Surgical endoscopy
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Comparative Study
Cardiovascular responses to prolonged carbon dioxide pneumoperitoneum in neonatal versus adolescent pigs.
Long-lasting minimally invasive procedures are increasingly used for children. However, the hemodynamic effects of a prolonged carbon dioxide (CO(2)) pneumoperitoneum (PP) on small infants are poorly understood and may differ from the effects on adolescents. This study aimed to detect and compare these effects in neonatal and adolescent pigs. ⋯ A prolonged CO(2) PP induces hypotension and cardiac depression in neonatal but not in adolescent pigs. Thus, intensive monitoring during prolonged laparoscopic procedures and particularly afterward may be mandatory for neonates.
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The placement of self-expanding metal stents (SEMS) is a safe and effective definitive procedure for the palliation of malignant colorectal obstruction. In this study, the clinical outcomes, including the technical and clinical success rates, and the risk factors associated with the long-term outcomes of palliative SEMS were evaluated. ⋯ Patients with bowel obstruction involving a short segment and those with a distal obstruction had better stent outcomes.
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Multicenter Study
Telesimulation: an effective method for teaching the fundamentals of laparoscopic surgery in resource-restricted countries.
Several challenges exist with laparoscopic skills training in resource-restricted countries, including long travel distances required by mentors for onsite teaching. Telesimulation (TS) is a novel concept that uses the internet to link simulators between an instructor and a trainee in different locations. The purpose of this study was to determine the effectiveness of telesimulation for teaching the Fundamentals of Laparoscopic Surgery (FLS) to surgeons in Botswana, Africa. ⋯ Remote telesimulation is an effective method for teaching the Fundamentals of Laparoscopic Surgery in Africa, achieving a 100% FLS skills pass rate. This training platform provides a cost-effective method of teaching in resource-restricted countries and could be used to teach laparoscopic skills anywhere in the world with internet access.
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Randomized Controlled Trial
Optimization of anesthesia antiemetic measures versus combination therapy using dexamethasone or ondansetron for the prevention of postoperative nausea and vomiting.
More than half of the patients undergoing laparoscopic cholecystectomy experience postoperative nausea and vomiting (PONV). This condition is related to the surgical, anesthetic, and patient factors. Volatile anesthetics, nitrous oxide, and opioids are known anesthetic risk factors for PONV, and thus preventive measures are justified. Propofol-based total intravenous anesthesia (TIVA), ondansetron, and dexamethasone each are reported to reduce PONV by approximately 30%. Avoiding or reducing perioperative narcotic analgesics, use of an 80% oxygen concentration, and proper intravenous fluid administration also reduce PONV. The anesthetic antiemetic measures have been studied separately. This study aimed to test the efficacy of these anesthetic antiemetic measures collectively with or without ondansetron or dexamethasone in preventing PONV among patients undergoing laparoscopic cholecystectomy. ⋯ Ondansetron or dexamethasone added to collective anesthetic antiemetic measures does not further decrease the incidence of PONV after laparoscopic cholycestectomy.
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Randomized Controlled Trial Comparative Study
Laparoscopic versus open appendectomy: a prospective randomized comparison.
Whether laparoscopy offers a benefit over open surgery in the management of acute appendicitis or not remains a subject of controversy despite the publication of numerous randomized studies. This study aimed to compare laparoscopic appendectomy (LA) with open appendectomy (OA) and to ascertain its therapeutic benefit. ⋯ Laparoscopic appendectomy is a useful tool in the treatment of acute appendicitis. Its advantages lie in its minimal invasiveness, its better cosmetic outcome, its lower rate of complications based on surgical expertise and state-of-the-art equipment. It can be recommended as an adoptable method for the routine patient with appendicitis.