Surgical endoscopy
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Laparoscopy may prove feasible to address surgical needs in limited-resource settings. However, no aggregate data exist regarding the role of laparoscopy in low- and middle-income countries (LMICs). This study was designed to describe the issues facing laparoscopy in LMICs and to aggregate reported solutions. ⋯ LMICs face many surgical challenges that require innovation. Laparoscopic surgery may be safe, effective, feasible, and cost-effective in LMICs, although it often remains limited in its accessibility, acceptability, and quality. This study may not capture articles written in languages other than English or in journals not indexed by the included databases. Surgeons, policymakers, and manufacturers should focus on plans for sustainability, training and retention of providers, and regulation of efforts to develop laparoscopy in LMICs.
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Clinical Trial
Impact of controlled intraabdominal pressure on the optic nerve sheath diameter during laparoscopic procedures.
Acute elevations of intraabdominal pressure (IAP) are seen in many clinical scenarios with a consequent elevation in intracranial pressure (ICP). With the optic nerve sheath (ONS) being a part of the dura mater and the optic nerve surrounded by cerebral spinal fluid, a change in pressure within the subarachnoid space would be detected by ultrasonography, and invasive methods could be avoided. The study objective was to evaluate ultrasonographic modifications observed on the optic nerve sheath diameter during acute elevations of IAP in patients undergoing laparoscopic procedures. ⋯ The acute elevation in IAP during laparoscopy significantly increased the optic nerve sheath diameter. The changes in the ONSD reflect a temporary and reversible increase in the ICP due to the acute elevation of IAP.
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Severe respiratory failure develops as a result of the involvement of the respiratory muscles in patients with amyotrophic lateral sclerosis (ALS). Implantation of diaphragm pacing system (DPS) has been carried out on ALS patients since 2005 to avoid these situations, but the importance of diaphragm thickness has not yet been established clearly. ⋯ Diaphragm thickness is an important criterion in cases for which DPS implantation is planned. We consider that avoidance of DPS implantation is more suitable for cases with a diaphragm thickness below 3.50 mm because of mortality.
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Blunt chest injuries are usually combined with multiple rib fractures and severe lung contusions. This can occasionally induce acute respiratory failure and prolong ventilations. In order to reduce the periods of ventilator dependency, we propose a less invasive method of fixing multiple rib fractures. ⋯ In the reconstruction of an injured chest wall, the VATS with TENs fixation in multiple rib fractures is feasible. This method is also effective in decreasing the length of the surgical wound. Because the structure of the chest cage is protected, the period of mechanical ventilation is shortened and the length of stay in the hospital and the ICU can be reduced.
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Since the introduction of laparoscopic colorectal surgery, there has been a controversy between creating an intracorporeal or extracorporeal ileocolic anastomosis in right hemicolectomy. The purpose is to report our experience in intracorporeal anastomosis following right hemicolectomy in both malignant and benign pathologies. ⋯ The intracorporeal procedure is a safe and feasible alternative for creating an ileocolic anastomosis. It involves a similar rate of complications and may prevent some of the drawbacks presented by extracorporeal anastomosis.