scholarly journals Smoke Evacuation During Laparoscopic Surgery: A Problem Beyond the COVID-19 Period. A Quantitative Analysis of CO2 Environmental Dispersion Using Different Devices

2021 ◽  
pp. 155335062110148
Author(s):  
Umberto Bracale ◽  
Vania Silvestri ◽  
Emanuele Pontecorvi ◽  
Immacolata Russo ◽  
Maria Triassi ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Quantitative Analysis ◽  
Flow Rate ◽  
Healthcare Professionals ◽  
Operative Time ◽  
Mean Value ◽  
Operating Theater ◽  
Surgical Smoke ◽  
Smoke Evacuation ◽  
Group A

Background. The COVID-19 pandemic leads to several debates regarding the possible risk for healthcare professionals during surgery. SAGES and EAES raised the issue of the transmission of infection through the surgical smoke during laparoscopy. They recommended the use of smoke evacuation devices (SEDs) with CO2 filtering systems. The aim of the present study is to compare the efficacy of different SEDs evaluating the CO2 environmental dispersion in the operating theater. Methods. We prospectively evaluated the data of 4 group of patients on which we used different SEDs or standard trocars: AIRSEAL system (S1 group), a homemade device (S2 group), an AIRSEAL system + homemade device (S3 group), and with standard trocars and without SED (S4 group). Quantitative analysis of CO2 environmental dispersion was carried out associated to the following data in order to evaluate the pneumoperitoneum variations: a preset insufflation pressure, real intraoperative pneumoperitoneum pressure, operative time, total volume of insufflated CO2, and flow rate index. Results. 16 patients were prospectively enrolled. The [CO2] mean value was 711 ppm, 641 ppm, 593 ppm, and 761 ppm in S1, S2, S3, and S4 groups, respectively. The comparison between data of all groups showed statistically significant differences in the measured ambient CO2 concentration. Conclusion. All tested SEDs seem to be useful to reduce the CO2 environmental dispersion respect to the use of standard trocars. The association of AIRSEAL system and a homemade device seems to be the best solution combining an adequate smoke evacuation and a stable pneumoperitoneum during laparoscopic surgery.

scholarly journals Laparoscopic Surgery in COVID-19 Era—Safety and Ethical Issues

Diagnostics ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. 673
Author(s):  
Dragos Serban ◽  
Catalin Gabriel Smarandache ◽  
Corneliu Tudor ◽  
Lucian Nicolae Duta ◽  
Ana Maria Dascalu ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Ethical Issues ◽  
Biologically Active ◽  
Published Data ◽  
Protective Equipment ◽  
Active Materials ◽  
Protective Measures ◽  
Surgical Smoke ◽  
Toxic Risk ◽  
Smoke Evacuation

(1) Background: The paper aims to review the available evidence regarding the health risk of the aerosolization induced by laparoscopy induced and impact of the COVID-19 pandemic upon minimally invasive surgery. (2) Materials and methods: A systematic review of the literature was performed on PubMed, Medline and Scopus until 10 July. (3) Results: Chemicals, carcinogens and biologically active materials, such as bacteria and viruses, have been isolated in surgical smoke. However, the only evidence of viral transmission through surgical smoke to medical staff is post-laser ablation of HPV-positive genital warts. The reports of SARS-CoV-2 infected patients who underwent laparoscopic surgery revealed the presence of the virus, when tested, in digestive wall and stools in 50% of cases but not in bile or peritoneal fluid. All surgeries did not result in contamination of the personnel, when protective measures were applied, including personal protective equipment (PPE) and filtration of the pneumoperitoneum. There are no comparative studies between classical and laparoscopic surgery. (4) Conclusions: Previously published data showed there is a possible infectious and toxic risk related to surgical smoke but not particularly proven for SARS-CoV-2. Implementing standardized filtration systems for smoke evacuation during laparoscopy, although increases costs, is necessary to increase the safety and it will probably remain a routine also in the future.

FACTORS INFLUENCING THE OPERATION TECHNIQUE OF PEFORATED DUODENAL ULCER REPAIR BY SINGLEPORT LAPAROSCOPIC SURGERY

2016 ◽  
pp. 99-105
Author(s):  
Huu Tri Nguyen ◽  
Loc Le ◽  
Doàn Van Phu Nguyen ◽  
Nhu Thanh Dang ◽  
Thanh Phuc Nguyen
Keyword(s):  
Duodenal Ulcer ◽  
Laparoscopic Surgery ◽  
Correlation Coefficient ◽  
Open Surgery ◽  
Operative Time ◽  
Single Port ◽  
Time Correlation ◽  
Patch Repair ◽  
Perforated Duodenal Ulcer ◽  
Conversion To Open Surgery

Background: Single-port laparoscopic surgery (SPLS) is increasingly used in surgery and in the treatment of perforated duodenal ulcer. The aim of this study was to evaluate technical factors for perforated duodenal ulcer repair by SPLS. Methods: A prospective study on 42 consecutive patients diagnosed with perforated duodenal ulcer and treated with SPLS at Hue university of medicine and pharmacy hospital and Hue central hospital from January 2012 to February 2015. Results: The mean age was 48.1 ± 14.2 (17 - 79) years. 40 patients were treated with suture of the perforation by pure SPLS. There was one case (2.4%) in which one additional trocar was required. Conversion to open surgery was necessary in one patient (2.4%) in which the perforation was situated on the posterior duodenal wall. Two patients (4.8%) with history of abdominal surgery were successfully treated by pure SPLS. The size of perforation was correlated with suturing time (correlation coefficient r = 0.459) and operative time (correlation coefficient r = 0.528). Considering suture type, X stitches were used in 95.5% cases, simple stitches were used in one case (2.4%) while Graham patch repair technique was utilized in one case (2.4%) with large perforation. Most cases (95.1%) required only simple suture without omental patch. Peritoneal drainage was spared in most cases (90.2%). Conclusions: SPLS is a safe method for the treatment of perforated duodenal ulcer. Posterior duodenal location is the main cause of conversion to open surgery. Factor related to operative time is perforation size. Key words: perforated duodenal ulcer, single port laparoscopic repair, single port laparoscopy

scholarly journals Laparoscopic surgery during the COVID-19 pandemic: detection of SARS-COV-2 in abdominal tissues, fluids, and surgical smoke

2021 ◽  
Author(s):  
Isaac Cheruiyot ◽  
Prabjot Sehmi ◽  
Brian Ngure ◽  
Musa Misiani ◽  
Paul Karau ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Surgical Smoke

scholarly journals Securing the surgical field for mobilization of right-sided colon cancer using the duodenum-first multidirectional approach in laparoscopic surgery

2021 ◽  
Author(s):  
K. Nagayoshi ◽  
S. Nagai ◽  
K. P. Zaguirre ◽  
K. Hisano ◽  
M. Sada ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Laparoscopic Surgery ◽  
Postoperative Complications ◽  
Blood Loss ◽  
Operative Time ◽  
Right Colectomy ◽  
R0 Resection ◽  
Medial Approach ◽  
Total Operative Time ◽  
Advanced Tumors

Abstract Background The aim of this study was to compare the short-term outcomes of the duodenum-first multidirectional approach (DMA) in laparoscopic right colectomy with those of the conventional medial approach to assess its safety and feasibility. Methods This retrospective study enrolled 120 patients who had laparoscopic surgery for right-sided colon cancer in our institution between April 2013 and December 2019. Fifty-four patients underwent colectomy using the multidirectional approach; among these, 20 underwent the DMA and 34 underwent the caudal-first multidirectional approach (CMA). Sixty-six patients underwent the conventional medial approach. Complications within 30 days of surgery were compared between the groups. Results There were 54 patients in the multidirectional group [29 females, median age 72 years (range 36–91 years)] and 66 in the medial group [42 females, median age 72 years (range 41–91 years)]. Total operative time was significantly shorter in multidirectional approach patients than conventional medial approach patients (208 min vs. 271 min; p = 0.01) and significantly shorter in patients who underwent the DMA compared to the CMA (201 min vs. 269 min; p < 0.001). Operative time for the mobilization procedure was also significantly shorter in patients who underwent the DMA (131 min vs. 181 min; p < 0.001). Blood loss and incidence of postoperative complications did not differ. In 77 patients with advanced T3/T4 tumors, the DMA, CMA, and conventional medial approach were performed in 13, 21, and 43 patients, respectively. Total operative time and operative time of the mobilization procedure were significantly shorter in patients undergoing DMA. Blood loss and incidence of postoperative complications did not differ. R0 resection was achieved in all patients with advanced tumors. Conclusions The DMA in laparoscopic right colectomy is safe and feasible and can achieve R0 resection with a shorter operative time than the conventional medial approach, even in patients with advanced tumors.

scholarly journals Precisely Closed Reduction of Nasal Bone Fracture Assisted With Plain Film Measurements Under the Picture Archiving and Communication System

2021 ◽  
pp. 014556132110121
Author(s):  
Tzu-Hsien Yang ◽  
Chien-Liang Fang ◽  
Chong-Bin Tsai ◽  
Ming-Shan Chen ◽  
Chih-Hsuan Changchien ◽  
...  
Keyword(s):  
Bone Fracture ◽  
Communication System ◽  
Closed Reduction ◽  
Operative Time ◽  
Nasal Bone ◽  
Plain Film ◽  
Ao Classification ◽  
Group A ◽  
Picture Archiving And Communication ◽  
Group B

Objectives: To prevent aesthetic and functional deformities, precisely closed reduction is crucial in the management of nasal fractures. Plain film radiography (PF), ultrasonography (USG), and computed tomography can help confirm the diagnosis and classification of fractures and assist in performing closed reduction. However, no study in the literature reports on precisely closed reduction assisted with PF measurements under the picture archiving and communication system (PACS). Methods: We retrospectively evaluated 153 patients with nasal bone fracture between January 2013 and December 2017. Surgeons conducted precisely closed reduction assisted with PF measurement of the distance between the fracture site and nasal tip under PACS on 34 patients (group A). Another group on 119 patients were reduced under surgeon’s experience (group B). Results: No significant differences in age, gender, Arbeitsgemeinschaft fur Osteosynthesefragen (AO) classification, and reduction outcome were observed between group A and group B ( P > .05). The operative time of the group A was significantly lower (12.50 ± 4.64 minutes) compared to group B (23.78 ± 11.20 minutes; P < .001). After adjusted age, gender, and AO classification, patients in group A scored 10.46 minutes less on the operative time than those in group B ( P < .001). In addition, the severity of nasal bone fracture (AO classification, β = 3.37, P = .002) was positive associated with the operative time. Conclusions: In this study, closed reduction in nasal bone fracture assisted with PF measurements under PACS was performed precisely, thereby effectively decreasing operative time and the occurrence of complications. This procedure requires neither the use of new instruments or C-arm nor USG or navigation experience. Moreover, reduction can be easily performed using this method, and it requires short operative time, helps achieve great reduction, less radiation exposures, and is cost-effective.

scholarly journals Numerical and Experimental Analysis of Flow and Pulsation in Hump Section of Siphon Outlet Conduit of Axial Flow Pump Device

2021 ◽  
Vol 11 (11) ◽  
pp. 4941
Author(s):  
Fan Yang ◽  
Yiqi Zhang ◽  
Yao Yuan ◽  
Chao Liu ◽  
Zhongbin Li ◽  
...  
Keyword(s):  
Flow Field ◽  
Flow Rate ◽  
Vortex Structure ◽  
Pressure Fluctuation ◽  
Axial Flow ◽  
Mean Value ◽  
Hydraulic Loss ◽  
Pressure Amplitude ◽  
Measuring Point ◽  
Outlet Conduit

In order to study the variation law of the flow field and pressure fluctuation in the hump section of the siphon outlet conduit, the flow field characteristics and frequency spectrum characteristics of the flow field were analyzed by combining a physical model test and numerical simulation under the conditions of the interaction between the axial flow pump and siphon outlet conduit, and the influence of the residual circulation at the outlet of the guide vane on the siphon outlet flow was investigated. Based on the influence of the flow field and hydraulic loss in the conduit, the equivalent surface method based on the Q criterion was used to analyze the vortex structure in the siphon outlet conduit and to analyze the internal vortex state. The results showed that with the increase of the flow rate, the intensity of the vortices in the cross-section of the hump section of the siphon outlet conduit decreased gradually, the average velocity circulation decreased gradually and the axial velocity distribution uniformity increased and tended to be stable; water flow stratification existed under three characteristic conditions with no circulation, and the hydraulic loss was greater with the circulation flow while it had a circulation under the small flow condition. Under the low flow rate conditions, the hydraulic loss was 6.6 times higher under the condition of circulation than without. Under a high flow condition, it was 1.3 times. Under the condition of a small flow rate, the vortex structure was distributed centrally at the inlet of the flow conduit, and under the other two characteristic conditions, the vortex structure mostly appeared as a strip; the pressure fluctuation in the hump section had obvious periodicity, and with the increase of the flow rate, the maximum pressure fluctuation amplitude in the hump section decreased gradually; with the decrease of the rotational speed, the pressure amplitude at the same measuring point in the hump section decreased gradually and at the optimum condition. Under the following conditions, the mean value of the pressure amplitude at the top of the hump section was reduced by 69.63%, and the mean value of the pressure amplitude at the bottom of the hump section was reduced by 63.5%. Under all the calculation conditions, the main frequency of pulsation at each measuring point of the hump section was twice the frequency of the rotation.

scholarly journals The effect of nano-hydroxyapatite/chitosan scaffolds on rat calvarial defects for bone regeneration

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Emmanouil Chatzipetros ◽  
Spyros Damaskos ◽  
Konstantinos I. Tosios ◽  
Panos Christopoulos ◽  
Catherine Donta ◽  
...  
Keyword(s):  
Bone Regeneration ◽  
Mean Value ◽  
Parietal Bone ◽  
Female Rats ◽  
Sprague Dawley ◽  
Post Surgery ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
The Right

Abstract Background This study aims at determining the biological effect of 75/25 w/w nano-hydroxyapatite/chitosan (nHAp/CS) scaffolds on bone regeneration, in terms of fraction of bone regeneration (FBR), total number of osteocytes (Ost), and osteocyte cell density (CD), as well as its biodegradability. Methods Two critical-size defects (CSDs) were bilaterally trephined in the parietal bone of 36 adult Sprague-Dawley rats (18 males and 18 females); the left remained empty (group A), while the right CSD was filled with nHAp/CS scaffold (group B). Two female rats died postoperatively. Twelve, 11, and 11 rats were euthanized at 2, 4, and 8 weeks post-surgery, respectively. Subsequently, 34 specimens were resected containing both CSDs. Histological and histomorphometric analyses were performed to determine the FBR, calculated as [the sum of areas of newly formed bone in lateral and central regions of interest (ROIs)]/area of the original defect, as well as the Ost and the CD (Ost/mm2) in each ROI of both groups (A and B). Moreover, biodegradability of the nHAp/CS scaffolds was estimated via the surface area of the biomaterial (BmA) in the 2nd, 4th, and 8th week post-surgery. Results The FBR of group B increased significantly from 2nd to 8th week compared to group A (P = 0.009). Both the mean CD and the mean Ost values of group B increased compared to group A (P = 0.004 and P < 0.05 respectively). Moreover, the mean value of BmA decreased from 2nd to 8th week (P = 0.001). Conclusions Based on histological and histomorphometric results, we support that 75/25 w/w nHAp/CS scaffolds provide an effective space for new bone formation.

scholarly journals Outcomes of Ureteroscopy and Laser Stone Fragmentation (URSL) for Kidney Stone Disease (KSD): Comparative Cohort Study Using MOSES Technology 60 W Laser System versus Regular Holmium 20 W Laser

2021 ◽  
Vol 10 (13) ◽  
pp. 2742
Author(s):  
Amelia Pietropaolo ◽  
Thomas Hughes ◽  
Mriganka Mani ◽  
Bhaskar Somani
Keyword(s):  
Operative Time ◽  
Laser System ◽  
Stone Fragmentation ◽  
System Versus ◽  
Number Of Patients ◽  
Higher Power ◽  
Group A ◽  
The Mean ◽  
Laser Group ◽  
Second Procedure

Background: For ureteroscopy and laser stone fragmentation (URSL), the use of laser technology has shifted from low power to higher power lasers and the addition of Moses technology, that allows for ‘fragmentation, dusting and pop-dusting’ of stones. We wanted to compare the outcomes of URSL for Moses technology 60 W laser system versus matched regular Holmium 20 W laser cases. Methods: Prospective data were collected for patients who underwent URSL using a Moses 60 W laser (Group A) and matched to historical control data using a regular Holmium 20 W laser (Group B), performed by a single surgeon. Data were collected for patient demographics, stone location, size, pre- and post-operative stent, operative time, length of stay, complications and stone free rate (SFR). Results: A total of 38 patients in each group underwent the URSL procedure. The stones were matched for their location (17 renal and 11 ureteric stones). The mean single and cumulative stone sizes (mm) were 10.9 ± 4.4 and 15.5 ± 9.9, and 11.8 ± 4.0 and 16.5 ± 11.3 for groups A and B, respectively. The mean operative time (min) was 51.6 ± 17.1 and 82.1 ± 27.0 (p ≤ 0.0001) for groups A and B. The initial SFR was 97.3% and 81.6% for groups A and B, respectively (p = 0.05), with 1 and 7 patients in each group needing a second procedure (p = 0.05), for a final SFR of 100% and 97.3%. While there were 2 and 5 Clavien I/II complications for groups A and B, none of the patients in group A had any infection related complication. Conclusions: Use of Moses technology with higher power was significantly faster for stone lithotripsy and reduced operative time and the number of patients who needed a second procedure to achieve a stone free status. It seems that the use of Moses technology with a mid-power laser is likely to set a new benchmark for treating complex stones, without the need for secondary procedures in most patients.

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