Surgical endoscopy
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Laparoscopic management of nonobstetric acute abdominal pain during pregnancy remains controversial. A gestational age of 26 to 28 weeks has been considered the upper limit for laparoscopy by some authors. A case series of nonobstetric surgery in advanced pregnancy is reported. ⋯ This study demonstrated that laparoscopic surgery in the third trimester of pregnancy is feasible and can be performed safely with an acceptable risk to the fetus and the mother. Access to the pregnant abdomen is easily obtained. Space generally is not a problem, and there is minimal uterine manipulation.
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Metabolic bone disease is a potential complication of bariatric surgery. The aims of our study were to evaluate the effects of laparoscopic gastric bypass on calcium and vitamin D metabolism, and to identify patients at high risk to develop secondary hyperparathyroidism (HPT). ⋯ Morbidly obese women have a high incidence of elevated PTH levels after gastric bypass surgery. Low vitamin D levels did not constitute the only reason behind this finding. African-American women and women older than 45 years of age were at significantly higher risk of developing secondary HPT. In these populations, aggressive supplementation with calcium citrate and vitamin D should be implemented.
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The SIMENDO is an affordable virtual reality simulator designed to train basic psychomotor skills for endoscopic surgery. This study aimed first to establish construct validity by determining which parameters can discriminate groups with different experience levels, and second to establish the extent to which training is useful by determining when inexperienced groups reach expert level. ⋯ The study was able to establish construct validity for the training program with the simulator under study. The learning curve showed that training with this simulator is useful for subjects with or without limited endoscopic experience. Furthermore, previous endoscopic camera navigation already improves motor skills to more than the basic level.
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Continuous insulin infusion (CII) is proven to decrease morbidity and mortality in surgical critical care patients. This study compared standard insulin therapy with CII in type 2 diabetes patients undergoing elective bariatric surgical procedures in a community hospital. ⋯ Perioperative CII can be administered safely to diabetic patients undergoing bariatric surgery. The insulin requirements in this population are higher than expected. Our study showed a decrease in the number of postoperative cholecystectomies in the CII group, but no effect on the stricture rate and an increase in the number of patients with postoperative port-site infections.
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Commonly used perioperative measurements of hemodynamics, such as Swan-Ganz catheter assessment, are invasive and may not be reliable under pneumoperitoneum. The purpose of this study was to validate the use of esophageal Doppler for noninvasive hemodynamic monitoring under pneumoperitoneum in an experimental pig model. ⋯ Esophageal Doppler monitoring is a valid noninvasive method of estimating cardiac output at baseline and during pneumoperitoneum in a porcine model. Corrected flow time did not correlate with other estimates of preload at baseline or during pneumoperitoneum.