Management of deep infiltrative endometriosis (DIE) causing gynecological morbidity: A urologist's perspective
Seema Chopra in Endometriosis, 2020
Segmental resection/partial cystectomy: Partial cystectomy involves full-thickness removal of the endometrial nodule with a normal bladder margin. It is generally a safe procedure when the lesion is at the dome and away from the ureteric orifices, though the technique may vary from laparotomy [61,64,67–70] to laparoscopy [62,64,71–75] or, more recently, robotic assistance [76–81]. However, the steps of the technique are essentially similar, that is, dissection of the vesicouterine pouch, cystotomy with complete full-thickness removal of the nodule, and watertight closure of the bladder with absorbable sutures. Laparoscopy has all the advantages of minimally invasive surgery including less magnified vision, postoperative pain, fewer wound-related problems, and early recovery. Robotic assistance has the added advantage of 3D vision and ease of intracorporeal suturing in the deep pelvis. The need for ureteric stenting can be assessed during the cystoscopy and is required when the nodule is close to the ureteric orifice (<2 cm) or recurrent nodules with scarring [82]. Patients may require ureteric re-implantation when complete excision of the nodule required excision of the vesicoureteral junction. All techniques have demonstrated excellent outcomes and recurrence rates following partial cystectomy, irrespective of the surgical approach used.
Complications of Laparoscopy in General Surgery
Stephen M. Cohn, Matthew O. Dolich in Complications in Surgery and Trauma, 2014
Minimally invasive surgery is a rapidly growing and maturing discipline that requires significant training and experience on the part of the surgeon as well as the healthcare team. When surgeon experience and facility resources allow, laparoscopy may offer the advantages of less pain, fewer wound-related complications, shorter hospital length of stay, and other benefits. Surgeons who gain sufficient experience with basic and advanced laparoscopy during their residency and fellowship training, hands-on courses, or proctorships fully appreciate the causes and incidences of potential complications associated with laparoscopy. As with any procedure, prevention and management of complications is paramount; moreover, the method of management should adhere to time-honored surgical principles. These complications are best avoided by perfecting and using proper laparoscopic technique and by understanding the unique pitfalls of each laparoscopic operation.
General Surgery
Kelvin Yan in 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.
Simulation of non-Newtonian flow of blood in a modified laparoscopic forceps used in minimally invasive surgery
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2021
Md. Abdul Raheem Junaidi, Harsha Sista, Ram Chandra Murthy Kalluri, Y. V. Daseswara Rao, Alla Gopala Krishna Gokhale
There has been a significant development in the field of surgery over the last few years to facilitate and improve surgeons' performance and patients' safety. Earlier, surgeons used to perform laparotomy procedures by cutting the abdominal cavity wide open, to view the internal organs directly. This often requires a big incision of about 100 mm in length (Buia et al. 2015). Laparoscopic procedure, on the other hand, is a minimally invasive surgery (MIS) used by surgeons to operate upon the abdominal cavity by viewing the internal organs through a monitor. Depending on the type of surgery, up to four small incisions of less than 10 mm are made in the abdomen through which instruments like a laparoscope, dissector forceps, and suction–irrigation (S–I) device are inserted. A laparoscope is a 330 mm long device with a high-resolution camera used for viewing organs in the abdominal cavity. The dissector forceps is used for grasping and dissecting the infected tissue. The S–I process is used to clean and disinfect the abdominal cavity to enable safe and efficient surgical intervention. This is done by sucking out blood and other body fluids and irrigating with a disinfectant such as saline water. S–I instruments must be sterilized properly to avoid the clotting of blood and trapping of tissue inside it. Some advantages of the laparoscopic procedures include minimal scarring, less trauma, less post-operative pain, less chances of infection to patients and surgeons, reduced duration of stay in the hospital, and faster recovery time (Chambers et al. 2011; Li 2011; Santos et al. 2011; Zhu et al. 2017).
Comparison of Ultrasound-Guided Erector Spinae Plane Block and Subcostal Transversus Abdominis Plane Block for Postoperative Analgesia after Laparoscopic Cholecystectomy: A Randomized, Controlled Trial
Published in Journal of Investigative Surgery, 2022
Halime Ozdemir, Coskun Araz, Omer Karaca, Emin Turk
Laparoscopic surgery (LC) is a surgical method that has many advantages since it involves smaller incisions with less bleeding and ileus in the postoperative period, and provides faster recovery and reduced hospital stay. Although one of the major advantages of laparoscopy is less postoperative pain, it does not completely disappear and can be severe. Therefore, it is still considered as an important issue [1]. Pain after LC is associated with phrenic nerve irritation due to abdominal tension, port-site incision, and CO2 insufflation. Therefore, pain that occurs after the removal of the gallbladder is of both visceral and somatic origin [2]. If not adequately treated, acute postoperative pain is associated with an increased risk of myocardial ischemia, thromboembolic and pulmonary complications, changes in the immune system due to opioid use, prolonged hospital stay, and chronic pain [3, 4]. Thus, pain should be treated before the development of central nervous system hyperexcitability and peripheral hypersensitivity [1].
A Propensity Score-Matched Analysis of Laparoscopic versus Open Surgery in Patients with COPD
Published in Journal of Investigative Surgery, 2021
Supreet Singh, Aziz M. Merchant
Patients in the laparoscopy cohort also showed a significantly lower likelihood of complications. Laparoscopic cholecystectomies were 52% (95% OR CI: 0.27–0.87, p = 0.015) less likely to have cardiac complications, 48% (95% OR CI: 0.40–0.67, p < 0.001) less likely to have respiratory complications, 60% (95% OR CI: 0.30–0.54, p < 0.001) less likely to have digestive complications, and 53% (95% OR CI: 0.39–0.57, p < 0.001) less likely to have any type of complications. Laparoscopic diagnostic procedures were also 62% (95% OR CI: 0.15–0.99, p = 0.048) less likely to have cardiac complications, 43% (95% OR CI: 0.41–0.81, p = 0.002) less likely to have respiratory complications, 45% (95% OR CI: 0.40–0.76, p < 0.001) less likely to have digestive complications, and 50% (95% OR CI: 0.39–0.65, p < 0.001) less likely to have any type of complications. Laparoscopic colectomies and procedures of the upper GI tract were associated with 39% (95% OR CI: 0.49–0.77, p < 0.001) and 58% (95% OR CI: 0.21–0.83, p = 0.013) fewer digestive complications, 22% (95% OR CI: 0.64–0.95, p = 0.016) and 75% (95% OR CI: 0.09–0.68, p = 0.007) fewer respiratory complications, and 29% (95% OR CI: 0.60–0.83, p < 0.001) and 65% (95% OR CI: 0.21–0.61, p < 0.001) fewer overall complications, respectively. Laparoscopic appendectomies were associated with a 56% (95% OR CI: 0.27–0.71, p = 0.001) decrease in digestive complications and a 45% (95% OR CI: 0.38–0.80, p = 0.002) decrease in overall complications (Table 2).