Surgical endoscopy
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Randomized Controlled Trial Clinical Trial
A randomized controlled trial assessing the benefit of humidified insufflation gas during laparoscopic surgery.
We conducted a randomized controlled trial during laparoscopic cholecystectomy to determine the extent of heat preservation and postoperative pain reduction using humidified carbon dioxide (CO2) gas insufflation instead of standard dry insufflation gas. ⋯ The use of humidified insufflation gas reduces postoperative pain following laparoscopic cholecystectomy, but except for these relatively brief procedures, the heat-preserving effect of humidified gas insufflation is not significant.
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Randomized Controlled Trial Clinical Trial
Humidified gas prevents hypothermia induced by laparoscopic insufflation: a randomized controlled study in a pig model.
This experimental study evaluated whether humidification of warmed insufflated CO2 during laparoscopic procedures would resolve the problem of laparoscopy-induced hypothermia. ⋯ The majority of heat lost during laparoscopic insufflation is due to water evaporation, and laparoscopic hypothermia may be prevented by using heated and humidified gas insufflation.
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Bile duct clearance at open cholecystectomy had become normal surgical practice before the introduction of laparoscopic cholecystectomy. However, perceived technical difficulties have deterred many surgeons from treating common bile duct stones at the time of laparoscopic cholecystectomy. This has led to a reliance on preoperative clearance of ducts known to have stones and postoperative clearance of ducts found to have stones at operation or those that subsequently develop complications of retained stones. ⋯ We believe that for surgeons familiar with open common bile duct exploration and laparoscopic cholecystectomy, the next logical step is laparoscopic exploration of the common bile duct at the time of cholecystectomy, which is safe and readily mastered.
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Communicating hydrocephalus can be handled either by the ventriculoperitoneal or, occasionally, the ventriculoatrial shunt. The lumboperitoneal shunt is another option. It does not require a transcranial approach; therefore, it is safer for the patient. ⋯ The LP shunt can be easily placed by a skilled laparoscopic surgeon. The incidence of infection and complications is lower, and the patency rate is higher. This should be the initial choice for communicating hydrocephalus.