Surgical laparoscopy & endoscopy
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Surg Laparosc Endosc · Feb 1996
Planning, development, and execution of an international training program in laparoscopic surgery.
In the late 1980s, minimally invasive surgery experienced unprecedented growth. Centers appeared worldwide, providing a variety of training opportunities and laboratory experiences. Because standard surgical training varies greatly from country to country, it became apparent that this variety was even more pronounced in the area of minimally invasive and laparoscopic surgery, posing significant credentialling difficulties for professional standards committees wishing to certify surgical staff who submit unevaluable credentials from all over the world. ⋯ Support from the hospital administrators and department chairs was instrumental in the program's success. Among the goals we accomplished was identification of persons in an institution who could serve as future instructors and certifiers for the hospital's self-sustaining program as well as providing a relationship in which international institutions can serve as a resource for further continuing medical education and clinical and laboratory training. This program may well serve as the model template for international credential standards of the future.
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Surg Laparosc Endosc · Dec 1995
Totally preperitoneal laparoscopic approach combined with minianterior dissection in the treatment of indirect inguinal hernias.
Totally preperitoneal laparoscopic hernioplasty has become more popular recently and will possibly replace the transabdominal preperitoneal procedure. This procedure, however, is more demanding for the surgeon, especially in large indirect hernias. ⋯ To date, it has been used in 15 patients, all with good success. The technique results in a shorter operative time and is easier for the surgeon.
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Surg Laparosc Endosc · Dec 1995
Case ReportsVATS resection of a mediastinal neurogenic dumbbell tumor.
Some posterior mediastinal tumors can be safely resected with video-assisted thoracic surgery (VATS), but the safety of resecting a dumbbell-shaped tumor has been questioned. This article reports the successful removal of a dumbbell-shaped cystic schwannoma at T4 using a posterior laminectomy and VATS, with the patient in the prone position.
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Surg Laparosc Endosc · Oct 1995
Laparoscopic lumbar diskectomy: preliminary report of a minimally invasive anterior approach to the herniated L5-S1 disk.
Approximately 300,000 patients each year in the United States undergo laminectomy for disabling lumbar disk herniation. Postlaminectomy hospitalization is 3-7 days and convalescence may be prolonged. As an alternative to laminectomy, we have developed a technique for performing L5-S1 lumbar diskectomy laparoscopically. ⋯ Five patients were discharged the next day and two on the second postoperative day. L5-S1 laparoscopic lumbar diskectomy is feasible and safe. It may be an effective minimally invasive alternative to laminectomy.
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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.