Surgical laparoscopy & endoscopy
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Surg Laparosc Endosc · Oct 1994
Can pulse oximetry and end-tidal capnography reflect arterial oxygenation and carbon dioxide elimination during laparoscopic cholecystectomy?
An investigation was carried out on 13 ASA class 1 or 2 adult patients undergoing laparoscopic cholecystectomy. Throughout laparoscopy, the end-tidal PCO2 was continuously monitored by capnography and the arterial hemoglobin oxygen saturation by pulse oximetry. Also, repeated measurements of arterial blood gases were done. ⋯ The report showed that both the mean end-tidal PCO2 and arterial PCO2 progressively increased following carbon dioxide insufflation, to reach a maximal value after 30 min, with no significant change in the arterial-alveolar PCO2 gradient. Also, the arterial PO2 significantly decreased, and the hemoglobin oxygen saturation was always above 98% whether monitored by arterial blood gas analysis or by pulse oximetry. The results suggest that end-tidal capnography and pulse oximetry can be used as noninvasive techniques for monitoring arterial oxygenation and carbon dioxide elimination during laparoscopic cholecystectomy.
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Surg Laparosc Endosc · Aug 1994
Case ReportsRight portal embolization before extended right hepatectomy using laparoscopic catheterization of the ileocolic vein: a prospective study.
Preoperative embolization of the right portal vein branch before extended right hepatectomy for hepatocellular carcinoma or hilar cholangiocarcinoma has been recommended for the prevention of postoperative liver failure. Percutaneous transhepatic insertion into the intrahepatic portal vein and insertion into the ileocolic vein at open laparotomy are used for inserting a catheter introducer into the portal vein. ⋯ Measurement of hepatic volume by computed tomography 3 weeks after right portal embolization showed a 28.6 to 66.0% increase in the volume of the predicted remnant liver. This minimally invasive procedure has three advantages: reduction of postoperative pain, avoidance of hepatic injury, and the opportunity for a laparoscopic observation of the liver and the intra-abdominal organs before right portal embolization and hepatectomy.
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Surg Laparosc Endosc · Jun 1994
Case ReportsDiagnosis and management of bile leaks following laparoscopic cholecystectomy.
Laparoscopic cholecystectomy is now the standard of care for the elective management of gallstone disease. Recent studies have shown the morbidity of laparoscopic cholecystectomy to be similar to that of open cholecystectomy. Postoperative bile leaks have been recognized to be a troublesome problem following laparoscopic cholecystectomy. ⋯ All eleven scans were positive, indicating the presence of a bile leak. Thirteen patients underwent endoscopic cholangiography confirming the presence of biliary leakage (the remaining two patients underwent prompt laparotomy). Five patients were taken to the operating room for management of their leaks (two with common bile duct injuries, two cystic duct leaks, one accessory duct leak).(ABSTRACT TRUNCATED AT 250 WORDS)
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Surg Laparosc Endosc · Apr 1994
Comparative Study Clinical Trial Controlled Clinical TrialComparative study of pain level and analgesic requirement after laparoscopic and open cholecystectomy.
The laparoscopic technique of cholecystectomy leads to shorter hospitalization, faster recuperation, and earlier return to economic activity. Although reduction in pain is considered a major factor, no objective clinical trial has confirmed this assumption. This prospective trial compared the pain level of laparoscopic (n = 28) and conventional (n = 11) cholecystectomy. ⋯ On the second and third postoperative day, the level of pain was not statistically different. All patients who had conventional cholecystectomy required at least one dose of analgesia (pethidine or naproxen), whereas only 53.6% of patients who had the laparoscopic procedure required analgesia (p < 0.05). This study verifies that pain reduction is an important advantage of laparoscopic cholecystectomy.
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Surg Laparosc Endosc · Feb 1994
Intraoperative sonography of biliary tree during laparoscopic cholecystectomy.
The use of routine cholangiography during laparoscopic cholecystectomy is still under debate. Previous reports have suggested that intraoperative sonography can replace cholangiography in the evaluation of common duct lithiasis during open cholecystectomy. The present study was performed to evaluate the possible role of sonography during laparoscopic cholecystectomy. ⋯ In this last case, stones were confirmed on later review of cholangiogram. No complications related to the method were observed. We suggest that intraoperative sonography can represent an adequate substitute for intraoperative cholangiography as a screening procedure for stone identification during laparoscopic cholecystectomy.