Surgical laparoscopy, endoscopy & percutaneous techniques
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Surg Laparosc Endosc Percutan Tech · Jun 2005
Randomized Controlled Trial Comparative Study Clinical TrialComparative cost-analysis of a propofol-cisatracurium-based anesthesia with remifentanil or fentanyl for laparoscopic surgery.
To compare the intraoperative costs of intravenous propofol-based anesthesia for laparoscopic cholecystectomy, a total of 42 patients were randomly assigned to receive remifentanil or fentanyl as adjuvant using the bispectral index anesthesia monitoring. The average anesthesia calculated costs per hour (and per minute) were 79.45 (1.32) in the fentanyl group and 65.36 (1.09) in the remifentanil group. ⋯ In conclusion, for propofol-cisatracurium-based anesthesia for laparoscopic surgery, when applying the bispectral index to guide the administration of hypnotic anesthetic drugs and ensure an adequate and stable depth of anesthesia, the cost of anesthesia is lower using remifentanil as an adjuvant rather than fentanyl. The clinical relevance is that it could be the intravenous anesthesia technique of choice in laparoscopic surgery for cholecystectomy from a cost-minimization standpoint.
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Surg Laparosc Endosc Percutan Tech · Apr 2005
ReviewA review of surgical simulation with attention to validation methodology.
The use of simulation technology for teaching and evaluating surgical skills has gained considerable attention in recent years. This is driven by interest in quality of care, concerns over increasing operative complexity, constraints on the use of animal models, limited available patient material, medicolegal pressures, and fiscal mandates for cost-effective performance. Traditional mechanical models are yielding to techniques dependent on electronic technology, including virtual reality. ⋯ Most of the literature pertaining to simulation techniques for surgical training has been published within the past 5 years and consist of review, opinion, and feasibility articles. There is an emerging body of evidence to establish the validity of simulation techniques for assessing surgical skills. Further refinement of simulation techniques, identification of specific performance measures, longitudinal evaluations, and comparison to practice outcomes are still needed to establish the validity and the value of surgical simulation for teaching and assessing surgical skills prior to considering implementation for certification purposes.
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Surg Laparosc Endosc Percutan Tech · Apr 2005
Randomized Controlled Trial Comparative Study Clinical TrialComparison of needlescopic appendectomy versus conventional laparoscopic appendectomy: a randomized controlled trial.
Laparoscopic appendectomy has been shown to improve postoperative recovery when compared with open appendectomy. The present randomized trial was conducted to evaluate any further difference in outcome between needlescopic appendectomy (NA) and conventional laparoscopic appendectomy (CLA) in the management of acute appendicitis. Patients with the clinical diagnosis of acute appendicitis were randomized to either NA (instrument size < or = 3 mm) or CLA (instrument size > or = 5 mm). ⋯ NA resulted in a longer operation time and higher conversion rate. Except for a smaller scar, the present study was unable to demonstrate any other short-term benefits. Thus, the technique cannot be routinely recommended.
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Surg Laparosc Endosc Percutan Tech · Oct 2004
Incidental cystadenoma after laparoscopic treatment of hepatic cysts: which strategy?
Biliary cystadenoma is a very rare hepatic neoplasm, accounting for fewer than 5% of cystic neoplasms of the liver; regardless of the various diagnostic modalities, such a lesion may be difficult to distinguish preoperatively from a cystadenocarcinoma. Although a diagnosis of cystadenoma during open hepatic surgery demands a complete surgical resection, there are few reports describing the correct approach to such lesions after a laparoscopic approach. This article presents the first case series of incidental cystadenoma after laparoscopic surgery for hepatic cystic lesions. ⋯ In one patient, there was a high suspicion of recurrence of cystadenoma after the laparoscopic fenestration of a large cyst, but a histopathological specimen obtained after the open surgical resection could not confirm any signs of cystadenoma. The incidental finding of biliary cystadenoma after laparoscopic fenestration of a cystic hepatic lesion requires an open hepatic resection. When a complete laparoscopic enucleation of the cyst may be assured, a strict clinical, biochemical, and radiologic follow-up could be considered as the definitive treatment, demanding the surgical intervention only in case of recurrence or high suspicion for malignancy.
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Surg Laparosc Endosc Percutan Tech · Jun 2004
Review Case ReportsStump appendicitis: case report and review.
The purpose of this study is to review the medical literature regarding the prevalence of appendicitis in patients with previous appendectomy. Stump appendicitis is a real entity not often considered when evaluating patients with right lower quadrant pain and a history of appendectomy. This leads to delays in diagnosis and treatment. ⋯ Stump appendicitis is a real, yet probably underreported entity. It can occur after either laparoscopic or open appendectomy. Avoidance of a long appendiceal stump is the only suggested means by which to avoid its occurrence.