Comparative study of modified open technique and closed technique for primary trocar insertion in laparoscopic surgery

Purpose: To compare long-term patency and limb survival rates for the classical in situ surgical bypass procedure versus a minimally invasive technique for femorodistal revascularization. Methods: From May 1992 to June 1994, a prospective multicenter study was undertaken at 4 centers to evaluate the open versus closed technique for femorodistal bypass grafting. Of 97 patients enrolled in the trial, 73 patients (49 men; mean age 71 years) were assigned to the long-term follow-up protocol and prospectively randomized to the open (n = 38) or closed (n = 35) procedure. The classical open technique is characterized by a long incision over the length of the bypass graft, while the minimally invasive procedure involves only two short incisions over each anastomosis site (the side branches are closed with a coaxial embolization catheter system). Graft patency was evaluated with duplex imaging periodically throughout the 4-year observation period. Results: There was no statistically significant difference between the treatment groups with respect to age, sex, hypertension, ischemic heart disease, or smoking. However, the open group had a significantly greater incidence of diabetes (p = 0.037). Over a median 4.7-year follow-up (range 0.3–6.4), 9 (12%) patients (3 open and 6 closed) were lost to follow-up: 2 died and 7 refused the duplex examination. No significant differences in 4-year patency, limb salvage, or survival was demonstrated between the open versus closed treatment groups; 4-year secondary patency was 62% versus 64%, respectively, and limb salvage was 72% versus 86%. Conclusions: The closed technique for femorodistal in situ bypass procedures yields favorable long-term outcomes compared to the traditional open technique.

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A comparative study to ascertain the efficacy of intravenous dexmedetomidine versus intravenous tramadol to prevent post-operative shivering after laparoscopic surgery

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20192082 ◽

2019 ◽

Vol 6 (3) ◽

pp. 713

Author(s):

Kishore K. ◽

Syed Ali Aasim ◽

Manish Kumar J.

Keyword(s):

Laparoscopic Surgery ◽

Side Effects ◽

Comparative Study ◽

General Anaesthesia ◽

Power Number ◽

Group Iii ◽

Group I ◽

Number Of Patients ◽

Envelope Method ◽

Level Of Significance

Background: Shivering is commonly encountered both after regional and general anaesthesia (GA) with a little higher incidence in patients receiving GA. The aim of study was to compare the effectiveness of dexmedetomidine and tramadol in decreasing postoperative shivering in patients undergoing laparoscopic surgery.Methods: Total 120 patients were included in this study. In order to get a 5% level of significance and 80% power number of patients required in each group was 40, with a total of 120 patients. Randomization of groups was done based on closed envelope method. Patients were allocated into three groups group I, II and III of 40 patients each. Patients in group I and group II were administered 0.75 μg/kg of dexmedetomidine and 1.5 mg /kg of tramadol in 100 ml NS respectively half a before extubation, while patients in group III did not receive any pharmacological intervention.Results: All three groups were comparable regarding distribution of age, gender, ASA grade and temperature at beginning and end of surgery and were non-significant.Conclusions: Dexmedetomidine seems to possess anti-shivering properties and was found to reduce the occurrence of shivering in patients undergoing general anaesthesia with minimal side effects although its anti-shivering effect was not superior to tramadol.

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Peer Review #2 of "Management of recurrent ureteral stricture: a retrospectively comparative study with robot-assisted laparoscopic surgery versus open approach (v0.1)"

10.7287/peerj.8166v0.1/reviews/2 ◽

2019 ◽

Keyword(s):

Laparoscopic Surgery ◽

Comparative Study ◽

Peer Review ◽

Ureteral Stricture ◽

Open Approach ◽

Robot Assisted

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Principles and Techniques of Abdominal Access and Physiology of Pneumoperitoneum

10.2310/vasc.2203 ◽

2018 ◽

Author(s):

Jon C. Gould ◽

Kathleen Simon

Keyword(s):

Laparoscopic Surgery ◽

Incisional Hernia ◽

Vascular Injury ◽

Air Embolism ◽

Recent Time ◽

Abdominal Pressure ◽

Visceral Injury ◽

Respiratory Effects ◽

Trocar Insertion ◽

Port Site Hernia

Laparoscopic surgery has gained popularity in recent time. An essential aspect of this technique is production of a pneumoperitoneum with insufflation for adequate visualization and manipulation of abdominal contents. Various techniques have been developed over the years for optimal access with minimization of complications. Some of these complications include vascular injury, visceral injury, and incisional hernia. Furthermore, considerations with regards to the patient’s physical morphology, and the cardiovascular/respiratory effects of increased abdominal pressure and anesthesia must be accounted for. The guidelines to optimize patient care in these regards are discussed in this review. This review contains 2 videos, 5 figures, 2 tables, and 79 references. Keywords: trocar insertion, port site hernia, Veress needle, optical trocar, trocar related injuries, Hassan cannula, pneumoperitoneum, air embolism, pneumoperitoneum physiology

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