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Alsubahi T, Alqutub S, Alqutub A. The Case of the "Disappearing Ventricle": A Report. Cureus 2024; 16:e56525. [PMID: 38646393 PMCID: PMC11026989 DOI: 10.7759/cureus.56525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 04/23/2024] Open
Abstract
Embolization of entrapped intracardiac air represents a significant risk to the patient undergoing open-heart surgery. Entrapment of as little as 0.5 mL of gas in the heart can cause temporary myocardial dysfunction, cardiac arrhythmias, and systemic emboli. In contrast, larger emboli can disrupt the evaluation of heart function by limiting visualization during echocardiography. We present the case of a 67-year-old male who presented with dizziness, nausea, and chest pain. A left heart catheterization revealed multi-vessel disease. Undergoing general anesthesia, the patient received three-vessel coronary artery bypass grafting, mitral valve repair, ring annuloplasty, and left atrial appendage closure. Upon aortic unclamping, transgastric echocardiography showed significant gas almost wholly obscuring the left heart chambers despite de-airing maneuvers. Successful resolution relied upon higher mean blood pressure and time, demonstrating the importance of intraoperative imaging and interdisciplinary collaboration.
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Affiliation(s)
- Turky Alsubahi
- Department of Anesthesiology, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Sadiq Alqutub
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Abdulsalam Alqutub
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
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2
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Kumar S, Dubey IB, Aggarwal VC, Soni RK. Evaluation of Open (Hasson's) and Closed (Veress) Technique of Intraperitoneal Access for Creation of Pneumoperitoneum in Laparoscopic Surgery. Cureus 2024; 16:e54770. [PMID: 38524074 PMCID: PMC10961137 DOI: 10.7759/cureus.54770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 03/26/2024] Open
Abstract
Background The creation of pneumoperitoneum is the first step in any laparoscopic surgery. There are various methods of creating pneumoperitoneum which can be divided into open or closed methods. The closed method involves the blind insertion of the Veress needle into the peritoneal cavity. The open technique involves making an incision and then dissecting the fascia to the peritoneal cavity to introduce the cannula under direct vision. This study was conducted to evaluate the safety and efficacy of open (Hasson's) and closed (Veress) techniques of intraperitoneal access for the creation of pneumoperitoneum in laparoscopic surgery. Material and methods The study was conducted in the Department of General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi. This was a prospective observational study and a total of 100 patients of laparoscopic surgeries fulfilling inclusion criteria were included in the study - 50 patients in group A undergoing the open method of creating pneumoperitoneum and 50 patients in group B undergoing the closed method of creating pneumoperitoneum were evaluated for the study period of 18 months from October 2020 through June 2022. Results The mean time to create pneumoperitoneum was 5.3 ± 1.41 minutes in the open method and 6.21 ± 1.36 minutes in the closed method. The mean time for umbilical port closure in our study was 7.33 ± 1.66 in the open group and 8.86 ± 2.19 in the closed group. In our study, there was no vascular or visceral injury noted in either of the methods used for the creation of pneumoperitoneum. Post-operative complications were almost equal in both the groups. Conclusions Both open and closed methods of intraperitoneal access are safe and effective for the creation of pneumoperitoneum during abdominal laparoscopy. The open method of creating pneumoperitoneum in laparoscopic surgery is a quicker method for the creation of pneumoperitoneum as compared to the closed method of intraperitoneal access.
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Affiliation(s)
- Saakshie Kumar
- Department of General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Indu B Dubey
- Department of General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Vridhi Chand Aggarwal
- Department of General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Rajesh K Soni
- Department of General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
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3
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Agarwal PK, Golmei J, Goyal R, Maurya AP. Comparison Between Closed and Open Methods for Creating Pneumoperitoneum in Laparoscopic Cholecystectomy. Cureus 2023; 15:e35991. [PMID: 36911586 PMCID: PMC10004421 DOI: 10.7759/cureus.35991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2023] [Indexed: 03/12/2023] Open
Abstract
Background: To study the efficacy of closed and open methods for creating pneumoperitoneum in laparoscopic cholecystectomy by comparing the two in terms of their outcome and complication. Study Design: Single-centre, prospective, observational study. Materials and study: Purposive sampling method where the inclusion criteria were all patients with cholelithiasis who were advised and consented to laparoscopic cholecystectomy of age 18-70 years were included in the study group. Exclusion criteria include patients with a paraumbilical hernia, a history of upper abdominal surgery, uncontrolled systemic illness, and local skin infection. Sixty cases of cholelithiasis satisfying exclusion and inclusion criteria who underwent elective cholecystectomy during the study period were included. Thirty-one of these cases underwent the closed method, while in the remaining 29 patients open method was adopted. Cases in which pneumoperitoneum created by closed technique were grouped as group A and those by open technique as group B. Parameters comparing the safety and efficacy of the two methods were studied. The parameters were access time, gas leak, visceral injury, vascular injury, need for conversion, umbilical port site hematoma, umbilical port site infection, and hernia. Patients were assessed on the first postoperative day, the seventh postoperative day, and then two months after surgery. Some follow-ups were done telephonically. Results: Out of 60 patients, 31 underwent the closed method, while 29 underwent the open method. Minor complications like gas leak during the procedure was observed more in the open method. The mean access time in the open-method group was less than in the closed-method group. Other complications like visceral injury, vascular injury, need for conversion, umbilical port site hematoma, umbilical port site infection, and hernia were not observed in either group during the allocated follow-up period in the study. Conclusion: Open technique for pneumoperitoneum is as safe and effective as the closed technique.
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Affiliation(s)
- Puneet K Agarwal
- General Surgery, All India Institute of Medical Sciences Bhopal, Bhopal, IND
| | - Jason Golmei
- General Surgery, All India Institute of Medical Sciences Bhopal, Bhopal, IND
| | - Richa Goyal
- Obstetrics and Gynecology Surgery, Dr. Agarwal Clinic, Jalesar, IND
| | - Ajeet P Maurya
- General Surgery, All India Institute of Medical Sciences Bhopal, Bhopal, IND
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Patterson KN, Beyene TJ, Minneci PC, Diefenbach KA. Rates of Air Embolism in Pediatric Patients Undergoing Surgical Procedures of the Peritoneum. J Laparoendosc Adv Surg Tech A 2022; 32:1220-1227. [PMID: 36318787 DOI: 10.1089/lap.2022.0246] [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: 11/05/2022] Open
Abstract
Background: Air embolism during laparoscopic surgery is a rare but feared complication in the pediatric population. The objective of this study was to identify rates of air embolus in pediatric patients during hospitalization for laparoscopic or open surgical procedures of the peritoneal cavity. Materials and Methods: Patients 0-18 years old within the Pediatric Health Information System who underwent a predefined, common inpatient laparoscopic or open surgical procedure involving the peritoneal cavity from 2015 to 2020 were studied. International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes for air embolism were then searched among patients during the same admission. Firth logistic regression was used to compare rates of air embolism in open and laparoscopic cohorts and in patients >1 and ≤1 year. Results: Unadjusted rates of air embolism were higher in patients undergoing open compared with laparoscopic surgery (open: 9/45,080; 20.0/100,000 patients versus laparoscopic: 3/101,892; 2.9/100,000 patients). In patients ≤1 year (45,726), 2 patients undergoing open surgery (2/1,031; 9.5/100,000 patients) and all 3 patients undergoing laparoscopic surgery had an air embolism diagnosis (3/22,329; 13.4/100,000 patients). For laparoscopic surgery, a suggested lower relative risk (RR) of air embolism was demonstrated for children >1 year compared with children ≤1 year (RR: 0.05, P = .05). Conclusion: Air embolism associated with common pediatric surgical procedures of the peritoneum is rare and patients undergoing laparoscopic and open surgery have similar risks for air embolism. Although rare, the risk should be considered during surgical planning and abdominal access, especially in children ≤1 year old.
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Affiliation(s)
- Kelli N Patterson
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Tariku J Beyene
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Peter C Minneci
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA.,Division of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Karen A Diefenbach
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA.,Division of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
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5
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Nakagawa R, Nohara T, Kadomoto S, Iwamoto H, Yaegashi H, Iijima M, Kawaguchi S, Shigehara K, Izumi K, Kadono Y, Mizokami A. Carbon dioxide gas embolism during robot‐assisted laparoscopic partial nephrectomy. IJU Case Rep 2022; 5:334-337. [PMID: 36090925 PMCID: PMC9436695 DOI: 10.1002/iju5.12472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 05/06/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction One of the complications of laparoscopic surgery is gas embolism, which has low incidence but high mortality. Carbon dioxide embolism diagnosed during robot‐assisted laparoscopic partial nephrectomy has been experienced. Case presentation 77‐year‐old woman with a left renal tumor received robot‐assisted laparoscopic partial nephrectomy. End‐tidal carbon dioxide pressure and oxygen saturation of peripheral artery suddenly decreased 5 min after the start of tumor resection with pneumoperitoneum pressure of 15 mmHg and positive end‐expiratory pressure turned off. Therefore, pulmonary artery gas embolism was diagnosed. The pneumoperitoneum pressure was dropped, and positive end‐expiratory pressure was restarted. These conditions improved and the procedure was completed. Conclusion Carbon dioxide gas embolism during robot‐assisted partial nephrectomy should be focused on because prompt diagnosis and treatment will improve life outcomes. The optimal pneumoperitoneum pressure for each case, rather than making it uniform, should be reconsidered.
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Affiliation(s)
- Ryunosuke Nakagawa
- Department of Integrative Cancer Therapy and Urology Kanazawa University Graduate School of Medical Science Kanazawa Japan
| | - Takahiro Nohara
- Department of Integrative Cancer Therapy and Urology Kanazawa University Graduate School of Medical Science Kanazawa Japan
| | - Suguru Kadomoto
- Department of Integrative Cancer Therapy and Urology Kanazawa University Graduate School of Medical Science Kanazawa Japan
| | - Hiroaki Iwamoto
- Department of Integrative Cancer Therapy and Urology Kanazawa University Graduate School of Medical Science Kanazawa Japan
| | - Hiroshi Yaegashi
- Department of Integrative Cancer Therapy and Urology Kanazawa University Graduate School of Medical Science Kanazawa Japan
| | - Masashi Iijima
- Department of Integrative Cancer Therapy and Urology Kanazawa University Graduate School of Medical Science Kanazawa Japan
| | - Shohei Kawaguchi
- Department of Integrative Cancer Therapy and Urology Kanazawa University Graduate School of Medical Science Kanazawa Japan
| | - Kazuyoshi Shigehara
- Department of Integrative Cancer Therapy and Urology Kanazawa University Graduate School of Medical Science Kanazawa Japan
| | - Kouji Izumi
- Department of Integrative Cancer Therapy and Urology Kanazawa University Graduate School of Medical Science Kanazawa Japan
| | - Yoshifumi Kadono
- Department of Integrative Cancer Therapy and Urology Kanazawa University Graduate School of Medical Science Kanazawa Japan
| | - Atsushi Mizokami
- Department of Integrative Cancer Therapy and Urology Kanazawa University Graduate School of Medical Science Kanazawa Japan
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Asami M, Kanai E, Yamauchi Y, Saito Y, Matsutani N, Kawamura M, Sakao Y. Positive Intrapleural Pressure with Carbon Dioxide May Limit Intraoperative Pulmonary Arterial Bleeding: Verification by Animal Model. Ann Thorac Cardiovasc Surg 2022; 28:403-410. [PMID: 36002270 PMCID: PMC9763713 DOI: 10.5761/atcs.oa.22-00104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Intraoperative complications, especially unexpected bleeding, are of great concern in the safety of thoracoscopic surgery. We investigated the hemostatic efficacy and safety of positive intrapleural pressure (PIP) with carbon dioxide insufflation by assessing the amount of blood loss in a pulmonary arterial hemorrhage model. METHODS An ex vivo experimental model of saline flow into a swine vessel was created in a container simulating a chest cavity. From the results, in vivo experiments (swine model) were conducted to compare the pulmonary arterial bleeding volume while applying PIP. RESULTS In the ex vivo experiment, regardless of the incision type, the outflow volumes did not significantly differ at flow pressures of 20, 30, and 40 mmHg. At each flow pressure, the outflow volumes at 10, 15, and 20 mmHg of positive pressure in the container were significantly smaller than those of the control (p = 0.027, p = 0.002, and p = 0.005, respectively). Similarly, the in vivo experiments showed that bleeding decreased as intrapleural pressure increased (slope = -0.22, F = 55.13, p <0.0001). CONCLUSION It may be possible to temporarily suppress pulmonary arterial bleeding by increasing the intrapleural pressure to 10 to 20 mmHg using carbon dioxide insufflation. This method may be an adjunctive hemostatic maneuver for intraoperative bleeding.
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Affiliation(s)
- Momoko Asami
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Eiichi Kanai
- Laboratory of Small Animal Surgery, Azabu University School of Veterinary Medicine, Sagamihara, Kanagawa, Japan
| | - Yoshikane Yamauchi
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Yuichi Saito
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Noriyuki Matsutani
- Department of Surgery, Teikyo University Mizonokuchi Hospital, Kawasaki, Kanagawa, Japan
| | - Masafumi Kawamura
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Yukinori Sakao
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan,Corresponding author: Yukinori Sakao. Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi, Tokyo 173-8605, Japan
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7
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Shimbo M, Endo F, Tominaga K, Sano M, Nishino T, Kyono Y, Komatsu K, Ohyama T, Sakurai M, Narimoto K, Matsushita K, Hattori K. Optimizing first trocar access for robot-assisted radical prostatectomy: Optical trocar access through the upper abdominal quadrant using the Kii Fios First Entry trocar. Asian J Endosc Surg 2021; 14:443-450. [PMID: 33145955 DOI: 10.1111/ases.12889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/01/2020] [Accepted: 10/14/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES A pre-equipped metal trocar is required to use as a camera trocar due to a specification change in the da Vinci X/Xi system (Intuitive Surgical). We observed slight slippage of a trocar placed by the open method. With optical trocar access (OTA), the initial trocar is viewed directly with a laparoscope during placement. Reports regarding OTA for robotic surgery are limited, particularly for robot-assisted radical prostatectomy (RARP). We modified the OTA procedure such that it was appropriate for RARP. PATIENTS AND METHODS A total of 158 patients were enrolled in this study. The first trocar placement time (FTPT) was compared between the open and OTA groups. In the OTA group, the trocar was mainly placed through the upper abdominal quadrant. We also analyzed the differences between the conventional and modified OTA procedures using the Kii Fios First Entry trocar (Applied Medical). We examined the factors affecting the FTPT using linear regression models. A P value <.05 was considered significant. RESULTS The FTPT was significantly shorter in the OTA group than the open group (P < .0001). The modified method was associated with a shorter FTPT (P = .0001). None of the patient characteristics affected the FTPT in either group. No major complications were observed. CONCLUSIONS OTA was applied successfully during RARP. Use of the Kii Fios First Entry trocar with upper abdominal quadrant placement was suitable for RARP.
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Affiliation(s)
- Masaki Shimbo
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Fumiyasu Endo
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Koki Tominaga
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Masayuki Sano
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Takato Nishino
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Yoko Kyono
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Kenji Komatsu
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Takehiro Ohyama
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Masato Sakurai
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Kazutaka Narimoto
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | | | - Kazunori Hattori
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
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8
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Matsumoto Y, Yoshimatsu G, Munechika T, Kajitani R, Taketomi H, Nagano H, Komono A, Morimoto M, Aisu N, Yoshida Y, Hasegawa S. A case of carbon dioxide embolism during the transperineal approach in total pelvic exenteration for advanced anorectal cancer. Asian J Endosc Surg 2021; 14:97-101. [PMID: 32790015 DOI: 10.1111/ases.12832] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 05/20/2020] [Accepted: 06/02/2020] [Indexed: 01/13/2023]
Abstract
The transanal and transperineal endoscopic approaches are useful advanced surgical options for removing rectal and anorectal cancers. Intraoperative carbon dioxide (CO2 ) embolisms, however, have been increasingly reported as potentially fatal complications associated with surgery employing these approaches. We report our experience with a CO2 embolism that was detected because of a sudden drop in end-tidal CO2 with decreasing saturation of percutaneous arterial oxygen during total pelvic exenteration using the transperineal endoscopic approach under pneumopelvis/pneumoperitoneum. Transesophageal echocardiography confirmed that it was a CO2 embolus. We reversed the pneumopelvis and pneumoperitoneum, which alleviated the cardiopulmonary problems, and the surgery then proceeded to achieve R0 resection. The patient was discharged without severe complications other than the CO2 embolism.
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Affiliation(s)
- Yoshiko Matsumoto
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Gumpei Yoshimatsu
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Taro Munechika
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Ryuji Kajitani
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hirotaka Taketomi
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hideki Nagano
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Akira Komono
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Mitsuaki Morimoto
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Naoya Aisu
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Yoichiro Yoshida
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Suguru Hasegawa
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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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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10
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El-Hossamy H, Morsi H. Recognition and Prevention of Gastric Injury During Gynecologic Laparoscopy. J Gynecol Surg 2014. [DOI: 10.1089/gyn.2013.0116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Hashem El-Hossamy
- Department of Obstetrics and Gynaecology, Dudley Hospitals NHS Foundation Trust, Dudley, West Midlands, United Kingdom
| | - Hassan Morsi
- Department of Obstetrics and Gynaecology, Dudley Hospitals NHS Foundation Trust, Dudley, West Midlands, United Kingdom
- Department of Obstetrics and Gynaecology, Russells Hall Hospital, Dudley Hospitals NHS Foundation Trust, Dudley, West Midlands, United Kingdom
- University of Birmingham, Birmingham, United Kingdom
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11
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Mohammadi-Fallah MR, Mehdizadeh A, Badalzadeh A, Izadseresht B, Dadkhah N, Barbod A, Babaie M, Hamedanchi S. Comparison of transperitoneal versus retroperitoneal laparoscopic adrenalectomy in a prospective randomized study. J Laparoendosc Adv Surg Tech A 2013; 23:362-6. [PMID: 23573882 DOI: 10.1089/lap.2012.0301] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE This article reports a prospective, randomized comparison of transperitoneal laparoscopic adrenalectomy (TLA) versus retroperitoneal laparoscopic adrenalectomy (RLA) for adrenal lesions with medium-term follow-up. SUBJECTS AND METHODS Between September 2008 and November 2011, 24 patients with surgical adrenal diseases were prospectively randomized to undergo TLA (Group 1, 11 patients) or RLA (Group 2, 13 patients). Study exclusion criteria were patients with a body mass index of >40 kg/m(2), significant prior abdominal surgery, and bilateral adrenalectomy. Mean follow-up was 9 months in both groups. RESULTS The groups were matched in regard to patients' age (P=.80), sex (P=.72), body mass index (P=.62), and laterality (P=.72). Median adrenal mass size was 2.92 cm (range, 2-5 cm) in the TLA group and 2.63 cm (range, 2-5 cm) in the RLA group (P=.55). TLA was comparable to RLA in terms of operative time (P=.22), estimated blood loss (P=.83), time to ambulation (P=.21), hospital stay (P=.25), analgesic requirement (P=.40), and postoperative pain (P=.40), whereas time to oral intake resumption (P=.001) and convalescence period (P=.002) were significantly shorter in the RLA group. One case from the RLA group was electively converted to open surgery. During a mean follow-up of 9 months, there were no late complications, and no deaths occurred in any group. CONCLUSIONS Laparoscopic adrenalectomy is a viable treatment option for removal of benign adrenal lesions that can be performed safely and effectively by either the transperitoneal or retroperitoneal approach. All operative parameters are similar in the two approaches, except that the convalescence period and time to oral intake resumptions that are significantly shorter with retroperitoneal surgery.
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Affiliation(s)
- Mohammad Reza Mohammadi-Fallah
- Urology, Nephrology, and Kidney Transplant Research Center, Department of Urology, Imam Medical Center, Urmia University of Medical Sciences, Urmia, Iran
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12
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Azevedo JLMC, Azevedo OC, Sorbello AA, Becker OM, Hypolito O, Freire D, Miyahira S, Guedes A, Azevedo GC. Intraperitoneal pressure and volume of gas injected as effective parameters of the correct position of the Veress needle during creation of pneumoperitoneum. J Laparoendosc Adv Surg Tech A 2010; 19:731-4. [PMID: 19792865 DOI: 10.1089/lap.2009.0080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim of this work was to establish reliable parameters of the correct position of the Veress needle in the peritoneal cavity during creation of pneumoperitoneum. METHODS The Veress needle was inserted into the peritoneal cavity of 100 selected patients, and a carbon-dioxide flow rate of 1.2 L/min and a maximum pressure of 12 mm Hg were established. Intraperitoneal pressure (IP) and the volume of gas injected (VG) were recorded at the beginning of insufflation and at every 20 seconds. Correlations were established for pressure and volume in function of time. Values of IP and VG were predicted at 1, 2, 3, and 4 minutes of insufflation, by applying the following formulas: IP = 2.3083 + 0.0266 x time +8.3 x 10(-5) x time(2) - 2.44 x 10(-7) x time(3); and VG = 0.813 + 0.0157 x time. RESULTS A strong correlation was observed between IP and preestablished time points during creation of the pneumoperitoneum, as well as between VG and preestablished time points during creation of the pneumoperitoneum, with a coefficient of determination of 0.8011 for IP and of 0.9604 for VG. The predicted values were as follows: 1 minute = 4.15; 2 minutes = 6.27; 3 minutes = 8.36; and 4 minutes = 10.10 for IP (mm Hg); and 1 minute = 1.12; 2 minutes = 2.07; 3 minutes = 3.01; and 4 minutes = 3.95 for VG (L). CONCLUSIONS Values of IP and VG at given time points during insufflation for creation of the pneumoperitoneum, using the Veress needle, can be effective parameters to determine whether the needle is correctly positioned in the peritoneal cavity.
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Affiliation(s)
- João L M C Azevedo
- Department of Surgery, Federal University of São Paulo, São Paulo, Brazil.
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13
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Tinelli A, Malvasi A, Hudelist G, Istre O, Keckstein J. Abdominal Access in Gynaecologic Laparoscopy: A Comparison Between Direct Optical and Open Access. J Laparoendosc Adv Surg Tech A 2009; 19:529-33. [DOI: 10.1089/lap.2008.0322] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Andrea Tinelli
- Department of Obstetrics and Gynecology, Vito Fazzi Hospital, Lecce, Italy
| | - Antonio Malvasi
- Department of Obstetrics and Gynecology, Santa Maria Hospital, Bari, Italy
| | - Gernot Hudelist
- Department of Obstetrics and Gynecology, LKH Villach, Centre for Endometriosis, Villach, Austria
| | - Olav Istre
- Department of Gynecology and Obstetrics, Ullevaal University Hospital, Kirkeveien, Oslo, Norway
| | - Joerg Keckstein
- Department of Obstetrics and Gynecology, LKH Villach, Centre for Endometriosis, Villach, Austria
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Miyano G, Yanai T, Okazaki T, Kobayashi H, Lane G, Yamataka A. Laparoscopy-assisted stoma closure. J Laparoendosc Adv Surg Tech A 2007; 17:395-8. [PMID: 17570797 DOI: 10.1089/lap.2006.0074] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The aim of this study was to describe our improved technique for stoma closure, laparoscopy-assisted stoma closure (LASC). PATIENTS AND METHODS Eleven (11) children had LASC at our institute during 2005. Their ages at LASC ranged from 4 to 23 months and their body weight ranged from 3.4 to 10.0 kg. Under general anesthesia, a 5-mm trocar was inserted through an infraumbilical, left-lower, or upper quadrant incision, and laparoscopy was used to observe the bowels, the stoma, the line of separation, and any adhesions. Externally, an incision was made around the stoma circumferentially, and a pair of mosquito forceps was inserted into the abdomen along the attachment between the stoma and the abdominal wall where no intra-abdominal adhesions were present, and the tips of the mosquito forceps were used to free the stoma along the proposed line of separation. Electrocautery was used for hemostasis and for completing the separation. After the stoma was taken down, the bowel was anastomosed and the abdomen closed in layers. RESULTS All stomas were taken down easily without any complications in all cases. The average time for each stomal separation, from incising around the stoma until the stoma was taken down, was 23.1 minutes (range, 17-42). Injury to the abdominal wall musculature was minimal. There was 1 case of postoperative small bowel obstruction and no wound infection or incisional herniation. CONCLUSIONS Although our experience is limited to only 11 patients, our LASC procedure appears to be an effective option for stoma closure.
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Affiliation(s)
- Go Miyano
- Department of Pediatric Surgery, Juntendo University School of Medicine, Tokyo, Japan.
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Sriprasad S, Yu DF, Muir GH, Poulsen J, Sidhu PS. Positional Anatomy of Vessels That May Be Damaged at Laparoscopy: New Access Criteria Based on CT and Ultrasonography to Avoid Vascular Injury. J Endourol 2006; 20:498-503. [PMID: 16859464 DOI: 10.1089/end.2006.20.498] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE To study the relations of major blood vessels (aortoiliac bifurcation and iliocaval confluence) and the inferior epigastric arteries to the umbilicus and the anterior superior iliac spine (ASIS) planes and to apply this information to define ideal, anatomically based locations for primary and secondary laparoscopic port insertions to minimize vascular injuries. MATERIALS AND METHODS Two hundred randomly selected postcontrast CT images of the abdomen and pelvis were assessed by two radiologists. The position of the umbilicus (mobile point), ASIS (fixed point), and relations with the great vessels were measured. The angle of the umbilicus with the aortic bifurcation, theta (theta), was calculated using trigonometric principles. The position and course of the inferior epigastric arteries (IEA) was analyzed in 103 patients with color Doppler ultrasonography. RESULTS The median distance of the aortoiliac bifurcation was 8 mm (interquartile range [IQR] 28.8 mm] and that of the iliocaval venous confluence 25 mm (IQR 32 mm) below the umbilicus. The aorta divided 48 mm (IQR 16 mm) and the iliac veins joined 33 mm (IQR 9 mm) above the ASIS plane. The angle of the umbilicus to the aortoiliac bifurcation in the sagittal plane had a range of 14 degrees to 34 degrees with a median of 21.6 degrees . The median distance from the right IEA to the midline at the umbilicus was 4.75 cm (IQR 0.7 cm), and the same distance in the ASIS plane was 4.8 cm (IQR 0.7 cm). The distance of the IEA to the midline did not exceed 6 cm in any patient on either side or in either plane. CONCLUSION The position of the umbilicus should not be relied on for access planning. The relation between the level of the ASIS and the aortic bifurcation is more consistent. The ideal primary port entry (or Veress needle site) is at the ASIS plane in the midline, and the ideal lateral port entry is in the same plane >6 cm from the midline. If the umbilicus is to be used, a Hasson insertion is desirable, but if a Veress needle is used at the umbilicus, an angle of 45 degrees in the sagittal plane should be used.
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Karigiannis M, Pavlidis G, Papageorgiou G, Feretis C, Stamou KM, Vlachopoulos P. Delayed Presentation of Ilio-Iliac Arteriovenous Fistula Following Laparoscopic Cholecystectomy Treated with Percutaneous Graft-Covered Stent Placement. J Laparoendosc Adv Surg Tech A 2005; 15:411-4. [PMID: 16108748 DOI: 10.1089/lap.2005.15.411] [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: 11/13/2022] Open
Abstract
Major vascular injuries during laparoscopic cholecystectomy are rare, usually readily apparent, and immediately treated. We report a case of delayed presentation of a retroperitoneal vascular injury. The patient presented with abdominal pain and increasing edema of the lower extremities 1 year after laparoscopic cholecystectomy and was found to have an ilio-iliac arteriovenous fistula. Endovascular treatment was accomplished using a graft-covered polytetrafluoroethylene stent. The patient remained free of symptoms at 1-year follow-up.
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Affiliation(s)
- Michael Karigiannis
- Department of Interventional Neuroradiology, Athens Medical Center Hospital, Athens, Greece
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Senapati PSP, Bhattacharya D, Ammori BJ. "Semi-open" blunt primary access to the abdominal cavity during laparoscopic surgery: a new technique. J Laparoendosc Adv Surg Tech A 2005; 13:313-5. [PMID: 14617389 DOI: 10.1089/109264203769681691] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Despite major technologic advances in laparoscopic surgery, the creation of the pneumoperitoneum remains a critical step and is associated with a recognized incidence of complications. The aim of this study was to evaluate the safety and feasibility of a new "semi-open" blunt technique for primary cannulation of the abdominal cavity in patients undergoing laparoscopic surgery. METHODS Between October 2000 and November 2001, 300 patients underwent laparoscopic surgery under the care of one surgeon. Surgery was elective in 158 patients and urgent/emergent in 142 patients. The semi-open blunt technique for primary cannulation of the peritoneal cavity was applied in 241 (80%) of the patients and was periumbilical in most cases. A closed blunt technique was applied in 48 (16%) of the patients, and the Veress needle was used in 11 (4%) of the patients. RESULTS The semi-open blunt technique for primary cannulation of the abdominal cavity successfully achieved access in all patients in whom it was attempted. Minor live injuries occurred in two patients (one with the semi-open method and one with the Veress needle). No port site incisional hernias were encountered during a median follow-up of 6 months. CONCLUSIONS The semi-open blunt technique of primary cannulation of the peritoneal cavity achieves rapid, safe, and successful access to the abdomen for laparoscopy. It is associated with minimal periportal gas leakage and port dislodgement and is an alternative method for primary cannulation.
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Rafii A, Camatte S, Lelièvre L, Daraï E, Lécuru F. Previous abdominal surgery and closed entry for gynaecological laparoscopy: a prospective study. BJOG 2005; 112:100-2. [PMID: 15663406 DOI: 10.1111/j.1471-0528.2004.00298.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess the morbidity from closed laparoscopic access and define the role of previous surgery on the occurrence of these complications. DESIGN AND METHODS We prospectively recorded data on all laparoscopic procedures between January 2000 and January 2001. We compared results from patients without previous abdominal surgery (group I) with patients with prior abdominal surgery (group II). The insertion site for the Verres needle was trans-umbilical for patients in group I and in the left upper quadrant for patients in group II. SETTING Gynaecology department of a University Hospital. POPULATION All laparoscopic procedures between January 2000 and January 2001. MAIN OUTCOME MEASURES We compared results from patients without previous abdominal surgery (group I) with patients with prior abdominal surgery (group II). The insertion site for the Verres needle was trans-umbilical for patients in group I and the left upper quadrant for patients in group II. RESULTS Four hundred and seventy-seven laparoscopies were carried out during the study period, 368 women without previous surgery were included in group I, and 109 women were included in group II. We recorded 1 complication (overall complication rate of 0.2% and 31 incidents (6.4%). One complication (small bowel injury) was related to the insertion of the Verres needle (0.2%). The incidents and complications occurred only in group II (P < 0.05). All the complications were treated by laparoscopy. CONCLUSION The complication rate of the entry step is low in gynaecological laparoscopy. A previous history of laparotomy increases the risk of these complications and incidents. Safety rules and other access method should be investigated for these patients.
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Affiliation(s)
- Arash Rafii
- Service de Gynécologie, Hôspital Européen Georges Pompidou, Paris, France
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Chapron C, Cravello L, Chopin N, Kreiker G, Blanc B, Dubuisson JB. Complications during set-up procedures for laparoscopy in gynecology: open laparoscopy does not reduce the risk of major complications. Acta Obstet Gynecol Scand 2004; 82:1125-9. [PMID: 14616258 DOI: 10.1046/j.1600-0412.2003.00251.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare the risk of major complications during the set-up procedures for laparoscopy according to whether the classic technique (creation of the pneumoperitoneum followed by introduction of the optics trocar) or open laparoscopy is used. METHODS Comparison was made of two retrospective series each carried out in a department promoting one of the two techniques. The setting was a university-affiliated hospital. Two groups of patients were compared: group A, classic laparoscopy, n = 8324; group B, open laparoscopy, n = 1562. We investigated the set-up procedures of operative laparoscopy according to the rules of classic or open laparoscopy. RESULTS The risk of failure requiring conversion to laparotomy is significantly higher in the group of patients who underwent open laparoscopy [three cases (0.19%) vs. 0 case (0.0%); p = 0.004]. The risk of major complications is comparable in the two groups [group A, four cases (0.05%) vs. group B, three cases (0.19%); p = 0.08]. In the classic laparoscopy group there were four major complications: one injury to the aorta and three bowel injuries. In the open laparoscopy group there were three major complications: two bowel injuries and one postoperative occlusion. CONCLUSIONS Open laparoscopy does not reduce the risk of major complications during the set-up procedures for laparoscopy. Randomized prospective trials are indispensable for comparing the risks involved with the classic technique and those of open laparoscopy.
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Affiliation(s)
- C Chapron
- Assistance Publique des Hôpitaux de Paris, Service de Gynécologie Obstétrique II, Unité de Chirurgie, Clinique Universitaire Baudelocque, CHU Cochin Port-Royal, Paris, France.
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Orlando R, Palatini P, Lirussi F. Needle and trocar injuries in diagnostic laparoscopy under local anesthesia: what is the true incidence of these complications? J Laparoendosc Adv Surg Tech A 2003; 13:181-4. [PMID: 12855100 DOI: 10.1089/109264203766207708] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Laparoscopy is a relatively safe invasive procedure, but complications can occur, mainly related to Veress needle and trocar insertion. The rate of these complications is generally reported to be low, but the true incidence may be higher because of underreporting. We retrospectively studied the records of 2650 consecutive diagnostic laparoscopies performed by the same operator with the aim of assessing the true incidence and nature of these complications. Major complications occurred in 0.41% of cases and included bladder injury, bowel perforation, hemoperitoneum, and abdominal wall hematoma. Minor complications, including omental and subcutaneous emphysema, occurred in 1.58% of cases. Some of these resolved spontaneously, whereas others required surgical or medical treatment. We believe that all laparoscopic complications should be reported to a registry so that their potential risk can be quantified. Simply reporting complications as major or minor on the basis of the follow-up does not allow laparoscopists to understand their true incidence completely.
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Affiliation(s)
- Rocco Orlando
- Department of Medical and Surgical Sciences, University of Padua, Padua, Italy
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22
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Molloy D, Kaloo PD, Cooper M, Nguyen TV. Laparoscopic entry: a literature review and analysis of techniques and complications of primary port entry. Aust N Z J Obstet Gynaecol 2002; 42:246-54. [PMID: 12230057 DOI: 10.1111/j.0004-8666.2002.00246.x] [Citation(s) in RCA: 124] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To obtain consensus as to the optimal form of entry technique for access to the peritoneal cavity. DESIGN A meta-analysis of all relevant English language studies of laparoscopic entry complications. MAIN OUTCOME MEASURES Incidence of bowel and major vascular injuries. RESULTS Bowel injuries occur in 0.7/1,000 and major vascular injuries in 0.4/1,000. The overall incidence of major injuries at time of entry is 1.1/1,000. The direct entry technique is associated with a significantly reduced major injury incidence of 0.5/1,000, when compared to both open and Veress entry produces (1.1 and 0.9/1,000 respectively, p = 0.0005). Entry-related bowel injuries are reported more often following general surgical laparoscopies than with gynaecological procedures (p = 0.001). No such difference is seen in the incidence of vascular injuries (p = 0.987). Open entry is statistically more likely to be associated with bowel injury than either Veress needle or direct entry However, open entry appears to minimise vascular injury at time of entry. CONCLUSIONS There remains no clear evidence as to the optimal form of laparoscopic entry in the low-risk patient. However, direct entry may be an under-utilised and safe alternative to the Veress needle and open entry technique.
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Affiliation(s)
- David Molloy
- Australian Gynaecological Endoscopy Society, University of New South Wales, Sydney
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23
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Carbonell AM, Harold KL, Smith TI, Matthews BD, Sing RF, Kercher KW, Heniford BT. Umbilical stalk technique for establishing pneumoperitoneum. J Laparoendosc Adv Surg Tech A 2002; 12:203-6. [PMID: 12184907 DOI: 10.1089/10926420260188119] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The Veress needle technique for establishing pneumoperitoneum is widely used yet associated with slow insufflation and potentially life-threatening complications. The open or Hasson technique is relatively safer but considered cumbersome by many. We describe a mini-open technique that uses a 5-mm transumbilical incision and placement of a 5-mm blunt cannula without the trocar. We have employed this technique for 4 years in 600 patients without a midline laparotomy incision incorporating the umbilicus and have accessed the abdomen safely for laparoscopy without any complications. The time from skin incision to the start of the procedure is usually under 2 minutes. Our umbilical stalk technique provides rapid and safe access to the abdomen, eliminating the dangers of a blind sharp needle or trocar insertion and the need for a larger incision with placement of stay sutures. We recommend this simple technique for entry into the uncomplicated abdomen.
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Affiliation(s)
- Alfredo M Carbonell
- Department of General Surgery, Carolinas Medical Center, Carolinas Laparoscopic and Advanced Surgery Program, Charlotte, North Carolina 28203, USA
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Dubuisson JB, Chapron C, Decuypère F, De Spirlet M. ‘Classic’ laparoscopic entry in a university hospital: a series of 8324 cases. ACTA ACUST UNITED AC 2001. [DOI: 10.1046/j.1365-2508.1999.00300.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Voitk A, Rizoli S. Blunt hasson trocar injury: long intra-abdominal trocar and lean patient--a dangerous combination. J Laparoendosc Adv Surg Tech A 2001; 11:259-62. [PMID: 11569519 DOI: 10.1089/109264201750539817] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Injury at the time of trocar placement with the Hasson approach is rare. The cone of the Hasson cannula is wedged into the skin for an air seal, and, using fascial sutures, fastened under tension to flanges of the cannula. The shorter the fascial securing suture, the greater the tension and the more secure the air seal. Flanges for securing the fascial suture were attached to the external cannula in early Hasson cannula models. With these, much of the trocar needs to be intra-abdominal in order to shorten the suture. For lean patients, with very little distance between the anterior and posterior abdominal walls, the force required to fasten the sutures to the flanges may allow an intra-abdominal trocar to damage intervening organs. Later versions of the cannula had the flanges attached to the cone, allowing for short suture without need for intra-abdominal cannula. These models avoid the possibility of such injury. An unusually lean patient underwent laparoscopic cholecystectomy using an older Hasson cannula with flanges for the fascial securing suture attached to the cannula. Postoperative changes in vital signs and hemoglobin led to a diagnosis of intra-abdominal bleeding, and laparotomy revealed a transsected branch of the middle colic artery. Earlier Hasson cannulas, where the flanges are attached to the cannula, should be replaced with those with flanges attached to the cone.
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Affiliation(s)
- A Voitk
- Department of Surgery, The Scarborough Hospital, Ontario, Canada.
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Bernik TR, Trocciola SM, Mayer DA, Patane J, Czura CJ, Wallack MK. Balloon blunt-tip trocar for laparoscopic cholecystectomy: improvement over the traditional Hasson and Veress needle methods. J Laparoendosc Adv Surg Tech A 2001; 11:73-8. [PMID: 11327130 DOI: 10.1089/109264201750162275] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Laparoscopic cholecystectomy (LC) is a routine procedure for most general surgeons, yet the technical aspects of gaining access to the peritoneal cavity continue to be quite diverse. We describe a prospective review of 180 LCs using three access techniques: open balloon blunt-tip trocar (BBTT), open Hasson (HA), and closed Veress needle (VN). We favor the BBTT because it is designed to avoid all sharp instrumentation and offers superior seal and mobility, as well as expeditious and easy abdominal access. PATIENTS AND METHODS The techniques and devices were evaluated prospectively with regard to simplicity of access, leakage of carbon dioxide, access time, and complications. All patients underwent LC by one of two Board-certified surgeons. RESULTS The mean time to insertion of the laparoscope for the BBTT (3.5 +/- 0.99 minutes) was significantly less than the insertion time for the VN technique (5.2 +/- 0.9 minutes, P < 0.05). The insertion time for the BBTT was also less than for the standard HA approach (4.25 +/- 1.0 minutes; P < 0.05). There were no visceral or vascular injuries noted, but CO2 leakage and subcutaneous insufflation of gas experienced in the standard HA and VN groups resulted in lengthened operative times. One patient in the BBTT group experienced a postoperative port-site herniation, which was repaired primarily without consequence. CONCLUSION The BBTT is an established, safe alternative to blind access for LC. Our technique is simple and rapid and avoids most of the technical difficulties encountered by other open access devices. We believe this method provides surgeons with an option that is efficient and easier to perform than most other conventional open-access laparoscopic techniques.
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Affiliation(s)
- T R Bernik
- Department of Surgery, Saint Vincents Hospital, New York, New York, USA.
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Bemelman WA, Dunker MS, Busch OR, Den Boer KT, de Wit LT, Gouma DJ. Efficacy of establishment of pneumoperitoneum with the Veress needle, Hasson trocar, and modified blunt trocar (TrocDoc): a randomized study. J Laparoendosc Adv Surg Tech A 2000; 10:325-30. [PMID: 11132912 DOI: 10.1089/lap.2000.10.325] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To compare three techniques of establishment of pneumoperitoneum for efficacy: the Veress needle/first trocar, the Hasson trocar, and a newly developed modified blunt trocar, the TrocDoc. PATIENTS AND METHODS Between June and December 1999, 62 patients eligible for laparoscopic surgery were randomized. The effectiveness of installation of the pneumoperitoneum using the three techniques was assessed by time-motion analysis. Primary efficacy measures were total time and number of actions required to establish the pneumoperitoneum. Secondary efficacy measures were procedure-related complications, wound complications, and occurrence of CO2 leakage. RESULTS Two patients were withdrawn from inclusion. The three groups were comparable for age and body mass index. Total time was shortest using the TrocDoc rather than the Veress needle/first trocar and the Hasson trocar (respectively, 138 +/- 58 v 237 +/- 56 v 350 +/- 103 seconds), and the number of actions was lowest for the Veress needle/first trocar combination: 22 +/- 7 v 32 +/- 12 (TrocDoc) v 53 +/- 17 (Hasson). There was no morbidity related to the installation of pneumoperitoneum nor trocar wound complications. Gas leakage occurred in five of the Hasson introductions. CONCLUSIONS Establishment of the pneumoperitoneum is more efficient using the TrocDoc compared with the Veress needle/first trocar and the Hasson trocar. The TrocDoc might replace the two alternatives because of its efficacy and open method of introduction.
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Affiliation(s)
- W A Bemelman
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
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Bemelman WA, De Wit LT, Busch OR, den Boer KT, Klaase JF, Grimbergen CA, Gouma DJ. Establishment of pneumoperitoneum with a modified blunt trocar. J Laparoendosc Adv Surg Tech A 2000; 10:217-8. [PMID: 10997845 DOI: 10.1089/109264200421612] [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: 11/12/2022] Open
Abstract
Veress needle and trocar-related accidents have caused many surgeons to adopt the Hasson technique for establishment of pneumoperitoneum, but this technique also has drawbacks. A modification of the sharp trocar has been developed that overcomes the disadvantages of the Veress needle and Hasson trocar.
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Affiliation(s)
- W A Bemelman
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
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Pickersgill A, Slade RJ, Falconer GF, Attwood S. Open laparoscopy: the way forward. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1999; 106:1116-9. [PMID: 10549953 DOI: 10.1111/j.1471-0528.1999.tb08134.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A Pickersgill
- Department of Obstetrics and Gynaecology, Hope Hospital, Salford
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Zaraca F, Catarci M, Gossetti F, Mulieri G, Carboni M. Routine use of open laparoscopy: 1,006 consecutive cases. J Laparoendosc Adv Surg Tech A 1999; 9:75-80. [PMID: 10194697 DOI: 10.1089/lap.1999.9.75] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Blind insertion of the Veress needle and of the first trocar is a significant cause of laparoscopic surgery complications. Despite this risk, the closed technique is still more popular than the open one. The authors retrospectively evaluated 1006 consecutive laparoscopic operations in which Hasson's technique was routinely performed. The overall complication rate was 2.2%, but the vast majority of complications occurred during the first 50 cases (6% vs. 1.9%). They conclude that after a learning phase of about 50 cases, Hasson's technique is a quick and safe procedure.
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Affiliation(s)
- F Zaraca
- Second Surgical Clinic, School of Medicine, University of Rome La Sapienza, Italy.
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Abstract
A modified method of open laparoscopy was performed on 568 consecutive patients requiring laparoscopy or laparoscopic surgery. There were no intraoperative complications related to the technique. All patients were reviewed at 1 week following surgery; 4% had minor umbilical sepsis, while none had a postoperative hernia. The modifications to the technique of open laparoscopy described here make it simple and efficient while maintaining the safety inherent with this technique.
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Affiliation(s)
- D H Wallace
- University Department of Surgery, Western Infirmary, Glasgow, UK
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