scholarly journals Intraoperative safety of low pressure pneumoperitoneum cholecystectomy: a comparative study

2017 ◽  
Vol 4 (11) ◽  
pp. 3679 ◽  
Author(s):  
Salil Mahajan ◽  
Manu Shankar ◽  
Vinod K. Garg ◽  
Vijender Gupta ◽  
Jaya Sorout
Keyword(s):  
High Pressure ◽  
Laparoscopic Cholecystectomy ◽  
Low Pressure ◽  
Parietal Peritoneum ◽  
Working Space ◽  
Significant Difference ◽  
Operative Difficulty ◽  
Secondary Port ◽  
Care Surgery ◽  
Bile Spillage

Background: With the establishment of laparoscopic cholecystectomy as gold standard for management of cholelithiasis, the current stress is on increasing patient safety. Hence, this study was undertaken to compare the effect of low pressure pneumoperitoneum (LPP <10mm Hg) versus high pressure pneumoperitoneum (HPP >14mm Hg) in a prospective randomized manner on intraoperative safety, assessing the working space and safety by seeing contact of parietal peritoneum to underlying viscera during secondary port insertion.Methods: 120 patients undergoing laparoscopic cholecystectomy were randomized into the LPP (<10mm Hg) group (n=60) and the HPP (>14mm Hg) group (n=60) prospectively. Available working space assessed directly, safety by contact of parietal peritoneum to underlying viscera during secondary port insertion and operative difficulty assessed by visualization, dissection and grasping, total duration of surgery; intra-operative gas consumption, and bile spillage were assessed.Results: There was no significant difference in terms of available working space, operative duration, consumption of carbon dioxide, surgeon’s operative difficulty and intraoperative bile spillage. Out of 180 secondary ports inserted, there was evident contact of 20 (11.1%) secondary ports in high pressure groups and 14 (7.7%) secondary ports in low pressure group, which is suggestive of adequate exposure and working space available for surgery at both pressures.Conclusions: Low-pressure cholecystectomy did not compromise intraoperative safety and should be the standard of care in day care surgery.

scholarly journals Outcome analysis of low pressure versus high pressure pneumoperitoneum laparoscopic cholecystectomy: a randomized clinical study

2017 ◽  
Vol 4 (11) ◽  
pp. 3740
Author(s):  
Salil Mahajan ◽  
Manu Shankar ◽  
Vinod K. Garg ◽  
Vijender Gupta ◽  
Jaya Sorout
Keyword(s):  
High Pressure ◽  
Laparoscopic Cholecystectomy ◽  
Shoulder Pain ◽  
Postoperative Period ◽  
Low Pressure ◽  
Randomized Clinical Study ◽  
Early Return ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Bile Spillage

Background: Laparoscopic cholecystectomy is established as gold standard for management of cholelithiasis. Intraoperative pneumoperitoneum affects the postoperative outcomes. The current stress is on increasing patient safety. Hence, this prospective study was undertaken to compare the effect of low pressure pneumoperitoneum (LPP <10 mm Hg) versus high pressure pneumoperitoneum (HPP > 14 mm Hg) on postoperative pain and ileus.Methods: 120 patients undergoing laparoscopic cholecystectomy were randomized into the LPP (<10mm Hg) group (n=60) and the HPP (>14 mm Hg) group (n=60). Total duration of surgery, intra-operative gas consumption, occurrence of bile spillage during operation, shoulder pain and abdominal pain in postoperative period, additional requirement of analgesia in postoperative period and postoperative ileus were assessed.Results: There was no significant difference in terms of operative duration, consumption of CO2 gas, intraoperative bile spillage, total hospital stay and tolerance to early feeding. The incidence of shoulder pain was higher in patients who underwent HPP laparoscopic cholecystectomy (p<0.05). There was early recovery and early return of bowel activity in LPP which was statistically significant.Conclusions: Low-pressure pneumoperitoneum is feasible and safe and results in reduced postoperative shoulder tip pain and near-equal operative time with early return of bowel activity compared with high-pressure pneumoperitoneum.

scholarly journals Prospective randomised trial of standard pressure versus low pressure laparoscopic cholecystectomy in a tertiary care hospital from Kolkata: Our experience

2018 ◽  
Vol 9 (4) ◽  
pp. 17-22
Author(s):  
Bikash Chandra Ghosh ◽  
Ambar Gangopadhyay
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Laparoscopic Surgery ◽  
Gall Stone ◽  
Low Pressure ◽  
Stone Disease ◽  
Care Hospital ◽  
Significant Difference ◽  
Gall Stone Disease ◽  
Standard Pressure ◽  
Symptomatic Gall Stone

Background: Laparoscopic cholecystectomy (LC), the procedure of choice for symptomatic gall stone disease. An emerging trend is to perform Low pressure pnuemoperitonium laparoscopic surgery as it has additive advantages over standard pressure to avoid complications while providing adequate working space.Aims and Objectives: The current study was designed with an aim to compare the advantage of low pressure pneumoperitoneum vs standard pressure pneumoperitoneum in laparoscopic cholecystectomy.Materials and Methods: The study was conducted in the department of General Surgery in R.G.Kar Medical College from January 2014 to June 2015. A total of 52 patients with symptomatic gall stone disease were recruited, 26 patients in each group randomly. Some intraoperative and post-operative parameters were studied.Results: All the intra-operative (IO) cardio-respiratory parameters (Pulse, Mean Arterial Pressure (MAP), End tidal CO2, spO2) were recorded just before incision, 20 minutes intra-operatively and before reversal of general anesthesia (GA). The IO parameters in our study, were found to be significant only at 20 minutes IO and before reversal of GA. The post-operative (PO) parameters (Pulse, MAP, Respiratory rate, spO2) and pain by VAS score at 6 hours, 12 hours and 24 hours post-operatively were studied. In PO period, we observed significant differences at 2 hours post-operatively in all parameters except MAP. There was significant difference in pain at 6, 12 and 24 hours when compared in both groups. The shoulder tip pain (STP) and 2 hours PO nausea and vomiting were found to be significantly higher in Standard pressure Laparoscopic cholecystectomy (SPLC) compared to Low pressure Laparoscopic cholecystectomy (LPLC). The operative time, duration of hospital stay and return to normal life after surgery though had differences but it was statisticallyinsignificant.Conclusion: Low pressure laparoscopic surgery is safe with least post operative complications when performed by experienced surgeons even in patients of ASA III.Asian Journal of Medical Sciences Vol.9(4) 2018 17-22

Role of Laparoscopic Surgery in the Current Management of Mirizzi Syndrome

2018 ◽  
Vol 84 (5) ◽  
pp. 667-671 ◽  
Author(s):  
Rondi Gelbard ◽  
Desmond Khor ◽  
Kenji Inaba ◽  
Obi Okoye ◽  
Crystal Szczepanski ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Length Of Stay ◽  
Open Cholecystectomy ◽  
Disease Process ◽  
Laparoscopic Approach ◽  
Mirizzi Syndrome ◽  
Open Approach ◽  
Significant Difference ◽  
Care Surgery

Mirizzi syndrome (MS) is an uncommon complication of cholelithiasis caused by extrinsic biliary compression by stones in the gallbladder infundibulum or cystic duct. The purpose of this study was to evaluate the outcomes associated with a laparoscopic approach to this disease process. This is a 10-year, retrospective study conducted at two academic medical centers with established acute care surgery practices. Patients with a diagnosis of MS confirmed intraoperatively were included. Eighty-eight patients with MS were identified with 55 (62.5%) being type 1. Twenty six (29.5%) patients, all type 1, underwent successful laparoscopic cholecystectomy. Of the 62 patients that underwent open cholecystectomy, 27.3 per cent had a laparoscopy converted to open procedure. There was no significant difference in overall complications (19.2 vs 29%) among those undergoing laparoscopic versus open cholecystectomy. Length of stay was lower in patients that had a laparoscopic approach ( P = 0.001). Laparoscopic cholecystectomy can safely be attempted in type 1 MS and seems to be associated with fewer overall complications and shorter length of stay compared with an open approach.

Nasalance and Nasality in Low Pressure and High Pressure Speech

1998 ◽  
Vol 35 (4) ◽  
pp. 293-298 ◽  
Author(s):  
Thomas Watterson ◽  
Kerry E. Lewis ◽  
Candace Deutsch
Keyword(s):  
High Pressure ◽  
Correlation Coefficient ◽  
Low Pressure ◽  
Communication Disorder ◽  
Test Sensitivity ◽  
Significant Difference ◽  
History Of ◽  
Hypernasal Speech ◽  
Test Specificity ◽  
The Mean

Objective This study compared nasalance measures and nasality ratings in low pressure (LP) and high pressure (HP) speech. Subjects The subjects for this study were 25 children ranging in age from 5 to 13 years. Twenty of the subjects were patients followed by a craniofacial team, and five had no history of communication disorder. Results The mean nasalance for the LP speech was 29.98% (SD, 16.16), and the mean nasalance for the HP speech was 30.28% (SD, 15.35). The mean nasality rating for the LP speech was 2.31, and the mean nasality rating for the HP speech was 2.59. Separate paired t tests revealed no significant difference between the LP or the HP speech for either the nasalance scores or the nasality ratings. The correlation coefficient between nasalance and nasality for the LP speech was r = 0.78, and for the HP speech r = 0.77. Using a cutoff of 26% for nasalance and 2.0 for nasality, Nasometer test sensitivity was 0.84 and test specificity was 0.88. Conclusions In general, clinicians may obtain valid measures of nasalance and/or ratings of nasality using either an LP stimulus or an HP stimulus. Sensitivity and specificity scores indicated that the Nasometer was reasonably accurate in distinguishing between normal and hypernasal speech samples.

scholarly journals The Effects of Different Pressure Pneumoperitoneum on the Pulmonary Mechanics and Surgical Satisfaction in the Laparoscopic Cholecystectomy

2021 ◽  
Vol 17 (6) ◽  
pp. 33-41
Author(s):  
B. Küçüköztaş ◽  
L. İyilikçi ◽  
S. Ozbilgin ◽  
M. Ozbilgin ◽  
T. Ünek ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Minute Ventilation ◽  
Peak Inspiratory Pressure ◽  
Low Pressure ◽  
Pulmonary Mechanics ◽  
Abdominal Pressure ◽  
Hemodynamic Parameters ◽  
Peripheral Oxygen Saturation ◽  
Significant Difference ◽  
Standard Pressure

Objectives. Inspiratory, hemodynamic and metabolic changes occur in laparoscopic surgery depending on pneumoperitoneum and patient position. This study aims to evaluate the effects of intra-abdominal pressure increase based on CO2 pneumoperitoneum in laparoscopic operations on hemodynamic parameters and respiratory dynamics and satisfaction of surgeon and operative view.Materials and Methods. A total of 116 consecutive, prospective, ASA class I–III cases aged 18–70 years undergoing laparoscopic cholecystectomy were enrolled in this study. Data of 104 patients were analysed. Patients were divided into two groups as the group Low Pressure (<12 mmHg) (Group LP) (n=53) and the group Standard Pressure (>13 mmHg) (Group SP) (n=51). In this study administration of general anesthesia used total intravenous anaesthesia in both groups. All groups had standard and TOF monitorization applied. The anaesthesia methods used in both groups were recorded. Before, during and after peritoneal insufflation, the peroperative ventilation parameters and hemodynamic parameters were recorded. The adequacy of pneumoperitoneum, gastric and the operative view were evaluated by the operating surgeon and recorded.Results. The peripheral oxygen saturation showed no significant difference between the low and standard pressure pneumoperitoneum in view of tidal volume, respiratory rate, end tidal CO2, mean and peak inspiratory pressure, and minute ventilation values. In terms of hemodynamics, when values just after intubation and before extubation were compared, it was observed that in the LP group systolic, diastolic and mean blood pressure values were higher. In terms of heart rate, no significant difference was observed in determined periods between groups. There was no significant difference between the groups in terms of surgical satisfaction and vision.Conclusion. Low pressure pneumoperitoneum provides effective respiratory mechanics and stable hemodynamics for laparoscopic cholecystectomy. It also provides the surgeon with sufficient space for hand manipulations. Anaesthetic method, TIVA and neuromuscular blockage provided good surgery vision with low pressure pneumoperitoneum.

scholarly journals Effects of pneumoperitoneum on kidney injury biomarkers: A randomized clinical trial

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0247088
Author(s):  
Marcos Antonio Marton Filho ◽  
Rodrigo Leal Alves ◽  
Paulo do Nascimento ◽  
Gabriel dos Santos Tarquinio ◽  
Paulo Ferreira Mega ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Laparoscopic Cholecystectomy ◽  
Cystatin C ◽  
Care Center ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Low Pressure ◽  
Abdominal Pressure ◽  
Pressure Group ◽  
Significant Difference

Background Increased intra-abdominal pressure causes hemodynamic changes that may affect renal biomarkers. Methods This randomized, single-blind, single-center clinical trial recruited patients undergoing laparoscopic cholecystectomy at a tertiary care center in Brazil. They were randomly allocated to a standard intra-abdominal pressure group (P10-12, 10–12 mm Hg) and a low intra-abdominal pressure group (P6-8, 6–8 mm Hg). The primary outcome was the change in neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C levels measured at the beginning of the procedure (T0), at the end of the procedure (T1), and 24 hours after the procedure (T2). P-values < 0.05 were considered statistically significant. Results In total, 64 patients completed the study—33 were given standard pressure and 31 were given low pressure. There was no significant difference in the biomarker between the groups (P = 0.580), but there was a significant difference between the time points with elevation at T1 (P < 0.001). Similar to NGAL, cystatin C had an elevation at T1 in both groups (P = 0.021), but no difference was found when comparing the groups. Conclusions In laparoscopic cholecystectomy, pneumoperitoneum increases NGAL and cystatin C levels intraoperatively, and the use of low-pressure pneumoperitoneum does not change the course of these biomarkers.

Nasalance Scores for Normal-Speaking Irish Children

2004 ◽  
Vol 41 (2) ◽  
pp. 168-174 ◽  
Author(s):  
Triona Sweeney ◽  
Debbie Sell ◽  
Myra O'Regan
Keyword(s):  
High Pressure ◽  
Low Pressure ◽  
Speech Sample ◽  
Male And Female ◽  
Speech Stimuli ◽  
Significant Difference ◽  
English Speaking ◽  
And Gender ◽  
Nasal Consonant ◽  
Normal Speaking

Objective To obtain normal nasalance values during the production of a standardized speech sample for Irish children and determine whether significantly different scores exist for different speech stimuli for female and male speakers. Design Mean nasalance scores were obtained for normal-speaking children during the repetition of 16 test sentences that were categorized according to consonant type within the sentences (high-pressure consonants, low-pressure consonants, nasal consonants). Participants Seventy children (36 girls and 34 boys, aged 4 years 11 months to 13 years) with normal articulation, resonance, and voice were included. Procedures Children repeated each of the 16 test sentences individually. The sentences were presented in groups according to consonant type, referred to as sentence categories. Data were collected and analyzed using the Kay nasometer (model 6200.3). Nasalance scores were obtained for the total speech sample and each sentence category. Data were statistically analyzed to investigate the effects of gender, sentence category, and gender by sentence category. Results Normative nasalance scores were obtained for the total speech sample (26%), high-pressure consonant sentences (14%), low-pressure consonant sentences (16%), and a nasal consonant sentence (51%). There was no significant difference in nasalance scores between male and female speakers. Significant differences were found between each sentence category (p ≤ .001), except between the high-pressure and low-pressure consonant sentence categories (p = .09). Conclusion The present study provides normative nasalance data for English-speaking Irish children. There was a significant difference between nasalance scores for different speech stimuli.

Intracuff Pressures Do Not Predict Laryngopharyngeal Discomfort after Use of the Laryngeal Mask Airway 

1997 ◽  
Vol 87 (1) ◽  
pp. 63-67 ◽  
Author(s):  
Armin Rieger ◽  
Bergit Brunne ◽  
Hans Walter Striebel
Keyword(s):  
High Pressure ◽  
Laryngeal Mask Airway ◽  
Sore Throat ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Low Pressure ◽  
Laryngeal Mask ◽  
Double Blind Study ◽  
Pressure Group ◽  
Significant Difference

Background The laryngeal mask airway (LMA) is a large foreign body that exerts pressure on the pharyngeal mucosa, which may lead to throat discomfort. To determine whether intracuff pressures are associated with such discomfort, a randomized, double-blind study was performed to determine the effect of high versus low intracuff pressures. Methods Seventy healthy women were randomly allocated to two groups with different LMA intracuff pressures: 30 mmHg (low pressure) or 180 mmHg (high pressure). Pressures were controlled with a microprocessor-controlled monitor. Insertion of the LMA was performed by one investigator and facilitated with propofol and verified fiberoptically. Anesthesia was maintained with enflurane and nitrous oxide. The LMAs were removed while the patients were still asleep. Patients assessed their laryngopharyngeal complaints (sore throat, dysphagia, hoarseness) at 8, 24, and 48 h after operation on a 101-point numerical rating scale. Results No significant difference was found in the overall incidence of complaints between both groups (low pressure: 50%; high pressure: 42%). On the day of surgery, dysphagia (38%) was more frequent than sore throat (16%) or hoarseness (6%) (P &lt; 0.05) within the high-pressure group. In the low-pressure group, the incidence of these complaints was not significantly different (33%, 20%, and 23%, respectively). On the following day, dysphagia was still present in 20% of the women in both groups, and other symptoms comprised 10% or less of the reported complaints. Conclusions Differences in LMA intracuff pressures did not influence either the incidence or severity of laryngopharyngeal complaints.

scholarly journals Cost Analysis and Supply Utilization of Laparoscopic Cholecystectomy

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Trishul Kapoor ◽  
Sean M. Wrenn ◽  
Peter W. Callas ◽  
Wasef Abu-Jaish
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Length Of Stay ◽  
Cost Of Care ◽  
Third Party ◽  
Acute Care Surgery ◽  
Case Volume ◽  
Case Duration ◽  
Significant Difference ◽  
Care Surgery ◽  
Supply Costs

Laparoscopic cholecystectomy (LC) is one of the highest volume surgeries performed annually. We hypothesized that there is a statistically significant intradepartmental cost variance with supply utilization variability amongst surgeons of different subspecialty. This study sought to describe laparoscopic cholecystectomy cost of care among three subspecialties of surgeons. This retrospective observational cohort study captured 372 laparoscopic cholecystectomy cases performed between June 2015 and June 2016 by 12 surgeons divided into three subspecialties: 2 in bariatric surgery (BS), 5 in acute care surgery (ACS), and 5 in general surgery (GS). The study utilized a third-party software, Surgical Profitability Compass Procedure Cost Manager and Crimson System (SPCMCS) (The Advisory Board Company, Washington, DC), to stratify case volume, supply cost, case duration, case severity level, and patient length of stay intradepartmentally. Statistical methods included the Kruskal-Wallis test. Average composite supply cost per case was $569 and median supply cost per case was $554. The case volume was 133 (BS), 109 (ACS), and 130 (GS). The median intradepartmental total supply cost was $674.5 (BS), $534 (ACS), and $564 (GS) (P<0.005). ACS and GS presented with a higher standard deviation of cost, $98 (ACS) and $110 (GS) versus $26 (BS). The median case duration was 70 min (BS), 107 min (ACS), and 78 min (GS) (P<0.02). The average patient length of stay was 1.15 (BS), 3.10 (ACS), and 1.17 (GS) (P<0.005). Overall, there was a statistically significant difference in median supply cost (highest in BS; lowest in ACS and GS). However, the higher supply costs may be attenuated by decreased operative time and patient length of stay. Strategies to reduce total supply cost per case include mandating exchange of expensive items, standardization of supply sets, increased price transparency, and education to surgeons.

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