the last decades and are now considered to be an established part in the rehabilitation of SCI patients. Conventional locomotion training goes along with improvements of the patients' walking abilities in particular speed and gait pattern. The neurologic controlled hybrid assistive limb (HAL®, Cyberdyne Inc., Ibraki, Japan) exoskeleton, however, is a new tailored approach to support motor functions synchronously to the patient's voluntary drive. This report presents two cases of severe chronic and therapy resistant neuropathic pain due to chronic SCI and demonstrates the beneficial effects of neurologic controlled exoskeletal intervention on pain severity and health-related quality of life (HRQoL). Both of these patients were engaged in a 12 weeks period of daily HAL®-supported locomotion training. In addition to improvements in motor functions and walking abilities, both show significant reduction in pain severity and improvements in all HRQoL domains. Although various causal factors likely contribute to abatement of CNP, the reported results occurred due to a new approach in the rehabilitation of chronic spinal cord injury patients. These findings suggest not only the feasibility of this new approach but in conclusion, demonstrate the effectiveness of neurologic controlled locomotion training in the long-term management of refractory neuropathic pain. Implications for Rehabilitation CNP remains a challenge in the rehabilitation of chronic SCI patients. Locomotion training with the HAL exoskeleton seems to improve CNP

  1. Impact of obesity on short- and long-term outcomes of laparoscopy assisted distal gastrectomy for gastric cancer.

    Shimada, Shoji; Sawada, Naruhiko; Ishiyama, Yasuhiro; Nakahara, Kenta; Maeda, Chiyo; Mukai, Shumpei; Hidaka, Eiji; Ishida, Fumio; Kudo, Sin-Ei


    Laparoscopy assisted distal gastrectomy (LADG) for gastric cancer has been rapidly adopted for the treatment of both early and advanced gastric cancers which need lymph node dissection, but remains difficult procedure, especially in patients with obesity. We evaluated the impact of obesity on short- and long-term outcomes of LADG for gastric cancer. We retrospectively investigated 243 patients who underwent LADG for gastric cancer between January 2007 and December 2014. The patients were classified based on their body mass index (BMI) into the Obese (BMI ≥ 25) and Non-Obese (BMI Obese Group. Fewer lymph nodes were retrieved in the Obese Group (38 ± 23.7 vs. 47.5 ± 24.3; P = 0.004). No differences were evident in postoperative complication rate (20% vs. 17%; P = 0.688) or the duration of postoperative hospital stay (9 ± 8.5 vs. 9 ± 5.1 days; P = 0.283) between the two groups. In the Obese Group, the 5-year overall survival rate was significantly lower than in the Non-Obese Group (67.6% vs. 90.3%; P = 0.036). Furthermore, 5-year disease-specific survival was significantly lower in the Obese Group than in the Non-Obese Group (72.7% vs. 94.9%; P = 0.015). LADG in patients with obesity could be performed as safe as in patients without obesity, with comparable postoperative results. But obesity may be a poor prognostic factor in gastric cancer.

  2. A Novel Endoscopic Catheter for "Laparoscopy-Like" Irrigation and Suction: Its Research and Development Process and Clinical Evaluation.

    Miyazaki, Yasuhiro; Nakajima, Kiyokazu; Hosaka, Makoto; Ban, Namiko; Takahashi, Tsuyoshi; Yamasaki, Makoto; Miyata, Hiroshi; Kurokawa, Yukinori; Takiguchi, Shuji; Mori, Masaki; Doki, Yuichiro


    Inspired by natural orifice translumenal endoscopic surgery (NOTES), the authors launched a development of novel endoscopic irrigation and suction (I/S) catheter for "laparoscopy-like" I/S in flexible gastrointestinal (GI) endoscopy. The aims were to describe its basic research and development (R&D) process and to estimate its performance in both preclinical and clinical settings. In basic R&D phase, a layout of side hole at apex nozzle of endoscopic I/S (EIS) catheter were theoretically calculated and designed. Material of nozzle was selected based on the strength analysis. The performance of final prototype EIS catheter was then assessed preclinically in the porcine stomach, to compare with conventional endoscopic "tip irrigation" and "tip suction" as control. After regulatory clearance, safety and feasibility of I/S using EIS catheter were clinically assessed by endoscopists in small number of patients. Bench tests revealed 0.4 mm in diameter, 24 holes, and 6-8 holes per circumference as most suitable layout of side holes, and polyetheretherketone as an optimal nozzle material, respectively. Time to inject 500 mL saline with the EIS catheter was significantly shorter than tip irrigation (101 ± 3.1 seconds versus 154 ± 3.1 seconds; P suction was significantly weaker than conventional endoscopic tip suction, though it remained within the practical range. No mucosal injuries were noted in the EIS suction. In clinical assessments for human use, no adverse events were observed, and high degree of satisfaction for endoscopists was obtained. The newly developed EIS catheter is safely used with satisfactory performance in flexible GI endoscopy.

  3. A matched cohort study of laparoscopy-assisted and open total gastrectomy for advanced proximal gastric cancer without serosa invasion

    Lin Jianxian; Huang Changming; Zheng Chaohui; Li Ping; Xie Jianwei; Wang Jiabin; Lu Jun


    Background Little is known about the feasibility and safety of laparoscopy-assisted total gastrectomy (LATG) with extended lymphadenectomy in patients with advanced gastric cancer (AGC).This study compared the technical feasibility,safety,and oncologic efficacy of LATG with open total gastrectomy (OTG) for AGC without serosa invasion.Methods From January 2009 to December 2011,235 patients underwent LATG and 153 patients underwent OTG for AGC without serosa invasion.Age,gender,and depth of invasion (pT2 and pT3) were matched by propensity scoring,and 116 patients (58 LATG and 58 OTG) were selected for analysis.Their clinicopathologic characteristics,postoperative outcomes,and survival were compared.Results There was no significant difference in clinicopathologic characteristics between the two propensity-matched groups.Median number of lymph nodes per patient was 29,and the mean number of retrieved lymph nodes was similar in the LATG and OTG groups (30.8±10.2 vs.29.0±8.3).Peri-operative characteristics,operation time,number of transfused units per patient,and time to resumption of activities were similar in the two groups; while blood loss,times to first flatus and resumption of soft diet,and post-operative stay were significantly lower in the LATG group (P <0.05,respectively).Rates of post-operative complications (12.1% vs.15.5%) and postoperative mortality (0% vs.1.7%),as well as cumulative survival rates,were similar.Conclusions LATG with D2 lymphadenectomy is a safe and feasible procedure for AGC patients without serosa invasion.ProsPective.multicenter,randomized trials are needed to confirm the efficacy of LATG in this patient population.

  4. Application of laparoscopy in the combined surgical procedures of gynecological and digestive disorders in obese women: a retrospective cohort study.

    Wang, Haibo; Zhou, Ailing; Fan, Min; Li, Ping; Qi, Shengwei; Gao, Licai; Li, Xiujuan; Zhao, Jinrong


    Laparoscopy surgery has been widely used for many decades and combined laparoscopic procedures have become favorable choices for concomitant pathologies in the abdomen. However, the type of combination procedures and their safety in obese women have not been well elucidated in obese women. Here we retrospectively reported 147 obese women underwent combined laparoscopic gynecological surgery and cholecystectomy/appendicectomy in our hospital from January 2003 to December 2011. Of the total number of patients (n = 147), various laparoscopic gynecological surgeries were combined with laparoscopic cholecystectomy in 93 patients, and were combined with laparoscopic appendectomy in the rest 54 patients. Patients' ages ranged from 24 to 55 years with an average of 33 years. Our results showed that combined procedures caused various operative time and blood loss, with no difference considering the time to resume oral intake and length of hospital stay. Intraoperative complications occurred in a total of 7 patients (4.8%). None of the patients suffered from major complications after laparoscopic surgery, and minor postoperative complications occurred in 30 patients (20.4%). The follow-up period ranged from 6 to 24 months (average, 18.5 months). None of the patients developed complications during follow-up, except that one patient suffered from colporrhagia. Our results further suggest that the combined abdominal laparoscopic procedures of gynecologic and general surgery are safe and economic choices for obese women, and benefit patients in many ways including lesser pain, shorter hospital stays and earlier recovery. Copyright © 2015 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  5. Curriculum development for basic gynaecological laparoscopy with comparison of expert trainee opinions; prospective cross-sectional observational study.

    Burden, Christy; Fox, Robert; Lenguerrand, Erik; Hinshaw, Kim; Draycott, Timothy J; James, Mark


    To develop content for a basic laparoscopic curriculum in gynaecology. Prospective cross-sectional observational study. Modified Delphi method with three iterations undertaken by an invited group of national experts across the United Kingdom (UK). Two anonymous online surveys and a final physical group meeting were undertaken. Junior trainees in gynaecology undertook a parallel iteration of the Delphi process for external validation. Population included: expert panel - certified specialists in minimal-access gynaecological surgery, RCOG national senior trainee representatives, and medical educationalists, junior trainees group - regional trainees in gynaecology in first and second year of speciality training. Experts (n=37) reached fair to almost complete significant agreement (κ=0.100-0.8159; pcurriculum. Findings indicated that 39 categories should be included in the curriculum. Port placement, laparoscopic equipment and patient selection were ranked the most important theoretical categories. Hand-eye co-ordination, camera navigation and entry techniques were deemed the most valuable skills. Diagnostic laparoscopy, laparoscopic sterilisation, and laparoscopic salpingectomy were the operations agreed to be most important for inclusion. Simulation training was agreed as the method of skill development. The expert panel favoured box trainers, whereas the junior trainee group preferred virtual reality simulators. A basic simulation laparoscopic hand-eye co-ordination test was proposed as a final assessment of competence in the curriculum. Consensus was achieved on the content of a basic laparoscopic curriculum in gynaecology, in a cost- and time-effective, scientific process. The Delphi method provided a simple, structured consumer approach to curriculum development that combined views of trainers and trainees that could be used to develop curricula in other areas of post-graduate education. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  6. Efficacy analysis of laparoscopy and conventional open surgery on immune function and neuroendocrine function in elderly patients with benign ovarian tumor

    Shu Xiao; Xin-Qiu Zheng; Hai-Wei Ou; Guang-Chi Huang


    Objective:To analyze the efficacy of laparoscopy and conventional open surgery on immune function and neuroendocrine function in elderly patients with benign ovarian tumor.Methods:A total of 84 cases of elderly patients with benign ovarian tumors were selected, and these patients were divided into observation group and control group with 42 cases each according to random number table method. The observation group was treated with laparoscopy, while the control group was given conventional open surgery. Operative time, blood loss, hospital stays, postoperative levels of T lymphocyte subsets and neuroendocrine function indicators includingβ-endorphin, glucagon and cortisol (COR) were compared between these two groups.Results:Blood loss ((93.25±14.75) mL) and hospital stays ((2.5±0.5) d) in observation group were significantly less than control group, with (110.57±17.36) mL for blood loss and (6.25±1.25) d for hospital stays (P<0.05), respectively. However, operative time in observation group ((90.36±15.14) min) was longer when compared with control group ((85.57±10.95) min) (P<0.05). The levels of CD3+, CD4+ and CD4+/CD8+ on the first and third day after surgery were higher, and the level of CD8+ on the first and third day after surgery was lower in observation group than control group (P<0.05). The levels ofβ-endorphin, glucagon and COR on the first and third day after surgery in observation group were significantly lower than control group (P<0.05).Conclusions:Laparoscopy has a slight influence on immune function and neuroendocrine function, making it a superior therapy for elderly patients with benign ovarian tumors.

  7. The role of ventilation mode using a laryngeal mask airway during gynecological laparoscopy on lung mechanics, hemodynamic response and blood gas analysis.

    Jarahzadeh, Mohammad Hossein; Halvaei, Iman; Rahimi-Bashar, Farshid; Behdad, Shekoufeh; Abbasizadeh Nasrabady, Rouhollah; Yasaei, Elahe


    There are two methods for ventilation in gynecological laparoscopy: volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV). To compare the lung mechanics, hemodynamic response and arterial blood gas analysis and gas exchange of two modes of VCV and PCV using laryngeal mask airway (LMA) at different time intervals. Sixty infertile women referred for diagnostic laparoscopy, based on ventilation mode, were randomly divided into two groups of VCV (tidal volume: 10 ml/kg) and PCV. In the PCV group, ventilation was initiated with a peak airway pressure (tidal volume: 10 ml/kg, upper limit: 35 cm H2O). In both groups, the arterial blood samples were taken in several time intervals (5, 10 and 15 min after LMA insertion) for blood gas evaluation. Also the lung mechanics parameters were continuously monitored and were recorded at different time intervals. There were no significant differences for patient's age, weight, height and BMI in two groups. The peak and plateau airway pressure were significantly higher in VCV group compared to PCV group 5 and 10 min after insertion of LMA. PaO2 was significantly higher after 10 and 15 min in VCV group compared to PCV group (p=0.005 and p=0.03, respectively). PaCO2 showed significant increase after 5 min in PCV group, but the differences were not significant after 10 and 15 min in two groups. The end tidal CO2 showed significant increase after 10 and 15 min in VCV compared to PCV group. Both VCV and PCV seem to be suitable for gynecological laparoscopy. However, airway pressures are significantly lower in PCV compared to VCV.

  8. Role of laparoscopy as a minimally invasive procedure in treatment of ruptured uterine scar during second-trimester induction of abortion.

    Zheng, Yanmei; Jiang, Qiaoying; Lv, Ya-Er; Liu, Feng; Yang, Liwei


    Uterine rupture is an uncommon complication following termination of pregnancy and is usually accompanied by severe lower abdominal pain and shock caused by intra-abdominal hemorrhage. Laparotomy should be carried out promptly in order to repair the uterus or even to resect the uterus. Here we present a case of uterine rupture of a scarred uterus, which occurred during a second-trimester induced abortion. The patient was successfully treated by laparoscopy with the help of laparoscopic ultrasound. This case suggests an alternative, effective approach to the diagnosis and treatment of uterine rupture. © 2015 Japan Society of Obstetrics and Gynecology.

  9. El papel de la laparoscopia en la cirugía abdominal urgente The role of laparoscopy in emergency abdominal surgery

    E. Balén


    Full Text Available La urgencia abdominal también puede ser intervenida mediante abordaje laparoscópico: el planteamiento puede ser de laparoscopia diagnóstica, cirugía asistida por laparoscopia o laparotomía dirigida según los hallazgos de la laparoscopia. Las contraindicaciones generales se refieren sobre todo al estado de inestabilidad hemodinámica del paciente y a pacientes graves (ASA IV. En ausencia de contraindicación específica para el procedimiento laparoscópico concreto a realizar, muchas enfermedades abdominales que requieren cirugía urgente pueden realizarse con abordaje laparoscópico. Las indicaciones más frecuentes son la apendicitis, la colecistitis aguda, la perforación gastroduodenal, la oclusión de intestino delgado, y algunos traumas abdominales. Con una correcta selección de pacientes y la oportuna experiencia del cirujano, los resultados son excelentes, y mejoran la cirugía abierta (menos infección de herida, complicaciones, estancia hospitalaria y dolor postoperatorio. Se explican con detalle los aspectos básicos de la técnica quirúrgica en los procedimientos más frecuentes de laparoscopia de urgencia.Abdominal emergencies can also be operated on through the laparoscopic approach: the approach can be diagnostic laparoscopy, surgery assisted by laparoscopy or laparotomy directed according to the findings of the laparoscopy. The general contraindications refer above all to the state of haemodynamic instability of the patient and to seriously ill patients (ASA IV. In the absence of any specific counter-indications for the specific laparoscopic procedure to be carried out, many abdominal diseases requiring emergency surgery can be performed with the laparoscopic approach. The most frequent indications are appendicitis, acute colecistitis, gastroduodenal perforation, occlusion of the small intestine, and some abdominal traumas. With a correct selection of patients and the appropriate experience of the surgeon, the results are

  10. Laparoscopy in the management of emphysematous cholecystitis and secondary appendicitis in an 11-year-old child with insulin-dependent diabetes mellitus

    Kamalesh Pal


    Full Text Available Acute abdomen in a diabetic child may cause diagnostic dilemma. Acalculous emphysematous cholecystitis (EC, although reported among critically ill or diabetic adults, is an uncommon occurrence in the children. It may complicate the presentation due to its varied manifestations; especially when associated with other concomitant intra-abdominal inflammatory pathologies. We encountered a rare concurrence of acute EC complicated with pericholecystic fluid collection and secondary appendicitis causing non-specific acute abdomen in an 11-year-old obese boy with insulin-dependent diabetes mellitus. Laparoscopy proved to be a highly useful tool in the diagnosis and treatment of this surgical dilemma.

  11. Clinical comparative research of the diagnosis and treatment of infertility by single-port laparoscopy and traditional laparoscopy%单孔腹腔镜与传统腹腔镜诊治不孕症的临床对比研究



    Objective To comparative the effects of using single-port laparoscopy and traditional laparoscopy in patients with infertility .Investigate the clinical values of diagnosis and treatment of infertility by single-port laparoscopy .Methods Retro-spective analysis of the clinical cases of patients with infertility who accept the treatment of laparoscopy in our hospital from January ,2011 to January ,2013 .Compared with operation time ,bleeding volume ,postoperative exhaust time ,postoperative hospital stay ,hospital cost and pregnancy rate .Results The two groups were successfully performed without open surgery .The operation time of single-port group is longer than traditional group(P0.05) .Conclusion The diagnosis and treatment of infertility by single-port laparoscopy is safe and feasible .Other-wise it's more minimally invasive ,and better cosmetic results .%目的比较单孔腹腔镜与传统腹腔镜诊治不孕症的临床效果,从而探讨单孔腹腔镜诊治不孕症的临床价值。方法回顾性分析2011年01月~2013年01月我院腹腔镜诊治不孕症患者的临床资料。比较两种术式的手术时间、术中出血量、术后并发症、术后住院天数、总住院费用及妊娠率等。结果两组均完成手术,无中转开腹。单孔组手术时间长于传统组(P<0畅05),其他各项指标无显著性差异(P >0畅05)。结论单孔腹腔镜手术治疗不孕症是安全可行的,而且更加微创,美容效果更好。

  12. Comparison of hysteroscopy combined with laparoscopy or laparoscopy alone in treatment of infertility%腹腔镜单用与宫腹腔镜联合应用在治疗不孕症中的对比分析

    罗克燕; 徐敏; 孙贵红


    目的 探讨宫腹腔镜联合应用在诊治女性不孕症中的价值和治疗后卵巢储备功能变化情况,并与腹腔镜单用诊治进行比较.方法 收集该科2010年1月~2011年12月治疗的238例不孕症患者的临床资料,分为宫腹腔镜联合治疗组(观察组)和腹腔镜单用治疗组(对照组),观察对比两组病因构成,并对患者治疗后妊娠情况及卵巢储备功能进行随访.结果 两组患者都以输卵管病变和盆腔病变为多见,观察组宫腔粘连、子宫肌瘤、纵隔子宫、子宫内膜息肉的检查阳性率明显高于对照组,两者比较差异有显著性(P<0.05).治疗后通过随访,观察组妊娠88例,妊娠率达61.54%,对照组妊娠46例,妊娠率为48.42%,两组比较差异有显著性(P<0.05).各组患者血清FSH、LH和E2水平在治疗后1个月较治疗前和治疗后其他时间结果差异有显著性(P<0.05),两组间血清FSH、LH和E2水平差异无显著性(P>0.05);两组间治疗前后卵巢截面积、PSV和EDV比较差异无显著性(P>0.05),各组治疗后1个月的卵巢截面积、EDV和PSV参数较治疗前和治疗后其他时间结果差异有显著性(P<0.05).结论 联合应用宫腹腔镜是诊治女性不孕症的有效方法,能够直观、准确、全面地对盆腔及宫腔进行检查,根据病因采取有针对性的治疗,能够提高妊娠率,具有临床推广应用价值.%[Objective] To investigate the value of combined use of hysteroscopy and laparoscopy in diagnosis and treatment of female infertility and evaluate the ovarian reserve function change after the laparoscopic operation.[Methods] 238 female infertile patients who underwent laparoscopic operation in our hospital during Jan.2010 and Dec.2011 were randomly divided into observation group and control group.The pregnancy rate and ovarian reserve function changes were followed up.[Results] Uterine tube and pelvic diseases were the factors that led to infertility.The positive

  13. Feasibility and analgesic efficacy of the transversus abdominis plane block after single-port laparoscopy in patients having bariatric surgery

    Wassef M


    Full Text Available Michael Wassef, David Y Lee, Jun L Levine, Ronald E Ross, Hamza Guend, Catherine Vandepitte, Admir Hadzic, Julio TeixeiraDepartment of Anesthesiology, St Luke's-Roosevelt Hospital Center, New York, NY, USAPurpose: The transversus abdominis plane (TAP block is a technique increasingly used for analgesia after surgery on the anterior abdominal wall. We undertook this study to determine the feasibility and analgesic efficacy of ultrasound-guided TAP blocks in morbidly obese patients. We describe the dermatomal spread of local anesthetic in TAP blocks administered, and test the hypothesis that TAP blocks decrease visual analog scale (VAS scores.Patients and methods: After ethics committee approval and informed consent, 35 patients with body mass index >35 undergoing single-port sleeve gastrectomy (SPSG were enrolled. All patients received balanced general anesthesia, followed by intravenous patient-controlled analgesia (IV-PCA; hydromorphone postoperatively; all reported VAS >3 upon arrival to the recovery room. From the cohort of 35 patients having single-port laparoscopy (SPL, a sealed envelope method was used to randomly select ten patients to the TAP group and 25 patients to the control group. The ten patients in the TAP group received ultrasound-guided TAP blocks with 30 mL of 0.2% Ropivacaine injected bilaterally. The dermatomal distribution of the sensory block (by pinprick test was recorded. VAS scores for the first 24 hours after surgery and opioid use were compared between the IV-PCA+TAP block and IV-PCA only groups.Results: Sensory block ranged from T5–L1. Mean VAS pain scores decreased from 8 ± 2 to 4 ± 3 (P=0.04 within 30 minutes of TAP block administration. Compared with patients given IV-PCA only, significantly fewer patients who received TAP block had moderate or severe pain (VAS 4–10 after block administration at 6 hours and 12 hours post-surgery. However, cumulative consumption of hydromorphone at 24 hours after SPSG surgery

  14. 腹腔镜手术诊治女性不孕症的价值探讨%Discussion on Diagnosis and Treatment Value of Laparoscopy in Infertility

    叶远征; 马彩玲


    腹腔镜手术在女性不孕症的诊治中可直观、方便且能迅速明确大部分不孕症的病因,使治疗有针对性,缩短治愈时间,辅助生育技术(ART)为生殖医学基础研究和临床治疗提供了新的方法,显著提高了对不孕症治疗的成功率和改善预后,特别是给输卵管阻塞性不孕患者带来了希望.但是腹腔镜手术与ART对不孕症的治疗的价值仍存在争议.%Laparoscopic operation could directly, conveniently quickly and clearly find the main causes of infertility in the diagnosis and treatment of female infertility, which the therapy targeted and shortened cure time. However, ART offer the new method for reproductive medicine basic research and clinical treatments, improves the treatment success rate and prognosis of infertility significantly, especially to tubal occlusion infertility and male sterility. But the laparoscopy in diagnosis and treatment for female infertility has been challenged and suspected with the development of ART. The purpose of this review is to summarize the value of laparoscopy in diagnosis and treatment of infertility caused by different factors.

  15. [Combination effects of capsicum plaster at the Korean hand acupuncture points k-d2 with prophylactic antiemetic on postoperative nausea and vomiting after gynecologic laparoscopy].

    Jung, Hyun Jung; Park, Sang Youn


    This study was done to evaluate the combination effects of capsicum plaster at the Korean hand acupuncture points K-D2 with prophylactic antiemetic on Postoperative Nausea and Vomiting (PONV). An experimental research design (a randomized, a double-blinded, and a placebo-control procedure) was used. The participants were female patients undergoing gynecologic laparoscopy; the control group (n=34) received intravenous prophylactic ramosetron 0.3mg, while the experimental group (n=34) had Korean Hand Therapy additionally. In the experimental group, capsicum plaster was applied at K-D2 of both 2nd and 4th fingers by means of Korean Hand Therapy for a period of 30 minutes before the induction of anesthesia and removed 8 hours after the laparoscopy. The occurrence of nausea, nausea intensity and need for rescue with antiemetic in the experimental group was significantly less than in the control group 2 hours after surgery. Results of the study show capsicum plaster at K-D2 is an effective method for reducing PONV in spite of the low occurrence of PONV because of the prophylactic antiemetic medication.

  16. Restorative proctocolectomy with an ileoanal pouch: the role of laparoscopy Proctocolectomía restauradora con reservorio ileoanal: el papel de la laparoscopia

    L. Delgado Plasencia


    Full Text Available Objectives: the aim of this retrospective study was to evaluate early experience with laparoscopic restorative proctocolectomy by analyzing the perioperative results of surgical treatment. Patients and methods: seven major surgeries were performed in six patients with familial adenomatous polyposis and ulcerative colitis. All procedures were performed under laparoscopy at our third-level hospital from June 2003 to October 2004. Results: mean surgical time was 287.5 ± 80.7 min, and median blood loss was 300 ± 249.0 cc. There were no conversions; return of peristalsis began at 32 ± 12.4 h; average time to first oral intake was 64.0 ± 32.8 h, and mean duration of hospital stay was 9.3 ± 1.2 days. There was one case of perineal sepsis due to ileal pouch-anal anastomotic leakage, which was successfully treated with oral intake restriction, parenteral nutrition, and intra-rectal drainage. The most common postoperative complication was postoperative ileus. Conclusions: we believe that the laparoscopic approach to restorative proctocolectomy may be considerably improved in our center. Particular aspects for improvement include efforts to achieve lower operating and hospitalization times to equate our results with those reported by multicenter studies for laparoscopic colon cancer surgery. In our opinion, learning and further training opportunities should be encouraged to improve surgeon experience in the field of laparoscopy, preferably at centers specializing in restorative proctocolectomy.

  17. FDG-PET/CT in advanced ovarian cancer staging: Value and pitfalls in detecting lesions in different abdominal and pelvic quadrants compared with laparoscopy

    De Iaco, Pierandrea [Department of Gynaecology, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S.Orsola-Malpighi, Bologna (Italy); Musto, Alessandra [Department of Nuclear Medicine, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S.Orsola-Malpighi, Bologna (Italy); Orazi, Luca [Department of Gynaecology, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S.Orsola-Malpighi, Bologna (Italy); Zamagni, Claudio; Rosati, Marta [Department of Medical Oncology, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S.Orsola-Malpighi, Bologna (Italy); Allegri, Vincenzo [Department of Nuclear Medicine, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S.Orsola-Malpighi, Bologna (Italy); Cacciari, Nicoletta [Department of Medical Oncology, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S.Orsola-Malpighi, Bologna (Italy); Al-Nahhas, Adil [Department of Nuclear Medicine, Hammersmith Hospital, London (United Kingdom); Rubello, Domenico, E-mail: [Department of Nuclear Medicine, PET/CT Centre, Radiology, Medical Physics, ' Santa Maria della Misericordia' Hospital, Viale Tre Martiri 140, 45100 Rovigo (Italy); Venturoli, Stefano [Department of Gynaecology, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S.Orsola-Malpighi, Bologna (Italy); Fanti, Stefano [Department of Nuclear Medicine, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S.Orsola-Malpighi, Bologna (Italy)


    Introduction and aim: Ovarian carcinoma (OC) is a common cancer in the Western Countries, and an important cause of death in patients suffering with gynaecologic malignancies. The majority of patients present with advanced disease at the time of diagnosis. Treatment with debulking surgery followed by chemotherapy is the standard approach while chemotherapy is contemplated when surgery is not possible. A correct pre-operative staging is important to ensure a most appropriate management. Laparoscopy (LPS) is the standard diagnostic tool for the assessment of intraperitoneal infiltration but is invasive and requires general anaesthesia. FDG-PET/CT is increasingly used for staging different types of cancer, and the aim of this study is to assess the value of FDG-PET/CT in staging advanced OC and its sensitivity to detect lesions in different quadrants of the abdominal-pelvic area compared to laparoscopy. Materials and methods: From September 2004 till April 2008, 40 patients with high suspicion of OC were referred to our hospital for diagnostic LPS to explore the possibility of optimal debulking surgery. Those who were not suitable for surgery were referred for chemotherapy. Before chemotherapy, the patients underwent an FDG-PET/CT scan. The findings in 9 quadrants of abdominal-pelvic area (total 360 quadrants) for PET/CT and LPS were recorded and compared. Results: In 14/360 areas (3.8%), surgical evaluation was not possible because of presence of adhesions, thus the number of areas explored by laparoscopy was 346. Tumour was found in 308 quadrants (38 quadrants free of disease). PET/CT was positive in all 40 patients with true negative results in 26/346 quadrants (7.5%), and true positives results in 243/346 quadrants (70.2%). False positive and negative PET/CT results were found in 12/346 and 65/346 quadrants, respectively. False positive PET/CT findings were evenly present in all quadrants. False negative PET/CT findings were present in 31/109 (28.4%) upper

  18. Cytoprotection with amifostine in radiotherapy or combined radio-chemotherapy of head and neck cancer; Zytoprotektion mit Amifostin in der Strahlentherapie bzw. Strahlen-/Chemotherapie von Kopf-Hals-Tumoren

    Altmann, S.; Hoffmanns, H. [Krankenhaus Maria-Hilf, Moenchengladbach (Germany). Strahlentherapie und Radiologische Onkologie


    Therapieformen. In der vorliegenden Untersuchung wird sein Einfluss auf die Akuttoxizitaet der alleinigen Strahlen- bzw. kombinierten Radiochemotherapie bei Patienten mit fortgeschrittenen Kopf-Hals-Tumoren ueberprueft. Patienten und Methodik: Es wurden 23 Patienten mit fortgeschrittenen Kopf-Hals-Tumoren, ueberwiegend im Stadium III und IV, mit praeoperativer Radiatio (n=1), prae- und postoperativer Radiatio (n=5), postoperativer Radiatio (n=11) bzw. kombinierter Radiochemotherapie (n=6) behandelt. Vor jeder Behandlung wurden 500 mg Amifostin intravenoes ueber 15 Minuten verabreicht. Die Therapiedokumentation dieser unselektierten Patientengruppe wurde retrospektiv mit einem historischen Patientenkollektiv verglichen, das 17 Patienten umfasste. Resultate: Bei 15 Patienten (65%) unter Amifostin kam es zu therapiebedingten Nebenwirkungen wie Mukositis und Dermatitis {<=}WHO-Grad 2, welche Radiotherapiepausen (Mittelwert: 6,5, maximal 17 Tage) erforderten. Schleimhaut- bzw. dermatoligische Nebenwirkungen vom WHO-Grad 3 oder 4 wurde bei keinem Patienten beobachtet. In der historischen Kontrollgruppe trat eine signifikant hoehere Akuttoxizitaet auf. Eine Stomatitis oder Epitheliolyse vom WHO-Grad 3 wurde bei sieben Patienten (41%) beobachtet. Bei 15 Patienten (88%) erforderten die therapiebedingten Nebenwirkungen Radiotherapiepausen (Mittelwert: 16, maximal 40 Tage; p=0,0016). Schlussfolgerung: Die zusaetzliche Gabe von Amifostin vor jeder Bestrahlung scheint in einer deutlichen Reduktion der Akuttoxizitaet bei der Strahlen- bzw. kombinierten Strahlen-/Chemotherapie bei Patienten mit Kopf-Hals-Tumoren zu resultieren und eine zeitgerechtere Applikation zu ermoeglichen. (orig.)

  19. Rendimiento de exopolisacáridos emulgentes producidos por bacterias halófilas nativas en tres concentraciones de melaza de Saccharum officinarum L. “caña de azúcar”

    Ángel Fuentes


    Full Text Available Los exopolisacáridos microbianos con propiedades emulgentes constituyen una alternativa a los polímeros químicos y a los procedentes de algas y plantas. Su producción en melaza como fuente de carbono disminuye el costo y genera un valor agregado a este subproducto de la industria azucarera, por lo que el objetivo del presente estudio fue determinar el rendimiento y productividad de exopolisacáridos emulgentes por bacterias halófilas nativas en melaza. A partir de muestras de agua y suelo de salinas en los distritos de San José y Santa Rosa, en Lambayeque, se obtuvieron 138 aislados de bacterias en medio sintético malta-extracto de levadura con 5 % p/v de sales. Con el 10,8 % de estas bacterias formadoras de colonias gomosas y cultivadas en glucosa como fuente de carbono se recuperaron EPS, cuyos valores máximos de emulsión en las mezclas agua – fase oleosa fueron 63,3 y 56,6 %, después de 1 y 24 horas. El aislado M510-1 C1 identificado como Halomonas sp.M5 sintetizó EPS emulgentes en caldo con 20, 30 y 40 gL-1 de melaza, alcanzando 0,296; 0,200 y 0,113 gg-1 de rendimiento Yp/s y 0,016; 0,017 y 0,010 gL-1h-1 de productividad , respectivamente, no existiendo diferencias significativas entre 20 y 30 g L -1. Con el control 10 gL-1 de glucosa se alcanzó un rendimiento Yp/s de 0,171 gg-1 y una productividad de 0,018 gL-1h-1. Se demostró que las bacterias halófilas nativas producen exopolisacáridos emulgentes en melaza como fuente de carbono.

  20. Noticias masoréticas en los midrašîm halákicos más antiguos y su comparación con los midrašîm exegéticos

    Martín Contreras, Elvira


    Full Text Available In this article the author examines all the examples of the oldest halakhic midrašîm (Sifre Numbers, Sifra Leviticus and Mĕkîlta’ de R. Ysmael in which a textual detail is commented in the language of the Masorah. The results of these analyses are then compared with the results obtained from the analysis of the exegetical midrašîm Genesis Rabbâ and Lamentations Rabbâ. This comparison shows that this type of commentaries are more numerous and varied in the exegetical midrašîm. The comparison of the textual notes shared by both midrašîm permits to appreciate the differences in the treatment and the formula. The conclusions of this study stress the significance of exegetical midrašîm, and the haggadic in general, in the studies about the history and development of Masorah.En este artículo se examinan todos los ejemplos de los midrašîm halákicos más antiguos (Sifré Números, Sifra Levíticos y Mĕkîlta’ de R. Yismael que comentan un detalle textual con un lenguaje similar al de la Masora. Los resultados de estos análisis son comparados con los obtenidos del análisis de los midrašîm exegéticos Génesis Rabbâ y Lamentaciones Rabbâ. Dicha comparación demuestra que este tipo de comentarios son más numerosos y variados en los midrašîm exegéticos. En cuanto a las noticias textuales que ambos señalan e interpretan, se pueden apreciar diferencias respecto al tratamiento y la fórmula. Todo ello confirma que en los midrašîm exegéticos esta era una práctica habitual de los rabinos, pero no así en los halákicos, donde parece ser un hecho puntual. Las conclusiones de este estudio resaltan la importancia de los midrašîm exegéticos, y en general los hagádicos, en los estudios sobre la historia y el desarrollo de la Masora.

  1. Sterilization by Laparoscopy

    ... If pregnancy does occur, the risk of an ectopic pregnancy is higher than in women who did not ... pregnant. Also, the risk of problems, such as ectopic pregnancy, is increased. What are some alternatives to sterilization? ...

  2. Laparoscopy and Hysteroscopy

    ... Diagnostic hysteroscopy is used to look inside the uterine cavity. If an abnormal condition is detected during the ... bleeding. Diagnostic hysteroscopy is used to examine the uterine cavity (Figure 3), and is helpful in diagnosing abnormal ...

  3. Determining Antibacterial Activity of Some Mosses (Cinclidotus riparius (Host ex Brid. Arn., Calliergonella cuspidata (Hedw. Loeske, Thamnobryum alopecurum (Hedw. Gangulee, Leucobryum juniperoideum (Brid. Müll.Hal., Cirriphyllum crassinervium (Taylor Loeske & M.Fleisch.

    Güray UYAR


    Full Text Available In this study, the antibacterial activity of 5 different moss extracts (Cinclidotus riparius (Host ex Brid. Arn., Calliergonella cuspidata (Hedw. Loeske, Thamnobryum alopecurum (Hedw. Gangulee, Leucobryum juniperoideum (Brid. Müll.Hal. and Cirriphyllum crassinervium (Taylor Loeske & M.Fleisch. which were common in Zonguldak province and its environs were tested in vitro against the 13 different microorganisms. The extracts were prepared in ethanol, acetone, methanol, and ethyl acetate (96%. Disk diffusion method was applied for the determination of antibacterial activity of moss extracts. In addition, standard antibiotic disks and blank solvent disks were used respectively for comparison and control. At the end of this study, T. alopecurum extracts in methanol and acetone at the same time L. juniperoideum extract in methanol were determined to the greatest antimicrobial activities than all the studied other moss species in Escherichia coli ATCC 11230 bacteria culture medium. Additionally, the antibacterial activities of ethanolic and acetonic extracts of T. alopecurum were the same with CTX30 (Cefotaxime and higher than AK30 (Amikacin as studied standard antibiotic discs. Moreover the antibacterial effect of L. juniperoideum extract in methanol was found only higher than AK30 (Amikacin.

  4. 腹腔镜在妇科急腹症诊治中的应用%Application of laparoscopy in the diagnosis and treatment of gynecological acute abdomen



    目的 探讨腹腔镜手术在妇科急腹症诊治中的应用价值.方法 回顾分析应用腹腔镜诊断和治疗妇科急腹症353例(A组)的临床资料,并与同期开腹手术297例(B组)比较,分析腹腔镜手术应用于妇科急腹症的应用价值.结果 A组353例顺利完成手术,包括异位妊娠286例,黄体破裂29例,巧克力囊肿破裂18例,卵巢囊肿蒂扭转12例,盆腔炎性疾病8例;中转开腹3例,未出现并发症.与B组比较,A组的手术时间短、术中出血量少、术后疼痛程度轻、肠道功能恢复早、住院时间短,无切口感染病例.结论 腹腔镜技术应用于妇科急腹症创伤小,在可明确诊断的同时,又能实施治疗.%Objective To investigate the role of laparoscopy in the diagnosis and treatment of gynecological acute abdomen. Methods Data of 353 patients (group A) with gynecological acute abdomen underwent laparoscopy were analyzed retrospectively. The results were compared to those in 297 patients (group B) with gynecological acute abdomen underwent open surgery. Results The diagnosis and surgery in group A were successfully performed, which included ectopic pregnancy in 286 cases,corpus luteum rupture in 29 cases,chocolate cyst burst in 18 cases,ovarian cyst Wendy turn in 12 cases,and pelvic inflammatory disease in 8 cases. Laparoscopy in group A had to be changed to open surgery in 3 cases. Compared to group B, laparoscopic surgery for gynecological acute abdomen had the advantages of shorter operation time, less blood loss and postoperative pain,early recovery of bowel function, and shorter hospital stay. Conclusion Compared to open operation, laparoscopic surgery for gynecological acute abdomen has minimal injury, and the diagnosis and surgery can be carried out simultaneously.

  5. Effects Observation of Laparoscopy Combined Therapy Tubal Infertility%宫腹腔镜联合治疗输卵管性不孕的效果观察



    目的:观察宫腹腔镜联合对输卵管性不孕的临床治疗效果。方法选取我院自2011年5月~2012年5月收治的输卵管性不孕患者80例,随机分为甲组和乙组各40例,对甲组患者进行宫腹腔镜联合治疗,对乙组患者进行宫腔镜治疗,对比两组患者的临床治疗效果。结果甲组输卵管通畅率为87.5%,宫内妊娠率为52.5%,异位妊娠率为2.5%。乙组输卵管通畅率为47.5%,宫内妊娠率为20%,异位妊娠率为12.5%。差异有统计学意义(P<0.05)。结论对输卵管性不孕患者进行宫腹腔镜联合治疗,可以提高输卵管通畅率和宫内妊娠率,降低异位妊娠率,具有良好的临床治疗效果。%Objective:To investigate the clinical therapeutic ef ect of hysteroscopy combined with laparoscopy for tubal infertility. Methods:in our hospital from 2011 May to 2012 May were 80 cases of patients with fal opian tube infertility, were randomly divided into group A and B group with 40 cases in each group, were combined laparoscopy and hysteroscopy in treatment of patients with hysteroscopy treatment group, group B patients, and compared the clinical ef icacy of two groups of patients. Results: the group of tubal patency rate was 87.5%, pregnancy rate 52.5%, ectopic pregnancy rate was 2.5%. Group B tubal patency rate was 47.5%, pregnancy rate 20%, ectopic pregnancy rate was 12.5%. The dif erence was statistical y significant (P<0.05). Conclusion:for the patients with tubal infertility by hysteroscopy combined with laparoscopy treatment, can improve the patency rate of oviduct and uterine pregnancy rate, decrease the ectopic pregnancy rate, with good clinical result.

  6. Dynamic real-time in vivo confocal laser endomicroscopy of the fallopian tube during laparoscopy in the prevention of ovarian cancer.

    Chene, Gautier; Chauvy, Lauriane; Buenerd, Annie; Moret, Stéphanie; Nadaud, Béatrice; Chabert, Philippe; Lamblin, Gery


    Recently it has been postulated that most ovarian cancers have a tubal origin. The identification of preinvasive tubal lesions would be of great interest in the early diagnosis of ovarian cancer. Optical biopsy has been developed and validated in the detection of precancerous lesions (such as Barrett's oesophagus). The first objective of this study was to assess the feasibility of optical biopsy in the study of fallopian tubes during laparoscopy. The second objective was to describe the images in benign premalignant and malignant tubes with a histopathological and immunohistochemical (p53 and Ki67 expressions) correlation. In this prospective study, 40 patients undergoing laparoscopic salpingectomy for benign conditions (benign hysterectomy), prophylactic conditions (BRCA mutation) or in case of pelvic cancers were included after obtaining informed and signed consent prior to surgery. The optical biopsy was performed on the fimbria of each tube in and ex vivo. A correlation was made with the histopathological and immunohistochemical analysis. The feasibility of optical biopsy was always confirmed during laparoscopy. The optical biopsy iconography revealed different images in benign tubal epithelium (well-defined black and grey structure), in adenomatoid tumour (tortuous architectural organization), in STIC precancerous lesion (enlarged, irregular and pleomorphic cells, dilated and distorted vessels) and in tubal metastasis of high grade serous ovarian cancer (dark neoplastic cells irregular in size and shape) CONCLUSIONS: Optical biopsy may be the first emerging mini-invasive technology that could detect tubal lesions and may be considered as a promising tool in the early detection of ovarian cancer. Copyright © 2017 Elsevier B.V. All rights reserved.

  7. A prospective randomised comparison of the LMA ProSeal™ versus endotracheal tube on the severity of postoperative pain following gynaecological laparoscopy.

    Griffiths, J D; Nguyen, M; Lau, H; Grant, S; Williams, D I


    Pain and postoperative nausea and vomiting (PONV) are common problems after gynaecologic laparoscopy. Two recent studies have shown that morphine requirements and PONV are lower when an LMA ProSeal™ is used, rather than an endotracheal tube (ETT), for female patients undergoing breast and gynaecological surgery. We conducted a patient and observer-blinded randomised controlled trial, recruiting non-obese women without gastro-oesophageal reflux undergoing laparoscopic gynaecological surgery. Patients received a standardised relaxant general anaesthetic and then were randomised to receive either an LMA ProSeal or an endotracheal tube. Patients were assessed at two and 24 hours post-anaesthesia. The primary outcome was postoperative pain score and secondary endpoints included morphine consumption, postoperative emesis and adverse upper airway symptoms. We recruited 116 patients to the study, 57 patients in the ETT group and 59 patients in the LMA ProSeal group. The patients were similar in demographic and surgical characteristics. At two hours, the ETT group was similar to the LMA ProSeal group in regards to pain scores (Visual Analogue Scale 3.0 vs 3.5, P=0.86), morphine consumption (7.2 vs 7.4 mg, P=0.56) and PONV (47.4 vs 47.5%, P=0.99). After 24 hours, pain scores and PONV rates were also similar. No significant difference in rates of sore throat or dysphagia was observed between the ETT and LMA ProSeal groups. No significant complications were attributable to either airway device. The LMA ProSeal did not decrease pain or PONV in patients undergoing gynaecological laparoscopy when compared to endotracheal intubation.

  8. [János Pusztay. Nyelvével hal a nemzet. Az oroszországi finnugor népek jelene és jövője 11 pontban] / Маргарита Кузнецова

    Кузнецова, Маргарита


    Arvustus: Pusztay, János. Nyelvével hal a nemzet. Az oroszországi finnugor népek jelene és jövője 11 pontban. Budapest, 2006. (A Magyarságkutatás könyvtára XXVIII). Soome-ugri rahvaste tänapäevast ja tulevikust Vene Föderatsioonis

  9. [János Pusztay. Nyelvével hal a nemzet. Az oroszországi finnugor népek jelene és jövője 11 pontban] / Маргарита Кузнецова

    Кузнецова, Маргарита


    Arvustus: Pusztay, János. Nyelvével hal a nemzet. Az oroszországi finnugor népek jelene és jövője 11 pontban. Budapest, 2006. (A Magyarságkutatás könyvtára XXVIII). Soome-ugri rahvaste tänapäevast ja tulevikust Vene Föderatsioonis

  10. Supportive treatment with megestrol acetate during radio-(chemo-)therapy. A randomized trial; Supportive Behandlung mit Megestrolacetat waehrend der Radio-(Chemo-)Therapie bei Patienten mit Tumoren im Kopf-Hals-Bereich. Eine randomisierte Studie

    Fietkau, R. [Erlangen-Nuernberg Univ., Erlangen (Germany). Strahlentherapeutische Klinik; Riepl, M. [Erlangen-Nuernberg Univ., Erlangen (Germany). Strahlentherapeutische Klinik; Kettner, H. [Bristol Arzneimittel GmbH, Muenchen (Germany). Medizinische Abt.; Hinke, A. [Wissenschaftlicher Service Pharma, Monheim (Germany); Sauer, R. [Erlangen-Nuernberg Univ., Erlangen (Germany). Strahlentherapeutische Klinik


    Tumoranorexie und -kachexie bei Patienten mit infauster Prognose ist bekannt. Ob sich ein supportiver Effekt von Megestrolacetat waehrend einer intensiven Radio-(Chemo-)Therapie ergibt, wurde bislang noch nicht untersucht. Dies erfolgte jetzt bei Patienten mit fortgeschritten Tumoren im Kopf-Hals-Bereich. Waehrend und bis sechs Wochen nach der Strahlentherapie erhielten die Patienten des Therapiearmes 160 mg/d Megestrolacetat. Vor, waehrend und nach der Strahlentherapie wurden anthropometrische und laborchemische Parameter bestimmt sowie die subjektive Lebensqualitaet der Patienten mittels des `Quality of life`-Index nach Padilla et al. erfasst. Ergebnisse: Zur endgueltigen Auswertung standen 61 Patienten (Kontrollarm: n=30, Therapiearm: n=31) zur Verfuegung. Ein Patient lehnte nach Randomisation die weitere Teilnahme ab. Je ein Patient im Kontroll- und Placeboarm schieden bei Verdacht auf Nebenwirkungen (Impotenz, Diarrhoe) aus. Weitere Nebenwirkungen wurden nicht beobachtet. Im Kontrollarm verschlechterten sich die Ernaehrungsparameter (Koerpergewicht, Trizepshautfaltendicke) und das subjektive Befinden unter der Bestrahlung sehr schnell und erholten sich anschliessend kaum. Im Gegensatz dazu konnten die mit Megestrolacetat behandelten Patienten diese Werte auf dem Ausgangsniveau stabiliseren. Dieser Unterschied zeigt sich am deutlichsten bei den ausschliesslich oral ernaehrten Patienten (Gewichtsverlust waehrend der Therapie im Kotrollarm: -4,1 kg; im Therapiearm: -0,8 kg; p=0,004), weniger bei den mittels perkutaner endoskopisch kontrollierten Gastrostomie (PEG) versorgten Patienten (Gewichtsverlust im Kontrollarm: -2,4 kg; im Therapiearm: -0,8 kg; p=0,14). Schlussfolgerungen: Die prophylaktische Gabe von Megestrolacetat kann bei Patienten mit Kopf-Hals-Tumoren waehrend einer Radio/(Chemo-)Therapie eine Verschlechterung des Ernaehrungszustands und tendenziell der Lebensqualitaet verhindern.

  11. High response rates following paclitaxel/5-FU and simultaneous radiotherapy in advanced head and neck carcinoma; Hohe Remissionsraten unter simultaner Radio- und Chemotherapie mit Paclitaxel/5-FU in der Behandlung fortgeschrittener Kopf-Hals-Tumoren

    Schroeder, M.; Westerhausen, M. [St.-Johannes-Hospital, Duisburg (Germany). Medizinische Klinik II; Makoski, H.B. [Staedtische Kliniken, Duisburg (Germany). Radioonkologie; Sesterhenn, K. [St. Anna-Krankenhaus, Duisburg (Germany). HNO-Klinik; Schroeder, R. [Bristol Myers Squibb, Muenchen (Germany). Dept. of Oncology


    The main stay of treatment for head and neck cancer patients with advanced disease has been chemotherapy with Cisplatin/5-FU and simultaneous applied radiotherapy. With this multimodality treatment including radical surgery after two cycles of neoadjuvant chemotherapy and 40 Gy radiotherapy we reported 60% complete remission after 5 years for patients with stage III/IV of head and neck cancer. Paclitaxel, a new plant product, has demonstrated significant antineoplastic activity in head and neck tumors (ECOG-Study: 40% RR). Therefore we performed a trial with Taxol/5-FU and simultaneous radiation in a neoadjuvant and postoperative adjuvant setting of stage III/IV squamous cell carcinoma of the head and neck with pre-existent contraindication against Cisplatin. Patients and Methods: 30 patients with a primarily inoperable stage III/IV of SCC of the head and neck were enrolled to receive day 1 and 29 Taxol 175 mg/m{sup 2} as a 3-hour-infusion, followed by 120-hour-cvi of 1000 mg/m{sup 2}/d 5-FU. Locally irradiation was given ad 40 Gy (2 Gy/d/day 1-26). Radical surgery followed about day 56. Postoperatively patients received again 2 cycles of Taxol/5-FU and simultaneous irradiation with 30 Gy. Results: So far 30 patients were treated and all patients reached a CR after complete treatment, ongoing for 23/30 patients for 6 till 34 months: 4 patients developed a second neoplasia, and 3 patients gloved a local relapse. The principal toxicity was moderate (neutropenia, peripheral neuropathy, arthralgia/myalgia) and sensible with supportive care (e.g. PEG). Conclusions: The results suggest that the treatment of SCC of the head and neck with Taxol/5-FU and simultaneous radiation and radical surgery is a highly effective schedule and comparable with the treatment with Cisplatin/5-FU. (orig.) [Deutsch] Der Standard in der Behandlung weit forgeschrittener, primaer inoperabler Kopf-Hals-Tumoren stellte die Cisplatinhaltige Chemotherapiekombination mit 5-FU dar mit simultan

  12. Training mode of surgeons for laparoscopy-assisted radical resection of rectal cancer%外科医师腹腔镜辅助直肠癌根治术培训模式探讨


      目的提高外科医师腹腔镜手术技能,普及腹腔镜技术。方法采取在腹腔镜辅助直肠癌根治术手术教学中引入手术模拟系统,结合手术室实地参观答疑的方法,探讨外科医师腹腔镜辅助直肠癌根治术的培训模式。结果104名普通外科高级职称医师参加培训,全部随访,随访率为100%,随访结果:99位学员(95%)反馈更加熟悉腹腔镜操作技巧,手术时间比培训前平均缩短45 min。结论通过本培训模式训练可有效提高外科医师对腹腔镜辅助直肠癌根治术手术操作流程的认识及局部解剖的技巧,提高操作手术效率、提升手术效果。%Objective To popularize the laparoscopic techniques in surgeons by improving their laparoscopy-assisted surgical skills. Methods The training model of surgeons for laparoscopy-assisted radical resection of rectal cancer was studied by introducing the surgery simulation system into teaching of laparoscopy-assisted radical resection of rectal cancer in combination with questions-answering in operation room. Results A total of 104 surgeons with a senior professional title from departments of general surgery were trained and followed up (with a follow-up rate of 100%), during which 99 surgeons (95%) reported that they were more skillful in laparoscopy-assisted radical resection of rectal cancer with the mean operation time shortened to 45 minutes after training as compared to that before training. Conclusion The training model of surgeons for laparoscopy-assisted radical resection of rectal cancer can effectively improve their laparoscopy-assisted surgical skills and local anatomy knowledge.

  13. Clinlical Study of Hysterosalpingography and Laparoscopy in Tubal Obstructive Infertility%子宫输卵管碘油造影及腹腔镜检查在输卵管性不孕中的应用



    Objective:To evaluate the clinical value of hysterosalpingography (HSG) and laparoscopy in the diagnosis of tubal or pelvic adhesions. Methods:The clinical data in 89 cases of tubal infertility by HSG and laparoscopy were retrospectively analyzed from Jan 2008 to Dec 2010 in our hospital, and they all received both HSG and laparoscopy examination before, the clinical data analyzed retrospectively. Results;Of the 176 fallopian tubes,the coincidence rate of HSG and laparoscopy was 79. 55% (140/176) . The sensitivity and the specificity of laparoscopy in the diagnosis of unobstructed tubes was 77. 89% and 71. 70%, and in the HSG it was 72.22% and 64. 41 %. Conclusions: HSG can be used as a preliminary screening method in patients with infertility, and laparoscopy with high accuracy in the diagnosis and treatment of infertility patients.%目的:通过子宫输卵管碘油造影(HSG)及腹腔镜检查,分析其对输卵管及盆腔粘连病变检查的临床诊断价值.方法:回顾性分析我院2008年1月至2010年12月收治的89例输卵管性不孕患者,行HSG检查及腹腔镜治疗的临床资料.结果:176条输卵管中,HSG与腹腔镜检查结果相符的有140条,符合率79.55%;腹腔镜诊断榆卵管通畅的灵敏度为77.89%,特异度为71.70%;HSG诊断通畅的灵敏度为72.22%,特异度为64.41%.结论:HSG检查可作为不孕症患者的初步筛查手段,腹腔镜检查准确性高,在不孕症患者的诊断中有重要的作用.

  14. Fotodynamisk terapi af hoved-hals-kraeft

    Lajer, Christel Braemer; Specht, Lena; Kirkegaard, Jørgen


    Photodynamic therapy (PDT) is a new treatment for head and neck cancer. The principle of the treatment is a photochemical reaction initiated by light activation of a photosensitizer, which causes the death of the exposed tissue. This article presents the modes of action of PDT and the techniques...

  15. Clinical study on colonscopy combined with laparoscopy in the treatment of difficulty type colorectal polyps%结肠镜、腹腔镜双镜联合治疗困难性结直肠息肉

    刘暄; 章晓路; 利民; 邱培才; 周志球; 李苏明


    目的:探讨结肠镜、腹腔镜双镜联合治疗困难性结直肠息肉的可行性和安全性.方法:10例结肠镜无法完整切除的结肠息肉或结肠镜术中可能出现并发症的病例联合应用腹腔镜、结肠镜,其中腹腔镜辅助结肠镜下治疗5例,结肠镜定位腹腔镜切除4例,结肠镜腹腔镜同步切除1例.结果:10例患者均顺利完成手术,无中转开腹,术后无并发症发生.结论:应用腹腔镜、结肠镜联合手术完成结肠镜无法治疗的结肠息肉,提高了手术的安全性和彻底性.%Objective: To explore the safety and feasibility combined colonscopy with laparoscopy in treatment of difficulty type colorectal polyps and polyp canceration.Methods: 10 cases with endoscopically unresectable colonic polyps or complications may occur by sole colonscopy were performed by laparoscopy combined with colonoscopy.Among them, 5 cases of underwent laparoscopic -assisted colonoscopic polypectomy, 4 cases of colonoscopic -assisted laparoscopic resection.1 case of synchronously colonoscopic and laparoscopic rsection.Results: 10 cases were performed by laparoscopy combined with colonscopy successfully.There were no complications or conversions to open surgery.Conclusion: Colonoscopy combined with laparoscopy available to patients with colonscopically unresectable colonic polyps.Compared with colonscopy alone, it is safety and feasibility and is minimally invasive to the patients.

  16. Pushing the envelope: laparoscopy and primary anastomosis are technically feasible in stable patients with Hinchey IV perforated acute diverticulitis and gross faeculent peritonitis.

    Di Saverio, Salomone; Vennix, Sandra; Birindelli, Arianna; Weber, Dieter; Lombardi, Raffaele; Mandrioli, Matteo; Tarasconi, Antonio; Bemelman, Willem A


    Modern management of severe acute complicated diverticulitis continues to evolve towards more conservative and minimally invasive strategies. Although open sigmoid colectomy with end colostomy remains the most commonly used procedure for the treatment of perforated diverticulitis with purulent/faeculent peritonitis, recent major advances challenged this traditional approach, including the increasing attitude towards primary anastomosis as an alternative to end colostomy and use of laparoscopic approach for urgent colectomy. Provided an accurate patients selection, having the necessary haemodynamic stability, pneumoperitoneum is established with open Hasson technique and diagnostic laparoscopy is performed. If faeculent peritonitis (Hinchey IV perforated diverticulitis) is found, laparoscopy can be continued and a further three working ports are placed using bladeless trocars, as in traditional laparoscopic sigmoidectomy, with the addition of fourth trocar in left flank. The feacal matter is aspirated either with large-size suction devices or, in case of free solid stools, these can be removed with novel application of tight sealing endobags, which can be used for scooping the feacal content out and for its protected retrieval. After decontamination, a sigmoid colectomy is performed in the traditional laparoscopic fashion. The sigmoid is fully mobilised from the retroperitoneum, and mesocolon is divided up to the origin of left colic vessels. Whenever mesentery has extremely inflamed and thickened oedematous tissues, an endostapler with vascular load can be used to avoid vascular selective ligatures. Splenic flexure should be appropriately mobilised. The specimen is extracted through mini-Pfannenstiel incision with muscle splitting technique. Transanal colo-rectal anastomosis is fashioned. Air-leak test must be performed and drains placed where appropriate. The video shows operative technique for a single-stage, entirely laparoscopic, washout and sigmoid colectomy

  17. Técnica de biópsia hepática em eqüino por laparoscopia Hepatic biopsy in horses by laparoscopy

    Luis Cláudio Lopes Correia da Silva


    Full Text Available Este trabalho experimental objetivou a avaliação do uso da laparoscopia para biópsia hepática em eqüino e o estudo das possíveis alterações clínicas e laboratoriais decorrentes de tal procedimento. Foram utilizados 10 animais, os quais foram submetidos a procedimento cirúrgico em posição quadrupedal, por abordagem pelo flanco direito, no 17º espaço intercostal, após jejum alimentar e hídrico de 36 e 18 horas respectivamente. A avaliação pós-operatória constou de exame físico diário e colheita de amostras de sangue seriadas. O procedimento possibilitou inspeção dos órgãos e estruturas anatômicas localizados dorsalmente à direita da cavidade abdominal, favorecendo a escolha do local de biópsia hepática. Não foram observadas alterações no exame físico dos animais. Os exames hematológicos e de função hepática não apresentaram alterações significativas. Concluiu-se que o emprego da laparoscopia para realização de biópsia hepática em eqüino é simples, eficaz e seguro.The purpose of this research was to evaluate the use of laparoscopy in obtaining hepatic biopsy in horses and to determine a possible clinical and laboratorial changes related to the procedure. Ten animals were submitted to 36 hours of fastening and 18 hours of water deprivation and then operated in the standing position, through a right flank approach at the level of the 17th intercostal space. Post-operative evaluation consisted of daily physical examination and seriated blood sampling. The procedure allowed for wide visualization of the viscera and anatomical structures located on the right side of the abdominal cavity, favouring the choice of the spot for hepatic biopsy collection. No changes were noted in the physical state of the animals and alterations in hemogram and hepatic function tests were not statistically significant. It was concluded that laparoscopy is a simple, effective and safe technique for obtaining hepatic biopsy

  18. Efeitos da densidade de plantio e da adição de nutrientes na produção de mudas de gramas halófitas em recipientes

    Adriana Martins Guedes de Azevedo


    Full Text Available RESUMO As gramas halófitas Spartina alterniflora e Spartina densiflora são espécies bioengenheiras, que podem ser utilizadas para mitigação de áreas degradadas de marismas e manguezais, para o controle da erosão costeira e para estabilização de dragado depositado em regiões estuarinas e costeiras. O objetivo deste trabalho foi avaliar os efeitos da densidade de plantio e da adubação com nitrogênio (N e fósforo (P sobre mudas de propagação vegetativa destas duas espécies, crescendo em bandejas (0,15 m2; 7500 cm3. Para isto, foram realizados em estufa agrícola, não climatizada, dois experimentos nos anos de 2009 e 2011. Em 2009, apenas S. alterniflora foi cultivada, em duas densidades de plantios (133 e 400 mudas m-2 e com dois níveis de adição de nutrientes (sem adubação e com adição total de 50,8 gN m-2 e 16 gP m-2. Em 2011, bandejas com 80 mudas m-2 de ambas as espécies foram adubadas com razões 2N:1P, 6N:1P, 10N:1P e 14N:1P (adição total de 115 gN m-2. A adubação com NP estimulou a formação foliar e, em recipientes fertilizados, o número médio de hastes de S. alterniflora, após 80 dias, foi o dobro do observado nos recipientes-controle. Entretanto, densidades iniciais de 400 ou mais hastes m-2 nas bandejas resultaram em alongamento vertical excessivo das hastes de S. alterniflora (cerca de 100 cm de altura, o que prejudica o manuseio e o plantio. A adubação com razão 2N:1P resultou em melhor perfilhamento de ambas as espécies.

  19. Estudio comparativo de las moléculas isovalentes de interés atmosférico CF3Cl y CF3Br y sus correspondientes halógenos aislados Cl y Br.

    Mayor, E.; Velasco, A. M.; Martín, I.; Lavín, C.

    Los estados Rydberg moleculares han suscitado en los últimos años un creciente interés entre los espectroscopistas experimentales, motivado en parte por el desarrollo de nuevas técnicas espectroscópicas capaces de investigar estos estados altamente excitados electrónicamente. Los procesos de fotoabsorción que implican estados Rydberg en los derivados halogenados del metano son de gran importancia, debido a su abundancia en la atmósfera y a sus implicaciones medioambientales. Por ello, la obtención de datos relativos a sus fuerzas de oscilador es de gran interés. En este trabajo se aborda el estudio de dichas propiedades para las moléculas isovalentes CF3Cl y CF3Br. Ambas moléculas presentan idéntica estructura electrónica para el estado fundamental por lo que se espera que sus espectros Rydberg presenten grandes similitudes, en ausencia de perturbaciones. Por ello y dada la escasez de datos relativos a fuerzas de oscilador, hemos establecido la corrección de nuestros resultados en base a las analogías esperadas en las intensidades espectrales correspondientes a transiciones análogas. Por otro lado, Novak y col. [1] han encontrado experimentalmente un marcado carácter atómico en el espectro correspondiente a estas moléculas, siendo muy similar a los de los átomos de Cl y Br. Por ello en el presente trabajo, además de establecer la comparación entre ambas moléculas hemos buscado las similitudes con sus respectivos halógenos. Los cálculos relativos a las especies moleculares se han realizado utilizando la Metodología Molécular de Orbítales de Defecto Cuántico (MQDO) [2], mientras que para el estudio de los átomos de Cl y Br se empleó la versión relativista del método (RQDO) [3].

  20. 超声手术刀在妇科腹腔镜手术中的应用价值%Application of ultrasonic scalpel in gynecologic operative laparoscopy

    林俊; 张信美; 徐开红


    Objective To investigate the applied value of the ultrasonic scalpel in gynecologic operative laparoscopy. Methods Gynecologic operations were performed using the ultrasonic scalpel under laparoscopy. Operative bleeding and time, perioperative body temperature and hemogram, and tissue damage were observed.Results Forty-two cases of benign gynecologic diseases were treated with the ultrasonic scalpel under laparoscopy. Among them, there were 4 hysterectomies, 9 ovarian cystectomies, 18 salpingotomies, 4 ectopic pregnancies, 3 myomectomies, 3 adhesiolysis and 1 adnexectomy. The amount of operative bleeding, operating time and the tissue injury were related to the type of operation. The minimual operative bleeding amount, operating time, depth of tissue necrosis, tissue injury score and fibrin deposition score were 24.77±4.71ml, 23.39±3.01 min, 0.22±0.10mm, 0.98±0.21 and 0.38±0.26, respectively. The maximal operative bleeding amount, operating time, depth of tissue necrosis, tissue injury score and fibrin deposition score were 166.7±47.18ml, 127.2±16.99 min, 0.35±0.20mm, 1.25±0.20 and 0.81±0.29, respectively. The levels of body temperature, white blood cells and hemoglobin before and after the operations were not statistically different (P>0.05) except for hysterectomy (P<0.05). Conclusion The ultrasonic scalpel can be safely applied for gynecologic operative laparoscopy and should be used widely.%目的探讨超声手术刀在妇科腹腔镜手术中的应用价值。方法在腹腔镜下应用超声手术刀进行各种妇科手术,观察术中失血量、手术时间、围手术期体温和血象变化以及组织的损伤程度。结果在腹腔镜下使用超声手术刀进行各种手术42例。其中子宫切除术4例,卵巢囊肿剥出或切除术9例,输卵管切除术18例,输卵管切开取胚术4例,子宫肌瘤挖出术3例,单纯粘连分离术3例,附件切除术1例。术中失血量、手术时间以及对组织的损伤程

  1. Role of Laparoscopy in Identifying the Clinical Significance and Cause of Adhesions and Chronic Pelvic Pain: a Retrospective Review at the Kiel School of Gynecological Endoscopy

    ALHujeily, Maher


    Objectives: We sought to define the role of laparoscopy in identifying the clinical significance, cause, and association between adhesions and chronic pelvic pain. Methods: A retrospective chart review was conducted from October 2004 to July 2005, at the Kiel School of Gynecological Endoscopy, University Hospitals Schleswig-Holstein, Campus Kiel, Germany. Included in the study was the analysis of 462 laparoscopic procedures; 275 (59.5%) of the patients undergoing these procedures had pelvic or abdominal adhesions. Of these, 84 (30.5%) patients were admitted with the main complaint of chronic pelvic pain. Further evaluation and assessment of this group was carried out. Results: Among those patients with adhesions, the second most frequent reason for admission was chronic pelvic pain (30.5%) (P<0.0005). In our study, adhesions were found in 79.2% (n=84) of patients (n=106) with chronic pelvic pain. These adhesions were thin- filmy (19.0%) or thick-fibrous (81.0%) adhesions containing blood vessels. Thick-fibrous adhesions were present in 50.0% of patients at multiple abdominopelvic sites (P<0.005). Conclusions: Thick-fibrous adhesions that extend beyond the pelvic sidewall can cause significant chronic abdominopelvic pain. PMID:17931511

  2. Effect of obesity on technical feasibility and postoperative outcomes of laparoscopy-assisted distal gastrectomy--comparison with open distal gastrectomy.

    Yamada, Hiroyuki; Kojima, Kazuyuki; Inokuchi, Mikito; Kawano, Tatsuyuki; Sugihara, Kenichi


    The aim of this study was to compare outcomes between laparoscopy-assisted distal gastrectomy (LADG) and open distal gastrectomy (ODG) in obese and non-obese patients. Subjects comprised 248 consecutive patients who underwent distal gastrectomy for gastric cancer between January 1999 and December 2005. Patients with body mass index (BMI) > or = 25 kg/m2 were defined as obese, and patients with BMI obese. Parameters analyzed included patients characteristics, tumor characteristics, operative details, postoperative outcomes, and prognosis. For LADG, 35 patients were considered obese, and 106 patients were non-obese. For ODG, 25 patients were considered obese, and 82 patients were non-obese. Mean operative times in each procedure were significantly longer for the obese group than for the non-obese group (ODG: 241.4 min vs. 199.5 min, p obese group than for the non-obese group in ODG (300 ml vs. 400 ml, p = 0.024), but no significant differences were observed between obese and non-obese groups for LADG. Incidence of major postoperative complications, number of retrieved lymph nodes, and disease-free survival rates were similar in obese and non-obese groups for each procedure. Our analysis revealed that LADG can be safely performed in obese patients, with complication rates and operation outcomes similar to those for non-obese patients.

  3. Hepatic splenosis mimicking HCC in a patient with hepatitis C liver cirrhosis and mildly raised alpha feto protein; the important role of explorative laparoscopy

    Primrose JN


    Full Text Available Abstract Background Splenosis is a heterotropic implantation of splenic fragments onto exposed vascularised peritoneal and intrathoracic surfaces, following splenic injury or elective splenectomy. Case presentation A 60 year old cirrhotic patient was referred to us with a hepatic mass, suspected to be HCC in a cirrhotic liver. A computerized tomography scan (CT demonstrated a cirrhotic liver with a 2 × 2.7 cm focal hypervascular nodule, lying peripherally at the junction of segment 7 and 8. Diagnostic laparoscopy demonstrated a 3 cm exofitic dark brown splenunculus attached to the diaphragm and indenting the surface of segment 7 of the liver. The lesion was easily resected laparoscopically and shaved from the live surface with no need for a liver resection. The histopathological assessment confirmed the diagnosis of splenunculus, with no evidence of neoplasia. Conclusion Hepatic splenosis is not a rare event and should be suspected in patients with a history of splenic trauma or splenectomy. Correct diagnosis is essential and will determine subsequent management plans. In doubtful cases laparoscopic investigation can offere essential information and should be part of the standard protocol for investigating suspected splenosis.

  4. Transverse Skin Crease versus Vertical Midline Incision versus Laparoscopy for Right Hemicolectomy: A Systematic Review—Current Status of Right Hemicolectomy

    Alberto Santoro


    Full Text Available Purpose. The right hemicolectomy may be conducted through laparoscopic or laparotomic surgery, transverse or midline incisions. The transverse laparotomy offers some advantages compared to the midline laparotomy and laparoscopy. A literature review was performed to evaluate the possible advantages of the transverse incision versus midline incision or laparoscopic right hemicolectomy. Methods. A systematic research was performed in Medline, Embase, Cochrane Central Register of Controlled Trials, CINAHL, BioMed Central, and the Science Citation Index. Results. Laparotomic right hemicolectomy with transverse incision is preferable to laparotomic hemicolectomy with midline incision. A transverse incision offers a lessened postoperative pain following physical activity, a lessened need to administer analgesic therapy during the post-operative time, better aesthetic results, and a better post-operative pulmonary function. Open surgery with transverse or midline incision ensured a shorter operative time, lower costs and a greater length of the incision compared to the laparoscopic. However, there are no differences in the oncological outcomes. Conclusions. It was not possible to identify significant differences between the open right hemicolectomy with transverse incision versus the open right hemicolectomy with midline incision or laparoscopic hemicolectomy.

  5. 腹腔镜和达芬奇机器人系统在胃肠外科中的应用%The application of laparoscopy and Da Vinci robotics surgical system in gastrointestinal surgery



    Laparoscopy was ifrst applied in 1990 and Da Vinci robotics surgical system emerged in 2002 in the ifeld of gastrointestinal surgery. Taking a wide view of the development of minimally invasive techniques in more than 20 years, surgeons have been grown up from the blindest pursuit of technological reform to standard application and objective evaluation, and constantly advanced to the update of technology, the consummate standards and the improvement of the efifcacy. Although laparoscopy and Da Vinci robotics surgical system possess the advantages of minimal invasiveness, less bleeding and rapid recovery, it is dififcult to be applied and spread. However, the three-dimensional laparoscopy has brought a brand new revolution. It has not only the technical characteristics of laparoscopy and robotic surgical system, but also obvious advantage in popularity and learning. Thus, we believe that the prospect of three-dimensional laparoscopy will be broader.%1990年,腹腔镜技术首次应用于胃肠外科;2002年,达芬奇机器人手术系统开始在胃肠外科领域崭露头角。纵观微创技术发展的20多年历程,外科医师已从盲目追求技术改革逐渐发展至规范应用和客观评价,并不断向技术更新、标准完善和疗效肯定的高标准迈进。此外,外科医师在看到腹腔镜和达芬奇机器人手术系统创伤小、术中出血少、术后恢复快等优势的同时,也在不断思考它们在应用和推广方面难以避免的劣势。3D腹腔镜的问世为微创外科带来了新的革命,其不仅同时具有腹腔镜和机器人手术系统的技术特点,而且在推广和学习曲线方面也占据明显优势。因此,我们相信3D腹腔镜技术的应用前景将更为广阔。

  6. Concurrent radiotherapy and chemotherapy with carboplatin in patients with unresectable advanced head and neck tumors stages III and IV; Simultane Radiochemotherapie mit Carboplatin bei Patienten mit inoperablen fortgeschrittenen Kopf-Hals-Tumoren der Stadien UICC III und IV

    Muecke, R.; Ziegler, P.G.; Libera, T.; Fietkau, R. [Rostock Univ. (Germany). Klinik und Poliklinik fuer Strahlentherapie; Blynow, M.; Dommerich, S.; Kramp, B. [Rostock Univ. (Germany). HNO-Klinik und Poliklinik; Kundt, G. [Rostock Univ. (Germany). Inst. fuer Medizinische Informatik und Biometrie


    Background: The results of treating advanced tumors in the head and neck region with radiotherapy alone are disappointing. Concurrent radiotherapy and chemotherapy may improve this situation. The treatment results of concurrent radiochemotherapy at the University of Rostock were analyzed retrospectively. Results: Six weeks after radiochemotherapy 56.5% of patients had a complete remission, 36% a partial remission and 7.5% `no change`. With a median follow-up of 42 months (6 to 74 months) overall survival, disease-free survival and local control were 24.3%, 28.9%, 18.0% 5 years after treatment. All these criteria were significantly better in patients with palliative tumor resection compared to no surgical treatment (uni- and multivariate) and in patients with Stage III than in patients with Stage IV carcinomas (univariate), overall survival was significantly better in patients with Stage III (multivariate). A pretherapeutic Hb level below 7.0 mmol/l (11.27 g/dl) reduced the local control significantly (uni- and multivariate). Grade III and IV mucositis was detected in 10%, Grade III leucopenia in 12% of treated patients. Grade IV leucopenia and Grade III thrombopenia were observed in 1 patient each. Conclusion: The toxicity of this treatment is tolerable. However, additional trials must be conducted before considering the palliative tumor resection as standard therapy. (orig./AJ) [Deutsch] Hintergrund: Die Therapieergebnisse der Behandlung fortgeschrittener Tumoren der Kopf-Hals-Region mit alleiniger Bestrahlung sind unbefriedigend. Eine simultane Radiochemotherapie verbessert diese Resultate vermutlich. In einer retrospektiven Analyse wurden Ergebnisse nach simultaner Radiochemotherapie an der Universitaet Rostock ausgewertet. Ergebnisse: Sechs Wochen nach Radiochemotherapie erreichten 56,5% der Patienten eine komplette und 36% der Patienten eine partielle Remission, ein `no change` war bei 7,5% der Patienten festzustellen. Bei einer medianen Beobachtungszeit von

  7. Analysis of the microtensile bond strength to enamel of two adhesive systems polymerized by halogen light or LED Análise da microtração em esmalte de dois sistemas adesivos ativados por LED ou por luz halógena

    Ana Paula Morales Cobra Carvalho


    Full Text Available With the development of composite resin polymerization techniques, LEDs were introduced to the market place. Based on the studied literature, the aim of this study was to evaluate, through microtensile testing, the bond strength to enamel of a composite resin associated to a conventional (multi-bottle adhesive system or to a self etching primer adhesive system, polymerized by halogen light or LED (light emitting diode. Bovine teeth were divided into 4 groups with 10 teeth each (n = 10. Then the adhesives Scotchbond Multipurpose Plus (3M-ESPE and Clearfil SE Bond (Kuraray were applied following the manufacturers’ instructions. Both systems were polymerized for 10 s by halogen light (Degulux Soft Start - Degussa Hulls set at 550 mW/cm² or by LED (Kerr Demetron set at 600 mW/cm². The composite resin Filtek Z-250 was applied in four 1 mm increments with the aid of a square, condensation silicon, 5 mm x 5 mm matrix, and polymerized by either of light sources for 40 s. Scotchbond Multipurpose Plus polymerized by halogen light presented the highest bond strength values (39.69 ± 7.07 MPa, and the other groups did not present statistically significant differences: Scotchbond Multipurpose Plus polymerized by LED (22.28 ± 2.63 MPa, Clearfil SE Bond polymerized by halogen light (27.82 ± 2.65 MPa and by LED (22.89 ± 5.09 MPa.Com a grande busca pelo desenvolvimento das técnicas de polimerização das resinas compostas e dos sistemas adesivos, foram introduzidos no mercado os LEDs. Com base na literatura estudada, neste trabalho é avaliada a força de união da resina composta ao esmalte associado a um sistema adesivo convencional e a um sistema autocondicionante polimerizados por luz halógena e LED, por meio do teste de microtração. Os dentes bovinos foram divididos em 4 grupos com 10 dentes em cada um (n = 10, para aplicação do adesivo Scotchbond Multipurpose Plus (3M-ESPE e do Clearfil SE Bond (Kuraray conforme orientação do fabricante

  8. 腹腔镜与内镜联合技术治疗胃肠疾病%Combined application of laparoscopy and endoscopy in the treatment of gastrointestinal diseases

    张忠涛; 吴国聪


    In recent years, the concept of minimally invasive surgery has become accepted by the surgical community, though there are limitations in locating small gastrointestinal tumors when laparoscopy is used alone. Meanwhile, endoscopy is an excellent tool for locating these small tumors, though one must take extreme care to avoid hollow viscus perforation. Combination of laparoscopy and gastroduodenoscopy has extensive application in the resection of gastrointestinal stromal tumors, sessile gastric polyps and early gastrointestinal carcinoma. During laparoscopic operation, the endoscopist can help to locate the tumor or polyp. Endoscopy can also help to determine whether or not the tumor or polyp has been resected completely. In performing traditional laparoscopic colectomy for left-sided colonic tumors, specimen retrieval necessitates a mini-incision which is often the cause of postoperative pain, wound infection, and other pain-related complications. The combination of laparoscopy with transanal endoscopic microsurgery is feasible for selected patients with left-sided colonic tumors, and complications related to mini-incision can be avoided completely. Combination of laparoscopy and gastrointestinal endoscopy also benefits patients with acute bowel obstruction prior surgical operation. With the help of perineum-bowel tube, sigmoidoscopic technique can relieve acute bowel obstruction, so that these patients may have chance for laparoscopic operation. In summary, this hybrid approach can not only decrease surgical incisions, but also avoid some of the surgical risks of emergent operations.%@@ 近年来腹腔镜技术与内镜技术均得到了迅猛的发展,在各自领域取得了令人瞩目的成绩 [1].但这两种技术应用于胃肠疾病的治疗各有其局限性.对于瘤体较小或未侵及浆膜面的胃肠道肿瘤,由于腹腔镜缺乏精细的触觉反馈,存在着术中定位不准确的缺陷 [2].

  9. Clasificación de los pastizales halófilos del noreste de México asociados con perrito de las praderas (Cynomys mexicanus: diversidad y endemismo de especies Classification, diversity and plant endemism in the halophytic grasslands in northeastern Mexico associated to prairie dogs (Cynomys mexicanus

    Eduardo Estrada-Castillón


    Full Text Available Se clasifican 39 áreas de pastizal halófilo del noreste de México con el objetivo de cuantificar la diversidad, superficie e impacto debido al manejo antrópico al que están sometidas. La cobertura, densidad, frecuencia y diversidad de las especies se cuantificaron al menos en 200 cuadrantes de 1 m² en cada área de pastizal. La información se analizó mediante índices de similitud de Sörensen, coeficientes de correlación cofenético, análisis de conglomerados, índice de diversidad de Shannon-Wiener y pruebas de Kruskall-Wallis. Se registraron 53 familias, 174 géneros y 284 especies de plantas vasculares; 17 especies son endémicas en estos pastizales. Las áreas de pastizal con manejo pastoreo-agricultura poseen mayor diversidad de especies, mayor abundancia de malezas y menor abundancia de endémicas. Las áreas con manejo de pastoreo, poseen menor diversidad de especies, menor abundancia de malezas y mayor densidad de especies endémicas. La agricultura mecanizada es la principal causa de pérdida de pastizal halófilo y del hábitat del perro de las praderas. La pérdida total de pastizal halófilo en el noreste de México fue de 71.5% de su superficie hasta el año 2007.The objective of this study was to classify the vegetation, to quantify the plant diversity, currently occupied surface and the impact in vegetal diversity in the 39 halophytic grassland areas in northeastern Mexico due to management activities. Canopy cover, density, frequency, and species diversity was quantified in at least 200 1 m² quadrats in each of the 39 grassland areas. Information and field data were analyzed by means of Sörensen Similarity Index, cophenetic correlation coefficient, cluster analysis, Shannon-Wiener diversity index, product moment correlation coefficient, and Kruskall-Wallis test. Grazing-agriculture areas have the highest plant diversity, higher weeds density, lower endemic species abundance. Grazing areas have lower plant diversity

  10. 腹腔镜在腹部外伤诊治中的应用(附326例报告)%Application of laparoscopy in diagnosis and treatment of abdominal trauma: A report of 326 cases

    杨志奇; 王光链; 孙振纲


    目的 探讨腹腔镜在腹部外伤诊治中的临床意义.方法 1994年3月至2011年4月对326例腹部外伤病人使用腹腔镜诊治,并根据镜检结果选择腹腔镜手术或中转开腹手术.结果 腹部外伤病人腹腔镜探查及明确诊断326例,腹腔镜下手术284例,中转开腹42例.结论 腹腔镜诊治腹部外伤安全、可行、有效,并可早期正确诊断,减少不必要的剖腹手术.%Objective To explore clinical significance of laparoscopy in diagnosis and treatment of abdominal trauma. Methods A retrospective study from March 1994 to April 2011 was performed on 326 cases of abdominal trauma which was diagnosed and treated with laparoscopy. Laparoscopic surgery or open surgical operation was carried. Results Three hundred and twenty-six cases were definitely explored and diagnosed through laparoscopic surgery. Two hundred and eighty-four cases received laparoscopic surgery, and 42 cases were converted to open surgical operatioa All cases were diagnosed definitely. Conclusion Laparoscopic surgery is a safe, feasible and effective procedure for the early diagnosis and treatment of abdominal trauma.

  11. Effect of Zusanli point injection of Metoclopramide on patients with abdominal distension after laparoscopy%足三里注射治疗腹腔镜术后腹胀的临床观察

    谭旭东; 张波; 张彬; 徐越


    Objective To observe the effect of Zusanli point injection of Metoclopramide on patients with abdominal distension after laparoscopy. Methods One hundred and forty-six patients with abdominal distension out of 1 158 after laparoscopy in our department from Jan. 2012 to April. 2013 were divided into two groups (n=73 each group), randomly based on stratified sampling. Except conventional therapy, Zusanli point injection of Metoclopramide was applied to the treatment group. We compared the operating time, blood loss, the onset time of abdominal distension, time to first flatus and the duration of abdominal distension between the groups. Results There was no difference in operating time, blood loss and the onset time of abdominal distension between the groups (P>0.05). Time to first flatus in treatment group was 29 hours ahead of that in control group (P0.05)。治疗组第1次肛门排气时间较对照组提前29 h (P<0.05);治疗组24 h和48 h治愈率分别为61.7%、90.5%,与对照组比较差异有统计学意义(P<0.05)。结论足三里注射胃复安能有效治疗腹腔镜术后腹胀。

  12. Hand-assisted robotic right donor nephrectomy in patient with total situs inversus: A case report

    Raquel Gonzalez-Heredia


    Full Text Available Total situs inversus” is an infrequent congenital condition. The robot has been already proved as a safe and attractive approach for living donor nephrectomies. We report here the first right donor nephrectomy in a patient with total situs inversus that is performed using the Da Vinci platform.

  13. 宫腹腔镜联合诊治女性不孕症500例临床分析%Clinical analysis on 500 infertile women diagnosed and treated with hysteroscopy combined with laparoscopy

    郭政; 王丽英; 李华


    Objective: To explore the value of laparoscopy combined with hysteroscopy in diagnosis and treatment of women with infertility. Methods: The results of 500 infertile women receiving hysteroscopy combined with laparoscopy from January 2008 to December 2009 were analyzed retrospectively. Results; 445 women were found with pelvic abnormality by hysteroscopy combined with laparoscopy, accounting for 89. 0%. The main causes of female infertility were chronic pelvic inflammatory disease (58. 6% ) , polycystic ovary syndrome (18. 0% ) and endometriosis ( 14. 0% ) . The proportion of chronic pelvic inflammatory disease in women with secondary infertility was significantly higher than that in women with primary infertility (x = 8. 60, P < 0. 01 ) , while the proportion of polycystic ovary syndrome in women with secondary infertility was significantly lower than that in women with primary infertility (x2 = 17. 02, P <0. 01) . The major surgical methods were pelvic adhesiolysis, fimbrioplasty and salpingostomy, ovarian drilling and cauiery of endometriosis. Conclusion:Laparoscopy combined with hysteroscopy can confirm the causes of female infertility, corresponding minimal invasive surgery can be conducted targeting to the causes of female infertility, the advantages of laparoscopy and hysteroscopy are complementary, which are the optimal methods to diagnose and treat women with infertility induced by pelvic factor.%目的:探讨宫、腹腔镜联合检查在女性不孕症中的诊治价值.方法:对2008年1月~2009年12月500例女性不孕症的宫、腹腔镜联合检查结果进行回顾性分析.结果:宫、腹腔镜检查发现盆腔异常445例,占89.0%.女性不孕症的主要原因依次为慢性盆腔炎(58.6%)、多囊卵巢综合征(18.0%)、子宫内膜异位征(14.0%).继发性不孕症中,慢性盆腔炎的构成比高于原发不孕(x2=8.60,P<0.01),多囊卵巢综合征的构成比低于原发不孕(x2=17.02,P<0.01).盆腔粘连松解术、输卵管伞

  14. Clinical value of laparoscopy in the diagnosis and treatment of gynecological acute abdomen%腹腔镜对妇科急腹症的诊疗价值



    Objective To investigate the clinical value of laparoscopy in the diagnosis and treatment of gynecological acute abdomen.Methods Data of 152 cases with acute abdomen in Guangxi Zhuang Autonomous Region National Hospital during March 2011 to March 2013 were retrospectively analyzed .76 cases with laparoscopic surgery were selected into observe group , 76 cases under laparotomy operation were selected into control group .The success rate of surgery patients , surgical index , and surgical complications and postoperative pain VAS pain scores recorded recovery time , simultaneously with traditional open surgery were analyzed .Results Surgical success rate of two groups were 100%, the amount of bleeding (37.6 ±9.7) mL, operative time (53.8 ±6.2) min, anus exhaust time ( 22.3 ±3.5 ) h, hospitalization time ( 7.5 ±2.6 ) d, 4 hours postoperative VAS pain score 2.2 ±2.3, 24 hours postoperative VAS pain score 4.8 ±4.5, postoperative pain recovery time (5.7 ±2.3) h of study group were less than that of control group [(81.7 ±8.4)mL、(74.9 ±8.1)min、(32.2 ±5.7)h、(12.9 ±3.7)d、(6.9 ±4.9) score、(7.3 ±5.7) score、(12.6 ±4.9) h ] ( all P<0.05 ) .Conclusion Laparoscopy is safe and effective in treatment of gynecological acute abdomen with a high clinical application value .%目的:探讨腹腔镜对妇科急腹症的诊疗价值。方法回顾性分析广西壮族自治区民族医院妇产科2011年3月至2013年3月收治的152例妇科急腹症患者的临床资料,76例经腹腔镜手术治疗患者为观察组,76例经普通开腹手术治疗患者为对照组,比较两组患者手术成功率、手术指标、术后并发症及术后疼痛视觉模拟评分法( visual analog scale , VAS)评分和术后疼痛恢复时间。结果两组患者手术成功率均为100%,观察组患者术中出血量(37.6±9.7)mL、手术时间(53.8±6.2)min、肛门排气时间(22.3±3.5)h、住院天数(7.5±2.6) d、术后4 h VAS

  15. Effectiveness of composite resin polymerization using light-emitting diodes (LEDs or halogen-based light-curing units Efetividade de polimerização de uma resina composta fotopolimerizada por diodos emissores de luz (LEDs ou luz halógena

    Bianca Micali


    Full Text Available The clinical performance of composite resins is greatly influenced by the quality of the light-curing unit used. The aim of this study was to compare the efficiency of a commercial light-emitting diode (LED with that of a halogen-based light-curing unit by means of dye penetration of a micro hybrid composite resin. The composite resin evaluated was Filtek Z250 (3M Dental. The composite was filled into acrylic moulds that were randomly polymerized for 40 seconds by each of the light-emitting systems: light-emitting diode Ultraled (Dabi Atlante or halogen light Degulux (Degussa Hüls curing units. Immediately after polymerization, each specimen was individually immersed in 1 ml of 2% methylene blue solution at 37°C ± 2°C. After 24 hours, the specimens were rinsed under running distilled water for 1 minute and stored at 37°C ± 2°C at relative humidity for 24 hours. The composite resins were removed from the moulds and individually triturated before being immersed in new test tubes containing 1 ml of absolute alcohol for 24 hours. The solutions were filtered and centrifuged for 3 minutes at 4,000 rpm and the supernatant was used to determine absorbance in a spectrophotometer at 590 nm. To verify the differences between groups polymerized by LED or halogen light t-test was applied. No significant differences were found between composite resins light-cured by LED or halogen light-curing unit (p > 0.05. The commercially LED-based light-curing unit is as effective to polymerize hybrid composite resins as the halogen-based unit.A longevidade clínica das resinas compostas é grandemente influenciada pela qualidade do aparelho fotopolimerizador utilizado. O objetivo deste trabalho foi comparar a eficácia de um aparelho fotopolimerizador de diodos emissores de luz e a de um de luz halógena através do grau de penetração de um corante em uma resina composta micro-híbrida. A resina composta utilizada (Filtek Z250/3M Dental foi inserida em matrizes

  16. Polimerización de un cemento de composite a través de restauraciones de cerómero utilizando lámparas halógenas y LEDs Polymerization of dual-cure resin luting cements through laboratory-processed-resins: LED versus halogen lights

    P. Grau Grullón; P.P. Portero; J. Laufer-Neto; O.M.M. Gomes


    Este estudio evaluó la influencia del grosor de una restauración indirecta de cerómero, el tipo de lámpara fotoactivadora y el tiempo de almacenamiento en la dureza Vickers de un cemento de composite. Dos lámparas de diodos (Optilight CL [CL] y Ultra-Lume 5 [UL]) fueron comparadas con la lámpara halógena (Optilux 401 [OH]). Fueron confeccionados especímenes en cerómero con un diámetro de 5 mm y una espesura de 1 y 2 mm, los cuales fueron interpuestos entre la luz y la matriz metálica de 5 mm ...

  17. Polimerización de un cemento de composite a través de restauraciones de cerómero utilizando lámparas halógenas y LEDs Polymerization of dual-cure resin luting cements through laboratory-processed-resins: LED versus halogen lights

    P. Grau Grullón; P.P. Portero; J. Laufer-Neto; O.M.M. Gomes


    Este estudio evaluó la influencia del grosor de una restauración indirecta de cerómero, el tipo de lámpara fotoactivadora y el tiempo de almacenamiento en la dureza Vickers de un cemento de composite. Dos lámparas de diodos (Optilight CL [CL] y Ultra-Lume 5 [UL]) fueron comparadas con la lámpara halógena (Optilux 401 [OH]). Fueron confeccionados especímenes en cerómero con un diámetro de 5 mm y una espesura de 1 y 2 mm, los cuales fueron interpuestos entre la luz y la matriz metálica de 5 mm ...

  18. Laparoscopy for benign disease: robotics.

    Talamini, Mark A


    Currently available robotic surgical systems appear to be particularly suited for use in benign diseases of the gastrointestinal system. Minimally invasive operations for foregut conditions, such as gastroesophageal reflux disease and achalasia, require excellent visibility and precise tissue dissection. Benign lower gastrointestinal diseases, including inflammatory bowel disease and diverticulitis, also can be approached using robotic assistance. Disadvantages include expense and the loss of tactile feedback. Early clinical results are promising.

  19. Laparoscopy for pelvic floor disorders.

    Van Geluwe, B; Wolthuis, A; D'Hoore, A


    Surgical treatment of pelvic floor disorders has significantly evolved during the last decade, with increasing understanding of anatomy, pathophysiology and the minimally-invasive 'revolution' of laparoscopic surgery. Laparoscopic pelvic floor repair requires a thorough knowledge of pelvic floor anatomy and its supportive components before repair of defective anatomy is possible. Several surgical procedures have been introduced and applied to treat rectal prolapse syndromes. Transabdominal procedures include a variety of rectopexies with the use of sutures or prosthesis and with or without resection of redundant sigmoid colon. Unfortunately there is lack of one generally accepted standard treatment technique. This article will focus on recent advances in the management of pelvic floor disorders affecting defecation, with a brief overview of contemporary concepts in pelvic floor anatomy and different laparoscopic treatment options.

  20. Laparoscopia na decisão da estratégia terapêutica para o casal infértil Laparoscopy in the decision of treatment strategy for the infertile couple

    Nuno Ricardo Goçalves Baptista Pereira


    laparoscopia revelou obstrução bilateral. Em 15 casos (65,2% em que a HSG havia demonstrado obstrução bilateral, a laparoscopia foi normal ou revelou apenas obstrução unilateral. CONCLUSÕES: a laparoscopia demonstrou sua relevância diagnóstica e terapêutica revelando-se fundamental na clarificação do status tubo-peritoneal. Permitiu a realização concomitante de atos terapêuticos, possibilitando a definição da melhor estratégia terapêutica no casal infértil.PURPOSE: to evaluate the contribution of diagnostic laparoscopy to approach the infertile couple. METHODS: retrospective analysis of 86 consecutive cases of patients who were accompanied in the infertility appointments and were submitted to diagnostic laparoscopy from January 2004 to December 2006. Eighty-two of these patients had been submitted to hysterosalpingography (HSG prior to laparoscopy. The laparoscopic findings were analyzed, as well as the accessory procedures, and the results of the hysterosalpingography and of the laparoscopy were correlated. Statistical analysis was performed by the use of the Statistical Package for the Social Sciences 15. The sensitivity and the specificity of HSG were determined and the confidence intervals were calculated with an alpha error of 0.05 (95%CI. RESULTS: the laparoscopy revealed 21 cases of endometriosis (24.4%, 14 cases of uni/bilateral inflammatory disease of the salpinx (16.3%, and 16 cases of pelvic inflammatory disease (18.6%. Adhesiolysis and ablation of endometrial lesions were performed in eight patients. There were also other accessory procedures: two salpingostomies, two paraovarian cystectomies, two ovarian cystectomies and three ovarian drillings. The tubal patency test during laparoscopy was normal in 44 cases (53%, revealed unilateral obstruction in 21 cases (25.3% and bilateral obstruction in 17 cases (20.5%. The results of the hysterosalpingography were similar to those of the laparoscopy in 44 out of the 82 cases (53.7%. HSG sensitivity was

  1. 基层医院腹腔镜技术在急腹症中的应用%Laparoscopy for Acute Abdominal Diseases in Basic Level Hospitals

    王玉祥; 李应红; 许兴; 孙勉勤; 敖士满


    From January 2002 to March 2011, we carried out laparoscopic abdominal exploration on 232 patients with acute abdominal diseases, 227 of the patients received laparoscopic diagnosis and treatment, and the other 5 patients were converted to open surgery because of frozen gallbladder triangle (2 cases) or abscess of the appendix (3 cases). The patients were followed up for 3 to 12 months with a mean of 5 months ( >6 months in 89 cases) , during which 1 patient developed left hole retina hernia 6 months after appendectomy, and then recovered in 11 days after a second surgery; 1 patients complained of recurrent pain at the right lower abdomen for twice in 12 months after appendectomy,and retinal adhesion was therefore considered, thus anti-inflammation was carried out; 6 patients, who had duodenum perforation, showed mild belching and acid regurgitation; no other complications were reported. We believe that laparoscopy is safe and effective for the diagnosis and treatment of acute abdominal diseases, especially for traumatic and pathological acute abdominal diseases. Strict indications and right timing for conversion to open surgery are the keys to the success of the procedure.%2002年1月~2011年3月我科应用腹腔镜对232例急腹症进行探查、手术,227例完成腹腔镜诊断和治疗,2例因胆囊三角冰冻样改变、3例因阑尾周围脓肿中转开腹手术.232例随访3~12个月,平均3.5月,其中随访>6个月89例:1例阑尾切除术后6个月左侧戳孔发生网膜内疝再次手术11 d后痊愈;1例阑尾切除术后12个月右下腹再发疼痛2次,考虑网膜粘连,给予消炎治疗后未再发;6例十二指肠球部穿孔有轻度嗳气、返酸等消化道症状;其余病人均无并发症发生.我们认为腹腔镜诊断和治疗急腹症安全、有效,其微创优势得到充分发挥,也适于女性右下腹急症明确诊断,尤其适合外伤性和病理性急腹症的早诊断、早治疗.严格选择适应证、合

  2. 未触及睾丸隐睾的腹腔镜手术体会%Experience of Laparoscopy for Impalpable Testis in Children

    段光琦; 王啸; 刘洁; 唐睿; 随帮志


    Objective To investigate the application value of laparoscopy in the treatment of impalpable testis in children . Methods Clinical data of 40 children with impalpable testis ( 45 sides ) from December 2007 to June 2014 were retrospectively analyzed.The sites and sizes of the testis were identified by abdominopelvic ultrasonography in all the patients .The findings and management included:33 cases of intra-abdominal testis (38 sides) were treated with one-session (29 cases, 33 sides) or two-staged (4 cases, 5 sides) orchidopexy; 6 cases of cord structure entering the internal inguinal ring (6 sides) were treated with inguinal exploration;1 case was given a vasectomy after laparoscope exploration indicating that cord structure was caecum (1 side). Results All the 40 cases (45 sides) were successfully operated .The operative time was 34-65 min ( mean, 46 min) and the postoperative hospital stay was 2-5 days (mean, 3.2 days).Forty cases were followed up for 6-24 months (mean, 8.7 months).There were 4 cases of testicular retraction to the top of the scrotum , 1 case of atrophy of testis , and 3 cases of scrotal edema and hematoma .No testicular torsion and necrosis happened . Conclusions Laparoscopic surgery can obtain clear exposure and anatomy , less damage the surrounding tissue , and less trauma in children , which can improve the success rate of the fixed testicular descent , especially for intra-abdominal blind vas deferens and high position of testis .Laparoscopic surgery has an important clinical value for treating children with high cryptorchidism .%目的:探讨腹腔镜在未触及睾丸隐睾患儿中的应用价值。方法选取2007年12月~2014年6月诊疗的未触及睾丸的隐睾患儿40例(45侧),根据患儿情况在腹腔镜下行相应手术治疗。腹腔内睾丸33例(38侧),其中行一期睾丸下降固定术29例(33侧),分期睾丸下降固定术4例(5侧);精索血管进入腹股沟管6例(6侧)

  3. 腹腔镜在未破裂型异位妊娠治疗中的应用%Application of laparoscopy in the treatment of unruptured ectopic pregnancy



    Objective:To investigate the clinical effect of laparoscopy in the treatment of unruptured ectopic pregnancy.Methods:64 patients with unruptured ectopic pregnancy were selected from January 2010 to December 2013.They were divided into the laparoscopy group(34 cases)and the conventional group(30 cases)according to the treatment plan.The treatment-related indicators of the two groups were compared.1 years of follow-up,the incidence of patients with ectopic pregnancy again was counted.Results:The intraoperative bleeding volume,vaginal bleeding days,the total amount of bleeding,hospitalization days,recovery time ofβ-HCG and other indicators of the laparoscopy group were better than the conventional group.3 years of follow-up,the incidence of ectopic re-pregnancy was 8.33%,significantly lower than the conventional group 38.46%.Conclusion:The effect of laparoscopic operation for the treatment of unruptured ectopic pregnancy is good.It can reduce the harm to the patient and reduce the incidence of ectopic re-pregnancy.%目的:探讨腹腔镜治疗未破裂型异位妊娠的临床效果。方法:2010年1月-2013年12月收治未破裂型异位妊娠患者64例,按照治疗方案分为腹腔镜组(34例)和常规组(30例),比较两组治疗相关指标,随访1年,统计患者再次异位妊娠发生率。结果:腹腔镜组患者术中出血量、阴道流血天数、总出血量、住院天数、β-HCG复常时间等指标均优于常规组,随访3年,再次异位妊娠发生率8.33%,明显低于常规组38.46%。结论:腹腔镜手术治疗未破裂型异位妊娠效果较好,可减少对患者的损伤,降低再次异位妊娠发生率。

  4. Development and validation of a risk stratification score for ventral incisional hernia after abdominal surgery: hernia expectation rates in intra-abdominal surgery (the HERNIA Project).

    Goodenough, Christopher J; Ko, Tien C; Kao, Lillian S; Nguyen, Mylan T; Holihan, Julie L; Alawadi, Zeinab; Nguyen, Duyen H; Flores, Juan R; Arita, Nestor T; Roth, J Scott; Liang, Mike K


    Ventral incisional hernias (VIH) develop in up to 20% of patients after abdominal surgery. No widely applicable preoperative risk-assessment tool exists. We aimed to develop and validate a risk-assessment tool to predict VIH after abdominal surgery. A prospective study of all patients undergoing abdominal surgery was conducted at a single institution from 2008 to 2010. Variables were defined in accordance with the National Surgical Quality Improvement Project, and VIH was determined through clinical and radiographic evaluation. A multivariate Cox proportional hazard model was built from a development cohort (2008 to 2009) to identify predictors of VIH. The HERNIAscore was created by converting the hazards ratios (HR) to points. The predictive accuracy was assessed on the validation cohort (2010) using a receiver operator characteristic curve and calculating the area under the curve (AUC). Of 625 patients followed for a median of 41 months (range 0.3 to 64 months), 93 (13.9%) developed a VIH. The training cohort (n = 428, VIH = 70, 16.4%) identified 4 independent predictors: laparotomy (HR 4.77, 95% CI 2.61 to 8.70) or hand-assisted laparoscopy (HAL, HR 4.00, 95% CI 2.08 to 7.70), COPD (HR 2.35; 95% CI 1.44 to 3.83), and BMI ≥ 25 kg/m(2) (HR1.74; 95% CI 1.04 to 2.91). Factors that were not predictive included age, sex, American Society of Anesthesiologists (ASA) score, albumin, immunosuppression, previous surgery, and suture material or technique. The predictive score had an AUC = 0.77 (95% CI 0.68 to 0.86) using the validation cohort (n = 197, VIH = 23, 11.6%). Using the HERNIAscore: HERNIAscore = 4(∗)Laparotomy+3(∗)HAL+1(∗)COPD+1(∗) BMI ≥ 25, 3 classes stratified the risk of VIH: class I (0 to 3 points),5.2%; class II (4 to 5 points),19.6%; and class III (6 points), 55.0%. The HERNIAscore accurately identifies patients at increased risk for VIH. Although external validation is needed, this provides a starting point to counsel patients and guide

  5. The combined treatment with laparoscopy and endoscopy for congenital fusiform dilation of bile ducts%腹腔镜联合内镜治疗梭状先天性胆管扩张症

    张军; 李龙; 刘树立; 李颀; 董宁; 张金山


    Objective To assess the efficacy of laparoscopy and endoscopy for congenital fusiform dilation of bile ducts in children.Methods From June 2006 to June 2012,the clinical manifestation,radiological features and surgical treatment of 18 cases with congenital fusiform dilation of bile ducts treated with combination of laparoscopy and endoscopy were retrospectively analyzed.Results The protein plugs and/or stones were removed completely under laparoscopy and endoscopy in 18 cases.Patients were followed up for 3 months to 6 years.The biochemical and ultrasound examinations showed no increase in pancreatic amylase or any recurrence of the stones in the common channel of biliary and pancreatic ducts or in the pancreatic duct.The median time of jaundice regression was 5 weeks (ranging from 3 to 8 weeks) postoperatively.Amylase decreased to the normal level after 4 to 9 days postoperatively (median 4.5 d).Transaminase turned to normal after 2 to 5 months postoperatively (median 3.3 months).Conclusions The combination of laparoscopy and endoscopy for treatment of patients with congenital fusiform dilation of bile ducts can effectively clear the protein plugs and/or stones in the common channel of biliary and pancreatic ducts.%目的 探讨梭状先天性胆管扩张症的腹腔镜联合内镜治疗的效果.方法 回顾性分析2006年6月至2012年6月腹腔镜联合内镜(胆道镜、尿道镜)手术治疗18例梭状先天性胆管扩张症患儿的临床症状、生化检查指标和影像检查结果.结果 本组均成功行腹腔镜、内镜(胆道镜、尿道镜)联合胆道探查、冲洗和取石及碎石,直视下解除共同管梗阻,行胆管扩张症根治术.患儿术后随访3个月~6年,无一例术后血和尿胰淀粉酶升高及再发共同管和胰管蛋白栓和(或)结石.黄疸术后3~8周(平均5周),逐渐消退;淀粉酶术后4~9 d(平均4.5d)恢复正常;转氨酶术后2~5个月(平均3.3个月)恢复正常.结论 梭状先天性胆

  6. 高龄患者腹腔镜下胃癌及直肠癌联合根治术两例%Laparoscopy-assisted combined radical resection for synchronous rectal and gastric cancer in elderly patients: report of two cases

    方佳峰; 卫洪波; 陈图锋; 黄勇; 魏波; 郑宗珩; 黄江龙; 徐皓中


    目的 探讨腹腔镜下高龄患者胃癌、直肠癌联合根治术的安全性和可行性.方法 回顾性分析接受腹腔镜胃癌、直肠癌同时根治性切除手术的2例高龄患者的临床资料.结果 2例患者年龄分别为78岁和75岁,术前均合并较多基础疾病,1例为Ⅱ期胃体癌和ⅠB期直肠癌,另1例为ⅢA期胃癌和ⅠB期直肠癌.予以腹腔镜下胃癌、直肠癌联合根治性切除术,手术切口长度为5cm,手术时间分别为260和255 min,术中出血量分别为60和80 ml,术程顺利,术中未出现任何并发症.术后恢复进食时间分别为4和5d,术后住院时间分别为13和14 d,术后亦未出现并发症.2例患者术后分别随访了13和12个月,均未发现肿瘤复发、转移.结论 由腹腔镜手术经验丰富的医师对高龄患者施行腹腔镜下胃癌、直肠癌联合根治术是安全、可行的,具有创伤小、恢复快的优点.%Objective To investigate the safety and feasibility of laparoscopy-assisted combined radical resection for synchronous rectal and gastric cancer in elderly patients.Methods Clinical data of two elderly patients undergoing laparoscopy-assisted combined radical resection for synchronous rectal and gastric cancer were analyzed retrospectively.Results The two cases were 78 and 75 years old respectively.Both were complicated with many medical conditions.One case suffered from stage Ⅱ cancer in the gastric body and stage Ⅰ B rectal cancer,and the other suffered from stage Ⅲ A gastric cancer and stage ⅠB rectal cancer.Both cases had received laparoscopy-assisted combined radical resection for synchronous rectal and gastric cancer,with 5 cm of incision.The operative time was 260 and 255 min and the intraoperative bleeding was 60 and 80 ml respectively.No complication occurred intraoperatively.Time to resume oral intake was 4 and 5 days and length of postoperative hospital stay was 13 and 14 days respectively.No postoperative complication occurred

  7. Laparoscopy in repairing in 27 patients with gastric and duodenum perforation.%腹腔镜胃十二指肠穿孔修补27例体会

    李军; 彭小妮; 崔海宁


    目的 总结腹腔镜胃、十二指肠穿孔修补经验.方法 对27例胃十二指肠穿孔患者施行腹腔镜修补术.结果 22例十二指肠穿孔、5例胃窦穿孔均行腹腔镜修补,平均住院5.2 d,无术中及术后并发症.结论 腹腔镜胃十二指肠穿孔修补术具有安全、可靠、患者恢复快和痛苦少等优点.对胃穿孔须考虑溃疡恶变或胃癌情况,术中须切取穿孔边缘组织行冰冻切片检查,以便及时发现胃癌,进行根治性治疗.%Objective To study the experience of laparoscopy in repairing in gastric and duodenum perforation. Methods 27 patients with gastric and duodenum perforation were performed hparoscopic repair. Results 22 patients with duodenum perforation and 5 patients with gastric perforation were safely operated. The mean time of hospitalization was 5.2days. There was no intraoperative and postoperative complication. Conclusion Laparoscopy is one of the safe, quick recovery and little pain in repairing duodenum perforation, but it should be done with great care in repairing gastric perforation for malignant change of gastric ulcer and primary gastric carcinoma. The perforated edge of frozen biopsy tissue should be preformed in order to discover gastric cancer and curative treatment.

  8. Experimental model to study correction of rectus diastasis by laparoscopy, in pigs Modelo experimental na correção de diástase de retos por laparoscopia

    Fábio Xerfan Nahas


    Full Text Available The use of swines as an experimental model to correct rectus diastasis by laparoscopy is described on this article. The correction of this deformity was achieved by the plication of the posterior rectus sheath with the insertion of two trocars on the inferior abdominal fold. One trocar was placed in the midline whereas the other was inserted laterally to the right rectus muscle. A continuous suture was made on the posterior rectus sheath with 0-Polipropilene. This suture was anchored at the anterior rectus sheath under direct vision. An incision of all layers was performed on the flank and the abdominal wall was turned inside out so that the area of plication could be assessed and evaluated. The experimental model described showed to be feasible to demonstrate the correction of rectus diastasis by laparoscopy.O uso de suínos como modelo experimental para a correção de diástase de retos por laparoscopia é descrito no presente artigo. A correção desta deformidade foi obtida pela plicatura da aponeurose posterior dos retos pela inserção de dois trocares na prega abdominal inferior. Um trocar foi introduzido na linha média enquanto o outro foi inserido lateralmente ao músculo reto abdominal direito. Uma sutura contínua de polipropileno-0 foi realizada na aponeurose posterior. Esta sutura foi ancorada na aponeurose anterior do músculo reto sob visão direta. Uma incisão foi realizada em todos os planos na região do flanco e a parede abdominal foi evertida para visualização e avaliação da área onde fora realizada a plicatura na aponeurose anterior. O modelo experimental descrito mostrou-se factível em demonstrar a correção da diástase de retos por laparoscopia.

  9. Simultaneous development of laparoscopy and robotics provides acceptable perioperative outcomes and shows robotics to have a faster learning curve and to be overall faster in rectal cancer surgery: analysis of novice MIS surgeon learning curves.

    Melich, George; Hong, Young Ki; Kim, Jieun; Hur, Hyuk; Baik, Seung Hyuk; Kim, Nam Kyu; Sender Liberman, A; Min, Byung Soh


    Laparoscopy offers some evidence of benefit compared to open rectal surgery. Robotic rectal surgery is evolving into an accepted approach. The objective was to analyze and compare laparoscopic and robotic rectal surgery learning curves with respect to operative times and perioperative outcomes for a novice minimally invasive colorectal surgeon. One hundred and six laparoscopic and 92 robotic LAR rectal surgery cases were analyzed. All surgeries were performed by a surgeon who was primarily trained in open rectal surgery. Patient characteristics and perioperative outcomes were analyzed. Operative time and CUSUM plots were used for evaluating the learning curve for laparoscopic versus robotic LAR. Laparoscopic versus robotic LAR outcomes feature initial group operative times of 308 (291-325) min versus 397 (373-420) min and last group times of 220 (212-229) min versus 204 (196-211) min-reversed in favor of robotics; major complications of 4.7 versus 6.5 % (NS), resection margin involvement of 2.8 versus 4.4 % (NS), conversion rate of 3.8 versus 1.1 (NS), lymph node harvest of 16.3 versus 17.2 (NS), and estimated blood loss of 231 versus 201 cc (NS). Due to faster learning curves for extracorporeal phase and total mesorectal excision phase, the robotic surgery was observed to be faster than laparoscopic surgery after the initial 41 cases. CUSUM plots demonstrate acceptable perioperative surgical outcomes from the beginning of the study. Initial robotic operative times improved with practice rapidly and eventually became faster than those for laparoscopy. Developing both laparoscopic and robotic skills simultaneously can provide acceptable perioperative outcomes in rectal surgery. It might be suggested that in the current milieu of clashing interests between evolving technology and economic constrains, there might be advantages in embracing both approaches.

  10. Gaseous distension of the urinary bag during CO2 laparoscopy in the usual operative settings:Does the CO2 diffuse into the urinary bladder or is it a sign of urinary tract injury?

    Kahramanlker; Tuncay Ok; smail Temur; rfettin Hseyinolu; Kemal Kl; Barlas Sl


    Objective:To compare the amounts of any clinically detectable gas passage into the urinary bag in laparoscopic and open surgeries.Methods:Seventy-nine women were allocated into two surgical groups;Group1: carbon dioxide(CO2) laparoscopy(n=37) andGroup2: gasless laparoscopy or laparotomy(n=42).All patients had urinary catheter during the surgeries.After checking the tightness of the connection of the urinary catheter and bag operations were performed.At the end of each surgery the urine volumes were recorded.The bags were immersed into a water containing container with a volume scale.The volume rise of the container was recorded.The valve of the outlet of the bag was turned on under the water and any leakage of air bubbles was observed.The final volume of the container was recorded once again while the bag was still in the water.The two groups were compared by using theStudent’storMannWhitney U tests.Results:We did not observe and hence measure any gas accumulation in the urine bags of both groups.The women’s ages, total intraoperative urine volume, urine production rate and total operative times of the groups were not significantly different.The mean operative time was (82.98±62.14) min in open surgeries and(73.46±52.74) minutes inCO2 laparoscopic surgeries.The difference between the groups was not significant(P=0.468).Conclusions:Any gas accumulation in the urine bag duringCO2 laparoscopic surgery should raise the suspicion of urinary tract injury.Urinary catheterization helps to diagnose the unnoticed bladder injuries.

  11. Synchronous atypical fibroxanthoma and Bowen’s disease of the head and neck in an otherwise normal patient – a case report and review of literature [Simultanes Auftreten eines atypischen Fibroxanthoms und Plattenepithelkarzinoms im Kopf-Hals-Bereich – Fallbericht und Literaturübersicht

    Eweida, Ahmad


    Full Text Available [english] Although both atypical fibroxanthoma and squamous cell carcinoma arise on top of sun-damaged skin of the elderly, there is no evidence in literature reporting a synchronous presentation of primary lesions of both malignancies in the head and neck regions. We report a case of synchronous atypical fibroxanthoma and squamous cell carcinoma in situ (Bowen’s disease of the head and neck in an otherwise normal old Caucasian male patient. We reviewed the literature for cases of head and neck atypical fibroxanthoma in association with other skin malignancies with an overview over the risk factors and modalities of treatment. We would like to raise the awareness for the concept of multiple synchronous primary malignant lesions and the importance to anticipate and differentiate between different pathologies in order to provide adequate investigations and treatment for the patient. [german] Obwohl sowohl das atypische Fibroxanthom der Haut als auch das Plattenepithelkarzinom bei sonnengeschädigter Haut älterer Menschen gehäuft vorkommen, gibt es in der Literatur keine Beschreibung eines simultanen Auftretens beider Malignome als Primärläsionen im Kopf-Hals-Bereich. Aus diesem Grund möchten wir über einen Fall berichten, bei dem sowohl ein atypisches Fibroxanthom als auch ein Morbus Bowen (als in situ Variante des Plattenepithelkarzinoms im Kopf-Hals-Bereich eines sonst gesunden 74-jährigen männlichen Patienten aufgetreten ist. Auf Grundlage der bestehenden Publikationen von Fällen mit atypischen Fibroxanthomen in Assoziation mit anderen Hautmalignomen, verglichen wir diese mit dem vorliegenden Fall, insbesondere in Hinblick auf die Risikofaktoren und das empfohlene Behandlungsregime. Ein simultanes Auftreten von mehreren primären Hauttumoren verschiedener Entität ist in einigen Fällen möglich und sollte daher insbesondere bei älteren Menschen deutlich häufiger in die Beurteilung und Diagnosestellung mit eingeschlossen werden

  12. Polymerization of a dual-cured cement through ceramic: LED curing light vs halogen lamp Polimerização de um cimento resinoso dual através de uma porcelana: LED vs lâmpada halógena

    Lawrence Gonzaga Lopes


    Full Text Available The aim of this study was to investigate the influence of light source, LED unit and halogen lamp (HL, on the effectiveness of Enforce dual-cured cement cured under a ceramic disc. Three exposure times (60, 80 and 120 s were also evaluated. Two experimental groups, in which the polymerization of the dual-cured cement was performed through a ceramic disc, and two control groups, in which the polymerization of the dual-cured cement was performed directly without presence of ceramic disc were subdivided into three subgroups (three different exposure times, with five specimens each: G1A- HL 60s; G1B- HL 80s; G1C- HL 120s; G2A- LED 60s; G2B- LED 80s; G2C- LED 120s; and control groups: G3A- HL 60s; G3B- HL 80s; G3C- HL 120s; G4A- LED 60s; G4B- LED 80s and G4C- LED 120s. Cement was applied in a steel matrix (4mm diameter, 1.2mm thickness. In the experimental groups, a ceramic disc was placed on top. The cement was light-cured through the ceramic by a HL and LED, however, the control groups were cured without the ceramic disc. The specimens were stored in a light-proof container at 37ºC for 24 hours, then Vickers hardness was determined. A four-way ANOVA and Tukey test (p£ 0.05 were performed. All specimens cured by LED for 60s showed inferior values compared with the halogen groups. In general, light-curing by LED for 80s and 120s was comparable to halogen groups (60s and 80s and their control groups. LED technology can be viable for light-curing through conventional ceramic indirect restorations, when curing time is increased in relation to HL curing time.O objetivo deste estudo foi estudar a influência da fonte de luz, LED e lâmpada halógena (LH, na efetividade de polimerização do cimento resinoso dual Enforce fotoativado sob um disco de porcelana. Três tempos de exposição (60, 80 e 120 segundos foram também avaliados. Dois grupos experimentais, na qual a polimerização do cimento resinoso foi feita através de um disco cerâmico, e dois

  13. Comparative study on the impact of laparoscopy and abdominal laparotomy to maternal-fetal at gestation period%妊娠期腹腔镜与开腹手术对母胎影响的对比研究

    黄晓晖; 范保维; 罗喜平; 金文艳; 曾俐琴; 陈丹


    Objective To compare and analyze the impact on maternal-fetal of laparoscopy and abdominal laparotomy and evaluate the safety of laparoscopy during pregnancy.Methods In this prospective controlled study,20 pregnant patients underwent a laparoscopy,and the other 20 pregnant patients underwent an exploratory laparotomy during the same period of time.The parameters including anesthesia time,operative time,blood loss,arterial blood gas analysis in the fifteen minute after surgery,uterine artery blood flow,postoperative pain,postoperative recovery and pregnancy outcomes were collected.Results The anesthesia time and the operative time in laparoscopic group were significantly shorter than those in laparotomy group [(18.91 ± 8.76) min vs (35.28 ± 14.67) min,t=4.28,P < 0.05,(17.85 ± 6.32) min vs (30.27 ± 10.41) min,t=4.56,P < 0.05].The blood loss was significantly different during laparoscopic group and laparotomy group [(15.48 ± 10.24) ml vs (25.48 ± 15.56) ml,t=2.40,P < 0.05].The stubbs catheter time,postoperative ambulation time,postoperative discharge time in the laparoscopic group were (6.58 ± 0.92) h,(6.98 ± 1.69) h and (18.52 ± 3.45) h respectively,while those were (24.63 ± 3.85) h,(25.37 ± 5.34) h,(23.67 ± 7.81) h in the laparotomy group (t=2.70,14.68,20.39; all P < 0.05).The postoperative pain by laparoscopy was significantly lighter than that by laparotomy (P < 0.05).There was no statistical significant difference between arterial blood gas analysis and uterine artery blood flow in two groups (P > 0.05),and we didn't see any difference from abortion rate,premature birth rate,term delivery rate,the rate of birth defects,neonatal Apgar score and full-term birth weight.Conclusion Compared with laparotomy,laparoscopy has relatively less impact on maternal-fetal,and it won't increase the risk of adverse pregnancy outcomes.%目的 对比分析妊娠期腹腔镜与开腹手术对母胎影响的情况,评估妊娠期腹腔镜的安全性.方法

  14. Thoracoscopy combined with laparoscopy in treatment of esophageal cancer radical operation (40 cases)%胸腹腔镜联合食管癌根治术40例临床总结

    杨立民; 张震; 凌锋; 赵杰


    Objective To explore and analyze the application and problems of esophageal cancer radical opera-tion by thoracoscopy combined with laparoscopy. Methods From July, 2011 to December, 2014, clinical data of 40 patients undergoing esophageal cancer radical operation by thoracoscopy combined with laparoscopy were analyzed retrospectively. Results Except 2 cases being relayed to assisted small thoracic incision because of 1 case with clear tumor invading to trachea and 1 case with obvious tumor invasion to thoracic aortic artery, the remaining 38 cases were successfully completed operation. There were 2 cases with postoperative anastomotic fistula in the neck, 2 cases of anastomotic stenosis and 1 case of hoarseness, there was no perioperative death. Follow-up was within 36 months, 2 patients died 10 months and 24 months after surgery respectively, due to tumor local recurrence. 1 patient with supraclavicular lymph node metastasis underwent local radiation therapy. The remaining was all survival with re-lapse-free. Conclusions Esophageal cancer radical operation by thoracoscopy combined with laparoscopy is a good method with safety and reliability, minimal invasion, fast recovering, and satisfied recent curative effect. It is worthy of applying clinically.%目的:探讨胸腹腔镜联合在食管癌根治性切除术中的应用和应注意的问题。方法回顾性分析2011年7月-2014年12月40例胸腹腔镜联合食管癌根治术的临床资料。结果除1例因肿瘤明显外侵气管,1例因肿瘤明显外侵胸主动脉而中转小切口开胸完成手术外,其余38例顺利完成手术。术后颈部吻合口瘘2例,吻合口狭窄2例,声音嘶哑1例,无围手术期死亡。通过通讯和复诊随访6~36个月,2例患者术后10和24个月因局部复发死亡,1例出现锁骨上淋巴结转移行局部放射治疗后缓解。失访2例。结论胸腹腔镜联合行食管癌根治术安全可靠、微创、恢复快,且近期疗效

  15. Evidence-based Nursing Given to the Patients with Ovarian Cyst Pediculotorsion Treated by Laparoscopy%循证护理在腹腔镜治疗卵巢囊肿蒂扭转中的应用

    石启彩; 刘凤侠; 孙动梅


    Objective:To explore the effects of evidence-based nursing applied to laparoscopy in treating ovar-ian cyst pediculotorsion. Methods:Forty patients were randomized into the observation group and the control group (they were performed with laparoscopy under general anesthesia). The control group accepted routine care and the observation group evidence-based nursing, the conditions of postoperative recovery and the changes of Con-nor-Davidson resilience scale (CD-RISC) in both groups were compared. Results:CD-RISC scores of the observa-tion group were (112.47±13.62), obviously higher than (103.81±15.29) of the control group (P<0.05);activity time of the patients in the observation group was (9.46 ±2.87)h, anal exhaust time (15.67 ±4.53)h, hospitalization time (4.76±1.75)d, significantly less than (16.83±4.61)h, (19.72±6.58)h and (6.64±2.04)d of the control group, P<0.05. Conclusion:Evidence-based nursing could effectively improve resilience of the patients who received laparoscopy in treating ovarian cyst pediculotorsion, and promote postoperative recovery.%目的:探讨循证护理在腹腔镜治疗卵巢囊肿蒂扭转中的应用效果。方法:将卵巢囊肿蒂扭转患者40例随机分为观察组和对照组各20例(均在全身麻醉下行腹腔镜手术),对照组实施常规护理,观察组给予循证护理。比较2组患者心理弹性量表(CD-RISC)评分变化和术后康复情况。结果:观察组CD-RISC评分为(112.47±13.62)分,明显高于对照组的(103.81±15.29)分(P<0.05);观察组患者术后下床活动时间为(9.46±2.87)h、肛门排气时间为(15.67±4.53)h、住院时间为(4.76±1.75)d,显著少于对照组的(16.83±4.61)h、(19.72±6.58)h、(6.64±2.04)d,P<0.05。结论:循证护理能有效提高腹腔镜治疗卵巢囊肿蒂扭转患者的心理弹性,促进术后康复。

  16. Application of mini-laparoscopy in the diagnosis and management of nonpalpable undescended testis in children%微型腹腔镜在未触及型小儿隐睾诊治中的应用

    赖志鸿; 郑燕君; 周凡; 郑文龙; 刘志军


    目的 探讨腹腔镜在未触及睾丸的隐睾诊治中的作用.方法 对38例未触及睾丸的隐睾患儿行腹腔镜探查(46个睾丸)及手术.结果 经腹腔镜、腹股沟探查及术后病理证实睾丸缺如2个,腹股沟型高位隐睾34个,睾丸位于腹腔内10个.除睾丸缺如者外,行微型腹腔镜辅助一期睾丸下降固定术41个睾丸,Fowler-Stephens (F-S)分期睾丸固定术3个睾丸;术后随访患侧睾丸萎缩2个,包括行腹腔镜下期睾丸固定术1个睾丸,F-S分期固定术1个睾丸;睾丸回缩1个,为腹腔镜下一期睾丸下降固定术者.结论 对于腹股沟未能查到睾丸的小儿隐睾症应行腹腔镜检查,该方法定位准确,且多数患儿能行一期下降固定,腹腔内较高位者需分期手术,总体治疗效果满意.%Objective To explore the application of mini-laparoscopy in the diagnosis and management of nonpalpable undescended testis in children.Methods 38 cases of impalpabal testes(46 testicular) had been operated by mini-laparoscopy in children with cryptorchidism.Results 38 children with nonpalpable undescended testis (46 testicular) had been operated by mini-laparoscope.Results After laparoscopic exploration,inguinal probe and postoperative pathology,it had been confirmed that 2 testicular were absent,34 testicular were found in high inguinal location,10 testicular were located in intraperitoneal cavity.In addition to the absent testicular,the rest had been performed with mini-laparoscope:one period descent fixation 41 testes,Fowler-Stephens (F-S) installment orchiopexy three testes.Follow-up with side testicular atrophy 2,including one period orchiopexy a testis,F-S installment fixation a testicular; Testicular rebound 1,who had been operated with one phase of testicular descent fixtion.Conclusion For inguinal failed to find the testicular,children with cryptorchidism should be done by laparoscopy because of its positioning accuracy,and most children can do a period drop

  17. Causes of nosocomial infections after laparoscopy surgery for rectal cancer and nursing%腹腔镜下直肠癌根治术后医院感染的原因分析及护理

    陈幼燕; 叶平江


    目的 探讨腹腔镜下直肠癌根治术患者医院感染的围手术期护理对策.方法 采用回顾性调查方法对2005年8月-2011年9月腹腔镜下直肠癌根治术患者资料进行分析研究.结果 患者有糖尿病、慢性支气管炎等基础疾病,长时间的手术是引起术后感染主要因素,而患者的一般情况、癌症的临床分期、手术方式与术后感染无明显关系.结论 术前准备工作、手术室空气质量、室温、无菌操作规程及手术时间的长短、术后切口的管理均是影响术后医院感染的主要因素.%OBJECTIVE To study the nursing measurement for hospital infections during perioperative period after laparoscopy surgery for rectal cancer. METHODS A retrospective method was taken to investigate the data of patients who received laparoscopy surgery for rectal cancer from 2005 to 2011. RESULTS The study showed that the main risk factors for the infection after the surgery were the underlying diseases such as diabetes mellitus and hemorrhoids and the long duration of operation, however m there was no significant correlation between the pathological stages of cancer, the general information of the patient, surgery approach and the postoperative infections. CONCLUSION The preparation before the surgery,the air quality and temperature in operating room, the regulations on aseptic operation,as well as postoperative incision and the duration of the surgery are the major factors that may affect the postoperative infections.

  18. Clinical experience of laparoscopy for treating esophageal hiatal hernia in 16 cases%腹腔镜治疗食管裂孔疝16例临床体会



    目的 探讨腹腔镜在食管裂孔疝修补术中应用的疗效及安全性.方法 应用腹腔镜对16例食管裂孔疝患者行食管裂孔疝修补术,同时将行Nissen胃底折叠术.结果 16例均顺利完成疝修补术,无中转开腹,未出现并发症.手术时间78~125 min,平均102.8 min.术后平均住院时间为4.3 d.术中失血量为40~180 mL,平均95 mL,均无输血.术后3个月行胃镜复查,显示患者的食道炎均已明显好转,未见消化性溃疡或糜烂性胃炎,术后随访3~30个月,无复发.结论 腹腔镜手术用以治疗食管裂孔疝是安全可行的,有手术损伤小、出血少、患者恢复快、住院时间短等优点,值得临床推广应用.%Objective To explore the effect and safety of the clinical application of laparoscopic repair in esophageal hi-atal hernia. Methods The esophageal hiatal repair was performed in 16 patients with esophageal hiatal hernia by laparoscopy. Meanwhile Nissen fundoplication was performed. Results Hermiorrhaphy in 16 cases were smoothly completed without convert-ing to laparotomy and complications occurrence. The average operation time was 117 min , the intraoperative bleeding amount was 40-180 mL(average 95 mL),without blood transfusion. The gastroscopic examination after postoperative 3 months showed that esophagitis was improved significantly and no peptic ulcers and erosive gastritis were found. No recurrence occurred by 3-30 months follow up. Conclusion Treating esophageal hiatal hernia by laparoscopy is safe and feasible ,has the advantages of little injury,less bleeding,rapid recovery and short hospitalization duration,which is worth clinical popularization and application.

  19. Efficacy and safety of laparoscopy and laparotomy in the treatment of acute cholecystitis%腹腔镜术和开腹术治疗急性胆囊炎的疗效及安全性分析

    佘明杰; 刘小虎


    Objective:To investigate the clinical application value of laparoscopy and laparotomy in the treatment of acute cholecystitis.Methods:129 cases with acute cholecystitis who had been treated by operation from June 2010 to December 2013.We retrospectively analyzed their clinical datas.They were divided into the laparoscopy group(69 cases were treated with laparoscopic cholecystectomy) and the open group(60 cases were treated with conventional open operation) according to the different surgical treatment.We analyzed the operation related index and postoperative condition of the two groups.Results:The operation time, amount of bleeding during operation and postoperative anal exhaust time for the first time of the laparoscopic group were significantly shorter than those of the open group(P<0.01).The postoperative incision infection,bile leakage rate of the laparoscopic group were significantly lower than those in the open group(P<0.05).Conclusion:The laparoscopic cholecystectomy in the treatment of acute cholecystitis with less bleeding,less postoperative complications and other advantages,so it is worthy of clinical application.%目的:探讨腹腔镜胆囊切除术治疗急性胆囊炎的临床应用价值。方法:2010年6月-2013年12月收治行手术治疗的急性胆囊炎患者129例,回顾性分析其临床资料,按照所行治疗术式不同分为腔镜组69例,行腹腔镜下胆囊切除术治疗和开腹组60例,行常规开腹手术治疗,对两组患者手术相关指标及术后情况进行对比分析。结果:腔镜组手术耗时、术中出血量及术后首次肛门排气时间均明显短于开腹组(P<0.01);腔镜组患者术后切口感染、胆汁漏发生率明显低于开腹组(P<0.05)。结论:腹腔镜微创胆囊切除术治疗急性胆囊炎具有出血少、术后并发症少等优势,值得临床推广应用。

  20. Conscious pain mapping by laparoscopy in women with chronic pelvic pain%腹腔镜清醒疼痛定位在慢性盆腔痛诊治中的应用

    许洪梅; 张震宇


    慢性盆腔痛在女性各个年龄阶段均可发病,严重影响患者身心健康.清醒疼痛定位指在局部麻醉下患者清醒,在患者的配合下了解疼痛位置和范围.腹腔镜清醒疼痛定位可以明确慢性盆腔痛疼痛部位和病因,避免不必要的手术,应用清醒疼痛定位指导腹腔镜保守性手术可以有效缓解慢性盆腔痛.%Chronic pelvic pain is a common and significant disorder of women. Conscious laparoscopic pain mapping (CLPM) is a diagnostic laparoscopy under local anesthesia directed at the identification of sources of pain. Diagnosis of an etiological lesion or organ is based on CLPM. CLPM can decrease unnecessary surgical interventions and improve pain relief.

  1. Evaluation of Patient Satisfaction Using the EORTC IN-PATSAT32 Questionnaire and Surgical Outcome in Single-Port Surgery for Benign Adnexal Disease: Observational Comparison with Traditional Laparoscopy

    Alessandro Buda


    Full Text Available Laparoscopic surgery has been demonstrated as a valid approach in almost all gynaecologic procedures including malignant diseases. Benefits of the minimally invasive approach over traditional open surgery have been well demonstrated in terms of minimal perioperative morbidity and reduced postoperative pain and hospital stay duration, with consequent quick postoperative recovery (Medeiros et al. (2009. Single-port surgery resurfaced in gynaecology surgery in recent years and renewed interest among other surgeons and within the industry to develop this field (Podolsky et al. (2009. Patient satisfaction is emerging as an increasingly important measure of quality which represents a complex entity that is dependent on patient demographics, comorbidities, disease, and, to a large extent, patient expectations (Tomlinson and Ko (2006. It can be broadly thought to refer to all relevant experiences and processes associated with health care delivery (Jackson et al. (2001. In this study we aim to compare single-port surgery (SPS with conventional laparoscopy in terms of patient satisfaction using the EORTC IN-PATSAT32 questionnaire. We also evaluate the main surgical outcomes of both minimally invasive approaches.

  2. Variação térmica da câmara pulpar e do gel clareador bloqueador de infravermelho ativado com lâmpada halógena = Temperature changes of pulpal chamber and infrared-blocking bleaching gel activated with halogen light

    Torres, Carlos Rocha Gomes


    Full Text Available Objetivo: Avaliar a temperatura da câmara pulpar (CP e do gel clareador bloqueador de infravermelho na superfície dental (SUP, durante a ativação com fotopolimerizadores com lâmpadas halógenas que emitem radiação na faixa do infravermelho (IV. Metodologia: Os géis clareadores Whiteness HP Maxx (com bloqueador de IV – MX e Whiteness HP (controle – CON foram aplicados em 10 incisivos centrais superiores. A ativação com luz foi realizada com os fotopolimerizadores (FP Optilight (600mW/cm2, OP e Jet Lite (1200mW/cm2, JL, sendo quatro ativações de 40s, sem intervalo (total de 3min e 20s. As temperaturas foram aferidas a cada 40s com um termômetro digital com dois termopares tipo K, um no interior da CP e outro na superfície dental (SUP. Os dados foram analisados com ANOVA a 3 fatores (tipo de gel – TG, FP e tempo de ativação e teste de Tukey. Resultados: Houve efeito significativo de TG e FP e para a interação FP/TG. As médias (DP (em graus Celsius foram: PC: [GT={MX-6,38(3,25a, CON-7,70(2,91b}, FC={OP- 5,51(2,54a, JL-8,56(2,93b}]; SUR: [GT={CON-9,85(3,89a, MX-14,21(7,76b}, FC={OP-7,32(2,50a, JL-16,74(5,82b}]. Conclusões: O gel bloqueador de IV resultou em menor aquecimento da CP e maior aquecimento do gel que o controle. O FP Jet Lite promoveu maior aquecimento que o Optilight

  3. The comparison of abdominal-wall-lift gasless and convention laparoscopy in myomectomy for gigantic hysteromyoma in posterior wall%无气腹悬吊式腹腔镜与传统气腹腹腔镜对后壁巨大子宫肌瘤剜除术的临床疗效比较

    吴继蓉; 彭晓梅; 陈霞


    目的 探讨无气腹悬吊式腹腔镜在困难子宫肌瘤剜除术中的应用价值.方法 对比分析2009年1月~2011年12月在妇产科同期施行无气腹腹腔镜与气腹腹腔镜后壁巨大子宫肌瘤剜除情况,比较两者手术时间、术中出血量、术后排气时间、住院日、住院费用等情况.结果 两组患者术中无并发症发生,无气腹组手术时间(67.6±24.7)min,术中出血量(80.0±50.1)ml,术后排气时间(1.1±0.5)d,平均住院日(7.2±1.8)d,平均住院费用(6274.5±500.4)元;气腹组手术时间(108.1±25.3)min,术中出血量(184.9±56.3)ml,术后排气时间(2.6±0.4)d,住院日(10.2±2.9)d,住院费用(7510.8±624.7)元.组间比较,差异有显著性(均P<0.05).结论 无气腹悬吊式腹腔镜后壁巨大子宫肌瘤剜除术优于传统气腹腹腔镜,可能会成为子宫肌瘤剜除术的标准术式.%Objective To discuss the value of abdominal lift gasless laparoscopy in g myomectomy for gigantic hysteromyoma in posterior wall. Methods Operation time, blood loss, anus exhaust time, the hospital day,and the cost of hospitalization were compared between 30 cases with gigantic hysteromyoma in the uterus back wall undergone laparoscopy without pneumoperitoneum and 30 cases undergone conventional laparoscopy. Results The general conditions (number and size of myoma) of 2 groups were not significantly different. There were no complications in both group. The average operating time (67. 6±24. 7)min, the amount of bleeding (80. 0±50.1)ml, anus exhaust timed. l±0. 5)d, the hospital day(7. 2±1. 8)d,and the cost of hospitalization(6274. 5±500. 4)RMB of Abdominal-wall-lift gasless laparoscopy group were significantly shorter and cheaper than those of convential laparoscopy group (108. 1±25. 3)min, (184. 9± 56.3)ml, (2.6±0.4)d, (10. 2±2. 9)d, (7510. 8±624. 7)RMB (P<0. 05). Conclusion Gasless laparoscopy exhibits more advantages than conventional laparoscopy in myomectomy for gigantic hysteromyoma

  4. Head-neck-radiology; Kopf-Hals-Radiologie

    Cohnen, Mathias (ed.) [Staedtische Kliniken Neuss Lukaskrankenhaus GmbH (Germany). Institut fuer klinische Radiologie


    The book on head-neck-radiology covers the following issues: (1) Methodic fundamentals: conventional radiography, angiography, sonography, computerized tomography, digital volume tomography, NMR imaging, nuclear medicine. (2) Base of the skull. (3) Petrous bone. (4) Pharynx. (5) Paranasal sinuses. (6) Eye socket. (7) Temporomandibular joint. (8) Salivary gland. (9) Oral cavity. (19) Parynx. (11) Neck soft tissue and lymph nodes. (12) Thyroid and parathyroid. (13) Teeth and jaw. (14) Interventions.

  5. Nekrotiserende fasciitis i hoved-hals-området

    Wolf, Henning; Ovesen, Therese


    OBJECTIVES: To describe the clinical, microbiological, serological and radiological findings including the results of treatment in a Danish patient population with necrotizing fasciitis (NF) in the head and neck region. MATERIALS AND METHODS: Data were retrieved from patient records with the ICD3...

  6. Nekrotiserende fasciitis i hoved-hals-området

    Wolf, Henning; Ovesen, Therese


    OBJECTIVES: To describe the clinical, microbiological, serological and radiological findings including the results of treatment in a Danish patient population with necrotizing fasciitis (NF) in the head and neck region. MATERIALS AND METHODS: Data were retrieved from patient records with the ICD3...... code DM725A from January 1, 2002-June 30 2007. Demographic data, clinical manifestations, microbiological and serological findings, treatment modalities, complications and sequelae were registered. RESULTS: Twelve patients were identified during the 5-year period at the ENT department, Aarhus...... University Hospital (median age 54 years; 8 males). Minor head and neck surgery had been performed in 7 patients before development of NF. The classical clinical course included a rapidly-developing erythema associated with extreme tenderness and pain in the region. A diffuse edema in the soft tissues...

  7. The application of da Vinci robot-assisted laparoscopy for elderly natients with henatobiliarv and pancreas diseases%达芬奇机器人肝胆胰手术在老年患者中的应用

    赵之明; 纪文斌; 张文智; 王宏光; 陆宏伟; 孔哲; 董家鸿


    Objective To evaluate the effect of da Vinci robot-assisted laparoscopy to elderly patients with hepatobiliary and pancreas diseases.Methods Retrospectively analyze the clinical data of 11 elderly patients whose laparoscopic operations were performed by da Vinci robot-assisted laparoscopic.Results Ten cases were operated on successfully by using da Vinci robot-assisted laparoscopy,except one case which was transferred to open pancreatic-enterostomy.The total operative time was(365.0±172.3) min ,and robot using time was (251.0±110.6)min.No blood transfusion was needed.Postoperative bowl movement recovery time was (43.0±22.0)h,and the average postoperative hospital stay time was (8.8±6.0)d.One old female was found with postoperative pulmonary infection after laparoscopic common bile duct exploration.Bile leakage was found in one patient.They were all cured by medicine, and no further complications were found.Conclusions Thanks to the three-dimensional imaging system and flexible surgical instruments of the da Vinci robot-assisted system,we performed a series of hepatobiliary pancreas laparoscopic operations for elderly patients.And the superiority of these systems was more obviously demonstrated in the complex laparoscopic operation for selected patients.%目的 评价达芬奇(da Vinci)机器人辅助腹腔镜手术在老年肝胆胰疾病患者中的应用价值.方法 回顾性分析11例老年肝胆胰疾病患者在达芬奇机器人辅助下行腹腔镜手术治疗的临床资料.结果 10例患者手术均在腹腔镜下顺利完成,1例胰十二指肠切除术中转开腹行胰肠吻合术.总手术时间为(365.0±172.3)min,机器人手术时间为(251.0±110.6)min.无手术输血,术后排气时间为(43.0±22.0)h,住院时间为(8.8±6.0)d.1例胆总管探查术后出现肺内感染,1例肝内胆管细胞癌术后发生胆漏,均经保守治疗后治愈.结论 选择合适的老年患者,借助于达芬奇机器人的三维成像系统及灵活的手

  8. The safety and feasibility of dezocing in gynecological laparoscopy under epidural anesthesia%地佐辛辅助硬膜外麻醉在妇科腹腔镜手术中的应用

    郑雁; 刘玲玲; 叶秀清


    AIM: To investigate the safety and feasibility of dezozine in gynecological lapa-raoscopy under epidural anesthesia. METHODS; Sixty ASA I or II patients, aged 18-55 yr, undergoing gynecological laparoscopy surgery, were randomly divided into 2 groups (n = 30 each): Dezocing group (group D) and Fentanyl group (group F). PeTCO2 and Ramsay sedation scales were recorded at the time points followed: pre-anesthesia ( T0), 10 min after administration (T1) instantly after pneumoperitoneum (T2), 30 min (T3) and 60 min (T4) after pneumoperitoneum, 5 min after eliminating pneumoperitoneum (T5). The incidences of side effects such as nausea, vomiting, algor and respiratory depression was observed. RESULTS:Ramsay seda- tion scales were not statistically different between the two groups. D group's PEt CO2 was lower than of F group at the time points of T3 and T4. The incidences of nausea, vomiting and respiratory depression were higher in F group (P<0. 05). CONCLUSION: Dezocine has significant advantages over fentanyl to assist epidural anesthesia in gynecological laparoscopy with respect to reduce discomfort during pneumoperitoneum, better analgesia and sedation, less side effects.%目的:探讨地佐辛辅助硬膜外麻醉在妇科腹腔镜手术中应用的可行性.方法:选择硬膜外麻醉下行妇科腹腔镜手术患者60例,ASA Ⅰ~Ⅱ级,年龄18~55岁,手术时间均不超过两个小时,随机均分为地佐辛组(D组)和芬太尼组(F组).记录给药前(T0)、给药后10 min (T1)、气腹后即刻(T2)、气腹后30 min(T3)、气腹后60 min(T4)、气腹消除后5 min(T5)的呼气末二氧化碳分压(PET CO2)及Ramsay镇静评分.观察两组患者出现恶心、呕吐、寒颤、呼吸抑制(呼吸频率低于8次/min或脉搏血氧饱和度(SpO2)低于90%)等不良反应的发生率.结果:两组患者的Ramsay镇静评分无统计学差异,T3、T4时点D组PFTCO2低于F组(P<0.05),恶心、呕吐、呼吸抑制的发生率F组明显高于D组.结论

  9. 腹腔镜下胆道镜液电碎石术治疗肝内外胆管结石%The clinical analysis of cholangioscopy electrohydraulic lithotripsy with laparoscopy to treat intrahepatic bile duct calculi

    朱晟; 喻强; 金昆; 陈明亮; 张京平


    Objective:To summarize the methods,efficacy and safety of the cholangioscopy electrohydraulic lithotripsy with laparoscopy to treat intrahepatic bile duct calculi. Methods: The clinical data of 23 cases from Jan. 2005 to Jan. 2012 with refractory extra-hepatic and intrahepatic bile duct stones underwent cholangioscopy electrohydraulic lithotripsy with laparoscopy were retrospectively analyzed. The calculi-free rate and the incidence of complications were observed. Results:The rate of lithotripsy was 100 % in 23 cases, of which 22 were one-time free of biliary calculi, the free rate was 95. 7% ;0ne cases with more calculi underwent choledochoscope lithotomy through the T tube six weeks after surgery. No complications including biliary tract perforation, bleeding, bile leakage, wound infection and others were accurred. The peritoneal drainage tube was removed 3-4 d after operation,The hospital stay time was 5-7 d. 4 weeks after surgery, routine T-tube cholangiography was done, the T-tube was pinched for 3 d and then was removed. Conclusions: Lap-aroscopic cholangioscopy combined with electrohydraulic lithotripsy could significantly improve the therapeutic effect of the extrahepatic and intrahepatic bile duct calculi,which is safe and reliable.%目的:总结腹腔镜下胆道镜液电碎石术治疗肝内外胆管结石的手术方法、效果及安全性.方法:回顾分析2005年1月至2012年1月采用腹腔镜下胆道镜液电碎石术治疗23例难取性肝内外胆管结石患者的临床资料,观察结石取净率及并发症发生率.结果:23例术中均碎石成功,其中22例一次性取净结石,结石取净率95.7%;1例因结石数量较多,术后6周经T管窦道行胆道镜取石术.无胆道穿孔、大出血、胆漏、切口感染等并发症发生.术后3~4d拔除腹腔引流管,5~7d出院.术后4周常规行T管造影,夹管3d后拔除T管.结论:腹腔镜下结合胆道镜液电碎石术可显著提高肝内外胆管结石的疗效,手术安全、可靠.

  10. Effects of monopolar electrocoagulation and bipolar electrocoagulation in laparoscopy for infertility on ovarian function%腹腔镜不孕症手术使用单、双极电凝对卵巢功能的影响



    目的:探讨腹腔镜不孕症手术中使用单、双极电凝对卵巢功能的影响.方法:选择100例因输卵管因素导致的不孕症患者,均行腹腔镜下输卵管的修复整形手术,使用不同的止血方法随机分为单极电凝组50例、双极电凝组50例.分别于术前、术后1、3个月抽血检测促卵泡激素(FSH)、黄体生成素(LH)、雌二醇(E2),月经第11天开始B超监测排卵情况,术后随访1年.结果:两组病例术后1、3个月较术前均出现不同程度的FSH、LH增高和E2下降,单极电凝组与术前比较差异有统计学意义(P<0.05),双极电凝组与术前比较差异无统计学意义(P>0.05).结论:腹腔镜下不孕症手术中使用单、双极电凝止血会引起对卵巢功能的损害,而使用单极电凝止血对卵巢功能的损害较使用双极电凝止血大.单极电凝组术后发生月经改变明显多于双极电凝组(P<0.05).双极电凝组术后妊娠率较单极电凝组高.%Objective: To explore the effects of monopolar electrocoagulation and bipolar electrocoagulation in laparoscopy for infertility on ovarian function. Methods: 100 infertile patients because of tubal factor were selected, and all the patients received fallopian tube surgery under laparoscope, then they were divided into monopolar electrocoagulation group ( 50 women) and bipolar electrocoagulation group (50 women) according to different hemostatic methods. Their blood samples were obtained to detect the levels of follicle - stimulating hormone ( FSH) , luteinizing hormone ( LH ) and estradiol before surgery, at one and three months after surgery, B ultrasound was used to monitor the ovulation situation from the eleventh day of menstrual cycle, all the patients were followed up for one year after surgery. Results: Compared with before surgery, the levels of FSH and LH at one and three months after surgery increased, the level of estradiol decreased, there was significant difference in monopolar

  11. 腹腔镜联合尿道镜微创保胆取石术治疗小儿胆囊结石%Laparoscopy combined with urethroscope in cholecystolithotomy with gallbladder preserved in the treatment of pediatric gallstone

    李旭; 管考平; 刘树立; 李颀; 董宁; 乔国梁; 李龙


    目的:探讨腹腔镜联合尿道镜微创保胆取石术治疗小儿胆囊结石的方法及临床应用价值。方法回顾性分析本院2009年8月至2013年8月采用腹腔镜联合尿道镜微创保胆取石术治疗的20例胆囊结石患儿临床资料,男11例,女9例,年龄1岁1月至15岁,胆囊多发并泥沙样结石13例,单发结石3例,遗传性球形红细胞增多症并胆囊结石4例。结果20例均顺利完成手术,手术时间30~90 min,出血量5~20 mL,无术中输血。4例遗传性球形红细胞增多症并胆囊结石患儿联合行腹腔镜下脾切除术。术后患儿临床症状基本消失,单纯胆囊结石患儿术后3d复查腹部彩超见结石无残留。随访6个月至4年,17例未发现胆囊结石复发;1例失访;1例术前大量泥沙样结石术后彩超可见少量结石残留,约0.1 cm大小,无临床症状;1例术前提示胆囊萎缩,胆囊多发结石合并胆囊炎,术后1周患儿仍腹痛,彩超发现胆囊少量泥沙样结石,予胆囊造瘘术,术后1个月拔除造瘘管,随访半年未见结石复发。结论腹腔镜联合尿道镜保胆取石术治疗小儿胆囊结石可保留胆囊功能,操作简单,术后恢复快、并发症少,复发率低,是治疗小儿胆囊结石的可行性方法。%Objective To evaluate the clinical value of minimally invasive laparoscopy combined with urethroscope in cholecystolithotomy with gallbladder preserved in the treatment of pediatric gallstone. Methods A retrospective review was made on the clinical data of 20 children with gallstone in our hospital from Aug. 2009 to Aug.2013,who underwent minimally invasive laparoscopy combined with urethroscope cholecystolitho-tomy with gallbladder preserved.Among them,1 1 patients were males and 9 were females with the age ranging from 1.1 to 15 years.Thirteen cases had multiple and muddy stones,3 cases with a single stone,and 4 cases had gallbladder stones combined with

  12. Outcome and influencing factors analysis of palace laparoscopy in treatment of infertile patients with fallopian tube%宫腹腔镜诊治输卵管性不孕患者结局及影响因素分析

    彭汝娇; 刘姜伶; 郑诗丹; 梁红梅; 余红秀; 方云


    Objective By exploring natural pregnancy rate and its related influencing factors of after the operation of palace laparoscopy to infertile patients with fallopian tube, to provide basis for doctors to accurately assess the opportunity of natural pregnancy after tubal infertility and to select the appropriate pregnancy program. Methods 93 cases of infertile patients with fallopian tube using palace laparoscopy operation with 2 year complete follow-up records were selected as the study objects. Natural pregnancy rate after operation was analyzed. They were divided into pregnancy group and non-pregnancy group according to natural pregnancy or not after operation. The main factors influencing the pregnancy rate after operation were aimed to find out. Results Among the 93 cases of patients, there were 36 cases of natural pregnancy within 2 years after palace laparoscopy operation, and the total natural pregnancy rate was 38.71%(36/93). The total natural pregnancy rate within 6 months was 30.11%(28/93).There were 6 cases of the total natural pregnancy rate within 7-12 months after operation.The cumulative natural pregnancy rate was 36.56%within 1 year after operation, which was close to total pregnancy rate.There were 2 cases of the total natural pregnancy rate within 13-24 months after operation.Pregnancy rate 1 year after operation was decreased significantly (P<0.05). In the relevant influencing factors, history of infertility, abortion, history of pelvic surgery and pelvic inflammatory disease, combined pelvic endometriosis, moderate and severe pelvic adhesion 7 factors were significant impacted on the postoperative pregnancy rate of the patients (P<0.05). Conclusion Infertility diagnosis should be treated as soon as possible, once it is established. After the operation, doctors should provide the optimal and individualized follow-up conception for the patients with the infertility, the related history and the operation condition. For the patients, whose fallopian

  13. Nursing Intervention of Laparoscopy in Diagnosis and Treatment Before and After of Infertility%宫腹腔镜诊治不孕症的术前及术后的护理干预

    杨芝兰; 滕树艳


    Objective:To explore the methods of nursing care in the treatment of infertility by hysteroscopy combined with laparoscopy.Method:80 cases were diagnosed as infertile patients, the diagnosis and treatment of hysteroscopy combined with laparoscopy operation.The patients were randomly divided into two groups,the intervention group and control group,40 cases in each group.The intervention group was trested perfect operation during in hospital preparation, careful postoperative nursing and the whole psychological support;the control group was treated conventional nursing.Result:The intervention group 28 cases of successful pregnancy, included 9 cases of primary infertility and 19 cases of secondary infertility, pregnancy of the shortest time was 2 months after the operation, with the longest up to 23 months after operation; 28 cases of successful pregnancy in patients with 4 cases of successful pregnancy after assisted reproductive technology, the rest were the natural pregnancy; abortion 1 cases, the other 27 cases were belong to full-term normal neonates.The control group 18 cases of successful pregnancy, included 5 cases of primary infertility and secondary infertility in 13 cases, the pregnancy time is the shortest 2.5 months postoperatively, the longest for 24 months after operation; 18 cases of successful pregnancy in patients with 6 cases of successful pregnancy after assisted reproductive technology, the rest were natural pregnancy; 2 cases of ectopic pregnancy, abortion 3 cases, the other 13 cases were belong to full-term normal neonates.two sets of ectopic pregnancy after statistics processing,the rate and abortion rate had no statistical significance.Conclusion:Hysteroscopy combined with laparoscopy for treatment of infertility can improve the effectiveness of diagnosis and treatment, psychological support of nurses nursing and full preoperative and postoperative therapy are the key to success.%目的:探讨宫腔镜联合腹腔镜在不孕症诊治中的

  14. Surgical methods and clinical effects of anatomical retroperitoneal laparoscopy radical ne-phrectomy%后腹腔镜下解剖性根治性肾切除术的手术方法及临床效果

    种庆贵; 宋爱君; 郭艳


    目的:介绍后腹腔镜下解剖性根治性肾切除术的手术方法及临床效果。方法对187例肾癌患者实施后腹腔镜下解剖性根治性肾切除术。其中左侧103例,右侧84例;肿瘤最大径2.0~8.2 cm,平均4.6 cm;所有患者均常规制备后腹腔间隙,按顺序分别进入相对无血管解剖层面进行分离,腰大肌为背侧标志,膈肌为肾上极后侧标志,肾上腺为肾上方内侧标志,腹膜为腹侧标志,下腔静脉与腹主动脉是内侧的标志,髂血管是 Gerota 筋膜锥尖部的解剖标志。结果所有手术均获成功,无中转开放手术,术中无明显并发症发生。手术时间90~150 min,平均110 min;出血60~100 ml,平均75 ml;恢复饮食和下床活动时间分别为 l.3 d 和1.2 d;术后3~7 d 出院。142例患者术后随访6~42个月,其中1例出现腹膜后淋巴结转移,余经 B 超及胸片检查未见局部复发或远处转移。结论后腹腔镜下解剖性根治性肾切除术具有解剖层次清楚,术中出血少,术野清晰,疗效确切,并发症少,恢复快等优点,为需要根治性肾切除术的患者提供了更好的选择。%Objective To introduce the technique and clinical effect of anatomical retroperitone-al laparoscopy radical nephrectomy. Methods A total of 187 patients underwent anatomical retroperito-neal laparoscopy radical nephrectomy. Among them,103 cases of tumor located in the left kidney and 84 cases located in the right kidney. The maximum diameter of tumor was 2. 0 to 8. 2 cm,with an average di-ameter of 4. 6 cm. Retroperitoneal space was created routinely at lateral decubitus position. Relatively bloodless planes were orderly entered for exposure and separation of the kidney outside Gerota’s fascia. In the first place,the greater psoas was identified as the dorsal marker. Then the diaphragmatic muscle was identified as the posterior mark of the upper pole of the kidney,and the adrenal gland as

  15. Laparoscopic splenectomy for massive splenomegaly: technical aspects of initial ligation of splenic artery and extraction without hand-assisted technique.

    Trelles, Nelson; Gagner, Michel; Pomp, Alfons; Parikh, Manish


    A 37-year-old man was referred for massive splenomegaly. In November 2005, he was diagnosed with non-Hodgkin's B-cell lymphoma in the setting of splenomegaly and thrombocytopenia. His laboratory results showed a coagulopathy owing to lupus anticoagulant. A computed tomography scan showed a 36 x 26 x 11 cm spleen and a prominent and sinuous splenic artery. The authors performed a laparoscopic splenectomy with an initial ligation of the splenic artery. The patient tolerated the procedure well and was discharged home on the fourth postoperative day in stable condition. Discussed in this paper is the safety and feasibility of the minimally invasive approach in massive splenomegaly.

  16. 腹腔镜与机器人手术上消化道重建合理吻合方式%Reasonable anastomotic mode of upper digestive tract reconstruction by laparoscopy and robotic surgery

    江志伟; 黎介寿; 李宁


    Fast-track surgery optimizes the perioperative management to enhance the earlier recovery of surgical patients, and is the next revolution in surgical care following laparoscopy. Laparoscopic total gastrectomy (LTG) has not become a commonly performed procedure due to the difficulties associated with using long rigid instruments to perform esophagojejunostomy, which are further constrained by the two-dimensional laparoscopic view. The da Vinci robot surgical system provides 3D visualization, enhanced magnification, and seven degrees of freedom of the instruments to suture and knot in the narrow surgical space. So a robot-sewing anastomosis for esophagojejunostomy reconstruction in robotic total gastrectomy for gastric cancer is feasible with painless and stressless and may be a standard surgical technique.%快速康复外科(fast track surgery)通过优化围手术期的处理加速了病人的康复速度,它是继腹腔镜外科以后的又一次外科革命.由于传统腹腔镜外科的器械及二维视野的局限,在腹腔镜下进行全胃切除后食管空肠吻合仍存在不少的困难.而机器人手术提供三维放大视野、7个自由度的器械等优势,有利于在狭小的空间内精准完成食管空肠吻合术.全机器人下吻合有利于切口的微小化以及减少术后并发症的发生,这将可能成为上消化道重建的标准手术方法之一,这也符合快速康复外科所追求的“无痛、无应激”的核心理念.

  17. 腹腔镜下电器械对卵巢组织热损伤的临床观察%Clinical Observation of Electro-surgical Unit’s Influence on the Heat Injury of Ovarian Tissue under Laparoscopy

    林碧娟; 林松波; 黄春玲; 颜青


    Objective:To study the electro-surgical unit’s clinical influence on the heat injury of ovarian tissue under laparoscope,for reference.Method:150 ovarian tumor patients were involved in the study,and grouped according to the random principle.They were divided into three groups:group of monopolar electrocoagulation (50 cases),group of bipolar electrocoagulation (50 cases),group of electrocoagulation ultrasonic scalpel (50 cases).The surgical procedures of three groups were compared.Result:Compared the length of surgery under Laparoscopy,length of activities,length of gas passing,length of hospital stays and the usage rate of painkiller of three groups,the differences were not statistically significant (P>0.05). Though the study of the depth and width of the zone of thermal necrosis’s heat injury of ovarian tissue,we concluded that electrocoagulation ultrasonic scalpel imposed the minimum damages,bipolar electrocoagulation the second,and monopolar electrocoagulation the maximum,the differences were statistically significant (P0.05)。从卵巢组织热损伤坏死带深度和宽度来看,超声刀组损伤最小,其次为双极电凝组,损伤最大的为单极电凝组,差异有统计学意义(P<0.05)。结论:不同电器械对卵巢组织所产生的热损伤不同,超声刀带来的热损伤最小,其次是双极电凝,单极电凝带来的热损伤最大,临床上治疗时需根据实际情况考虑,尽量选用热损伤范围小的PK刀。最好选用缝合止血,从而减少卵巢组织的损伤,保护患者术后卵巢排卵的生育功能。

  18. Polimerización de un cemento de composite a través de restauraciones de cerómero utilizando lámparas halógenas y LEDs Polymerization of dual-cure resin luting cements through laboratory-processed-resins: LED versus halogen lights

    P. Grau Grullón


    Full Text Available Este estudio evaluó la influencia del grosor de una restauración indirecta de cerómero, el tipo de lámpara fotoactivadora y el tiempo de almacenamiento en la dureza Vickers de un cemento de composite. Dos lámparas de diodos (Optilight CL [CL] y Ultra-Lume 5 [UL] fueron comparadas con la lámpara halógena (Optilux 401 [OH]. Fueron confeccionados especímenes en cerómero con un diámetro de 5 mm y una espesura de 1 y 2 mm, los cuales fueron interpuestos entre la luz y la matriz metálica de 5 mm de ancho y 0,5 mm de grosor que contenía el cemento de composite. Los 45 cuerpos de prueba fueron divididos en 9 grupos: G1: exposición directa de luz DLE/OH; G2: 1 mm/OH; G3: 2 mm/OH; G4: DLE/CL; G5: 1 mm/CL; G6: 2 mm/CL; G7: DLE/UL; G8: 1 mm/UL y G9: 2 mm/UL. La fotoactivación fue realizada durante 60 segundos. La dureza Vickers (50 g/30s fue medida en la superficie tope de todos los especímenes luego de 24 horas y 180 días de almacenamiento. La lámpara fotoactivadora y el grosor del cerómero fueron estadísticamente significativas (pThis study evaluated the influence of indirect composite resin thickness, the storage time and light-curing units on the Vickers hardness of a dual-cure resin luting cement. Two light-emitting diodes lights (Optilight CL [CL] and UltraLume5 [UL] were compared with a quartz tungsten halogen unit (Optilux 401 [OH]. Laboratory-processed composite specimens with a diameter of 5mm and thickness of 1 and 2 mm were constructed to be interposed between the light guide and the metal matrix (5mm wide and 0.5 mm deep with the resin luting cement. Then, 45 dual-cure resin luting specimens were divided in nine groups: G1: direct light exposure DLE/OH; G2: 1 mm/OH; G3: 2 mm/OH; G4: DLE/CL; G5: 1 mm/CL; G6: 2 mm/CL; G7: DLE/UL; G8: 1 mm/UL and G9: 2 mm/UL. The light curing was performed for 60 seconds. The Vickers hardness (50g/30s was measured at the top surface of all specimens, either after 24 hours or 180 days. The Light

  19. Dentine bond strength of a composite resin polymerized with conventional light and argon laser Resistência de união à dentina de resina composta polimerizada com luz halógena e laser de argônio

    Patricia Ramos Lloret


    Full Text Available The use of argon laser (488 nm has been suggested as a new alternative for polymerizing adhesive materials. This study aimed to evaluate the tensile bond strength of a microfilled composite (A110, 3M inserted by incremental technique (3 increments of 1 mm and by single increment (3 mm polymerized by argon laser for 10, 20 and 30 seconds and halogen light for 40 seconds. Eighty (8 groups of 10 teeth freshly extracted bovine teeth were stored in a freezer in distilled water for one week. The crowns were cross-sectioned from the roots. Pulpectomy was performed and the pulp chambers were sealed with wax. The buccal surfaces of the teeth were ground with wet sandpaper (grains: 120, 400, and 600 to expose the surface dentin, and the teeth were then included in acrylic resin. A metal device was used to fix each sample and a black propylene matrix25 (3 mm high with an internal millimetric delimitation was used to insert the material according to the groups studied. The polymerization intervals were of 10, 20 and 30 seconds for the laser polymerization and 40 seconds for the conventional polymerization. Tensile tests were performed by a Universal Testing Machine 4442 (Instron at a speed of 0.5 mm/min and 500 N load. According to the methodology used, the incremental technique increased bond strength values. There was no difference between the studied polymerization techniques when resin was filled in 3 increments.O uso do laser de argônio (488 nm tem sido sugerido como uma nova alternativa para polimerização de materiais adesivos. Este estudo tem o objetivo de avaliar a resistência adesiva de uma resina composta microparticulada (A110, 3M inserida pela técnica incremental (3 incrementos de 1 mm e de incremento único (3 mm polimerizada com laser de argônio por 10, 20 e 30 segundos e com luz halógena por 40 segundos. Oitenta (8 grupos com 10 dentes dentes bovinos recém-extraídos foram armazenados em geladeira, em água destilada, por uma semana

  20. 罗哌卡因局部浸润对妇科腹腔镜术后镇痛的影响研究%Local Infiltration of Ropivacaine for Postoperative Analgesia in Patients Undergoing Gynecologic Laparoscopy

    王琳; 徐铭军


    Background Gynecological laparoscopic surgery has the characteristics of small trauma and less pain and has been widely used in clinic. Patient controlled intravenous analgesia(PCIA)is often used for post - operative analgesia after laparoscopic surgery. The analgesic effect is exact but it is a general analgesia with many adverse reactions. So it is of great signifi-cance to seek a perfect analgesic method with less adverse reactions. Objective To evaluate the effect of local infiltration of ropiv-acaine on postoperative analgesia in patients underwent gynecologic laparoscopy. Methods 60 patients with ovarian lesions admit-ted to Beijing Obstetrics and Gynecology Hospital,Capital Medical University from November 2011 to June 2012 were select-ed. All the patients were scheduled for gynecologic laparoscopy. The patients were randomly divided into research group and control group with each group 30 cases. In the research group,local infiltration of 0. 4% ropivacaine was performed,and 10 ml(40 mg)was injected on the navel incision while 5 ml(20 mg)was injected on the unilateral incision above the Mcburney′ s point. The two groups of patients both received PCIA with sufentanil after operation. The operation time and bleeding volume were recorded,and the score of visual analogue scale(VAS)at 2 h,4 h,6 h and 24 h,Ramsay sedation score and BCS comfort level were also recorded. The consumption of sufentanil within 24 h after operation,the number of successfully delivered doses (D1 )and the number of attempts(D2 )within 24 h after operation were recorded. The D1 / D2 was calculated. The patients′ satis-faction and the adverse reactions were also recorded. Results The operation time and bleeding volume between the two groups showed no statistically significant difference(P > 0. 05). VSA score at different time,Ramsay sedation score showed statistical-ly significant differences between the two groups(P 0. 05). Compared with the control group,the sufentanil used in PCIA

  1. 腹腔镜辅助D2根治术治疗进展期胃癌的效果观察%Effect of laparoscopy-assisted gastric D2 radical surgery in treating advanced gastris cancer

    何平; 梁杰雄; 邵天松; 宋辉; 郭洋; 李洋


    Objective To investigate the clinical effect of laparoscopy-assisted gastric D2 radical surgery in treating advanced gastris cancer.Methods Totally 78 cases with advanced gastric cancer from January 2008 to June 2013 were randomly divided into observation group (36 cases) receiving laparoscopic D2 radical gastrectomy and control group (40 patients) receiving laparotomy D2 radical gastrectomy.The incision length,operation duration,intraoperative blood loss,number of lymph nodes dissected,time of liquid diet intake,anal exhaust time,duration of hospitalization,complications and survival rate were compared between groups.Results The incision length,intraoperative blood loss,exhaust time,duration of hospitalization,incidence of complications in observation group were all significantly lower than those in control group [(5.7 ±0.4) cm vs (17.4 ± 1.5) cm,(164 ±35) ml vs (255 ± 87) ml,(2.8 ±1.6) d vs (4.9±2.5) d,(4.2±0.8) d vs (6.7±1.0) d,(12±3) d vs (15 ±4) d,13.9% (5/36) vs 32.5% (13/40)] (P <0.05);the operation duration,number of lymph nodes dissected,survival rate were not significantly different between two groups (P >0.05).Conclusion Laparoscopy-assisted distal gastric resection D2 is safe and feasible,it can achieve similar curative effect with laparotomy in treating advanced gastric cancer.%目的 探究腹腔镜辅助D2根治术治疗进展期胃癌的疗效.方法 对2008年1月至2013年6月于首都医科大学附属北京安贞医院接受手术治疗的76例进展期胃癌患者的临床资料进行回顾性分析,根据手术方式分为腹腔镜辅助手术组(观察组,36例)和开腹手术组(对照组,40例).比较2组患者切口长度、手术时间、术中出血量、清扫淋巴结个数、进食流质时间、肛门排气时间、术后住院时间、并发症发生情况以及术后存活率.结果 观察组患者切口长度、术中出血量、排气时间、进食流质时间、住院时间、术后并发症发

  2. Effect of GnRHa on pregnancy for post-laparoscopy patient with endometriosis%腹腔镜治疗子宫内膜异位症术后应用 GnRHa对妊娠的影响

    吴益青; 李亚妮; 米阳


    目的:探讨腹腔镜术后应用药物治疗有生育要求的子宫内膜异位症( EMs)对妊娠的影响。方法84例在陕西省妇幼保健院行腹腔镜下卵巢囊肿剥除术后确诊为EMs并排除输卵管因素及男方因素的不孕症患者,随机分为促性腺素释放激素激动剂(GnRHa)组42例和孕三烯酮组42例。 GnRHa组于术后第1次月经来潮第1天给予GnRHa(达菲林3.75mg)肌内注射,每28天1次,共3次;GnRHa组于术后第1次月经来潮第1天口服孕三烯酮片2.5mg,每周2次,连续3个月。两组均于停药恢复月经后口服克罗米芬诱发排卵共1~6周期,于月经周期第5天起口服克罗米芬5mg/日,共5天,同时口服补佳乐1mg/日,共10天(若妊娠终止促排卵治疗)。观察两组患者术后治疗3个月及术后9月(即停药后6个月)后妊娠情况、痛经及复发率情况。结果 GnRHa组术后3个月,术后9个月(即停药6个月)临床累积妊娠率均高于孕三烯酮组,差异有统计学意义(χ2值分别为5.845、10.720,均P<0.05)。 GnRHa组术后3个月,术后9个月(即停药6个月)痛经复发率均低于孕三烯酮组,差异有统计学意义(χ2值分别为6.462、12.07,均P<0.05)。结论腹腔镜治疗有生育要求的EMs患者术后应用GnRHa治疗可提高术后妊娠率;延长EMs的复发时间。%Objective To explore the effect of pharmacotherapy on pregnancy for post-laparoscopy patients with endometriosis ( EMs ) . Methods Totally 84 infertile patients with confirmed diagnosis of EMs following laparoscopic operations of ovarian cyst stripping in Shaanxi Maternal and Child Care Service Centre were selected.Fallopian and male factors for infertility were excluded.Patients were randomly allocated to gonadotropin-releasing hormone agonist ( GnRHa) group (42 patients) and gestrinone group (42 patients) .GnRHa group was given intramuscular injection of GnRHa (3

  3. Laparoscopy of rats with experimental liver metastases

    Kobaek-Larsen, Morten; Rud, Lene; Østergaard-Sørensen, Finn


    condition. Liver metastases were modelled by hepatic subcapsular injection of a syngeneic rat colon cancer cell line (DHD/K12-PROb) in BDIX/OrlIco rats. In this study, we present a detailed description of a laparoscopic technique for the direct inspection of liver metastases. That way a qualitative...

  4. Appendagitis following Diagnostic Laparoscopy and Laparoscopic Appendicectomy

    R. Kumar


    Full Text Available Appendagitis is an uncommon clinical entity, often not recognised, and mistaken for more serious infective conditions. We describe a proven case of appendagitis which occurred after confirmed appendicitis. We postulate that this condition can coexist with appendicitis and indeed may be the result of coinflammation. This has several implications. Firstly, clinicians must retain an index of suspicion for this condition in a patient with localised abdominal pain which occurs after appendicitis. Secondly, it would be reasonable to suggest careful examination of colocated appendages in a patient with an otherwise normal-appearing appendix. Treatment might require laparoscopic resection, as performed in this case.

  5. Laparoscopy and Intra-Abdominal Sepsis



    Full Text Available Context Intra-abdominal sepsis has significant morbidity and mortality. In the developed world, there are many common causes originating from the lower gastrointestinal tract including diverticular disease, appendicitis, perforated cancers, and inflammatory bowel disease. It has a high cost and is associated with high levels of significant morbidity and mortality. Management options include radiologic drainage and surgical options include resection for more widespread sepsis. Laparoscopic surgery has increased and has been useful in elective setting. Its use in the emergency setting is less evaluated. Evidence Acquisition Evidence was acquired by searching online medical databases including Pubmed, Medline and Embase. Results Laparoscopic surgery has been shown to have a role in the acute setting. Studies show it has become the gold standard in the appendicitis. High quality Randomized controlled trials are in short supply but observational and cohort studies have shown equivalence and with increasing experience complication rates are reduced. Evidence is also increasing in the management of diverticular disease, crohn’s and ulcerative colitis as well as post-operative complication management and acute presentations of colorectal cancer. Conclusions Laparoscopic surgery is feasible in the management of intra-abdominal sepsis. It has become the new accepted standard in the management of appendicitis, and is safe, feasible and increasing in the management of complex diverticular disease, acute IBD and colorectal cancer in the emergency and post-operative setting.

  6. ONSTEP versus laparoscopy for inguinal hernia repair

    Andresen, Kristoffer; Burcharth, Jakob; Rosenberg, Jacob


    a learning curve of about 50-100 cases and decreases chronic pain, but slightly increases the risk of serious complications compared with open mesh repairs. Therefore, a simpler kind of operation is needed. The ONSTEP technique is a possible solution to this problem. The objective of the present randomised......INTRODUCTION: The optimal repair of inguinal hernias remains controversial. It is recommended that an inguinal hernia be repaired using a mesh, either with a laparoscopic or an open approach. In Denmark, the laparoscopic approach is used in an increasing number of cases. The laparoscopic repair has...... clinical trial described in this protocol is to evaluate chronic pain after inguinal hernia repair using the ONSTEP method versus the laparoscopic approach. METHODS: This study is designed as a non-inferiority, two-arm, multicentre, randomised clinical trial, with a 1:1 allocation to ONSTEP or laparoscopic...

  7. Factors influencing the feasibility of laparoscopy colectomy

    He Zhiyun; Zhang Zhongtao


    Objective The objective was to review the factors affecting the feasibility of performing successful laparoscopic colectomy.Data sources The literatures about the risk factors closely related to the ability to perform laparoscopic colectomy on different surgical diseases of the colon cited in this review were obtained from PubMed published in English from 2006 to 2012.Study selection Original articles regarding the risk factors that affect the ability to perform laparoscopic colectomy were selected.Results Obesity,diabetes,inflammatory bowel diseases,advanced age,emergency operation,and pelvic anatomy are all important risk factors that increase the risk of developing serious complications such as hemorrhage,anastomotic leak,and skin and soft tissue infections following laparoscopic colectomy.These factors also increase the likelihood of conversion to an open operation.In this study,we reviewed the recent original articles about the relationship of laparoscopic colectomy with these risk factors.We also describe some strategies that limit the likelihood of these complications and the likelihood of conversion to an open operation.Conclusions Obesity,diabetes,inflammatory bowel diseases,age,emergency operation,and pelvic anatomy are all important risk factors that increase the risk of either serious complications or conversion to open operation with laparoscopic colectomy.Evaluation of these risk factors preoperatively should influence the decision to perform colectomy using laparoscopic techniques.

  8. ONSTEP versus laparoscopy for inguinal hernia repair

    Andresen, Kristoffer; Burcharth, Jakob; Rosenberg, Jacob


    INTRODUCTION: The optimal repair of inguinal hernias remains controversial. It is recommended that an inguinal hernia be repaired using a mesh, either with a laparoscopic or an open approach. In Denmark, the laparoscopic approach is used in an increasing number of cases. The laparoscopic repair has...... clinical trial described in this protocol is to evaluate chronic pain after inguinal hernia repair using the ONSTEP method versus the laparoscopic approach. METHODS: This study is designed as a non-inferiority, two-arm, multicentre, randomised clinical trial, with a 1:1 allocation to ONSTEP or laparoscopic...

  9. ONSTEP versus laparoscopy for inguinal hernia repair

    Andresen, Kristoffer; Burcharth, Jakob; Rosenberg, Jacob


    INTRODUCTION: The optimal repair of inguinal hernias remains controversial. It is recommended that an inguinal hernia be repaired using a mesh, either with a laparoscopic or an open approach. In Denmark, the laparoscopic approach is used in an increasing number of cases. The laparoscopic repair has...... a learning curve of about 50-100 cases and decreases chronic pain, but slightly increases the risk of serious complications compared with open mesh repairs. Therefore, a simpler kind of operation is needed. The ONSTEP technique is a possible solution to this problem. The objective of the present randomised...... clinical trial described in this protocol is to evaluate chronic pain after inguinal hernia repair using the ONSTEP method versus the laparoscopic approach. METHODS: This study is designed as a non-inferiority, two-arm, multicentre, randomised clinical trial, with a 1:1 allocation to ONSTEP or laparoscopic...

  10. ONSTEP versus laparoscopy for inguinal hernia repair

    Andresen, Kristoffer; Burcharth, Jakob; Rosenberg, Jacob


    INTRODUCTION: The optimal repair of inguinal hernias remains controversial. It is recommended that an inguinal hernia be repaired using a mesh, either with a laparoscopic or an open approach. In Denmark, the laparoscopic approach is used in an increasing number of cases. The laparoscopic repair has...... clinical trial described in this protocol is to evaluate chronic pain after inguinal hernia repair using the ONSTEP method versus the laparoscopic approach. METHODS: This study is designed as a non-inferiority, two-arm, multicentre, randomised clinical trial, with a 1:1 allocation to ONSTEP or laparoscopic...

  11. Pregnancy following laparoscopy ovarian drilling for clomiphene ...

    She achieved pregnancy following Laparoscopic Ovarian Drilling at the Assisted ... Conception following ovarian drilling. Omokanye .... advocated as this will drastically reduce the time to achieve ... laparoscopic laser diathermy in polycystic.

  12. 开腹与腹腔镜辅助下远端胃癌D2根治术对进展期胃癌的近期疗效分析%An analysis of short-term effects of open and laparoscopy-assisted the distal gastric D2 radical surgery for advanced gastric cancer



    Objective To investigate the clinical value of laparoscopy surgery conducted on advanced gastric cancer by the comparative analysis of short-term effect of open and laparoscopy-assisted the distal gastric D2 radical surgery.Methods The clinicopathologic features of 75 patients with advanced gastric cancer received laparoscopy(n=42) and open surgery(n=33) respectively from June 2009 to July 2012 in this hospital were collected,and the outcome result was analyzed.Results All of the patients were received successful distal gastric D2 radical surgery.The mean operation time,length of incision,blood loss,first flatus time,ground activity time,liquid diet intake time and hospital stay in laparoscopy group,which were definitely shorter than open surgery group,were (162.00±12.99)min,(5.99±0.77)cm,(149.14±26.87)mL,(4.15±0.80)d,(2.93±0.83)d,(4.23±0.78)d and (13.30± 2.78)d respectively(P<0.05) ;but there was no significant difference between laparoscopy and open surgery with number of lymph nodes removed and length of proximal and distal margin to the cancer(P>0.05),which were 29.13 ±17.87,(6.05 ± 1.12)cm and (7.13± 1.08)cm respectively.The probability of incision infection and lung infection in the open surgery group was much higher than the laparoscopy group(P<0.05),but there was no significant difference in the probability of leakage and bleeding of anastomotic stoma,and postoperative gastroparesis between two groups(P>0.05).Conclusion Compared with open surgery,laparoscopy-assisted the distal gastric D2 radical surgery used on advanced gastric cancer had similar radical effect.At the same time,it has the advantages of shorter time of operation,shorter incision,less bleeding,faster recovery,safety and reliability.%目的 通过对开腹与腹腔镜辅助下远端胃癌D2根治术对进展期胃癌的近期疗效进行对比分析,从而评价腹腔镜手术在进展期胃癌的临床应用价值.方法 收集2009年6月至2012年7月期间75例进展期

  13. Laparoscopy-assisted versus open total colectomy: Comparison of clinical outcomes%腹腔镜辅助与开腹全结肠切除术的临床疗效比较

    崔建; 张建立; 江秀丽


    Objective With the extensive application of minimally invasive techniques, laparoscopy-assisted total colectomy ( LATC ) has been used to treat a variety of colorectal diseases. The article is to compare the clinical outcome of LATC with that of open total colectomy, and investigate the safety and feasibility of LATC. Methods We retrospectively analyzed 12 cases of open total colectomy and 11 cases of LATC, and compared the demographics, peri- and post-operative data, and treatment outcomes between the two groups. Results Total colectomy was successfully accomplished in 22 of the cases without severe complications, but changed to open abdominal surgery in the other 1 case of multiple colonic cancer. Compared with the patients that underwent open surgery, the LATC group showed significantly less blood loss, shorter incision and postoperative hospital stay ( P 0.05 ). During the 6 - 18 months follow-up, no local recurrence or distant metastasis was found, and the stool frequency was 2-5 times per day. Conclusion Laparocopy-assisted total colectomy is an applicable option for its safety and desirable short-term outcome.%目的 随着微创技术的广泛应用,腹腔镜全结肠切除术已应用于治疗多种结直肠疾病.文中比较腹腔镜辅助与开腹全结肠切除术的临床疗效,探讨腹腔镜辅助全结肠切除术的安全性和可行性.方法 回顾性分析23例全结肠切除术的临床资料,分为开腹手术组(l2例)和腹腔镜手术组(11例),比较2组患者的一般情况、手术情况、术后情况以及疗效评价.结果 22例患者顺利完成手术,无相关并发症,1例结肠多原发癌患者中转开腹.腹腔镜组的失血量、术后住院天数和切口长度均少于或小于开腹组(P0.05),腹腔镜组手术时间相比开腹手术组延长105min(P<0.05).术后随访6~18个月,患者均未见转移及复发,排便次数2~5次/d.结论 腹腔镜辅助全结肠切除术安全可行,近期疗效良好.

  14. 后腹腔镜治疗肾囊性疾病36例临床分析%Clinical analysis of treating renal cystic diseases with retroperitoneal laparoscopy:a report of 36 cases

    方文革; 关超; 徐卫强; 许海斌; 谷明利; 郭园园; 谢海龙


    Objective:To explore the operation method and observe the efficacy of treating renal cystic diseases by retroperitoneal laparoscopy. Methods:Thirty-six patients with renal cystic diseases were treated with retroperitoneal laparoscopic cyst decompression,including:32 cases with simple renal cyst,3 cases with polycystic kidney and 1 case with parapelvic cyst. Results:The operations were successfully in all 36 patients without changing to opening operation. The operation time of simple renal cyst was 30 -90 min, polycystic kidney was 90 - 120 min and parapelvic cyst was 110 min. The blood loss of simple renal cyst was < 30 ml, the two others were <50 ml. The hospital stay was 3 -6 days,6 -8 days and 7 days respectively. Patients were followed up for 3 - 12 months,all cases were no recurrence. In 3 cases with polycystic kidney,lumbar pain was relieved. The renal function of 1 patient with renal insufficiency was got better. The pressure of 1 patient with high blood pressure preoperative was decreased to normal level. Thirty-six cases were no severe complications. Conclusions: Retroperitoneal laparoscopic cyst decompression is an optimum method for treating renal cystic diseases with the advantages of good curative effect, minimal trauma, rapid recovery and short hospitalization, it will be worthy of clinical recommendation.%目的:探讨后腹腔镜治疗肾囊性疾病的手术技巧,并观察临床疗效.方法:应用后腹腔镜去顶减压术治疗肾囊性疾病36例,其中单纯性肾囊肿32例,多囊肾3例,肾盂旁囊肿1例.结果:36例手术均获成功,无一例中转开放手术.手术时间单纯性肾囊肿30~90 min,多囊肾90~120 min,肾盂旁囊肿约110 min.单纯性肾囊肿出血<30 ml,多囊肾和肾盂旁囊肿出血<50 ml.住院时间单纯性肾囊肿3~6天,多囊肾6~8天,肾盂旁囊肿7天.随访3~12个月无复发病例;3例多囊肾患者术后腰部胀痛缓解,1例肾功能不全患者术后肾功能明显改善,1例术

  15. 腹腔镜诊治子宫内膜异位症相关性慢性盆腔痛的临床研究%Combined Treatment of Endometriosis-Related Chronic Pelvic Pain with Laparoscopy

    胡碧洪; 李莉芳; 王帅; 黄浩


    Objective: To evaluate the diagnosis and treatment of endometriosis-related chronic pelvic pain (EMT-related CPP) by laparoscope. Methods:The relationship between site, stage of endometriosis (EMT) and the effect of laparoscope, as well as the pain degree in 86 cases of endometriosis-related chronic pelvic pain patients were retrospectively analyzed. Results;The remission rate of EMT-related CPP by laparoscopic surgery was 90. 7%. Ⅰ degree of pain in n stage by rAFS was 71.4%, more than II degree of pain in 1 and IV stage was 95. 5%. I and U degree of pain in simple ovarian chocolate cysts and (or) pelvic peritoneum EMT pain was 88.4%. II to 1 degree of pain in EMT patients with ectopic lesions invasion of uterosacral ligaments, Douglas pouch, posterior wall of uterus and deep infiltrating was 93. 0%. Conclusions;The main causes of EMT-related CPP are invasion of uetrosacral ligament, Douglas pouch, posterior wall of uterus and deep infiltrating in pelvic endometriosis. Laparoscopy can confirm the diagnosis and treat EMT-related CPP, the therapy is satisfactory.%目的:评价腹腔镜在子宫内膜异位症(EMT)相关性慢性盆腔痛诊断及治疗中的应用价值.方法:回顾性分析86例EMT相关性慢性盆腔痛患者行腹腔镜手术治疗的效果及疼痛程度与EMT分期及部位的关系.结果:腹腔镜手术治疗EMT相关性慢性盆腔痛疼痛缓解率90.7%.rAFS分期Ⅱ期患者Ⅰ度疼痛占71.4%,Ⅲ期和Ⅳ期患者Ⅱ度以上疼痛占95.5%.单纯卵巢巧克力囊肿和(或)盆腔腹膜EMT患者Ⅰ、Ⅱ度疼痛占88.4%,病灶侵犯宫骶韧带、直肠子宫陷凹和子宫后壁以及深部浸润的EMT患者Ⅱ、Ⅲ度疼痛占93.0%.结论:盆腔子宫内膜异位病灶侵犯宫骶韧带、直肠子宫陷凹、子宫后壁和深部浸润是引起EMT相关性慢性盆腔痛的主要原因,腹腔镜能明确诊断及治疗EMT相关性慢性盆腔痛,治疗效果满意.

  16. 腹腔镜探查在多发伤合并腹部损伤中的应用%Applaication of selective laparoscopy combined abdominal injuries in multiple trauma

    田宇剑; 李伟; 李界明; 吴胜; 陈金锁; 唐晓明


    Objective To investigate the value of elective laparoscopic exploration in treatment of the polytrauma combined with abdominal injuries. Methods January 2007 to June 2011 laparoscopic clinical data of 45 cases of polytrauma combined with abdominal injuries were retrospectively analyzed. Results Totally 45 cases a clear diagnosis: liver rupture nine cases (2 cases of biliary tract injury) .splenic rupture (including spleen and subcapsular hematoma) 13 cases,stomach rupture in two cases of pancreatic duodenal injury in two cases,rupture of small intestine 8 cases of colon rupture in S cases,the mesenteric vascular injury and retinal vascular injury in 3 cases,2 cases of abdominal wall hematoma ,abdominal negative probe five cases;33 cases of laparoscopic surgery and laparotomy in 9 cases,assisted small incision in 3 cases; One cases of spleen and subcapsular hematoma after conservative treatment of postoperative five days delayed spleen rupture,abdominal surgery in a timely manner,a good prognosis and patients with severe brain trauma within 2 weeks of death ,the remaining 43 cases were followed up for 6 months without concurrent. Conclusions The selective application of laparoscopy for the complexity of polytrauma combined with abdominal injuries patients can provide early diagnosis,early treatment and avoid unnecessary laparotomy,endoscopic surgery can be done by laparoscopic;In line with modern surgical concept of minimally invasive,so it is should be promoted.%目的 探讨选择性腹腔镜探查在多发伤合并腹部损伤患者中的诊断及治疗的应用价值.方法 对2007年1月至2011年6月实施腹腔镜探查45例患者多发伤合并腹部损伤的临床资料进行回顾性分析.结果 45例均明确诊断:肝破裂9例(2例合并胆道损伤),脾破裂(含脾包膜下血肿)13例,胃破裂2例,胰腺十二指肠损伤2例,小肠破裂8例,结肠破裂5例,肠系膜血管损伤及大网膜血管损伤3例,腹壁血肿2例,腹腔阴性探查5

  17. 经脐单孔腹腔镜技术治疗精索静脉曲张54例临床观察%Treatment of varicocele by transumbilical single port laparoscopy

    王东; 罗一钊; 马志伟; 邓洁; 周铣; 邱明星


    Objective To investigate the method of transumbilical single port laparoscopy in the treatment of vari-cocele. Methods 54 cases were underwent transumbilical single port aparoscopic high ligation of spermatic vein (30 cases on the left side,24 cases on both sides). Cut in layer by layer to dispose the vagina musculi recti abdodminis through a 1. 5-2. 0 cm curve incision on the edge of the navel. Strip subcutaneous tissue for 1cm with an angle of 45°downward to the body side on both left and right. Puncure in the pneumascos needle in the middle of the curve incision to form pneumoper-itoneum. Puncture in a 10mm trocar ( trocar 1) at the distal point of the lcm stripping area to the right body side and connect it to the pneumopertoneum machine. Puncture in a self-made soft 5mm trocar beside the pneumascos needle (tro-car2) and at the distal point of the lcm stripping area to the left body side (trocar 3) respectively. Place a laparoscope in trocar 2, and other corresponding flexible devices in trocar 1 and trocar 3 respectively to operate. Results All of the operations were performed successfully and no complication had been noted. The average operative time was 18min on the left side and 25min On both sides. Mean postoperative hospital stay was 1d. Conclusion Transumbilical single port lapa-roscopic high ligation of spermatic vein is effective to treat varicocele and is worthy to be recommended because of its advantages of less interferences,few complications,quick recovery,and low recurrence rate..%目的 探讨经脐单孔腹腔镜技术治疗精索静脉曲张的临床价值.方法 施行经脐单孔腹腔镜精索静脉高位结扎术54例,其中左侧30例,双侧24例.沿脐缘1.5~2.0cm弧形切口逐层游离显露腹直肌鞘后,分别向左右两侧外下方45°角游离皮下组织1cm;弧形切口正中穿入气腹针建立气腹,于右侧外下方45°角远端处穿刺10mm Trocar(trocar1),并连接气腹机,于切口中间及左侧外下方45°角远

  18. The Clinical Effects of Laparoscopy for Tubal Obstruction Infertility Diagnosis and Treatment%腹腔镜用于输卵管梗阻不孕症的临床疗效分析



    Objective: To investigate clinical effect of laparoscopy for diagnosis and treatment of tubal obstruction infertility. Method: 90 cases of tubal obstruction infertility patients which were received and treated from January of 2009 to December of 2010 in our hospital were chosen, and through the laparoscope, every part in the abdominal and pelvic cavity of these patients was explored, Then according to the different prevalence of patients, different operation were choosed, including tubal ostomy, fallopian tube dilation, resection of peritubal adhesion etc. The fluent ability of oviducts were observated and the condition of intrauter-ine pregnancy were followed-up by telephone. Result: The fallopian tube patency rate was 71. 11% after surgery was significantly higher than 41.11% which is the rate of pre-operative ( P 0. 05 ), the difference was not statistically significance. Conclusion: Laparoscope was used in tubal obstruction infertility has advantages, such as small incision, good vision, high precisional surgery, recovery quickly, fewer complications. And it can significantly improve intrauterine pregnancy rate, the effect was confirmed, deserves widespread recommendation.%目的:探讨腹腔镜用于输卵管梗阻不孕症诊治的临床效果.方法:选择我院于2009年1月至2010年12月收治的90例输卵管梗阻不孕症患者,在腹腔镜下,对患者腹、盆腔内各部位情况进行探查,然后根据患者不同的患病情况,选择采取不同手术,包括输卵管造口术、输卵管伞部扩张术、输卵管周围粘连松解术等.观察患者术后输卵管的通畅情况,并通过电话随访跟踪患者术后宫内妊娠情况.结果:手术后输卵管的通畅率71.11%显著高于手术前输卵管的通畅率41.11,且P0.05,差异无统计学意义.结论:腹腔镜应用于输卵管梗阻不孕症,具有切口小、视野良好、手术精度高、恢复快、并发症少且能显著提高宫内妊娠率的优点,效果显著,值得在临床中推广.

  19. Estudo in vivo e in vitro com e sem termociclagem, da resistência ao cisalhamento de braquetes colados com fonte de luz halógena In vivo and in vitro study, with or without thermocycling, of shear bond strength of brackets bonded with halogen light

    Sérgio Milton Martins de Oliveira Penido


    Full Text Available OBJETIVO: avaliar a resistência de braquetes metálicos colados em dentes humanos com resina polimerizada com luz halógena por meio de ensaios mecânicos de cisalhamento. METODOLOGIA: para este estudo foram realizados ensaios in vivo com dinamômetro portátil digital e in vitro com máquina de ensaios mecânicos universal com e sem termociclagem, complementado pelo Índice de Adesivo Remanescente (IAR. Braquetes Edgewise Standard (Abzil foram colados utilizando adesivo Transbond Plus Self Etching Primer (SEP e Resina Transbond XT. Foram formados 3 grupos com 10 dentes em cada um deles. No GI os braquetes foram colados nos segundos pré-molares dos pacientes. Nos GII e GIII utilizaram-se primeiros pré-molares extraídos por motivos ortodônticos. Os ensaios mecânicos do GI foram realizados 24 horas após a polimerização diretamente na boca dos pacientes com dinamômetro portátil digital. No GII os corpos-de-prova foram armazenados em água destilada e levados à estufa a 37ºC durante 24 horas e, posteriormente, submetidos à termociclagem, com 1000 ciclos a 5 e 55ºC. No GIII os corpos-de-prova foram armazenados em água destilada em temperatura ambiente por 24 horas e posteriormente submetidos aos ensaios mecânicos. RESULTADOS: os valores médios da resistência ao cisalhamento em Megapascal foram de: GI = 4,39; GII = 7,11 e GIII = 7,35. Após a descolagem foram realizadas fotografias das áreas de colagem, tanto dos dentes submetidos a testes in vivo quanto in vitro e ampliadas 5x para facilitar a visualização. As imagens obtidas foram analisadas, classificadas de acordo com o IAR e, por meio de gráficos de dispersão, foi verificada a relação entre a resistência ao cisalhamento e este índice. CONCLUSÃO: a média dos ensaios mecânicos realizados in vivo foi estatisticamente menor em relação aos ensaios in vitro. Não houve diferenças na resistência ao cisalhamento in vitro entre o grupo termociclado e o n

  20. 宫腔镜、腹腔镜与药物联合治疗多囊卵巢综合征合并不孕症的效果观察%Efficacy of Hysteroscopy,Laparoscopy and Drug Therapy for Infertile Women With Polycystic Ovary Syndrome

    李小晖; 张秀红


    Objective To analysis the efficacy of hysteroscopic and laparoscopic and drug combination for the treatment of polycystic ovary syndrome combined infertility. Methods 65 cases were analysed by hysteroscopy and laparoscopy combined drug therapy of polycystic ovary syndrome with infertility patients clinical data. Results 61 cases of patients with normal menstrual cycle,ovulation rate is 96.9%,follow up until August 2015,the pregnancy rate was 86.2%. Postoperative LH,T,LH/FSH significantly lower compared with preoperative,P< 0.05. Conclusion Hysteroscopy and laparoscopy combined drugs in the treatment of polycystic ovary syndrome with infertility.%目的:分析宫腔镜、腹腔镜与药物联合治疗多囊卵巢综合征合并不孕症的效果。方法分析65例经宫腔镜、腹腔镜联合药物治疗的多囊卵巢综合征合并不孕症患者临床资料。结果61例患者月经周期正常,排卵率96.9%,随访至2015年8月,妊娠率86.2%。术后LH、T、LH/FSH较术前降低,P<0.05。结论宫腔镜、腹腔镜联合药物治疗多囊卵巢综合征合并不孕症效果显著。

  1. 宫腹腔镜联合手术治疗剖宫产术后子宫切口憩室疗效分析%Clinical Analysis of Uterine Incision Diverticulum after Cesarean Section Treated by Laparoscopy Combined with Operation

    曾建红; 彭洁茹


    目的探讨剖宫产术后子宫切口憩室宫腹腔镜联合手术治疗的效果。方法对我院2009年2月~2015年2月剖宫产术后子宫切口憩室30例病例进行回顾性分析。结果15例采取B超引导下宫腔镜下电技术治疗剖宫产术后憩室,术中1例子宫穿孔,术后随访1例经期较前无明显缩短,余经期恢复正常,15例采用宫腹腔镜联合手术,术中无并发症,术后恢复良好。结论宫腹腔镜联合手术治疗剖宫产术后子宫切口憩室疗效好,安全,无并发症。%Objective To investigate the cesarean incision laparoscopy combined with surgical treatment of diverticulitis ef ect. Methods The hospital from February 2009 to February 2015 cesarean incision diverticulum 30 cases were retrospectively analyzed. Results 15 cases taken under B ultrasound-guided hysteroscopic treatment of diverticulitis after cesarean section, intraoperative case of uterine perforation, postoperative fol ow-up period compared with the previous one case without significantly shorter period than normal, 15 cases of the use of the Palace laparoscopic surgery, surgery without complications, postoperative recovery was good.Conclusion Combined surgical laparoscopy good cesarean incision diverticulum ef icacy, safety, no complications.

  2. 腹腔镜在胆道损伤修复手术中的临床应用(附9例报告)%Laparoscopy for Reconstruction of the Bile Duct: Report of 9 Cases

    陈德兴; 徐刚; 曹春和; 董加纯; 李晓勇; 侯敬袆; 王鹤


    -enteric anastomosis (3 cases of high hepatic duct injury).③ Cystic duct transfer plus T tube drainage ( 1 case of hepatic duct defect with 10 mm in diameter at the anterior biliary wall).Results All the 9 patients were cured.In the patients who underwent end-to-end anastomosis of the hepatic duct developed bile leakage and was cured by peritoneal drainage for 20 days.Stress ulcer and postoperative bleeding occurred in 2 cases of high hepatic duct injury.All the 9 cases were followed up from 1 to 9 years with a mean of 4 years.No anastomotic stenosis occurred during the period.Conclusions With laparoscopy, we may achieve optimal anastomosis for better observation of surgical field and thin bile ducts.T-tube as a supporter can maximally avoid anastomotic stricture and thus provides a precise anastomosis for bile duct repair.

  3. 十二指肠镜联合腹腔镜治疗胆囊和胆总管结石的临床分析%Duodenoscopy combined with laparoscopy in the treatment of gallstone and choledocholithiasis

    周政; 黄志刚; 王光明; 刘有理; 章社民


    目的:评价十二指肠镜联合腹腔镜治疗胆囊结石和胆总管结石的临床效果,与传统开腹胆囊切除、胆总管切开取石比较分析。方法选择60例胆囊结石并胆总管结石患者,按随机数字表法分为双镜微创组和开腹组,其中30例双镜微创组先行内镜胰胆管造影(ERCP)+十二指肠乳头 Oddis 括约肌切开术(EST)+胆总管取石术,再行腹腔镜胆囊切除术(LC 术)。另外30例行传统开腹胆囊切除+胆总管切开取石术。将两组的手术时间、平均住院时间、并发症发生率进行比较分析。结果双镜微创组26例患者 ERCP +EST +胆总管取石术成功,胆总管结石全部取出,术后留置鼻胆管引流;4例由于结石过大未取出,留置胆管支架。25例1周内行三孔法 LC 术。10例并发胰腺炎,2例患者年龄较大,合并高血压病等基础病,治疗后2周行 LC 术。双镜微创组创伤小,出血量少,恢复快,但容易并发胰腺炎。传统开腹组创伤大,出血量较多,12例结石未完全取出,容易并发切口感染,恢复时间长。结论ERCP 联合 LC 术用于治疗胆囊、胆总管结石具有效果好、创伤小、术后并发症少、恢复快等优点,临床疗效满意。%Objective To evaluate the clinical effect of duodenoscopy combined with laparoscopy in the treatment of gallstone and cho-ledocholithiasis,and to compare with traditional cholecystectomy and choledocholithotomy.Methods Sixty patients of gallstone and choledocholithiasis admitted were randomized into minimally invasive double endoscopic group and laparotomy group.The 30 patients of minimally invasive double endoscopic group were firstly given endoscopic retrograde cholangiopancreatography(ERCP)+endoscopic sphincterotomy(EST)+choledocholithotomy,then given laparoscopic cholecystectomy (LC).The other 30 patients underwent tradition-al cholecystectomy and choledocholithotomy.The operation

  4. Diagnosis and Treatment by Laparoscopy for Congenital Duodenal Obstruction in Newborn Infants%腹腔镜诊治新生儿先天性十二指肠梗阻

    耿娜; 李索林; 李英超; 时保军; 于增文; 马亚贞


    目的 评价腹腔镜诊断和治疗新生儿先天性十二指肠梗阻(CDO)的可行性和疗效.方法 回顾性分析2002年7月-2010年10月新生儿CDO患儿21例行腹腔镜手术的临床资料,腹腔镜下探查病因,并依据其病理类型予以相应手术矫治.结果 21例患儿均在腹腔镜下明确诊断,并顺利完成手术,肠旋转不良13例实施Ladd手术,十二指肠狭窄4例腔镜下纵行切开其前壁横行缝合,十二指肠闭锁2例和环状胰腺2例成功进行空肠十二指肠菱形吻合术.手术时间(73.0±21.3) min (45~135 min),除1例术后发生暂时性吻合口漏,给予禁食水及肠外营养处理自愈外,无术中并发症出现.术后上消化道造影检查吻合口通畅,术后7~12 d痊愈出院.随访(31.3±4.8)个月,患儿生长发育正常.仅1例术后2个月出现肠黏连梗阻,予手术松解治愈.结论 腹腔镜诊治新生儿CDO是一种安全有效的方法,具有创伤小、进食早、恢复快、美观等特点.但新生儿期腹腔镜手术对麻醉及围术期管理要求更高.%Objective To evaluate the feasibility and availability of laparoscopy in diagnosis and treatment for newborn infants with congenital duodenal obstruction(CDO). Methods Twenty - one neonates with CDO who underwent laparoscopic surgery were analyzed retrospectively from Jul. 2002 to Oct. 2010. Under the laparoscopic vision ,the cause of CDO was explored and the CDO was treated proportionally according to corresponding pathological types. Results All procedures were successfully performed and the etiology was identified. A standard Ladd's procedure was carried out in 13 newborns with intestinal nalrotation. Four cases with duodenal diaphragmatic stenosis underwent a partial excision of the diaphragm after vertical incision of the anterior part in the duodenum followed by a transverse suture. A diamond - shaped side - to - side duodenal anastomosis was completed in 2 cases of duodenal atresia and 2 cases of annular

  5. Viviperception on renal vessel variation by retroperitoneal laparoscopy a report of 525 cases%肾脏525例腹腔镜手术肾血管变异分析

    宋刚; 张晓春; 周利群; 姚鲲; 张仲一; 龚侃; 李宁忱; 席志军; 吴士良; 宋毅


    目的 观察并分析腹腔镜肾脏手术肾血管变异情况,提高腹腔镜肾脏手术的安全性.方法 统计北京大学第一医院泌尿外科2004年1月至2008年6月接受腹腔镜肾切除术或肾部分切除术的525例患者.其中男316例,女209例,平均年龄(58±13)岁.手术均为腹膜后途径,通过术中腹腔镜的观察和操作,对肾脏动脉、静脉的变异情况进行记录和分析.结果 525例患者中有58例存在肾脏血管变异(11.0%,58/525).18例患者单侧具有2支肾动脉(3.4%,18/525),10例患者有2支肾静脉(1.9%,10/525),1例患者有3支肾静脉,3例患者同时具有双肾动脉、双肾静脉.25例患者有副肾动脉(4.8%,25/525),其中19例(76.0%,19/25)患者的副肾动脉走向肾上极.1例患者的左侧精索静脉与肾静脉直径相当,二者与腰静脉同时汇入下腔静脉.结论 肾动脉的变异较肾静脉常见.副肾动脉出现率较高,多走向肾上极.在腹腔镜肾脏手术中,应对肾血管变异引起高度重视.%Objective To study the variation of renal vessels with retroperitoneal laparoscopy so as to increase the safety of retroperitoneal laparoscopic surgeries.Methods A total of 525 patients underwent retroperitoneal laparoscopic nephrectomy or partial nephrectomy at our hospital between January 2004 and June 2008.There were 316 males and 209 females with a mean age of (58 ± 13) years old.The procedures were as follows:(1) patients lay on one side with their waist up and the retroperitoneal cavity was established with our institutional method;(2) gerota's fascia was separated widely along the ventral surface of major psoas muscle;(3) the tissues around renal arteries and veins were isolated by ultrasonic scalpel.Careful observation was performed to explore if there were duplicated or accessory renal vessels;(4) renal vessels were cut by Endo-GIA/Hem-o-lok or blocked by bulldog clamps;(5) whole or partial kidney was finally resected (remaining procedures omitted

  6. The application of suspended gasless laparoscopy in colorectal cancer surgery%元气腹腹壁悬吊技术在大肠癌腹腔镜手术中的应用

    张树琦; 伍冀湘; 贺建业; 赵良玉


    Objective To observe the outcome of suspended gasless laparoscopic with gas laparoscopic in colorectal carcinoma patients. Methods Totally 56 patients from 2006 June to 2009 July who underwent gasless laparoscopic or laparoscopic colorectal tumorectomy were enrolled. 30 patients underwent suspended gasless lapam-scopic and 26 patients underwent gas laparoscopic tumorectomy. Operating time, bleeding volume, lymph node clearance number and the time of passage gas by anus were recorded and compared separately. Results The oper-ating time of gasless laparoscopic group was 180-310 minutes[mean(234.29±10.89) minutes] and The operating time of gaslaparoscopic group was 205-480 min [mean (266.36±13.53) min] (P=0.1). The number of lymph node clearance :gasless laparescopic group: 10-15, mean value: 12.64±0.48; gas laparoscopic group: 9-17, mean value :13.00±0.47. The time of passage gas by anus: gasless laparoscopic group:26-43 h,mean value: (34.50±5.54) h; gas laparoscopic group: 18-48 h, mean value: (30.73±7.11) h. The postoperative pain degree: gasless laparoscopic group:2-5, mean value:3.21±0.21; gas laparoscopic group:2-5, mean value:3.14±0.12. In the gas laparoscopic group, one case had urethra injury and two cases were converted to open operations. In the gasless laparoscopic group, one case had rectal-vagina fistula. During postoperative period of rectectomy, each group had one case that had anastomotic stoma fistula. There was no statistic significance between these two groups. Conclu-sions Abdominal wall lifting laparoscopy is a safe method of operation. The operation time, bleeding volume and lymph node clearance number showed no significant difference between these two methods. Suspended gasless lapa-roscopic surgery is a way of laparoscopic operation without CO_2 and it may become a promising option for the patients with cardiacrespiratory dysfunction or old age.%目的 对比观察无气腹腹腔镜(悬吊组)与气腹腹腔镜(气腹组)在大肠癌

  7. [Mini-laparoscopy vs. laparoscopy for the gallblader stone treatment. Prospective and comparative study].

    Lada, Paul Eduardo; Forez, Francisco; Janikov, Christian; Mariot, Daniela; Sanchez Tassone, Carlos; Massa, Martin


    Antecedentes: La colecistectomía por video-laparoscópica es considerada como el gold-standard del tratamiento de la colecistolitiasis. No obstante, en la literatura internacional sigue teniendo presencia las incisiones pequeñas adaptadas como procedimiento alternativo. Objetivos: El objetivo de este estudio es evaluar los resultados obtenidos con la video-laparoscopia (CVL) y las incisiones pequeñas adaptadas (IPA) en el tratamiento de la colecistolitiasis. Diseño: Prospectivo y comparativo protocolizado. Lugar de aplicación: Servicio de Cirugía General “Pablo Luis Mirizzi” del Hospital Nacional de Clínicas. Material y Métodos: Entre enero del 1994 y diciembre del 2011, hemos tratado quirúrgicamente 3822 pacientes con colélitiasis. En 1735 pacientes se práctico una CVL y en 2087 por IPA, configurando dos grupos, que en lo relacionado a la edad, sexo, operaciones previas y diagnóstico preoperatorio constituyen dos grupos comparables. Resultados: Ninguno de los procedimientos tuvo mortalidad. 115 casos (6,62%) fueron convertidos a cirugía abierta en la CVL. Las complicaciones postoperatorias quirúrgicas fueron del 2,40 % para la CVL y del 6,37 % para las IPA. Las causas de bilirragias fueron superiores y de mayor gravedad en la CVL, cuya incidencia fue del 0,55 % en contraposición del 0,23 % de los operados por IPA. Conclusiones: Sin duda en manos experimentadas la CVL constituye el procedimiento de elección o gold standard en el tratamiento de la colecistolitiasis. No obstante, sobretodo en ambientes o regiones con restricciones presupuestarias las IPA representa una excelente gold estándar alternativo, por ser un procedimiento seguro, muy económico y complejidad razonable con menor índice de lesiones quirúrgicas graves.

  8. Hysteroscopy plus laparoscopy on stress response and pregnancy in patients with tubal infertility%宫-腹腔镜联合应用对输卵管阻塞不孕患者应激反应和受孕率的影响



    Objective To study hysteroscopy plus laparoscopy on stress response and pregnancy in patients with tubal infertility.Methods According to the digital table,80 patients with tubal infertility were randomly divided into two groups,the control group(n =40 cases) and the observation group(n =40 cases).The control group were operated through hysteroscopy,while the observation group were operated through hysteroscopy plus laparoscopy.Operative time,blood loss and hospital stay were observed.Serum cortisol (Cor) and hsCRP were measured before and after surgery.Results In the observation group,operative time,blood loss and hospitalization stay were less than those of the control group(t =3.268,4.928,2.728,all P < 0.05).Postoperative serum Cor and hs-CRP were significantly higher,but the observation group were lower than the control group,there were a significant differences between the two groups(t =3.165,2.147,all P < 0.05).In the observation group,intrauterine pregnancy was significantly higher and ectopic pregnancy was significantly lower than those of the control group(x2 =4.78,4.16,both P < 0.05).Conclusion Hysteroscopy plus laparoscopy can improve pregnancy and decrease stress response in patients with tubal infertility.%目的 探讨宫-腹腔镜联合应用对输卵管阻塞不孕患者应激反应和受孕率的影响.方法 80例输卵管阻塞导致不孕患者按照数字表法随机分为两组,对照组40例,观察组40例,对照组采用宫腔镜治疗,观察组采用宫-腹腔镜联合治疗.观察两组手术时间、术中出血量、住院时间.测定术前后血清皮质醇(Cor)和hsCRP.结果 观察组手术时间、术中出血量和住院时间均少于对照组(t=3.268、4.928、2.728,均P <0.05).两组术后血清Cor和hsCRP均明显升高,但是观察组较对照组更低(=3.165、2.147,均P<0.05).观察组宫内妊娠明显高于对照组(x2=4.78,P<0.05),异位妊娠明显低于对照组(x2=4.16,均P<0.05).结论 宫-腹腔镜联

  9. Evaluation the effects of conservative surgery of tubal pregnancy under laparoscopy by hydrotubation under hysteroscopy for application on improving re-pregnancy rate%医用生物蛋白胶在腹腔镜下输卵管保守性手术中提高患者再孕率的应用

    谢静; 陈秀文


    目的 探讨医用生物蛋白胶在腹腔镜下输卵保守性手术中提高者再孕率的价值.方法 回顾性分析本院3年间应用医用生物蛋白胶治疗输卵保守性手术150例的治疗效果及优越性,选择腹腔镜下异位始娠开窗取胚术150例(对照组)与在对照组的基础上再用医用生物蛋白胶150例为研究对象(观察组).结果 观察组均获成功,与对照组相比,加用医用生物蛋白胶组术中出血少,损伤少,术后随访患者持续异妊娠再次宫外孕率、不孕率均低于对照组,宫内妊娠率高.结论 医用生物蛋白胶能提高异位妊娠手术的成功率及术后宫内妊娠率.%Objective of Fibrin gel which ape: Evaluation the effectplies on conservative surgery of tubal pregnancy under laparoscopy for improving pregnancy rate. Methods 150 cases of patients who received fibrin gel of tubal pregnancies conservative surgery had great effect on the application during the past 3 years within our hospital. 150 cases of patients (basic group) took laparoscopic fenestration under Laparoscopy, after the operation, the 150 patients (as an observation group) used fibrin glue also. Results The observation group was successful. Comparing the basic group, with postoperative follow-up of two different sustained rates the patients who received fibrin glue group are in a less blood losing, less damage situation, and of pregnancy outside again infertility rates are lower than the basic group. Conclusions Fibrin gel is able to improve the success rate on surgery of ectopic pregnancy and postoperative intra-uterine pregnancy.

  10. Repercussões respiratórias e hemodinâmicas do pneumoperitônio na lesão do diafragma: estudo experimental Hemodynamic and respiratory changes caused by CO2 laparoscopy in an experimental model of diaphragmatic injury

    Sílvia Cristine Soldá


    Full Text Available OBJETIVO: Analisar as alterações hemodinâmicas e respiratórias secundárias à laparoscopia em modelo experimental de lesão diafragmática. MÉTODOS: Foram utilizados 15 suínos, distribuídos em três grupos com cinco animais cada, assim constituídos: Grupo 1 - Portadores de lesão diafragmática e avaliados sem pneumoperitônio (CLSP; Grupo 2 - Sem lesão diafragmática e avaliados com pneumoperitônio (SLCP; Grupo 3 - Portadores de lesão diafragmática e avaliados com pneumoperitônio (CLCP. Foram avaliadas variáveis gasométricas, hemodinâmicas e respiratórias. RESULTADOS: Houve alterações significantes da pressão média de artéria pulmonar (PAP, pressão de capilar pulmonar (PCP, PAO2, SAO2 e SVO2. CONCLUSÃO: A videolaparoscopia na presença de lesão do diafragma não acarreta alterações do débito cardíaco e pode ser realizada com segurança, desde que a pressão de pneumoperitônio não ultrapasse valores de 15 mmHg.OBJECTIVE: The objective of this study was to analyze the hemodynamic and respiratory changes caused by CO2 laparoscopy in an experimental model of diaphragmatic injury. METHODS: Fifteen animals chosen at random were submitted to diaphragmatic injury by means of CO2 laparoscopy. Evaluation consisted of drawing blood samples to analyze blood gases, as well as the hemodynamic and respiratory variables. RESULTS: Alterations occurred in APA, CPP, PAO2, ASO2, VSO2. CONCLUSION: We concluded that videolaparoscopy with pneumoperitoneum pressure under 15mmHg is a safe procedure in patients with diaphragmatic injuries because this pressure level does not cause hemodynamic changes, such as decrease of the cardiac output. [Rev Assoc Med Bras 2007; 53(4: 294-9

  11. Curative effect analysis of hysteroscopy combined with laparoscopy in the diagnosis and treatment of refrac-tory polycystic ovarian syndrome complicated with infertility%宫-腹腔镜联合诊治难治性多囊卵巢综合征合并不孕的疗效分析



    目的:探讨宫-腹腔镜联合诊治难治性多囊卵巢综合征合并不孕的必要性和疗效。方法选择多囊卵巢综合征(PCOS)合并不孕患者80例,按随机数字表法分为两组各40例,研究组使用宫-腹腔镜联合诊治,对照组仅单纯使用腹腔镜诊治。比较两组手术前后卵巢、卵泡及血清激素水平变化情况,同时记录两组术后正常排卵率、妊娠率及流产率。结果研究组术后卵泡个数及卵巢体积均较治疗前明显下降,且明显低于对照组,差异均有统计学意义(t =3.82、3.80、3.74、3.75,均 P <0.05)。研究组术后血清 T、LH 及 LH/FSH 较术前明显降低,且明显低于对照组,差异均有统计学意义(t =9.32、4.06、3.80,均 P <0.05)。研究组术后正常排卵率、妊娠率及流产率分别为90.0%、62.5%及7.5%,与对照组的72.5%、50.0%及15.0%差异均有统计学意义(χ2=4.02、4.10、3.90,均 P <0.05)。结论宫-腹腔镜联合诊治 PCOS 合并不孕疗效显著,可有效提高患者术后排卵率及妊娠率,并降低自然流产率,值得临床推广应用。%Objective To investigate the effect and necessity of hysteroscopy combined with laparoscopy in the diagnosis and treatment of refractory polycystic ovarian syndrome complicated with infertility.Methods 80 cases of patients with polycystic ovary syndrome (PCOS)combined with infertility were randomly divided into two groups with 40 cases in each group.The testing group used hysteroscopy combined with laparoscopy in diagnosis and treatment while the laparoscopy was only used in the control group.The changes of ovary,ovarian follicles and serum hormone level of the two groups which before and after operation were compared,and the data of postoperative normal ovulation rate,pregnancy rate and abortion rate of the two groups were recorded.Results The follicle number and ovarian

  12. Effects of preoperative tramadol injection on postoperative analgesia in patients undergoing gynaecologiral laparoscopy%静脉应用不同剂量曲马多超前镇痛对妇产科腹腔镜手术后疼痛的影响



    目的 观察曲马多术前给药用于妇产科腹腔镜全麻术后镇痛的效果.方法 全麻下行妇产科腹腔镜手术80例,随机分为4组,每组20例,分别在手术切皮前静注:Ⅰ组生理盐水2 ml、Ⅱ组曲马多1.5 ms/ks、Ⅲ组曲马多2 ms/kg、Ⅳ组曲马多2.5 ms/kg.采用VAS评分和Ramsay镇静评分对患者拔管后、离室前以及术后1 h,2 h,4 h,8 h、12 h、24 h进行疼痛和镇静程度评分,并记录恶心、呕吐、头晕、嗜睡、躁动、恶梦、瘙痒、多汗等副作用.结果 与对照组Ⅰ相比,Ⅱ、Ⅲ、Ⅳ组在术后8 h内VAS评分显著降低,在3种剂量下未见量效相关性.4组Ramsay镇静评分均为0~2分.与Ⅰ组相比,Ⅱ、Ⅲ、Ⅳ组恶心、呕吐以及出汗的发生例数较多,Ⅳ与Ⅰ组相比有统计学差异,P<0.05或P<0.01;而Ⅱ、Ⅲ组与Ⅳ组之间的比较则无统计学差异.结论 妇产科腹腔镜全麻术前单次注射曲马多1.5 ms/kg~2 ms/kg可有效缓解术后疼痛,减少辅助镇痛药用量,副作用较少,是临床上较好的镇痛方法.%Objective To assess the effects of preoperative tramadol injection on postoperative analgesia in patients undergoing gynaecological laparoscopy. Methods A total of 80 patients scheduled for receiving gynaecological laparoscopic procedure under general anesthesia were randomly divided into four groups (n=20). 2 ml normal saline, 1.5 mg/kg, 2 mg/kg, 2.5 mg/kg tramadol was intravenously injected before anesthesia in Groups Ⅰ, Ⅱ, Ⅲ, Ⅳ, respectively. Visual analog scale (VAS) pain score and Ramsay sedation score were measured at postoperative 1 h, 2 h, 4 h, 8 h, 12 h and 24 h, respectively. Adverse effects were also recorded. Results The VAS score was significantly lower within postoperative 8 hours in Groups Ⅱ,Ⅲ and Ⅳ than that in Group Ⅰ, while no significant difference was found among Groups Ⅱ, Ⅲ and Ⅳ at each time point. The postoperative Ramsay sedation score was 0-2 in each group. Incidence of

  13. Prognosis of gestational trophoblast neoplasia accidentally diagnosed by laparoscopy for a presumed ectopic pregnancy%疑似异位妊娠腹腔镜手术后意外诊断的妊娠滋养细胞肿瘤患者的预后

    郭琦; 冯凤芝; 向阳; 万希润; 任彤


    目的:研究因疑似异位妊娠而进行腹腔镜手术中意外发现的妊娠滋养细胞肿瘤( GTN)患者的预后。方法回顾性分析了自2009年1月至2013年12月期间,11例因疑似异位妊娠在北京协和医院接受腹腔镜手术,而术后意外发现为GTN患者的临床资料。结果因疑似异位妊娠进行腹腔镜探查术,而术后病理诊断为GTN的患者有11例,包括5例胎盘部位滋养细胞肿瘤(PSTT),5例绒毛膜癌及1例异位妊娠性绒癌。在术后1~9 d内[均值(1.9±1.6) d],11例患者中9例进行了氟尿嘧啶(5-FuDR)为基础的联合药物化疗,2例进行了EMA/CO方案化疗。另外,3例患者在化疗后进行全子宫切除的辅助治疗。中位随访时间为48个月(16~72个月),所有随访患者都达到了血清学完全缓解(SCR),只有1例PSTT患者出现了复发,而复发后经过补救化疗,再次获得SCR。结论尽管有些GTN的临床特点类似异位妊娠,经腹腔镜探查手术明确诊断后,通过化疗,仍能获得极好的预后。%Objective: To investigate the prognosis of gestational trophoblast neoplasia ( GTN) diagnosed incidentally by laparoscopy for a presumed ectopic pregnancy. Methods: Clinical data of the patients with GTN diagnosed incidentally after laparoscopy for a presumed ectopic pregnancy in Peking Union Medical College Hospital from Jan 2009 to Dec 2013 were analyzed retrospectively. Results: Eleven patients were diagnosed as GTN based on postoperative pathology after laparoscopic lesion resection for a presumed ectopic pregnancy,including 5 patients with trophoblastic tumor ( PSTT) at placenta site,5 patients with choriocarcinoma and 1 patient with ectopic gestational choriocarcinoma. Of 11 patients, 9 patients received floxuridine (5-FuDR)-based multidrug chemotherapy and 2 received EMA/CO chemotherapy within 1-6 days [mean (1. 9±1. 6) days)] after surgery. In addition,3 patients underwent adjuvant hysterectomy combined with chemotherapy. The follow

  14. 气腹与腹壁悬吊无气腹结合腹腔镜手术治疗滑动型食管裂孔疝17例疗效分析%Seventeen cases of analysis of efficacy for sliding esophageal hiatal hernia by laparoscopy via pneumoperitoneum and non-pneumoperitoneum through abdominal wall lifting

    张葆勋; 伍冀湘; 蒋俭; 于涛; 于磊; 李建业


    Objective To evaluate the clinical value of the method of surgical treatment in patients with sliding esophageal hiatal hernia by laparoscopy via pneumoperitoneum and non-pneumoperitoneum through abdominal wall lifting.Methods The clinical data of 17 cases of laparoscopic esophageal hiatal hernia repair combined with and gastric folding via pneumoperitoneum and non-pneumoperitoneum through abdominal wall lifting was collected between May 2012 and May 2014,including 15 cases of Nissen operation and,2 cases of Toupet operation.Results Surgeries in all patients were successfully completed,no transferring laparotomy,the average operation time was 45 to 220 minutes,intraoperative blood loss was less than 50 ml,there were no postoperative complications,all patients were cured and discharged,and the average hospitalization time was 10 days.Follow-up period was between 1 to 24 months.Clinical symptoms in 16 patients disappeared completely,and clinical symptoms in 1 case partly relieved,with no relapsed case.Conclusion Sliding esophageal hiatal hernia by laparoscopy via pneumoperitoneum and non-pneumoperitoneum through abdominal wall lifting is a safe and effective surgical treatment,and has wide value of popularization.%目的:评估气腹与腹壁悬吊无气腹结合腹腔镜食管裂孔疝修补和胃底折叠术治疗滑动型食管裂孔疝的临床价值。方法回顾性分析2012年5月至2014年5月,北京同仁医院胸外科进行的17例气腹与腹壁悬吊无气腹结合腹腔镜食管裂孔疝修补和胃底折叠术的临床资料,其中采用Nissen 术式15例,Toupet 术式2例。结果所有患者均顺利完成手术,无中转开腹,平均手术时间为45~220 min,术中出血量均小于50 ml,无术后并发症,全部治愈出院,术后平均住院时间10 d。随访时间1~24个月,16例患者临床症状完全消失,1例临床症状部分缓解,无明确复发病例。结论气腹与腹壁悬吊无气腹结合腹腔镜

  15. Efectividad del adhesivo tisular Tisuacryl® para el cierre de heridas cutáneas en cirugía laparoscópica Effectiveness of the Tisuacryl® as tissue adhesive for closure of cutaneous wounds in laparoscopy surgery

    Rosalba Roque González


    Full Text Available INTRODUCCIÓN. Uno de los beneficios de la utilización de procedimientos laparoscópicos en cirugía es reducir la morbilidad relacionada con el traumatismo quirúrgico. Es conocido que el empleo del adhesivo tisular Tisuacryl® en el cierre de heridas cutáneas favorece la hemostasia, la recuperación rápida del tejido y la disminución del edema posquirúrgico, y evita complicaciones como infección y reacción del tejido a un cuerpo extraño. Fue objetivo de esta investigación evaluar la efectividad y seguridad de la utilización del Tisuacryl® para la síntesis de los puertos de entrada en pacientes intervenidos por cirugías mínimamente invasivas, sin necesidad de aplicar sutura. MÉTODOS. Se aplicó el adhesivo tisular a 100 pacientes que acudieron al Centro Nacional de Cirugía de Mínimo Acceso para realizarse diferentes procedimientos quirúrgicos. Como variables para evaluar la efectividad y seguridad del tratamiento se tomaron la dehiscencia de la herida, aparición de infección, tiempo de síntesis de la herida y estética de la cicatriz. Los pacientes se evaluaron en el posoperatorio inmediato y en consulta externa a los 7 y 21 días de la cirugía. RESULTADOS. Se lograron excelentes resultados en cuanto al afrontamiento y la estética de las heridas. Además, los pacientes no refirieron molestias ocasionadas por el material, ni se produjeron casos de infección. CONCLUSIONES. Los resultados de la investigación realizada demuestran que el Tisuacryl® puede utilizarse con alta efectividad para el cierre de las heridas de 5 mm y 10 mm en la cirugía laparoscópica, sustituyendo a las suturas.INTRODUCTION. One of the more beneficial uses of laparoscopy procedures in surgery is to decrease the morbidity related to surgical trauma. It is known that the use of the Tisuacryl® tissue adhesive for closure of cutaneous wounds favors the hemostasis, a fast tissue recovery and decrease of postsurgical edema avoiding complications

  16. The clinical analysis of laparoscopy and hysteroscopy of ectopic pregnancy in 39 cases with the cesarean scar%宫腔镜及宫腹腔镜联合治疗39例剖宫产瘢痕妊娠的临床分析

    梅立; 岳军; 谢兰


    Objective The feasibility and outcome of laparoscopy and hysteroscopy for patients with ectopic pregnancy in the cesarean section scar was studied. Methods From January 2006 to December 2011 , 39 patients diagnosed with ectopic pregnancy in a previous cesarean section scar underwent laparoscopic or hysteroscopic removal of the gestational sac at our department. All the cases were divided into two types; A and B. A retrospective review of medical records of these patients was performed. Results In all of them, the ectopic gestational sacs of type 1 were removed by hysteroscopy, those of type II were removed by hyste-roscopy and laparoscopy without converting to laparoctomy and the scar defect was repaired by intracorporeal sutures. All the cases had a steady decline of the serum β-hCG level. The lasting time of the serum β-hCG level in Type B was shorter than that in Type A (P<0. 05)o All the patients required additional methotrexate administration postoperatively. Conclusion Hysteroscopic/ Laparoscopic and hysteroscopic removal of ectopic gestational sac within a cesarean scar seems to be a feasible and safe procedure that might be considered as a treatment option.%目的 探讨宫腔镜及宫腹腔镜联合治疗剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)患者的临床疗效.方法 回顾性分析我院2006~2011年诊治的CSP患者39例,根据孕囊生长的方向分为内生型(A)组和外生型(B)组,A组23例,B组16例,A组采用宫腔镜下清宫术,配合药物辅助治疗;B组行宫腹腔镜联合妊娠病灶切除+子宫瘢痕修补术,配合药物辅助治疗.结果 治疗/后两组血hCG值的差异无统计学意义(P>0.05),而B组血HCG恢复正常的时间较A组短,差异有统计学意义(P<0.05).结论 对于CSP患者,采用积极手术干预配合药物治疗的方法,治疗周期短,效果确切,有利于提高患者生活质量.术前如充分分析患者病情,明确诊断及CSP类型,均能采用不同的保留子宫的保守性手术治疗.

  17. HAL/SM language specification. [programming languages and computer programming for space shuttles

    Williams, G. P. W., Jr.; Ross, C.


    A programming language is presented for the flight software of the NASA Space Shuttle program. It is intended to satisfy virtually all of the flight software requirements of the space shuttle. To achieve this, it incorporates a wide range of features, including applications-oriented data types and organizations, real time control mechanisms, and constructs for systems programming tasks. It is a higher order language designed to allow programmers, analysts, and engineers to communicate with the computer in a form approximating natural mathematical expression. Parts of the English language are combined with standard notation to provide a tool that readily encourages programming without demanding computer hardware expertise. Block diagrams and flow charts are included. The semantics of the language is discussed.

  18. The HubBLe trial: haemorrhoidal artery ligation (HAL versus rubber band ligation (RBL for haemorrhoids

    Tiernan Jim


    Full Text Available Abstract Background Haemorrhoids (piles are a very common condition seen in surgical clinics. After exclusion of more sinister causes of haemorrhoidal symptoms (rectal bleeding, perianal irritation and prolapse, the best option for treatment depends upon persistence and severity of the symptoms. Minor symptoms often respond to conservative treatment such as dietary fibre and reassurance. For more severe symptoms treatment such as rubber band ligation may be therapeutic and is a very commonly performed procedure in the surgical outpatient setting. Surgery is usually reserved for those who have more severe symptoms, as well as those who do not respond to non-operative therapy; surgical techniques include haemorrhoidectomy and haemorrhoidopexy. More recently, haemorrhoidal artery ligation has been introduced as a minimally invasive, non destructive surgical option. There are substantial data in the literature concerning efficacy and safety of 'rubber band ligation including multiple comparisons with other interventions, though there are no studies comparing it to haemorrhoidal artery ligation. A recent overview has been carried out by the National Institute for Health and Clinical Excellence which concludes that current evidence shows haemorrhoidal artery ligation to be a safe alternative to haemorrhoidectomy and haemorrhoidopexy though it also highlights the lack of good quality data as evidence for the advantages of the technique. Methods/design The aim of this study is to establish the clinical effectiveness and cost effectiveness of haemorrhoidal artery ligation compared with conventional rubber band ligation in the treatment of people with symptomatic second or third degree (Grade II or Grade III haemorrhoids. Design: A multi-centre, parallel group randomised controlled trial. Outcomes: The primary outcome is patient-reported symptom recurrence twelve months following the intervention. Secondary outcome measures relate to symptoms, complications, health resource use, health related quality of life and cost effectiveness following the intervention. Participants: 350 patients with grade II or grade III haemorrhoids will be recruited in surgical departments in up to 14 NHS hospitals. Randomisation: A multi-centre, parallel group randomised controlled trial. Block randomisation by centre will be used, with 175 participants randomised to each group. Discussion The results of the research will help inform future practice for the treatment of grade II and III haemorrhoids. Trial Registration ISRCTN41394716

  19. The HubBLe trial: haemorrhoidal artery ligation (HAL) versus rubber band ligation (RBL) for haemorrhoids.

    Tiernan, Jim; Hind, Daniel; Watson, Angus; Wailoo, Allan J; Bradburn, Michael; Shephard, Neil; Biggs, Katie; Brown, Steven


    Haemorrhoids (piles) are a very common condition seen in surgical clinics. After exclusion of more sinister causes of haemorrhoidal symptoms (rectal bleeding, perianal irritation and prolapse), the best option for treatment depends upon persistence and severity of the symptoms. Minor symptoms often respond to conservative treatment such as dietary fibre and reassurance. For more severe symptoms treatment such as rubber band ligation may be therapeutic and is a very commonly performed procedure in the surgical outpatient setting. Surgery is usually reserved for those who have more severe symptoms, as well as those who do not respond to non-operative therapy; surgical techniques include haemorrhoidectomy and haemorrhoidopexy. More recently, haemorrhoidal artery ligation has been introduced as a minimally invasive, non destructive surgical option.There are substantial data in the literature concerning efficacy and safety of 'rubber band ligation including multiple comparisons with other interventions, though there are no studies comparing it to haemorrhoidal artery ligation. A recent overview has been carried out by the National Institute for Health and Clinical Excellence which concludes that current evidence shows haemorrhoidal artery ligation to be a safe alternative to haemorrhoidectomy and haemorrhoidopexy though it also highlights the lack of good quality data as evidence for the advantages of the technique. The aim of this study is to establish the clinical effectiveness and cost effectiveness of haemorrhoidal artery ligation compared with conventional rubber band ligation in the treatment of people with symptomatic second or third degree (Grade II or Grade III) haemorrhoids. A multi-centre, parallel group randomised controlled trial. The primary outcome is patient-reported symptom recurrence twelve months following the intervention. Secondary outcome measures relate to symptoms, complications, health resource use, health related quality of life and cost effectiveness following the intervention. 350 patients with grade II or grade III haemorrhoids will be recruited in surgical departments in up to 14 NHS hospitals. A multi-centre, parallel group randomised controlled trial. Block randomisation by centre will be used, with 175 participants randomised to each group. The results of the research will help inform future practice for the treatment of grade II and III haemorrhoids. ISRCTN41394716.

  20. HAL/SM system functional design specification. [systems analysis and design analysis of central processing units

    Ross, C.; Williams, G. P. W., Jr.


    The functional design of a preprocessor, and subsystems is described. A structure chart and a data flow diagram are included for each subsystem. Also a group of intermodule interface definitions (one definition per module) is included immediately following the structure chart and data flow for a particular subsystem. Each of these intermodule interface definitions consists of the identification of the module, the function the module is to perform, the identification and definition of parameter interfaces to the module, and any design notes associated with the module. Also described are compilers and computer libraries.

  1. Human-rating Automated and Robotic Systems - (How HAL Can Work Safely with Astronauts)

    Baroff, Lynn; Dischinger, Charlie; Fitts, David


    Long duration human space missions, as planned in the Vision for Space Exploration, will not be possible without applying unprecedented levels of automation to support the human endeavors. The automated and robotic systems must carry the load of routine housekeeping for the new generation of explorers, as well as assist their exploration science and engineering work with new precision. Fortunately, the state of automated and robotic systems is sophisticated and sturdy enough to do this work - but the systems themselves have never been human-rated as all other NASA physical systems used in human space flight have. Our intent in this paper is to provide perspective on requirements and architecture for the interfaces and interactions between human beings and the astonishing array of automated systems; and the approach we believe necessary to create human-rated systems and implement them in the space program. We will explain our proposed standard structure for automation and robotic systems, and the process by which we will develop and implement that standard as an addition to NASA s Human Rating requirements. Our work here is based on real experience with both human system and robotic system designs; for surface operations as well as for in-flight monitoring and control; and on the necessities we have discovered for human-systems integration in NASA's Constellation program. We hope this will be an invitation to dialog and to consideration of a new issue facing new generations of explorers and their outfitters.


    Putu Sumiasi


    Full Text Available The article entitled The Withdrawal of the Leasing Object in the event ofCustomer’s Default in Payment. The main issue discussed is that whether thewithdrawal of the leasing object is acceptable by the law in the event ofcustomer’s default in payment.The research in this paper is classified as a Normative Legal research, whichis based on primary and secondary legal materials. The approach taken was thestatutory and the analytical conceptual approach.The research results indicate that with the withdrawal of leasing object in alease agreement by the creditor according to law (under the provisions of Article 1338of Indonesian Civil Code can be justified and lawful. The agreement of waivingthe provisions of article 1266 of paragraph 2 of Indonesian Civil Codebinding on the partie based on the principle of freedom of contract

  3. Radiology trainer. Head and neck. 2. ed.; Radiologie-Trainer. Kopf und Hals

    Staebler, Axel [Radiologie Muenchen-Harlaching (Germany); Erlt-Wagner, Birgit [Klinikum der Universitaet Muenchen (Germany). Inst. fuer Klinische Radiologie; Hartmann, Marius (eds.) [HELIOS Klinikum Berlin-Buch (Germany). Inst. fuer Neuroradiologie


    The radiology training textbook is based on case studies of the clinical experience, including radiological imaging and differential diagnostic discussion. The scope of this volume is head - neck. The following issues are covered: tumor diseases, vascular diseases, infectious and inflammatory diseases and white matter diseases, congenital malformations, traumatic diseases, cranium and basis of the skull, eye socket, facial bones, neck, spinal canal.

  4. Prognostiske faktorer af betydning for den recidivfrie overlevelse efter kirurgisk behandling af hoved-hals-melanom

    Andersson, A P; Gottlieb, J; Søndergaard, K;


    The clinico-pathological and therapeutic data of 512 patients with clinical stage I invasive head and neck melanoma of the skin were re-evaluated. There were 287 females and 225 males. The median age at primary surgery was 65 years, range 18 to 96 years. The median observation period was 5 years...

  5. 右美托咪定预防妇科腹腔镜全身麻醉苏醒期躁动及对认知功能的影响%Dexmedetomidine Prevention of Restlessness in Recovery Period of General Anesthesia for Laparos-copy and Its Effect on Cognitive Function



    目的:探讨右美托咪定预防妇科腹腔镜患者全身麻醉苏醒期躁动及对认知功能的影响。方法选择2014年1月至2015年3月大连市妇女儿童医疗中心收治的行妇科腹腔镜手术的女性患者80例作为研究对象,依据抽签法随机分为试验组和对照组,各40例。对照组患者给予常规的麻醉,试验组患者在此基础上于手术结束前30 min 静脉泵注0.5μg/kg 右美托咪定,15 min 内完成。比较两组患者麻醉苏醒期间的镇静评分、躁动评分、寒战评分、不良反应及认知功能。结果试验组镇静评分、躁动评分、寒战评分均高于对照组[(3.73±0.13)分比(1.48±0.10)分,(92.1±2.3)分比(79.6±2.4)分,(93.2±2.4)分比(79.8±1.3)分],差异有统计学意义(P<0.01)。术后,试验组简易精神状态评价量表评分低于对照组[(25.4±1.0)分比(27.5±0.7)分],差异有统计学意义(P<0.01)。试验组总不良反应发生率低于照组[7.5%(3/40)比35.0%(14/40)],差异有统计学意义( P<0.05)。结论右美托咪定预防妇科腹腔镜患者全身麻醉苏醒期躁动及寒战具有显著的临床效果,对认知功能影响小,值得推广。%Objective To explore dexmedetomidine prevention of restlessness in recovery period of gen-eral anesthesia for gynecological laparoscopy restlessness and its effect on cognitive function .Methods Total of 80 female patients admitted to Women and Children Health Care Center of Dalian from Jan .2014 to Mar. 2015 were selected as the research objects,all the patients were randomly assigned to the trial group and the control group according to lottery method,40 patients each.The control group was treated with routine anes-thesia treatment,while the trial group was given dexmedetomidine by 0.5 μg/kg half an hour before the end of surgery,administered within 15 min.The anesthesia sedation score,agitation score

  6. Curative effect of laparoscopic conservative operation and laparoscopy combined with methotrexate in treat-ment of ectopic pregnancy%单纯腹腔镜保守性手术和腹腔镜联合氨甲喋呤治疗异位妊娠的疗效比较

    马建芳; 刘丽娜


    目的:比较单纯应用腹腔镜保守性手术和腹腔镜保守性手术联合氨甲喋呤(MTX)治疗未破异位妊娠的疗效。方法:将我院2009年3月至2012年5月收治的65例有生育要求的未破裂型输卵管妊娠患者分别采用单纯腹腔镜保守手术(单纯手术组)和腹腔镜保守性手术联合氨甲喋呤(联合治疗组)进行治疗,其中单纯手术组32例,联合治疗组33例。观察两组患者的治愈率、血β-HCG下降至正常的时间和术后持续性异位妊娠的发生率。于1年半内观察随访宫内妊娠的成功率和异位妊娠复发率。结果:腹腔镜保守性手术联合氨甲喋呤治疗异位妊娠的治愈率高、住院时间短、血β-HCG降至正常的时间快且持续性异位妊娠的发生率低,差异有统计学意义(P<0.05)。治疗后1年半内联合治疗组再次妊娠率显著高于单纯手术组,差异有统计学意义(P<0.05)。结论:腹腔镜保守性手术联合氨甲喋呤治疗异位妊娠临床疗效确切,住院时间短,值得在临床上推广,作为有生育要求的异位妊娠患者的首选方案。%Objectives:To compare the curative effect of simple laparoscopic conservative operation and laparoscopy combined with methotrexate (MTX)in the treatment of unruptured ectopic pregnancy.Methods:From March 2009 to May 201 2,65 unruptured tubal pregnancy cases in our hospital were selected,who all had fertility requirements and were treated with laparoscopic conservative operation (simple operation group,32 cases)or lapa-roscopy combined with methotrexate (combined treatment group,33 cases).The cure rate,time needed for serumβ-HCG decreased to normal and the incidence rate of postoperative persistent ectopic pregnancy of the two groups were compared.In one and a half years’follow-up,the intrauterine pregnancy success rate and recurrence rate of ectopic pregnancy of both groups were compared.Results:In the treatment of

  7. 腹腔镜联合胃镜治疗胃底部间质瘤32例报告%The resection of gastric stromal tumors in the gastric fundus with laparoscopy combined with gastroscopy: a report of 32 cases

    高红雷; 孙作成; 徐文广


    Objective: To discuss the security, feasibility and prospect of resection of gastric stromal tumors (GSTs) in the gastric fundus with laparoscopy combined with gastroscopy. Methods: The clinical data of 32 patients with GSTs in the gastric fundus who underwent resection with laparoscopy combined with gastroscopy from Dec. 2009 to Feb. 2008 were retrospectively analyzed. Twenty-five of them underwent gastroscopy assisted laparoscopic wedge resection of the stomach, and 7 of them underwent gastroscopy assisted lapa-roscopic endoorgan resection of gastric wall tumors. Results: All the 32 surgeries were accomplished successfully. No complications such as rupture of tumors or stenosis of stomach cavity occurred. No convension to laparotomy occurred. The mean operative time was (81.4 ± 25.7) min,the mean intraoperative blood loss was (38. 2 ± 16. 1 ) ml, recovery time of intestinal tract function was (34. 6 ± 3. 8) h,the mean time to take food was (58. 6 ± 10. 8) h and the mean postoperative hospital stay was (4. 6 ± 1. 3) d. The postoperative pathological margin was negative in all patients,and no stenosis of gastric cavity was found in 3 months after operation by gastroscopy and barium meal. No recurrence or distant metastasis occurred during the following-up of ( 14. 8 ±3. 4) m by X-ray,B-ultrasound and CT scan examination. Conclusions: It is helpful to find and diagnose GSTs and predict the risk before operation by the gastroscopy and endoscopic ultrasonography. For the GSTs in the gastric fundus, laparoscopic gastric partial resection is safe and effective with the location of gastroscopy. This procedure fits to the therapeutic criteria of GSTs and has advantages of minimal invasion, good prognosis and reduction of the rate of cardial stenosis.%目的:探讨腹腔镜联合胃镜治疗胃底部间质瘤的安全性、可行性及发展前景.方法:回顾分析2009年12月至2012年2月为32例胃底部间质瘤患者行腹腔镜结合胃

  8. Day surgery for gynaecological laparoscopy: Clinical results from an RCT

    Gudex, Claire; Sørensen, Jan; Clausen, Ingo


    improvements (p pain; similar proportions (64% and 74%, respectively) experienced postoperative nausea; 39% of inpatients and 58% of ambulatory patients reported problems after hospital discharge. Severity of pelvic pain was lower for both groups 1 month after operation...

  9. Assessment of construct validity of a virtual reality laparoscopy simulator.

    Rosenthal, Rachel; Gantert, Walter A; Hamel, Christian; Hahnloser, Dieter; Metzger, Juerg; Kocher, Thomas; Vogelbach, Peter; Scheidegger, Daniel; Oertli, Daniel; Clavien, Pierre-Alain


    The aim of this study was to assess whether virtual reality (VR) can discriminate between the skills of novices and intermediate-level laparoscopic surgical trainees (construct validity), and whether the simulator assessment correlates with an expert's evaluation of performance. Three hundred and seven (307) participants of the 19th-22nd Davos International Gastrointestinal Surgery Workshops performed the clip-and-cut task on the Xitact LS 500 VR simulator (Xitact S.A., Morges, Switzerland). According to their previous experience in laparoscopic surgery, participants were assigned to the basic course (BC) or the intermediate course (IC). Objective performance parameters recorded by the simulator were compared to the standardized assessment by the course instructors during laparoscopic pelvitrainer and conventional surgery exercises. IC participants performed significantly better on the VR simulator than BC participants for the task completion time as well as the economy of movement of the right instrument, not the left instrument. Participants with maximum scores in the pelvitrainer cholecystectomy task performed the VR trial significantly faster, compared to those who scored less. In the conventional surgery task, a significant difference between those who scored the maximum and those who scored less was found not only for task completion time, but also for economy of movement of the right instrument. VR simulation provides a valid assessment of psychomotor skills and some basic aspects of spatial skills in laparoscopic surgery. Furthermore, VR allows discrimination between trainees with different levels of experience in laparoscopic surgery establishing construct validity for the Xitact LS 500 clip-and-cut task. Virtual reality may become the gold standard to assess and monitor surgical skills in laparoscopic surgery.

  10. Laparoscopy-assisted Robotic Myomectomy Using the DA Vinci System

    Shih-Peng Mao


    Conclusion: Minimally invasive surgery is the trend of the future. Robot-assisted laparoscopic surgery is a new technique for myomectomy. This robotic system provides a three-dimensional operative field and an easy-to-use control panel, which may be of great help when applying the suturing techniques and may shorten the learning curve. More experience with and long-term follow-up of robotic surgery may be warranted to further validate the role the robot-assisted approach in gynecologic surgery.

  11. Laparoscopy in 100 consecutive patients with 128 impalpable testes

    Cortes, D; Thorup, J M; Lenz, K


    ; in the remainder, cord structures could be seen passing through the ring, indicating an intracanalicular testis. The impalpable testis was absent in 77% of patients with a contralateral scrotal testis. A seminoma was found in one 18.6-year-old patient with bilateral cryptorchidism. No intratubular germ cell...

  12. [Infusional therapy: an alternative for shouder pain post-laparoscopy].

    Ureña-Frausto, Cielo Alborada; Plancarte-Sánchez, Ricardo; Reyes-Torres, Juan Ignacio; Ramírez-Aranda, José Manuel


    Neuraxial anesthesia in upper abdominal laparoscopic surgery decreases perioperative morbidity and mortality. However, shoulder pain is common and difficult to control. Use of a major opioid (e.g., fentanyl) for the control of this event may depress respiratory function. This is why we believe that a safe and effective therapeutic control of this disease pain is a multimodal analgesic scheme which we have called infusional therapy. To compare various schemes for controlling shoulder pain secondary to pneumoperitoneum. Nonrandomized clinical trial with 56 patients ASA I-II divided into four groups undergoing laparoscopic cholecystectomy. Group I (n= 15) managed with ketorolac 1 mg kg, group II (n = 12) ketoprofen 100 mg, group III (n = 14) ketoprofen 50 mg + 50 mg tramadol, and group IV (n = 15) ketoprofen 100 mg + 100 mg tramadol. The following ariables were analyzed: presence and intensity of pain, analgesia rescue and operative time. Group I had more shoulder pain events compared to other groups (p= 0.002) in the same way the group IV required less rescue analgesia (p= 0.034). preemptive analgesia to infusional therapy with ketoprofen-tramadol at doses of 100 mg each is safe for laparoscopic surgery.

  13. Clinical Analysis of 5 Cases of Laparoscopy in Pregnant Patients

    杨佳欣; 冷金花; 郎景和


    @@ Five pregnant patients were given laparoscopicsurgery in PUMCH in recent two years. All the pa-tients have the indications for operation. The age ofthe patients was 25 to 33 years old. The operationwas done in the first and second trimester. The dura-tion of the operation was about 30 mins with no ma-nipulation of the cervix.