Surgical endoscopy
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Comparative Study
Insufflation profile and body position influence portal venous blood flow during pneumoperitoneum.
We investigated changes in portal venous blood flow (PVBF) during carbon dioxide (CO2) pneumoperitoneum to evaluate the effects of different insufflation profiles and body positions. ⋯ CO2 pneumoperitoneum reduces PVBF significantly (>30%). Extreme body positions (35 degrees tilt) significantly intensify PVBF reduction. PVBF reduction is significantly more dramatic in subjects placed in a 35 degrees head-down position. Short desufflation periods did not improve mean PVBF, but it may have beneficial immunological and oncological effects that warrant further investigation.
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Bronchogenic cysts are rare congenital anomalies located in the mediastinum and lung parenchyma. We present the clinical findings and describe the mediastinoscopic treatment of a bronchogenic cyst at the subcarinal space in a 50-year-old man. CT revealed a lesion at the subcarinal space with soft tissue density. ⋯ Histopathological evaluation of biopsy material taken from the cyst wall confirmed that the lesion was a bronchogenic cyst. The cyst contents were drained and a sclerosant agent was applied to the cyst lumen via the drainage tube. Mediastinoscopy not only provides diagnostic information but can also be used safely in the treatment of anterior bronchogenic cysts in patients not amenable to a second operation.
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Pneumothorax is a known complication of laparoscopy, with most pneumothoraces diagnosed postoperatively with conventional chest x-ray. Electrocardiogram (ECG) conduction changes are associated with pneumothorax. In a sheep model, ECG changes were evaluated as a potential indicator of intraoperative pneumothorax. Additionally, resolution rates of helium (He) and carbon dioxide (CO2) pneumothorax were also evaluated in this model. ⋯ Precordial ECG changes appear to be a very sensitive indicator of pneumothorax, with very small pneumothorax (<100 cc) consistently being detected by reduction of the QRS complex amplitude. Intraoperative use of precordial ECG leads could result in rapid identification of pneumothorax during laparoscopic surgery. Carbon dioxide pneumothorax shows near 100% resolution in a 2-h period. This supports recommendations of expectant management in asymptomatic patients with CO(2) pneumothorax. However, He pneumothorax does not resolve spontaneously quickly and may require aspiration even in asymptomatic patients.
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Case Reports
Diaphragmatic hernia resulting from injury during microwave-assisted laparoscopic hepatectomy.
A 31-year-old woman underwent microwave-assisted laparoscopic hepatectomy of the left lateral segment for focal nodular hyperplasia on January 14, 1998. On September 9, 1998, she felt continuous left abdominal pain and was admitted to our hospital for further examination. An upper gastrointestinal series showed converging folds of the greater curvature of the upper third of the stomach and craniad displacement of this portion. ⋯ The stomach was returned to the peritoneal cavity and the defect sutured. The patients postoperative course was uneventful. Although diaphragmatic hernia after laparoscopic surgery is a rare complication, with the performance of more advanced laparoscopic procedures and the use of higher-technology tissue-destruction/hemostatic devices such as the microwave coagulator, more caution should be observed to prevent injury to adjacent organs such as the diaphragm.
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Randomized Controlled Trial Comparative Study Clinical Trial
A prospective randomized study of prophylactic antibiotics in elective laparoscopic cholecystectomy.
Elective laparoscopic cholecystectomy (LC) has a low risk for infective complications, but many surgeons still use prophylactic antibiotics. The use of prophylactic antibiotics for LC is inconsistent and varies widely among surgeons. ⋯ In patients undergoing elective LC, antibiotic prophylaxis is justified only in high-risk patients. In all other patients, antibiotic prophylaxis does not seem to affect the incidence of postoperative infective complications. In low-risk patients, eliminating the unnecessary use of prophylactic antibiotics would result in a cost reduction; moreover, it would lower the risk of adverse reaction and reduce microbial resistance.