Surgical endoscopy
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Randomized Controlled Trial Comparative Study Clinical Trial
Cardiac function during laparoscopic vs open gastric bypass.
Hypercarbia and increased intraabdominal pressure during prolonged pneumoperitoneum can adversely affect cardiac function. This study compared the intraoperative hemodynamics of morbidly obese patients during laparoscopic and open gastric bypass (GBP). ⋯ Prolonged pneumoperitoneum during laparoscopic gastric bypass does not impair cardiac function and is well tolerated by morbidly obese patients.
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Approximately 10% of patients treated with intrapleural instillation of fibrinolytics fail to respond and therefore need more invasive techniques, such as video-assisted thoracoscopic surgery (VATS). ⋯ We found that VATS is a safe, effective, and well-tolerated surgical procedure in CPE and PE patients who have failed to resolve with initial treatment with fibrinolytics.
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Clinical Trial Controlled Clinical Trial
A prospective trial of analgesia following endoscopic totally extraperitoneal (TEP) inguinal hernioplasty.
The extraperitoneal instillation of bupivacaine has been shown to be superior to the use of a placebo for postoperative analgesia following endoscopic extraperitoneal inguinal hernioplasty. The objective of the present study was to compare the efficacy of postoperative analgesia by local wound infiltration to instillation of the extraperitoneal space with bupivacaine. ⋯ Compared to local wound infiltration with bupivacaine, the extraperitoneal instillation of bupivacaine did not bestow any additional analgesic benefits. Therefore, the routine infiltration of skin incisions with bupivacaine is recommended after endoscopic extraperitoneal inguinal hernioplasty.
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We describe the successful laparoscopic resection of a functional paraganglioma in the organ of Zuckerkandl. A 47-year-old man with hypertension and diabetes mellitus was found to have an abdominal mass beside the aorta. The tumor was diagnosed as a functional paraganglioma by diagnostic imaging and biochemical tests. ⋯ The operation time was 450 min and blood loss was 410 ml. The postoperative course was uneventful and there has been no local recurrence or distant metastasis during the 18-month follow-up period. Laparoscopic resection of functional extraadrenal paragangliomas is technically feasible and safe if adequate pre- and intraoperative medical management and a careful, steady surgical technique are used.