Surgical technology international
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Laparoscopic cholecystectomy is one of the most commonly undertaken procedures in General Surgery with more than 500,000 performed annually. Overall, the complication rate is less than 1.5%, and the mortality rate is less than 0.1%. As such, laparoscopic cholecystectomy was considered by most to be at its zenith since its inception in the early 1990 s. ⋯ Traditional four-port cholecystectomy has given way to three- and even two-port techniques. Standard 12-mm ports have been replaced by 2-mm ports, and experiments have now been implemented to achieve cholecystectomy with no ports-known as the transgastric technique. The authors reviewed evolution of these techniques that included a synopsis of our experience with the three-port cholecystectomy, as well as the future direction of laparoscopic surgery.
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We investigated the feasibility and outcome of adhesiolysis in patients with severe and reccurent adhesions using lift (gasless) laparoscopy and a SprayGel adhesion barrier at the Institute for Endoscopic Gynecology (EndoGyn). The design included a prospective evaluation of lift (gasless) laparoscopic adhesiolysis in combination with a SprayGel adhesion barrier. A new score for bowel adhesions was developed and applied. ⋯ Adhesiolysis with Abdo-Lift and SprayGel had unparalleled efficacy in the adhesiolysis procedure even in those patients in whom other solutions have not worked. An overall reduction of adhesions by 89.9% at second-look laparoscopy was found. Even if five patients (14.3%) required a third-look laparoscopy where four cases of adhesion reformation were confirmed, the scores were reduced when compared to the initial surgery, especially in grade and severity.
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The exclusive charge-coupled device (CCD) camera system for the endoscope and electronic fiberscopes are in widespread use. However, both are usually stationary in an office or examination room, and a wheeled cart is needed for mobility. The total costs of the CCD camera system and electronic fiberscopy system are at least US Dollars 10,000 and US Dollars 30,000, respectively. ⋯ The new system (a mini-DV video camera and an adaptor) costs only US Dollars 1,000. Therefore, the system is both cost-effective and useful for the outpatient clinic or casualty setting, or on house calls for the purpose of patient education. In the future, the authors plan to introduce the clinical application of a high-vision camera and an infrared camera as medical instruments for clinical and research situations.
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The degenerative processes in an aging spine have been defined traditionally only by our knowledge of the biology of disc and facet degeneration, as well as interpretation of post-mortem cryosections by forensic anatomist Wolfgang Rauschning, M. D. In this chapter, visualization of in-vivo patho-anatomy in a degenerating disc and spinal segment is demonstrated at surgery using the Yeung Endoscopic Spine System (Y. ⋯ Visualization and treatment of pathologic findings inside (annular tears) and outside the disc in Herniated Nucleus Pulposus (HNP), synovial cysts, foraminal stenosis, central stenosis, spondylolisthesis, is demonstrated. The endoscopic foraminal approach to the spine and disc is a technique that provides access to patho-anatomy in the lumbar spine not usually feasible with traditional surgical methods. Favorable surgical results allow for continued evolution of the endoscopic method, concomitant with the continued evolution of endoscopic spinal surgery.
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With increased life expectancy and an aging population, many patients suffering from progressive lumbar spinal stenosis with symptomatic neurogenic intermittent claudication (NIC) have been limited to a choice between nonsurgical therapies or a more traumatic decompressive surgical procedure, with or without lumbar fusion. The interspinous process decompression (IPD) system, the X-STOP implant, was developed to provide a minimally invasive alternative therapeutic treatment of lumbar spinal stenosis. The X-STOP IPD system, surgical indications, operative techniques, and the potential complications and their avoidance are described and discussed herein.