scholarly journals Retroperitoneal versus Transperitoneal Laparoscopic approach for Management of Upper Ureteric Stones

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
W A Maged ◽  
M K A Tolba ◽  
M E E Elfiky
Keyword(s):  
Statistical Significance ◽  
Laparoscopic Approach ◽  
Oral Intake ◽  
Postoperative Recovery ◽  
Retroperitoneal Approach ◽  
Ureteral Stones ◽  
University Hospitals ◽  
Transperitoneal Approach ◽  
Hospitalization Period ◽  
Laparoscopic Transperitoneal

Abstract Background Current options for ureteral stones include medical treatment, extracorporeal shockwave lithotripsy (SWL), and various endoscopic procedures, with the standard open ureterolithotomy being less frequently practiced nowadays. The use of laparoscopy in the management of ureteral stones was one of the earliest applications of laparoscopy in urology, the first report being made by Wickham in 1979. Objective To compare the laparoscopic Retroperitoneal ureterolithotomy with the Laparoscopic Transperitoneal ureterolithotomy as a better alternative to conventional open surgery to extract a large, impacted and hard stones at the proximal two thirds of the ureter. Methods In this study we present our experience with laparoscopic ureterolithotomy comparing both transperitoneal approach and retroperitoneal approach through a retrospective randomized comparative study that conducted on 50 patients admitted through the outpatient clinic of Urology in Ain shams University Hospitals and Nasser institute hospital. The 50 patients divided into two groups each one was 25 patients, first group was performed by the laparoscopic transperitoneal approach and the other group by the laparoscopic retroperitoneal approach Between October 2017 and October 2018. Results This study revealed that the length of the Hospitalization period and the duration of drainage and urethral catheter were shorter in the transperitoneal approach than in the retroperitoneal approach with statistical significance between the groups. In the present study, the mean time to oral intake was significantly shorter in the Retroperitoneal group than in the Transperitoneal group. This is due to the mobilization of the colon, dissection and retraction of the viscera, and blood and urine leak in the peritoneal cavity, causing intestinal movements and sounds to be more delayed in the LTU group. In contrast, the lost blood during the retroperitoneal procedure does not come into contact with the bowel, and if urine leakage occurs, it would be contained within the retroperitoneal space. Also we find that both approaches are safe with few complications that were significantly wider at the transperitoneal group; vascular injury didn’t occur at any of the cases with no need for blood transfusion. Conclusion Through our study we concluded that Laparoscopic ureterolithotomy is technically feasible and safe and both of its two approaches either transperitoneal or retroperitoneal are successful procedures with a success rate nearly the same in both techniques, but and based on our results through this study, we recommend the retroperitoneal approach for laparoscpic extraction of the ureteral stones due to the fact that it has the least operative time than the transperitoneal approach, getting rid of the all stone burden, lower rate of complications and a better postoperative recovery.

scholarly journals Comparison of lateral transperitoneal and retroperitoneal approaches for homolateral laparoscopic adrenalectomy

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhao Liu ◽  
Da-wei Li ◽  
Lei Yan ◽  
Zhong-Hua Xu ◽  
Gang-li Gu
Keyword(s):  
Blood Loss ◽  
Laparoscopic Adrenalectomy ◽  
Operative Time ◽  
Oral Intake ◽  
Patient Characteristics ◽  
Retroperitoneal Approach ◽  
Perioperative Outcomes ◽  
Transperitoneal Approach ◽  
Operative Data

Abstract Background There is a lack of data regarding the appropriateness of transperitoneal and retroperitoneal approaches for homolateral laparoscopic adrenalectomy. The aim of this study is to compare lateral transperitoneal and retroperitoneal approach for left-sided and right-sided laparoscopic adrenalectomy respectively. Methods Between January 2014 and December 2019, 242 patients underwent left-sided and 252 patients underwent right-sided laparoscopic adrenalectomy. For left side, transperitoneal approach was used in 132 (103 with tumors < 5 cm and 29 with tumors ≥ 5 cm) and retroperitoneal approach in 110 (102 with tumors < 5 cm and 8 with tumors ≥ 5 cm). For right side, transperitoneal approach was used in 139 (121 with tumors < 5 cm and 18 with tumors ≥ 5 cm) and retroperitoneal approach in 113 (102 with tumors < 5 cm and 11 with tumors ≥ 5 cm). Patient characteristics and perioperative outcomes were recorded. For each side, both approaches were compared for tumors < 5 cm and ≥ 5 cm respectively. Results For left-sided tumors < 5 cm, transperitoneal approach demonstrated shorter operative time, less blood loss and longer time to oral intake. For left-sided tumors ≥ 5 cm, the peri-operative data of both approaches was comparable. For right-sided tumors < 5 cm, transperitoneal approach demonstrated shorter operative time and less blood loss. For right-sided tumors ≥ 5 cm, the peri-operative data was comparable. Conclusions Lateral transperitoneal and retroperitoneal approach are both effective for laparoscopic adrenalectomy. Lateral transperitoneal approach is faster with less blood loss for tumors < 5 cm.

scholarly journals Surgical approach to adrenal ganglioneuroma: Case report and literature review

2018 ◽  
Vol 90 (2) ◽  
pp. 145
Author(s):  
Danilo Abate ◽  
Giuseppe Giusti ◽  
Nicola Caria ◽  
Marco Lucci Chiarissi ◽  
Antonello De Lisa
Keyword(s):  
Case Report ◽  
Laparoscopic Surgery ◽  
Adrenal Mass ◽  
Benign Tumor ◽  
Slow Growth ◽  
Laparoscopic Approach ◽  
Retroperitoneal Mass ◽  
Transperitoneal Approach ◽  
Laparoscopic Transperitoneal ◽  
Adrenal Ganglioneuroma

Objective: Ganglioneuroma (GN) is a benign tumor with a slow growth that can originate from any paravertebral sympathetic plexus. It is usually asymptomatic or with nonspecific symptoms. TC and RM scan are helpful to study GN. It is usually represented by an ovalshaped retroperitoneal mass or, in case of adrenal impairment, by low radiologic contrast media attenuation. Surgical treatment is mandatory. Literature shows how the laparoscopic approach is the most used, especially in lesions that are 6 cm or smaller. Our purpose is to describe our experience on an incidental adrenal GN of about 5 cm treated by the laparoscopic transperitoneal approach. Materials and methods: A 33-year-old male had ultrasound occasional finding of an about 4 cm adrenal mass. TC and RM scan identified a retroperitoneal mass (max diameter 48 mm). The lesion was removed with a transperitoneal laparoscopic approach. Results: No intraoperative or postoperative complications occurred. The patient was discharged 3 days after surgery. Conclusions: Up to the present laparoscopic surgery is the best approach for GN treatment.

Revolving door syndrome: A new meaning for an old concept?

2011 ◽  
Vol 26 (S2) ◽  
pp. 1114-1114
Author(s):  
P. Garrido ◽  
C. Saraiva
Keyword(s):  
Health Care ◽  
Hospital Admissions ◽  
Strong Predictor ◽  
Statistical Significance ◽  
Revolving Door ◽  
Full Time ◽  
University Hospitals ◽  
Short Term ◽  
Care Services ◽  
Psychiatric Units

Introduction“Revolving Door Syndrome” is usually defined as a cyclical pattern of short-term readmissions to the psychiatric units of health care centers, by young adults with chronic psychiatric disorders. Concerning the actual politics in health care sistems, with sucessive budget cuts and reduction of full-time hospital beds, the authors' aim has been to identify the patients that enter into a vicious circle of being admitted to hospital, discharged, and admitted again, as well as the underlying psychosocial reasons.ObjectivesThe purpose of this study was to identify factors associated with short-term readmissions to psychiatric acute care services, with statistical significance, and clinical interest, within a portuguese sample.Material and methodsRetrospective cohort study, in which the medical records of patients admitted to Coimbra University Hospitals two or more times (with short-term readmissions) between January and December of 2009, were analysed for socio-demographic characteristics, psychiatric diagnostic, presence of comorbidities, number of hospital admissions within that year, psychofarmacological treatments and presence of social and familiar support.Results and conclusionsThe authors found that lack of social and familiar support is a strong predictor for “Revolving Door Syndrome”, as well as the presence of a chronic psychiatric disorder.

Lack of influence of the antidopaminergic drug domperidone on basal and TRH-stimulated TSH-serum levels after oral administration

1982 ◽  
Vol 101 (4) ◽  
pp. 550-554 ◽  
Author(s):  
K. W. Wenzel ◽  
J. Döring
Keyword(s):  
Oral Administration ◽  
Thyroid Function ◽  
Oral Absorption ◽  
Statistical Significance ◽  
Oral Intake ◽  
Serum Levels ◽  
The Novel ◽  
Antiemetic Drug ◽  
First Pass ◽  
The Difference

Abstract. Since antidopaminergic drugs are known to elevate basal and TRH-stimulated TSH-serum levels and since this effect was also shown after iv administration of the novel dopamine antagonistic agent domperidone, it was investigated, whether this antiemetic drug could interfere after oral intake with the evaluation of thyroid function. Oral domperidone caused a marked TSH-enhancement of TRH-induced TSH increments in 6 out of 14 euthyroid subjects, with no statistical significance, however. The difference between oral and parenteral influence as well as inter-individual changes are probably due to the varying first pass effect of the drug after oral absorption.

scholarly journals OV15 EMERGENCY SURGERY OF OBSTRUCTED VENTRAL HERNIA USING TAPP TECHNIQUE: A SAFE AND FEASIBLE APPROACH

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Victor Vaello ◽  
Angela Santana ◽  
Diego Oto ◽  
Luz Juez ◽  
Raquel Arranz ◽  
...  
Keyword(s):  
Elective Surgery ◽  
Intestinal Resection ◽  
Laparoscopic Approach ◽  
Right Hemicolectomy ◽  
Postoperative Recovery ◽  
Preperitoneal Space ◽  
Open Approach ◽  
Emergency Procedures ◽  
Peritoneal Flap ◽  
Ventral Incisional Hernia

Abstract Aim to explain and show the feasibility of laparoscopic TAPP technique in emergency procedures Material and Methods we present a 71-year-old female with personal history of obesity (BMI 32) and a laparoscopic right hemicolectomy performed in 2018, presenting at the ER with a 24-hour intestinal obstruction due to incarcerated ventral incisional hernia. Results laparoscopic reduction of the hernia contents was achieved without need of intestinal resection, prior to access to the preperitoneal space, creating a peritoneal flap that was dissected around the hernia. Following closure of the hernia defect, a polypropylene mesh was placed and the peritoneal flap closed. There were no intraoperative or postoperative events and patient was discharged on 3rd POD. Conclusions laparoscopic approach to emergency hernias in selected patients doesn’t differ from elective surgery, and offers great advantages in terms of evaluation of the incarcerated elements, and postoperative recovery, especially in obese patients where a conventional open approach has higher morbidity.

scholarly journals Healthcare Workers Infection Rate in the Era of Coronavirus Disease 2019 - in Tertiary Teaching Hospital

2021 ◽  
Vol 9 (A) ◽  
pp. 651-658
Author(s):  
Mona Mohiedden ◽  
Aml M. Said ◽  
Ahmed M. Ali ◽  
Mohammed M. Abdel Razik ◽  
Maha Ali Gad
Keyword(s):  
Healthcare Workers ◽  
Statistical Significance ◽  
Descriptive Analysis ◽  
Control Measures ◽  
University Hospitals ◽  
Cross Sectional ◽  
Infection Control Measures ◽  
Increased Risk ◽  
Tertiary Teaching ◽  
Potential Risk Factors

BACKGROUND: Healthcare workers (HCWs) are at the frontline defense against coronavirus disease 2019 (COVID-19) pandemic. AIM: The study aimed to describe the characteristics and appraise potential risk factors of COVID-19 transmission among HCWs who tested positive for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in one of Cairo University Hospitals. METHOD: Cross-sectional descriptive analysis of confirmed polymerase chain reaction (PCR) positive versus negative cases for COVID-19. RESULTS: Through March–June 2020, (145/846; 17%) suspected HCWs were tested for COVID-19 by PCR; out of them (70/145; 48.3%) were confirmed as positive, these positive cases represented (70/846; 8.3%) of all HCWs of the hospital. About 33% of confirmed COVID-19 positive HCWs acquired the infection from the healthcare while only (13/70; 19%) from community settings, and no clear exposure data were identified in (34/70; 48%) of cases. Most of symptomatic cases showed a positive PCR test for SARS-CoV-2 versus asymptomatic cases, p < 0.001. There was no statistical significance regarding gender, age, presence of comorbidity, workload or the type of acquisition. CONCLUSION: HCWs are at an increased risk of COVID-19 infection at the workplace. Strict implementation of infection control measures is of crucial role in preventing transmission of COVID-19 infection in health-care settings.

scholarly journals Role of Laparoscopy in Treatment of Diaphragmatic Hernia in Adult

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A A Almenawy ◽  
A M Almaraghy ◽  
M S Farahat ◽  
R M Nageeb
Keyword(s):  
Minimally Invasive ◽  
Diaphragmatic Hernia ◽  
Laparoscopic Approach ◽  
Rare Condition ◽  
University Hospitals ◽  
Male And Female ◽  
Traumatic Diaphragmatic Hernia ◽  
Surgery Department ◽  
Oral Diet

Abstract Background congenital diaphragmatic hernia in adult is a rare condition, most of cases are asymptomatic and discovered accidental. We reported 10 cases of diaphragmatic hernia repaired successfully via the laparoscopic approach. Objectives to describe the role of laparoscopy in treatment of congenital and traumatic diaphragmatic hernia in adult. Methods prospective study was conducted on 10 adult patients suffering from diaphragmatic hernia to evaluate the role of laparoscopy in treatment of diaphragmatic hernia in adult. The study was conducted at general surgery department of Ain shams university hospitals and Kafr ash Shaykh general hospital including all symptomatic types of diaphragmatic hernia on both adult male and female patients with age more than 18 years. Results We achieved satisfactory intracorporeal repair of these diaphragmatic defects. The patients had excellent recovery and started on oral diet one to two days postoperative except one patient (10%) started on the 5th day due to resection anastomoses, and then were discharged with symptomatic relieve after surgery. Conclusion The minimally invasive advantage of laparoscopic approach offers a secure, reliable and satisfactory way to confirm the diagnosis and achieve the repair of diaphragmatic hernia.

Exploiting Distributed, Heterogeneous and Sensitive Data Stocks while Maintaining the Owner’s Data Sovereignty

2015 ◽  
Vol 54 (04) ◽  
pp. 346-352 ◽  
Author(s):  
M. Lablans ◽  
D. Kadioglu ◽  
M. Muscholl ◽  
F. Ückert
Keyword(s):  
Data Protection ◽  
Statistical Significance ◽  
Distributed Databases ◽  
Peer Pressure ◽  
National Registry ◽  
University Hospitals ◽  
Project Proposal ◽  
Federated Search ◽  
Explicit Consent ◽  
Patient Consent

SummaryBackground: To achieve statistical significance in medical research, biological or data samples from several bio- or databanks often need to be complemented by those of other institutions. For that purpose, IT-based search services have been established to locate datasets matching a given set of criteria in databases distributed across several institutions. However, previous approaches require data owners to disclose information about their samples, raising a barrier for their participation in the network.Objective: To devise a method to search distributed databases for datasets matching a given set of criteria while fully maintaining their owner’s data sovereignty.Methods: As a modification to traditional federated search services, we propose the decentral search, which allows the data owner a high degree of control. Relevant data are loaded into local bridgeheads, each under their owner’s sovereignty. Researchers can formulate criteria sets along with a project proposal using a central search broker, which then notifies the bridgeheads. The criteria are, however, treated as an inquiry rather than a query: Instead of responding with results, bridgeheads notify their owner and wait for his/her decision regarding whether and what to answer based on the criteria set, the matching datasets and the specific project proposal. Without the owner’s explicit consent, no data leaves his/ her institution.Results: The decentral search has been deployed in one of the six German Centers for Health Research, comprised of eleven university hospitals. In the process, compliance with German data protection regulations has been confirmed. The decentral search also marks the centerpiece of an open source registry software toolbox aiming to build a national registry of rare diseases in Germany.Conclusions: While the sacrifice of real-time answers impairs some use-cases, it leads to several beneficial side effects: improved data protection due to data parsimony, tolerance for incomplete data schema mappings and flexibility with regard to patient consent. Most importantly, as no datasets ever leave their institution, owners can reject projects without facing potential peer pressure. By its lower barrier for participation, a decentral search service is likely to attract a larger number of partners and to bring a researcher into contact with the right potential partners.

Pregnancy-Preserving Laparoscopic Treatment of Acute Hemoperitoneum Following Lutein Cyst Rupture in Early Gestation

2019 ◽  
Vol 223 (02) ◽  
pp. 109-112
Author(s):  
Rafał Watrowski
Keyword(s):  
Case Report ◽  
Laparoscopic Approach ◽  
Postoperative Recovery ◽  
Absorbable Suture ◽  
Laparoscopic Treatment ◽  
Healthy Baby ◽  
Early Gestation ◽  
Cyst Rupture ◽  
Hemoglobin Drop ◽  
In Pregnancy

AbstractAcute hemoperitoneum (AHP) in early gestation is commonly treated via laparotomy. A ruptured corpus luteum (CL) cyst is a rare cause of AHP in pregnancy. This case report describes a 33-year-old, hemodynamically stable G2/P1 who presented at 5+5 gestational weeks with an acute abdomen due to ruptured CL cyst (7 cm). Emergent laparoscopy was performed. After evacuation of 1 L of hemoperitoneum, an atraumatic hemostasis was obtained without diathermy by use of hemostatic matrix (Floseal®). The ovary was reformed with an absorbable suture under preservation of CL. The postoperative recovery was uncomplicated. The hemoglobin drop was 2.8 g/dl. Further pregnancy course was uneventful. A healthy baby (2860 g) was delivered vaginally at 38+3 weeks of gestation. Conclusion Laparoscopic approach to AHP in early pregnancy is suitable. CL preservation is feasible by use of atraumatic hemostatics.

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