Surgical endoscopy
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Randomized Controlled Trial Comparative Study
Positive end-expiratory pressure in pressure-controlled ventilation improves ventilatory and oxygenation parameters during laparoscopic cholecystectomy.
During laparoscopy, pneumoperitoneum may result in intraoperative atelectasis, which impairs normal gas exchange. This study investigated whether positive end-expiratory pressure (PEEP) of 5 cmH(2)O in pressure-controlled ventilation (PCV) mode can improve ventilatory and oxygenation parameters during pneumoperitoneum. ⋯ Application of PEEP of 5 cmH(2)O should be considered in PCV during laparoscopic surgeries to decrease intraoperative atelectasis caused by pneumoperitoneum to improve gas exchange and oxygenation.
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Comparative Study
Long-term effects of laparoscopic sleeve gastrectomy, gastric bypass, and adjustable gastric banding on type 2 diabetes.
This study aimed to compare the efficacy of laparoscopic sleeve gastrectomy (SG) with that of laparoscopic gastric bypass (GBP) and laparoscopic adjustable gastric banding (AGB) for glucose homeostasis in morbidly obese subjects with type 2 diabetes mellitus (T2DM) at a 3-year follow-up assessment and to elucidate the role of weight loss in the T2DM resolution after SG. ⋯ All three bariatric procedures are effective in treating diabetes, with a 3-year follow-up evaluation showing an effect that lasts. The AGB procedure was the least effective. The antidiabetic effect was similarly precocious after GBP and SG compared with AGB. This difference may indicate that a hormonal mechanism may be involved, independent of weight loss.
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Comparative Study
Ischemic conditioning shows a time-dependant influence on the fate of the gastric conduit after minimally invasive esophagectomy.
Minimally invasive esophagectomy (MIO) is now established as a valid alternative to open surgery for the management of esophagogastric cancers. However, a high incidence of ischemia-related gastric conduit failure (ICF) is observed, which is detrimental to any potential benefits of this approach. ⋯ Ischemic failure of the gastric conduit significantly impairs recovery after MIO. Ischemic conditioning 2 weeks before surgery may reduce this complication and allow the benefits of this approach to be realized.
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Comparative Study
Early experience in human hybrid transgastric and transvaginal endoscopic cholecystectomy.
Abdominal procedures have been performed for a long time through the anterior abdominal wall. Since the first reports in the 1980s, laparoscopy has become the standard for cholecystectomy, with many advantages over open procedures. Now a natural-orifice approach to the peritoneal cavity may further reduce the invasiveness of surgery by either diminishing or avoiding abdominal incisions. Several orifice routes to the abdominal cavity have been described: transgastric, transvaginal, transvesical, and transcolonic. Although most experiences with the porcine model showed the possibility of these approaches, few surgeons reported experiences with humans. The authors present their complete early experience with transgastric (TG) and transvaginal (TV) cholecystectomies in human beings. ⋯ Transgastric and transvaginal cholecystectomies are feasible. Although these NOTES procedures were laparoscopically assisted and current flexible endoscopes were used, it seems possible that major intra-abdominal surgeries may one day be performed without skin incisions. However, a learning curve is mandatory and, although there were no major bile duct injuries, there were NOTES-related complications. These trends toward incisionless surgery demand coordinated research in an interdisciplinary setting involving both surgeons and device manufacturers to further define appropriate indications, contraindications, and applications for natural-orifice surgery.
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The harmonic scalpel (HS) has been used in endoscopic thyroidectomy with encouraging results. However, additional instruments are frequently required to complete hemostasis. The current study aimed to assess the safety and efficacy of the clipless and sutureless technique using the HS in endoscopic thyroidectomy without supplementary instrumentation. ⋯ The HS alone in clipless and sutureless endoscopic thyroidectomy provides a good alternative to the conventional ligation or clipping technique because it is associated with a shorter operating time and a relatively low incidence of complications.