Surgical laparoscopy, endoscopy & percutaneous techniques
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Surg Laparosc Endosc Percutan Tech · Jun 2009
Randomized Controlled Trial Comparative StudyA prospective randomized, controlled study comparing low pressure versus high pressure pneumoperitoneum during laparoscopic cholecystectomy.
The increase in intra-abdominal pressure by insufflation of carbon dioxide during laparoscopy brings certain changes in function of organ systems and also leads to postoperative pain. Degree of intra-abdominal pressure is directly related with such change. Laparoscopic cholecystectomy can be performed at low pressure pneumoperitoneum. However, available space for dissection is less than the high pressure pneumoperitoneum. ⋯ An uncomplicated gall stone disease can be treated by low pressure laparoscopic cholecystectomy with reasonable safety by an experienced surgeon. Though surgeons experience more difficulty in dissection during low pressure pneumoperitoneum, it is significantly advantageous in terms of postoperative pain, use of analgesics, preservation of pulmonary function, and hospital stay.
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Surg Laparosc Endosc Percutan Tech · Apr 2009
Replacement of a feeding tube through the gastric tube in patients after esophagectomy with retrosternal reconstruction.
We present our technique of endoscopic replacement of the jejunostomy through the stomach conduit in patients after esophagectomy with retrosternal reconstruction. ⋯ We believe that the endoscopic percutaneous approach described in this report is safe and effective in patients after esophagectomy with retrosternal reconstruction.
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Abdominal paracentesis and thoracocentesis are common bedside procedures with diagnostic, therapeutic and palliative roles. We describe a useful and familiar a useful and familiar technique with the use of a multiple lumen catheter commonly used for central venous line insertion for drainage of ascites or moderate to large pleural effusions. The use of a multiple lumen catheter allows easier and more rapid aspiration of fluid with a smaller probability of the side holes being blocked as compared to the standard needle or single catheter methods. This is particularly useful in situations where the dedicated commercial kits for thoracocentesis and abdominal paracentesis are not readily available.
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Surg Laparosc Endosc Percutan Tech · Dec 2008
Review Meta AnalysisEffect of heated and humidified carbon dioxide on patients after laparoscopic procedures: a meta-analysis.
To systematically analyze the role of heated humidified carbon dioxide (CO2) in laparoscopy. ⋯ The use of heated humidified CO2 for pneumoperitoneum in laparoscopic procedures is associated with lesser postoperative pain, lower risk of postoperative hypothermia, and lower analgesic requirements. However, total hospital stay and lens fogging rates do not differ. Hence, the heated and humidified CO2 may be considered as the first choice for pneumoperitoneum in laparoscopic procedures.
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Surg Laparosc Endosc Percutan Tech · Dec 2008
Randomized Controlled TrialRoutine administration of antibiotics to patients suffering accidental gallbladder perforation during laparoscopic cholecystectomy is not necessary.
Accidental rupture of the gallbladder is an event which occurs in up to 20% of laparoscopic cholecystectomies, mainly in those where dissection is difficult, or during extraction when the gallbladder is withdrawn directly through the laparoscope port. It has been commonly assumed that contamination by bile in the abdominal cavity could be a cause of infection and lead to the formation of a residual abscess or even to surgical wound infection. It is common practice, therefore, for the surgeon to prescribe the application of an antibiotic at the moment when gallbladder perforation occurs. ⋯ Routine application of an antibiotic to patients experiencing accidental perforation of the gallbladder during laparoscopic cholecystectomy is not necessary. In the case of patients with diabetes mellitus, those who are older than 60, or who have an ASA classification of 3 or more, or if the operation itself is likely to last more than 70 minutes, the recommendation is to start antibiotic therapy in the preoperative phase immediately before surgery.