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Chatziisaak D, Sparn M, Krstic D, Bauci G, Warschkow R, Brunner W, Schmied B, Hahnloser D, Bischofberger S. Be prepared! Impact of structured video-assisted coaching on performance in a simulated bleeding exercise during laparoscopic surgery. Surg Endosc 2024; 38:6120-6127. [PMID: 39187730 PMCID: PMC11458636 DOI: 10.1007/s00464-024-11173-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 08/05/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND Bleeding during laparoscopic surgery is stressful and requires immediate efficient management. Skills for complication management are rarely trained. This study aims to investigate the impact of video-assisted coaching on laparoscopic skills acquisition and performance in emergency bleeding situations. METHODS Participants faced simulated emergency scenarios during laparoscopy involving bleeding management in porcine aorta/kidney specimens. Four sequences were conducted over two days, with a structured video-assisted coaching provided between sequences. Performance was assessed using the Global Operative Assessment of Laparoscopic Skills (GOALS) score. The study involved 27 participants attending the advanced colorectal surgery module at the 40th Annual Davos Course in 2023. RESULTS 54 video sequences were analyzed. Structured video-assisted coaching improved the GOALS sum score by 0.36 (95%CI: 0.21-0.50, P < 0.001) in contrast to simple repetition (0.05 with 95%CI: -0.43 to 0.53, P = 0.826). This association was observed for depth of perception (P < 0.001), bimanual dexterity (P < 0.001), tissue handling (P < 0.001), overall performance (P < 0.001), and efficiency (P < 0.001). Autonomy did not significantly improve (P = 0.55). Findings were consistent regardless of age, gender, and overall laparoscopic experience of the participants. However, a weaker effect of structured video-assisted coaching was observed in participants with experience in laparoscopic surgery. CONCLUSION Structured video-assisted coaching improved performance in laparoscopic skills in complex and stress-inducing bleeding scenarios. The findings of this study support the incorporation of video-assisted coaching and complication management exercises into surgical training curricula.
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Affiliation(s)
- Dimitrios Chatziisaak
- Department of Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
- Department of Visceral Surgery, University Hospital Lausanne, Lausanne, Switzerland
| | - Moritz Sparn
- Department of Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Daniel Krstic
- Department of Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Gabriele Bauci
- Department of Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Réne Warschkow
- Department of Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Walter Brunner
- Department of Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
- Paracelsus Medical University, Salzburg, Austria
| | - Bruno Schmied
- Department of Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Dieter Hahnloser
- Department of Visceral Surgery, University Hospital Lausanne, Lausanne, Switzerland.
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Cizmic A, Killat D, Häberle F, Schwabe N, Hackert T, Müller-Stich BP, Nickel F. Simulation training of intraoperative complication management in laparoscopic cholecystectomy for novices-A randomized controlled study. Curr Probl Surg 2024; 61:101506. [PMID: 39098335 DOI: 10.1016/j.cpsurg.2024.101506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/02/2024] [Indexed: 08/06/2024]
Affiliation(s)
- Amila Cizmic
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany.
| | - David Killat
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Frida Häberle
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Nils Schwabe
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Thilo Hackert
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Beat P Müller-Stich
- Department of Digestive Surgery, University Digestive Healthcare Center Basel, Basel, Switzerland
| | - Felix Nickel
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
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Luo Y, Zhang H, Wu Q, Chen Y, Ye Z, Liu R, Chai C. Indocyanine green fluorescence imaging-assisted laparoscopy resection of retroperitoneal tumors in children: case report and literature review. Front Pediatr 2024; 12:1374919. [PMID: 38903767 PMCID: PMC11188581 DOI: 10.3389/fped.2024.1374919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/17/2024] [Indexed: 06/22/2024] Open
Abstract
This study examined the applicability of indocyanine green (ICG) fluorescence imaging to assist the laparoscopic resection of retroperitoneal tumors in pediatric patients via an abdominal approach. Conducted prospectively at the Guangzhou Women and Children's Medical Center from May to September 2023, the research included three pediatric cases, for whom laparoscopic retroperitoneal tumor resections were performed utilizing ICG fluorescence imaging. In each case, ICG was intravenously administered (0.3 mg/kg) prior to surgery, enabling the visualization of vital vascular structures through real-time fluorescence imaging. The trocar's placement was guided by a "four-hole" technique from the healthy side in a 70-degree lateral decubitus position. The operations were accomplished successfully without any complications. Pathological analysis of the patients identified one case of Wilms tumor of the embryonal type, one ganglioneuroblastoma of the mature type without N-MYC gene amplification, and one mature cystic teratoma. The findings suggest that with careful patient selection and skilled surgical execution, the utilization of ICG fluorescence imaging in the laparoscopic resection of retroperitoneal tumors is both safe and effective in children. This approach significantly improves the visualization of critical blood vessels, thus enhancing surgical safety.
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Affiliation(s)
- Yuanyuan Luo
- Department of Gastrointestinal Surgery, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Hong Zhang
- Department of Gastrointestinal Surgery, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Qiang Wu
- Department of Gastrointestinal Surgery, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yan Chen
- Department of Gastrointestinal Surgery, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Zhihua Ye
- Department of Gastrointestinal Surgery, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Ruiyu Liu
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
- Department of Urinary Surgery, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Chengwei Chai
- Department of Gastrointestinal Surgery, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
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Hamid M, Kershaw M, Bhakthavalsalan R, Shivamurthy R, Davies S, Singhal R, Nijjar R, Wiggins T, Camprodon R, Ahmed Z. Pre-Operative Group and Save in Elective and Emergency Laparoscopic Cholecystectomy: Necessity, Cost-Effectiveness, and Own Experience. J Clin Med 2024; 13:2749. [PMID: 38792291 PMCID: PMC11122548 DOI: 10.3390/jcm13102749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/07/2024] [Accepted: 04/30/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Laparoscopic cholecystectomy is associated with a high safety profile. This study seeks to quantify the incidence of blood transfusion in both the elective and emergency settings, examine related patient outcomes, and investigate selection criteria for pre-operative Group and Save (G&S) sampling. Methods: A prospective multi-centre observational study was conducted to investigate patients undergoing either elective or emergency laparoscopic cholecystectomy in the UK between January 2020 and May 2021. Multivariate logistical regression models were used to identify patient factors associated with the risk of transfusion and explore outcomes linked to pre-operative G&S sampling. Results: This study comprised 959 patients, with 631 (65.8%) undergoing elective cholecystectomy and 328 (34.2%) undergoing emergency surgery. The median age was 48 years (range: 35-59), with 724 (75.5%) of the patients being female. Only five patients (0.5%) required blood transfusions, receiving an average of three units, with the first unit administered approximately six hours post-operatively. Among these cases, three patients (60%) had underlying haematological conditions. In adjusted models, male gender was significantly associated with the need for a blood transfusion (OR 11.31, p = 0.013), while the presence of a pre-operative Group and Save sample did not demonstrate any positive impact on patient outcomes. Conclusions: The incidence of blood transfusion following laparoscopic cholecystectomy is very low. Male gender and haematological conditions may present as independent risk factors. Pre-operative G&S sampling did not yield any positive impact on patient outcomes and could be safely excluded in both elective and emergency cases, although certain population subsets will warrant further consideration.
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Affiliation(s)
- Mohammed Hamid
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, UK
- Dudley Group NHS Foundation Trust, Russell’s Hall Hospital, Pensnett Rd., Dudley DY1 2HQ, UK
| | - Marie Kershaw
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Resya Bhakthavalsalan
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Rishika Shivamurthy
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Sian Davies
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Rishi Singhal
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Rajwinder Nijjar
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Tom Wiggins
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Ricardo Camprodon
- Dudley Group NHS Foundation Trust, Russell’s Hall Hospital, Pensnett Rd., Dudley DY1 2HQ, UK
| | - Zuhair Ahmed
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, UK
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Lee M, Bang H, Lee E, Park S, Yoo H, Oh WY, Lee S. Imaging peritoneal blood vessels through optical coherence tomography angiography for laparoscopic surgery. JOURNAL OF BIOPHOTONICS 2024; 17:e202300221. [PMID: 37675626 DOI: 10.1002/jbio.202300221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/20/2023] [Accepted: 09/05/2023] [Indexed: 09/08/2023]
Abstract
Laparoscopic surgery presents challenges in identifying blood vessels due to lack of tactile feedback. The image-guided laparoscopic surgical tool (IGLaST) integrated with optical coherence tomography (OCT) has potential for in vivo blood vessel imaging; however, distinguishing vessels from surrounding tissue remains a challenge. In this study, we propose utilizing an inter-A-line intensity differentiation-based OCT angiography (OCTA) to improve visualization of blood vessels. By evaluating a tissue phantom with varying flow speeds, we optimized the system's blood flow imaging capabilities in terms of minimum detectable flow and contrast-to-noise ratio. In vivo experiments on rat and porcine models, successfully visualized previously unidentified blood vessels and concealed blood flows beneath the 1 mm depth peritoneum. Qualitative comparison of various OCTA algorithms indicated that the intensity differentiation-based algorithm performed best for our application. We believe that implementing IGLaST with OCTA can enhance surgical outcomes and reduce procedure time in laparoscopic surgeries.
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Affiliation(s)
- Minsuk Lee
- Medical Device Development Center, Osong Medical Innovation Foundation, Cheongju, Chungbuk, Korea
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea
| | - Hyeonjin Bang
- Medical Device Development Center, Osong Medical Innovation Foundation, Cheongju, Chungbuk, Korea
| | - Eungjang Lee
- Medical Device Development Center, Osong Medical Innovation Foundation, Cheongju, Chungbuk, Korea
| | - Sungsoo Park
- Division of Foregut Surgery, Anam Hospital, Korea University College of Medicine, Seoul, Korea
- Department of Surgery, Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hongki Yoo
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea
| | - Wang-Yuhl Oh
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea
| | - Seungrag Lee
- Medical Device Development Center, Osong Medical Innovation Foundation, Cheongju, Chungbuk, Korea
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Cheng Z, Lindberg Schwaner K, Dall'Alba D, Fiorini P, Savarimuthu TR. An electrical bioimpedance scanning system for subsurface tissue detection in Robot Assisted Minimally Invasive Surgery. IEEE Trans Biomed Eng 2021; 69:209-219. [PMID: 34156935 DOI: 10.1109/tbme.2021.3091326] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In Robot Assisted Minimally Invasive Surgery, discriminating critical subsurface structures is essential to make the surgical procedure safer and more efficient. In this paper, a novel robot assisted electrical bio-impedance scanning (RAEIS) system is developed and validated using a series of experiments. The proposed system constructs a tri-polar sensing configuration for tissue homogeneity inspection. Specifically, two robotic forceps are used as electrodes for applying electric current and measuring reciprocal voltages relative to a ground electrode which is placed distal from the measuring site. Compared to the other existing electrical bioimpedance sensing technology, the proposed system is able to use miniaturized electrodes to measure a site flexibly with enhanced subsurfacial detection capability. In this paper, we present the concept, the modeling of the sensing method, the hardware design, and the system calibration. Subsequently, a series of experiments are conducted for system evaluation including finite element simulation, saline solution bath experiments and experiments based on ex vivo animal tissues. The experimental results demonstrate that the proposed system can measure the resistivity of the material with high accuracy, and detect a subsurface non-homogeneous object with 100% success rate. The proposed parameters estimation algorithm is able to approximate the resistivity and the depth of the subsurface object effectively with one fast scanning.
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Management of Bleeding Complications in Virtual Reality Laparoscopy. Int Surg 2020. [DOI: 10.9738/intsurg-d-15-00190.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to compare the impact of induced bleeding complication training with regular training on a virtual reality laparoscopic (VRL) simulator. Although bleeding complications occur rarely during laparoscopic surgery, they usually arise without warning and may have severe consequences for the patient because complication management training is not currently widespread. Third-year medical students (n = 41) were randomly selected for 2 curricular courses on how to perform a bimanual task on a VRL simulator. Both the regular training group (RTG) and the induced bleeding complication training (ICT) group performed 2 regular training sessions and 9 training sessions. For the ICT group the training sessions were with a bleeding complication. The 2 groups were comparable regarding their initial performance levels and improved significantly in task time and handling economics throughout the course (P < 0.001). When a bleeding complication occurred during the initial phase, performance parameters were significantly worse (P < 0.05). During a bleeding complication, the ICT group showed a significant improvement in time, handling economics, and blood loss (P < 0.001) throughout the training course, whereas the RTG group showed no improvement. Induced complication training has a positive influence on the management of bleeding on the VRL simulator. Structured laparoscopic complication management training should be implemented during surgical education as an add-on to regular procedural training.
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Abstract
This review article summarizes the epidemiology of vascular injuries during urologic surgery and discusses intraoperative strategies to control bleedings. Techniques of vascular approaches (arteries and veins) are discussed and tricks for vascular repair are explained. Generally, vascular injuries during urologic surgery are rare. However, hemorrhage due to vascular injury is a common cause of critical morbidity and mortality in the perioperative period. Susceptibility to vascular complications such as oncological debulking and revision surgery increase risk for damage. As vascular injuries range from arrosion to avulsion, treatment is also broad, ranging from vascular suture to open or endovascular repair. Prevention of exsanguination requires visual control to stop the bleeding. The surgeon must act quickly to initiate appropriate repair, aiming for damage control and stabilization of the patient. Planning the surgery and consulting an experienced surgeon are decisive for successful management. Catastrophic bleeding has to be controlled and in the case of arterial injury it is often necessary to reconstitute perfusion. Reconstructions such as vascular anastomoses, patch angioplasty or interposition grafts are the preferred surgical techniques which are influenced by the nature of the injury. Vessels have to be thoroughly prepared before cross clamping to prevent injury by vascular clamps. Veins can often be ligated. Endovascular repair is also a possibility to control the bleeding, but nowadays it is often a definitive therapy method. For example, resuscitative endovascular balloon occlusion is useful to stabilize the patient and then to initiate vascular repair. Depending on the type of surgery performed, different vessels are concerned. Severe bleeding is usually located retroperitoneal affecting the aorta, renovisceral and iliac vessels. Predisposing urologic operations are lymphadenectomy, nephrectomy and (cysto)prostatectomy and also the laparoscopic approach can cause bleeding complications.
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Affiliation(s)
- J D Süss
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, St. Antonius Hospital gGmbH Eschweiler, Akademisches Lehrkrankenhaus der RWTH Aachen, Dechant-Deckers-Straße 8, 52249, Eschweiler, Deutschland.
| | - J Kranz
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, St. Antonius Hospital gGmbH Eschweiler, Akademisches Lehrkrankenhaus der RWTH Aachen, Dechant-Deckers-Straße 8, 52249, Eschweiler, Deutschland
| | - M Gawenda
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, St. Antonius Hospital gGmbH Eschweiler, Akademisches Lehrkrankenhaus der RWTH Aachen, Dechant-Deckers-Straße 8, 52249, Eschweiler, Deutschland
| | - J Steffens
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, St. Antonius Hospital gGmbH Eschweiler, Akademisches Lehrkrankenhaus der RWTH Aachen, Dechant-Deckers-Straße 8, 52249, Eschweiler, Deutschland
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Differential short-term outcomes of laparoscopic resection in colon and rectal cancer patients aged 80 and older: an analysis of Nationwide Inpatient Sample. Surg Endosc 2020; 35:872-883. [DOI: 10.1007/s00464-020-07459-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 02/11/2020] [Indexed: 12/29/2022]
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Guo J, Zeng Z, Cao R, Hu J. Intraoperative serious complications of laparoscopic urological surgeries: a single institute experience of 4,380 procedures. Int Braz J Urol 2019; 45:739-746. [PMID: 31063283 PMCID: PMC6837612 DOI: 10.1590/s1677-5538.ibju.2018.0601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 01/30/2019] [Indexed: 11/26/2022] Open
Abstract
This study aimed to share a single institute experience of 4,380 procedures about in-traoperative serious complications of laparoscopic urological surgeries. From January 2005 to December 2013, 4,380 cases of laparoscopic urological surgeries were recruited in our department. The distribution, incidence, and characteristics of intraoperative serious complications were retrospectively sorted out and analyzed. The surgeries were divided into three groups: very difficult (VD), difficult (D), and easy (E). The com¬plication at Satava class II was defined to be serious. One hundred thirty one cases with intraoperative serious complications were found (3.0%). The incidence of these complications was significantly increased along with the difficulty of the surgeries (P<0.05). The highest morbidity of serious complication belonged to total cystectomy with a ratio of about 17% as compared with other surgeries (P<0.05). The types of these complications included small vascular injury demanding blood transfusion (101 cases, 77.1%), large vascular (venous and artery) injury (16 cases), hypercapnia & acidosis (8 cases), and organ injury (6 cases). The cases of conversion to open surgery were 37 (≤1%). There was no significant difference in the rates of conversion to open surgery among the three groups (P>0.05). The overall tendency of the intraoperative serious complications was decreasing with the time from 2005 to 2013. In conclusion, through standardized training including improving the surgical technique, being familiar with the anatomic relationship, and constantly summarizing the experience and lessons, laparoscopic surgery could be safe and effective with not only minimal invasion but also few complications.
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Affiliation(s)
- Ju Guo
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zhigang Zeng
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Runfu Cao
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jieping Hu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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González J, Angulo-Morales FJ, Lledó-García E. Vascular Injury During Urologic Surgery: Somebody Call My Mother. Curr Urol Rep 2019; 20:2. [PMID: 30649624 DOI: 10.1007/s11934-019-0869-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To provide the critical elements to effectively manage hemorrhage from vascular injuries sustained during planned urological interventions. RECENT FINDINGS The frequency of intraoperative vascular injuries is increasing. However, literature concerning the management of iatrogenic operative vascular injuries is scarce. Although rare, intraoperative vascular injuries may be associated with potential catastrophic complications and death. The decision-making process following a potential life-threatening intraoperative vascular injury occurs in a very short time frame. Appropriate knowledge of the critical elements to identify the source of bleeding, initiate first-line hemostatic measures, select the candidate for damage control strategies, and perform the indicated operative repairing maneuvers and techniques have been proved crucial to ensure hemodynamic stability and bleeding cessation. The key surgical principles to counteract the impact of exsanguinating bleeding, and the aim to obtain the best achievable outcomes after definitive repair, are described in detail in this review.
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Affiliation(s)
- Javier González
- Servicio de Urología, Hospital General Universitario Gregorio Marañón, C/ Doctor Esquerdo, 46, 28007, Madrid, Spain.
| | - Francisco J Angulo-Morales
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Central de la Cruz Roja San José y Santa Adela, Universidad Alfonso X el Sabio, Villanueva de la Cañada, Spain
| | - Enrique Lledó-García
- Servicio de Urología, Hospital General Universitario Gregorio Marañón, C/ Doctor Esquerdo, 46, 28007, Madrid, Spain
- Departmento de Cirugía, Universidad Complutense de Madrid, Madrid, Spain
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Cassata G, Palumbo V, Cicero L, De Luca A, Damiano G, Fazzotta S, Buscemi S, Lo Monte AI. OneShot-M: A New Device for Close Laparoscopy Pneumoperitoneum. Surg Innov 2018; 25:570-577. [PMID: 30196768 DOI: 10.1177/1553350618799542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The induction of pneumoperitoneum is the first and most critical phase of laparoscopy, due to the significant risk of serious vascular and visceral complications. The closed technique for the creation of pneumoperitoneum could lead to several surgical complications. The present study aimed to overcome the complications associated with the insertion of Veress needle, improving its use, and facilitating the rapid creation of pneumoperitoneum. METHODS Thirty large white female pigs were enrolled in our study. A common plunger was modified in order to allow the passage of a 15-cm long Veress needle. This method was applied to 26 laparoscopic procedures (26 pigs) of several specialist branches. RESULTS OneShot-M close laparoscopy pneumoperitoneum creation device allowed us to obtain pneumoperitoneum quickly in all attempts, without any intraoperative and postoperative complications related to the use of the Veress needle. CONCLUSION The use of the proposed device showed an induction time as quick as the standard laparoscopic closed abdominal entry. The patented device is cheap and allows a safe abdominal entry. In addition, abdominal entry is much faster than the classic open technique.
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Affiliation(s)
| | - Vincenzo Palumbo
- 2 Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy.,3 Euro-Mediterranean Institute of Science and Technology (IEMEST), Palermo, Italy
| | - Luca Cicero
- 1 "A. Mirri" Sicily Zooprophilactic Institute, Palermo, Italy
| | | | - Giuseppe Damiano
- 2 Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Salvatore Fazzotta
- 2 Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Salvatore Buscemi
- 2 Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
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Chaturvedi A, Shukair SA, Le Rolland P, Vijayvergia M, Gunn JW, Subramanian H. Blood vessel detection, localization and estimation using a smart laparoscopic grasper: a Monte Carlo study. BIOMEDICAL OPTICS EXPRESS 2018; 9:2027-2040. [PMID: 29760967 PMCID: PMC5946768 DOI: 10.1364/boe.9.002027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 03/18/2018] [Accepted: 03/20/2018] [Indexed: 06/08/2023]
Abstract
For centuries, surgeons have relied on their sense of touch to identify vital structures such as blood vessels in traditional open surgery. Over the past two decades, surgeons have shifted to minimally invasive surgical (MIS) approaches, including laparoscopic surgery, which include benefits such as less scarring, less risk for infection, and quicker recovery times. In fact, some surgeries such as cholecystectomies have seen more than an 80% adoption of this technique because of those benefits. However, due to the fundamental challenges associated with using laparoscopic surgery, there has been a lower adoption in more complex specialties, such as colorectal and thoracic surgery, where the field of surgery has bleeding, fat, scar tissue, and adhesions. These problems are exacerbated by complicating factors such as inflammation, cancer, chronic disease, obesity, and re-operations. Importantly, surgeons will often convert from laparoscopy to open surgery if they can no longer proceed using the minimally invasive approach because of issues described with these complicating factors, thereby negating the benefits that the patient would have seen. When the surgeon does attempt these procedures with those issues, the surgery takes on average 30 min - 1 hour longer. A new method by which surgeons can visualize structures like blood vessels could reduce the conversion rates and operating time, thereby driving a greater adoption of laparoscopic surgery in these complex procedures. Here, we show that by adding near infrared (NIR) LEDs and a linear image sensor onto the opposing jaws of the laparoscopic graspers, blood vessels that are embedded within tissues can be detected and localized efficiently, even those not visible using current imaging techniques. We show the results of Monte Carlo simulations to support our claim, including that blood vessels ranging from 2 to 6 mm and buried under up to 1 cm of tissue can be detected. We also report developing a smart grasper handheld prototype to run ex vivo experiments. The results of these experiments matched with those of the Monte Carlo simulations and the estimated blood vessel size showed a strong correlation with the actual size. This technology will be incorporated into already existing laparoscopic tools to assist surgeons during MIS procedures.
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Masci E, Faillace G, Longoni M. Use of oxidized regenerated cellulose to achieve hemostasis during laparoscopic cholecystectomy: a retrospective cohort analysis. BMC Res Notes 2018; 11:239. [PMID: 29642951 PMCID: PMC5896066 DOI: 10.1186/s13104-018-3344-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 03/30/2018] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Laparoscopic cholecystectomy is the first-choice treatment for symptomatic cholelithiasis. Though generally safe, this procedure is not without complications, with bleeding the most frequent cause of conversion to open cholecystectomy. Oxidized regenerated cellulose (ORC) added to conventional hemostatic strategies, is widely used to control bleeding during surgery despite limited evidence supporting its use. This retrospective study analyzed patients undergoing laparoscopic cholecystectomy in an Italian center over a 16-month period, between October 2014 and February 2016, who experienced uncontrollable bleeding despite the use of conventional hemostatic strategies, requiring the addition of ORC gauze (Emosist®). RESULTS Of the 530 patients who underwent laparoscopic cholecystectomy, 24 (4.5%) had uncontrollable bleeding from the liver bed. Of these, 62.5% had acute cholecystitis and 33.3% chronic cholecystitis; 1 patient was diagnosed with gallbladder carcinoma, postoperatively. Most patients had comorbidities, 16.7% had liver cirrhosis, and 37.5% used oral anticoagulants. The application of ORC rapidly controlled bleeding in all patients. Patients were discharged after a mean duration of 2.2 days. ORC was easy to use and well tolerated. Bleeding complications remain a relevant issue in laparoscopic cholecystectomy. ORC was able to promptly stop bleeding not adequately controlled by conventional methods and appears, therefore, to be a useful hemostat.
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Affiliation(s)
- Emilia Masci
- Division of General Surgery, Ospedale Edoardo Bassini, ASST Nord Milano, Via Gorki 50, 20092 Cinisello Balsamo, MI Italy
| | - Giuseppe Faillace
- Division of General Surgery, Ospedale Edoardo Bassini, ASST Nord Milano, Via Gorki 50, 20092 Cinisello Balsamo, MI Italy
| | - Mauro Longoni
- Division of General Surgery, Ospedale Edoardo Bassini, ASST Nord Milano, Via Gorki 50, 20092 Cinisello Balsamo, MI Italy
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15
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Penza V, Du X, Stoyanov D, Forgione A, Mattos LS, De Momi E. Long Term Safety Area Tracking (LT-SAT) with online failure detection and recovery for robotic minimally invasive surgery. Med Image Anal 2018; 45:13-23. [PMID: 29329053 DOI: 10.1016/j.media.2017.12.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 09/18/2017] [Accepted: 12/19/2017] [Indexed: 11/29/2022]
Abstract
Despite the benefits introduced by robotic systems in abdominal Minimally Invasive Surgery (MIS), major complications can still affect the outcome of the procedure, such as intra-operative bleeding. One of the causes is attributed to accidental damages to arteries or veins by the surgical tools, and some of the possible risk factors are related to the lack of sub-surface visibilty. Assistive tools guiding the surgical gestures to prevent these kind of injuries would represent a relevant step towards safer clinical procedures. However, it is still challenging to develop computer vision systems able to fulfill the main requirements: (i) long term robustness, (ii) adaptation to environment/object variation and (iii) real time processing. The purpose of this paper is to develop computer vision algorithms to robustly track soft tissue areas (Safety Area, SA), defined intra-operatively by the surgeon based on the real-time endoscopic images, or registered from a pre-operative surgical plan. We propose a framework to combine an optical flow algorithm with a tracking-by-detection approach in order to be robust against failures caused by: (i) partial occlusion, (ii) total occlusion, (iii) SA out of the field of view, (iv) deformation, (v) illumination changes, (vi) abrupt camera motion, (vii), blur and (viii) smoke. A Bayesian inference-based approach is used to detect the failure of the tracker, based on online context information. A Model Update Strategy (MUpS) is also proposed to improve the SA re-detection after failures, taking into account the changes of appearance of the SA model due to contact with instruments or image noise. The performance of the algorithm was assessed on two datasets, representing ex-vivo organs and in-vivo surgical scenarios. Results show that the proposed framework, enhanced with MUpS, is capable of maintain high tracking performance for extended periods of time ( ≃ 4 min - containing the aforementioned events) with high precision (0.7) and recall (0.8) values, and with a recovery time after a failure between 1 and 8 frames in the worst case.
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Affiliation(s)
- Veronica Penza
- Department of Electronics Information and Bioengineering, Politecnico di Milano, P.zza L. Da Vinci, 32, Milano 20133, Italy; Department of Advanced Robotics, Istituto Italiano di Tecnologia, via Morego, 30, Genova, 16163, Italy.
| | - Xiaofei Du
- Centre for Medical Image Computing, Department of Computer Science, University College London, United Kingdom
| | - Danail Stoyanov
- Centre for Medical Image Computing, Department of Computer Science, University College London, United Kingdom
| | - Antonello Forgione
- Ospedale Niguarda Ca' Granda, P.zza Dell'Ospedale Maggiore, 3, Milano 20162, Italy
| | - Leonardo S Mattos
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, via Morego, 30, Genova, 16163, Italy
| | - Elena De Momi
- Department of Electronics Information and Bioengineering, Politecnico di Milano, P.zza L. Da Vinci, 32, Milano 20133, Italy
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16
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Thanachaiviwat A, Magno A, Modi V, Huang KG. Uncommon Vascular Injury Caused by Scalpel Incision of Umbilicus for Primary Laparoscopy Entry. J Gynecol Surg 2017. [DOI: 10.1089/gyn.2016.0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Angelito Magno
- Department of Obstetrics and Gynecology, University of Perpetual Help DALTA Medical Center, Las Pinas, Philippines, and DeLa Salle University Medical Center, Cavite, Philippines
| | - Vijal Modi
- Modi Clinic Nursing and Maternity Home, Vadodara, Gujarat, India
| | - Kuan-Gen Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou Medical Center and Chang Gung University College of Medicine, Kweishan, Taoyuan, Taiwan
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17
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Ortenzi M, Ghiselli R, Baldarelli M, Cardinali L, Guerrieri M. Is the bipolar vessel sealer device an effective tool in robotic surgery? A retrospective analysis of our experience and a meta-analysis of the literature about different robotic procedures by investigating operative data and post-operative course. MINIM INVASIV THER 2017; 27:113-118. [PMID: 28604140 DOI: 10.1080/13645706.2017.1329212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The latest robotic bipolar vessel sealing tools have been described to be effective allowing to perform procedures with reduced blood loss and shorter operative times. The aim of this study was to assess the efficacy and reliability of these devices applied in different robotic procedures. MATERIAL AND METHODS All robotic operations, between 2014 and 2016, were performed using the EndoWrist One VesselSealer (EWO, Intuitive Surgical, Sunnyvale, CA), a bipolar fully wristed device. Data, including age, gender, body mass index (BMI), were collected. Robot docking time, intraoperative blood loss, robot malfunctioning and overall operative time were analyzed. A meta-analysis of the literature was carried out to point the attention to three different parameters (mean blood loss, operating time and hospital stay) trying to identify how different coagulation devices may affect them. RESULTS In 73 robotic procedures, the mean operative time was 118.2 minutes (75-125 minutes). Mean hospital stay was four days (2-10 days). There were two post-operative complications (2.74%). CONCLUSIONS The bipolar vessel sealer offers the efficacy of bipolar diathermy and the advantages of a fully wristed instrument. It does not require any change of instruments for coagulation or involvement of the bedside assistant surgeon. These characteristics lead to a reduction in operative time.
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Affiliation(s)
- Monica Ortenzi
- a Department of Clinica Chirurgica , Ospedali Riuniti, Università Politecnica delle Marche , Ancona , Italy
| | - Roberto Ghiselli
- a Department of Clinica Chirurgica , Ospedali Riuniti, Università Politecnica delle Marche , Ancona , Italy
| | - Maddalena Baldarelli
- a Department of Clinica Chirurgica , Ospedali Riuniti, Università Politecnica delle Marche , Ancona , Italy
| | - Luca Cardinali
- a Department of Clinica Chirurgica , Ospedali Riuniti, Università Politecnica delle Marche , Ancona , Italy
| | - Mario Guerrieri
- a Department of Clinica Chirurgica , Ospedali Riuniti, Università Politecnica delle Marche , Ancona , Italy
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18
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Garcia-Martinez A, Vicente-Samper JM, Sabater-Navarro JM. Automatic detection of surgical haemorrhage using computer vision. Artif Intell Med 2017; 78:55-60. [PMID: 28764873 DOI: 10.1016/j.artmed.2017.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 05/02/2017] [Accepted: 06/05/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND OBJECTIVES On occasions, a surgical intervention can be associated with serious, potentially life-threatening complications. One of these complications is a haemorrhage during the operation, an unsolved issue that could delay the intervention or even cause the patient's death. On laparoscopic surgery this complication is even more dangerous, due to the limited vision and mobility imposed by the minimally invasive techniques. METHODS In this paper it is described a computer vision algorithm designed to analyse the images captured by a laparoscopic camera, classifying the pixels of each frame in blood pixels and background pixels and finally detecting a massive haemorrhage. The pixel classification is carried out by comparing the parameter B/R and G/R of the RGB space colour of each pixel with a threshold obtained using the global average of the whole frame of these parameters. The detection of and starting haemorrhage is achieved by analysing the variation of the previous parameters and the amount of pixel blood classified. RESULTS When classifying in vitro images, the proposed algorithm obtains accuracy over 96%, but during the analysis of an in vivo images obtained from real operations, the results worsen slightly due to poor illumination, visual interferences or sudden moves of the camera, obtaining accuracy over 88%. The detection of haemorrhages directly depends of the correct classification of blood pixels, so the analysis achieves an accuracy of 78%. CONCLUSIONS The proposed algorithm turns out to be a good starting point for an automatic detection of blood and bleeding in the surgical environment which can be applied to enhance the surgeon vision, for example showing the last frame previous to a massive haemorrhage where the incision could be seen using augmented reality capabilities.
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Affiliation(s)
- Alvaro Garcia-Martinez
- Systems and Automatics Engineering Department, Miguel Hernández University, Avinguda de la Universitat d'Elx, Elche, 03202, Spain.
| | - Jose María Vicente-Samper
- Systems and Automatics Engineering Department, Miguel Hernández University, Avinguda de la Universitat d'Elx, Elche, 03202, Spain
| | - José María Sabater-Navarro
- Systems and Automatics Engineering Department, Miguel Hernández University, Avinguda de la Universitat d'Elx, Elche, 03202, Spain
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19
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Penza V, De Momi E, Enayati N, Chupin T, Ortiz J, Mattos LS. EnViSoRS: Enhanced Vision System for Robotic Surgery. A User-Defined Safety Volume Tracking to Minimize the Risk of Intraoperative Bleeding. Front Robot AI 2017. [DOI: 10.3389/frobt.2017.00015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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20
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Radunovic M, Lazovic R, Popovic N, Magdelinic M, Bulajic M, Radunovic L, Vukovic M, Radunovic M. Complications of Laparoscopic Cholecystectomy: Our Experience from a Retrospective Analysis. Open Access Maced J Med Sci 2016; 4:641-646. [PMID: 28028405 PMCID: PMC5175513 DOI: 10.3889/oamjms.2016.128] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 10/08/2016] [Accepted: 11/05/2016] [Indexed: 01/10/2023] Open
Abstract
AIM: The aim of this study was to evaluate the intraoperative and postoperative complications of laparoscopic cholecystectomy, as well as the frequency of conversions. MATERIAL AND METHODS: Medical records of 740 patients who had laparoscopic cholecystectomy were analysed retrospectively. We evaluated patients for the presence of potential risk factors that could predict the development of complications such as age, gender, body mass index, white blood cell count and C-reactive protein (CRP), gallbladder ultrasonographic findings, and pathohistological analysis of removed gallbladders. The correlation between these risk factors was also analysed. RESULTS: There were 97 (13.1%) intraoperative complications (IOC). Iatrogenic perforations of a gallbladder were the most common complication - 39 patients (5.27%). Among the postoperative complications (POC), the most common ones were bleeding from abdominal cavity 27 (3.64%), biliary duct leaks 14 (1.89%), and infection of the surgical wound 7 patients (0.94%). There were 29 conversions (3.91%). The presence of more than one complication was more common in males (OR = 2.95, CI 95%, 1.42-4.23, p < 0.001). An especially high incidence of complications was noted in patients with elevated white blood cell count (OR = 3.98, CI 95% 1.68-16.92, p < 0.01), and CRP (OR = 2.42, CI 95% 1.23-12.54, p < 0.01). The increased incidence of complications was noted in patients with ultrasonographic finding of gallbladder empyema and increased thickness of the gallbladder wall > 3 mm (OR = 4.63, CI 95% 1.56-17.33, p < 0.001), as well as in patients with acute cholecystitis that was confirmed by pathohistological analysis (OR = 1.75, CI 95% 2.39-16.46, p < 0.001). CONCLUSION: Adopting laparoscopic cholecystectomy as a new technique for treatment of cholelithiasis, introduced a new spectrum of complications. Major biliary and vascular complications are life threatening, while minor complications cause patient discomfort and prolongation of the hospital stay. It is important recognising IOC complications during the surgery so they are taken care of in a timely manner during the surgical intervention. Conversion should not be considered a complication.
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Affiliation(s)
- Miodrag Radunovic
- Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
| | - Ranko Lazovic
- Center for General and Digestive Surgery, Clinical Centre of Montenegro, Podgorica, Montenegro
| | - Natasa Popovic
- Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
| | | | - Milutin Bulajic
- Clinic for Gastroenterology, Clinical Centre of Belgrade, University of Belgrade, Belgrade, Serbia
| | - Lenka Radunovic
- General Medical Health, Primary Health Care Berane, Berane, Montenegro
| | - Marko Vukovic
- Urology and Nephrology Clinic, Clinical Centre of Montenegro, Podgorica, Montenegro
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21
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Gaunay GS, Elsamra SE, Richstone L. Trocars: Site Selection, Instrumentation, and Overcoming Complications. J Endourol 2016; 30:833-43. [DOI: 10.1089/end.2016.0128] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
- Geoffrey S. Gaunay
- The Smith Institute for Urology, Hofstra University School of Medicine, Northwell Health, New Hyde Park, New York
| | - Sammy E. Elsamra
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Lee Richstone
- The Smith Institute for Urology, Hofstra University School of Medicine, Northwell Health, New Hyde Park, New York
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22
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Simforoosh N, Basiri A, Ziaee SAM, Tabibi A, Nouralizadeh A, Radfar MH, Sarhangnejad R, Mirsadeghi A. Major vascular injury in laparoscopic urology. JSLS 2016; 18:JSLS-D-13-00283. [PMID: 25392667 PMCID: PMC4208903 DOI: 10.4293/jsls.2014.00283] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Major vascular injury is the most devastating complication of laparoscopy, occurring most commonly during the laparoscopic entry phase. Our goal is to report our experience with major vascular injury during laparoscopic entry with closed- and open-access techniques in urologic procedures. METHODS All 5347 patients who underwent laparoscopic urologic procedures from 1996 to 2011 at our hospital were included in the study. Laparoscopic entry was carried out by either the closed Veress needle technique or the modified open Hasson technique. Patients' charts were reviewed retrospectively to investigate for access-related major vascular injuries. RESULTS The closed technique was used in the first 474 operations and the open technique in the remaining 4873 cases. Three cases of major vascular injury were identified among our patients. They were 3 men scheduled for nephrectomy without any history of surgery. All injuries occurred in the closed-access group during the setup phase with insertion of the first trocar. The injury location was the abdominal aorta in 2 patients and the external iliac vein in 1 patient. Management was performed after conversion to open surgery, control of bleeding, and repair of the injured vessel. CONCLUSIONS Given the high morbidity and mortality rates associated with major vascular injury, its clinically higher incidence in laparoscopic urologic procedures with the closed-access technique leads us to suggest using the open technique for the entry phase of laparoscopy. Using the open-access technique may decrease laparophobia and encourage a higher number of urologists to enter the laparoscopy field.
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Affiliation(s)
- Nasser Simforoosh
- Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshty University of Medical Sciences, Tehran, Iran
| | - Abbas Basiri
- Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshty University of Medical Sciences, Tehran, Iran
| | - Seyed-Amir-Mohsen Ziaee
- Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshty University of Medical Sciences, Tehran, Iran
| | - Ali Tabibi
- Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshty University of Medical Sciences, Tehran, Iran
| | - Akbar Nouralizadeh
- Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshty University of Medical Sciences, Tehran, Iran
| | - Mohammad Hadi Radfar
- Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshty University of Medical Sciences, Tehran, Iran
| | - Reza Sarhangnejad
- Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshty University of Medical Sciences, Tehran, Iran
| | - Amin Mirsadeghi
- Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshty University of Medical Sciences, Tehran, Iran
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23
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Suuronen S, Kivivuori A, Tuimala J, Paajanen H. Bleeding complications in cholecystectomy: a register study of over 22,000 cholecystectomies in Finland. BMC Surg 2015; 15:97. [PMID: 26268709 PMCID: PMC4535785 DOI: 10.1186/s12893-015-0085-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 08/04/2015] [Indexed: 12/15/2022] Open
Abstract
Background Major bleeding is rare but among the most serious complications of laparoscopic surgery. Still very little is known on bleeding complications and related blood component use in laparoscopic cholecystectomy (LC). The aim of this study is to compare bleeding complications, transfusion rates and related costs between LC and open cholecystectomy (OC). Methods Data concerning LCs and OCs and related blood component use between 2002 and 2007 were collected from existing computerized medical records (Finnish Red Cross Register) of ten Finnish hospital districts. Results Register data included 17175 LCs and 4942 OCs. In the LC group, 1.3 % of the patients received red blood cell (RBC) transfusion compared to 13 % of the patients in the OC group (p < 0.001). Similarly, the proportions of patients with platelet (0.1 % vs. 1.2 %, p < 0.001) and fresh frozen plasma (FFP) products (0.5 % vs. 5.8 %) transfusions were respectively higher in the OC group than in the LC group. The mean transfused dose of RBCs, PTLs and FFP product Octaplas® or the mean cost of the transfused blood components did not differ significantly between the LC and OC groups. Conclusions Laparoscopic cholecystectomy was associated with lower transfusion rates of blood components compared to open surgery. The severity of bleeding complications may not differ substantially between LC and OC.
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Affiliation(s)
- S Suuronen
- Department of Surgery, Mikkeli Central Hospital, 50100, Mikkeli, Finland
| | - A Kivivuori
- Department of Surgery, Mikkeli Central Hospital, 50100, Mikkeli, Finland
| | - J Tuimala
- Finnish Red Cross Blood Service, 00100, Helsinki, Finland
| | - H Paajanen
- Department of Surgery, Kuopio University Hospital, PL 1777, 70600, Kuopio, Finland. .,School of Medicine, University of Eastern Finland, 70600, Kuopio, Finland.
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Abstract
A hostile abdomen index presents a way to stratify risk and help track laparoscopic surgical complications. Background: Common life-threatening complications associated with laparoscopy, including bleeding and inadvertent enterotomy, are described in the literature. We investigated the application of the Hostile Abdomen Index related to these complications. We hypothesize that the preoperative score may guide a surgeon in risk stratification. Methods: We used data from Monmouth Medical Center morbidity and mortality conferences and reviewed bleeding and enterotomy complications in laparoscopic abdominal surgery. Complications were tracked using the Hostile Abdomen Index compared between 2 periods: published early experience with laparoscopic surgery (1998–2003) and unpublished late experience (2004–2010). The index ascribes a number (1–4) before a laparoscope is inserted and another number (1–4) after the laparoscope is inserted into the abdomen. Results: From 1998 to 2010, 43 patients had bleeding complications (0.45%) and 28 had inadvertent enterotomies (0.29%). There was no difference in bleeding between the early and late experiences. Enterotomy complications decreased in the late experience (P < .001). Our rescue success was 97.2% over 13 years. Those laparoscopic cases with high preoperative scores (3–4) had a higher rate of conversion to open procedures. Conclusions: The Hostile Abdomen Index can be used to track 2 potentially life-threatening laparoscopic complications. The index score has been explained to our surgeons on numerous occasions. A higher chance of bleeding and enterotomy or risk stratification correlates with a preoperative 3 or 4 score and may lead to a more cautious approach toward initial laparotomy or earlier conversion.
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Affiliation(s)
- Michael A Goldfarb
- Department of Surgery, Monmouth Medical Center, 300 Second Avenue, Long Branch, NJ 07740, USA.
| | - Bogdan Protyniak
- Department of Surgery, Monmouth Medical Center, Long Branch, NJ, USA
| | - Molly Schultheis
- Department of Surgery, Monmouth Medical Center, Long Branch, NJ, USA
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25
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Cuss A, Bhatt M, Abbott J. Coming to terms with the fact that the evidence for laparoscopic entry is as good as it gets. J Minim Invasive Gynecol 2014; 22:332-41. [PMID: 25460522 DOI: 10.1016/j.jmig.2014.10.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 10/27/2014] [Accepted: 10/30/2014] [Indexed: 02/07/2023]
Abstract
Entry to the peritoneal cavity for laparoscopic surgery is associated with defined morbidity, with all entry techniques associated with substantial complications. Debate over the safest entry technique has raged over the last 2 decades, and yet, we are no closer to arriving at a scientifically valid conclusion regarding technique superiority. With hundreds of thousands of patients required to perform adequately powered studies, it is unlikely that appropriately powered comparative studies could be undertaken. This review examines the risk of complications related to laparoscopic entry, current statements from examining bodies around the world, and the medicolegal ramifications of laparoscopic entry complications. Because of the numbers required for any complications study, with regard to arriving at an evidence-based decision for laparoscopic entry, we ask: is the current literature perhaps as good as it gets?
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Affiliation(s)
- Amanda Cuss
- Royal Hospital for Women, Sydney, Australia and University of New South Wales, Sydney, Australia
| | | | - Jason Abbott
- Royal Hospital for Women, Sydney, Australia and University of New South Wales, Sydney, Australia.
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Laparoscopic incisionless stoma creation for patients with colorectal malignant stricture. Surg Laparosc Endosc Percutan Tech 2014; 25:37-39. [PMID: 24477031 DOI: 10.1097/sle.0b013e3182a834bf] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Minimally invasive techniques have been applied with increasing frequency to stoma creation. A recent focus in the field of minimally invasive surgery is laparoscopic single-site surgery. The aim of this study was to assess whether this procedure is a feasible option compared with other techniques of stoma creation. MATERIALS AND METHODS We introduced laparoscopic surgery to fecal diversion in April 2010 at the Cancer Institute Hospital of the Japanese Foundation for Cancer Research. This technique was performed on 53 patients, including 15 laparoscopic single-site surgeries, from April 2010 to December 2011. RESULTS Of these 15 cases, 8 ileostomies and 7 colostomies were created. The mean operative time was 65.9 minutes (range, 32 to 93 min). The estimated volume of blood loss was small in all cases. There were no intraoperative complications. All patients started an oral diet on the second postoperative day with the exception of 1 patient who suffered from prolonged paralytic ileus. CONCLUSIONS A laparoscopic single-site approach to stoma creation may be a feasible option in fecal diversion.
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Techniques for laparoscopic repair of major intraoperative vascular injury: case reports and review of literature. Surg Endosc 2013; 27:3021-7. [DOI: 10.1007/s00464-013-2845-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Accepted: 01/07/2013] [Indexed: 10/27/2022]
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Blunt versus bladed trocars in laparoscopic surgery: a systematic review and meta-analysis of randomized trials. Surg Endosc 2013; 27:2312-20. [PMID: 23389070 DOI: 10.1007/s00464-013-2793-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 01/07/2013] [Indexed: 01/12/2023]
Abstract
BACKGROUND Trocar-associated visceral injuries are rare but potentially fatal complications of laparoscopic access. More commonly, abdominal wall bleeding occurs, which usually requires hemostatic measures and prolongs operative time. Blunt-tipped trocars have been postulated to carry a lower risk of abdominal wall bleeding and intra-abdominal injuries. The aim of the present systematic review and meta-analysis was to comparatively evaluate the relative risks of abdominal wall bleeding, visceral injuries, and overall complications with the use of bladed and blunt-tipped laparoscopic trocars. METHODS The databases of Medline, EMBASE, and the Cochrane Central Register of Randomized Trials were searched to identify randomized studies that compared trocar-associated complications with the use of blunt and bladed trocars. Primary outcome measure was the relative risk of abdominal wall trocar site bleeding, and secondary outcome measures included visceral injuries and overall complications. Outcome data were pooled and combined overall effect sizes were calculated using the fixed- or random-effects model. RESULTS Eight eligible randomized trials were identified; they included 720 patients with a median Jadad score of 4. The incidence of abdominal wall bleeding for the blunt and the bladed trocar group was 3 and 9 %, respectively [odds ratio (OR) 0.42, 95 % confidence interval (CI) 0.21-0.88]. Trocar-associated morbidity rate, excluding bleeding events of the abdominal wall, was documented at 0.2 and 0.7 % of the blunt and the bladed trocar arm, respectively (OR 0.43, 95 % CI 0.06-2.97). The overall trocar-associated morbidity rate was 3 % in the blunt trocar group and 10 % in the bladed trocar group (OR 0.38, 95 % CI 0.19-0.77). CONCLUSIONS Reliable data support a lower relative risk of trocar site bleeding and overall complications with blunt laparoscopic cannulas than bladed trocars. Transition to blunt trocars for secondary cannulation of the abdominal wall is thus strongly recommended. Larger patient populations are required to estimate the relative risk of visceral injuries.
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Kaushik R. Bleeding complications in laparoscopic cholecystectomy: Incidence, mechanisms, prevention and management. J Minim Access Surg 2011; 6:59-65. [PMID: 20877476 PMCID: PMC2938714 DOI: 10.4103/0972-9941.68579] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Accepted: 06/16/2010] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) has established itself firmly as the 'gold standard' for the treatment of gallstone disease, but it can, at times, be associated with significant morbidity and mortality. Existing literature has focused almost exclusively on the biliary complications of this procedure, but other complications such as significant haemorrhage can also be encountered, with an immediate mortality if not recognized and treated in a timely manner. MATERIALS AND METHODS Publications in English language literature that have reported the complication of bleeding during or after the performance of LC were identified and accessed. The results thus obtained were tabulated and analyzed to get a true picture of this complication, its mechanism and preventive measures. RESULTS Bleeding has been reported to occur with an incidence of up to nearly 10% in various series, and can occur at any time during LC (during trocar insertion, dissection technique or slippage of clips/ ligatures) or in the postoperative period. It can range from minor haematomas to life-threatening injuries to major intra-abdominal vessels (such as aorta, vena cava and iliacs). CONCLUSION Good surgical technique, awareness and early recognition and management of such cases are keys to success when dealing with this problem.
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Affiliation(s)
- Robin Kaushik
- Department of Surgery, Government Medical College and Hospital, Chandigarh, India
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Chang TC, Chen CC, Wang MY, Yang CY, Lin MT. Gasless laparoscopy-assisted distal gastrectomy for early gastric cancer: analysis of initial results. J Laparoendosc Adv Surg Tech A 2011; 21:215-20. [PMID: 21254869 DOI: 10.1089/lap.2010.0054] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Laproscopic surgery is widely used in treating gastrointestinal disease. This study investigated the clinical result, short-term outcomes, and cost analysis of the newly developed gasless laparoscopy-assisted distal gastrectomy (GLADG) and compared it with conventional open distal gastrectomy (ODG). METHODS Seventy-five patients underwent distal gastrectomy with radical lymph node dissection for early gastric cancer from December 2005 to January 2008. Thirty-one patients underwent GLADG and 44 underwent ODG. Postoperative pain, morphine use, disease-free and overall survival, and surgical and hospital costs were measured postoperatively and compared between the two groups. RESULTS Patients in the two groups were comparable by age, sex, body mass index, tumor size, tumor location, cancer staging, and operative time. The GLADG group had early start of oral intake and shorter postoperative hospital stay (P < .05). There was less morphine use from postoperative day 1 to 4 in the GLADG group than in the ODG group (P < .05), and body temperature from postoperative day 1 to 2 was lower in the GLADG than in the ODG group (P < .05). Cost analysis showed that operation cost (100,242 ± 5385 versus 36,455 ± 1419) and equipment cost (65,909 ± 5385 versus 2122 ± 1419) was higher in the GLADG group, but its total hospital cost (193,552 ± 12,715 versus 206,676 ± 41,920) was lower than in the ODG group (P < .05). The 2-year disease-free and overall survival rates were not different between the two groups. CONCLUSIONS GLADG is feasible for early gastric cancer. It is advantageous because of less pain, less postoperative inflammatory response, less blood loss, and shorter total hospital stay while achieving the same oncologic results as ODG.
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Affiliation(s)
- Tung-Cheng Chang
- Division of General Surgery, Department of Surgery, Taipei Medical University Shuang-Ho Hospital, Taipei County, Taiwan
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Chang TC, Wu MH, Wu YM, Lee PH, Lin MT. Technical Innovation: Gasless Laparoscopic Hepatectomy Using Self-Designed Abdominal Lifting System. J Laparoendosc Adv Surg Tech A 2009; 19:541-4. [DOI: 10.1089/lap.2008.0435] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Tung-Cheng Chang
- Department of Surgery, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan
| | - Ming-Hsun Wu
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Yao-Ming Wu
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Huang Lee
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Tsan Lin
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
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Lam A, Kaufman Y, Khong SY, Liew A, Ford S, Condous G. Dealing with complications in laparoscopy. Best Pract Res Clin Obstet Gynaecol 2009; 23:631-46. [PMID: 19539536 DOI: 10.1016/j.bpobgyn.2009.03.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Accepted: 03/16/2009] [Indexed: 11/26/2022]
Abstract
With increasing adoption of laparoscopic surgery in gynaecology, there has been a corresponding rise in the types and rates of complications reported. This article sets out to classify complications associated with laparoscopy according to the phases of the surgery; assess the incidence, the mechanisms, the presentations; and recommend methods for preventing and dealing with complications in laparoscopic surgery. Its aim is to promote a culture of risk management based on the development of strategies to improve patient safety and outcome.
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Affiliation(s)
- Alan Lam
- Centre for Advanced Reproductive Endosurgery, (CARE), Royal North Shore Hospital, University of Sydney, Sydney, Australia.
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Zhao J, Liao D, McMahon BP, O'Donovan D, Schiretz R, Heninrich R, Gregersen H. Functional luminal imaging probe geometric and histomorphologic analysis of abdominal wall wound induced by different trocars in pigs. Surg Endosc 2008; 23:1004-12. [PMID: 18814012 DOI: 10.1007/s00464-008-0105-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2008] [Revised: 07/01/2008] [Accepted: 07/20/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND This study aimed to investigate wound geometry and tissue damage caused by several different trocar types using a quantitative functional luminal imaging probe (FLIP) geometric profile and histomorphologic analysis. METHODS Four pigs were used in this study. After general anesthesia, six different trocars were randomly inserted at preselected locations in the porcine abdominal wall. The hydration status of the animals was monitored and maintained. A bag mounted on a FLIP was used to profile the geometry of the trocar holes during distension. After the FLIP study, the abdominal wall surrounding the trocar holes was harvested. The tissue was fixed in neutral 10% buffered formalin solution for more than 24 h. The samples contained control tissue (undamaged) and test tissue (damaged) through the entire rectangular tissue block. Approximately four to seven slides were cut parallel to the surface from each sample. Each slide was photographed, and the morphometry of the hole and damaged areas were measured and displayed three-dimensionally. The histologic sections were analyzed with regard to acute damage, bleeding, and acute inflammation of the skin, muscle, and fascia. RESULTS The FLIP study demonstrated differences between the six trocars. These were mainly due to differences between the Versaport Plus V2 bladed trocar with the smooth cannula, the Applied Medical Separator nonbladed access system with threaded cannula, and the VersaStep Plus trocar. The morphometry data showed the smallest hole and damage areas for the Versaport Plus V2 bladed trocar with the smooth cannula. The damaged area divided by the trocar hole area was smallest for the VersaStep plus trocar and the Ethicon Endopath bladed trocar with a stability cannula (p < 0.05). The histologic analysis showed that the VersaStep Plus trocar and the Ethicon Endopath bladed trocar with a stability cannula gave the least bleeding and inflammation (p < 0.05). CONCLUSION An agreement was found between the geometric data obtained by FLIP, the morphometric analysis, and the histology.
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Affiliation(s)
- Jingbo Zhao
- Center for Visceral Biomechanics and Pain, Aalborg Hospital Science and Innovation Center, Sdr. Skovvej 15, 9000, Aalborg, Denmark,
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Danan D, Winfree CJ, McKhann GM. INTRA-ABDOMINAL VASCULAR INJURY DURING TROCAR-ASSISTED VENTRICULOPERITONEAL SHUNTING. Neurosurgery 2008; 63:E613; discussion E613. [DOI: 10.1227/01.neu.0000325261.29689.fc] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
ABSTRACT
OBJECTIVE
Laparoscopic trocar injury is a relatively well-described complication of cholecystectomies and gynecological procedures. However, this type of injury has not been reported in association with adult neurological surgery. To increase awareness of this very serious risk, we report a case of intra-abdominal vascular injury during a shunt procedure involved with a common neurosurgical procedure.
CLINICAL PRESENTATION
A 76-year-old man with no previous abdominal surgical history presented with probable normal pressure hydrocephalus.
INTERVENTION
After an appropriate preoperative workup confirming probable normal pressure hydrocephalus, the patient consented to placement of a ventriculoperitoneal shunt with a programmable valve. During placement of the distal catheter using an abdominal trocar, the aorta was punctured inadvertently, necessitating emergency laparotomy for vascular repair.
CONCLUSION
An abdominal trocar should be used with caution in ventriculoperitoneal shunt surgery. Even with meticulous technique, vascular injury can occur with any trocar-based abdominal procedure. The neurosurgeon who uses this technique must be prepared to initiate emergent vascular access and repair, with a vascular surgery team available should such an injury occur. Alternatively, open placement of peritoneal catheters avoids blind peritoneal instrumentation and is an effective method for minimizing potentially catastrophic vascular injuries.
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Affiliation(s)
- Deepa Danan
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York
| | - Christopher J. Winfree
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York
| | - Guy M. McKhann
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York
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Jamadar DA, Jacobson JA, Girish G, Balin J, Brandon CJ, Caoili EM, Morag Y, Franz MG. Abdominal wall hernia mesh repair: sonography of mesh and common complications. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2008; 27:907-917. [PMID: 18499850 DOI: 10.7863/jum.2008.27.6.907] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The purposes of this study were (1) to review the sonographic in vitro and in vivo appearances of mesh for surgical repair of abdominal wall hernias, (2) to describe sonographic techniques and discuss the limitations of sonography in evaluation of mesh hernia repair, and (3) to illustrate common complications after mesh repair shown with sonography. METHODS We identified interesting cases from the musculoskeletal sonographic database as well as from the teaching files of the authors, with surgical or other cross-sectional imaging corroboration. RESULTS A compilation of the sonographic appearances of mesh used for anterior abdominal wall and inguinal hernia repair and complications diagnosable by sonography is presented. CONCLUSIONS Sonography can be effective for evaluation of mesh and complications after mesh repair of anterior abdominal wall and inguinal hernias.
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Affiliation(s)
- David A Jamadar
- Department of Radiology, University of Michigan Hospitals, 1500 E Medical Center Dr, Ann Arbor, MI 48109 USA.
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Chou TH, Wu MH, Wang MY, Yang CY, Lai PS, Lin MT, Lee PH. Gasless laparoscopy-assisted subtotal gastrectomy for early gastric cancer: a novel minimally invasive surgery. J Gastrointest Surg 2008; 12:695-700. [PMID: 17968633 DOI: 10.1007/s11605-007-0339-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2007] [Accepted: 09/11/2007] [Indexed: 01/31/2023]
Abstract
BACKGROUND Due to the highly invasive nature of traditional surgery and the limitation of gas-filling laparoscopic surgery in gastric cancers, we developed a new method of gasless laparoscope-assisted subtotal gastrectomy (GLASG). This study investigated the technique and clinical results of this procedure and compared it with traditional radical subtotal gastrectomy (TRSG) for early gastric cancers. METHODOLOGY From December 2004 to January 2006, 41 patients diagnosed with early gastric cancer were included in the study. All cases underwent subtotal gastrectomy with standard radical lymph node dissection. Twenty patients underwent GLASG, whereas the other 21 patients underwent TRSG. In the GLASG group, we performed our newly developed method using three working ports created at the bilateral subcostal and umbilicus, which provided a 3-dimensional sensation by direct vision through a minilaparotomy and laparoscopic view simultaneously. B-II gastrojejunostomy reconstruction was performed by intracorporeal anastomosis using an endostapler. The TRSG group underwent the standard open method used for gastric cancer. Preoperative characteristics and postoperative recovery between the two groups were compared. RESULTS The operative time was comparable between the two groups, but the bleeding was significantly less severe in the GLASG group. Postoperative pain was significantly less in the GLASG group, as well as body temperature from postoperative day 2 to 7. The number of days to first flatus, first oral intake, and discharge were all significantly less in the GLASG group. No major complications were noted in either group. CONCLUSIONS GLASG may be a feasible and safe procedure for early gastric cancer. Gasless laparoscopic gastrectomy has the advantages of less pain, better cosmetic outcome, and earlier recovery. The newly developed gasless environment may hybridize the advantages of open method and pure laparoscopic method.
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Affiliation(s)
- Tzung-Hsin Chou
- Department of General Surgery, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan
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Reynolds MW, Clark J, Crean S, Samudrala S. Risk of bleeding in surgical patients treated with topical bovine thrombin sealants: a review of the literature. Patient Saf Surg 2008; 2:5. [PMID: 18348725 PMCID: PMC2276484 DOI: 10.1186/1754-9493-2-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2008] [Accepted: 03/18/2008] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND One of the most anticipated, but potentially serious complications during or after surgery are bleeding events. Among the many potential factors associated with bleeding complications in surgery, the use of bovine thrombin has been anecdotally identified as a possible cause of increased bleeding risk. Most of these reports of bleeding events in association with the use of topical bovine thrombin have been limited to case reports lacking clear cause and effect relationship determination. Recent studies have failed to establish significant differences in the rates of bleeding events between those treated with bovine thrombin and those treated with either human or recombinant thrombin. METHODS We conducted a search of MEDLINE for the most recent past 10 years (1997-2007) and identified all published studies that reported a study of surgical patients with a clear objective to examine the risk of bleeding events in surgical patients. We also specifically noted the reporting of any topical bovine thrombin used during surgical procedures. We aimed to examine whether there were any differences in the risk of bleeds in general surgical populations as compared to those studies that reported exposure to topical bovine thrombin. RESULTS We identified 21 clinical studies that addressed the risk of bleeding in surgery. Of these, 5 studies analyzed the use of bovine thrombin sealants in surgical patients. There were no standardized definitions for bleeding events employed across these studies. The rates of bleeds in the general surgery studies ranged from 0.1%-20.2%, with most studies reporting rates between 2.6%-4%. The rates of bleeding events ranged from 0.0%-13% in the bovine thrombin studies with most studies reporting between a 2%-3% rate. CONCLUSION The risk of bleeds was not clearly different in those studies reporting use of bovine thrombin in all patients compared to the other surgical populations studied. A well-designed and well-controlled study is needed to accurately examine the bleeding risks in surgical patients treated and unexposed to topical bovine thrombin, and to evaluate the independent risk associated with topical bovine thrombin as well as other risk factors.
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Affiliation(s)
- Matthew W Reynolds
- Epidemiology and Database Services, United BioSource Corporation, Medford, MA, USA.
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Multicenter Analysis of 74 000 Cholecystectomies Age Dependent Morbidity and Transfusion Rate. POLISH JOURNAL OF SURGERY 2007. [DOI: 10.2478/v10035-007-0015-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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