Surgical endoscopy
-
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.
-
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.
-
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.
-
Randomized Controlled Trial Comparative Study
Ramosetron versus ondansetron for the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy.
Patients undergoing general anesthesia for laparoscopic cholecystectomy are at high risk for postoperative nausea and vomiting (PONV). This study compared ramosetron and ondansetron in terms of efficacy for PONV prevention after laparoscopic cholecystectomy. ⋯ Ramosetron 0.3 mg and ondansetron 8 mg are more effective than ondansetron 4 mg for the prevention of PONV (2 h). Ramosetron 0.3 mg is as effective as ondansetron 8 mg for the prophylaxis of PONV after laparoscopic cholecystectomy.
-
Randomized Controlled Trial
Long-term outcome of laparoscopic Nissen and laparoscopic Toupet fundoplication for gastroesophageal reflux disease: a prospective, randomized trial.
A prospective, randomized trial was performed to evaluate the long-term outcome and patient satisfaction of laparoscopic complete 360 degrees fundoplication compared with partial posterior 270 degrees fundoplication. Partial fundoplication is purported to have fewer side effects with a higher failure rate in controlling gastroesophageal reflux disease (GERD), while complete fundoplication is thought to result in more dysphagia and gas-related symptoms. ⋯ LN and LT are equally effective in restoring the lower esophageal sphincter function and provide similar long-term control of GERD with no difference in dysphagia. Esophageal dysmotility had no influence on the outcome of either operation.