Surgical endoscopy
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The recent introduction of hand-assist devices in laparoscopic colorectal surgery has renewed interest in the influence of incision length. This study aimed to define the impact of extraction incision length on the postoperative outcomes of laparoscopic left-sided colon and rectal resections. ⋯ Patients undergoing laparoscopic colorectal surgery appear to achieve the same perioperative outcomes irrespective of their extraction incision lengths. To maintain the short-term benefits of laparoscopy, surgeons should consider pursuing a minimally invasive technique, even when a larger extraction incision will ultimately be required.
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The laparoscopic duodenal switch (LDS) is a complex bariatric procedure that can be split into two steps to lower the rate of morbidity and mortality. This strategy also identifies patients who do not require the second malabsorptive step to achieve substantial weight loss. ⋯ Two-step LDS is feasible, safe, and effective. It leads to substantial weight loss and improvement in comorbidities over the short term for superobese individuals.
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Randomized Controlled Trial Comparative Study
Pressure-controlled versus volume-controlled ventilation during one-lung ventilation in the prone position for robot-assisted esophagectomy.
The prone position during robotic esophageal mobilization for minimally invasive esophagectomy (MIE) provides several advantages with regards to operative times, surgeon ergonomics, and surgical view; however, this technique requires one-lung ventilation (OLV). There are no guidelines about ventilatory modes during OLV in the prone position. We investigated the effects of volume-controlled (VCV) and pressure-controlled ventilation (PCV) on oxygenation and intrapulmonary shunt during OLV in the prone position in patients who underwent robot-assisted esophagectomy. ⋯ PCV provides no advantages compared with VCV with regard to respiratory and hemodynamic variables during OLV in the prone position. Either ventilatory mode can be safely used for patients who undergo robot-assisted esophagectomy and who have normal body mass index and preserved pulmonary function.
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Randomized Controlled Trial
Effectiveness for pain after laparoscopic cholecystectomy of 0.5% bupivacaine-soaked Tabotamp placed in the gallbladder bed: a prospective, randomized, clinical trial.
Some scientific studies, with controversial results, have evaluated the efficacy in reducing pain of some different local anesthetic molecules, which were administered at different dosages and in different ways. The primary goal of this randomized, controlled, prospective study (Clinical Trials.gov ID NCT00599144) was to assess the effectiveness of 0.5% bupivacaine for pain control after video-laparoscopic cholecystectomy at its optimal dosage of 2 mg/kg infiltrated in the muscular fasciae of the trocars, or positioned in the gallbladder soaking a sheet of regenerated oxidized cellulose (Tabotamp). ⋯ Bupivacaine, either infiltrated in trocars' wounds or kept soaked in a regenerated oxidized cellulose sheet positioned in the gallbladder bed, although safe and not economically demanding, can increase postoperative comfort.
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Placement of retrievable inferior vena cava filters (rIVCF) may be beneficial in high-risk morbidly obese patients undergoing bariatric procedures. Patients with a previous history of venous thromboembolism (VTE) are at high risk for postoperative deep venous thrombosis (DVT) and pulmonary embolism (PE). ⋯ We observed a 21% incidence of recurrent DVT and 15% incidence of thrombus in the IVCF, yet no PE occurred. IVCF retrieval was successful in 70% with one complication. Concurrent IVCF placement is safe, feasible, and an effective preventative measure in high-risk morbidly obese patients. We recommend the use of rIVCFs in conjunction with standard VTE prophylaxis in this patient population.