Surgical laparoscopy, endoscopy & percutaneous techniques
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Surg Laparosc Endosc Percutan Tech · Apr 2015
Antenna coupling explains unintended thermal injury caused by common operating room monitoring devices.
Unintended thermal injury from patient monitoring devices (eg, electrocardiogram pads, neuromonitoring leads) results in third-degree burns. A mechanism for these injuries is not clear. The monopolar "bovie" emits radiofrequency energy that transfers to nearby, nonelectrically active cables or wires without direct contact by capacitive and antenna coupling. The purpose of this study was to determine if, and to what extent, radiofrequency energy couples to common patient monitoring devices. ⋯ Stray energy couples to commonly used patient monitoring devices resulting in potentially significant thermal injury. The handheld bovie cord transfers energy via antenna coupling to neuromonitoring leads that can raise tissue temperatures over 100°F (39°C) using standard settings. The most effective ways to decrease this energy coupling is to reduce generator power, increase the separation between wires, or utilize lower voltage energy devices such as ultrasonic or bipolar energy.
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Surg Laparosc Endosc Percutan Tech · Dec 2014
Multicenter Study Comparative StudyAdmission levels of serum amyloid a and procalcitonin are more predictive of the diagnosis of acute appendicitis compared with C-reactive protein.
Acute appendicitis is the commonest surgical emergency, but its diagnosis can be elusive with a negative appendicectomy rate of 20%. The aims of this study were to investigate the potential value of the markers of acute inflammation, serum amyloid A (SAA), and serum procalcitonin (ProCT), in the diagnosis of acute appendicitis in adults and to compare that with the commonly used serum C-reactive protein (CRP). ⋯ The measurement of SAA and serum ProCT on admission in patients with clinically suspected acute appendicitis seems to outperform serum CRP in aiding that diagnosis.
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Surg Laparosc Endosc Percutan Tech · Dec 2014
Comparative StudyPercutaneous cholecystostomy versus laparoscopic cholecystectomy in patients with acute cholecystitis and failed conservative management: a matched-pair analysis.
The role of percutaneous cholecystostomy (PC) or laparoscopic cholecystectomy (LC) in the management of patients with acute cholecystitis presenting beyond 72 hours from the onset of symptoms is unclear and undefined. The aim of this study was to examine and compare the outcomes of PC or LC in the management of these patients, who failed 24 hours of initial nonoperative management. ⋯ In this matched cohort analysis, PC failed to show a significant reduction in morbidity compared with LC and was associated with a significantly longer hospital stay.
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Surg Laparosc Endosc Percutan Tech · Oct 2014
Randomized Controlled TrialSugammadex reduces postoperative pain after laparoscopic bariatric surgery: a randomized trial.
Morbid obese (MO) population is increasing every year worldwide, and laparoscopic bariatric surgery (LBS) has a central role in their treatment. The postoperative period of MO is not free from complications. The introduction of sugammadex has brought huge developments in patient's safety and nowadays LBS is performed with better care and quality. However, the effect of this agent in postoperative pain is still unknown. ⋯ Sugammadex is associated with less pain felt in the PACU. This "opioid-sparing" effect, combined with less PONV and a faster discharge from the PACU, makes sugammadex an indispensable drug in this type of patients and allows fast-track surgery in the MO.
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Surg Laparosc Endosc Percutan Tech · Aug 2014
Review Meta AnalysisMinimally invasive surgical approach compared with open pancreaticoduodenectomy: a systematic review and meta-analysis on the feasibility and safety.
Laparoscopic and robotic pancreaticoduodenectomy have started utilization tentatively; however, the clinical benefits are still controversial. This study aims to evaluate the safety and efficiency of minimally invasive pancreaticoduodenectomy. ⋯ This meta-analysis indicates minimally invasive pancreaticoduodenectomy may be associated with shorter hospital stay, less estimated blood loss, and positive margin rate without compromising surgical safety as open surgery. Surgical duration of robotic method could even be equivalent as laparotomy. Minimally invasive approach can be a reasonable alternative to laparotomy pancreaticoduodenectomy with potential advantages. Nevertheless, future large-volume, well-designed RCTs with extensive follow-up are awaited to confirm and update the findings of this analysis.