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Nishimura M, Matsumoto S, Ohara Y, Minowa K, Tsunematsu R, Takimoto K, Imai K, Tsuzuki Y, Ota H, Nakajima A, Fukushi Y, Wada S, Fujino T, Ito YM. Complications Related to the Initial Trocar Insertion of 3 Different Techniques: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2018; 26:63-70. [PMID: 30352290 DOI: 10.1016/j.jmig.2018.06.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 05/30/2018] [Accepted: 06/18/2018] [Indexed: 10/28/2022]
Abstract
This systematic review aimed to investigate complications related to initial trocar insertion among 3 different laparoscopic techniques: Veress needle (VN) entry, direct trocar entry (DTE), and open entry (OE). A literature search was completed, and complications were assessed. Major vessel injury, gastrointestinal injury, and solid organ injury were defined as major complications. Minor complications were defined as subcutaneous emphysema, extraperitoneal insufflation, omental emphysema, trocar site bleeding, and trocar site infection. Arm-based network meta-analyses were performed to identify the differences in complications among the 3 techniques. Seventeen studies were included in the quantitative analysis. DTE resulted in fewer major complications when compared with VN entry although the difference was not significant (p = .23) as well as significantly fewer minor complications (p < .001). There were no significant differences in minor complications when comparing OE and DTE (p = .74). Fewer major complications were observed with OE compared with VN entry although the difference was not significant (p = .31). There were significantly fewer minor complications for patients who underwent OE (p = .01). DTE patients experienced the least number of minor complications followed by VN entry and OE. In conclusion, major complications are extremely rare, and all 3 insertion methods can be performed without mortality.
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Affiliation(s)
- Mai Nishimura
- Department of Obstetrics and Gynecology, Teine Keijinkai Hospital, Sapporo, Japan (Drs. Nishimura, Matsumoto, Ohara, Minowa, Tsunematsu, Takimoto, Imai, Tsuzuki, Ota, Nakajima, Fukushi, Wada, and Fujino).
| | - Sachiko Matsumoto
- Department of Obstetrics and Gynecology, Teine Keijinkai Hospital, Sapporo, Japan (Drs. Nishimura, Matsumoto, Ohara, Minowa, Tsunematsu, Takimoto, Imai, Tsuzuki, Ota, Nakajima, Fukushi, Wada, and Fujino)
| | - Yasuhiro Ohara
- Department of Obstetrics and Gynecology, Teine Keijinkai Hospital, Sapporo, Japan (Drs. Nishimura, Matsumoto, Ohara, Minowa, Tsunematsu, Takimoto, Imai, Tsuzuki, Ota, Nakajima, Fukushi, Wada, and Fujino)
| | - Kaoru Minowa
- Department of Obstetrics and Gynecology, Teine Keijinkai Hospital, Sapporo, Japan (Drs. Nishimura, Matsumoto, Ohara, Minowa, Tsunematsu, Takimoto, Imai, Tsuzuki, Ota, Nakajima, Fukushi, Wada, and Fujino)
| | - Risa Tsunematsu
- Department of Obstetrics and Gynecology, Teine Keijinkai Hospital, Sapporo, Japan (Drs. Nishimura, Matsumoto, Ohara, Minowa, Tsunematsu, Takimoto, Imai, Tsuzuki, Ota, Nakajima, Fukushi, Wada, and Fujino)
| | - Kanako Takimoto
- Department of Obstetrics and Gynecology, Teine Keijinkai Hospital, Sapporo, Japan (Drs. Nishimura, Matsumoto, Ohara, Minowa, Tsunematsu, Takimoto, Imai, Tsuzuki, Ota, Nakajima, Fukushi, Wada, and Fujino)
| | - Kazuaki Imai
- Department of Obstetrics and Gynecology, Teine Keijinkai Hospital, Sapporo, Japan (Drs. Nishimura, Matsumoto, Ohara, Minowa, Tsunematsu, Takimoto, Imai, Tsuzuki, Ota, Nakajima, Fukushi, Wada, and Fujino)
| | - Yoko Tsuzuki
- Department of Obstetrics and Gynecology, Teine Keijinkai Hospital, Sapporo, Japan (Drs. Nishimura, Matsumoto, Ohara, Minowa, Tsunematsu, Takimoto, Imai, Tsuzuki, Ota, Nakajima, Fukushi, Wada, and Fujino)
| | - Hajime Ota
- Department of Obstetrics and Gynecology, Teine Keijinkai Hospital, Sapporo, Japan (Drs. Nishimura, Matsumoto, Ohara, Minowa, Tsunematsu, Takimoto, Imai, Tsuzuki, Ota, Nakajima, Fukushi, Wada, and Fujino)
| | - Ayako Nakajima
- Department of Obstetrics and Gynecology, Teine Keijinkai Hospital, Sapporo, Japan (Drs. Nishimura, Matsumoto, Ohara, Minowa, Tsunematsu, Takimoto, Imai, Tsuzuki, Ota, Nakajima, Fukushi, Wada, and Fujino)
| | - Yoshiyuki Fukushi
- Department of Obstetrics and Gynecology, Teine Keijinkai Hospital, Sapporo, Japan (Drs. Nishimura, Matsumoto, Ohara, Minowa, Tsunematsu, Takimoto, Imai, Tsuzuki, Ota, Nakajima, Fukushi, Wada, and Fujino)
| | - Shinichiro Wada
- Department of Obstetrics and Gynecology, Teine Keijinkai Hospital, Sapporo, Japan (Drs. Nishimura, Matsumoto, Ohara, Minowa, Tsunematsu, Takimoto, Imai, Tsuzuki, Ota, Nakajima, Fukushi, Wada, and Fujino)
| | - Takafumi Fujino
- Department of Obstetrics and Gynecology, Teine Keijinkai Hospital, Sapporo, Japan (Drs. Nishimura, Matsumoto, Ohara, Minowa, Tsunematsu, Takimoto, Imai, Tsuzuki, Ota, Nakajima, Fukushi, Wada, and Fujino)
| | - Yoichi M Ito
- Department of Biostatistics, Faculty of Medicine, Graduate School of Medicine Hokkaido University, Sapporo, Japan (Dr. Ito)
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Ahlborg L, Weurlander M, Hedman L, Nisell H, Lindqvist PG, Felländer-Tsai L, Enochsson L. Individualized feedback during simulated laparoscopic training:a mixed methods study. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2015; 6:93-100. [PMID: 26223033 PMCID: PMC4537795 DOI: 10.5116/ijme.55a2.218b] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 07/12/2015] [Indexed: 06/01/2023]
Abstract
OBJECTIVE This study aimed to explore the value of individualized feedback on performance, flow and self-efficacy during simulated laparoscopy. Furthermore, we wished to explore attitudes towards feedback and simulator training among medical students. METHODS Sixteen medical students were included in the study and randomized to laparoscopic simulator training with or without feedback. A teacher provided individualized feedback continuously throughout the procedures to the target group. Validated questionnaires and scales were used to evaluate self-efficacy and flow. The Mann-Whitney U test was used to evaluate differences between groups regarding laparoscopic performance (instrument path length), self-efficacy and flow. Qualitative data was collected by group interviews and interpreted using inductive thematic analyses. RESULTS Sixteen students completed the simulator training and questionnaires. Instrument path length was shorter in the feedback group (median 3.9 m; IQR: 3.3-4.9) as compared to the control group (median 5.9 m; IQR: 5.0-8.1), p<0.05. Self-efficacy improved in both groups. Eleven students participated in the focus interviews. Participants in the control group expressed that they had fun, whereas participants in the feedback group were more concentrated on the task and also more anxious. Both groups had high ambitions to succeed and also expressed the importance of getting feedback. The authenticity of the training scenario was important for the learning process. CONCLUSIONS This study highlights the importance of individualized feedback during simulated laparoscopy training. The next step is to further optimize feedback and to transfer standardized and individualized feedback from the simulated setting to the operating room.
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Affiliation(s)
- Liv Ahlborg
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet at Karolinska University Hospital, Sweden
| | - Maria Weurlander
- School of Education and Communication in Engineering Science (ECE), KTH Royal Institute of Technologyg, Sweden
| | - Leif Hedman
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet at Karolinska University Hospital, Sweden
| | - Henry Nisell
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet at Karolinska University Hospital, Sweden
| | - Pelle G. Lindqvist
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet at Karolinska University Hospital, Sweden
| | - Li Felländer-Tsai
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet at Karolinska University Hospital, Sweden
| | - Lars Enochsson
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet at Karolinska University Hospital, Sweden
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Abstract
Gastroesophageal reflux (GER) is one of the most frequent symptomatic clinical disorders affecting the gastrointestinal tract of infants and children. During the past 2 decades, GER has been recognized more frequently because of an increased awareness of the condition and also because of the more sophisticated diagnostic techniques that have been developed for both identifying and quantifying the disorder. Gastroesophageal fundoplication is currently one of the three most common major operations performed on infants and children by pediatric surgeons in the United States. Normal gastroesophageal function is a complex mechanism that depends on effective esophageal motility, timely relaxation and contractility of the lower esophageal sphincter, the mean intraluminal pressure in the stomach, the effectiveness of contractility in emptying of the stomach, and the ease of gastric outflow. More than one of these factors are often abnormal in the same child with symptomatic GER. In addition, in patients with GER disease, and particularly in those patients with neurologic disorders, there appears to be a high prevalence of autonomic neuropathy in which esophagogastric transit and gastric emptying are frequently delayed, producing a somewhat complex foregut motility disorder. GER has a different course and prognosis depending on the age of onset. The incompetent lower esophageal sphincter mechanism present in most newborn infants combined with the increased intraabdominal pressure from crying or straining commonly becomes much less frequent as a cause of vomiting after the age of 4 months. Chalasia and rumination of infancy are self-limited and should be carefully separated from symptomatic GER, which requires treatment. The most frequent complications of recurrent GER in childhood are failure to thrive as a result of caloric deprivation and recurrent bronchitis or pneumonia caused by repeated pulmonary aspiration of gastric fluid. Children with GER disease commonly have more refluxing episodes when in the supine position, particularly during sleep. The reflux of acid into the mid or upper esophagus may stimulate vagal reflexes and produce reflex laryngospasm, bronchospasm, or both, which may accentuate the symptoms of asthma. Reflux may also be a cause of obstructive apnea in infants and possibly a cause of recurrent stridor, acute hypoxia, and even the sudden infant death syndrome. Premature infants with respiratory distress syndrome have a high incidence of GER. Esophagitis and severe dental carries are common manifestations of GER in childhood. Barrett's columnar mucosal changes in the lower esophagus are not infrequent in adolescent children with chronic GER, particularly when Heliobacter pylori is present in the gastric mucosa. Associated disorders include esophageal dysmotility, which has been recognized in approximately one third of children with severe GER. Symptomatic GER is estimated to occur in 30% to 80% of infants who have undergone repair of esophageal atresia malformations. Neurologically impaired children are at high risk for having symptomatic GER, particularly if nasogastric or gastrostomy feedings are necessary. Delayed gastric emptying (DGE) has been documented with increasing frequency in infants and children who have symptoms of GER, particularly those with neurologic disorders. DGE may also be a cause of gas bloat, gagging, and breakdown or slippage of a well-constructed gastroesophageal fundoplication. The most helpful test for diagnosing and quantifying GER in childhood is the 24-hour esophageal pH monitoring study. Miniaturized probes that are small enough to use easily in the newborn infant are available. This study is 100% accurate in diagnosing reflux when the esophageal pH is less than 4.0 for more than 5% of the total monitored time.
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