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Surgery for biliary atresia: Open and laparoscopic
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Mark Davenport, Atsuyuki Yamataka
The liver should be mobilized and everted onto the abdominal wall (Figure 55.8). This can be achieved by dividing the falciform ligament and left coronary ligaments. The right-sided attachments around the “bare” area of the liver can be left intact and the liver still everted. The authors believe this to be a crucial step, which allows full exposure of the portal hepatis and facilitates the subsequent detailed dissection. Nonetheless, it is possible to dissect the porta with the liver in situ although most proponents will sling the portal vessels to achieve the visualization of the portal plate. It is imperative to warn the anesthetist at this stage as the maneuver impairs venous return to the heart by kinking the cava and will need an increase in IV volume support.
Adult Autopsy
Published in Cristoforo Pomara, Vittorio Fineschi, Forensic and Clinical Forensic Autopsy, 2020
Cristoforo Pomara, Monica Salerno, Vittorio Fineschi
The liver occupies the right hypochondrium and a portion of the epigastrium. It is almost completely covered by the peritoneum and the suspensory ligaments of the liver: the falx ligament,4 the coronary ligament,5 and the lesser omentum, which fix the liver in place. The inferior vena cava is also fixed to the liver’s dorsal ligament6 (Figures 2.99 and 2.100). To remove the liver, move it laterally and medially, up and down, to free it from its suspensory ligaments (Figure 2.99). Then, cut each of the ligaments by first placing traction on the ligament to be incised and making an incision inclined at 90° perpendicular to the ligament and parallel to the hepatic surface curvatures. First, incise the right triangular ligament, then the coronary ligament, orientating the scalpel posteriorly and parallel to the inferior surface of the liver. Take great care to preserve the right adrenal gland as it is immediately adjacent. The lesser omentum and the ileocecal folds are then divided with a crescent-shaped incision. The same procedure is followed with the triangular left ligament and the coronary ligaments. Lower one hand below the right dome of the diaphragm and stretch the fingers like a fan, thereby separating the dome itself of the liver from the diaphragm. Finally, separate the remaining ligaments and inferior vena cava, freeing the organ.
The knee
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
Andrew Price, Nick Bottomley, William Jackson
Situated as they are between these complexly moving surfaces, the fibrocartilaginous menisci are prone to injury, particularly during unguarded movements of extension and rotation on the weight bearing leg. The medial meniscus is especially vulnerable because, in addition to its loose attachments via the coronary ligaments, it is firmly attached at three widely separated points: the anterior horn, the posterior horn and to the medial collateral ligament. The lateral meniscus more readily escapes damage because it is attached only at its anterior and posterior horns and these are close to each other.
Comparative evaluation of intraperitoneal bupivacaine and bupivacaine ketamine combined with lung recruitment for reducing postoperative shoulder pain in laparoscopic cholecystectomy
Published in Egyptian Journal of Anaesthesia, 2018
Raham Hasan Mostafa, Yehia Mamdouh Hassan Mekki
Shoulder tip pain was almost unheard of in open cholecystectomy era and was first reported after laparoscopic gynecological procedures [11]. Nowadays, SP is assumed to be multifactorial in nature. A proposed cause is direct damage and/or irritation of the diaphragmatic peritoneal nerves and so pain might occur due to carbonic acid produced from CO2 within the peritoneal cavity [12]. Another etiology is peritoneal surface stretching leading to traction and tearing of microvascular structures with subsequent hemorrhage that may be microscopic or macroscopic. It causes pain due to the release of inflammatory mediators [13]. Another possible theory is the loss of the ’suction’ effect between the liver and diaphragm allowing traction on the triangular and coronary ligaments of the liver that leads to sub diaphragmatic pain and SP [14].
Contemporary use of ultrasonic versus standard electrosurgical dissection in laparoscopic nephrectomy: Safety, efficacy and cost
Published in Arab Journal of Urology, 2018
Nand Kishore Arvind, Qutubuddin Ali, Onkar Singh, Shilpi Gupta, Surbhi Sahay
In the ES group, there were three complications (4.2%): direct inadvertent burn to bowel and diaphragm injury, both of which were repaired laparoscopically, and the third case had blunt injury to renal artery adventitial vessels during circumferential dissection by hook cautery, which was managed by application of Hem-o-lok clip proximally. In the USD group, there were also three intraoperative complications (4.3%): blunt injury to splenic vessels in one patient and lumbar vein complex in the second patient, both caused by excessive traction and were managed by selective use of metal clips. In the third case there was injury to the liver during dissection of the coronary ligament and was managed by application of Surgicel and argon-beam coagulation. The conversion rate to open surgery was 12.5% (17/136), with no statistical differences between the groups (ES nine vs USD eight). The reasons to convert to an open procedure were: bleeding (nine cases), presence of fibrosis or adhesions (six cases), and locally advanced neoplasm (two cases).