Journal of laparoendoscopic & advanced surgical techniques. Part A
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J Laparoendosc Adv Surg Tech A · Mar 2012
Laparoscopic cholecystectomy without intraoperative cholangiography.
The role of intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) remains controversial. This study evaluates the outcomes of a management policy of LC without IOC. ⋯ The selective use of preoperative MRCP and ERCP to detect and treat choledocholithiasis facilitates the safe application of a policy of LC without IOC. Careful operative technique is necessary to avoid duct injury.
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J Laparoendosc Adv Surg Tech A · Mar 2012
Thoracoscopic repair of esophageal atresia and tracheo-esophageal fistula in neonates: evolution of a technique.
Advancements in minimally invasive surgical techniques and instruments for neonates have allowed even the most complex neonatal procedures to be endoscopically approached. In 1999, the first successful thoracoscopic repair of an esophageal atresia (EA) was performed in a 2-month-old infant. One year later, the first totally thoracoscopic repair of an atresia with distal fistula (tracheo-esophageal fistula [TEF]) was realized in a newborn. ⋯ There were no deaths and no recurrent fistula. Thoracoscopic TEF repair has proved to be an effective and safe technique. Evolution of the technique has resulted in fewer complications while avoiding the significant short- and long-term morbidity associated with thoracotomy in neonates.
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J Laparoendosc Adv Surg Tech A · Jan 2012
Randomized Controlled TrialThe use of a single Hem-o-lok clip in securing the base of the appendix during laparoscopic appendectomy.
During laparoscopic appendectomy, the standard technique in securing the base of the appendix is by endoloop ligatures or a stapler. We earlier demonstrated the possibility of the application of a double Hem-o-lok(®) clip in securing of the base of the appendix. The application of only one plastic clip would, however, lower the cost of the laparoscopic procedure even further and shorten the surgery time. The objective of this prospective study was to evaluate the possible advantages of securing of the base of the appendix using only one Hem-o-lok clip. ⋯ The use of one Hem-o-lok clip is as safe as an endoloop and/or stapler; however, the time of the laparoscopic procedure using the Hem-o-lok was shorter in comparison with the use of an endoloop, with the cost of the procedure being the lowest.
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J Laparoendosc Adv Surg Tech A · Nov 2011
The use of high-frequency oscillating ventilation to facilitate stability during neonatal thoracoscopic operations.
Thoracoscopy has become a surgical option for the repair of esophageal atresia (EA) and congenital diaphragmatic hernia (CDH). Insufflation of carbon dioxide combined with one lung ventilation creates an anesthetic challenge to control acidosis and maintain oxygenation while allowing optimal operative exposure. We have overcome these issues by utilizing the high-frequency oscillating ventilator (HFOV) and report our early experience. ⋯ Usage of HFOV allows for good intraoperative exposure with excellent oxygenation and elimination of carbon dioxide to prevent acidosis.
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J Laparoendosc Adv Surg Tech A · Nov 2011
Laser ablation of placental vessels in twin-to-twin transfusion syndrome: a paradigm for endoscopic fetal surgery.
Endoscopic fetal surgery is most commonly used for the treatment of twin-to-twin transfusion syndrome (TTTS), but the surgical techniques can be applied to other forms of fetal surgery. We present our experience with endoscopic fetal surgery over the past 10 years. From 2000 to 2010, 70 endoscopic laser ablations of placental vessels for TTTS were performed. ⋯ The combination of an open surgical approach, Seldinger technique, and uterine plugging led to outcomes similar to other reports, with a significantly lower PROM rate. Although TTTS is the most common application of endoscopic fetal surgery, this approach is applicable for other indications. Insertion and removal of tracheal occlusion balloons for severe congenital diaphragmatic hernia are currently being performed at our institution.