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Laparoscopy - always the superior alternative?

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Laparoscopy - always the superior alternative?

01/08/2002

Laparoscopy has been established as the standard procedure in many fields of surgery, but it is nevertheless still open to discussion in many others. MEDICA.de highlights some recent comparative research:

Laser laparoscopy for endometriosis

A research team by the Minimal Access Therapy Training Unit, Guildford, critically evaluates the evidence for the laparoscopic management of endometriosis and endometriotic cysts.

Endometriosis, a common condition for women during their reproductive years, is diagnosed at laparoscopy, and operative laparoscopic surgery for endometriosis is also possible.
So far, few randomized controlled trials have been undertaken to evaluate the surgical management of endometriosis.

The 61 women involving study showed very little difference between the two groups at 3 months postoperation, but at 6 months the difference reached statistical significance and 62.5% of the patients who had the laparoscopic laser treatment had sustained pain relief. Only 22.6% of the patients who had no treatment stated they were better. The authors conclude therefore that endoscopic surgery should be the treatment of choice for patients with endometriosis and endometriotic cysts. - Surg Endosc 2002 Jul 29; [epub ahead of print]

Wound Complications of Laparoscopic vs Open Colectomy

A team by Washington University School of Medicine conducted a study to determine if laparoscopic colon surgery has changed the incidence of wound complications after colon resection.

The trial focused on eighty-three patients to undergo either laparoscopic (LCR) or open colon resection (OCR) for cancer. LCR was performed using a limited midline incision for anastomosis and specimen extraction.

Incision length was significantly greater in the OCR group (19.4 +/- 5.6 cm) compared to the LCR extraction site (6.3 +/- 1.4 cm). Wound infections occurred in 13.5% of patients after LCR and in 10.9% of patients after OCR. Over a mean follow-up period incisional hernias developed in 24.3% of patients after LCR and 17.4% after OCR. In the LCR group, extraction sites accounted for 85.7% of all wound complications.

The extraction site for LCR is associated with a high incidence of complications, comparable to open colectomy. Strategies to alter operative technique should be considered to reduce the incidence of these complications, the authors conclude. - Surg Endosc 2002 Jun 27; [epub ahead of print]

Safety and Benefit of Laparoscopic Liver Resections

A team of the Beaujon Hospital in France investigated the safety and benefits of laparoscopic liver resections in patients with benign solid liver tumors.

During their trials, no patient experienced gas embolism or was converted, and clamping of the hepatic pedicle resulted in hemodynamic variations comparable to those observed during open surgery. Duration of surgery (177 vs 156 min.), intraoperative blood loss (218 vs 285 ml), modifications of postoperative liver function tests, and incidence of postoperative complications (10% vs 10%) were comparable to those after open surgery. Laparoscopic resection was associated with a 50% reduction in morphine consumption during the first postoperative days, a reduction of the delay to oral intake and of in-hospital stay.

They conclude that liver resections of up to two segments can be performed by laparoscopy using the same technique as that used during open surgery. However, the benefits observed compared with open surgery appear to be limited, they caution.
- J Hepatobiliary Pancreat Surg 2002;9(2):242-8