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General Surgery
Published in Kelvin Yan, Surgical and Anaesthetic Instruments for OSCEs, 2021
There are a number of factors that may cause complications in a laparoscopy. These include consequences from the laparoscopic instruments, the physiological changes from pneumoperitoneum and positioning. Laparoscopic Instruments: Vascular and visceral injury, bleeding and scarring.Pneumoperitoneum: Venous gas embolism, vagal stimulation > bradycardia + asystole, raised intraabdominal pressure > compression of the inferior vena cava > reduced preload > decreased cardiac output, splinting of the diaphragm > reduced lung compliance > hypoxaemia, increased CO2 intraabdominally > hypercarbia > increased intracranial pressure (ICP).Positioning: Trendelenburg position > raised ICP + further splinting of the diaphragm and hypoxaemia/hypercarbia. Reverse Trendelenburg > reduced preload > hypotension. Very rarely, the Trendelenburg position may cause “Well Leg Compartment Syndrome” due to reduced perfusion and venous drainage.
Ectopic Pregnancy: Extrauterine Pregnancy and Pregnancy of Unknown Location
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
The current gold standard for surgical treatment of an EP is laparoscopy, which has replaced laparotomy. Laparoscopy is associated with less intraoperative blood loss, shorter postoperative hospital stays, and less overall hospital costs than laparotomy [39]. In addition, the operating time, anesthesia, and time to resume activities of daily living are also reduced when the patient undergoes laparoscopy [39, 40]. Laparoscopy and laparotomy do not differ with regard to repeat EP or IUP rates. The time taken for β-hCG to return to normal is similar for laparoscopy and laparotomy, although earlier investigations revealed higher rates of persistent trophoblast tissue in laparoscopic surgery [38, 41, 42] compared to open surgery. Because surgical skills in laparoscopy have made considerable progress in the past few years, the procedure has become the state of the art in the surgical treatment of EPs.
Laparoscopic Ileocecal Resection
Published in Haribhakti Sanjiv, Laparoscopic Colorectal Surgery, 2020
Ileocecal resection is a challenging surgery, as it involves resection and anastomosis of two different parts of the luminal digestive tract along with resection of a valve. The applied anatomy and physiology of the ileocecal area is to be kept in mind while planning a resection. Prior to resection, a thorough evaluation to identify the medical morbidities is imperative, so that the operative approach and involvement of multidisciplinary teams can be adjusted as necessary. Preoperative imaging studies and endoscopies must be reviewed by the operating surgeon. Overall, the ileo-ascending anastomosis is considered one of the reliable anastomoses among various anastomoses performed in the digestive tract. However, the possibility of leak increases in cases of inflammatory bowel disease, amoebic typhilitis, and acute mesenteric ischemia. Long-term consequences and physiological changes should be kept in view in surgeries for benign disease. Gall stones, oxalate urinary stones, diarrhea or at least increased stool frequency, or disturbances in digestive function may present consequently to ileocecal valve resection. Though ileocecal resection is a relatively easier surgery, its selection process, execution, and consequences require meticulous planning. Laparoscopy is a feasible option, with its inherent advantages of being minimally invasive. Laparoscopy-assisted resections balances cost and benefit in the Indian scenario as per our belief.
Visual Observation of Abdominal Adhesion Progression Based on an Optimized Mouse Model of Postoperative Abdominal Adhesions
Published in Journal of Investigative Surgery, 2023
Zijun Wang, Enmeng Li, Cancan Zhou, Bolun Qu, Tianli Shen, Jie Lian, Gan Li, Yiwei Ren, Yunhua Wu, Qinhong Xu, Guangbing Wei, Xuqi Li
To investigate the progression of PAAs, the peritoneal brushing method was used to establish a PAA model. A flow chart of the laparoscopic observation of PAA progression in the groups of mice is shown in Figure S2. Briefly, 60 mice were used to complete this procedure, including 10 untreated mice as the control group. The other 50 mice were used to establish the mouse model, were randomly divided into five groups and euthanized on POD 1, 3, 5, 7 or 14. A laparoscope was purchased in China (Xiaomi, Zhejiang, China). Before laparoscopy, a syringe was used to inject 3 ml of air into the abdominal cavity to establish pneumoperitoneum. The laparoscope was inserted into the abdominal cavity through a 5-mm incision in the left upper abdomen. After laparoscopy, the peritoneum was closed with polyglycolic acid absorbable sutures (6/0 sutures), and the abdominal wall was closed using 6/0 nonabsorbable silk sutures.
“Comparison of Nissen Rossetti and Floppy Nissen techniques in laparoscopic reflux surgery”
Published in Annals of Medicine, 2023
Cem Kaan Parsak, İlker Halvacı, Uğur Topal
Laparoscopic fundoplication procedures have proven to be successful for the treatment of gastroesophageal reflux disease with low morbidity. As can be seen, gastrointestinal symptoms occur at various rates after laparoscopic surgery, and multiple theories have been put forward to explain the mechanisms behind their occurrence. There are different mechanisms behind the development of different symptoms, including vagal injury, tight fundoplication, the shift of the fundoplication into the thorax, dietary habits and air swallowing [21,38]. A previous study found postoperative symptoms to be more common when vagotomy was added to anti-reflux surgery [39], suggesting that vagal injury during laparoscopic anti-reflux surgery may lead to the development of gastrointestinal symptoms in the postoperative period. It is believed that postoperative adhesions may also be an effective factor delaying gastric and duodenal emptying, although these dyspeptic symptoms may also be related to an underlying undiagnosed disease. In such cases, the operation may not be the direct cause of the symptoms but may play a supporting role in their emergence. Nissen recommends care during surgery not to cause vagal injury [21,40].
Surgical waiting times and all-cause mortality in patients with non-metastatic renal cell carcinoma
Published in Scandinavian Journal of Urology, 2022
Andreas Karlsson Rosenblad, Pernilla Sundqvist, Ulrika Harmenberg, Mikael Hellström, Fabian Hofmann, Anders Kjellman, Britt-Inger Kröger Dahlin, Per Lindblad, Magnus Lindskog, Sven Lundstam, Börje Ljungberg
The updated TNM 2017 classification system [26] was used for tumour staging. RCC type was classified as clear cell, papillary, chromophobe, or other. Tumour size was defined as the maximal tumour diameter measured by tomographic imaging. Surgical treatment was dichotomised as open or non-open surgery, with the latter including laparoscopy or robot-assisted laparoscopy. Ablation treatment (n = 425, 4.3%) was classified as a non-open surgical treatment. Age at surgery was calculated as the time from the date of birth to the date of surgery, while the SWTs were calculated as the times from the date of radiological diagnosis to the dates of surgery (WRS) and treatment decision (WRT) and from the date of treatment decision to the date of surgery (WTS), respectively. Time to follow-up was measured as the time from the date of surgery to the date of death or censoring, with the latter occurring if the participant emigrated, changed PIN or was still alive at the end of follow-up on 9 December 2021.