Thermal Processes in Bile Ducts During Laparoscopic Cholecystectomy with Monopolar Instruments. Experimental Study Using Real-Time Intraluminal and Surface Thermography

2020 ◽  
pp. 155335062097982
Author(s):  
Taras Nechay ◽  
Alexander Sazhin ◽  
Svetlana Titkova ◽  
Mikhail Anurov ◽  
Alexander Tyagunov ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Ducts ◽  
Thermal Injury ◽  
Cell Damage ◽  
Early Postoperative Period ◽  
Tissue Temperature ◽  
Critical Threshold ◽  
Thermal Processes ◽  
Tissue Heating ◽  
Signal Amplifier

Introduction. A significant rate of complications during laparoscopic cholecystectomy (LC) occurs due to thermal injury caused by monopolar electrosurgery (MES) equipment. Most of them manifest weeks and months after surgery with the common bile duct (CBD) and large duodenal papilla strictures, some in the early postoperative period with bile leaks. Objective. To study thermal processes occurring in the lumen and on the surface of the bile ducts during monopolar coagulation in a porcine model of LC. Methods. The temperature of the bile ducts was measured using instrumentation consisted of biliary stent with temperature sensors, which was inserted in the porcine CBD, signal amplifier, and current sense transformer. Surface temperature was measured with a scientific grade thermal camera. Cholecystectomy was performed using a standard “critical view of safety” (CVS) approach with 5 mm monopolar laparoscopic instruments. Results. Application of MES caused significant tissue heating. Lateral thermal spread and the rate of tissue heating depended on the duration of energy application and the initial tissue temperature. In 5 out of 6 experiments, the intraluminal temperature rose up to the critical threshold, and the exposure time ranged from 54 to 560 seconds. A sensor positioned at the papilla site was heated in all the experiments but still below the cell damage inducing threshold. The analysis of thermographic charts revealed the presence of the “current channeling” effect and the pedicle effect. Conclusion. There is a possibility of a direct and delayed thermal injury to the bile ducts during LC.

scholarly journals Delayed Perforation of the Large Bowel due to Thermal Injury during Laparoscopic Cholecystectomy

2005 ◽  
Vol 33 (3) ◽  
pp. 360-363 ◽  
Author(s):  
A Polychronidis ◽  
AK Tsaroucha ◽  
AJ Karayiannakis ◽  
S Perente ◽  
E Efstathiou ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Laparoscopic Surgery ◽  
Large Bowel ◽  
Thermal Injury ◽  
Clinical Signs ◽  
Exploratory Laparotomy ◽  
Hepatic Flexure ◽  
Temporary Ileostomy ◽  
Delayed Perforation

We report a case of delayed perforation of the large bowel because of thermal injury during a laparoscopic cholecystectomy. A 78-year-old male with symptomatic cholelithiasis underwent a difficult laparoscopic cholecystectomy because of multiple adhesions resulting from two previous cholecystitis episodes. The patient recovered well after surgery and was discharged on post-operative day 2. On postoperative day 10, the patient returned to the hospital with peritonitis. An exploratory laparotomy revealed perforation of the wall of the hepatic flexure of the large bowel, which was centred in a necrotic area 1 cm in diameter. The perforation was sutured and a temporary ileostomy performed, which was closed at a later date. The patient was doing well at a 10-month follow-up review. A delayed rupture of any part of the bowel after laparoscopic surgery can be potentially fatal if not treated during an emergency exploratory laparotomy, even if the clinical signs are not severe.

scholarly journals For the 30th anniversary of laparoscopic cholecystectomy: problems remain

2019 ◽  
Vol 100 (3) ◽  
pp. 537-541
Author(s):  
I V Fedorov ◽  
A N Chugunov ◽  
L E Slavin ◽  
D A Slavin ◽  
V I Fedorov
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Ducts ◽  
Perioperative Complications ◽  
Open Cholecystectomy ◽  
Intrahepatic Bile Ducts ◽  
Negative Effect ◽  
Iatrogenic Damage ◽  
Extrahepatic Bile Ducts ◽  
Legal Costs

The review describes perioperative complications of laparoscopic cholecystectomy. Over the past 30 years, laparoscopy has become the «gold standard» for cholecystectomy and one of the most frequently performed procedures in abdominal surgery. Nevertheless, despite the advantages of the method, it has an «Achilles heel» - the frequency of iatrogenic damage to the extrahepatic bile ducts is 3-5 times higher than with an open cholecystectomy. This complication has a negative effect on the survival of patients after surgery, leads to deterioration in the quality of life and is a major source of legal costs in many countries. In general, the total range for any damage to the biliary tract during laparoscopic cholecystectomy is 0.32-0.52%, while the complication rate and mortality rate are 1.6-5.3% and 0.08-0.14%, respectively. Patients who have undergone a complete intersection of the hepaticoholedochus, become «bile cripples» for life. Recurrent cholangitis, strictures of anastomoses with a possible outcome in liver cirrhosis are quite likely in later periods after damage to the intrahepatic bile ducts. Technological efforts to improve the results of laparoscopic cholecystectomy reside. These include the routine use of intraoperative cholangiography, infrared fluorescent cholangiography, etc. Nevertheless, despite the growing number of methods designed to reduce these complications, evidence of their effectiveness remains limited. The most important factors ensuring the safety of laparoscopic cholecystectomy are recognized: understanding of anatomy, adequate exposure when using electrosurgery, psychological readiness to invite a senior colleague in time for help, the ability to recognize a situation that requires conversion and rejection of laparoscopy.

scholarly journals Hepatic steatosis associated with decreased β-oxidation and mitochondrial function contributes to cell damage in obese mice after thermal injury

2018 ◽  
Vol 9 (5) ◽  
Author(s):  
Li Diao ◽  
Christopher Auger ◽  
Hisato Konoeda ◽  
Ali-Reza Sadri ◽  
Saeid Amini-Nik ◽  
...  
Keyword(s):  
Hepatic Steatosis ◽  
Mitochondrial Function ◽  
Thermal Injury ◽  
Cell Damage ◽  
Obese Mice

Towards temperature controlled retinal laser treatment with a single laser at 10 kHz repetition rate

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Mario Mordmüller ◽  
Viktoria Kleyman ◽  
Manuel Schaller ◽  
Mitsuru Wilson ◽  
Dirk Theisen-Kunde ◽  
...  
Keyword(s):  
Temperature Measurement ◽  
Laser Treatment ◽  
Repetition Rate ◽  
Continuous Wave ◽  
Cell Damage ◽  
Pulsed Laser ◽  
Extended Kalman Filtering ◽  
Tissue Heating ◽  
Pulsed Heating ◽  
Measurement And Control

Abstract Laser photocoagulation is one of the most frequently used treatment approaches in ophthalmology for a variety of retinal diseases. Depending on indication, treatment intensity varies from application of specific micro injuries down to gentle temperature increases without inducing cell damage. Especially for the latter, proper energy dosing is still a challenging issue, which mostly relies on the physician’s experience. Pulsed laser photoacoustic temperature measurement has already proven its ability for automated irradiation control during laser treatment but suffers from a comparatively high instrumental effort due to combination with a conventional continuous wave treatment laser. In this paper, a simplified setup with a single pulsed laser at 10 kHz repetition rate is presented. The setup combines the instrumentation for treatment as well as temperature measurement and control in a single device. In order to compare the solely pulsed heating with continuous wave (cw) tissue heating, pulse energies of 4 µJ were applied with a repetition rate of 1 kHz to probe the temperature rise, respectively. With the same average laser power of 60 mW an almost identical temporal temperature course was retrieved in both irradiation modes as expected. The ability to reach and maintain a chosen aim temperature of 41 °C is demonstrated by means of model predictive control (MPC) and extended Kalman filtering at a the measurement rate of 250 Hz with an accuracy of less than ±0.1 °C. A major advantage of optimization-based control techniques like MPC is their capability of rigorously ensuring constraints, e.g., temperature limits, and thus, realizing a more reliable and secure temperature control during retinal laser irradiation.

Radio-Frequency Ablation in a Realistic Reconstructed Hepatic Tissue

2006 ◽  
Vol 129 (3) ◽  
pp. 354-364 ◽  
Author(s):  
Prasanna Hariharan ◽  
Isaac Chang ◽  
Matthew R. Myers ◽  
Rupak K. Banerjee
Keyword(s):  
Temperature Rise ◽  
Cell Damage ◽  
Three Dimensional ◽  
Thermal Response ◽  
Tumor Location ◽  
Tissue Temperature ◽  
Patient Specific ◽  
Hepatic Tissue ◽  
Thermal Dose ◽  
Element Mesh

This study uses a reconstructed vascular geometry to evaluate the thermal response of tissue during a three-dimensional radiofrequency (rf) tumor ablation. MRI images of a sectioned liver tissue containing arterial vessels are processed and converted into a finite-element mesh. A rf heat source in the form of a spherically symmetric Gaussian distribution, fit from a previously computed profile, is employed. Convective cooling within large blood vessels is treated using direct physical modeling of the heat and momentum transfer within the vessel. Calculations of temperature rise and thermal dose are performed for transient rf procedures in cases where the tumor is located at three different locations near the bifurcation point of a reconstructed artery. Results demonstrate a significant dependence of tissue temperature profile on the reconstructed vasculature and the tumor location. Heat convection through the arteries reduced the steady-state temperature rise, relative to the no-flow case, by up to 70% in the targeted volume. Blood flow also reduced the thermal dose value, which quantifies the extent of cell damage, from ∼3600min, for the no-flow condition, to 10min for basal flow (13.8cm∕s). Reduction of thermal dose below the threshold value of 240min indicates ablation procedures that may inadequately elevate the temperature in some regions, thereby permitting possible tumor recursion. These variations are caused by vasculature tortuosity that are patient specific and can be captured only by the reconstruction of the realistic geometry.

Observations on oocyst development of Eimeria stiedai in rabbits

2014 ◽  
Vol 59 (3) ◽  
Author(s):  
Stanley Ball ◽  
Micheal Pittilo ◽  
Keith Snow
Keyword(s):  
Bile Duct ◽  
Outer Layer ◽  
Bile Ducts ◽  
Cell Damage ◽  
Parasite Development ◽  
Oocyst Wall ◽  
Duct Epithelium ◽  
Bile Duct Epithelium ◽  
Eimeria Stiedai ◽  
Membrane Cell

AbstractThe formation of the oocyst wall was examined in Eimeria stiedai in the bile duct epithelium of the rabbit and was found to follow the general eimerian pattern. However from the beginning of the formation of the outer layer of the oocyst wall the parasite was surrounded by a rarely reported veil membrane. Cell damage of the bile ducts at the gamogony stage of parasite development is depicted.

scholarly journals Tulžies latakų sužalojimai atliekant laparoskopinę cholecistektomiją

2007 ◽  
Vol 5 (2) ◽  
pp. 0-0
Author(s):  
Donatas Venskutonis ◽  
Linas Urbanavičius ◽  
Juozas Juočas ◽  
Saulius Bradulskis ◽  
Virmantas Daubaras ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Bile Duct Injury ◽  
General Surgery ◽  
Bile Ducts ◽  
Diffuse Peritonitis ◽  
Clinical Hospital ◽  
Bile Duct Injuries ◽  
Extrahepatic Bile Ducts ◽  
Iatrogenic Bile Duct Injury

Donatas Venskutonis, Linas Urbanavičius, Juozas Juočas, Saulius Bradulskis, Virmantas Daubaras, Juozas KutkevičiusKauno medicinos universiteto Bendrosios chirurgijos klinika,VšĮ Kauno II klinikinė ligoninė, Josvainių g. 2, LT-47133 KaunasEl paštas: [email protected] Įvadas / tikslas Manoma, kad atliekant laparoskopinę cholecistektomiją ekstrahepatiniai tulžies latakai sužalojami dažniau nei atvirąją. Įvykus tulžies latakų sužalojimui, svarbu jį kuo skubiau diagnozuoti ir tinkamai gydyti. Siūlomos įvairios sužalojimų prevencijos priemonės. Šio darbo tikslas – išanalizuoti KMU Bendrosios chirurgijos klinikoje 1994–2006 metais laparoskopinės cholecistektomijos metu įvykusių ekstrahepatinių tulžies latakų jatrogeninių sužalojimų dažnį, priežastis, gydymo metodus, padarinius ir prevencijos priemones, apžvelgti literatūros duomenis. Ligoniai ir metodai Analizavome 1994–2006 m. KMU Bendrosios chirurgijos klinikoje (VšĮ II KKL) dėl tulžies latakų jatrogeninių sužalojimų, įvykusių laparoskopinės cholecistektomijos metu, gydytų pacientų ligos istorijas. Rezultatai Per minėtą laikotarpį atliktos 5396 laparoskopinės cholecistektomijos: 1681 (31,2%) pacientui – dėl ūminio ir 3715 (68,8%) – dėl lėtinio cholecistito. Po operacijos 7 ligoniai mirė. Vienas ligonis mirė nuo bendrojo tulžies latako sužalojimo ir pankreatito. Kitos mirties priežastys: trims ligoniams buvo plaučių arterijos embolija, vienam – dvylikapirštės žarnos perforacija ir peritonitas, dviem – gangreninis cholecistitas ir lokalus peritonitas. Bendras mirštamumas 0,13%. Ekstrahepatiniai tulžies latakai sužaloti 10 ligonių (0,19%). Vienas ligonis gydytas nuo tulžies latakų sužalojimo kitoje ligoninėje. Išvados Apibendrinus rezultatus galima tvirtinti, kad tulžies latakų sužalojimo ir mirties atvejai operuojant laparoskopiškai yra reti, o laparoskopinė cholecistektomija mūsų klinikoje – saugi operacija. Atvira cholecistektomija pranašesnė tik sunkiais, komplikuotais atvejais (neaiški anatomija, tulžies pūslės-žarnyno fistulės) ir nesant galimybės išgydyti tulžies latakų akmenligės endoskopiškai. Pagrindiniai žodžiai: cholecistitas, laparoskopinė cholecistektomija, ekstrahepatiniai tulžies latakai, sužalojimai Bile duct injuries during laparoscopic cholecystectomy donatas venskutonis, linas urbanavičius, juozas juočas, saulius bradulskis, virmantas daubaras, juozas kutkevičiusKaunas University of Medicine Clinic of General Surgery, Kaunas 2nd Clinical Hospital,Josvainių str. 2, LT-47133, Kaunas, LithuaniaE-mail: [email protected] Background / objective Laparoscopic cholecystectomy is associated with a higher risk of extrahepatic bile duct injuries. Timely diagnosis and proper management of bile duct injury are very important. Various preventive measures are widely discussed. Our aim was to analyze iatrogenic injuries of extrahepatic bile ducts sustained during laparoscopic cholecystectomy over the period 1994–2006 at the Clinic of General Surgery of Kaunas University of Medicine and to review the relevant pub-lished reports. Patients and methods Analysis of the case histories of patients treated for iatrogenic bile duct injuries sustained during laparoscopic cholecystectomy over the period 1994–2006 at the Clinic of General Surgery of Kaunas University of Medicine (2nd Clinical Hospital), Lithuania. Results During the period 1994–2006, 5396 patients underwent laparoscopic cholecystectomy for acute cholecystitis (n = 1681, 31.2%) and chronic gallstone disease (n = 3715, 68.8%). Seven patients died after surgery: one patient died of bile duct injury, 3 patients of pulmonary artery embolism; there were one case of duodenum perforation and diffuse peritonitis, one case of severe acute pancreatitis, and 2 cases of gangrenous cholecystitis with peritonitis. The overall mortality rate was 0.13%. Iatrogenic bile duct injury occurred in 10 cases (0.19%). One patient was referred from another hospital and was treated for a iatrogenic bile duct injury. Conclusions The incidence of bile duct injuries and the death rate were low. Laparoscopic cholecystectomy was performed with acceptable safety in our clinic. Conventional cholecystectomy was preferred to laparoscopic cholecystectomy in difficult, complicated cases (unclear anatomy, biliary enteric fistulas) and in cases of unsuccessful endoscopic treatment of choledocholithiasis and obstructive jaundice. Keywords: cholecystitis, laparoscopic cholecystectomy, extrahepatic bile ducts, injuries

scholarly journals Evaluation of potential tissue heating during percutaneous drill-assisted bone sampling in an in vivo porcine study

2021 ◽  
Author(s):  
Stefan M. Niehues ◽  
Sefer Elezkurtaj ◽  
Keno K. Bresssem ◽  
Bernd Hamm ◽  
Christoph Erxleben ◽  
...  
Keyword(s):  
Thermal Damage ◽  
Critical Threshold ◽  
In Vivo Model ◽  
Bone Lesions ◽  
Bone Drilling ◽  
Tissue Quality ◽  
Tissue Heating ◽  
Bone Biopsies ◽  
Median Change

Abstract Background Minimally invasive, battery-powered drilling systems have become the preferred tool for obtaining representative samples from bone lesions. However, the heat generated during battery-powered bone drilling for bone biopsies has not yet been sufficiently investigated. Thermal necrosis can occur if the bone temperature exceeds a critical threshold for a certain period of time. Purpose To investigate heat production as a function of femur temperature during and after battery-powered percutaneous bone drilling in a porcine in vivo model. Methods We performed 16 femur drillings in 13 domestic pigs with an average age of 22 weeks and an average body temperature of 39.7 °C, using a battery-powered drilling system and an intraosseous temperature monitoring device. The standardized duration of the drilling procedure was 20 s. The bone core specimens obtained were embedded in 4% formalin, stained with haematoxylin and eosin (H&E) and sent for pathological analysis of tissue quality and signs of thermal damage. Results No significant changes in the pigs’ local temperature were observed after bone drilling with a battery-powered drill device. Across all measurements, the median change in temperature between the initial measurement and the temperature measured after drilling (at 20 s) was 0.1 °C. Histological examination of the bone core specimens revealed no signs of mechanical or thermal damage. Conclusion Overall, this preliminary study shows that battery-powered, drill-assisted harvesting of bone core specimens does not appear to cause mechanical or thermal damage.

scholarly journals Results of surgical treatment of extrahepatic bile duct injuries

2020 ◽  
Vol 37 (1) ◽  
pp. 63-72
Author(s):  
L. P. Kotelnikova ◽  
I. G. Burnyshev ◽  
O. V. Bazhenova ◽  
D. V. Trushnikov
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Surgical Treatment ◽  
Bile Duct ◽  
Bile Ducts ◽  
Bile Leakage ◽  
Biliary Reconstruction ◽  
Long Term Outcomes ◽  
Endoscopic Retrograde ◽  
Extrahepatic Bile Ducts

Aim. To evaluate the short-and long-term outcomes after surgical repair of iatrogenic lesions of extrahepatic bile ducts depending on the timing of diagnosis in conditions of specialized clinic. Materials and methods. Our study involved a retrospective analysis of 159 patients who were treated for iatrogenic lesions of extrahepatic bile ducts during 1987-2017. These patients were divided into two groups depending on the timing of surgical treatments: early biliary reconstruction ( 5 days after bile duct transection) and late biliary reconstruction ( 5 days post-transection). These groups were compared on the basis of postoperative morbidity and long-term outcomes. Results. Following laparoscopic cholecystectomy, 2 patients received endoscopic retrograde stents due to bile leakage from the cystic ducts, and 14 patients underwent hepaticocholedochostomy using Ker drainage. The incidence of bile leakage was observed in 14. 3 % of cases during the early post-operative period, strictures appeared in 28.6 % of cases. Hepaticojejunostomy was performed in 91 cases: in 62 with stents and in 29 without stents. Bile leakage was observed in 17.6 % of cases, and strictures in 19.8 % of cases. Our statistical analyses revealed no significant differences between the two groups (i.e., early and late timing of surgical treatment) in the rates of bile leakage and strictures. The extent of surgeons experience in bile surgery significantly correlated with positive outcomes. Conclusions. Endoscopic retrograde stent proved to be an effective and fast solution in cases of bile leakage from cystic ducts following laparoscopic cholecystectomy. Although it is preferable to perform reconstructive surgeries within the first five days after bile duct injury, our results indicated that in the presence of external bile fistula without peritonitis and severe cholangitis, reconstructive surgery can be performed in specialized surgical departments later than 5 days with satisfactory results.

scholarly journals Evaluation of Efficacy of Free Opioid Anesthesia for Laparoscopic Cholecystectomy: A Prospective, Randomized Double-blinded Study

2020 ◽  
Vol 14 (1) ◽  
pp. 73-79
Author(s):  
Nguyen V. Luong ◽  
Nguyen T. Giang ◽  
Hoang V. Chuong ◽  
Nguyen M. Cuong ◽  
Ngo V. Dinh ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Lower Incidence ◽  
Early Postoperative Period ◽  
Military Hospital ◽  
Intraoperative Awareness ◽  
Intraoperative Hypotension ◽  
Anesthesia Group ◽  
Adequate Sedation ◽  
Double Blinded ◽  
A Prospective Study

Objectives: To evaluate efficacy and side effects of free opioid anesthesia for laparoscopic cholecystectomy. Methods: A prospective study was performed on 94 patients undergoing laparoscopic cholecystectomy in Military Hospital 103 from May 2018 to February 2019. These patients were randomly allocated into two groups: patients in FOA (free - opioid anesthesia) group were administered lidocaine (2 mg/kg before induction and 1.5 mg/kg/h for maintenance), magnesium (30 mg/kg before induction and 1.5 g infusion for maintenance) combined with Intravenous (IV) injection of ketamine (0.5 mg/kg), and ketorolac (30 mg); while patients in OA group (opioid anesthesia) were provided with IV fentanyl (5 mcg/kg for induction and 1.5 mcg/kg every 30 minutes for maintenance of anesthesia). Both groups received total intravenous anesthesia by propofol. The depth of anesthesia was monitored by the entropy module during surgery. Neuromuscular blockade was reversed by sugammadex 2 mg/kg at the end of surgery. The postoperative analgesia was delivered using IV fentanyl for 48 to 72 hours. Visual Analog Scale (VAS) score was measured 10 mins, 20 mins, 1 hour, 2 hours and 3 hours after surgery. Results: All patients had an excellent quality of anesthesia with RE (Respond Entropy), SE (State Entropy) always under 60 from induction to abdominal closure without intraoperative awareness and postoperative recall of the operation; 100% of the patients were extubated immediately after surgery. In the first three postoperative hours fentanyl consumption in Group FOA was significantly lower than in Group OA (31.91 ± 3.98 mcg versus 34.47 ± 7.17 mcg, p=0,035). In the OA group, the rate of intraoperative hypotension was higher compared to its counterpart. Despite the higher risk of hypersalivation, group FOA had a significantly lower incidence of nausea and vomiting. Conclusion: Free opioid anesthesia provided adequate sedation and amnesia and may be an alternative approach to opioid anesthesia for laparoscopic cholecystectomy. Patients under free opioid anesthesia experienced a lower incidence of intraoperative hypotension, lower rate of nausea, vomiting and lower demand for analgesia in the early postoperative period (0 - 3 h) compared to those receiving opioid anesthesia.

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