scholarly journals 231 Colecistectomias Laparoscópicas em Ambulatório: Que Resultados?

2013 ◽  
Vol 26 (5) ◽  
pp. 564
Author(s):  
André Goulart ◽  
Margarida Delgado ◽  
Maria Conceição Antunes ◽  
João Braga dos Anjos
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Ambulatory Surgery ◽  
Standard Procedure ◽  
Outpatient Basis ◽  
Readmission Rates ◽  
Overnight Stay ◽  
Stay Time ◽  
Safe Technique ◽  
The Mean ◽  
Mean Time

Introduction: Laparoscopic cholecystectomy is the gold standard procedure for the treatment of lithiasic gallblader pathology and acute cholecystitis. Whether or not it should be done as ambulatory surgery is still being discussed. The present study aims to analyze the quality and safety of laparoscopic cholecystectomy conducted by the Ambulatory Unit of Hospital de Braga and compare the results with those from other European surgical centers performing LC as ambulatory surgery.Material and Methods: Observational prospective study of patients submitted to laparoscopic cholecystectomy in ambulatory surgery during a period of 26 months. Data regarding patients’ demography, peri- and postoperative complications, surgical time, time in recovery room, and readmission rates was collected.Results: A total of 231 patients were subjected to Laparoscopic cholecystectomy in the ambulatory unit with overnight stay (time to discharge less than 24 hours). Three patients presented with intra-operative complications, which needed conversion to laparotomy, and four patients were admitted after surgery. The mean time for the procedure was 58 minutes and the mean time for recovery was 19h19 minutes. Postoperative morbidity was 7.8% with 2 nonscheduled admission having occurred.Discussion: One of the controversies regarding laparoscopic cholecystectomy as an outpatient procedure is the need for overnight hospital surveillance. In our unit, we have started LC on an outpatient basis with an overnight stay. Using this protocol, over the past two years, we have operated 231 patients and our results show that this is a completely safe technique.Conclusions: Data from the study suggests that LC is a safe technique when performed in ambulatory practice, having similar results to other european surgical centers.

scholarly journals Mid-stream clean catch urine collection in newborns: a non-invasive and safe technique

2019 ◽  
Vol 6 (2) ◽  
pp. 349 ◽  
Author(s):  
Rajendra Kumar ◽  
Nithin . ◽  
Sudha Rudrappa
Keyword(s):  
Success Rate ◽  
Urine Sample ◽  
Invasive Technique ◽  
Urine Collection ◽  
Non Invasive ◽  
Invasive Method ◽  
Safe Technique ◽  
The Mean ◽  
Invasive Techniques ◽  
Mean Time

Background: The aim of this study is to determine the success rate and safety of a non-invasive technique to obtain clean-catch midstream urine samples in newborns.Methods: Prospective bedside clinical study. After obtaining written informed consent,120 consecutive newborns admitted in NICU with no dehydration, poor feeding, need for immediate urine sample by invasive method  for whom urine collection was advised for various reasons who met the inclusion criteria were included in the study with consent being taken from the parents. After adequate milk intake supra pubic and lumbar para vertebral areas were stimulated in repeated cycles of 30 s until micturition began.Results: Success rate in obtaining a midstream urine sample within 5 min. The success rate was 90%. The mean time taken to collect urine was 64.24s, for males it was 62.55s and for females 65.93s.Conclusions: The technique has been demonstrated to be safe, quick and effective. The discomfort and time consumption usually associated with bag collection methods as well as invasive techniques can be avoided.

scholarly journals Performance of Venous Port Catheter Insertion by a General Surgeon: A Prospective Study

2015 ◽  
Vol 100 (5) ◽  
pp. 827-835 ◽  
Author(s):  
Mehmet Aziret ◽  
Oktay İrkörücü ◽  
Cihan Gökler ◽  
Enver Reyhan ◽  
Süleyman Çetinkünar ◽  
...  
Keyword(s):  
Vascular Access ◽  
Catheter Insertion ◽  
Port Catheter ◽  
Insertion Procedure ◽  
Venous Port ◽  
Stay Time ◽  
The Mean ◽  
Group 2 ◽  
Mean Time ◽  
Group 1

As part of the vascular access procedures, venous ports, commonly referred to as catheters, are placed under the skin to enable safe and easy vascular access for administration of repeated drug treatments. 122 patients who had received a venous port catheter insertion procedure in the general surgery department between January 1012 and January 2014 were involved in this study. Patients were divided into two groups: those who had undergone a fluoroscopy (group 1) and those who had not undergone a fluoroscopy (group 2). Complications that emerged during and after the port catheter insertion procedure and successful insertion rates were recorded in the database. Data of these patients were presented in a prospective manner. There were 92 to 30 patients in groups 1 and 2, respectively. In group 1, the mean age was approximately 56.8, total catheter stay time was 20,631 days, and mean time of port use was 224.2 days. In group 2, the mean age was approximately 61.2, total catheter stay time was 13,575 days, and mean time of port use was 452.5 days. Successful insertion rate was 100% and 90% in groups 1 and 2, respectively (P < 0.05). The proper insertion of the port catheter accompanied by monitoring methods can decrease procedure-related complications. Statistical comparisons between the two groups in terms of malposition and successful insertion rates also support this view (P < 0.05). The findings support the view that in cancer patients, a venous port catheter insertion accompanied by a fluoroscopy can be safely performed by general surgeons.

scholarly journals Subsequent Marking under Ultrasound Guidance of Vacuum-Assisted Breast Biopsy Areas after Receipt of Histology: A Feasibility Study of a New Technique

Breast Care ◽  
2020 ◽  
Vol 15 (6) ◽  
pp. 628-634
Author(s):  
Clara Park ◽  
Frauke Chevalier ◽  
Volker Möbus ◽  
Petra Hoedl ◽  
Kerstin Engelmann ◽  
...  
Keyword(s):  
Breast Biopsy ◽  
Standard Procedure ◽  
Cost Effective ◽  
Target Lesion ◽  
Us Guidance ◽  
Institutional Ethics ◽  
Biopsy Site ◽  
Residual Elements ◽  
The Mean ◽  
Mean Time

<b><i>Purpose:</i></b> The aim of this study was to evaluate the feasibility and the accuracy of a secondary, metachronous ultrasound (US)-guided marking of the stereotactic vacuum-assisted breast biopsy (ST-VABB) area. <b><i>Materials and Methods:</i></b> The institutional ethics committee approved the study. The retrospective study included 98 patients. In ST-VABB of 45 women, no tissue markers were deployed at the biopsy site, even if no residual calcifications remained. After histology proved the necessity for a subsequent operation, the biopsy site was marked under US guidance using a coil marker. All interventions were technically successful. No complications occurred. Mammography was done to visualize the coil deployment. The distances from the center of the lesion and the biopsy cavity to the coil location were measured in both planes to evaluate the accuracy of the marking procedure. <b><i>Results:</i></b> In 24 of the 46 cases, the whole lesion was biopsied without residual elements. The mean time between ST-VABB and sonographic marking of the lesion was 9.7 days (median 6.5). The biopsy cavity could be detected in 40 (87%) cases and thus marked exactly. The mean time of US-guided marking was 12.5 min. The mean distance between the coil and the target lesion was 0.6 ± 1.5 cm in the craniocaudal (cc) view and 0.5 ± 1.5 cm in the mediolateral (ml) view for all markings. The mean delta value from the distance nipple–original lesion and from the distance nipple–coil was 0.85 ± 1.2 cm (median 0.5) in the cc view and 0.88 ± 1.2 cm (median 0.6) in the ml view for all cases. Clip migration was not observed. <b><i>Conclusion:</i></b> Our study demonstrates the feasibility and the technical success of secondary metachronous coil marking of the biopsy site under US guidance after receipt of histology. This approach seems to be a cost-effective alternative to the standard procedure of the primary coil marking especially in all completely removed lesions. It may offer advantages for allergic patients.

scholarly journals Is suture ligation of cystic duct in laparoscopic cholecystectomy a safe alternative to clipping? Our experience in a rural centre

2019 ◽  
Vol 6 (10) ◽  
pp. 3715
Author(s):  
K. R. Manoj Prabu ◽  
Dhinesh Balaji ◽  
Vishwanath M. Pai
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Complications ◽  
Cystic Duct ◽  
Operating Time ◽  
Cost Effective ◽  
Safe Alternative ◽  
Suture Ligation ◽  
Medical College ◽  
The Mean ◽  
Mean Time

Background: Laparoscopic cholecystectomy is one of the most common surgeries performed nowadays. It remains an enigma regarding efficacy, safety and postoperative complications for using suture ligation for ligating cystic duct in laparoscopic cholecystectomy. The aim of the present study was to study the efficacy of ligating the cystic duct with sutures in laparoscopic cholecystectomy.Methods: This prospective study was performed between June 2018 and April 2019 in Saveetha Medical College and Hospital, in a rural center, Kanchipuram, India. All the patients included consented for the study. Patients who underwent subtotal cholecystectomy were excluded from the study.Results: The study included 70 patients who underwent laparoscopic cholecystectomy in a single unit. All cases were operated by a single surgeon. Of the 70 patients, the Cystic duct (CD) was simply ligated in 55 patients with CD <5 mm in diameter. The CD in 15 of those patients had to be divided and sutured in continuity for wide CD (>5 mm). The mean time for ligation of cystic duct was 5 min. Similarly, the mean time for ligation of cystic artery was 1.50 min. The mean operative time was 50 mins. There were no postoperative complications, such as bile leakage.Conclusions: SL of the CD is a very safe and secure alternative to the application of metal clips. It can be used in dilated CD, readily available and very cost effective and the complications of clips are avoided. The only disadvantage is that it needs expertise to perform and subsequently increasing the operating time. This technique is recommended in all laparoscopic cholecystectomies, especially in difficult cases.

scholarly journals Laparoscopic cholecystectomy in Jordan

2001 ◽  
Vol 7 (4-5) ◽  
pp. 838-840
Author(s):  
A. Al Raymoony
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
Return To Work ◽  
Hospital Stay ◽  
Operative Time ◽  
Safe Procedure ◽  
Short Hospital Stay ◽  
Early Return ◽  
The Mean ◽  
Mean Time

This study was conducted on 100 patients with symptomatic gallbladder stones, aged 22-81 years with a mean of 51.5 years, who underwent cholecystectomy in Zarqa city, Jordan between July 1998 and July 1999. The success rate was 87% and the procedure was completed using the conventional method in 13 patients. The mean operative time was 60 minutes, complication rate was 5% and there were no deaths. The mean hospital stay was 1 day and mean time to return to work was 10 days. This study showed that laparoscopic cholecystectomy is a safe procedure with reasonable operative time, less postoperative pain, a short hospital stay, early return to work, and a low morbidity and mortality rate.

scholarly journals Navigation with laparoscopic ultrasound during fundus-first laparoscopic cholecystectomy-a single-centre retrospective case control study

2020 ◽  
Author(s):  
Maciej Sebastian ◽  
Agata Sebastian ◽  
Jerzy Rudnicki
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Statistical Significance ◽  
Laparoscopic Ultrasound ◽  
Retrospective Case ◽  
Exact Test ◽  
Critical View ◽  
Critical View Of Safety ◽  
The Mean ◽  
Mean Time ◽  
Bail Out

Abstract Background Laparoscopic cholecystectomy is considered as the gold standard treatment for cholecystolithiasis. The critical view of safety is a generally accepted technique of intraoperative visualization but during inflammation and fibrosis in the region of Calot’s triangle it may fail. Fundus-first laparoscopic cholecystectomy with laparoscopic ultrasound navigation may be an attractive bail-out option when the intraoperative conditions are difficult. Methods The study group consisted of 900 patients with symptomatic cholecystolithiasis which was divided into two subgroups. The first subgroup where the only method of intraoperative identification was the critical view of safety consisted of 402 patients, the second subgroup where the critical view of safety and laparoscopic ultrasound were used consisted of 498 patients. In the first subgroup fundus-first laparoscopic cholecystectomy was performed in 13 patients, in the second subgroup in 42 patients. Statistical analysis included the Mann-Whitney U test for continuous and Fisher’s exact test for binary variables. The level of statistical significance was set at 95% (p < 0.05). Results Fundus-first technique was significantly more often in the subgroup with laparoscopic ultrasound and the hospitalization time of fundus-first laparoscopic cholecystectomies was significantly shorter than in converted cases. The mean time of laparoscopic cholecystectomy and the mean time to obtain the transection level between the gallbladder and the hepatoduodenal ligament were significantly shorter and the conversion rate was significantly lower in the fundus-first and laparoscopic ultrasound group. Conclusions Fundus-first technique with laparoscopic ultrasound navigation may be a very efficient bail-out option during laparoscopic cholecystectomy due to a more precisely and significantly faster defined plane of dissection what enables safe performance of laparoscopic cholecystectomy with significantly lower rate of conversions.

Successful outpatient treatment of sinusitis exacerbations caused by community-acquired methicillin-resistant Staphylococcus aureus

2005 ◽  
Vol 132 (6) ◽  
pp. 828-833 ◽  
Author(s):  
Roland Z. Gerencer
Keyword(s):  
Outpatient Treatment ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Outpatient Basis ◽  
Oral Antibiotics ◽  
Clinical Resolution ◽  
Topical Antibiotics ◽  
Intravenous Antibiotics ◽  
The Mean ◽  
Mean Time

OBJECTIVE: To determine whether community-acquired MRSA sinusitis can be adequately treated on an outpatient basis without the need for intravenous antibiotics. STUDY DESIGN AND SETTING: Retrospective review of all cases of community-acquired MRSA sinusitis encountered by the author over a 36-month period. RESULTS: Of 29 patients who tested positive for MRSA sinusitis, 26 patients had follow-up information available and were retrospectively reviewed. The average follow-up period was 12.0 months (range: 1–36 mo). Twelve infectious episodes of MRSA were treated with oral antibiotics alone and 16 were treated with a combination of oral and topical antibiotics. The mean time to clinical resolution with these regimens was 5.7 weeks (range: 3–8 wks). Two patients experienced recurrent MRSA infections resulting in a recurrence rate of 7.7% and an overall resolution rate of 92.3%. CONCLUSIONS: Community-acquired MRSA sinusitis can be very adequately treated on an outpatient basis with culture-directed oral and topical antibiotics.

scholarly journals Opioid Usage During Admission in Hip Fracture Patients—The Effect of the Continuous Femoral Nerve Block

2016 ◽  
Vol 7 (4) ◽  
pp. 197-201 ◽  
Author(s):  
Ida Helsø ◽  
Christopher Jantzen ◽  
Jes Bruun Lauritzen ◽  
Henrik Løvendahl Jørgensen
Keyword(s):  
Hip Fracture ◽  
Nerve Block ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
University Hospital ◽  
Stay Time ◽  
Continuous Femoral Nerve Block ◽  
The Mean ◽  
Surgery Mortality ◽  
Mean Time

Introduction: The aim of this study was to investigate whether there was a difference in opioid usage during admission for hip fracture patients with continuous femoral nerve block (cFNB) when compared to patients nonfemoral nerve block (nFNB). Methods and Materials: Patients were identified from the local database on all hip fracture patients admitted to Bispebjerg University Hospital, Denmark. Four hundred fifty-six hip fracture patients were included during the period September 2008 to October 2010. Results: Three hundred sixty-six hip fracture patients had cFNB. The mean time with cFNB was 3.4 days. There were no significant differences in gender, length of stay, time to surgery, mortality rate, in-hospital falls, or resurgery rates during admission between the 2 groups. The nFNB group had an insignificant higher use of morphine as needed during the first 5 days of admission (nFNB: 53.1 mg, 95% confidence interval [CI]: 34.4-71.7; cFNB: 47.7 mg, 95% CI: 40.7-64.3; P = .54) and during the whole admission (cFNB: 34.3 mg, 95% CI: 23.2-45.5; cFNB: 30.3 mg, 95% CI: 26.6-33.0; P = .4). Some 8.47% of the total morphine consumption during admission was morphine as needed for the nFNB group and 9.89% for the cFNB group. Conclusion: Patients with cFNB did only have a marginally lower opioid usage during admission when compared to patients without the block, with no significance between the 2 groups. This could indicate that the cFNB is an ineffective analgesic strategy, especially in the postoperative period, but larger randomized studies are needed in order to clarify this.

scholarly journals "One step procedure" local anaesthesia for inguinal hernia repair in ambulatory surgery conditions: District general hospital experience

2012 ◽  
Vol 59 (1) ◽  
pp. 87-93 ◽  
Author(s):  
Dejan Dabic ◽  
Vladan Perunicic ◽  
Biljana Maric
Keyword(s):  
Inguinal Hernia ◽  
Local Anaesthesia ◽  
Ambulatory Surgery ◽  
Operating Time ◽  
District General Hospital ◽  
Outpatient Basis ◽  
Lichtenstein Technique ◽  
Step Procedure ◽  
One Step ◽  
The Mean

Ambulatory surgery refers to hospitalization that does not exceed 24 hours, during which a surgical procedure is performed. Inguinal hernia repairs done under local anaesthesia on an outpatient basis are no longer performed exclusively in specialized hernia centers. They are becoming widely accepted by surgeons working in district hospitals, which was significantly contributed to by the publication of the EHS Guidelines on the Treatment of Inguinal Hernia. OBJECTIVE: The objective of this retrospective study is to show local anaesthesia practicability for inguinal hernia repairs through "one-step procedure", being a one-day procedure used in District General Hospital. METHODS: From January 2006 to June 2011, 460 elective surgery procedures were performed on 428 patients with inguinal hernia (396 with unilateral and 32 with bilateral inguinal hernia), using Lichtenstein technique, UHS/PHS, plug repair, and Shouldice technique. All the proceduress were performed under local anaesthesia by the same surgeon using "one-step procedure" in ambulatory surgery. The following anaesthetics were used: Lidocaine for intradermal and subcutaneous anaesthesia as well as Bupivacaine/Levobupivacaine for subfascial anaesthesia. RESULTS: From January 2006 to June 2011, 460 surgical procedures were performed on 428 patients with inguinal hernia (396 with unilateral and 32 with bilateral inguinal hernia). The mean age was 58.2 yrs (20-84). All the patients were in the ASA I - III group. In unilateral hernias, the mean operating time using Lichtenstein technique was 38mins (28-56), using PHS/UHS 28mins (22-40), with plug 33mins (27- 39) and using Shouldice technique 43mins (32-53). In bilateral hernias, the mean operating time using Lichtenstein technique was 71mis (56-87), and using PHS /UHS 56mins (49-64). The mean hospital stay was 2.9hrs (2-6). The mean distance of residence from the hospital was 23km (1-150). During the course of the surgery, 15 patients (3.5%) had problems such as pain, bradycardia, hypotension, or perspiration. The complications during the mean follow-up of 31 months (1-60) was: 1.4% (6 patients) - a hematoma, 1.87% (8 patients) - seroma, 0.47% (2 patients) - wound infection, 0.23% (1 patient) - chronic pain, and 0.47% (2 patients) - recurrence. Revision due to active bleeding was conducted in two patients (0.47%), after using PHS and Lichtenstein techniques. These were the only patients who were rehospitalized due to complications. CONCLUSION: In hernia repairs on an outpatient basis, "one-step procedure" in local anaesthetic administration is reliable, easy, safe, effective, and the type of the surgical technique is not a determining factor. The success rate and treatment outcome depend on the surgical technique and the surgeon?s experience in using local anaesthesia in ambulatory surgery.

scholarly journals Laparoscopic cholecystectomy with two mini incisions: an innovative, feasible and safe technique with superior cosmetic outcomes

2020 ◽  
Author(s):  
Yong-fu Xu ◽  
Ai-dong Wang ◽  
Zhe-ping Fang ◽  
Qi-qiang Dai ◽  
Zhenyu Li
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
Gallbladder Disease ◽  
Operation Time ◽  
Good Alternative ◽  
Conventional Instruments ◽  
Significant Difference ◽  
Safe Technique ◽  
The Mean ◽  
A New Technique

Abstract The conventional laparoscopic cholecystectomy (CLC) is usually performed with four incisions in a simple and safe way. Minimally invasive surgery for gallbladder disease with advantages of less pain and smaller scars, has become increasingly popular in patients. This study aimed to describe our experience in performing a new technique of two-incision laparoscopic cholecystectomy (TILC) with conventional instruments and make a comparison with CLC. In this study, forty-three prospective patients undergoing TILC and another forty-three historical cases operated by CLC were involved. The patients were examined in respect of operative time, postoperative pain, cosmesis and complications. We found that there was no significant difference in the gender, age, body mass index, bile duct damage, blood loss and days of postoperative hospital stay between TILC and CLC. The mean operation time in TILC was longer than that in CLC, but not statistically different. Significantly lower postoperative pain scores were reported in the TILC group than those in the CLC one (p = 0.019). The mean cosmetic satisfaction score was significantly higher in TILC group than that in CLC group (p < 0.05). These results confirm that TILC is a safe and feasible technique with less postoperative pain and a significant improvement in cosmesis for patients, only by using conventional instruments. It may be a good alternative to CLC in the future.

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