Surgical technology international
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Multicenter Study Clinical Trial
Lift-(gasless) laparoscopic surgery under regional anesthesia.
The objective of this Chapter was to investigate the feasibility and outcome of gasless laparoscopy under regional anesthesia. A prospective evaluation of Lift-(gasless) laparoscopic procedures under regional anesthesia (Canadian Task Force classification II-1) was done at three endoscopic gynecology centers (franchise system of EndGyn(r)). Sixty-three patients with gynecological diseases comprised the cohort. ⋯ All patients were operated without conversion to general anesthesia and without perioperative or anesthesiologic complications. Lift-laparoscopy under regional anesthesia can be recommended to all patients who desire laparoscopic intervention without general anesthesia. For elderly patients, those with cardiopulmonary risks, during pregnancy, or with contraindications for general anesthesia, Lift-laparoscopy under regional anesthesia should be the procedure of choice.
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Review Comparative Study
Haemostasis using a ready-to-use collagen sponge coated with activated thrombin and fibrinogen.
Adequate haemostasis is an important part of any surgical procedure, but particularly so in the case of visceral organ surgery where apparently insignificant ooze can ultimately result in significant haemorrhage and coagulopathy. To achieve haemorrhage control, the surgeon may use conventional techniques (eg, suture ligation, diathermy, and swab compression), but failing this has the option of using physical coagulation tools (eg, the argon beam coagulator) and haemostasis adjuncts (eg, fibrin glues and collagen sheets). Advances in manufacturing have led to development of several other haemostatic products including absorbable gelatin sponges, cyanoacrylates, and polymer-based adhesives. ⋯ It may be applied directly to the bleeding surface, without the need for preparation or reconstitution. This chapter reviews the published evidence and compares its use to other classes of haemostasis adjuncts across a range of surgical specialties, namely hepatic, splenic, thoracic, vascular, and minimally invasive surgery. It also aims to highlight the apparent advantages and limitations of the fibrinogen and thrombin-coated collagen sponge compared to other commercially available haemostasis adjuncts, and identify potential applications for the product.
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An Hypothermia is defined as a decrease in core temperature below 35 degrees C. The well-described deleterious effects of accidental hypothermia on outcome in multiple-trauma patients contrast the beneficial effect of controlled hypothermia on organ function during ischemia in elective surgery. Experimental studies have shown that induced hypothermia during hemorrhagic shock might have beneficial effects on outcome. ⋯ Together with this immunosuppressive profile, coagulopathy and bleeding might limit the use of induced hypothermia after multiple trauma and elective surgery. The purpose of this Chapter is to highlight current knowledge regarding the interaction of hypothermia and posttraumatic immune reactivity. A better understanding of these mechanisms would assist the introduction of preventive and therapeutic strategies into clinical practice.
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Deformities of a totally burned face present a profound challenge to the reconstructive plastic surgeon. Skin grafting has been used traditionally for resurfacing with limited success, especially when the burns were so severe the deeper structures were destroyed. Total face reconstruction, using bilateral extended scapular free flap, has been reported previously for severe deformities following an extensive facial burn. ⋯ With five complementary procedures, including a costal cartridge graft, the shape of the nose was restored, and acceptable functional and aesthetic results were obtained. This method did not require a separate tissue transfer for nasal reconstruction. To our knowledge, this is the first case of successful reconstruction with one flap for total face reconstruction that included the nose.