Surgical laparoscopy & endoscopy
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Surg Laparosc Endosc · Jun 1995
Review Case ReportsExtensive subcutaneous emphysema and hypercapnia during laparoscopic cholecystectomy: two case reports.
We report two cases of marked hypercapnia of more than 60 mm Hg (PaCO2) and extensive subcutaneous emphysema noted during laparoscopic cholecystectomy. The first case, a 55-year-old man was diagnosed as having cholecystolithiasis and had hypercapnia up to 83.5 mm Hg (PaCO2) during laparoscopic cholecystectomy. The patient resumed spontaneous respiration under controlled ventilation accompanied by persistent bigeminal pulse. ⋯ Mild hypercapnia during pneumoperitoneum of about 50 mm Hg (PaCO2) has been reported previously. As compared with cases in the literature, the present cases suggest that hypercapnia is due to extensive subcutaneous emphysema. The large absorption surface area in the subcutaneous tissue and the large difference in the partial pressure cause the extensive gaseous interchange of CO2 between subcutaneous tissue and blood perfusing into it at the moment between peritoneal cavity and blood perfused the peritoneum.
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Surg Laparosc Endosc · Jun 1995
Review Comparative StudyLaparoscopic cholecystectomy in obese patients compared with nonobese patients.
Obese patients treated by laparoscopic cholecystectomy currently appear to be the largest risk subgroup amenable to consistent scientific evaluation. Here we report our experience and compare the results in obese patients with those obtained in nonobese patients undergoing the laparoscopic procedure. ⋯ Obese patients present significant anesthesiological complications (p < or = 0.001). The results of this experience and the literature review indicate that the therapeutic advantages proved in nonobese patients can be extended to the obese population.
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Surg Laparosc Endosc · Jun 1995
An alternative technique to create the pneumoperitoneum for laparoscopic surgery.
A method for creating the pneumoperitoneum for laparoscopic surgery in 200 patients used the Lazarus-Nelson technique. A needle half the diameter of the Veress needle was used. A guide wire followed by a catheter with multiple side ports allowed for rapid infusion of CO2. A technique used safely in hundreds of thousands of peritoneal lavages gives the surgeon a safe and rapid technique to create a pneumoperitoneum.