scholarly journals Trans umbilical first trocar access during laparoscopic surgery

2019 ◽  
Vol 7 (8) ◽  
pp. 3039
Author(s):  
Ritvik Resutra ◽  
Neha Mahajan ◽  
Rajive Gupta
Keyword(s):  
Carbon Dioxide ◽  
Laparoscopic Surgery ◽  
Peritoneal Cavity ◽  
Routine Procedure ◽  
Midline Laparotomy ◽  
Previous Abdominal Surgery ◽  
Closed Technique ◽  
Laparoscopic Procedures ◽  
Carbon Dioxide Pneumoperitoneum ◽  
History Of

Background: In order to perform laparoscopic procedures, it is necessary to first access the peritoneal cavity and establish carbon dioxide pneumoperitoneum. The placement of the first trocar remains a critical step in laparoscopic surgery. In order to minimize complications associated with placement of first trocar, several techniques have been reported. Author describe a surgical technique that provides a quick, safe, and reliable initial access to the peritoneal cavity with its excellent functional and cosmetic results.Methods: Retrospective study of patients who underwent various laparoscopic procedures at Maxx lyfe Hospital, Bathindi, Jammu was carried out by the closed technique for initial access to the peritoneal cavity through the umbilicus from July 2016 to May 2019. In this study, patients who had a prior midline laparotomy with involvement of the umbilicus were excluded.Results: Authors analyzed 456 patients (M = 190; F = 266) in the study period. Average age of the patients was 32 years (range:12-86). A physiologic defect was identified in the umbilical region in all patients who had no history of previous abdominal surgery in that region. The average time to access the peritoneal cavity was 30 seconds (range: 20-50).Conclusions: This technique is quick, safe, reliable, simple, and easy to learn and easy to perform. It is associated with no mortality and minimal morbidity and has excellent cosmetic results. Based on authors experience, authors believe that this method provides surgeons with an effective and safe way to insert the first trocar and recommend it as a routine procedure to access the peritoneal cavity for abdominal laparoscopic surgery.

scholarly journals A comparative study of esmolol and dexmedetomidine on hemodynamic responses to carbon dioxide pneumoperitoneum during laparoscopic surgery

2016 ◽  
Vol 10 (3) ◽  
pp. 580 ◽  
Author(s):  
Suhrita Paul ◽  
DhurjotiProsad Bhattacharjee ◽  
Sauvik Saha ◽  
Sanjib Paul ◽  
Shibsankar Roychowdhary ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Laparoscopic Surgery ◽  
Comparative Study ◽  
Hemodynamic Responses ◽  
Carbon Dioxide Pneumoperitoneum

Arterial to End-tidal Carbon Dioxide Pressure Difference during Laparoscopic Surgery in Pregnancy

2000 ◽  
Vol 93 (2) ◽  
pp. 370-373 ◽  
Author(s):  
Kodali Bhavani-Shankar ◽  
Richard A. Steinbrook ◽  
David C. Brooks ◽  
Sanjay Datta
Keyword(s):  
Carbon Dioxide ◽  
Laparoscopic Surgery ◽  
Pulmonary Ventilation ◽  
Respiratory Acidosis ◽  
Gas Analysis ◽  
Carbon Dioxide Pneumoperitoneum ◽  
Arterial Blood ◽  
End Tidal Carbon Dioxide ◽  
Carbon Dioxide Pressure ◽  
End Tidal

Background There is controversy about whether capnography is adequate to monitor pulmonary ventilation to reduce the risk of significant respiratory acidosis in pregnant patients undergoing laparoscopic surgery. In this prospective study, changes in arterial to end-tidal carbon dioxide pressure difference (PaCO2--PetCO2), induced by carbon dioxide pneumoperitoneum, were determined in pregnant patients undergoing laparoscopic cholecystectomy. Methods Eight pregnant women underwent general anesthesia at 17-30 weeks of gestation. Carbon dioxide pnueumoperitoneum was initiated after obtaining arterial blood for gas analysis. Pulmonary ventilation was adjusted to maintain PetCO2 around 32 mmHg during the procedure. Arterial blood gas analysis was performed during insufflation, after the termination of insufflation, after extubation, and in the postoperative period. Results The mean +/- SD for PaCO2--PetCO2 was 2.4 +/- 1.5 before carbon dioxide pneumoperitoneum, 2.6 +/- 1.2 during, and 1.9 +/- 1.4 mmHg after termination of pneumoperitoneum. PaCO2 and pH during pneumoperitoneum were 35 +/- 1.7 mmHg and 7.41 +/- 0.02, respectively. There were no significant differences in either mean PaCO2--PetCO2 or PaCO2 and pH during various phases of laparoscopy. Conclusions Capnography is adequate to guide ventilation during laparoscopic surgery in pregnant patients. Respiratory acidosis did not occur when PetCO2 was maintained at 32 mmHg during carbon dioxide pneumoperitoneum.

Laparoscopy Using Room Air Insufflation in a Rural African Jungle Hospital: The Bongolo Hospital Experience, January 2006 to December 2013

2017 ◽  
Vol 24 (3) ◽  
pp. 264-267
Author(s):  
Zachary O’Connor ◽  
Marco Faniriko ◽  
Keir Thelander ◽  
Jennifer O’Connor ◽  
David Thompson ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Laparoscopic Surgery ◽  
Postoperative Complications ◽  
Open Surgery ◽  
The Other ◽  
Laparoscopic Procedures ◽  
Time Period ◽  
Free Air ◽  
The World ◽  
Air Insufflation

Introduction. Carbon dioxide is the standard insufflation gas for laparoscopy. However, in many areas of the world, bottled carbon dioxide is not available. Laparoscopy offers advantages over open surgery and has been practiced using filtered room air insufflation since 2006 at Bongolo Hospital in Gabon, Africa. Objective. Our primary goal was to evaluate the safety of room air insufflation related to intraoperative and postoperative complications. Our secondary aim was to review the types of cases performed laparoscopically at our institution. Methods. This retrospective review evaluates laparoscopic cases performed at Bongolo Hospital between January 2006 and December 2013. Demographic and perioperative information for patients undergoing laparoscopic procedures was collected. Insufflation was achieved using a standard, oil-free air compressor using filtered air and a standard insufflation regulator. Results. A total of 368 laparoscopic procedures were identified within the time period. The majority of cases were gynecologic (43%). There was a 2% (8/368) complication rate with one perioperative death. The 2 complications related to insufflation were episodes of hypotension responsive to standard corrective measures. No intracorporeal combustion events were observed in any cases in which the use of diathermy and room air insufflation were combined. The other complications and the death were unrelated to the use of insufflation with air. Conclusion. Insufflation complications with room air occurred in our study. However, the complications related to insufflation with room air in our study were no different than those described in the literature using carbon dioxide. As room air is less costly than carbon dioxide and readily available, confirming the safety of room air insufflation in prospective studies is warranted. Room air appears to be safe for establishing and maintaining pneumoperitoneum, making laparoscopic surgery more accessible to patients in low-resource settings.

scholarly journals Role of ultrasound in reducing complication during primary trocar insertion in laparoscopic surgery: prospective observational study

2018 ◽  
Vol 7 (7) ◽  
pp. 2747
Author(s):  
Vandana Dhama ◽  
Vipin Dhama ◽  
Rachna Chaudhary ◽  
Shakun Singh ◽  
Saba Aafrin
Keyword(s):  
Laparoscopic Surgery ◽  
Abdominal Surgery ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Abdominal Cavity ◽  
Rectus Sheath ◽  
Previous Abdominal Surgery ◽  
Slide Test ◽  
History Of ◽  
Visceral Slide

Background: Patients presenting to Gynecology OPD at LLRM Medical College, Meerut, UP, India for benign laparoscopic surgery from June 2016 to May 2017 were included in the study. A total of 130 women completed the study of which 30 had history of previous abdominal surgery and 100 had no history of previous abdominal surgery. The ability of the visceral slide test to detect periumbilical adhesions was compared with laparoscopic detection of adhesions.Methods: Patients fulfilling inclusion and exclusion criteria and preanaesthetic clearance were subjected to office based Visceral Slide test using high frequency ultrasound probe (7.5 MHz) in the sagittal plane at the level of umbilicus. Distance between the skin and posterior rectus sheath was measured. Diagnostic accuracy of visceral slide test and mean time taken to perform the test was noted.Results: On laparoscopy 4 women had periumbilical adhesions while 24 women in the total sample had adhesions elsewhere in the abdominal cavity. The visceral slide test had a sensitivity of 75%, specificity of 98%, positive predictive value of 75% and negative predictive value of 99%. The diagnostic accuracy of the test is 97%. The median time to perform the examination was 1.69 minutes.Conclusions: The visceral slide technique was convenient and rapid to perform, and reliably identified adhesions in the periumbilical area.

scholarly journals EFFECTS OF METOPROLOL ON HAEMODYNAMIC RESPONSE TO CARBON DIOXIDE PNEUMOPERITONEUM FOR LAPAROSCOPIC SURGERY

2015 ◽  
Vol 4 (62) ◽  
pp. 10758-10764
Author(s):  
Dhurjoti Prosad Bhattacharjee ◽  
Sujata Ghosh ◽  
Souvik Saha ◽  
Debdas Saha ◽  
Gautam Piplai ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Laparoscopic Surgery ◽  
Haemodynamic Response ◽  
Carbon Dioxide Pneumoperitoneum

Anesthesia for Laparoscopic Surgery: Anesthetic Management and Complications

2022 ◽  
Author(s):  
Edward A. Bittner ◽  
Shiliang Alice Cao
Keyword(s):  
Carbon Dioxide ◽  
Laparoscopic Surgery ◽  
Subcutaneous Emphysema ◽  
Anesthetic Management ◽  
Multiple Organ ◽  
Port Placement ◽  
Carbon Dioxide Pneumoperitoneum ◽  
Carbon Dioxide Gas ◽  
Surgical Access ◽  
Organ Systems

Laparoscopic surgery results in physiologic changes that encompass multiple organ systems, with respiratory, cardiovascular and neurologic and splanchnic effects. Insufflation of the peritoneum results in reduced lung volumes, atelectasis, and endobronchial migration of the endotracheal tube. Pneumoperitoneum can result in changes to venous return, cardiac output and blood pressure. Hypercapnia due to carbon dioxide gas used in insufflation can reduce cerebral perfusion pressure. Complications during laparoscopic surgery often occur during port placement and creation of the pneumoperitoneum. Problems include injury to blood vessels during trocar entry, vascular injury in the pneumoperitoneum with limited surgical access, severe bradycardia and arrhythmias due to vagal stimulation from peritoneal stretching, subcutaneous emphysema, pneumothorax, gas embolism, and complications associated with steep Trendelenburg positioning. A thorough understanding of the physiologic changes associated with laparoscopic procedures and recognition of potential complications will facilitate in optimal patient care.  This review contains 4 figures, 1 table and 52 references Keywords: Laparoscopy; laparoscopic surgery; carbon dioxide; pneumoperitoneum; capnothorax; general anesthesia; subcutaneous emphysema; insufflation 

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