Surgical endoscopy
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Bile duct injury is a major complication of laparoscopic cholecystectomy. The purpose of this study was to evaluate our management strategy and outcomes for the treatment of such injuries. ⋯ Treatment of bile duct injury associated with laparoscopic cholecystectomy is optimally done using a multidisciplinary approach. Surgical reconstruction is required in most cases and can be safely accomplished with minimal morbidity and excellent long-term outcomes.
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Comparative Study
Laparoscopic vs open adrenalectomy for benign adrenal neoplasm.
The aim of this study was to compare the outcome of laparoscopic adrenalectomy (LA) performed for benign adrenal neoplasm to the open procedure in a similar group of patients. ⋯ LA for benign adrenal disorders is a safe procedure that is associated with significantly lower morbidity, shorter ileus and hospitalization, reduced postoperative pain, and a faster return to normal activity than the open procedure.
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The use of video-assisted thoracic surgery (VATS) techniques to mobilize the phrenic nerve in the thoracic cavity for neurotization after brachial plexus injury was studied. ⋯ Mobilization of the phrenic nerve by VATS is a safe and minimally invasive method for elongating the nerve for neurotization after brachial plexus injury.
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There is controversy regarding the amount of training necessary to safely perform advanced laparoscopic surgery. General surgical residency often provides only a low volume of advanced laparoscopic cases and there is growing interest in nonaccredited fellowships focused on laparoscopic surgery. ⋯ Residents clearly perceive a need for additional training in advanced laparoscopic surgery. Residents from programs without a laparoscopic fellowship are concerned about a negative impact on their experience from a laparoscopic fellow, but residents from programs with a laparoscopic fellowship are neutral about the impact of a fellow.
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Randomized Controlled Trial Comparative Study Clinical Trial
Preincisional intravenous low-dose ketamine and local infiltration with ropivacaine reduces postoperative pain after laparoscopic cholecystectomy.
The preincisional use of ketamine combined with local tissue infiltration with Ropivacaine may reduce noxious input during surgery. The goal of this study was to examine whether this combination improves postoperative pain control after laparoscopic cholecystectomy. ⋯ Preincisional treatment with low-dose IV ketamine and local infiltration with ropivacaine 1% reduces postoperative pain after laparoscopic cholecystectomy.