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Jong HS, Lim TW, Jung KT. Optimal Insertion Depth of Gastric Decompression Tube with a Thermistor for Patients Undergoing Laparoscopic Surgery in Trendelenburg Position. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14708. [PMID: 36429426 PMCID: PMC9690127 DOI: 10.3390/ijerph192214708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 06/16/2023]
Abstract
Monitoring core temperature is crucial for maintaining normothermia during general anesthesia. Insertion of a gastric decompression tube (GDT) may be required during laparoscopic surgery. Recently, a newly designed GDT with a thermistor for monitoring esophageal temperature has been introduced. The purpose of the present study was to evaluate the optimal insertion depth of a GDT with a thermistor. Forty-eight patients undergoing elective laparoscopic surgery in the Trendelenburg position were included in the study. The GDT was inserted to a depth of nose-earlobe-xiphoid distance (NEX) + 12 cm and withdrawn sequentially, 2 cm at a time, at 5-min intervals. Temperatures of the GDT thermistor were compared with the core temperature of the tympanic membrane (TM) using Bland and Altman analysis. The correlation between optimal insertion depth of the GDT and anatomical distance (cricoid cartilage to the carina, CCD; carina to the left hemidiaphragm, CLHD) was evaluated, and a mathematical model to predict the optimal insertion depth of the GDT with a thermistor was calculated. Temperatures of TM and GDT thermistor at NEX + 4 cm showed good agreement and strong correlation, but better agreement and stronger correlation were seen at the actual location with the most minor temperature differences. The optimal insertion depth of the GDT was estimated as -15.524 + 0.414 × CCD - 0.145 × CLHD and showed a strong correlation with the actual GDT insertion depth (correlation coefficient 0.797, adjusted R2 = 0.636). The mathematical formula using CCD and CLHD would be helpful in determining the optimal insertion depth of a GDT with a thermistor.
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Affiliation(s)
- Hwa Song Jong
- Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju 61453, Korea
| | - Tae Won Lim
- Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju 61453, Korea
| | - Ki Tae Jung
- Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju 61453, Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine and Medical School, Chosun University, Gwangju 61452, Korea
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Watrowski R, Kostov S, Alkatout I. Complications in laparoscopic and robotic-assisted surgery: definitions, classifications, incidence and risk factors - an up-to-date review. Wideochir Inne Tech Maloinwazyjne 2021; 16:501-525. [PMID: 34691301 PMCID: PMC8512506 DOI: 10.5114/wiitm.2021.108800] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 06/30/2021] [Indexed: 11/26/2022] Open
Abstract
Almost all gynecological and general-surgical operations are - or can be - performed laparoscopically. In comparison to an abdominal approach, the minimally invasive access offers several advantages; however, laparoscopy (both conventional and robotic-assisted) can be associated with a number of approach-specific complications. Although the majority of them are related to the laparoscopic entry, adverse events may also occur due to the presence of pneumoperitoneum or the use of laparoscopic instruments. Unfortunately, a high proportion of complications (especially affecting the bowel and ureter) remain unrecognized during surgery. This narrative review provides comprehensive up-to-date information about definitions, classifications, risk factors and incidence of surgical complications in conventional and robotic-assisted laparoscopy, with a special focus on gynecology. The topic is discussed from various perspectives, e.g. in the context of stage of surgery, injured organs, involved instruments, and in relation to malpractice claims.
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Affiliation(s)
- Rafał Watrowski
- St. Josefskrankenhaus, Teaching Hospital of the University of Freiburg, Freiburg, Germany
| | - Stoyan Kostov
- Department of Gynecology, Medical University Varna, Varna, Bulgaria
| | - Ibrahim Alkatout
- Department of Gynecology and Obstetrics, Kiel School of Gynecological Endoscopy, University Hospitals Schleswig-Holstein, Kiel, Germany
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Implementation of a novel efficacy score to compare sealing and cutting devices in a porcine model. Surg Endosc 2017; 32:1002-1011. [DOI: 10.1007/s00464-017-5778-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 07/28/2017] [Indexed: 12/22/2022]
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Cornette B, Berrevoet F. Trocar Injuries in Laparoscopy: Techniques, Tools, and Means for Prevention. A Systematic Review of the Literature. World J Surg 2016; 40:2331-41. [DOI: 10.1007/s00268-016-3527-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Introduction: Approximately, 20% of undescended testes (UDT) are nonpalpable. Surgical management of the nonpalpable testis comprises laparoscopy. The aim of this study was to determine if ultrasonography can be used as a preoperative tool to localize the nonpalpable inguinal testis, eliminating the need for laparoscopy. Methods: We identified 46 patients diagnosed with nonpalpable UDT between 2007 and 2012 who underwent an inguino-scrotal ultrasound preoperatively. We analyzed correlations between radiological and surgical findings. Results: A total of 46 patients (53 UDT), median age 14 months (quartile 1st: 7; 3rd: 80) were included. Ultrasound localized the testis as intracanalicular in 24/53 (45.2%), intraabdominal in 10/53 (18.8%), scrotal in 1/53 (1.8%), and could not localize 18/53 (33.9%) testes. In 35/53 (66%) testes, the ultrasound location correlated with the surgical findings (P < 0.001). Ultrasound detection showed 96% sensitivity and 56% specificity for intracanalicular testes. Conclusion: The use of preoperative ultrasound in this series was helpful in identifying the location of nonpalpable testes in children. In particular, the ultrasound finding of an intracanalicular testis may preclude the need for laparoscopy.
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Affiliation(s)
| | - Luis A Guerra
- Department of Surgery, Division of Urology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Michael P Leonard
- Department of Surgery, Division of Urology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
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Wallwiener CW, Junginger SH, Zubke W, Brucker SY, Enderle MD, Neugebauer A, Schönfisch B, Wallwiener M. Bipolar vessel sealing: instrument contamination and wear have little effect on seal quality and success in a porcine in vitro model. Langenbecks Arch Surg 2014; 399:863-71. [DOI: 10.1007/s00423-014-1234-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 07/16/2014] [Indexed: 10/25/2022]
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Liu Q, Sun XB. Indirect electrical injuries from capacitive coupling: a rarely mentioned electrosurgical complication in monopolar laparoscopy. Acta Obstet Gynecol Scand 2012. [PMID: 23193981 DOI: 10.1111/aogs.12049] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Electrothermal injuries in monopolar laparoscopy may derive indirectly, but rarely, from capacitive coupling releasing stray currents into neighboring non-targeted tissues, with intact instrument insulation. Since 2007, seven episodes of indirect electrosurgical damage to non-targeted tissues have been observed in our gynecological practice, including incidental coagulative necrosis of appendix, Fallopian tube, cystic pedicle, and broad ligament stump. Such an electrical response becomes greater where there is increased contact with the cystic wall (cysts <3 cm in diameter). Appropriate measures are available for minimizing capacitive coupling specifically caused by monopolar electrocautery. Thorough staff training, regular safety inspections, and strict procedure performance should exist to minimize such risks and injuries.
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Affiliation(s)
- Qiang Liu
- Department of Minimally Invasive Gynecology, Specialist Clinic Affiliated to the Fourth Military Medical University, Xi'an, China.
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Hendrickson DA. A review of equine laparoscopy. ISRN VETERINARY SCIENCE 2012; 2012:492650. [PMID: 23762585 PMCID: PMC3671724 DOI: 10.5402/2012/492650] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 10/05/2012] [Indexed: 11/23/2022]
Abstract
Minimally invasive surgery in the human was first identified in mid 900's. The procedure as is more commonly practiced now was first reported in 1912. There have been many advances and new techniques developed in the past 100 years. Equine laparoscopy, was first reported in the 1970's, and similarly has undergone much transformation in the last 40 years. It is now considered the standard of care in many surgical techniques such as cryptorchidectomy, ovariectomy, nephrosplenic space ablation, standing abdominal exploratory, and many other reproductive surgeries. This manuscript describes the history of minimally invasive surgery, and highlights many of the techniques that are currently performed in equine surgery. Special attention is given to instrumentation, ligating techniques, and the surgical principles of equine minimally invasive surgery.
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Affiliation(s)
- Dean A Hendrickson
- American College of Veterinary Surgeons, USA ; College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
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Rothmund R, Kraemer B, Neis F, Brucker S, Wallwiener M, Reda A, Hausch A, Scharpf M, Szyrach MN. Efficacy and safety of the novel electrosurgical vessel sealing and cutting instrument BiCision®. Surg Endosc 2012; 26:3334-43. [DOI: 10.1007/s00464-012-2337-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 04/16/2012] [Indexed: 12/31/2022]
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Rothmund R, Schaeller D, Neugebauer A A, Scharpf M M, Fend F F, Schenk M, Wallwiener D, Kraemer B. Evaluation of Thermal Damage in a Pig Model. J INVEST SURG 2012; 25:43-50. [DOI: 10.3109/08941939.2011.591895] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Quantifying Electrosurgery-Induced Thermal Effects and Damage to Human Tissue: An Exploratory Study with the Fallopian Tube as a Novel In-Vivo In-Situ Model. J Minim Invasive Gynecol 2010; 17:70-7. [DOI: 10.1016/j.jmig.2009.09.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Revised: 09/07/2009] [Accepted: 09/14/2009] [Indexed: 11/19/2022]
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Wallwiener CW, Rajab TK, Zubke W, Isaacson KB, Enderle M, Schäller D, Wallwiener M. Thermal conduction, compression, and electrical current--an evaluation of major parameters of electrosurgical vessel sealing in a porcine in vitro model. J Minim Invasive Gynecol 2008; 15:605-10. [PMID: 18640881 DOI: 10.1016/j.jmig.2008.05.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Revised: 05/03/2008] [Accepted: 05/03/2008] [Indexed: 10/21/2022]
Abstract
Bipolar vessel sealing is pivotal in laparoscopic hemostasis. However, major coaptive desiccation parameters have yet to be investigated in detail. The current investigation aims to study the impact of compressive pressure, thermal conduction, and electrical current effects on seal quality in a randomized, controlled experimental trial in an in vitro porcine model of vessel sealing. A total of 106 porcine vessels were sealed with either bipolar current or thermal conduction. Compressive pressure on the sealing site and maximum temperature were varied and monitored. Additionally, the longitudinal vessel tension was measured. The burst pressure of the resulting seal was determined as an indicator of seal quality. In bipolar coaptation, seal quality depends on the compressive pressure applied to the coagulation site in both arteries and veins. The optimal pressure interval was around 270 mN/mm2 for arteries and 200 mN/mm2 for veins. Deviation from these optimal pressures towards low and high extremes led to significantly fewer successful seals. We also found that both maximum coaptation temperature and vessel shrinking correlated with the seal quality. This correlation was reciprocal in arteries and veins. Thermal conduction alone was less successful than sealing by bipolar current. Therefore, compressive pressure during coaptation determines the seal quality. Upper and lower pressure boundaries for safe coaptation exist for both arteries and veins. Vessel sealing by thermal conduction without electrical current effects is possible but represents a less effective method for coaptation. These findings have implications for the rational design of new electrosurgical instruments.
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Singh SS, Condous G, Lam A. Primer on risk management for the gynaecological laparoscopist. Best Pract Res Clin Obstet Gynaecol 2007; 21:675-90. [PMID: 17398160 DOI: 10.1016/j.bpobgyn.2007.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The gynaecologist practising operative laparoscopy should be seen as part of a team that actively promotes patient safety, minimizing risks and optimizing outcomes. Building a culture of safety which focuses on proactive initiatives to manage risk and remove individual 'blame' should be an integral part of any operative laparoscopy unit. Thus, when adverse clinical incidents or outcomes occur, reporting of such events is encouraged and seen to be acceptable behaviour within the framework of complete patient care. By recognizing and analysing adverse outcomes, the team can develop strategies to prevent or manage a recurrence of such events. Implementing systems or solutions to prevent harm to patients is the cornerstone of any risk management programme. In this review, we discuss the development and implementation of risk management strategies in the clinical setting, and in particular how this applies to operative laparoscopy.
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Affiliation(s)
- Sukhbir S Singh
- Centre for Advanced Reproductive Endosurgery, Royal North Shore Hospital, University of Sydney, St Leonards, Sydney, NSW, Australia.
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Wallwiener C, Wallwiener M, Neunhoeffer E, Menger M, Isaacson K, Zubke W. Intelligent, impedance-regulated, pulsed coagulation in a porcine renal artery model. Fertil Steril 2007; 88:206-11. [PMID: 17462642 DOI: 10.1016/j.fertnstert.2006.11.204] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2006] [Revised: 11/08/2006] [Accepted: 11/08/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare the efficacy of conventional pulsed coagulation (CPC) and newly developed intelligent, impedance-regulated, pulsed coagulation (IPC) in the sealing of porcine renal arteries. DESIGN Prospective, randomized experimental study. SETTING Isolated porcine artery model in an academic research environment. ANIMAL(S) Female Swabian Hall pigs. INTERVENTION(S) Renal arteries were harvested from Swabian pigs, flushed with saline, and sealed with bipolar open forceps by using high-frequency modulations of CPC (CPC-I: 800-ms pulse, 30-ms pause; CPC-II: 800-ms pulse, 300-ms pause) or IPC (self-regulation of the current flow to tissue impedance during thermal alteration). Additional vessels underwent multiple CPC. Burst pressure and seal failure were measured by increasing the pressure in the sealed arteries with saline infusion until rupture of the seal or the vessel wall. MAIN OUTCOME MEASURE(S) Mean burst pressure, number of instant and secondary seal failures, and relation of burst pressure to vessel diameter. RESULT(S) Mean burst pressure after IPC (585.5 +/- 56.8 mm Hg) was statistically significantly higher than that after CPC (CPC-I: 372.6 +/- 40.0 mm Hg; CPC-II: 334.2 +/- 44.2 mm Hg). Only 5.0% of the vessel seals after IPC, but 34.0% and 39.5% after CPC-I and CPC-II, showed instant or secondary seal failures, which also was a statistically significant difference. Seal quality after multiple CPC was comparable to that observed after the single IPC application (burst pressure, 597.3 +/- 60.1 [MCPC-I] mm Hg and 656.2 +/- 56.5 mm Hg [MCPC-II]; seal failure rate, 0). CONCLUSION(S) In an isolated porcine renal artery model, self-regulating modulation of energy-based vessel coagulation achieved superior thermal fusion of vascular tissue than did CPC. This promising novel technique should be analyzed further to determine its in vivo efficacy in long-term studies.
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Affiliation(s)
- Christian Wallwiener
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany.
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