Surgical endoscopy
-
Comparative Study
Laparoscopic vs open hemicolectomy for colon cancer.
The role of laparoscopic resection in the management of colon cancer is still a subject of debate. In this clinical study, we compared the perioperative results and long-term outcome for two unselected groups of patients undergoing either laparoscopic or open hemicolectomy for colon cancer. ⋯ These results suggest that laparoscopic hemicolectomy for colonic cancer can be performed safely, with morbidity, mortality, and long-term results comparable to those of open surgery.
-
Comparative Study
Ultrasound of the inguinal floor for evaluation of hernias.
This study aimed to evaluate the utility of ultrasound in the diagnosis of inguinal hernias and obscure groin pain. ⋯ Ultrasound is a useful adjunct in evaluating the groin for hernia, and can be performed by surgeons.
-
The anterior laparoscopic approach requires precarious dissection around the iliac vessels to expose the L4-L5 level. Furthermore, a retroperitoneal endoscopic approach to the L4-L5 level requires a technically demanding dissection to access the L5-S1 disc space. A unique lateral laparoscopic approach to the L4-L5 disc space allows concurrent access to the L5-S1 space while avoiding major dissection around the iliac vessels. This article describes this novel lateral approach and reviews the initial clinical outcomes. ⋯ For multilevel fusions including the L4-L5 disc space, the lateral laparoscopic exposure is a safe and efficacious procedure allowing simultaneous access to multiple disc spaces while avoiding the sympathetic chain, ureter, and major vascular structures. The lateral approach affords excellent exposure for accurate deployment of the appropriate orthopedic hardware.
-
Comparative Study
Impact of additional pleurodesis in video-assisted thoracoscopic bullectomy for primary spontaneous pneumothorax.
Bullectomy for primary spontaneous pneumothorax has been associated with high postoperative recurrence rates when video-assisted thoracoscopic surgery (VATS) has been used rather than thoracotomy. The aim of this study was to evaluate the efficacy and identify the disadvantages, if any, of adding pleurodesis to VATS bullectomy to prevent recurrent pneumothorax. ⋯ Pleurodesis is a minimally invasive technique that is effective in preventing postoperative recurrences of pneumothorax when added to VATS bullectomy. Additional pleurodesis has no disadvantages vs bullectomy alone in terms of worsening postoperative chest pain or pulmonary function.
-
Comparative Study
Mechanical ventilation with positive end-expiratory pressure preserves arterial oxygenation during prolonged pneumoperitoneum.
Laparoscopic surgery usually requires a pneumoperitoneum by insufflating the abdominal cavity with carbon dioxide (CO2). Increased intraabdominal pressure causes diaphragmatic displacement resulting in compressed lung areas, which leads to formation of atelectasis, especially during mechanical ventilation. Application of positive end-expiratory pressure (PEEP) can maintain pulmonary gas exchange. The objective of this study was to investigate the effect of abdominal gas insufflation on arterial oxygenation during mechanical ventilation with and without PEEP in rats. ⋯ PEEP preserves arterial oxygenation during prolonged pneumoperitoneum in rats with minimal adverse hemodynamic effects.