Surgical endoscopy
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Pneumoperitoneum and patient positioning are essential factors during laparoscopic surgical procedures. They cause hemodynamic and anatomical changes in several abdominal organs among which the caudal cava vein (CCV) is involved. Hemodynamic changes in this vein (decreased venous return) have been described in the porcine model, but how the vein morphology and size is affected at different abdominal levels is unknown. We sought to assess the morphological and morphometrical changes in the CCV of the pig caused by pneumoperitoneum and the reverse Trendelenburg position by in vivo magnetic resonance imaging (MRI). ⋯ The pneumoperitoneum and reverse Trendelenburg position caused morphological and morphometrical changes in the prehepatic and hepatic portions of the CCV, which should assist in gaining a better understanding of the hemodynamic changes described in the literature.
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Comparative Study
Long-term comparison of laparoscopy-assisted distal gastrectomy and open distal gastrectomy in advanced gastric cancer.
The use of laparoscopy-assisted distal gastrectomy (LADG) in advanced gastric cancer (AGC) remains a controversial topic, mainly because of doubts about its oncologic validity. To date, literature on the prognosis for AGC after LADG is scarce. This study evaluated the procedure's long-term benefits compared with those of the conventional, open distal gastrectomy (ODG). ⋯ The combination of the long- and short-term data indicates that LADG should be considered as a feasible alternative to ODG for the treatment of AGC. Its widespread integration requires the accumulation of similar results across multiple centers worldwide.
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Comparative Study
Case-matched analysis comparing outcomes of revisional versus primary laparoscopic Roux-en-Y gastric bypass.
Laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the most common approaches used to revise post-bariatric patients with inadequate weight loss or significant weight regain. Previous studies have analyzed the outcomes of open revisional RYGB versus primary RYGB, but no case-control matched analysis comparing revisional LRYGB versus primary LRYGB has been performed. ⋯ Revisional LRYGB is characterized by lower EWL and higher morbidity than primary LRYGB. However, our data suggest that revisional LRYGB is still capable of providing significant weight loss in these high-risk patients.
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Randomized Controlled Trial
High positive end-expiratory pressure preserves cerebral oxygen saturation during laparoscopic cholecystectomy under propofol anesthesia.
Positive end-expiratory pressure (PEEP) can improve respiratory mechanics during pneumoperitoneum, but may influence intracranial and cerebral perfusion pressure. This study investigated the changes in hemodynamic parameters and cerebral oxygen saturation (rSO(2)) associated with 10 cmH(2)O PEEP during pneumoperitoneum while undergoing laparoscopic cholecystectomy under propofol anesthesia. ⋯ Application of PEEP with 10 cmH(2)O during CO(2) pneumoperitoneum could preserve the rSO(2) value and hemodynamic stability in patients undergoing laparoscopic cholecystectomy under propofol anesthesia.
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Randomized Controlled Trial
Surgeons blinded by enhanced navigation: the effect of augmented reality on attention.
Advanced image-guidance systems allowing presentation of three-dimensional navigational data in real time are being developed enthusiastically for many medical procedures. Other industries, including aviation and the military, have noted that shifting attention toward such compelling assistance has detrimental effects. Using the detection rate of unexpected findings, we assess whether inattentional blindness is significant in a surgical context and evaluate the impact of on-screen navigational cuing with augmented reality. ⋯ Inattentional blindness was evident in both groups. Although more accurate, the AR group was less likely to identify significant unexpected findings clearly within view. Advanced navigational displays may increase precision, but strategies to mitigate attentional costs need further investigation to allow safe implementation.