Factors Affecting Conversion From Laparoscopic Cholecystectomy to Open Cholecystectomy at a Tertiary Care Facility in Saudi Arabia: A Cross-Sectional Study

Background:

Despite the growing importance and increased use of laparoscopy for gallbladder diseases in Saudi Arabia, several factors reportedly result in conversion to open surgery. This leads to increased operative time and increased hospital resource utilization, and, importantly, it impacts patient welfare. Although laparoscopic cholecystectomy and its conversion rates have been investigated in Saudi Arabia, there is little information on the factors associated with this conversion. Therefore, we analyzed the prevalence and factors associated with the conversion from laparoscopic to open cholecystectomy.

Materials and methods:

This was a quantitative, retrospective, observational, cross-sectional study. We reviewed the health care records of all patients who underwent laparoscopic cholecystectomy during the study period (January 2014–December 2015). We analyzed patient demographics, preoperative factors, ultrasound findings, and intraoperative factors associated with higher conversion rates. We calculated means, SDs, and medians for numerical variables and percentages and frequencies for nominal variables. The χ2 and two-tailed t tests were used to compare the categorical and continuous variables, respectively, between patients who underwent laparoscopic cholecystectomy and those who underwent conversion to open cholecystectomy to analyze their relationship with the possibility of conversion. Statistical significance was considered at P < 0.05.

Results:

Age > 40 years, diabetes, history of admission for gallstones, and increased total bilirubin, direct bilirubin, and alkaline phosphatase levels were the preoperative factors and adhesions, bleeding, and stone spillage were the intraoperative factors associated with conversion.

Conclusion:

Recognizing the factors for conversion would improve treatment planning and help predict when conversion may be necessary.

DESIGN, FABRICATION, AND TEST OF A NOVEL CLAMPER FOR AORTIC CROSS-CLAMPING IN MINIMALLY INVASIVE CARDIAC SURGERY

One of the main procedures in the most minimally invasive cardiothoracic surgery is clamping the ascending aorta to disconnect the heart from circulation. In this paper, a new aortic clamping instrument which is applicable in minimally invasive cardiac surgery has been presented. The instrument consists of a parallelogram mechanism for opening and closing the jaws, a detachable holder with a two degree of freedom joint that makes the precise position and orientation of the jaws and leaves the clamping component in the patient’s body to make the inserting port free, and a handle for easy manipulation. In vitro test has been performed to evaluate the performance of the clamper compared to the conventional clampers. For this purpose, the force required for aortic cross-clamping and the maximum aortic displacement have been studied in four groups including parallel clamper and conventional clamper with angles of 1[Formula: see text], 2[Formula: see text], and 3[Formula: see text] between jaws, with 10 bovine aorta specimens in each group. These experiments show that the amount of required force for cross-clamping by using the parallel clamper, is statistically significant ([Formula: see text]) compared with the conventional clampers. Also, the increase of angle between jaws makes a significant increase in the percentage of aortic displacement.

Analysis of the structural behaviour of colonic segments by inflation tests: Experimental activity and physio-mechanical model

A coupled experimental and computational approach is provided for the identification of the structural behaviour of gastrointestinal regions, accounting for both elastic and visco-elastic properties. The developed procedure is applied to characterize the mechanics of gastrointestinal samples from pig colons. Experimental data about the structural behaviour of colonic segments are provided by inflation tests. Different inflation processes are performed according to progressively increasing top pressure conditions. Each inflation test consists of an air in-flow, according to an almost constant increasing pressure rate, such as 3.5 mmHg/s, up to a prescribed top pressure, which is held constant for about 300 s to allow the development of creep phenomena. Different tests are interspersed by 600 s of rest to allow the recovery of the tissues' mechanical condition. Data from structural tests are post-processed by a physio-mechanical model in order to identify the mechanical parameters that interpret both the non-linear elastic behaviour of the sample, as the instantaneous pressure-stretch trend, and the time-dependent response, as the stretch increase during the creep processes. The parameters are identified by minimizing the discrepancy between experimental and model results. Different sets of parameters are evaluated for different specimens from different pigs. A statistical analysis is performed to evaluate the distribution of the parameters and to assess the reliability of the experimental and computational activities.

Characteristics of locomotion efficiency of an expanding–extending robotic endoscope in the intestinal environment

Robotic endoscopes with locomotion ability are among the most promising alternatives to traditional endoscopes; the locomotion ability is an important factor when evaluating the performance of the robot. This article describes the research on the characteristics of an expanding–extending robotic endoscope’s locomotion efficiency in real intestine and explores an approach to improve the locomotion ability in this environment. In the article, the robot’s locomotion efficiency was first calculated according to its gait in the gut, and the reasons for step losses were analyzed. Next, dynamical models of the robot and the intestine were built to calculate the step losses caused by failed anchoring and intestinal compression/extension. Based on the models and the calculation results, methods for reducing step losses were proposed. Finally, a series of ex vivo experiments were carried out, and the actual locomotion efficiency of the robot was analyzed on the basis of the theoretical models. In the experiment, on a level platform, the locomotion efficiency of the robot varied between 34.2% and 63.7%; the speed of the robot varied between 0.62 and 1.29 mm/s. The robot’s efficiency when climbing a sloping intestine was also tested and analyzed. The proposed theoretical models and experimental results provide a good reference for improving the design of robotic endoscopy.

Scorpion sting prevention and treatment in ancient Iran

Due to the medical and therapeutic importance of scorpions in Iranian traditional medicine, this review was conducted on the treatment of scorpion sting as performed by traditional healers in order to realize complications, clinical manifestations, diversities, and deficiencies in the prevention, control, and treatment as mentioned in the pertained literatures. This study tried to make known and investigate attitudes of the Iranian national and traditional medicine towards controlling these venomous animals. Keywords and articles were searched through relevant sites on the Internet. We investigated different journals and references for the Iranian traditional medicine. Based on the articles and books found, we tried to find suitable solutions to problems from the viewpoint of traditional medicine. Scorpion sting dates back to ancient Iran and has been widely reflected in the resources of Iranian traditional medicine. The traditional medicine offers various guidelines that can be beneficial in this respect. New attitude towards scorpion sting with regard to traditional medicine resources can enhance control and prevention of scorpion stings. Consequently, this attitude leads authorities and researchers to a decreased level of scorpion stings or related consequences.

A novel haemostatic powder delivery device applicable in minimally invasive surgery

Haemostatic powder is an effective solution commonly used in various open surgeries. However, there is no specific intra-abdominal delivery device for application of haemostatic powder at the bleeding site during minimally invasive surgery (MIS). In this study, design, construction and test of a novel powder delivery device were carried out. The device uses pressurized gas to deliver the haemostatic powder to the bleeding point. The effect of the gas pressure and the spraying distance on the geometry of the powder dispersion surface area was investigated and found to be significant. The findings indicate that the driving gas pressure range of 60-80 mmHg and the spraying distance range of 2-5 cm achieve the most concentrated powder dispersion surface area. Additionally, in vivo experiments confirmed the effectiveness of the device in live tissue.

Constitutive formulations for the mechanical investigation of colonic tissues

A constitutive framework is provided for the characterization of the mechanical behavior of colonic tissues, as a fundamental tool for the development of numerical models of the colonic structures. The constitutive analysis is performed by a multidisciplinary approach that requires the cooperation between experimental and computational competences. The preliminary investigation pertains to the review of the tissues histology. The complex structural configuration of the tissues and the specific distributions of fibrous elements entail the nonlinear mechanical behavior and the anisotropic response. The identification of the mechanical properties requires to perform mechanical tests according to different loading situations, as different loading directions. Because of the typical functionality of colon structures, the tissues mechanics is investigated by tensile tests, which are performed on taenia coli and haustra specimens from fresh pig colons. Accounting for the histological investigation and the results from the mechanical tests, a specific hyperelastic framework is provided within the theory of fiber-reinforced composite materials. Preliminary analytical formulations are defined to identify the constitutive parameters by the inverse analysis of the experimental tests. Finite element models of the specimens are developed accounting for the actual configuration of the colon structures to verify the quality of the results. The good agreement between experimental and numerical model results suggests the reliability of the constitutive formulations and parameters. Finally, the developed constitutive analysis makes it possible to identify the mechanical behavior and properties of the different colonic tissues.