scholarly journals Veress needle versus direct trocar entry for laparoscopy: a retrospective study

Author(s):  
Sushma Sinha ◽  
Surya Malik

Background: The aim of this paper is to compare the outcomes of veress needle entry versus direct trocar for laparoscopy in terms of the duration of the procedure, ease of performance and the complications encountered during each technique.Methods: The present study was conducted on a retrospective basis from April ‘2008 to September 2017, in the dept of Obstetrics and Gynecology, in a 100 bedded hospital, ABGH hospital. All the cases who underwent laparoscopic ligation procedure during this time were taken into account. From 2008 to 2012 traditional technique of veress needle entry was used for access(group -1) but it had been switched over to direct trocar since 2013(group -2) These two groups were compared in terms of the demographic profile, duration of procedure, previous h/o surgical interventions ,ease of performance and various complications encountered during the procedure.Results: The total number of patients who underwent ligation during this period were 1912, which were divided into two groups ,till 2012(veress needle entry group,group-1) 754 patients(39.44%),and after 2012 (direct trocar,group -2) 1158 patients(60.56%).Duration of procedure was 4.5±1.2 min in group 1 which was significantly higher than group 2,2.2±0.8 min(p-value <0.001).Amount of gas required was greater in group 1, 4.9±1.3 lts as compared to group 2,2.4±0.5lts.Conclusions: Direct trocar entry is a reliable alternative to traditional technique for pneumoperitoneum establishment and should be regarded as a part of the surgical armamentarium of a trained laparoscopic surgeon.

MedAlliance ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 8-14

SummaryIntroduction. With the ongoing COVID-19 pandemic, finding new treatments is an extremely important issue. The effectiveness of heliox was previously demonstrated in the complex treatment of patients with various bron-chopulmonary pathologies. Therefore, this method has been recommended for the treatment of pneumonia associated with COVID-19. Purpose. To study the safety and efficacy of inhaled heliox therapy in the treatment of pneumonia in COVID-19. Materials and methods. A sing-le-center prospective study was carried out for the period from 01.12.2020 to 15.02.2021. The study included 91 pa-tients. The patients were divided into two groups: group 1 (using heliox) included 46 people, and group 2 (con-trol) — 45. Inhalations of a heated oxygen-helium mixture heliox (70% helium, 30% oxygen) were carried out using “Ingalit-B2-01” inhaler. Objective (saturation, O2 flow) and laboratory parameters (lactate dehydrogenase, C-reactive protein), as well as chest organs CT data were studied. Differences between groups were determined using the χ2 test, as well as the Mann–Whitney U-test. The p value <0.05 was considered significant. Results. In group 1, side effects developed in 5 (11.3%) patients. These patients refused to further participate in the study. Final number of patients in group 1 — 41. Among patients of group 1, there was a tendency towards a more rapid normalization of lactate dehydrogenase and C-reactive protein, as well as a decrease in oxygen dependence. In group 1, according to CT data, no progression of pneumonia was recorded. In group 2, progression was observed in 6 (13.3%) patients. The overall effectiveness of treatment among patients in group 1 was 100%, among patients in group 2 — 86.7%. The differences between the groups are statistically sig-nificant (p=0.02). Conclusion. The use of inhalations with a heated oxygen-helium mixture heliox (30% oxygen, 70% helium) has shown its effectiveness and safety in the treatment of viral pneumonia (CT1- 2) associated with COVID-19.


Author(s):  
Uğurkan Erkayıran ◽  
Bülent Köstü ◽  
Alev Özer

Background: To compare cranial 15º angulation of Veres needle to classic Veress needle entry in closed laparoscopic entry in obese patients. Method: Patients with BMI index>30 were divided into two groups. Initial entry into the abdomen in Group 1 (n=29) was performed with the intraumbilical insertion of Veress needle in 90o angle relative to the horizontal plane. In Group 2 (n=31) the Veress needle was placed intraumbilically in a cranial direction, the tip of the needle towards the thoracic cavity, with an angle of 15o to the horizontal plane. Two groups were compared with respect of the operative outcomes. Results: In Group 2, the mean number of Veress needle entries attempt was significantly lower than Group 1 (p=0.01). Time to insertion of the Veress needle was found to be significantly shorter in Group 2 than in Group 1 (p<0.001). While entry failure occurred in 3 patients in Group 1 (10.3%), no failures were monitored in any patients in Group 2 (p= 0.01). Complication rate was significantly lower in Group 2 than in Group 1 (p= 0.03). Conclusion: Placement of Veress needle intraumbilically in a cranial direction at 15°angle to the horizontal plane increases entry success and reduces complications.


2021 ◽  
Vol 43 (5-6) ◽  
pp. 103-110
Author(s):  
A.K. Prasath ◽  
Senthil Kumar ◽  
Mohanhariraj Angamuthammal ◽  
Agnes Evangleen

Introduction: Laparoscopic cholecystectomy is considered minimally invasive, but pain following laparoscopy is moderate to severe, leading to increased morbidity and length of hospital stay. Various medications, including opioids, NSAIDs, and techniques like intraperitoneal local anesthetic infiltration, are used. In this study, we investigated interpleural block with bupivacaine for pain relief following laparoscopic cholecystectomy. Methods: A total of 60 patients were included in the study. 30 patients received 20 ml of 0.5% interpleural bupivacaine (group 1), and 30 patients recieved 20 ml of 0.9% normal saline (group 2). We recorded visual analog score (VAS), vital signs, and postoperative opioid requirements. Tramadol (2 mg/kg) was rescue medication if VAS ≥ 5. Results: Significant difference between study groups was recorded among VAS scores measured at 30 minutes, 1, 2, 6, 10, and 12 hours (p value < 0.05). The difference in VAS scores at 15 minutes and 14 hours between study groups was insignificant (p value > 0.05). The number of patients who received tramadol was 9 (30%) patients in group 1 and 29 (96.7%) patients in group 2. The difference in proportion for tramadol intake at 6 hours was significant among study groups (p-value < 0.05). Conclusion: Interpleural bupivacaine 20 ml of 0.5% used as analgesia reduces post-operative opioid requirement following laparoscopic cholecystectomy. Hence interpleural block can be safely used as a regional technique for pain relief following laparoscopic cholecystectomy.


2020 ◽  
Vol 27 (11) ◽  
pp. 2478-2482
Author(s):  
Nisa Mohsin

Department of Obstetrics and Gynecology, Isra University Hospital Sindh Pakistan. Objectives: To compare the efficacy of clomiphene citrate versus letrozole in attaining optimum follicular growth among infertile women of reproductive age group in Isra University Hospital Hyderabad. Study Design: Randomized Controlled trial. Setting: Department of Obstetrics and Gynecology, Isra University Hospital Sindh, Pakistan. Period: May 2016 to November 2016. Material & Methods: A total of 128 women with anovulation due to known endocrine disorders were included in this study. These were randomly allocated in group 1 and 2. Group 1 consisted of 64 women received 50mg of clomiphene citrate and 64 in group 2, treated with letrozole. Proformas were filled and results regarding the drug achieving follicular diameter of >18mm by Trans abdominal Ultrasound in maximum number of women in any of the group was supervised by consultant gynecologist practicing for more than 10 years. Stastical analysis was done using SPSS version 19.The average age of women was 27.21+3.21. Number of patients with primary infertility were 60 (93.8%) and 57 (89.1%) in group 1 and 2 respectively while secondary infertility was observed in 4 (6.3%) and 7(10.9%) in group 1 and 2 respectively. Regarding endocrine disorders, 34 (26.6%) were polycystic ovaries and 35(27.3%) hypothalamic. Results: The average age of women was 27.21±3.21 years. Efficacy was significantly high in clomiphene citrate (group 1) as compared to letrozole (group 2) [92.19% vs 79.69%; p=0.042]. Conclusion: This study demonstrates that clomiphene citrate is superior to letrozole as an inducer of ovulatory cycles. However there is need for larger well designed randomized trials to generate robust data in order to establish the true potential of clomiphene.


2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
E Pilichowska ◽  
J Baran ◽  
P Kulakowski ◽  
B Zaborska

Abstract PURPOSE Left atrial (LA) fibrosis is the hallmark of LA remodeling in atrial fibrillation (AF), alters LA function and may predict poor catheter ablation (CA) outcome. LA fibrosis may be assessed invasively using electroanatomical mapping (EAM) during electrophysiological study. The aim was to assess LA function parameters in relation to degree of LA fibrosis derived from EAM in patients with AF. METHODS Patients (pts) n = 39 (79% males, mean age 56+/-10) with non-valvular AF were studied with TTE and TEE before first CA during sinus rhythm. LA strain (LAS) and strain rate (LASR) were analyzed in reservoir (r), conduit (cd) and contractile (ct) phases. The velocities of mitral A, E" and A" were measured with Doppler. E/E" and LA stiffness index - the ratio of E/E" to LASr were assessed. LA appendage flow velocity (LAAv) was measured in TEE. LA volume using biplane area-length method was calculated. The EAM of LA was build using Carto System before CA. Low amplitude potentials area (LAPA) was quantitatively analyzed and expressed as a percentage of LA surface using the cut-off &lt;0.5 mV to detect sites of fibrosis. LA parameters were compared between mild (LAPA &lt;10%) moderate (LAPA 10-40%) and extensive degree of LA fibrosis (LAPA &gt;40%) (table). RESULTS The mean LA volume was 35 ± 11 mL/m². The LAPA ranged from 2 to 78 % of LA surface. Reduced LA function was observed in the LAPA &gt;40% group. Extensive LAPA altered mainly LA compliance parameters. Traditional LA systolic function parameters did not differ in relation to degree of LAPA. CONCLUSION LA compliance is mostly affected by LA fibrosis, thus LA diastolic parameters may be useful in the noninvasive assessment of LA fibrosis. Whether these parameters should be a part of the proper selection of candidates for CA requires further studies. LA function parameters LA parameters Group 1 LAPA &lt;10% n = 13 Group 2 LAPA &gt;10% &lt;40% n = 13 Group 3 LAPA &gt;40% n = 13 P-value Group 1 + 2 vs 3 Mitral A 0.55 ± 0.10 0.55 ± 0.24 0.73 ± 0.32 0.077 A" 9.19 ± 1.74 7.85 ± 1.43 7.92 ± 2.40 0.376 LASr 31.48 ± 4.52 26.48 ± 8.79 19.63 ± 6.76 &lt;0.001 LAScd 17.30 ± 3.05 15.44 ± 6.93 10.91 ± 4.04 0.003 LASct 14.18 ± 5.36 11.05 ± 3.67 8.72 ± 4.78 0.024 LASRr 1.22 ± 0.19 1.24 ± 0.21 0.92 ± 0.20 &lt;0.001 LASRct -1.71 ± 0.46 -1.37 ± 0.34 -1.04 ± 0.33 &lt;0.001 LA stiffness 0.20 ± 0.07 0.34 ± 0.17 0.63 ± 0.29 &lt;0.001 LAAv 0.83 ± 0.18 0.55 ± 0.17 0.60 ± 0.16 0.178


2020 ◽  
pp. 105566562098023
Author(s):  
Ashwina S. Banari ◽  
Sanjeev Datana ◽  
Shiv Shankar Agarwal ◽  
Sujit Kumar Bhandari

Objectives: To compare nasal and upper airway dimensions in patients with cleft lip and palate (CLP) who underwent nasoalveolar molding (NAM) with those without NAM during infancy using acoustic pharyngometry and rhinometry. Materials and Methods: Eccovision acoustic pharyngometry and rhinometry (Sleep Group Solutions) was used for assessment of mean area and volume of nasal and upper airway in patients with complete unilateral CLP (age range 16-21 years) treated with NAM (group 1, n = 19) versus without NAM (group 2, n = 22). Results: The mean nasal cross-sectional areas and volume were higher in group 1 compared to group 2 on both cleft ( P value <.001) and noncleft side ( P value >.05). The mean area and volume of upper airway were also significantly higher in group 1 compared to group 2 ( P value <.05). Conclusions: Nasoalveolar molding being one of the first interventions in chronology of treatment of patients with CLP, its long-term outcome on nasal and upper airway patency needs to be ascertained. The results of the present study show that the patients with CLP who have undergone NAM during infancy have better improvement in nasal and upper airway patency compared with those who had not undergone NAM procedure. The basic advantages of being noninvasive, nonionizing and providing dynamic assessment of nasal and upper airway patency make acoustic pharyngometry and rhinometry a diagnostic tool of choice to be used in patients with CLP.


2021 ◽  
Vol 12 ◽  
pp. 215145932110096
Author(s):  
Christina Polan ◽  
Heinz-Lothar Meyer ◽  
Manuel Burggraf ◽  
Monika Herten ◽  
Paula Beck ◽  
...  

Background: The COVID-19 pandemic is challenging healthcare systems worldwide. This study examines geriatric patients with proximal femur fractures during the COVID-19 pandemic, shifts in secondary disease profile, the impact of the pandemic on hospitalization and further treatment. Methods: In a retrospective monocentric study, geriatric proximal femur fractures treated in the first six months of 2020 were analyzed and compared with the same period of 2019. Pre-traumatic status (living in a care home, under supervision of a legal guardian), type of trauma, accident mechanism, geriatric risk factors, associated comorbidities, time between hospitalization and surgery, inpatient time and post-operative further treatment of 2 groups of patients, aged 65-80 years (Group 1) and 80+ years (Group 2) were investigated. Results: The total number of patients decreased (70 in 2019 vs. 58 in 2020), mostly in Group 1 (25 vs. 16) while the numbers in Group 2 remained almost constant (45 vs. 42). The percentage of patients with pre-existing neurological conditions rose in 2020. This corresponded to an increase in patients under legal supervision (29.3%) and receiving pre-traumatic care in a nursing home (14.7%). Fractures were mostly caused by minor trauma in a home environment. In 2020, total number of inpatient days for Group 2 was lower compared to Group 1 (p = 0.008). Further care differed between the years: fewer Group 1 patients were discharged to geriatric therapy (69.6% vs. 25.0%), whereas in Group 2 the number of patients discharged to a nursing home increased. Conclusions: Falling by elderly patients is correlated to geriatric comorbidities, consequently there was no change in the case numbers in this age group. Strategic measures to avoid COVID-19 infection in hospital setting could include reducing the length of hospital stays by transferring elderly patients to a nursing home as soon as possible and discharging independent, mobile patients to return home.


2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
K Banerjee ◽  
B Singla

Abstract Study question To assess the role of subcutaneous granulocyte colony-stimulating factor (G-CSF) in thin endometrium cases. Summary answer G CSF has beneficial role to improve the endometrium thickness in thin endometrium. What is known already Endometrium is very important for embryo implantation and the endometrial thickness is the marker of receptivity of the endometrium. Study design, size, duration Study design - Retrospective analysis Size - 88 infertile females with thin endometrium (&lt; 7 mm) in the age group of 23 to 40 years Duration - one year. Participants/materials, setting, methods In the group 1 of 44 females, subcutaneous infusion of G CSF (300 mcg/ml) was added along with other supplements and if lining was not more than 7 mm in 72 hours, then second infusion was given. In the group 2 of 44 females, only estradiol valerate and sildenafil were given.The efficacy of G CSF was evaluated by assessing the endometrium thickness before embryo transfer, pregnancy rates and clinical pregnancy rates. Main results and the role of chance There was no difference between the two groups regarding demographic variables, egg reserve, sperm parameters, number of embryos transferred and embryo quality. . The pregnancy rate was 60% (24 out of 40 cases) in the group 1 that was significantly higher than in-group 2 that was 31% (9 out of 29 cases) with p value &lt; 0.0001. The clinical pregnancy rate was also significantly higher in-group 1 (55%) as compared to group 2 (24%) with p value &lt; 0.0001. Limitations, reasons for caution Further larger cohort studies are required to explore the subcutaneous role of G CSF in thin endometrium. Wider implications of the findings: Granulocyte colony-stimulating factor has beneficial role to improve the endometrium thickness in thin endometrium. In most of previous studies, the intrauterine infusion of G CSF was given to improve the uterine lining. This is one of the few studies done that showed subcutaneous role of G CSF in thin endometrium. Trial registration number Not applicable


QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Basma Helal Mohamed ◽  
Othman Ali Othman Ziko ◽  
Hisham M Khairy Abd El Dayem ◽  
Nancy Ezzelregal Khamis Ahmed

Abstract Purpose to compare between recurrence incidence after primary pterygium excision when using preoperative subconjunctival injection of Bevacizumab (Avastin) and using it as a postoperative eye drops. Methods thirty two eyes of thirty patients (two patients had bilateral pterygium) with primary pterygia were clinically examined, classified into 3 groups and operated by simple excision with bare sclera technique. Group 1 included 10 patients received Bevacizumab (Avastin) in the form of eye drops (10 mg/ml) 3 times daily for 6 days postoperative. Group 2 included 10 patients received preoperative Bevacizumab in the form of subconjunctival injection (1.25 mg/0.05ml) single dose 1 week preoperative. Group 3 included 10 patients (12 eyes) 2 patients with bilateral Pterygium didn’t receive any form of Bevacizumab. Postoperative follow up was done clinically and by serial photography at 1 week, 1 month, 3 months and 6 months searching for signs of recurrence and/or complications. Results The results showed different grades of recurrence in 18 eyes of 32.True recurrence was seen in 7 patients of 18 (1 patient in group 1, 2 in group 2 and 4 in group3).Recurrence grades in group 1and 2 who used the Bevacizumab (20%grade II, 50% grade III, and 30% grade IV). Recurrence could be predicted by 100% depending on fibrovascular tissue appearing in the surgical bed at 3 months postoperative (P value 0.038).Preoperative fleshy pterygium has high statistical significance in realation to recurrence(P value = 0.006).Patient’s sex, residence and occupation had no statistically significant value in the process of recurrence (P value &gt; 0.05). Patients with recurrent Pterygia (in group 1&2) had statistically significant changes in the corneal K- readings at 3 months and 6 months.No significant difference in the limbal or central corneal thickness in the operated eye and the other eye (Pvalue &gt; 0.05). Conclusion Bevacizumab (Avastin) is a well tolerated drug with multiple drug delivery methods.The eye drops give better results than the subconjunctival injection.Appearance of fibrovascular tissue in the surgical bed at 3 months predict the recurrence by 100%. Preoperative fleshy pterygia will mostly recur again whatever Bevacizumab form was used .The corneal thickness by anterior segment OCT has no role in prediction or detection of early pterygium recurrence.


2020 ◽  
Author(s):  
Fikret Salık ◽  
Mustafa Bıçak ◽  
Hakan Akelma

Abstract Background Although regional techniques have been suggested more in order to provide postoperative analgesia in inguinal hernia repairs, the ideal method is still controversial. The aim of this study was to evaluate the effect of preemptive transversus abdominis plane (TAP) block, local anesthetic infiltration (LAI) and intravenous dexketoprofen (IVD) on postoperative pain in inguinal hernia repairs. Methods This prospective study included 120 patients with American Society of Anesthesiologists status 1-3 between 18-75 years of age who undergoing elective inguinal hernia surgery under spinal anesthesia. The patients were allocated into three groups: USG-guided TAP block (Group 1, n = 40), USG-guided LAI (Group 2, n = 40) and IVD (Group 3, n = 40) before surgical incision. The mean of tramadol consumption, number of patients in requiring rescue analgesics, duration of postoperative analgesia and complications were recorded for 24 hours postoperatively. VAS scores were evaluated at the 30 minute, 1, 2, 4, 8, 12, 16 and 24th hours. Results There was no significant difference between the postoperative mean tramadol consumption [Group 1: 22.5 mg; Group 2: 20 mg; Group 3: 27.5 (p 0.833)]. The number of patients requiring rescue analgesics was statistically similar (p 0.787). VAS scores at 30. min, 1, 2, 4, 8 and 12 hours were statistically lower in Group 1 than in the other groups (p 0.003, 007, 0013, 0049, 0015, 0021). VAS scores at 30. min and 2. h were lower in Group 1 than Group 2 (p 0.049, 0.037). İn addition, VAS scores at 30 min, 1, 2, 8 and 12 hours were lower in Group 1 than in Group 3 (p 0.003, 0.006, 0.021, 0.017, 0.016). VAS scores at all hours were statistically similar between Group 2 and Group 3. Conclusion This study demonsrated that preemptive transversus abdominis plane block, local anesthetic infiltration or iv dexketoprofen for postoperative analgesia in inguinal hernia repairs had similar effects on postoperative tramadol consumption and number of requiring rescue analgesic patients. However, TAP block provides lower VAS values and excellent analgesia in more patients in the first 24 hours postoperatively.


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