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Chung E. Narrative review: evolution in device technology and advances in surgical techniques on AMS 800 device in the last 50 years. Transl Androl Urol 2024; 13:1657-1665. [PMID: 39280659 PMCID: PMC11399039 DOI: 10.21037/tau-23-10] [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] [Received: 01/03/2023] [Accepted: 02/02/2024] [Indexed: 09/18/2024] Open
Abstract
Background and Objective The current AMS 800 artificial urinary sphincter (AUS) device is designed to simulate the function of the biological urinary sphincter to prevent urinary flow through mucosal coaptation, compression, and pressure transmission. The challenges in designing the AMS 800 device involve not only the mechanical operation of the artificial sphincter device but also producing a device that is effective, safe, and durable for patients in the long term. The following article provides a narrative review regarding the evolution and development of the AMS 800 devices over the years and evaluates the advances in surgical techniques relating to AMS 800 implantation. Methods Available literature pertaining to the AMS 800 device was reviewed from the MEDLINE and EMBASE databases between 1 January 2000 to 31 December 2022. Emphasis is placed on key scientific publications including previous reviews and clinical guidelines relevant to AMS 800 device(s) and surgical techniques. Key Content and Findings From the engineering point of view, the current AMS 800 device is ingenious and has stood the test of time. The basic design of this modern AUS consists of 3 separate components namely a pressure regulating balloon (PRB), an inflatable cuff, and a control pump. Continued innovations in device design and technology, coupled with refinements in surgical techniques over the past 5 decades have ensured that the AMS 800 device is and remains the standard of care in male stress urinary incontinence. While the long-term AMS 800 efficacy, safety, and durability are well documented, it is not without its limitations and complications. Mechanical and non-mechanical complications can occur especially in high-risk populations (such as in radiated patients) despite strict adherence to surgical principles and manufacturer's guidelines. Conclusions Continued innovations in device design, technology, and surgical techniques have ensured that the AMS 800 device is an effective and safe treatment for male stress urinary incontinence (SUI). Future directions in the treatment of male SUI likely reside in cellular regenerative therapy and nanotechnology to restore, replace, or simulate the damaged native urinary sphincter.
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Affiliation(s)
- Eric Chung
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia
- Department of Urology, Macquarie University Hospital, Sydney, Australia
- AndroUrology Centre, Brisbane, QLD, Australia
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2
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Gopalan V, Khan IA, Zade AA, Malhotra G, Durge S, Jain Y, Rekavari SG. Diagnostic Challenges and Treatment Options for Mucocle of the Appendix: A Comprehensive Review. Cureus 2024; 16:e66142. [PMID: 39233991 PMCID: PMC11374133 DOI: 10.7759/cureus.66142] [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] [Received: 07/18/2024] [Accepted: 08/04/2024] [Indexed: 09/06/2024] Open
Abstract
Mucocles of the appendix, encompassing mucinous cystadenomas and mucinous cystadenocarcinomas, represent rare but clinically significant appendiceal lesions characterized by the accumulation of mucin within the appendix lumen. This review explores the diagnostic complexities and treatment strategies associated with mucocles, emphasizing the importance of its accurate recognition and management. Diagnostic challenges arise due to overlapping symptoms with acute appendicitis and other appendiceal pathologies, necessitating a multidimensional approach that includes imaging, histopathological analysis, and clinical correlation. Treatment options range from appendectomy for benign lesions to more extensive surgical procedures, such as right hemicolectomy for malignant forms. Prognostic factors, including histological subtype and tumor size, influence treatment decisions and long-term outcomes. By synthesizing current evidence and clinical insights, this review aims to provide a comprehensive framework for clinicians to navigate the complexities of mucocles of the appendix, offering perspectives that can guide effective management and future research endeavors.
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Affiliation(s)
- Vasundara Gopalan
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Imran Ali Khan
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anup A Zade
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Geetika Malhotra
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shubham Durge
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Yashraj Jain
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sai Goutham Rekavari
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Ismail MI, Al-Gharaibeh OR, Talafha L, Gammaldi D, Varrassi G, Grasso G. Anesthetic Management of a Patient With Wolff-Parkinson-White Syndrome Undergoing Gynecological Robotic Surgery. Cureus 2024; 16:e62842. [PMID: 39036161 PMCID: PMC11260423 DOI: 10.7759/cureus.62842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 06/20/2024] [Indexed: 07/23/2024] Open
Abstract
Robotic surgery provides precision and safety for minimally invasive gynecological operations but introduces unique anesthetic challenges, especially for individuals with pre-existing conditions like Wolff-Parkinson-White (WPW) syndrome. This case report addresses the anesthetic management of a 32-year-old female with WPW syndrome undergoing a myomectomy. A thorough pre-operative evaluation, including an ECG, echocardiogram, and Holter monitoring, was performed to assess the anesthetic and cardiac risks. The patient was administered a combination of loco-regional and general anesthesia, with an emphasis on neuromuscular monitoring, antiarrhythmic preparedness, and pain management to effectively manage the complexities introduced by WPW syndrome and robotic surgery. The anesthetic protocol comprised premedication with midazolam, induction using sufentanil, propofol, and rocuronium, and maintenance with desflurane, along with techniques to mitigate the effects of pneumoperitoneum and Trendelenburg positioning. Employing these strategies, the surgery concluded successfully without any anesthetic or surgical complications. The patient experienced a rapid and complete awakening, achieved optimal pain control, and was able to mobilize early, leading to her discharge 24 hours post-surgery. This case demonstrates the essential nature of customized anesthetic management for patients with WPW syndrome undergoing robotic surgery. It underscores the necessity of an exhaustive pre-operative assessment, diligent intraoperative monitoring, and active postoperative care to ensure patient safety and promote swift recovery.
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Affiliation(s)
| | | | - Lana Talafha
- Clinical Sciences, Faculty of Medicine, Yarmouk University, Irbid, JOR
| | | | | | - Giovanna Grasso
- Anesthesiology, Azienda Ospedaliera Universitaria (AOU) Federico II, Napoli, ITA
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Keating K, Holdren C, Eames R, Pulford C, O'Pry E, Peifer D, Rohloff M, Fletcher J, Maatman TJ. The impact of low pressure pneumoperitoneum in robotic assisted radical prostatectomy II: a prospective, randomized, double blinded trial. World J Urol 2024; 42:347. [PMID: 38789638 DOI: 10.1007/s00345-024-05038-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
OBJECTIVE To analyze postoperative ileus rates and postoperative complications between the different pneumoperitoneum settings. The secondary objective was to evaluate narcotic use and intraoperative blood loss between the different pneumoperitoneum settings. METHODS A prospective, randomized, double blinded study was conducted at pneumoperitoneum pressures of either 12 mmHg or 15 mmHg for patients undergoing robotic assisted radical prostatectomy with bilateral pelvic lymph node dissection by a single high volume surgeon. RESULTS The risk of ileus in the 12 mmHg group was 1.9% (2/105) compared to 3.2% (3/93) in the 15 mmHg group (OR 0.58, 95%CI 0.1-3.6). There was no difference in the risk of any complication with a complication rate of 4.8% (5/105) in the 12 mmHg arm compared to 4.3% (4/93) in the 15 mmHg arm (OR 1.1, 95% CI 0.3 - 4.3). CONCLUSION Pneumoperitoneum pressure setting of 12 mmHg has no significant difference to 15 mmHg in the rate of postoperative complications, narcotic use, and intraoperative bleeding. Additional research is warranted to understand the optimal.
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Affiliation(s)
- Kevin Keating
- Department of Urological Surgery, University of MI Health - West, 5900 Byron Center Ave., Wyoming, MI, 49519, USA.
| | - Charla Holdren
- Department of Urological Surgery, University of MI Health - West, 5900 Byron Center Ave., Wyoming, MI, 49519, USA
| | - Richard Eames
- Department of Urological Surgery, University of MI Health - West, 5900 Byron Center Ave., Wyoming, MI, 49519, USA
| | - Christopher Pulford
- Department of Urological Surgery, University of MI Health - West, 5900 Byron Center Ave., Wyoming, MI, 49519, USA
| | - Emiley O'Pry
- Department of Urological Surgery, University of MI Health - West, 5900 Byron Center Ave., Wyoming, MI, 49519, USA
| | - David Peifer
- Department of Urological Surgery, University of MI Health - West, 5900 Byron Center Ave., Wyoming, MI, 49519, USA
| | - Matthew Rohloff
- Department of Urological Surgery, University of MI Health - West, 5900 Byron Center Ave., Wyoming, MI, 49519, USA
| | - Jeffery Fletcher
- Department of Urological Surgery, University of MI Health - West, 5900 Byron Center Ave., Wyoming, MI, 49519, USA
| | - Thomas J Maatman
- Department of Urological Surgery, University of MI Health - West, 5900 Byron Center Ave., Wyoming, MI, 49519, USA
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Takemoto S, Asada M, Maki J, Setoguchi H, Hoka S. Anesthetic Management of an Adult Patient Post a Fontan Procedure in Laparoscopic Surgery: A Case Report. Cureus 2024; 16:e59594. [PMID: 38826999 PMCID: PMC11144442 DOI: 10.7759/cureus.59594] [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: 05/03/2024] [Indexed: 06/04/2024] Open
Abstract
We report the successful anesthetic management of laparoscopic surgery in a 21-year-old female patient with Fontan circulation. A preoperative careful review of cardiac catheterization results helped assess the risk of the surgery and implement anesthetic management. Intraoperative management focused on minimizing the impact on pulmonary vascular resistance and venous return by optimizing ventilation and applying lower pneumoperitoneum pressure without tilting the position. Milrinone was administered to reduce pulmonary vascular resistance and provide inotropic support with minimally invasive monitoring. The patient remained stable throughout the procedure without complications. This case highlights the importance of thorough preoperative assessment, individualized intraoperative management, and collaboration with the surgical team when caring for adult Fontan patients undergoing laparoscopic surgery.
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Affiliation(s)
- Sho Takemoto
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, USA
- Department of Cardiovascular Surgery, Kyushu University Graduate School of Medical Sciences, Fukuoka, JPN
| | - Masako Asada
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Graduate School of Medicine, Fukuoka, JPN
| | - Jun Maki
- Intensive Care Unit, Kyushu University Hospital, Fukuoka, JPN
| | - Hidekazu Setoguchi
- Department of Anaesthesiology, Kyushu University Beppu Hospital, Oita, JPN
| | - Sumio Hoka
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Graduate School of Medicine, Fukuoka, JPN
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Abstract
An increased intraabdominal pressure, particularly when occurring during periods of hemodynamic instability or fluid overload, is regarded as a major contributor to acute kidney injury (AKI) in intensive care units. During abdominal laparoscopic procedures, intraoperative insufflation pressures up to 15 mmHg are applied, to enable visualization and surgical manipulation but with the potential to compromise net renal perfusion. Despite the widely acknowledged renal arterial autoregulation, net arterial perfusion pressure is known to be narrow, and the effective renal medullary perfusion is disproportionately impacted by venous and lymphatic congestion. At present, the potential risk factors, mitigators and risk-stratification of AKI during surgical pneumoperitoneum formation received relatively limited attention among nephrologists and represent an opportunity to look beyond mere blood pressure and intake-output balances. Careful charting and reporting duration and extent of surgical pneumoperitoneum represents an opportunity for anesthesia teams to better communicate intraoperative factors affecting renal outcomes for the postoperative clinical teams. In this current article, the authors are integrating preclinical data and clinical experience to provide a better understanding to optimize renal perfusion during surgeries. Future studies should carefully consider intrabdominal insufflation pressure as a key variable when assessing outcomes and blood pressure goals in these settings.
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Yen HH, Yeh CC, Lai IR. Laparoscopic versus open distal gastrectomy for elderly patients with advanced gastric cancer: a retrospective comparative study. World J Surg Oncol 2022; 20:355. [PMID: 36348420 PMCID: PMC9644532 DOI: 10.1186/s12957-022-02819-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Laparoscopic radical distal gastrectomy (LDG) has been more frequently performed for locally advanced distal gastric cancer (AGC) than open distal gastrectomy (ODG). However, the benefits of LDG for elderly AGC patients (AGC-lap) remain unclear. METHODS Patients aged ≥ 70 years who underwent D2 distal gastrectomy from July 2014 to July 2021 were enrolled consecutively. Perioperative parameters, pathological features, and oncological outcomes of AGC-lap patients (n = 39) were compared with those of elderly AGC patients receiving ODG (AGC-open; n = 37) and elderly early gastric cancer patients receiving LDG (EGC-lap; n = 41) respectively. RESULTS The median age of all AGC patients was 77 years, and 28% of them had an Eastern Cooperative Oncology Group score ≥ 2. Most of the perioperative and pathological features (including the number of lymph nodes harvested) were similar between the AGC-lap and AGC-open groups. AGC-lap patients had longer median operative times (215 min versus 192 min) but significantly less surgical complications (10.3% versus 37.8%) and shorter median hospital stays (11 days versus 13 days) than did AGC-open patients (all p < 0.05). The 3-year recurrence-free and overall survival was 66.2% and 88.8% in the AGC-lap group and 51% and 66.3% in the AGC-open group (both p = 0.1). The perioperative features, including operative time, number of lymph nodes harvested, hospital stay, and complication rates, were similar between the AGC- and EGC-lap groups. CONCLUSIONS LDG was safely and effectively performed in elderly AGC patients, resulting in faster recovery and a lower complication rate than ODG, without compromising oncological outcomes.
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Affiliation(s)
- Hung-Hsuan Yen
- Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu County, Taiwan
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Chuan Yeh
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - I-Rue Lai
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
- Graduate Institute of Anatomy and Cell Biology, College of Medicine, National Taiwan University, Taipei, Taiwan.
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The impact of low-pressure pneumoperitoneum on robotic-assisted radical cystectomy and intracorporeal ileal conduit urinary diversion: a case-control study. World J Urol 2022; 40:2467-2472. [PMID: 36065029 PMCID: PMC9512870 DOI: 10.1007/s00345-022-04117-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/20/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose To evaluate the role of low intra-abdominal pressure (IAP) in improving postoperative recovery in Robotic-assisted radical cystectomy (RARC) and intracorporeal ileal conduit urinary diversion (ICUD). Methods A retrospective case–control study of 49 bladder cancer patients offered RARC/ICUD with standard (12 mmHg, n = 24) or low IAP (8 mmHg, n = 25). Outcomes of interest included length of procedure (LoP), estimated blood loss (EBL), blood transfusion, margin positivity rates, time to first flatus (TtFF), time to first bowel movement (TtFBM), ileus and small bowel obstruction (SBO) rates, time to safe discharge (TtSD), postoperative hospital stay (PHS) and pain levels on a postoperative day (POD) 1 and 3. Perioperative complications were recorded using the Clavien-Dindo system. Results Demographic and baseline clinical characteristics, LoP, EBL and margin positivity rates were similar between groups. No transfusions were recorded. Median (IQR) TtFF, TtFBM and TtSD were significantly longer in Group 1 vs Group 2 (4 (1) vs 2 (1), 7 (3) vs 6 (2) and 8.5 (5.75) vs 5.0 (1), respectively). PHS and rates of postoperative ileus and SBO were lower in Group 2, however not statistically significant. Severe pain was uncommon in both groups but moderate/severe pain was significantly higher in Group 1 (95.8% vs 48% on POD1 and 62.5% vs 16% on POD3). No significant intraoperative complications were recorded and ≥ Grade 3 postoperative complications at 30 and 90 days were similar. Conclusion With limitations, Low-IAP RARC can be safely offered to RARC/ICUD patients and leads to faster bowel recovery, and shorter time to safe discharge compared to standard pneumoperitoneum.
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Giampaolino P, Della Corte L, Mercorio A, Bruzzese D, Coviello A, Grasso G, Del Piano AC, Bifulco G. Laparoscopic gynecological surgery under minimally invasive anesthesia: a prospective cohort study. Updates Surg 2022; 74:1755-1762. [PMID: 35759109 PMCID: PMC9244282 DOI: 10.1007/s13304-022-01310-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/31/2022] [Indexed: 11/29/2022]
Abstract
The purpose of this study is to assess the feasibility and the perioperative outcomes of laparoscopic gynecological surgery in regional anesthesia (RA) from the point of view of the surgeon, anesthesiologist and patient. This is a prospective cohort study comprising sixty-six women planned to undergo gynecologic laparoscopy surgery for benign pathology at tertiary care gynecolgical center of the University Federico II of Naples. Women were assigned, according to their preference, to either RA (Group A) or general anesthesia (GA) (Group B). Surgical, anesthesiologic and postoperative recovery data were recorded. Postoperative pain was considered as the primary outcome. Secondary outcomes included mobilization, length of hospital stay, global surgeons and patient satisfaction, intraoperative pain assessment in Group A. Immediate postoperative pain was significantly lower in Group A 0 vs 2 (p < 0.001), with no significant differences at 24 h. The secondary outcome demonstrated early patient’s mobilization (p < 0.001) as well as early discharge (p < 0.001) and greater patient’s satisfaction for the Group A. In these patients, a maximum pain score of 3 points out of 5 was recorded through the entire surgery. RA showed to decrease the impact of surgical stress and to guarantee a quicker recovery without compromising surgical results. Although several surgical approaches can be employed to treat different conditions, RA technique could be a viable option for well-selected patients affected by gynecological diseases.
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Affiliation(s)
- Pierluigi Giampaolino
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Antonio Mercorio
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy.
| | - Dario Bruzzese
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Antonio Coviello
- Department of Anesthesiology and Intensive Care Medicine, Policlinico - Federico II University Hospital, Naples, Italy
| | - Giovanna Grasso
- Department of Anesthesiology and Intensive Care Medicine, Policlinico - Federico II University Hospital, Naples, Italy
| | - Anna Claudia Del Piano
- Department of Anesthesiology and Intensive Care Medicine, Policlinico - Federico II University Hospital, Naples, Italy
| | - Giuseppe Bifulco
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
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Wang C, Reynolds JC, Calle P, Ladymon AD, Yan F, Yan Y, Ton S, Fung KM, Patel SG, Yu Z, Pan C, Tang Q. Computer-aided Veress needle guidance using endoscopic optical coherence tomography and convolutional neural networks. JOURNAL OF BIOPHOTONICS 2022; 15:e202100347. [PMID: 35103420 PMCID: PMC9097560 DOI: 10.1002/jbio.202100347] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/17/2022] [Accepted: 01/20/2022] [Indexed: 05/03/2023]
Abstract
During laparoscopic surgery, the Veress needle is commonly used in pneumoperitoneum establishment. Precise placement of the Veress needle is still a challenge for the surgeon. In this study, a computer-aided endoscopic optical coherence tomography (OCT) system was developed to effectively and safely guide Veress needle insertion. This endoscopic system was tested by imaging subcutaneous fat, muscle, abdominal space, and the small intestine from swine samples to simulate the surgical process, including the situation with small intestine injury. Each tissue layer was visualized in OCT images with unique features and subsequently used to develop a system for automatic localization of the Veress needle tip by identifying tissue layers (or spaces) and estimating the needle-to-tissue distance. We used convolutional neural networks (CNNs) in automatic tissue classification and distance estimation. The average testing accuracy in tissue classification was 98.53 ± 0.39%, and the average testing relative error in distance estimation reached 4.42 ± 0.56% (36.09 ± 4.92 μm).
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Affiliation(s)
- Chen Wang
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK 73019
| | | | - Paul Calle
- School of Computer Science, University of Oklahoma, Norman, OK 73019
| | - Avery D. Ladymon
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK 73019
| | - Feng Yan
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK 73019
| | - Yuyang Yan
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK 73019
| | - Sam Ton
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK 73019
| | - Kar-ming Fung
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104
| | - Sanjay G. Patel
- Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104
| | - Zhongxin Yu
- Children’s Hospital, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104
| | - Chongle Pan
- School of Computer Science, University of Oklahoma, Norman, OK 73019
- ,
| | - Qinggong Tang
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK 73019
- ,
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Zafar W, Kalra K, Ortiz-Melo DI. Oncosurgery-Related Acute Kidney Injury. Adv Chronic Kidney Dis 2022; 29:161-170.e1. [PMID: 35817523 DOI: 10.1053/j.ackd.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/22/2022] [Accepted: 04/01/2022] [Indexed: 11/11/2022]
Abstract
Oncosurgery is a surgical specialty that focuses on the diagnosis, staging, and management of cancer and cancer-related complications. Acute kidney injury is a common and important complication related to oncologic surgery, associated with longer hospital length of stay, greater costs, increased risk of incident or progressive chronic kidney disease (CKD), and higher mortality. The pathogenesis of oncosurgery-related acute kidney injury is multifactorial and determined by different variables, including patient characteristics (comorbidities, volume status, age, pre-existing CKD), specific cancer type or location, surgical procedure involved, as well as intrinsic neuroendocrine and hemodynamic responses to anesthesia and/or surgery. Early nephrology evaluation may be helpful to assist with preservation of kidney function and prevention of further kidney injury.
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Affiliation(s)
- Waleed Zafar
- Division of Nephrology, Geisinger Medical Center, Danville, PA
| | - Kartik Kalra
- Division of Nephrology, Geisinger Medical Center, Danville, PA
| | - David I Ortiz-Melo
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC.
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12
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Sarkar S, Bhardwaj N, Yaddanapudi S, Jain D. Effect of two different levels of positive end-expiratory pressure (PEEP) on oxygenation and ventilation during pneumoperitoneum for laparoscopic surgery in children: A randomized controlled study. Saudi J Anaesth 2022; 16:430-436. [PMID: 36337428 PMCID: PMC9630667 DOI: 10.4103/sja.sja_445_22] [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: 06/14/2022] [Accepted: 07/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Positive end-expiratory pressure (PEEP) is used to attenuate the changes in respiratory parameters because of pneumoperitoneum during laparoscopic (LAP) surgery. As the ideal level of PEEP during LAP in children is not known, this study compared the effect of 5- and 10–cm H2O of PEEP on oxygenation, ventilator, and hemodynamic parameters during pediatric LAP. Method: After obtaining approval from the Institute Ethics Committee and written informed parental consent, 30 American Society of Anesthesiologists (ASA) I and II children aged 2–10 years, undergoing LAP were randomized to receive PEEP of 5- or 10–cm H2O during pneumoperitoneum. Baseline hemodynamic and ventilatory parameters, PaO2, and PaCO2 were measured 2 min after tracheal intubation, 2 min and 1 h after pneumoperitoneum, and after deflation of pneumoperitoneum. Oxygenation index, dynamic compliance, and alveolar-arterial oxygen gradient (D (A-a) O2) were calculated at the above-mentioned time points. Data were analyzed using Student's t-test and repeated measures ANOVA with Bonferroni correction. Results: The oxygenation index and D(A-a)O2 decreased in PEEP 5 Group and increased in PEEP 10 Group after pneumoperitoneum, the difference between the two groups being statistically significant (P = 0.001). The dynamic compliance decreased in PEEP 5 Group and increased or remained the same in PEEP 10 Group after pneumoperitoneum, the difference between the two groups being significant (P = 0.001). There were no significant changes in the hemodynamic parameters in the two groups. Conclusion: Use of 10-cm H2O PEEP during pneumoperitoneum in children improves ventilation and oxygenation, without significant hemodynamic changes.
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13
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Fukui S, Kagebayashi Y, Iemura Y, Matsumura Y. Severe subcutaneous emphysema caused by small injury to the abdominal wall during robot-assisted laparoscopic radical prostatectomy. Urol Case Rep 2021; 40:101904. [PMID: 34745898 PMCID: PMC8551592 DOI: 10.1016/j.eucr.2021.101904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/16/2021] [Accepted: 10/17/2021] [Indexed: 11/09/2022] Open
Abstract
A 67-year-old man underwent RARP in the Trendelenburg position with pneumoperitoneum at 12 mmHg. Gradual elevation of End-tidal CO2(EtCO2) began, and extensive subcutaneous emphysema was recognized when EtCO2 reached 58 mmHg. After interruption of pneumoperitoneum, careful observation of the surgical field led to detect an injury of the abdominal wall of 1 cm in length, suggesting the cause of severe subcutaneous emphysema. The injury was repaired and RARP was terminated without any cardiovascular problems. Attention should be paid that even minor abdominal wall injury could lead to severe subcutaneous emphysema which may cause respiratory or cardiovascular problems during laparoscopic surgeries. Severe subcutaneous emphysema with severe hypercarbia occurred during RARP. A small but deep abdominal wall injury cause severe subcutaneous emphysema. Minor abdominal wall injury lead to subcutaneous emphysema, which could be fatal.
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Affiliation(s)
- Shinji Fukui
- Department of Urology, Nara Prefecture General Medical Center, Nara City, Nara, Japan.,Department of Urology and Andrology, Kansai Medical University, Hirakata City, Osaka, Japan
| | - Yoriaki Kagebayashi
- Department of Urology, Nara Prefecture General Medical Center, Nara City, Nara, Japan
| | - Yusuke Iemura
- Department of Urology, Nara Prefecture General Medical Center, Nara City, Nara, Japan
| | - Yoshiaki Matsumura
- Department of Urology, Nara Prefecture General Medical Center, Nara City, Nara, Japan
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Jin YN, Feng H, Wang ZY, Li J. Analysis of the Risk Factors for Hypotension in Laparoscopic Hiatal Hernia Repair. Int J Gen Med 2021; 14:5203-5208. [PMID: 34512003 PMCID: PMC8423486 DOI: 10.2147/ijgm.s327259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/16/2021] [Indexed: 11/23/2022] Open
Abstract
Objective This study aimed to investigate the risk factors for hypotension in patients undergoing laparoscopic hiatal hernia repair. Methods The clinical data of patients who underwent laparoscopic repair of a hiatal hernia in the Beijing Chao-Yang Hospital of Capital Medical University between February 2018 and January 2021 were retrospectively collected, and their perioperative data were obtained by querying the electronic medical record system. The patients were divided into two groups—a hypotension group and a normal group—based on the occurrence of intraoperative hypotension, which was defined as a mean arterial pressure <65 mmHg and lasting ≥1 minute during the operation. The variables with a P value ≤0.1 in univariate regression analysis and clinically considered relevant variables were included in multivariate regression analysis in order to screen the risk factors for hypotension in these patients. Results A total of 114 patients were included in the analysis. The incidence of hypotension was 54.4%. Old age was identified as the only risk factor for hypotension during hiatal hernia surgery. Conclusion Old age is the only risk factor for intraoperative hypotension in patients undergoing laparoscopic hiatal hernia repair.
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Affiliation(s)
- Ya-Nan Jin
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Hao Feng
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Zhen-Yuan Wang
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Jie Li
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China
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15
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Gupta A, Brown E, Davis JT, Sekabira J, Ramanujam N, Mueller J, Fitzgerald TN. KeyLoop: Mechanical Retraction of the Abdominal Wall for Gasless Laparoscopy. Surg Innov 2021; 29:88-97. [PMID: 34242531 DOI: 10.1177/15533506211031084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Despite favorable outcomes of laparoscopic surgery in high-income countries, its implementation in low- and middle-income countries (LMICs) is challenging given a shortage of consumable supplies, high cost, and risk of power outages. To overcome these barriers, we designed a mechanical retractor that provides vertical tension on the anterior abdominal wall. Methods. The retractor design is anatomically and mathematically optimized to provide exposure similar to traditional gas-based insufflation methods. Anatomical data from computed tomography scans were used to define retractor size. The retractor is constructed of biocompatible stainless steel rods and paired with a table-mounted lifting system to provide 5 degrees of freedom. Structural integrity was assessed through finite element analysis (FEA) and load testing. Functional testing was performed in a laparotomy model. Results. A user guide based on patient height and weight was created to customize retractor size, and 4 retractor sizes were constructed. FEA data using a 13.6 kg mass (15 mm Hg pneumoperitoneum) show a maximum of 30 mm displacement with no permanent deformation. Physical load testing with applied weight from 0 to 13.6 kg shows a maximum of 60 mm displacement, again without permanent deformation. Retraction achieved a 57% larger field of view compared to an unretracted state in a laparotomy model. Conclusions. The KeyLoop retractor maintains structural integrity, is easily sterilized, and can be readily manufactured, making it a viable alternative to traditional insufflation methods. For surgeons and patients in LMICs, the KeyLoop provides a means to increase access to laparoscopic surgery.
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Affiliation(s)
- Aryaman Gupta
- Department of Biomedical Engineering, 3065Duke University, Durham, NC, USA
| | - Erin Brown
- Department of Biomedical Engineering, 3065Duke University, Durham, NC, USA
| | - Joseph T Davis
- Department of Radiology, 3065Duke University, Durham, NC, USA
| | - John Sekabira
- Department of Pediatric Surgery, 249321Mulago Hospital, Kampala, Uganda
| | - Nimmi Ramanujam
- Department of Biomedical Engineering, 3065Duke University, Durham, NC, USA.,Duke Global Health Institute, Durham, NC, USA
| | - Jenna Mueller
- Department of Bioengineering, University of Maryland, College Park, MD, USA
| | - Tamara N Fitzgerald
- Duke Global Health Institute, Durham, NC, USA.,Department of Surgery, 3065Duke University, Durham, NC, USA
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16
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Marton Filho MA, Alves RL, do Nascimento P, Tarquinio GDS, Mega PF, Pinheiro Módolo NS. Effects of pneumoperitoneum on kidney injury biomarkers: A randomized clinical trial. PLoS One 2021; 16:e0247088. [PMID: 33606739 PMCID: PMC7895340 DOI: 10.1371/journal.pone.0247088] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/29/2021] [Indexed: 01/22/2023] Open
Abstract
Background Increased intra-abdominal pressure causes hemodynamic changes that may affect renal biomarkers. Methods This randomized, single-blind, single-center clinical trial recruited patients undergoing laparoscopic cholecystectomy at a tertiary care center in Brazil. They were randomly allocated to a standard intra-abdominal pressure group (P10-12, 10–12 mm Hg) and a low intra-abdominal pressure group (P6-8, 6–8 mm Hg). The primary outcome was the change in neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C levels measured at the beginning of the procedure (T0), at the end of the procedure (T1), and 24 hours after the procedure (T2). P-values < 0.05 were considered statistically significant. Results In total, 64 patients completed the study—33 were given standard pressure and 31 were given low pressure. There was no significant difference in the biomarker between the groups (P = 0.580), but there was a significant difference between the time points with elevation at T1 (P < 0.001). Similar to NGAL, cystatin C had an elevation at T1 in both groups (P = 0.021), but no difference was found when comparing the groups. Conclusions In laparoscopic cholecystectomy, pneumoperitoneum increases NGAL and cystatin C levels intraoperatively, and the use of low-pressure pneumoperitoneum does not change the course of these biomarkers.
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Affiliation(s)
- Marcos Antonio Marton Filho
- Department of Surgical Specialties and Anesthesiology, Botucatu School of Medicine, Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
- Centro Universitário Estácio de Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil
- * E-mail:
| | - Rodrigo Leal Alves
- Department of Anesthesiology, São Rafael Hospital and Federal University of Bahia, Salvador, Brazil
| | - Paulo do Nascimento
- Department of Surgical Specialties and Anesthesiology, Botucatu School of Medicine, Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
| | | | - Paulo Ferreira Mega
- School of Medicine, Pontifícia Universidade Católica de Campinas (PUC-CAMPINAS), Campinas, São Paulo, Brazil
| | - Norma Sueli Pinheiro Módolo
- Department of Surgical Specialties and Anesthesiology, Botucatu School of Medicine, Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
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Kienle P, Magdeburg R. [Minimally invasive and robot-assisted surgery for chronic inflammatory bowel disease : Current status and evidence situation]. Chirurg 2021; 92:21-29. [PMID: 33274393 DOI: 10.1007/s00104-020-01306-4] [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: 10/22/2022]
Abstract
The majority of cases of inflammatory bowel disease (IBD) can be treated by minimally invasive surgery. The advantages of standard laparoscopic approaches compared to open surgery with respect to short-term and long-term outcome parameters have been adequately proven with evidence level 1 for ileocecal resection in Crohn's disease. For many other indications there are at least several larger registry or case-control studies that have shown advantages for laparoscopy. For robot-assisted surgery the feasibility has principally been demonstrated for IBD, whereby at least for ulcerative colitis limited data suggest comparable results to the standard laparoscopic approach. Single port approaches have so far not been able to demonstrate any relevant advantages in IBD surgery. Major advantages for transanal minimally invasive surgery (TAMIS) for performing restorative proctocolectomy could not be demonstrated in two larger case-controlled studies but it was at least shown to be a comparable alternative to standard laparoscopy. Overall, it seems unlikely that the recently described new laparoscopic approaches will result in measurable advantages for the patient in comparison to standard laparoscopy as the access trauma is not significantly changed. In general, the indications to perform minimally invasive surgery must always be based on the basic principles of IBD surgery and contraindications have to be considered in individual cases as the advantages of laparoscopic approaches are levelled out in the long run.
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Affiliation(s)
- Peter Kienle
- Allgemein- und Viszeralchirurgie, Theresienkrankenhaus, Bassermannstr. 1, 68165, Mannheim, Deutschland.
| | - Richard Magdeburg
- Allgemein- und Viszeralchirurgie, Theresienkrankenhaus, Bassermannstr. 1, 68165, Mannheim, Deutschland
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18
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A different technique in gasless, laparoendoscopic, single-site myomectomy. Surg Endosc 2020; 35:5508-5514. [PMID: 33315132 PMCID: PMC8437916 DOI: 10.1007/s00464-020-08044-y] [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] [Received: 11/26/2019] [Accepted: 09/22/2020] [Indexed: 11/18/2022]
Abstract
Background The aim of this study was to introduce a novel technique for gasless, laparoendoscopic, single-site (GLESS) myomectomy and to evaluate its feasibility and safety. Methods A retrospective observational study was performed at a hospital from Sep 2017 to Nov 2018. 15 patients with symptomatic subserosal or intramural myomas underwent GLESS myomectomy. Results The mean age and body mass index were 41.73 ± 8.58 years and 22.72 ± 2.27 kg/m2, respectively. 5 patients had a history of abdominal surgery, including four caesarean deliveries and one myomectomy. The mean operative duration, blood loss volume, time to specimen removal, time of bowel activity and postoperative hospitalization duration were 156.47 ± 62.19 min, 57.33 ± 72.35 ml, 29.87 ± 13.6 min, 27.67 ± 10.06 h, and 3.4 ± 0.74 days, respectively. The operation was successful in all patients, there were no surgical or wound complications in any patient, and the histopathological result was leiomyoma in all 15 patients. Conclusion The procedure is feasible and safe in selected patients with symptomatic myomas. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-020-08044-y.
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19
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Rohloff M, Peifer G, Shakuri-Rad J, Maatman TJ. The impact of low pressure pneumoperitoneum in robotic assisted radical prostatectomy: a prospective, randomized, double blinded trial. World J Urol 2020; 39:2469-2474. [PMID: 33057936 DOI: 10.1007/s00345-020-03486-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/03/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Robotic surgery has revolutionized postoperative outcomes across surgical specialties. However, the use of pneumoperitoneum comes with known risks given the change in physiological parameters that accompany its utilization. A recent internal review found a 7% decrease in postoperative ileus rates when utilizing a pneumoperitoneum of 12 mmHg over the standard 15 mmHg in robotic assisted radical prostatectomies (RARP). OBJECTIVE The purpose of this study is to prospectively evaluate the utility of lower pressure pneumoperitoneum by comparing 8 mmHg and 12 mmHg during RARP. DESIGN, SETTING AND PARTCIPANTS Patients were randomly assigned to undergo robotic assisted radical prostatectomy at a pneumoperitoneum pressure of 12 mmHg or 8 mmHg. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcome was development of postoperative ileus and secondary outcomes were length of operation, estimated blood loss and positive surgical margin status. RESULTS AND LIMITATIONS A total of 201 patients were analyzed; 96 patients at 8 mmHg and 105 patients at 12 mmHg. The groups were adequately matched as there were no differences between demographic parameters or medical comorbidities. There was a decrease in postoperative ileus rates with lower pneumoperitoneum pressures; 2% at 8 mmHg and 4.8% at 12 mmHg. There were no clinically significant differences in estimated blood loss, total length of operative time and positive margin status. CONCLUSIONS Lower pressure pneumoperitoneum during robotic assisted radical prostatectomy is non-inferior to higher pressure pneumoperitoneum levels and the experienced surgeon may safely perform this operation at 8 mmHg to take advantage of the proposed benefits.
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Affiliation(s)
- Matthew Rohloff
- Department of Urological Surgery, Metro Health: University of Michigan Health, 5900 Byron Center Ave., Wyoming, MI, 49519, USA.
| | - Greggory Peifer
- Department of Urological Surgery, Metro Health: University of Michigan Health, 5900 Byron Center Ave., Wyoming, MI, 49519, USA
| | - Jaschar Shakuri-Rad
- Department of Urological Surgery, Metro Health: University of Michigan Health, 5900 Byron Center Ave., Wyoming, MI, 49519, USA
| | - Thomas J Maatman
- Department of Urological Surgery, Metro Health: University of Michigan Health, 5900 Byron Center Ave., Wyoming, MI, 49519, USA
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20
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Association of laparoscopy and laparotomy with adverse fetal outcomes: a retrospective population-based case-control study. Surg Endosc 2020; 35:6048-6054. [PMID: 33048230 DOI: 10.1007/s00464-020-08094-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 10/03/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND This study aimed to evaluate fetal adverse outcomes of laparoscopy and laparotomy in pregnant women to determine the safety of these surgical approaches. METHODS This was a retrospective nationwide case-control study of women who became pregnant for the first time between 2000 and 2012 in Taiwan. The case (with adverse fetal outcomes) and control groups comprised 208,604 and 417,124 participants, respectively. Participants who underwent appendectomy, cholecystectomy, ovarian cystectomy, or myomectomy were treated with either laparoscopy or laparotomy. A conditional logistic regression model was used to calculate the odds ratios (ORs) for adverse fetal outcomes. RESULTS The laparotomy and laparoscopy groups comprised 632 and 536 patients, respectively. Women who underwent laparoscopy had a significantly higher risk of adverse fetal outcomes (adjusted OR [AOR] = 2.33; 95% CI 1.66-2.99) than those who underwent laparotomy. Adverse fetal outcomes were found to be significantly associated with laparoscopy among women aged 20-39 years (AOR = 2.30; 95% CI 1.70-3.31). Regarding surgical indication, unlike laparotomy, laparoscopic cholecystectomy and appendectomy were not associated with adverse fetal outcomes. However, laparoscopic myomectomy and ovarian surgeries were associated with a higher incidence of adverse fetal outcomes than the laparotomy group (AOR = 2.29 [95% CI 1.57-3.35, p < 0.0001] and AOR = 2.52 [95% CI 1.58-4.04, p = 0.0001], respectively). CONCLUSIONS Pregnant women who underwent laparoscopic surgery experienced significantly more adverse fetal outcomes than those who underwent laparotomy. Therefore, pregnant women undergoing either laparotomy or laparoscopy should be informed of the risk of adverse fetal outcomes.
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21
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Moss EL, Morgan G, Martin AP, Sarhanis P, Ind T. Surgical trends, outcomes and disparities in minimal invasive surgery for patients with endometrial cancer in England: a retrospective cohort study. BMJ Open 2020; 10:e036222. [PMID: 32938592 PMCID: PMC7497536 DOI: 10.1136/bmjopen-2019-036222] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To examine surgical outcomes and trends in the implementation of minimally invasive surgery (MIS) use for endometrial cancer (EC). DESIGN Retrospective cohort study. SETTING English National Health Service hospitals 2011-2017/2018. POPULATION 35 304 patients having a hysterectomy for EC identified from Hospital Episode Statistics. METHODS Univariate and multivariate analyses compared MIS to open hysterectomy (OH) by assessing the association between demographic, clinical and hospital characteristics by using logistic regression. A propensity score was created, to control for confounding factors including demographics, clinical and hospital characteristics, from a logistic regression which enabled the inverse probability weighting of treatment to be applied in order to compare outcomes of treatment. MAIN OUTCOME MEASURES The association between route of surgery on perioperative morbidity and mortality. RESULTS The MIS rate rose from 40.3% in 2011 to 68.7% in 2017/2018, however, there was significant geographical variation (p<0.001). The overall 90-day mortality was significantly higher with OH versus MIS (OR 0.34, 95% CI 0.18 to 0.62, p=0.0002). MIS rates were significantly lower in patients from the lowest socioeconomic group (LSEG) compared with patients from the highest group (HSEG) (55.4% vs 59.9%, p<0.01), and in the black population as compared with white and Asian populations (40.4% vs 58.6% and 56.0%, p<0.0001). When patients from LSEG and black patients were treated in hospitals with high MIS rates, the MIS rate increased close to that of the HSEG and white patients (81.0% and 74.1% vs 83.2% and 82.6%). CONCLUSIONS Further investigation is needed to understand the barriers to MIS and improve access so that as many patients as possible can benefit from the reduced morbidity/mortality associated with MIS.
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Affiliation(s)
- Esther L Moss
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| | | | - Antony P Martin
- HCD Economics, Warrington, UK
- Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Panos Sarhanis
- Department of Gynaecology, North West London Hospitals NHS Trust, Harrow, UK
| | - Thomas Ind
- Department of Gynaecological Oncology, Royal Marsden Hospital NHS Trust, London, UK
- Department of Obstetrics and Gynaecology, St George's University of London, London, UK
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22
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Jo YY, Lee KC, Chang YJ, Jung WS, Park J, Kwak HJ. Effects of an Alveolar Recruitment Maneuver During Lung Protective Ventilation on Postoperative Pulmonary Complications in Elderly Patients Undergoing Laparoscopy. Clin Interv Aging 2020; 15:1461-1469. [PMID: 32921992 PMCID: PMC7457882 DOI: 10.2147/cia.s264987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/07/2020] [Indexed: 10/26/2022] Open
Abstract
Purpose Controversy remains over whether alveolar recruitment maneuvers (ARMs) can reduce postoperative pulmonary complications. We hypothesized that performing an ARM in addition to lung protective ventilation (LPV) could improve intraoperative arterial oxygenation and postoperative pulmonary complications (PPCs) in elderly patients undergoing laparoscopy in the Trendelenburg position. Patients and Methods Sixty-two patients (aged 65-85) scheduled for laparoscopic low anterior resection were randomized to receive LPV only (LPV group, n = 32) or LPV with an ARM (ARM group, n = 30). LPV was set to a tidal volume of 6 mL/kg with a positive end expiratory pressure (PEEP) of 5 cmH2O. The ARM was performed by serially increasing the PEEP to 10 cmH2O for 3 breaths, 15 cmH2O for 3 breaths, then 20 cmH2O for 10 breaths, both immediately before and after abdominal insufflation. The primary end-point was the frequency of PPCs such as desaturation (SpO2 <90%), atelectasis, and pneumonia. Secondary end-points were changes in intraoperative respiratory and gas exchange parameters and hemodynamic variables. Results One patient in the LPV group experienced desaturation on the first postoperative day. The frequency of chest X-ray abnormalities such as atelectasis or pleural effusion was comparable between groups (6 (19%) and 5 (17%) patients, respectively, P = 0.676). Changes in other respiratory, gas exchange and hemodynamic parameters over time were not significantly different between the groups. However, vasopressor requirements during surgery were higher in the ARM than the LPV group (9 (30%) and 2 (6%) patients, respectively, P = 0.014). Conclusion This study suggests that performing an ARM during LPV may not improve postoperative respiratory outcomes and intraoperative oxygenation compared to LPV alone in geriatric patients undergoing laparoscopy in the Trendelenburg position. In addition, since the ARM could cause a significant deterioration in hemodynamic parameters, applying ARM to elderly patients should be carefully considered.
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Affiliation(s)
- Youn Yi Jo
- Department of Anesthesiology and Pain Medicine, Gachon University College of Medicine, Gil Hospital, Incheon, Republic of Korea
| | - Kyung Cheon Lee
- Department of Anesthesiology and Pain Medicine, Gachon University College of Medicine, Gil Hospital, Incheon, Republic of Korea
| | - Young Jin Chang
- Department of Anesthesiology and Pain Medicine, Gachon University College of Medicine, Gil Hospital, Incheon, Republic of Korea
| | - Wol Seon Jung
- Department of Anesthesiology and Pain Medicine, Gachon University College of Medicine, Gil Hospital, Incheon, Republic of Korea
| | - Jongchul Park
- Department of Anesthesiology and Pain Medicine, Gachon University College of Medicine, Gil Hospital, Incheon, Republic of Korea
| | - Hyun Jeong Kwak
- Department of Anesthesiology and Pain Medicine, Gachon University College of Medicine, Gil Hospital, Incheon, Republic of Korea
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Foley CE, Ryan E, Huang JQ. Less is more: clinical impact of decreasing pneumoperitoneum pressures during robotic surgery. J Robot Surg 2020; 15:299-307. [PMID: 32572753 DOI: 10.1007/s11701-020-01104-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/09/2020] [Indexed: 01/01/2023]
Abstract
The objective of this study was to investigate the effects of decreasing insufflation pressure during robotic gynecologic surgery. The primary outcomes were patient-reported postoperative pain scores and length of stay. Secondary outcomes include surgical time, blood loss, and intraoperative respiratory parameters. This is a retrospective cohort study of patients undergoing robotic surgery for benign gynecologic conditions by a single minimally invasive surgeon at an academic hospital between 2014 and 2017. Patients were categorized by the maximum insufflation pressure reached during the surgery as either 15, 12, 10, or 8 mmHg. Continuous variables were compared using analysis of variance and χ2 test was used for categorical variables. 598 patients were included in this study with no differences in age, BMI, race, prior abdominal surgeries, or specimen weight between the four cohorts. When comparing cohorts, each decrease in insufflation pressure correlated with a significant decrease in initial pain scores (5.9 vs 5.4 vs 4.4 vs. 3.8, p ≤ 0.001), and hospital length of stay (449 vs 467 vs 351 vs. 317 min, p ≤ 0.001). There were no differences in duration of surgery (p = 0.31) or blood loss (p = 0.09). Lower operating pressures were correlated with significantly lower peak inspiratory pressures (p < 0.001) and tidal volumes (p < 0.001). Surgery performed at lower-pressure pneumoperitoneum (≤ 10 mmHg) is associated with lower postoperative pain scores, shorter length of stay, and improved intraoperative respiratory parameters without increased duration of surgery or blood loss. Operating at lower insufflation pressures is a low-cost, reversible intervention that should be implemented during robotic surgery as it results in the improved pain scores and shorter hospital stays.
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Affiliation(s)
- Christine E Foley
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, USA. .,Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. .,Magee-Womens Hospital, 300 Halket Street, Suite 2300, Pittsburgh, PA, 15213, USA.
| | - Erika Ryan
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, USA
| | - Jian Qun Huang
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, USA
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24
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Jangra K, Bellapukonda S, Sabharwal P. Laparoscopic cholecystectomy in a patient with distal renal tubular acidosis associated with Sjogren's syndrome: An anesthetic challenge. J Anaesthesiol Clin Pharmacol 2020; 36:127-128. [PMID: 32174678 PMCID: PMC7047703 DOI: 10.4103/joacp.joacp_78_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 05/24/2019] [Indexed: 11/30/2022] Open
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25
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Jain A, Sinha R, Pandey S, Sahu V. Comparative Evaluation of Dexmedetomidine and Pregabalin as Premedication Agent to Attenuate Adverse Hemodynamic and Stress Response in Patients Undergoing Laparoscopic Cholecystectomy. Anesth Essays Res 2019; 13:608-614. [PMID: 32009703 PMCID: PMC6937902 DOI: 10.4103/aer.aer_115_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 07/25/2019] [Accepted: 10/23/2019] [Indexed: 11/26/2022] Open
Abstract
Background: Laparoscopic cholecystectomy is the most commonly performed laparoscopic procedure. The goal of anesthetic management is to minimize stress response and early discharge. Dexmedetomidine, and pregabalin have been used successfully to attenuate laryngoscopy and intubation response in various surgical procedures. Aim: To compare efficacy of pregablin and dexmedetomidine in attenuating hemodynamic and stress response. Setting and Design: A prospective, double blind randomized trial comprising 130 ASA physical status class I and II patients posted for laparsoscopic cholecystectomy. Materials and Methods: Patients were randomized in to Group A and Group B. Group A received intravenous dexmedetomidine in a dose of 1 ug.kg-1, through an infusion pump 20 min prior to induction of anaesthesia. Group B subjects received oral pregabalin 150 mg. Parameters observed were vitals, discharge time, cortisol level, side effects if any. Results: Post intervention heart rate got reduced significantly in Group A and it remained low in comparison to baseline during whole peri-operative period. In Group B, immediate post-pneumoperitoneum heart rate, and post exubation heart rate was higher than baseline. Blood pressure (BP) decreased significantly post intervention in Group A which persisted till pneumoperitoneum. In Group B there was statistically significant rise in systolic, diastolic and mean blood pressure postpneumoperitoneum as compared to baseline blood pressure. Post-operative cortisol level was significantly higher than baseline values and the level is more in Group B. Conclusion: Intravenous dexmedetomidine is more effective than oral pregabalin in attenuating perioperative stress response.
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Affiliation(s)
- Anshul Jain
- Department of Anaesthesiology, MLB Medical College, Jhansi, Uttar Pradesh, India
| | - Rajeev Sinha
- Department of Surgery, MLB Medical College, Jhansi, Uttar Pradesh, India
| | - Shivali Pandey
- Department of Anaesthesiology, MLB Medical College, Jhansi, Uttar Pradesh, India
| | - Vivek Sahu
- Department of Anaesthesiology, MLB Medical College, Jhansi, Uttar Pradesh, India
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26
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Kazakova T, Hammond B, Talarek C, Sinha AC, Brister NW. Anesthetic Management for Paraesophageal Hernia Repair. Thorac Surg Clin 2019; 29:447-455. [PMID: 31564402 DOI: 10.1016/j.thorsurg.2019.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Paraesophageal hernia repairs are complex surgical cases frequently performed on patients of advanced age with multiple comorbidities, both of which create difficulties in the anesthetic management. Preoperative evaluation is challenging because of overlapping cardiopulmonary symptoms. The patient's symptoms and anatomy lead to an increased aspiration risk and the potential need for a rapid sequence induction. Depending on the surgical approach, lung isolation may be required. Communication with the surgeon is vital throughout the case, especially when placing gastric tube and bougies. Multimodal analgesia should include regional and/or neuraxial techniques, in addition to the standard intravenous and oral pain medications.
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Affiliation(s)
- Tatiana Kazakova
- Department of Family Medicine, Jefferson Health NE, 10800 Knights Road, Philadelphia, PA 19114, USA
| | - Bradley Hammond
- Department of Anesthesiology, Temple University Hospital, 3401 North Broad Street, B300 Outpatient Building Floor, Philadelphia, PA 19140, USA
| | - Chad Talarek
- Department of Anesthesiology, Temple University Hospital, 3401 North Broad Street, B300 Outpatient Building Floor, Philadelphia, PA 19140, USA
| | - Ashish C Sinha
- Department of Anesthesiology, Temple University Hospital, 3401 North Broad Street, B300 Outpatient Building Floor, Philadelphia, PA 19140, USA
| | - Neil W Brister
- Department of Anesthesiology, Temple University Hospital, 3401 North Broad Street, B307 Outpatient Building Floor, Philadelphia, PA 19140, USA.
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27
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Singh S, Merchant AM. A Propensity Score-Matched Analysis of Laparoscopic versus Open Surgery in Patients with COPD. J INVEST SURG 2019; 34:70-79. [PMID: 30897984 DOI: 10.1080/08941939.2019.1581307] [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: 10/27/2022]
Abstract
Purpose: This study aims to compare outcomes of laparoscopic surgery to the outcomes of open surgery in patients with chronic obstructive pulmonary disease (COPD). Plethora of studies compares laparoscopic and open surgery in the general population; however, there is a paucity of existing literature examining the optimal surgical techniques in the COPD population. Materials and Methods: A propensity score-matched analysis using the 2012-2015 National Inpatient Sample (NIS) was conducted to match COPD patients undergoing the most common laparoscopic procedures to COPD patients undergoing the same procedures through an open approach. A multivariate logistic regression model was used to assess mortality and complications, and a multivariate linear regression model was used to compare the length of stay and total cost between open and laparoscopic surgery groups in COPD patients. Results: In general, open surgeries in COPD patients had worse outcomes than laparoscopic surgeries. Laparoscopic cholecystectomies were 45% less likely, colectomies were 58% less likely, and diagnostic procedures were 44% less likely to result in mortality than their open counterparts. All surgical cohorts except incisional hernia repairs had higher complication rates with an open approach. Aggregate complication rate reduction among procedures ranged between 29% and 65%. Total costs were higher in all open surgical cohorts except for appendectomies ($3,424-8,455). All open surgeries were associated with a longer length of stay, ranging from an extra day to 3 days, depending on surgery type. Conclusions: Laparoscopic surgery should not be considered a contraindication in patients with COPD. Careful consideration of surgical technique can have significant implications on patient outcomes and hospital costs in the COPD population.
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Affiliation(s)
- Supreet Singh
- Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Aziz M Merchant
- Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
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28
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Boddu V, Swaminathan S, Balachander H, Sivakumar RK. Evaluation of Neuromuscular Blockade with Vecuronium during General Anesthesia with Oxygen, Nitrous Oxide, Isoflurane versus Oxygen, Air, Isoflurane: A Randomized Controlled Study. Anesth Essays Res 2019; 13:44-49. [PMID: 31031479 PMCID: PMC6444955 DOI: 10.4103/aer.aer_2_19] [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] [Indexed: 11/04/2022] Open
Abstract
Background: The use of air oxygen mixture with isoflurane has become more common in the place of nitrous oxide, especially in laparoscopic and abdominal surgeries. With a varied mixture of gases and isoflurane used in general anesthesia, the exact dosing requirement and time duration of action have not been precisely studied with vecuronium when given as a bolus, as is given routinely. Purpose: This study was undertaken to evaluate and compare the neuromuscular effect of vecuronium during anesthesia with oxygen, nitrous oxide and isoflurane versus oxygen, air and isoflurane. Methodology: The study was a prospective, randomized controlled trial on 70 patients allocated into two groups as follows: Group N (nitrous oxide group) and Group A (medical air group). The primary objective was to measure and compare the posttetanic count (PTC1) – train of four (TOF1) interval, to evaluate the time taken for recovery from the intense blockade in both groups. The secondary objectives were to compare time duration for twitch height depression to be 30% of baseline after administering vecuronium, time duration from vecuronium administration to appearance of the first PTC1, PTC (n) at the reappearance of the 1st twitch, time interval between TOF1 and TOF3 and time from vecuronium administration to appearance of TOF3 in both the groups. Results: There is no significant difference between both the groups with reference to the block onset time using 30% depression of single twitch and recovery time from neuromuscular blockade using PTC, PTC1-TOF1 and TOF1-TOF3 time intervals. Conclusion: Measuring and comparing neuromuscular transmission monitoring parameters such as the onset time(ST depression to 30%), and recovery using PTC, PTC1-TOF1 and TOF1-TOF3 time intervals, it is concluded that the character of neuromuscular block with vecuronium is unaffected and not prolonged with or without nitrous oxide when used with isoflurane.
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Affiliation(s)
- Vishanth Boddu
- Department of Anaesthesiology and Critical Care, JIPMER, Puducherry, India
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29
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Srisawat N, Kongwibulwut M, Laoveeravat P, Lumplertgul N, Chatkaew P, Saeyub P, Latthaprecha K, Peerapornratana S, Tiranathanagul K, Eiam-Ong S, Tungsanga K. The role of intraoperative parameters on predicting laparoscopic abdominal surgery associated acute kidney injury. BMC Nephrol 2018; 19:289. [PMID: 30348111 PMCID: PMC6198484 DOI: 10.1186/s12882-018-1081-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 10/08/2018] [Indexed: 12/14/2022] Open
Abstract
Background Laparoscopic abdominal surgery has been widely used to reduce the length of hospital stay and complications from open abdominal surgery. During the operation, the creation of pneumoperitoneum is used for better visualization of the operating field. However, the effect of pneumoperitoneum on kidney function is unknown. We aimed to identify risk factors and predictors associated with AKI development following laparoscopic abdominal surgery. Methods A single-center prospective cohort study of laparoscopic abdominal surgery patients between June 2012 and December 2013. Acute kidney injury (AKI) was identified by Kidney Disease Improving Global Outcome (KDIGO) criteria. Urinary neutrophil gelatinase associated lipocalin (uNGAL) was measured on the first 3 days after surgery as a surrogate marker of AKI. Results Of the 64 patients, 23 (35%) developed postoperative AKI. The mean age, initial blood pressure, and initial glomerular filtration rate were not different between AKI and non-AKI groups. Inflation time and exposure index were significantly higher in the AKI group compared to non-AKI group (192.0 vs 151.1 min, p = 0.045, and 2325.9 vs 1866.1 mmHg-minutes, p = 0.035). Operation time, mean intra-abdominal pressure, duration of intraoperative hypotension, amount of blood loss and intravenous fluid were not different between groups. In multivariable analysis adjusted for age, diabetes, baseline estimated glomerular filtration rate, and type of operation (urological surgery), exposure index was significantly associated with postoperative AKI, with odds ratio (95% CI) 1.47 (1.05–2.04), p = 0.024. By combining the intraoperative parameters with clinical model the area under the receiver operating characteristic curve was 0.71 (95% CI 0.58–0.84). Conclusions AKI was a common condition in laparoscopic abdominal surgery. Exposure index has been proposed as a novel predictor of laparoscopic abdominal surgery associated AKI. Electronic supplementary material The online version of this article (10.1186/s12882-018-1081-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nattachai Srisawat
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Pathumwan, Bangkok, 10330, Thailand. .,Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand.
| | - Manasnun Kongwibulwut
- Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Passisd Laoveeravat
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Pathumwan, Bangkok, 10330, Thailand.,Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand
| | - Nuttha Lumplertgul
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Pathumwan, Bangkok, 10330, Thailand.,Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand
| | - Pornlert Chatkaew
- Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Pipat Saeyub
- Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Krittayot Latthaprecha
- Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sadudee Peerapornratana
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Pathumwan, Bangkok, 10330, Thailand.,Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand
| | - Khajohn Tiranathanagul
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Pathumwan, Bangkok, 10330, Thailand.,Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand
| | - Somchai Eiam-Ong
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Pathumwan, Bangkok, 10330, Thailand
| | - Kriang Tungsanga
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Pathumwan, Bangkok, 10330, Thailand
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30
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Sara JP, Kydes A, Pryjdun O, Jacoby M, McBride W, Pandya S, Barst S. Anesthesia for Pygopagus Conjoined Twins During Single-Twin and Simultaneous Pneumoperitoneum: A Case Report. A A Pract 2018; 11:71-72. [PMID: 29634556 DOI: 10.1213/xaa.0000000000000739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We present the case of the first stage of separation of 9-month-old pygopagus conjoined twins who demonstrated minimal shared vasculature on preoperative imaging and no cross-sedation or cross-neuromuscular blockade during separate inductions of anesthesia. Laparoscopy was implemented in 1 twin at a time, then in both twins simultaneously. Despite insufflation of a single-twin's abdomen, both twins demonstrated hypercapnia and signs of a concomitant respiratory acidosis because of carbon dioxide diffusion through a shared peritoneal membrane. This is the first documented case of simultaneous laparoscopy-induced pneumoperitoneum in pygopagus conjoined twins.
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Affiliation(s)
| | - Ashley Kydes
- From the Departments of Pediatric Anesthesiology
| | | | | | - Whitney McBride
- Pediatric General Surgery at Westchester Medical Center, New York Medical College, Valhalla, New York
| | - Samir Pandya
- Pediatric General Surgery at Westchester Medical Center, New York Medical College, Valhalla, New York
| | - Samuel Barst
- From the Departments of Pediatric Anesthesiology
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31
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Corcione A, Angelini P, Bencini L, Bertellini E, Borghi F, Buccelli C, Coletta G, Esposito C, Graziano V, Guarracino F, Marchi D, Misitano P, Mori AM, Paternoster M, Pennestrì V, Perrone V, Pugliese L, Romagnoli S, Scudeller L, Corcione F. Joint consensus on abdominal robotic surgery and anesthesia from a task force of the SIAARTI and SIC. Minerva Anestesiol 2018; 84:1189-1208. [PMID: 29648413 DOI: 10.23736/s0375-9393.18.12241-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Minimally invasive surgical procedures have revolutionized the world of surgery in the past decades. While laparoscopy, the first minimally invasive surgical technique to be developed, is widely used and has been addressed by several guidelines and recommendations, the implementation of robotic-assisted surgery is still hindered by the lack of consensus documents that support healthcare professionals in the management of this novel surgical procedure. Here we summarize the available evidence and provide expert opinion aimed at improving the implementation and resolution of issues derived from robotic abdominal surgery procedures. A joint task force of Italian surgeons, anesthesiologists and clinical epidemiologists reviewed the available evidence on robotic abdominal surgery. Recommendations were graded according to the strength of evidence. Statements and recommendations are provided for general issues regarding robotic abdominal surgery, operating theatre organization, preoperative patient assessment and preparation, intraoperative management, and postoperative procedures and discharge. The consensus document provides evidence-based recommendations and expert statements aimed at improving the implementation and management of robotic abdominal surgery.
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Affiliation(s)
- Antonio Corcione
- Department of Critical Care Area, A.O. Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Pierluigi Angelini
- Department of General, Laparoscopic and Robotic Surgery, A.O. Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Lapo Bencini
- Division of Surgical Oncology and Robotics, Department of Oncology, Careggi University Hospital, Florence, Italy
| | - Elisabetta Bertellini
- Department of Anesthesia and Intensive Care, New Civile S. Agostino-Estense, Policlinico Hospital, Modena, Italy
| | - Felice Borghi
- Division of General and Surgical Oncology, Department of Surgery, S. Croce e Carle Hospital, Cuneo, Italy
| | - Claudio Buccelli
- Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Giuseppe Coletta
- Division of Operating Room Management, Department of Emergency and Critical Care, S. Croce e Carle Hospital, Cuneo, Italy
| | - Clelia Esposito
- Department of Critical Care Area, A.O. Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Vincenzo Graziano
- Department of Anesthesia and Critical Care Medicine, Cardiothoracic Anesthesia and Intensive Care, Pisa University Hospital, Pisa, Italy
| | - Fabio Guarracino
- Department of Anesthesia and Critical Care Medicine, Cardiothoracic Anesthesia and Intensive Care, Pisa University Hospital, Pisa, Italy
| | - Domenico Marchi
- Department of General Surgery, New Civile S. Agostino-Estense, Policlinico Hospital, Modena, Italy
| | - Pasquale Misitano
- Unit of General and Mini-Invasive Surgery, Department of General Surgery, Misericordia Hospital, Grosseto, Italy
| | - Anna M Mori
- Department of Anesthesiology and Reanimation, IRCCS Policlinic San Matteo Foundation, Pavia, Italy
| | - Mariano Paternoster
- Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Vincenzo Pennestrì
- Department of Anesthesia and Intensive Care Medicine, Misericordia Hospital, Grosseto, Italy
| | - Vittorio Perrone
- Department of General and Transplant Surgery, Pisa University Hospital, Pisa, Italy
| | - Luigi Pugliese
- Unit of General Surgery 2, IRCCS Policlinic San Matteo, Foundation, Pavia, Italy
| | - Stefano Romagnoli
- Department of Anesthesia and Critical Care, Careggi University Hospital, Florence, Italy
| | - Luigia Scudeller
- Unit of Clinical Epidemiology, Scientific Direction, IRCCS Policlinic San Matteo Foundation, Pavia, Italy -
| | - Francesco Corcione
- Department of General, Laparoscopic and Robotic Surgery, A.O. Ospedali dei Colli, Monaldi Hospital, Naples, Italy
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32
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Akyol I. Re: Global minimally invasive pyeloplasty study in children: Results from the pediatric urology expert group of the European association of urology young academic urologists working party. J Pediatr Urol 2018; 14:205. [PMID: 29559275 DOI: 10.1016/j.jpurol.2017.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 11/02/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Ilker Akyol
- Nisa Hospital, Department of Urology, Istanbul, Turkey.
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33
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Lin W, Lin JH, Chiu KH, Ho DR, Huang YC, Huang KT, Chen CS. Performing laparoscopic radical cystectomy is feasible for the elderly with marginal cardiopulmonary function. UROLOGICAL SCIENCE 2018. [DOI: 10.4103/uros.uros_9_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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34
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Jo YY, Kwak HJ. What is the proper ventilation strategy during laparoscopic surgery? Korean J Anesthesiol 2017; 70:596-600. [PMID: 29225741 PMCID: PMC5716816 DOI: 10.4097/kjae.2017.70.6.596] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 07/14/2017] [Accepted: 07/14/2017] [Indexed: 11/26/2022] Open
Abstract
The main stream of intraabdominal surgery has changed from laparotomy to laparoscopy, but anesthetic care for laparoscopic surgery is challenging for clinicians, because pneumoperitoneum might aggravate respiratory mechanics and arterial oxygenation. The authors reviewed the literature regarding ventilation strategies that reduce deleterious pulmonary physiologic changes during pneumoperitoneum for laparoscopic surgery under general anesthesia and make appropriate recommendations.
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Affiliation(s)
- Youn Yi Jo
- Department of Anesthesiology and Pain Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Hyun-Jeong Kwak
- Department of Anesthesiology and Pain Medicine, Gachon University Gil Medical Center, Incheon, Korea
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35
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Pelizzo G, Carlini V, Iacob G, Pasqua N, Maggio G, Brunero M, Mencherini S, De Silvestri A, Calcaterra V. Pediatric Laparoscopy and Adaptive Oxygenation and Hemodynamic Changes. Pediatr Rep 2017; 9:7214. [PMID: 28706621 PMCID: PMC5494445 DOI: 10.4081/pr.2017.7214] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 06/02/2017] [Accepted: 06/03/2017] [Indexed: 11/23/2022] Open
Abstract
Adaptive changes in oxygenation and hemodynamics are evaluated during pediatric laparoscopy. The children underwent laparoscopy (LAP Group, n=20) or open surgery (Open Group, n=10). Regional cerebral (rScO2) and peripheral oxygen saturation (SpO2), heart rate (HR), diastolic (DP) and systolic pressure (SP) were monitored at different intervals: basal (T0); anesthesia induction (T1); CO2PP insufflation (T2); surgery (T3); CO2PP cessation (T4); before extubation (T5). At T1, in both the LAP and Open groups significant changes in rScO2, DP and SP were recorded compared with T0; a decrease in SatO2 was also observed at T5. In the LAP group, at T2, changes in HR related to CO2PP pressure and in DP and SP related to IAP were noted; at T4, a SP change associated with CO2PP desufflation was recorded. Open group, at T3 and T5 showed lower rScO2 values compared with T1. Pneuperitoneum and anesthesia are influent to induce hemodynamics changes during laparoscopy.
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Affiliation(s)
- Gloria Pelizzo
- Pediatric Surgery Unit, Children's Hospital, Istituto Mediterraneo di Eccellenza Pediatrica, Palermo
| | - Veronica Carlini
- Pediatric Surgery Unit, Fondazione IRCCS Policlinico San Matteo Pavia, Pavia
| | - Giulio Iacob
- Pediatric Surgery Unit, Fondazione IRCCS Policlinico San Matteo Pavia, Pavia
| | - Noemi Pasqua
- Pediatric Surgery Unit, Fondazione IRCCS Policlinico San Matteo Pavia, Pavia
| | - Giuseppe Maggio
- Anesthesiology and Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Marco Brunero
- Pediatric Surgery Unit, Fondazione IRCCS Policlinico San Matteo Pavia, Pavia
| | - Simonetta Mencherini
- Anesthesiology and Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Annalisa De Silvestri
- Biometry and Clinical Epidemiology, Scientific Direction, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Valeria Calcaterra
- Pediatric Unit, Department of Maternal and Child Health Fondazione IRCCS Policlinico San Matteo Pavia, Italy.,Department of Internal Medicine an Therapeutics, University of Pavia, Italy
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36
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Balachandran B, Hufford TA, Mustafa T, Kochar K, Sulo S, Khorsand J. A Comparative Study of Outcomes Between Single-Site Robotic and Multi-port Laparoscopic Cholecystectomy: An Experience from a Tertiary Care Center. World J Surg 2017; 41:1246-1253. [PMID: 28058471 DOI: 10.1007/s00268-016-3799-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND The aim of this study was to compare the outcomes of single-site robotic cholecystectomy with multi-port laparoscopic cholecystectomy within a high-volume tertiary health care center. METHODS A retrospective analysis of prospectively maintained data was conducted on patients undergoing single-site robotic cholecystectomy or multi-port laparoscopic cholecystectomy between October 2011 and July 2014. A single surgeon performed all the surgeries included in the study. RESULTS A total of 678 cholecystectomies were performed. Of these, 415 (61%) were single-site robotic cholecystectomies and 263 (39%) were multi-port laparoscopic cholecystectomies. Laparoscopic patients had a greater mean BMI (30.5 vs. 29.0 kg/m2; p = 0.008), were more likely to have undergone prior abdominal surgery (83.3 vs. 41.4%; p < 0.001) and had a higher incidence of preexisting comorbidities (76.1 vs. 67.2%; p = 0.014) as compared to the robotic group. There was no statistical difference in the total operative time, rate of conversion to open procedure and mean length of follow-up between the two groups. The mean length of hospital stay was shorter for patients within the robotic group (1.9 vs. 2.4 days; p = 0.012). Single-site robotic cholecystectomy was associated with a higher rate of wound infection (3.9 vs. 1.1%; p = 0.037) and incisional hernia (6.5 vs. 1.9%; p = 0.006). CONCLUSION Multi-port laparoscopic cholecystectomy should remain the gold standard therapy for gallbladder disease. Single-site robotic cholecystectomy is an effective alternative procedure for uncomplicated benign gallbladder disease in properly selected patients. This must be carefully balanced against a high rate of surgical site infection and incisional hernia, and patients should be informed of these risks.
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Affiliation(s)
- Banujan Balachandran
- Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, IL, USA
| | - Theadore A Hufford
- University of Illinois Metropolitan Group General Surgery Residency, Advocate Lutheran General Hospital, Park Ridge, IL, USA
| | - Taha Mustafa
- Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, IL, USA
| | - Kunal Kochar
- Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, IL, USA
| | - Suela Sulo
- Russell Institute for Research and Innovation, Advocate Lutheran General Hospital, Park Ridge, IL, USA
| | - Joubin Khorsand
- Division of General Surgery, Advocate Lutheran General Hospital, 1775 Dempster Street, Park Ridge, IL, USA.
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37
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Lin JH, Chiu KH, Ho DR, Huang YC, Huang KT, Chen CS, Lin WY. Laparoscopic radical cystectomy is feasible for the elderly with marginal cardiopulmonary function. UROLOGICAL SCIENCE 2017. [DOI: 10.1016/j.urols.2017.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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38
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Xu R, Zhou S, Yang J, Li H, Zhang Q, Zhang G, Xu S, Peng Q. Total intravenous anesthesia produces outcomes superior to those with combined intravenous-inhalation anesthesia for laparoscopic gynecological surgery at high altitude. J Int Med Res 2017; 45:246-253. [PMID: 28222645 PMCID: PMC5536599 DOI: 10.1177/0300060516687230] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 12/11/2016] [Indexed: 02/05/2023] Open
Abstract
Objective We compared efficacy and adverse outcomes following totally intravenous anesthesia (TIVA) versus combined intravenous-inhalation anesthesia (CIVIA) on hemodynamics and postoperative recovery following laparoscopic gynecological (LG) surgery at high altitudes. Methods We enrolled 80 ASA I or II patients scheduled for LG surgery and randomly assigned them to TIVA with propofol (group P, n = 40) or CIVIA with isoflurane (group I, n = 40). Mean arterial pressure, heart rate, pulse oxygen saturation, and partial pressure of end-tidal carbon dioxide were measured at various time points. Outcome measures were interval to spontaneous ventilation, eye opening, return to consciousness, extubation, operating room duration. Intraoperative awareness and postoperative nausea/vomiting were assessed at follow-up. Results No differences in hemodynamic parameters were detected in either group. Group P had a significantly shorter postoperative anesthetic recovery time and lower incidence of postoperative nausea/vomiting. Conclusion TIVA is superior to CIVIA for GL surgery at high altitudes.
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Affiliation(s)
- Rui Xu
- Department of Anesthesiology, Zhujiang Hospital, Southern medical University, Guangzhou, Guangdong, China
| | - Shuqin Zhou
- Department of Anesthesiology, Zhujiang Hospital, Southern medical University, Guangzhou, Guangdong, China
- Department of Anesthesiology, the First People’s Hospital of Kashi, Kashi, Xinjiang, China
| | - Jin Yang
- Departement of Anesthesiology, People’s Hospital of Linzhi Area, Tibet, China
| | - Haiyan Li
- Department of Hepatobiliary Surgery II, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Qingguo Zhang
- Department of Anesthesiology, Zhujiang Hospital, Southern medical University, Guangzhou, Guangdong, China
| | - Guohong Zhang
- Department of Pathology, Shantou University Medical College, Shantou, Guangdong, China
| | - Shiyuan Xu
- Department of Anesthesiology, Zhujiang Hospital, Southern medical University, Guangzhou, Guangdong, China
- Shiyuan Xu and Qing Peng, Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510282, China; Department of Hepatobiliary Surgery II, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong 510282, China. Emails: ;
| | - Qing Peng
- Department of Hepatobiliary Surgery II, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
- Shiyuan Xu and Qing Peng, Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510282, China; Department of Hepatobiliary Surgery II, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong 510282, China. Emails: ;
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40
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Liu YX, Zhang Y, Huang JF, Wang L. Meta-analysis comparing the safety of laparoscopic and open surgical approaches for suspected adnexal mass during the second trimester. Int J Gynaecol Obstet 2016; 136:272-279. [PMID: 28099685 DOI: 10.1002/ijgo.12069] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 10/15/2016] [Accepted: 11/23/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND The safety of laparoscopic surgery during the second trimester of pregnancy remains a controversial subject. OBJECTIVES To compare the safety of laparoscopic surgery and laparotomy for suspected adnexal mass during the second trimester. SEARCH STRATEGY Articles published in any language prior to April 31, 2016, were retrieved from PubMed, Scopus, EMBSCO, and the Cochrane Library using keywords including pregnant, adnexal mass, laparoscopy, laparotomy, pregnancy outcomes, and surgical outcomes. SELECTION CRITERIA Randomized and non-randomized controlled trials reporting at least one obstetric or surgical outcome were included if they compared laparoscopic surgery and laparotomy for adnexal masses during the second trimester. DATA COLLECTION AND ANALYSIS Data were independently extracted by two reviewers. Homogeneous data were pooled using a fixed effects model and heterogeneous data were qualitatively analyzed. MAIN RESULTS Four comparative effectiveness studies including a total of 240 patients were identified. Laparoscopic surgery was associated with a reduced risk of post-operative adverse events (relative risk 0.20, 95% confidence interval 0.06-0.72); no difference was recorded in the risk of post-operative spontaneous abortion (P=0.26) or threatened spontaneous abortion (P=0.13). CONCLUSIONS Laparoscopic surgery could be preferable to laparotomy for suspected adnexal mass during the second trimester of pregnancy.
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Affiliation(s)
- Yi-Xuan Liu
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Yang Zhang
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Department of Obstetrics and Gynecology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jin-Feng Huang
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Li Wang
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Department of Obstetrics and Gynecology, Shanghai Medical College, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China
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41
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Whealon MD, Moghadamyeghaneh Z, Carmichael JC. Robotic ventral rectopexy. SEMINARS IN COLON AND RECTAL SURGERY 2016. [DOI: 10.1053/j.scrs.2016.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Current status of the implantable LVAD. Gen Thorac Cardiovasc Surg 2016; 64:501-8. [PMID: 27270581 DOI: 10.1007/s11748-016-0671-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 05/29/2016] [Indexed: 10/21/2022]
Abstract
With the ongoing shortage of available organs for heart transplantation, mechanical circulatory support devices have been increasingly utilized for managing acute and chronic heart failure that is refractory to medical therapy. In particular, the introduction of the left ventricular assist devices (LVAD) has revolutionized the field. In this review, we will discuss a brief history of the LVAD, available devices, current indications, patient selection, complications, and outcomes. In addition, we will discuss recent outcomes and advancements in the field of noncardiac surgery in the LVAD patient. Finally, we will discuss several topics for surgical consideration during LVAD implantation.
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Ishii T, Igarashi T, Naya Y, Aoe T, Isono S. Physiological and Biochemical Responses to Continuous Saline Irrigation Inside the Abdominal Cavity in Anesthetized Pigs. J Laparoendosc Adv Surg Tech A 2016; 26:600-5. [PMID: 27195464 DOI: 10.1089/lap.2015.0463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Water-filled laparoendoscopic surgery (WaFLES) has been proposed as a novel surgical system achieving a wide surgical field in the intra- and extraperitoneal space with continuous irrigation of isotonic fluid into the field. Despite its technical feasibility and advantages, the safety of the technique, particularly with respect to physiological functions, has not been evaluated. METHODS Various types of minor abdominal surgeries were performed under general anesthesia in nine adult pigs either by conventional laparoscopy (n = 3) or WaFLES (n = 6). In addition to esophageal temperature and body weight, cardiorespiratory variables such as blood pressure, heart rate, and arterial blood gas parameters were compared before and after the surgeries. Blood samples were obtained for assessing changes in biochemical parameters before and after the surgeries. RESULTS Three to seven hours of various surgeries were completed without critical cardiorespiratory events in all animals. Oxygenation and ventilation were maintained regardless of the techniques used for the surgeries. A minor increase of body weight (2.5% of initial body weight), metabolic acidosis, hyperkalemia, and impaired hepatic function were observed after WaFLES surgeries. CONCLUSIONS The preliminary study indicated no serious immediate adverse effects of the WaFLES technique.
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Affiliation(s)
- Takuro Ishii
- 1 Center for Frontier Medical Engineering, Chiba University , Chiba, Japan
| | - Tatsuo Igarashi
- 1 Center for Frontier Medical Engineering, Chiba University , Chiba, Japan
| | - Yukio Naya
- 2 Department of Urology, Teikyo University Chiba Medical Center , Ichihara, Japan
| | - Tomohiko Aoe
- 3 Department of Anesthesiology, Teikyo University Chiba Medical Center , Ichihara, Japan
| | - Shiroh Isono
- 4 Department of Anesthesiology, Graduate School of Medicine, Chiba University , Chiba, Japan
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Coronil ÁB, Sanchez-Cañete AM, Bartakke AA, Fernández JG, García AIP. Life-threatening subcutaneous emphysema due to laparoscopy. Indian J Anaesth 2016; 60:286-8. [PMID: 27141115 PMCID: PMC4840812 DOI: 10.4103/0019-5049.179469] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ángel Blanco Coronil
- Department of Anaesthesiology and Intensive Care, Hospital Puerta de Hierro Majadahonda, Madrid, Spain
| | | | - Ashish A Bartakke
- Department of Anaesthesiology and Perioperative Medicine, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Javier Garcia Fernández
- Department of Anaesthesiology and Intensive Care, Hospital Puerta de Hierro Majadahonda, Madrid, Spain
| | - Ana Isabel Peral García
- Department of Anaesthesiology and Intensive Care, Hospital Puerta de Hierro Majadahonda, Madrid, Spain
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Balkin DM, Duh QY, Kind GM, Chang DS, McGrath MH. Failed pneumoperitoneum for laparoscopic surgery following autologous Deep Inferior Epigastric Perforator (DIEP) flap breast reconstruction: a case report. BMC Surg 2016; 16:28. [PMID: 27120999 PMCID: PMC4848842 DOI: 10.1186/s12893-016-0143-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 04/20/2016] [Indexed: 11/22/2022] Open
Abstract
Background Laparoscopic abdominal surgery may prove difficult in patients who have undergone previous abdominal procedures. No reports in the medical literature have presented an aborted laparoscopic procedure for failed pneumoperitoneum following autologous flap-based breast reconstruction. Case presentation A 55-year-old woman presented with recurrent invasive lobular carcinoma of the right breast as well as a history of ductal carcinoma in situ of the left breast. The patient desired to proceed with bilateral skin- and nipple-sparing mastectomies with right axillary lymph node biopsy, followed by immediate bilateral autologous deep inferior epigastric perforator (DIEP) flap-based breast reconstruction. Preoperatively, a computerized tomography angiogram was obtained for reconstructive preparation, which revealed a left adrenal mass. Ensuing work-up diagnosed a pheochromocytoma. Given the concern for breast cancer progression, the patient elected to proceed first with breast cancer surgery and reconstruction prior to addressing the adrenal tumor. Subsequently, 3 months later the patient was brought to the operating room for a laparoscopic left adrenalectomy for the pheochromocytoma. With complete pharmacologic abdominal relaxation, the abdomen proved too tight to accommodate sufficient pneumoperitoneum and the laparoscopy was aborted. The patient was evaluated in the outpatient setting for assessment of abdominal wall compliance at regular intervals. Five months later, the patient was taken back to the operating room where pneumoperitoneum was established without difficulty and the laparoscopic left adrenalectomy was performed without complications. Conclusion Pneumoperitoneum for laparoscopic surgery subsequent to autologous DIEP flap-based breast reconstruction may prove difficult as a result of loss of abdominal wall compliance. Prior to performing laparoscopy in such patients, surgeons should consider the details of the patient’s previous reconstructive procedure and assess potential risk factors for difficulty with insufflation. Lastly, careful abdominal examination should be performed to indicate whether laparoscopy for elective procedures should be delayed until abdominal wall compliance normalizes.
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Affiliation(s)
- Daniel M Balkin
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Quan-Yang Duh
- Department of Surgery, Section of Endocrine Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Gabriel M Kind
- Department of Plastic Surgery, California-Pacific Medical Center, San Francisco, CA, USA
| | - David S Chang
- Department of Plastic Surgery, California-Pacific Medical Center, San Francisco, CA, USA
| | - Mary H McGrath
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California San Francisco, San Francisco, CA, USA.
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The Effect of Warm Water Intake on Bowel Movements in the Early Postoperative Stage of Patients Having Undergone Laparoscopic Cholecystectomy. Gastroenterol Nurs 2016; 39:340-7. [DOI: 10.1097/sga.0000000000000181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Leong WQ, Ganpathi IS, Kow AWC, Madhavan K, Chang SKY. Comparative study and systematic review of laparoscopic liver resection for hepatocellular carcinoma. World J Hepatol 2015; 7:2765-2773. [PMID: 26644820 PMCID: PMC4663396 DOI: 10.4254/wjh.v7.i27.2765] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 08/25/2015] [Accepted: 10/27/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare the surgical outcomes between laparoscopic liver resection (LLR) and open liver resection (OLR) as a curative treatment in patients with hepatocellular carcinoma (HCC).
METHODS: A PubMed database search was performed systematically to identify comparative studies of LLR vs OLR for HCC from 2000 to 2014. An extensive text word search was conducted, using combinations of search headings such as “laparoscopy”, “hepatectomy”, and “hepatocellular carcinoma”. A comparative study was also performed in our institution where we analysed surgical outcomes of 152 patients who underwent liver resection between January 2005 to December 2012, of which 42 underwent laparoscopic or hand-assisted laparoscopic resection and 110 underwent open resection.
RESULTS: Analysis of our own series and a review of 17 high-quality studies showed that LLR was superior to OLR in terms of short-term outcomes, as patients in the laparoscopic arm were found to have less intraoperative blood loss, less blood transfusions, and a shorter length of hospital stay. In our own series, both LLR and OLR groups were found to have similar overall survival (OS) rates, but disease-free survival (DFS) rates were higher in the laparoscopic arm.
CONCLUSION: LLR is associated with better short-term outcomes compared to OLR as a curative treatment for HCC. Long-term oncologic outcomes with regards to OS and DFS rates were found to be comparable in both groups. LLR is hence a safe and viable option for curative resection of HCC.
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Al-Shather H, El-Boghdadly K, Pawa A. Awake laparoscopic sleeve gastrectomy under paravertebral and superficial cervical plexus blockade. Anaesthesia 2015; 70:1210-1. [DOI: 10.1111/anae.13220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - A. Pawa
- Guy's & St Thomas' NHS Foundation Trust; London UK
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Apollos JR, Lawrence M, Guest RV. A dual-valve system to minimize loss of pneumoperitoneum in laparoscopic surgery. JSLS 2015; 19:JSLS.2015.00020. [PMID: 26005321 PMCID: PMC4432722 DOI: 10.4293/jsls.2015.00020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Loss of visualization of the surgical field due to pneumoperitoneum deflation when CO2 insufflator cylinders become empty can occur at key moments during laparoscopic surgery. The purpose of this study was to examine the incidence of intraoperative cylinder exhaustion in the United Kingdom, determine its impact on patient safety, and design and test a novel device to minimize the phenomenon. METHODS We performed a national cross-sectional survey of U.K. surgeons, inviting all members of the Association of Surgeons of Great Britain and Ireland (ASGBI) and the Association of Upper GI Surgeons (AUGIS) to participate. We designed and tested a novel dual-valve system to allow rapid intraoperative exchange of CO2 cylinders. RESULTS Eighty-five percent of the U.K. surgeons surveyed reported loss of surgical visualization at critical times during laparoscopic surgery, caused by the decrease in pneumoperitoneum during CO2 cylinder exchange. Eighty-four percent said that the process contributed to the surgeon's stress, and 63% said that a device that maintains uninterrupted pneumoperitoneum would reduce the risk of intraoperative complications. In our locale, a timed cylinder exchange was, on average, 30 times quicker with the novel dual valve than by conventional cylinder exchange (mean conventional exchange time, 61.3 ± 7.3 s vs. novel device, 2.0 ± 0.2 s; P ≤ .0001) and could be performed just as rapidly by staff unfamiliar with the device (2.2 ± 0.3 s vs. 1.9 ± 0.4 s P = .1945). We suggest that this simple, low-cost system could be developed for use in a clinical setting to enhance patient safety.
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Affiliation(s)
| | - Matthew Lawrence
- Anaesthesia, Dumfries & Galloway Royal Infirmary, National Health Service (NHS) Dumfries & Galloway, Dumfries, United Kingdom
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Shnaiderman-Torban A, Epstein A, Kelmer G. Thoracotomy for repair of a large dorsal diaphragmatic hernia in an 18-year-old mare. EQUINE VET EDUC 2015. [DOI: 10.1111/eve.12367] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A. Shnaiderman-Torban
- Large Animal Department; Veterinary Medicine Teaching Hospital; Koret School of Veterinary Medicine; the Robert H. Smith Faculty of Agriculture; the Hebrew University of Jerusalem; Rehovot Israel
| | - A. Epstein
- Large Animal Department; Veterinary Medicine Teaching Hospital; Koret School of Veterinary Medicine; the Robert H. Smith Faculty of Agriculture; the Hebrew University of Jerusalem; Rehovot Israel
| | - G. Kelmer
- Large Animal Department; Veterinary Medicine Teaching Hospital; Koret School of Veterinary Medicine; the Robert H. Smith Faculty of Agriculture; the Hebrew University of Jerusalem; Rehovot Israel
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