http://www.laparoscopyhospital.com Laparoscopy Hospital is dedicated for Laparoscopic Treatment Training and Research. It contains free Laparoscopic Pictures, Laparoscopic Videos, Laparoscopic operative procedures and Laparoscopic course for surgeon and Gynaecologist. Free laparoscopic advice for patient is also provided. en http://www.laparoscopyhospital.com/wals.gif http://www.laparoscopyhospital.com http://www.laparoscopyhospital.com/laparoscopic_presacral_neurectomy.htm drebubekirr@msn.com Approximately 20% of all patient visits to gynaecologist are suffering from pelvic pain. Pelvic pain can arise from a number of observable disorders or functional disorders in which obvious pathology is not present. The acute onset of pelvic pain is almost always related to an episodic event, such as ovulation, a rupturing ovarian cyst, or possible an ectopic pregnancy. CPP on the other hand is usually related to an evolving disorder such as endometriosis, pelvic adhesions, a slowly enlarging fibroid tumour or an ovarian cyst. In many cases where no definitive cause of chronic pain in females of reproductive age group is established, the PSN is one of the good options. New standards have been established for various indications. Patient comfort is a great consideration in the 21st century. The acquisition of recent technology and skills now affords a better choice of the mode of surgery. This document reviews the recent advances in treatment technique applicable to LPSN, examines the literature, and suggests guidelines for laparoscopic intervention in patients with CPP. http://www.laparoscopyhospital.com/snehal.htm snehalkshama@yahoo.com The aim of this review article is to compare the effectiveness and safety of laparoscopic and conventional open repair in the treatment of inguinal hernia. A literature review was performed using Springer link, Bmj, Journal of MAS and major general search engines like Google, MSN, and Yahoo etc. The following search terms were used: Laparoscopic inguinal hernia repair, Hernioplasty and Laparoscopic vs. open inguinal hernia repair. 1,600 citations found in total selected papers were screened for further references. Criteria for selection of literature were the number of cases excluded if less than 20, methods of analysis statistical or non statistical, operative procedure only universally accepted procedures were selected and the institution where the study was done Specialized institution for laparoscopic inguinal hernia repair were given more preference. http://www.laparoscopyhospital.com/Research.htm md@laparoscopyhospital.com We hypothesize that task performance improves with the use of balanced degree of shadow and illumination compared to no or maximum shadow contrast and shadow-casting illumination from above compared to the side of the operative field. The standard task entailed touching target points on an undulating surface using a surgical hook. Each run consisted of 13 target points in a random sequence. The end points for each run were the execution time and number of errors. There is a need to develop a system that illuminates the operative field from above in order to create optimum shadow for endoscopic task performance. Fibre-optic light bundles can be deployed inside a super-elastic diverging shape memory alloy tubes to provide ceiling shadow-casting illumination. Such system also provides a balance between illumination and shadow contrast. Further research is required to develop the ideal shadow-producing video-endoscopic system. http://www.laparoscopyhospital.com/Research.htm md@laparoscopyhospital.com Laparoscopic appendectomy is equally safe, and can provide less postoperative morbidity in experienced hands, as open appendectomy. Most cases of acute appendicitis can be treated laparoscopically. Laparoscopic appendectomy is a useful method for reducing hospital stay, complications and return to normal activity. With better training in minimal access surgery now available, the time has arrived for it to take its place in the surgeons repertoire. http://www.laparoscopyhospital.com/laparoscopic_research_at_laparoscopy_hospital.htm md@laparoscopyhospital.com While laparoscopy has been an enormous advance from open surgery, recent development in microfibres and lenses have seen the creation of even tinier laparoscopes measuring two to four millimeters which are known as micro and mini laparoscopes, respectively. At the same time, small laparoscopic instruments have been produced and so the total laparoscopic procedure can be performed with incisions of two to four millimeters. Conventional laparoscopy uses a 10 mm umbilical incision for the laparoscope and 5 mm to 10 mm incisions elsewhere. Because of the small diameter of the micro and mini laparoscopes, under suitable circumstances surgeries may be performed without general anesthesia. http://www.laparoscopyhospital.com/dr_fadhil_yaba_muhamed.htm editor@laparoscopyhospital.com Ventral hernia occur as a result of weakness in the musculofacial layer of anterior abdominal wall, the most popular classifications are congenital, acquired, incisional and traumatic. According to several medical literatures the successful series of laparoscopic repair for ventral hernia were done by LeBlanc in 1993. Since then it has been proved that to be accepted surgical technique. New standards have been noted for various indication, contraindication, light mesh in incisional hernia, which is considered as a common surgical complication with long term incidence of ten to twenty percent and controversies in laparoscopic repair, operative costs may be optimized with selection of mesh and optimal use of transabdominal suture and fixation device. This review article reveals the recent advances and progression in laparoscopic ventral hernia repair technique even in patient with morbid obesity and old adult with incisional hernia. http://www.laparoscopyhospital.com/dr_mohamad.htm editor@laparoscopyhospital.com The incidence of perforated Duodenal Perforation remains the same. Operative treatment of perforated duodenal ulcer consists of time honoured practice of omental patch closure but now this can be done by laparoscopic method . Laparoscopic approaches to closure of duodenal perforation are now being applied widely and may become the gold standard in the future especially in patient with less than 10mm perforation size presented with in the first 24 hrs of onset of pain. Perforated duodenal ulcer is a surgical emergency. Urgent simple closure of the perforation with omental patching is widely applied for the vast number of these patients the general consensus is to perform simple closure alone without definite procedures especially patients with poor surgical risks and sever peritonitis. Various laparoscopic techniques have been advocated for closing the perforation intra and extra corporeal knots, sutureless techniques, holding the omental patch by fibrin glue or sealing with a gelatin sponge, stapled patch closure, or gastroscopically aided management in the perforation. Many surgeons has reported patient with sealed perforation by peritoneal lavage and drainage only. http://www.laparoscopyhospital.com/minimal_access_robotic_surgery.htm md@laparoscopyhospital.com Although minimally invasive prostate removal aided by a robot can lead to less blood loss, shorter hospital stays and fewer complications, there is no evidence that the procedure improves cure rates, according to a new technology assessment. http://www.laparoscopyhospital.com/LAPAROSCOPIC VERSUS OPEN MANAGEMENT OF ADNEXAL TORSION.htm md@laparoscopyhospital.com Adnexal torsion is a rare gynecologic emergency of women at reproductive ages but may cover pregnancy, childhood, adolescence and pre and postmenopausal periods. Since it covers women who desire fertility in future, early diagnosis and conservative adnexa- sparing surgery is very important. Laparoscopic adnexal detorsion of the torted adnexa with blunt instruments and if necessary cyst excision is the treatment of choice in all women except pre and post menopausal period because of suspicion of malignancy is more. Detorsion must be performed even in necrotic appearing adnexa because of a high rate of survival of ovaries even looking necrotic. Laparoscopy surgery must be the choice for less post operative morbity, and a better cosmetic appearance. Laparoscopic procedures in pregnancy are also safe and fetal and maternal outcome is comparable to laparotomy.The literature supports laparoscopic surgery in carefully selected cases for adnexal torsion. http://www.laparoscopyhospital.com/Role of Laparoscopy In Ascites.htm md@laparoscopyhospital.com Laparoscopy has a valuable roles in diagnosis, preoperative assessment, and therapy of ascites.It was used in diagnosis and to confirm the diagnosis in ascites of unknown origin which could be cirrhotic or non cirrhotic as carcinoma peritoneie, tuberculous peritonitis or nephrogenic origin. It is also used in preoperative assessment and staging of gastric, pancreatic and liver tumour.Thrapeutic roles was also discussed as in hemorrhagic pancreatitis, chylous ascitis and catheter placement for dialysis. Precautions and operative procedures also discussed. http://www.laparoscopyhospital.com/A comparison of laparoscopy and laparotomy for the treatment of Ectopic pregnancy.htm md@laparoscopyhospital.com A review of studies comparing laparoscopy versus laparotomy for the treatment of ectopic pregnancy. This review compared 8 studies in multiple countries. The consensus favored laparoscopic surgery for hemodynamically stable patients. http://www.laparoscopyhospital.com/A comparison of laparoscopy and laparotomy for the treatment of Ectopic pregnancy.htm md@laparoscopyhospital.com Preventable laparotomy in patients with abdominal trauma who present with haemoperitoneum but with stable hemodynamics may be avoided if a diagnostic or therapeutic laparoscopy is performed. The assessment of a patient with abdominal trauma can be complicated by many factors, and the resultant inaccurate or delay in diagnosis has contributed to the unacceptable high mortality and morbidity for this type of injury. Diagnostic laparoscopy for the evaluation of injuries in patients with abdominal trauma has been shown to decrease the morbidity and mortality associated with mandatory laparotomy.The prognosis of abdominal trauma depends in most cases not only on the extent of existing injuries but also on prompt therapy. Thus, diagnostic measures have to clarify rapidly and accurately whether laparotomy has to be performed or not. Difficulties in decision for the surgeon arise especially in cases of abdominal trauma where diagnostic imaging (ultrasonography, CT scan) do not lead to clear-cut results. The use of laparoscopy as a diagnostic method dates back to the first decades of this century. Laparoscopic surgical techniques were first used by gynecologists and later, in 1989, Dubois performed the first cholecystectomy using a laparoscopic approach. Since then, in the space of a few years, there has been an overwhelming spread of video laparoscopic operating methods, extending the therapeutic possibilities to gastroenterological surgery, as well as to thoracic, oncological, urological, and of course, gynecological surgery. The use of the laparoscope as a diagnostic method in abdominal trauma was proposed in the 70s by a number of authors, but only now, due to technological progress and the constant use of elective laparoscopic surgery, have surgeons been able to use this method for the diagnosis and treatment of patients with blunt or penetrating abdominal trauma. Rather than open laparotomy, laparoscopy can be used safely and effectively for the diagnosis and treatment of traumatic abdominal injuries. The following study was undertaken to find out the role of minimal invasive surgery in the diagnosis and management of abdominal trauma. http://www.laparoscopyhospital.com/Laparoscopic Assisted Vaginal Hysterectomy Versus Vaginal Hysterectomy for Non prolapsed Uterus.htm md@laparoscopyhospital.com Hysterectomy is one of the commonest gynecological operations. The outcomes following vaginal hysterectomy have been proved to be better than those following abdominal hysterectomy. Since the availability and widespread use of laparoscopic hysterectomy, the mode of hysterectomy is an issue of debate in cases of non prolapsed uteri, amongst proponents of vaginal and laparoscopic surgery. Laparoscopic surgeons propose that with the aid of laparoscope, a potential abdominal hysterectomy can be converted to a vaginal one and a difficult vaginal hysterectomy can be converted into a fairly simple vaginal hysterectomy. Laparoscopy can facilitate surgery vaginally in cases of suspected adnexal disease, endometriosis, narrow vagina and in cases where uterine size is greater than 12 weeks gestation. Many gynecologists however routinely perform salpingo ophorectomy and vaginal hysterectomy for nulliparous uteri. Vaginal hysterectomy is the route of choice for benign uterine disease. Size of uterus, previous pelvic surgery, mild endometriosis, uterine fibroids, and history of pelvic infections should not be considered as absolute contraindications for vaginal surgery. There are few trials comparing the outcomes of laparoscopic assisted vaginal hysterectomy versus vaginal hysterectomy .This article compares these outcomes and presents difference in outcomes in terms of operating time, estimated blood loss, analgesia and post-operative pain relief, recovery milestones, hospital stay and cost effectiveness, complication rates and patient satisfaction. Laparoscopic approach has definite advantages in cases of severe endometriosis, selected patients with a suspicion of coexisting pathology and post operatively to rule out hemorrhage. http://www.laparoscopyhospital.com/THE IMPACT OF THE LEARNING CURVE IN LAPAROSCOPIC SURGERY.htm md@laparoscopyhospital.com Hysterectomy is one of the commonest gynecological operations. The outcomes following vaginal hysterectomy have been proved to be better than those following abdominal hysterectomy. Since the availability and widespread use of laparoscopic hysterectomy, the mode of hysterectomy is an issue of debate in cases of non prolapsed uteri, amongst proponents of vaginal and laparoscopic surgery. Laparoscopic surgeons propose that with the aid of laparoscope, a potential abdominal hysterectomy can be converted to a vaginal one and a difficult vaginal hysterectomy can be converted into a fairly simple vaginal hysterectomy. Laparoscopy can facilitate surgery vaginally in cases of suspected adnexal disease, endometriosis, narrow vagina and in cases where uterine size is greater than 12 weeks gestation. Many gynecologists however routinely perform salpingo ophorectomy and vaginal hysterectomy for nulliparous uteri. Vaginal hysterectomy is the route of choice for benign uterine disease. Size of uterus, previous pelvic surgery, mild endometriosis, uterine fibroids, and history of pelvic infections should not be considered as absolute contraindications for vaginal surgery. There are few trials comparing the outcomes of laparoscopic assisted vaginal hysterectomy versus vaginal hysterectomy .This article compares these outcomes and presents difference in outcomes in terms of operating time, estimated blood loss, analgesia and post-operative pain relief, recovery milestones, hospital stay and cost effectiveness, complication rates and patient satisfaction. Laparoscopic approach has definite advantages in cases of severe endometriosis, selected patients with a suspicion of coexisting pathology and post operatively to rule out hemorrhage. http://www.laparoscopyhospital.com/Diagnostic Laparoscopy Versus Exploratory Laparotomy.htm md@laparoscopyhospital.com Diagnostic laparoscopy is a minimally invasive surgical procedure that allows the visual examination and documentation of intra abdominal organs in order o detect any pathology. Diagnostic laparoscopy was first introduced in 1901, when kelling, performed a peritoneoscopy in a dog and was called Celioscopy. A Swedish internist named Jacobaeuse its credited with performing the first Diagnostic laparoscopy on human in 1910. He described its application in patient with ascites and for the early diagnosis of malignant lesion. Elective diagnosis laparoscopy refers to the use of the procedure in chronic intra-abdominal disorders. Emergency diagnostic laparoscopy is performed in patients presenting with acute abdomen. This document describe compare the diagnostic laparoscopy with exploratory laparotomy. Diagnostic laparoscopy is safe well tolerated and can be performed in an outpatient and inpatient setting under general anaesthesia. http://www.laparoscopyhospital.com/THE IMPACT OF THE LEARNING CURVE IN LAPAROSCOPIC SURGERY.htm md@laparoscopyhospital.com T.P.Wright originally introduced the concept of a learning curve in aircraft manufacturing in 1936. He described a basic theory for costing the repetitive production of airplane assemblies. The term was introduced to medicine in the 1980s after the advent of minimal access surgery. It also caught the attention of the public and the legal profession when a surgeon told a public enquiry in Britain that a high death rate was inevitable while surgeons were on a learning curve. Recently it has been labeled as a dangerous curve with a morbidity, mortality and unproven outcomes. Yet there is no standardization of what the term means. In  an endeavor to help laparoscopic surgeons towards evidence based practices this commentary will define and describe the learning curve, its drawing followed by a discussion of the factors affecting it, statistical evaluation, effect on randomized controlled trials and clinical implications for both practice and training, the limitations and pitfalls, ethical dilemmas and some thoughts to pave the way ahead. http://www.laparoscopyhospital.com/EVALUATION OF THE INTRAPERITONEAL (ONLAY) AND THE PREPERITONEAL (INLAY) TECHNIQUES IN LAPAROSCOPIC VENTRAL HERNIA REPAIR.htm md@laparoscopyhospital.com Ventral hernias refer to fascial defects of the anterolateral abdominal wall through which intermittent or continuous protrusion of abdominal tissue or organs may occur. They are either congenital or acquired. In adults more than 80% of ventral hernias result from previous surgery hence the term incisional hernias. They have been reported to occur after 0-26% of abdominal procedures. Although these hernias mostly become clinically manifest between 2 to 5 years after surgery, studies have shown that, the process starts within the first postoperative month. They are said to occur as a result of a biomechanical failure of the acute fascial wound coupled with clinically relevant impediments to acute tissue repair and normal support function of the abdominal wall. The objective of this review was to compare the efficacy and safety of these two LVHR techniques by analysing the evidence in available literature. It has suggested that, the proposed laparoscopic preperitoneal placement of prostheses seems to negate most of the positive attributes of the intraperitoneal approach to LVHR in most ways. The proposed new technique may be advantageous in small primary hernias, in a highly selected patients population. However, it may not be of benefit to the majority of patients that usually present with this structural disability.