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Quality Indicators in Endometriosis Surgery
Published in Nazar N. Amso, Saikat Banerjee, Endometriosis, 2022
Caryl M. Thomas, Richard J. Penketh
Postoperative recovery is typically accelerated with laparoscopic surgery with a quick return to normal function and return to work. All hospital readmissions should be reported and all postoperative complications audited.
Surgical Treatments of Obesity
Published in Ruth Chambers, Paula Stather, Tackling Obesity and Overweight Matters in Health and Social Care, 2022
Only experienced and trained surgeons in specialist centres should perform these operations. The standard approach for these operations is laparoscopic surgery due to the significant benefits to patients in terms of shorter hospital stay and reduction in complications such as infections, incisional hernias and smaller scars, resulting in an early return to normal activities and work. The advent of laparoscopic surgery has resulted in a global massive uptake of bariatric surgery. Endoscopic techniques are evolving, the most popular one being placement of an intra-gastric balloon. The commonly performed operations are laparoscopic gastric bypass, laparoscopic sleeve gastrectomy, anastomosis or mini gastric bypass, laparoscopic gastric banding and duodenal switch.
General Surgery
Published in Kelvin Yan, Surgical and Anaesthetic Instruments for OSCEs, 2021
This is a laparoscopic port (Figure 7.19). It is a pen-shaped laparoscopic instrument with a sharp end which is encased by a sleeve/cannula. It is inserted through the skin to create a surgical opening into the body cavity. The trocar is then removed leaving the cannula/sleeve in situ providing surgical access to the site of operation laparoscopically whilst sealing the skin. It makes laparoscopic surgery possible by providing access to surgical equipment including laparoscopes, graspers and electrosurgical electrodes. It also allows the removal of body tissues including biopsy samples.
Minimally Invasive Surgery for Cervical Cancer: Should We Look beyond Squamous Cell Carcinoma?
Published in Journal of Investigative Surgery, 2022
Andrea Giannini, Ottavia D’Oria, Vito Chiantera, Chrysoula Margioula-Siarkou, Mariano Catello Di Donna, Sanja Terzic, Zaki Sleiman, Antonio Simone Laganà
The gold standard treatment of early CA is radical hysterectomy, as recommended by current guidelines [5]. Conventional laparotomy or laparoscopic surgery are the surgical options. The evidence about the optimal surgical approach for patients with CA is still insufficient, because current recommendations are mostly based on patients with cervical squamous cell cancer [6]. The laparoscopic approach is widely known for reducing recovery time and minimizing postoperative pain, although the recent results of the multicenter phase 3 randomized Laparoscopic Approach to Cervical Cancer (LACC) trial comparing minimally invasive surgery (robot-assisted or laparoscopic) with open surgery for International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IA (with lymphovascular space invasion [LVSI+]) −IB1 cervical cancer showed lower disease-free survival (DSF) and overall survival (OS) in the minimally invasive group [7]. A recent multicentric study tried to investigate the possible surgery-related factors associated with poor oncologic outcomes in patients who underwent laparoscopic surgery, suggesting that the tumor size represents the most important risk factors [8].
Predictive value of thromboelastography for postoperative lower extremity deep venous thrombosis in gastric cancer complicated with portal hypertension patients
Published in Clinical and Experimental Hypertension, 2021
Chunhong Gong, Kaihu Yu, Nianrong Zhang, Juan Huang
The surgical method of the laparoscopic surgery is as follows. After routine preoperative preparations, endotracheal intubation combined with general intravenous anesthesia was performed. The patient takes the conventional supine position, separates the legs, and makes a 10 mm small hole at the lower edge of the patient’s umbilicus. After the cannula is used as an observation hole, the patient is inflated to establish a carbon dioxide pneumoperitoneum and maintain the abdominal pressure at 12 mmHg. After the laparoscope enters the abdominal cavity, the whole abdomen is explored first. After determining the location of the lesion, explore whether there is metastasis to the abdominal cavity and surrounding lymph nodes. After the exploration, the lymph nodes were cleaned with an electric knife or ultrasonic knife under a laparoscope, and the stomach was freed. Then make a 5–6 cm incision in the middle of the upper abdomen, then protrude the omentum and stomach into the abdominal cavity, excise the tumor (13).
Evolving treatment modalities for immune thrombocytopenia in adults
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Sushmita Khadka, Vineela Kasireddy, Pravash Kumar Dhakal, Chandrakala Dadiboyina
Splenectomy now holds an important role in second-line therapy. A systematic review in 2004 showed a durable platelet response in 66% of the patients at the end of 153 months after splenectomy, mortality was 0.8%, and total complication rates including bleeding, infection, thrombosis were 12%. Both mortality and complications were significantly lower with laparoscopic surgery compared to laparotomy [12]. Spleen being a vital organ in the human immune system, there is a 5% risk of a lifetime infection in patient after splenectomy despite immunizations and prophylactic antibiotics [13]. Depletion of macrophages and marginal B cell make patients more vulnerable to encapsulated bacterial infection with Streptococcus pneumoniae, Hemophilus influenzae, and Neisseria meningitidis. Risk is highest in a few months after the surgery [14]. Immunizations prior to splenectomy and counseling regarding antibiotic prophylaxis following surgery is now included in American Society of Hematology 2019 guidelines for ITP [6]. The accepted recommendation now is to treat ITP with medical management for a year before considering splenectomy [6].