Keywords : Laparoscopy


Evaluation of Clinical Parameters that Predict Difficulties During Laparoscopic Cholecystectomy

Karam Kamal Younis; Layth Qassid Al-Harbawi; Omar Abbas Ashoor

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 2, Pages 175-180

ABSTRACT:
BACKGROUND:
Laparoscopic cholecystectomy(LC) may be rendered ‘difficult’ by various problems encountered
during surgery e.g accessing the peritoneal cavity, dissecting the gall bladder … etc.
OBJECTIVE:
To identify certain preoperative clinical parameters to predict technical difficulties during (LC) .
SETTING: Surgical wards of Al-Jamhoori Teaching Hospital between October 2009 to October 2010.
METHODS:
A prospective analysis of150 patients who underwent (LC). Prospective analysis of different
preoperative data including patient's age, gender, weight, height, previous abdominal surgery and
previous attack of acute cholecystitis were done. The dependent variables (outcomes) included the
duration of operation, bleeding, difficult accessing, bile leak, difficult dissection of gall bladder, and
conversion to open cholecystectomy. Surgeons who performed the operations had operative experience
of more than 50 (LC)
RESULTS:
The difficulties were met in 57(38%) patients. The mean duration of surgery was 79·83 ± 1·30 minutes.
Factors contributed to difficult (LC) were; male gender, previous upper abdominal surgery and BMI >
35.
CONCLUSION:
Preoperative clinical patient's factors including male gender, BMI > 35 and history of previous upper
abdominal surgery are significant predictive preoperative parameters for difficult (LC). Knowledge of
these parameters preoperatively can predict difficulties during (LC).

Safety of Elective Laparoscopic Cholecystectomy in the Hands of Postgraduate Trainees

Haitham. H. Al-Najafi; Muthanna A.Al-Sharbaty; Adil M. Al- Ibadi

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 1, Pages 137-145

ABSTRACT:
BACKGROUND:
From the start of era of laparoscopic surgery the debate starts regarding the best time for laparoscopic training and in most developed countries the training is part of residency program nowadays; the safety of surgeons performing laparoscopic cholecystectomy assessed by results of surgery in addition to different scoring systems( like GOALS and Thomas R Eubanks).
OBJECTIVE:
The purpose of this study is to evaluate the safety of elective laparoscopic cholecystectomy done by postgraduate trainees under supervision and the introduction of proper training program of laparoscopic surgery in postgraduate residency programs in Iraq. The safety of the procedure performed was determined using The Global Operative Assessment of Laparoscopic Skills (GOALS) and Thomas R. Eubank scoring systems which were designed for evaluation of resident and surgeon in training laparoscopic performance .
PATIENTS AND METHODS:
This prospective study includes 200 consecutive cases underwent laparoscopic cholecystectomy for symptomatic cholelithiasis, conducted in AL-Jumhoori Teaching Hospital in Mosul city - Iraq during the period from (October 2010 to October 2011). These laparoscopic cholecystectomies were performed by(5th&4th year) postgraduate trainees under supervision of senior laparoscopic surgeons.
RESULTS:
Among 200 cases, there were 45 (22.5 %) males and 155 (77.5 %) females. The age of patients ranged from 18-65 years. All cases were done by 4th and 5th post graduate trainees with minimal complications. The results and observations were made for the operating time, difficulty in dissection, open conversion rate and early complications, The mean operating time was 40 minutes. The open conversion was 3%. and gut injury was 0.5% with no mortality.
CONCLUSION:
laparoscopic cholecystectomy can be performed safely by resident postgraduate trainees according to the outcome data , "Global Operative Assessment of Laparoscopic Skills" (GOALS) and Thomas R Eubanks scoring system and this proves the effectiveness of the suggested training program

Laparoscopic Varicocelectomy for Bilateral Varicoceles in Infertile Males

Saad D. Farhan; Muayed Abass Fadhel

Iraqi Postgraduate Medical Journal, 2011, Volume 10, Issue 3, Pages 317-322

ABSTRACT:
BACKGROUND :
Varicoceles, present in 15% to 20% of men, are the most common abnormal finding among men presenting with infertility.Despite the very long history of the disease and many records on different surgical and radiological solutions, the ideal method of spermatic vein ligation for varicocele is still a matter of controversy. The perfect technique would be one that preserves testicular function and eliminates the varicocele with a low rate of recurrence, hydrocele formation and any other complications.
OBJECTIVE:
To assess the efficacy of laparoscopic Varicocelectomy for management of bilateral palpable varicoceles in infertile males.
METHODS:
We analysed the result of 25 patients presented with history of infertility and diagnosed to have bilateral palpable varicoceles treated in our department with Bilateral laparoscopic ligation of the spermatic vessels between January 2009 and November 2010.
RESULTS:
The average operative (Bilateral Laparoscopic Varicocelectomy) time was 34 minutes. There were no intra operative complications in the study group. Hydrocele formation was seen in 3 (6%) patients recurrence was seen in one (2%) patient .The average hospital stay was 18 hours. postoperative analgesics (1-2) doses , daily activities initiation usually started after 48 hrs and physical exercise 72 hrs . non of the patient has developed an atrophic testis as a result of the laparoscopic procedure. eighteen patients (72% )of the patients had improvement of the seminal fluid parameters During follow up period (6 months),with seminal fluid analysis, clinical and ultrasonic examination.
CONCLUSION:
Laparoscopic varicocele ligation is a simple and safe technique, causing minimal morbidity and enabling rapid return to normal activity

Role of Surgery and Laparoscopy in Management of Abdominal Tuberculosis

Bashar A. Abdul Hassan; Anees K.Nile; Enas Adnan Abdulrasul Al-Kazaaly; Ahmed H. Ismael

Iraqi Postgraduate Medical Journal, 2011, Volume 10, Issue 2, Pages 261-268

ABSTRACT :
BACKGROUD:
Tuberculosis (TB) considered as the most communicable disease world wid. Among extra pulmonary TB the prevalence of abdominal TB shows rising tendency. Abdominal TB is defined as an infection of one or more common of two or more of the following sites; peritoneum, mesentery, gastrointestinal tract and or solid organs. Reported incidence of abdominal TB varies from country to country. The most common clinical features are abdominal pain, fever and weight loss.
OBJECTIVE:
To evaluate the role of surgery in the management of abdominal TB especially with the advent of minimal access surgery (laparoscopy) in the diagnosis of this disease.
PATIENT AND METHODS:
Prospective study was conducted in Al-Kadhymia Teaching Hospital over three years (2007-2010), fifty six patients with abdominal TB were included, the patients were managed by full surgical and or medical teams, results was analyzed by appropriate statistical measures.
RESULTS:
Most patients were in the 2nd, 3rd and 4th decades of life. Female to male ratio was 1.5:1. Most of the patients (82%) considered to have primary abdominal TB. Diagnostic laparoscopy was done for 21 patients and proved TB in 19 patients. Explorative laparotomy was done in 19 patients, the commonest operative finding was ascites and peritoneal tubercles.
CONCLUSION:
Abdominal TB should be considered in all patients who presented with unexplained abdominal symptoms and signs. Laparoscopy is an effective modality for diagnosis of abdominal TB.