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  • 1
    Electronic Resource
    Electronic Resource
    Laparoscopic cholecystectomy (1995)
    Springer
    Surgical endoscopy and other interventional techniques 9 (1995), S. 25-28 
    Details
    ISSN: 1432-2218
    Keywords: Laparoscopic cholecystectomy ; Conversion to open cholecystectomy ; Risk factor analysis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In 1,300 patients undergoing laparoscopic cholecystectomy (LC) 56 patients (4.3%) required conversion to open cholecystectomy (OC); 41 (73%) of the conversions were elective, whereas 15 (27%) were enforced. The causes of the 56 conversions are described and analyzed. Logistic regression analysis of 23 parameters identified the following data as associated with a higher risk for conversion: pain or rigidity in the right upper abdomen (P〈0.01), thickening of the gallbladder wall on preoperative ultrasound (P〈0.05), intraoperatively found dense adhesions to the gallbladder or in Calot's triangle (P〈0.001), and intraoperatively found acute inflammation of the gallbladder (P〈0.01). Clinical findings of an acute cholecystitis associated with intraoperative dense scarring in Calot's triangle were the best factors predicting conversion from LC to OC. As a result of the study we preoperatively select our patients for either LC or OC, and a difficult case is performed by a more experienced surgeon to keep conversion rate and complications low.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00187880
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  • 2
    Electronic Resource
    Electronic Resource
    EAES ductal stone study (1996)
    Springer
    Surgical endoscopy and other interventional techniques 10 (1996), S. 1130-1135 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Ductal calculi—Endoscopic sphincterotomy— Laparoscopic Ductal Clearance—Randomized controlled clinical trial
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: The current management of patients with ductal calculi and gallstone disease consists of endoscopic stone extraction (ESE) followed by laparoscopic cholecystectomy (LC). The advent of techniques of laparoscopic ductal stone clearance has introduced an alternative single stage laparoscopic treatment for these patients. The EAES ductal stone trial was set up to compare the relative efficacy and outcome of these two management options. Methods: The study consists of a prospective randomized controlled clinical trial comparing two management options of patients undergoing LC and suspected of harbouring common duct stones. Patients registered into the trial are randomized to one of two arms: (i) Group A—preoperative ERC with ESE followed by LC during the same hospital admission. (ii) Group B—single stage laparoscopic management consisting of LC and laparoscopic stone extraction either by the trans-cystic duct route or by direct supraduodenal common duct exploration. Results: This preliminary analysis was carried out on 207 randomized patients with comparisons being made on the intention to treat principle. The two groups (A = 106, B = 101) were comparable with respect to clinical features. ASA grade, serum biochemistry and ultrasound findings. Conclusions: These preliminary findings indicate equivalent success rates and patient morbidity between the two management options but a shorter hospital stay (cost benefit) with the single stage laparoscopic treatment. Trans-cystic duct extraction is a more benign procedure than laparoscopic supraduodenal CBD exploration and is accompanied by a significantly shorter hospital stay. The higher incidence of conversion in the single stage laparoscopic group compared to the two-stage arm is due to the preference for open common duct exploration when the laparoscopic attempt failed by the majority of participating surgeons. The results to-date suggest that in fit patients, single stage laparoscopic treatment is the better option and the role of ESE should change to selective use in those patients in whom laparoscopic ductal stone extraction has failed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649900264
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  • 3
    Electronic Resource
    Electronic Resource
    A diagnostic score to predict the difficulty of a laparoscopic cholecystectomy from preoperative variables (1998)
    Springer
    Surgical endoscopy and other interventional techniques 12 (1998), S. 148-150 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Laparoscopic cholecystectomy — Difficult laparoscopic cholecystectomy — Score model — Conversion to open cholecystectomy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Modified logistic regression analysis of 24 variables in 300 patients undergoing laparoscopic cholecystectomy found the following parameters independently predictive for a difficult operation: right upper quadrant pain (p 〈 0.01), rigidity in right upper abdomen (p 〈 0.01), previous upper abdominal surgery (p 〈 0.01), biliary colic within the last 3 weeks (p 〈 0.05), white blood cell count 〉10 × 109/l (p 〈 0.05), thickening of the gallbladder wall (p 〈 0.05), hydroptic gallbladder (p 〈 0.05), pericholecystic fluid (p 〈 0.01), shrunken gallbladder (p 〈 0.01), and no filling of the gallbladder in preoperative intravenous cholangiography (p 〈 0.05). Methods: Based on these variables a diagnostic model was developed to predict the difficulty of a laparoscopic cholecystectomy, with scores ranging from 0 (ideal case) to IV (conversion to open cholecystectomy expected) prior to surgery. Results: When the reliability of our model was examined in a second study in 340 consecutive patients undergoing laparoscopic cholecystectomy 80% of the patients were predicted correctly. Conclusions: Our model should help to select patients for either laparoscopic or open cholecystectomy based on the expected difficulties and the experience of the surgeon.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649900616
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  • 4
    Electronic Resource
    Electronic Resource
    Videothoracoscopy for the management of mediastinal mass lesions (1996)
    Springer
    Surgical endoscopy and other interventional techniques 10 (1996), S. 715-717 
    Details
    ISSN: 1432-2218
    Keywords: Videothoracoscopy ; Mediastinal mass lesion ; Adenopathy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: The indications for video-assisted thoracoscopy have steadily expanded during recent years and include now the management of various mediastinal disorders. Methods: Until now we have used videothoracoscopy for the diagnosis or treatment of mediastinal mass lesions in 28 patients. The indication for the procedure was bilateral or unilateral mediastinal adenopathy in 16, a suspected malignant anterior mediastinal mass lesion in six, and a presumable benign tumor of the posterior or anterior mediastinum in six patients. Results: Video-assisted thoracoscopy provided an accurate tissue diagnosis in all patients with adenopathy and in all but one patient with a malignant mass lesion of the anterior mediastinum. It further allowed complete excision of all benign tumors of the anterior or posterior mediastinum. There were no intra- or postoperative complications, but conversion to open thoracotomy was necessary in one patient. Conclusions: Video-assisted thoracoscopy is a valuable adjunct to traditional surgical techniques for the diagnosis of malignant mediastinal disease and may overcome some of the limitations of mediastinoscopy and mediastinotomy. In the future, it may become the procedure of choice for the resection of small benign tumors of the anterior or posterior mediastinum.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00193041
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  • 5
    Electronic Resource
    Electronic Resource
    Diagnostic laparoscopy through the right lower abdominal incision following open appendectomy (1999)
    Springer
    Surgical endoscopy and other interventional techniques 13 (1999), S. 133-135 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Laparoscopic appendectomy — Diagnostic laparoscopy — Open appendectomy — Acute lower abdominal pain
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Diagnostic laparoscopy through the right lower abdominal incision following open appendectomy for suspected acute appendicitis may help in making the correct diagnosis in the absence of pathology of the appendix. Methods: Fourteen patients with a clinical diagnosis of acute appendicitis underwent diagnostic laparoscopy through the right lower quadrant incision after open appendectomy to exclude further pathology in the case of a noninflamed appendix. Results: In 10 of the 14 patients, laparoscopy helped to correct the diagnosis. In two patients, the etiology of the acute right lower abdominal pain remained unclear. In two others, histological examination showed acute appendicitis despite a normal macroscopic appearance. Conclusions: Diagnostic laparoscopy through the right lower quadrant incision may help to correct the diagnosis in patients who are operated on for clinically acute appendicitis but in whom no acute appendicitis or other pathological findings are seen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649900921
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  • 6
    Electronic Resource
    Electronic Resource
    Laparoscopic removal of dislocated ventriculoperitoneal shunts (1994)
    Springer
    Surgical endoscopy and other interventional techniques 8 (1994), S. 1113-1114 
    Details
    ISSN: 1432-2218
    Keywords: Laparoscopic surgery ; Ventriculoperitoneal shunt complications ; Dislocated hydrocephalus shunt ; Laparoscopic shunt removal
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In two patients the dislocated abdominal catheter of a ventriculoperitoneal (VP) shunt was successfully removed from the abdominal cavity by laparoscopy. Avoiding laparotomy, only two small abdominal incisions were necessary to insert the laparoscope and the grasping forceps. Postoperative course was uncomplicated except for protrusion of a part of the greater omentum through the umbilical incision in one patient. Both patients were mobilized on the operative day. Surgery required only 10 min, provided an excellent view of the entire abdomen, and led to prompt identification and removal of the lost catheter.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00705733
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  • 7
    Electronic Resource
    Electronic Resource
    Gallbladder remnant after laparoscopic cholecystectomy (1995)
    Springer
    Surgical endoscopy and other interventional techniques 9 (1995), S. 844-844 
    Details
    ISSN: 1432-2218
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00190098
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  • 8
    Electronic Resource
    Electronic Resource
    Metabolic responses after laparoscopic or open hernia repair (1996)
    Springer
    Surgical endoscopy and other interventional techniques 10 (1996), S. 628-632 
    Details
    ISSN: 1432-2218
    Keywords: Laparoscopic inguinal hernia ; Shouldice repair ; Metabolic response ; Acute-phase proteins ; Cytokines
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: The purpose of a prospective randomized study was to compare the surgical trauma in patients undergoing laparoscopic or open hernia repair. Methods: Postoperative pain, analgesic consumption, and metabolic response to surgery were assessed in 30 patients undergoing laparoscopic (group 1; n=15) or open (group II; n=15; Shouldice repair) unilateral inguinal hernia repair. Both groups were comparable with respect to age, sex, and type and size of inguinal hernia. Results: Postoperative visual analogue scales (VAS) for pain were reduced on mobilization for patients of group I with a significant difference (P=0.02) on the operative day, whereas pain scores at rest and analgesic requirements were similar for both groups. No differences between groups I and II were found in postoperative levels of interleukin-1, interleukin-6, tumor necrosis factor alpha, Creactive protein, fibrinogen, transferrin, alpha-1-antitrypsin, and white blood cells. Postoperative polymorphonuclear (PMN) elastase concentrations remained within normal range in group II but showed a significant increase in patients operated laparoscopically for postoperative days 1 and 2. Conclusions: No major surgical trauma was found after herniorraphy compared to open hernia repair.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00188515
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  • 9
    Electronic Resource
    Electronic Resource
    Role of laparoscopic surgery in treatment of mesenteric cysts (1999)
    Springer
    Surgical endoscopy and other interventional techniques 13 (1999), S. 937-939 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Mesenteric cyst — Laparoscopy — Cyst resection
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Mesenteric cysts are rare benign intraabdominal lesions without typical clinical findings. Treatment is indicated if they become symptomatic due to enlargement of the cyst. We report 3 patients who were treated by laparoscopic surgery. In 3 patients (3 women, ages 18, 18, 46 years) admitted to our hospital with uncharacteristic abdominal pain, a mesenteric cyst 4.5–18 cm in diameter was diagnosed by ultrasonography and CT scan or MRI. One cyst was partially resected laparoscopically by unroofing of the surface, and the other two were resected completely. There were no intra- or postoperative complications. During follow-up, cyst recurrence was diagnosed in the patient with cyst unroofing 10 months after surgery, and complete cyst resection was successfully performed laparoscopically. Mesenteric cysts can be successfully managed laparoscopically. In order to prevent recurrence, complete resection should be performed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649901140
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  • 10
    Electronic Resource
    Electronic Resource
    Klinische Anwendung der Biopsie des leitenden Lymphknotens beim Mammacarcinom (1998)
    Springer
    Der Chirurg 69 (1998), S. 1072-1076 
    Details
    ISSN: 1433-0385
    Keywords: Key words: Breast cancer ; Sentinel node biopsy ; Axillary lymph node dissection ; Axillary staging. ; Schlüsselwörter: Mammacarcinom ; leitender Lymphknoten ; Axilladissektion ; Axillastaging.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Die Biopsie des leitenden Lymphknotens („sentinel node“, SN) zur Evaluierung des axillären Lymphknotenstatus beim Mammacarcinom stellt bei ausgewählten Patienten eine Alternative zur kompletten Axilladissektion dar. Nach Vorstudien zur Beurteilung der Praktikabilität der SN-Biopsie wurde die Technik bei 23 selektionierten Patientinnen klinisch angewandt. Präoperativ wurde eine Lymphoszintigraphie zur Bestimmung des Lymphabflußgebiets durchgeführt, der SN intraoperativ mit einer Gammakamera und durch Vitalfarbstoffärbung lokalisiert. Zeigte sich der SN im Schnellschnitt tumorinfiltriert, wurde eine komplette Axilladissektion durchgeführt, andernfalls auf eine solche verzichtet. Der SN wurde in allen 23 Fällen gefunden. In 17 von 23 Fällen fand die Schnellschnittuntersuchung einen tumorfreien Lymphknoten, es wurde keine weitere axilläre Dissektion durchgeführt. In der endgültigen histologischen Aufarbeitung zeigte jedoch ein ursprünglich als metastasenfrei beurteilter SN eine Mikrometastasierung, womit eine nachträgliche Axilladissektion in einem 2. Eingriff notwendig wurde. Sechsmal fand sich ein Tumorbefall des SN, eine komplette Axilladissektion der Level I und II wurde durchgeführt. Die intraoperative Biopsie des SN beim Mammacarcinom macht, falls der SN tumorfrei ist, in ausgewählten Fällen, wie kleinen Carcinomen, höheres Alter und günstiger Tumorhistologie/Tumorgrading, eine komplette Axilladissektion überflüssig und verringert somit die damit verbundene Morbidität.
    Notes: Summary. Sentinel lymph node (SN) biopsy in primary breast cancer seems to be an alternative to complete axillary lymph node dissection for evaluation of the axillary lymph node status in selected patients. Following evaluation of the technique of SN biopsy, we applied SN biopsy clinically to 23 selected patients. A lymphoscintigraphy was performed preoperatively to evaluate lymphatic drainage. The SN was identified in the operating room by use of a hand-held gamma camera and a blue vital dye. The SN was found in all 23 patients. In 17/23 the SN was tumor free and no axillary dissection was performed; 6/23 showed a positive SN and complete axillary dissection was done. Intraoperative lymphatic mapping and SN biopsy may be the treatment of choice for evaluation of axillary node status in selected patients, for it combines accurate nodal staging and low morbidity.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00002561
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