Laparoscopic urogynaecology

2020 ◽  
pp. 155-164
Author(s):  
Helen Jefferis ◽  
Natalia Price
Keyword(s):  
Laparoscopic Surgery ◽  
Patient Selection ◽  
Selection Methods ◽  
Advantages And Disadvantages ◽  
Laparoscopic Procedures

Laparoscopic surgery is well-established in the management of benign gynaecological conditions, and is increasing in use in urogynaecology. This chapter provides an overview of the advantages and disadvantages to laparoscopic surgery for both the surgeon and the patient, and then outlines key considerations in patient selection. Methods of entry are described and compared, and a list of laparoscopic procedures is included, alongside tips for training.

scholarly journals Acute Ischemic Stroke: A Review of Imaging, Patient Selection, and Management in the Endovascular Era. Part II: Patient Selection, Endovascular Thrombectomy, and Postprocedure Management

2018 ◽  
Vol 02 (03) ◽  
pp. 169-183
Author(s):  
Sharath Kumar G G ◽  
Chinmay Nagesh
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Patient Selection ◽  
Secondary Brain Injury ◽  
Selection Methods ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Advantages And Disadvantages ◽  
Imaging Patient ◽  
Selection Of

AbstractAppropriate patient selection and expedient recanalization are the mainstay of modern management of acute ischemic stroke (AIS). Only a minority of patients (7–15%) of patients are eligible for endovascular therapy. Patient selection may be time based or perfusion based. Central to both paradigms is the selection of a patient with a small core, a significant penumbra that can be differentiated from areas of oligemia. A brief review of patient selection methods is presented. Endovascular thrombectomy techniques using stentrievers or aspiration catheters have now become the treatment of choice for AIS with large vessel occlusion. A range of devices, each with its own advantages and disadvantages, are available in the market for the neurointerventionist to choose. Techniques vary between devices and between operators, but standardization and protocolization are important within each center. Complications must be anticipated to be avoided. Once reperfusion is achieved, outcomes must be safeguarded with competent postprocedure management to prevent secondary brain injury. These aspects are reviewed in this article.

scholarly journals A review of optimal prostate biopsy: indications and techniques

2019 ◽  
Vol 11 ◽  
pp. 175628721987007 ◽  
Author(s):  
Justin Streicher ◽  
Brian Lee Meyerson ◽  
Vidhya Karivedu ◽  
Abhinav Sidana
Keyword(s):  
Prostate Cancer ◽  
Patient Selection ◽  
Prostate Biopsy ◽  
Specific Antigen ◽  
Transrectal Ultrasound ◽  
Diagnostic Technique ◽  
Fusion Biopsy ◽  
Advantages And Disadvantages ◽  
Software Platforms ◽  
Selection For

Prostate biopsy is the gold standard diagnostic technique for the detection of prostate cancer. Patient selection for prostate biopsy is complex and is influenced by emerging use of prebiopsy imaging. The introduction of the magnetic resonance imaging (MRI)–transrectal ultrasound (TRUS) fusion prostate biopsy has clear advantages over the historical standard of care. There are several biopsy techniques currently utilized with unique advantages and disadvantages. We review and summarize the current body of literature pertaining to when and how a prostate biopsy should be performed. We discuss current recommendations regarding patient selection for biopsy and discuss future directions regarding prebiopsy imaging. We offer a description of the MRI–TRUS fusion biopsy technique and a comparison of many of the currently available fusion software platforms. Articles pertaining to the title were obtained via PubMed index search with relevant keywords supplemented with personal collection of related publications. Prostate biopsy should be considered for patients with gross digital rectal exam (DRE) abnormality, patients with a prostate-specific antigen (PSA) greater than 4 ng/ml, and concomitant risk factors for prostate cancer or patients with lesions identified on multiparametric MRI (mpMRI) with Prostate Imaging Reporting and Data System 2 (PI-RADS2) score of 4 or 5. MRI–TRUS fusion biopsy has demonstrated advantages in cancer detection when compared with TRUS-guided biopsy. There are currently several fusion software platforms available with a variety of biopsy approaches. Future efforts should detail the role of prebiopsy imaging as a triage tool for prostate biopsy. Consensus should be sought regarding the preferred modality of fusion biopsy. Additional data describing each fusion software platform would enable a more rigorous comparison of platform sensitivities.

Ureteral laparoscopic surgery: 5 years experience

1996 ◽  
Vol 63 (3) ◽  
pp. 360-367
Author(s):  
E. Belgrano ◽  
C. Trombetta ◽  
C. Lodolo
Keyword(s):  
Laparoscopic Surgery ◽  
Ureteral Obstruction ◽  
Retroperitoneal Fibrosis ◽  
Locally Advanced ◽  
Laparoscopic Procedures ◽  
The World ◽  
Vesico Ureteral Reflux

The main problem in surgically treating ureteral pathologies is the choice of approach. In this study we describe our experience in 8 cases of laparoscopic surgery. Two of these cases involved vesico-ureteral reflux, two retroperitoneal fibrosis, two ureterocele in a poorly functioning duplicated kidney and the last two cases dealt with ureteral obstruction from locally advanced pelvic neoplasia. The most widely performed ureteral laparoscopic procedures in the world are also reviewed.

scholarly journals Perspectives on Laparoscopic Surgery Among Chinese General Surgery Residents: Single-Site Survey Study with Instructive Lessons for Program Directors and Teaching Hospitals

2019 ◽  
Author(s):  
Bao Jin ◽  
Zhibo Zheng ◽  
Yongchang Zheng ◽  
Haifeng Xu ◽  
Tianyi Chi ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Surgical Procedure ◽  
Final Analysis ◽  
Survey Study ◽  
Teaching Hospitals ◽  
First Year ◽  
Laparoscopic Procedures ◽  
Surgical Residents ◽  
Site Survey ◽  
Hands On

Abstract Background To assess resident perspectives on laparoscopic surgery and how it might differ compared to open surgery. Materials and Methods Anonymous surveys were sent to residents who came to hepatic surgery service rotation during Sep 2013 to Aug 2017. Statistical comparisons were conducted using student T-test, comparing mean satisfaction and preferences. Results A total of 80 residents responded to the survey, distributed across the spectrum of training levels. Of the 80 respondents, 9 were in their first year of training, while 18, 41, and 12 were in their second, third, or fourth years of training, respectively. Among them, there were 11 residents were not included in the final analysis. Residents indicated that they preferred open procedures for conferring greater exposure to operating (7.172 ± 1.4646 for open vs 4.414 ± 2.1442 for laparoscopy, p < 0.001). Residents indicated that laparoscopic procedures were preferred in aiding in understanding of the surgical procedure (6.814 ± 1.3323 for open vs 7.407 ± 1.3014 for laparoscopy, p = 0.016). Conclusions These results suggest that residents prefer open procedures for hands-on experience, while laparoscopic procedures confer the advantage of facilitating the learning of a surgical procedure. This provides an opportunity for intervention, as minimally invasive surgeries(MIS) are a major component of modern surgical practice and, therefore, must be an area of strength in the training of surgical residents.

scholarly journals Obstetric and non-obstetric surgery during pregnancy: A 20-year Danish population-based prevalence study

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e028136 ◽  
Author(s):  
Anne Staub Rasmussen ◽  
Christian Fynbo Christiansen ◽  
Niels Uldbjerg ◽  
Mette Nørgaard
Keyword(s):  
Laparoscopic Surgery ◽  
Surgical Procedures ◽  
Outcome Measure ◽  
Smoking Status ◽  
Population Based ◽  
Main Outcome Measure ◽  
Medical Databases ◽  
Laparoscopic Procedures ◽  
High Prevalence ◽  
Obstetric Surgery

ObjectivesPopulation-based studies on use of non-obstetric and obstetric surgical procedures during pregnancy are sparse. Therefore, our objective was to estimate the prevalence of surgery during pregnancy, including potential time trends, overall and by trimester and describe the characteristics of pregnant women undergoing surgery.DesignThis study is a large nationwide cohort study.SettingFrom administrative and medical databases, we obtained information about all pregnancies ending in a live birth, a stillbirth or an abortion (spontaneous and induced) in Denmark during 1996–2015. Procedures (excluding caesarean sections) conducted during pregnancy were categorised as a non-obstetric or obstetric surgery and further divided into laparoscopic or non-laparoscopic procedures.Main outcome measureMain outcome measure is prevalence of surgery during pregnancy.ResultsWe included 1 687 176 pregnancies of which 108 502 (6.4%) received 117 424 surgical procedures. The prevalence of non-obstetric surgery was almost stable (1.5% in 1996–1999 to 1.6% in 2012–2015), whereas non-obstetric abdominal or gynaecological laparoscopic procedures increased from 0.5% to 0.8%. For appendectomies, the proportion of laparoscopic surgery increased from 4.2% to 79.2% during the study period. In 49 pregnancies, surgery for internal herniation was conducted in 2012–2015 versus none in 1996–1999. The prevalence of obstetric surgery, excluding invasive diagnostic tests, increased from 0.2% to 0.8%. High multiplicity, smoking, increasing age, body mass index (BMI) and parity were factors associated with a high prevalence of surgery during pregnancy.ConclusionsThe increase in the prevalence of laparoscopic surgery during pregnancy may reflect a decreased restraint concerning conductance of these surgical procedures during pregnancy. The increasing proportion of laparoscopic procedures complies with clinical recommendations, and the prevalence of surgery during pregnancy varied by multiplicity, smoking status, parity, age and BMI.

Abstract W MP5: The Global Impact of Recent Intra-Arterial Therapy (IAT) Randomized Controlled Trials on Current and Future Stroke Practice

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Amrou Sarraj ◽  
Wafi Bibars ◽  
Amelia K Boehme ◽  
Sheryl Martin-Schild ◽  
James C Grotta ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Randomized Controlled Trials ◽  
Patient Selection ◽  
Controlled Trials ◽  
Selection Methods ◽  
Web Based ◽  
Clinical Criteria ◽  
Global Impact ◽  
Randomized Controlled ◽  
Stent Retrievers

Background and Objective: Recent RCTs have failed to show benefit of intra-arterial therapy (IAT). We sought to determine whether these trials have affected the views and practice of IAT amongst stroke-treating physicians. Methods: An international web-based survey was sent to 753 stroke-treating physicians across the globe. Results: 322 physicians responded (43% rate); 25% were interventionalists; 80% practice in 24/7 IAT capable centers (fig 1). IAT volume per year prior to the RCTs (fig 2) has now decreased according to nearly half of the respondents. Physicians are now more selective (59%) while a third made no changes in pursuing IAT and 6% “do not pursue IAT anymore” (fig 3). Although 76% still perceive IAT is effective under certain criteria, two thirds said they feel “less obligated” to offer IAT. When asked about the RCTs, respondents felt the devices were outdated (36%), patient selection methods were “not optimal” (32%), recanalization rates could have been better (25%) or the trials should have been better designed (20%). Interestingly, centers currently enrolling in IAT trials intervene on large proportions of patients outside of studies (fig 4). The single most important factor in patient selection is shown in fig 5. Over half prefer a CT modality for patient selection; while 16% chose MRI and 11% use clinical criteria only when deciding to pursue IAT. Finally, three quarters of the contributors said that patients should be taken to IAT only in the context of clinical trials to test its efficacy, 21% said IAT should be continued “outside of trials” and only 3% pronounced it not useful (fig 6). Conclusion: While the results of recent RCTs have changed the views of stroke treating physicians, IAT continues to be practiced worldwide. The majority of our respondents is more selective and awaits results of new trials with the stent retrievers and better selection methods. Despite endorsing the practice of IAT only within trials, over half are still treating cases outside studies.

scholarly journals Design of an Endoscope Lens Shielding Device for Use in Laparoscopic Procedures

2010 ◽  
Vol 4 (2) ◽  
Author(s):  
Sterling Anderson ◽  
Julia Zimmerman ◽  
Emily Houston ◽  
Kevin Farino ◽  
Nikolai Begg
Keyword(s):  
Laparoscopic Surgery ◽  
Surgical Procedures ◽  
Recovery Time ◽  
Current Practice ◽  
Significant Problem ◽  
Loss Of Vision ◽  
Laparoscopic Procedures ◽  
Multiple Trials ◽  
Laparoscopic Surgical Procedures

In recent years, laparoscopic surgical procedures have revolutionized many gynecological and abdominal procedures, leading to dramatic reductions in recovery time and scarring for the patient. While techniques and instruments for performing laparoscopic surgery have improved over the years, loss of vision through the endoscopic lens caused by fog, liquid, and solid debris common to laparoscopic procedures remains a significant problem. In this paper, a shielding mechanism that maintains visibility through the laparoscope by removing debris from the distal end of the lens is presented. This device provides an inexpensive and convenient alternative to the current practice of removing, cleaning, and re-inserting the laparoscope during surgical procedures. This device is shown in multiple trials to repeatably remove debris from the distal tip of the lens, thereby restoring vision for the surgeon without requiring removal or reinsertion of the endoscope.

Laparoscopy Using Room Air Insufflation in a Rural African Jungle Hospital: The Bongolo Hospital Experience, January 2006 to December 2013

2017 ◽  
Vol 24 (3) ◽  
pp. 264-267
Author(s):  
Zachary O’Connor ◽  
Marco Faniriko ◽  
Keir Thelander ◽  
Jennifer O’Connor ◽  
David Thompson ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Laparoscopic Surgery ◽  
Postoperative Complications ◽  
Open Surgery ◽  
The Other ◽  
Laparoscopic Procedures ◽  
Time Period ◽  
Free Air ◽  
The World ◽  
Air Insufflation

Introduction. Carbon dioxide is the standard insufflation gas for laparoscopy. However, in many areas of the world, bottled carbon dioxide is not available. Laparoscopy offers advantages over open surgery and has been practiced using filtered room air insufflation since 2006 at Bongolo Hospital in Gabon, Africa. Objective. Our primary goal was to evaluate the safety of room air insufflation related to intraoperative and postoperative complications. Our secondary aim was to review the types of cases performed laparoscopically at our institution. Methods. This retrospective review evaluates laparoscopic cases performed at Bongolo Hospital between January 2006 and December 2013. Demographic and perioperative information for patients undergoing laparoscopic procedures was collected. Insufflation was achieved using a standard, oil-free air compressor using filtered air and a standard insufflation regulator. Results. A total of 368 laparoscopic procedures were identified within the time period. The majority of cases were gynecologic (43%). There was a 2% (8/368) complication rate with one perioperative death. The 2 complications related to insufflation were episodes of hypotension responsive to standard corrective measures. No intracorporeal combustion events were observed in any cases in which the use of diathermy and room air insufflation were combined. The other complications and the death were unrelated to the use of insufflation with air. Conclusion. Insufflation complications with room air occurred in our study. However, the complications related to insufflation with room air in our study were no different than those described in the literature using carbon dioxide. As room air is less costly than carbon dioxide and readily available, confirming the safety of room air insufflation in prospective studies is warranted. Room air appears to be safe for establishing and maintaining pneumoperitoneum, making laparoscopic surgery more accessible to patients in low-resource settings.

scholarly journals Trans umbilical first trocar access during laparoscopic surgery

2019 ◽  
Vol 7 (8) ◽  
pp. 3039
Author(s):  
Ritvik Resutra ◽  
Neha Mahajan ◽  
Rajive Gupta
Keyword(s):  
Carbon Dioxide ◽  
Laparoscopic Surgery ◽  
Peritoneal Cavity ◽  
Routine Procedure ◽  
Midline Laparotomy ◽  
Previous Abdominal Surgery ◽  
Closed Technique ◽  
Laparoscopic Procedures ◽  
Carbon Dioxide Pneumoperitoneum ◽  
History Of

Background: In order to perform laparoscopic procedures, it is necessary to first access the peritoneal cavity and establish carbon dioxide pneumoperitoneum. The placement of the first trocar remains a critical step in laparoscopic surgery. In order to minimize complications associated with placement of first trocar, several techniques have been reported. Author describe a surgical technique that provides a quick, safe, and reliable initial access to the peritoneal cavity with its excellent functional and cosmetic results.Methods: Retrospective study of patients who underwent various laparoscopic procedures at Maxx lyfe Hospital, Bathindi, Jammu was carried out by the closed technique for initial access to the peritoneal cavity through the umbilicus from July 2016 to May 2019. In this study, patients who had a prior midline laparotomy with involvement of the umbilicus were excluded.Results: Authors analyzed 456 patients (M = 190; F = 266) in the study period. Average age of the patients was 32 years (range:12-86). A physiologic defect was identified in the umbilical region in all patients who had no history of previous abdominal surgery in that region. The average time to access the peritoneal cavity was 30 seconds (range: 20-50).Conclusions: This technique is quick, safe, reliable, simple, and easy to learn and easy to perform. It is associated with no mortality and minimal morbidity and has excellent cosmetic results. Based on authors experience, authors believe that this method provides surgeons with an effective and safe way to insert the first trocar and recommend it as a routine procedure to access the peritoneal cavity for abdominal laparoscopic surgery.

The impact of the changes to United Kingdom psychiatry training recruitment in 2021

2022 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Alexander Challinor ◽  
Jonathon Whyler
Keyword(s):  
Empirical Evidence ◽  
Evidence Base ◽  
Psychiatry Training ◽  
Selection Methods ◽  
Recruitment Process ◽  
Content Type ◽  
Recruitment Methods ◽  
Advantages And Disadvantages ◽  
The Uk ◽  
The Impact

Purpose The purpose of this paper is to review and critically evaluate UK psychiatry national recruitment process for 2021, which was re-structured following the COVID-19 pandemic. Additionally, this paper aims to review the empirical evidence of the selection methodologies in psychiatry recruitment. Design/methodology/approach The UK national psychiatry recruitment process is discussed, with a focus on the changes made to recruitment in 2021. The advantages and disadvantages of different selection methodologies are explored, with an emphasis on evaluating the validity, acceptability and reliability of different recruitment selection methodologies. The potential impact of the changes to psychiatry recruitment are explored. Findings The decision of the National Recruitment Office to remove certain selection methods for recruitment in 2021 may have limited their ability to choose the best candidate for the training place and be fair to the applicant. Overall, there is a lack of research into the validity of the selection methods used in psychiatry recruitment. A framework for outcome criteria relevant to psychiatry recruitment should be developed, which would allow research into selection methods and guide the NRO to examine the evidence base effectively. Originality/value This paper examined the recruitment methods used to choose doctors for psychiatry training in the UK, demonstrating that the empirical evidence base for psychiatry recruitment is limited. This paper can contribute to our understanding of selection methodologies used in psychiatry recruitment and highlights the value of different recruitment approaches for choosing the best psychiatrists of the future.

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