Surgical endoscopy
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Comparative Study
Intraoperative thermal regulation in patients undergoing laparoscopic vs open surgical procedures.
Although perioperative hypothermia is a well-known consequence of general anesthesia, it has been hypothesized that laparoscopic surgery exacerbates hypothermia to a greater extent than open surgery. The aim of this study was to demonstrate that laparoscopic surgery does not represent an increased risk for hypothermia. ⋯ This study demonstrates that patients who undergo laparoscopic and open procedures of similar duration under endotracheal general anesthesia have similar profiles in terms of perioperative hypothermia.
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Historical Article
Accomplishments and challenges of surgical simulation.
For nearly a decade, advanced computer technologies have created extraordinary educational tools using three-dimensional (3D) visualization and virtual reality. Pioneering efforts in surgical simulation with these tools have resulted in a first generation of simulators for surgical technical skills. ⋯ However, enormous challenges remain, which include improvement of technical fidelity, standardization of accurate metrics for performance evaluation, integration of simulators into a robust educational curriculum, stringent evaluation of simulators for effectiveness and value added to surgical training, determination of simulation application to certification of surgical technical skills, and a business model to implement and disseminate simulation successfully throughout the medical education community. This review looks at the historical progress of surgical simulators, their accomplishments, and the challenges that remain.
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Carbon dioxide can extravasate from the abdominal cavity during insufflation and result in pneumomediastinum, pneumothorax, and subcutaneous emphysema. We report a case of unilateral pneumothorax with pneumomediastinum and subcutaneous emphysema after laparoscopic extraperitoneal bilateral inguinal hernia repair. ⋯ Because of the natural resolution of CO2 pneumothoraces, observation for asymptomatic patients is appropriate, whereas tube thoracostomy should be reserved for symptomatic patients. It is utmost importance to determine the etiology of gas extravastion and consider other complications such as airway or esophageal injury or pulmonary barotrauma.
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Endoscopic thoracic sympathectomy or sympathicotomy is the standard method for the treatment of axillary hyperhidrosis. But postoperative compensatory sweating may be troublesome in some patients. Therefore, we use endoclips to perform the T3 and T4 sympathetic blockade instead of permanently interrupting the transmission of nerve impulses from the sympathetic trunk. ⋯ Video-assisted thoracoscopic T3 and T4 sympathetic blockade by clipping is a safe and effective method for the treatment of patients with axillary hyperhidrosis. Patients who experience excessive compensatory sweating may require a reverse operation for endoclip removal.
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Randomized Controlled Trial Comparative Study Clinical Trial
A randomized controlled trial assessing the effect of heated carbon dioxide for insufflation on pain and recovery after laparoscopic fundoplication.
Insufflation with heated gas for laparoscopy may reduce postoperative pain. This study assessed the effect of heated gas on outcome after fundoplication. ⋯ Heated gas provides no benefit for patients and may be associated with increased early pain. The elevation of core body temperature observed with heated CO2 is of little clinical significance.