scholarly journals Laparoscopic total hysterectomy still not routinely chosen Operative description and available instruments

2019 ◽  
Vol 12 (3) ◽  
pp. 301-307
Author(s):  
Alexandra Popa ◽  
◽  
◽  
Catalin Copaescu ◽  
Valerica Horhoianu ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Broad Ligament ◽  
Laparoscopic Approach ◽  
Laparoscopic Hysterectomy ◽  
Vaginal Wall ◽  
Surgical Instruments ◽  
Minimal Invasiveness ◽  
Advantages And Disadvantages ◽  
Surgical Positioning ◽  
Increasing Trend

Hysterectomy is the most common gynecological surgical intervention; therefore, there are many technical variations in different healthcare systems around the world. We aimed to review, step by step, the technique of laparoscopic hysterectomy as well as to present the available variety of surgical instruments impartially so that the operative team can decide in an informed manner the model and characteristics of the equipment used. The surgical technique is presented based on the experience of the authors, focusing mainly on intraoperative recommendation and suggestions. Advantages and disadvantages of the available instruments are also extensively detailed. Surgical positioning, as well as inserting the uterine manipulator are essential steps. The open technique is used to create pneumoperitoneum. The utero-ovarian ligament or the infundibulopelvic ligament is identified, coagulated and cut. The round ligament is incised, entering the space between the two layers of the broad ligament and advancing caudally in this space, which, if correctly identified, should be avascular. The uterine vessels located on the posterior sheet of the broad ligament are dissected and coagulated. The vaginal wall is sectioned with the help of the manipulator’s cap, making it easier to expose the insertion line of the vagina on the cervix. The uterus is removed through the vagina or through a trans-parietal incision. Thereafter, the vagina is sutured using separate Vicryl sutures. Between 2011 and 2016, laparoscopic hysterectomy had an increasing trend all over Europe. With a reported percentage of 3%, Romania ranks last in hysterectomies performed laparoscopically. The laparoscopic approach offers the advantages of minimal invasiveness: less pain, faster recovery and early social reintegration; therefore, this trend of improvement should become more accepted.

Application of Nasomer in surgical treatment of patients with polyposis rhinosinusitis

2018 ◽  
pp. 39-42
Author(s):  
Vladimir Bereznyuk ◽  
Alexander Chernokur ◽  
Oleg Gospod
Keyword(s):  
Nasal Cavity ◽  
Postoperative Period ◽  
Paranasal Sinuses ◽  
Standard Treatment ◽  
Surgical Intervention ◽  
Sodium Hyaluronate ◽  
Main Group ◽  
Control Group ◽  
Nasal Breathing ◽  
Minimal Invasiveness

Relevance: Modern endonasal surgery allows to remove polyps from all affected paranasal sinuses, following the principles of minimal invasiveness. Minimal traumatic of surgical intervention gives the best results, accompanied by less progression of the disease. Minimal invasiveness of surgical intervention and its obligatory combination with postoperative medical treatment are common practice in many countries. One of the drugs that actively effect the restoration of the mucous membrane of the nasal cavity and paranasal sinuses in the early postoperative period is Nazomer, which includes sodium hyaluronate and dexpanthenol in saline solution. The purpose of the study is to investigate the effectiveness of the drug Nazomer in patients with polyposis rhinosinusitis after endoscopic polyposynosotomy. Results and discussion: The main group consisted of 30 patients with polyposis rhinosinusitis, who were prescribed Nasomer in addition to standard treatment in the postoperative period. The control group included 30 patients who underwent standard treatment in the postoperative period. As criteria for clinical efficacy, data from endoscopic examination of the nasal cavity and indicators of anterior rhinomatometry, measured by the «Optimus» device, were selected. In the main group, the index of nasal breathing according to rhinomatometry was better than the results of patients in the control group on the 3rd and 5th day of the postoperative period by 26% and 24%, respectively. Conclusion: The use of the drug Nazomer in the postoperative period in patients with polyposis rhinosinusitis contributes to more active restoration of respiratory function of the nasal cavity compared with the control group, according to rhinomatometry, up to 26%. Based on the results obtained, the drug Nazomer is an effective anti-inflammatory and regenerative agent in the postoperative period in patients with polyposis rhinosinusitis.

scholarly journals THREE CASES OF BOWEL OBSTRUCTION BY BROAD LIGAMENT HERNIA

2021 ◽  
Vol 108 (Supplement_3) ◽  
Author(s):  
M Soto Dopazo ◽  
E Pérez Prudencio ◽  
A Arango Bravo ◽  
C Nuño Iglesias ◽  
C Mateos Palacios ◽  
...  
Keyword(s):  
Small Bowel ◽  
Bowel Obstruction ◽  
Broad Ligament ◽  
Intestinal Resection ◽  
Laparoscopic Approach ◽  
Exploratory Laparotomy ◽  
X Rays ◽  
Intestinal Necrosis ◽  
Urgent Surgery ◽  
Internal Hernias

Abstract INTRODUCTION Internal hernias caused by broad ligament defects are an infrequent cause of bowel obstruction. These defects may be congenital or acquired mainly by gynecological antecedents. Small bowel is the most common affected and the diagnosis is difficult due to nonspecific symptoms and absences of characteristic radiological signs. MATERIAL AND METHODS We report the cases of three women aged from 43 to 56 years old, who came to the emergency with abdominal pain, vomiting and bloating of hours duration. One patient has a history of laparoscopic appendectomy, the rest of them with no surgical history. In all of the cases, x-rays showed dilatation of small bowel loops and air-fluid levels and the abdominal TC revealed a generalized distention of bowel loops with transition point in the terminal ileum with no identifiable cause compatible with small bowel obstruction. RESULTS We decided to perform an urgent surgery with an exploratory laparotomy in one case and the rest by laparoscopic approach, finding an internal hernia occasioned by incarceration of small bowel through a broad ligament defect. In all cases, the hernia content was liberated without evidence of ischemia with no need for intestinal resection, and the defect was closed. All patients had a favourable postoperative course without complications. DISCUSSION Broad ligament defects are a rare cause of internal hernias. These are difficult to diagnose clinically as well as radiologically for an absence of characteristic signs. A high level of clinical suspicion allows early diagnosis and the treatment should be performed as soon as possible to reduce the chances of intestinal necrosis.

scholarly journals Closest and long-term prospects of 3D-printing for obstetrics and gynecology

2021 ◽  
Vol 20 (1) ◽  
pp. 76-81
Author(s):  
E. V. Kudryavtseva ◽  
V. V. Kovalev ◽  
E. S. Zakurinova ◽  
G. Muller-Kamskii ◽  
V. V. Popov
Keyword(s):  
3D Printing ◽  
Scientific Literature ◽  
Simulation Models ◽  
Surgical Instruments ◽  
Obstetrics And Gynecology ◽  
Scientific Review ◽  
Advantages And Disadvantages ◽  
The Creation ◽  
Dimensional Printing

Introduction. Despite the notable and rapid progress in the development of medical 3D printing in recent years, not much is known about the use of this technology in obstetrics and gynecology.The purpose of our review of scientific literature was to determine the current level of 3D printing development, discuss the closest and long term prospects for using this technology in obstetrics and gynecology, and analyze its potential advantages and disadvantages.Materials and methods. We searched for scientific literature. 378 papers passed a three-step screening, as a result of which 42 sources were selected for the final scientific review.Results and discussion. The main areas in which dimensional printing can be used in this area of medicine is the creation of simulation models and training for students, the creation of anatomical models for preoperative preparation, the surgical instruments, the creation of new dosage drug forms (including transvaginal ones), and bioprinting of organs and tissues.Conclusion. The presented literary review allows us to conclude that 3D printing the obstetrics and gynecology is a current rapidly developing direction. The organization of 3D modeling and printing laboratories can significantly increase the efficiency of teaching students and residents. In addition, obstetricians-gynecologists and surgeons should be informed about the possibility of 3D printing surgical instruments according to an individual design. It can inspire them to implement their own ideas and develop domestic innovative developments. Three-dimensional printing of dosage forms and bioprostheses requires more complex technological solutions, and is not yet used in clinical practice. However, given the enormous prospects for these areas, various grants should be envisaged for their development in Russia

scholarly journals Acute Lower Gastrointestinal Bleeding: Part II

2001 ◽  
Vol 15 (8) ◽  
pp. 517-521 ◽  
Author(s):  
Robert Enns
Keyword(s):  
Gastrointestinal Bleeding ◽  
Surgical Intervention ◽  
Lower Gastrointestinal Bleeding ◽  
Lower Gastrointestinal Hemorrhage ◽  
Nuclear Scintigraphy ◽  
Diagnostic Strategies ◽  
Advantages And Disadvantages ◽  
Therapeutic Value ◽  
The Face ◽  
Acute Lower Gastrointestinal Hemorrhage

Diagnostic strategies for lower gastrointestinal bleeding include nuclear scintigraphy, mesenteric angiography and endoscopic evaluation of the lower gastrointestinal tract. Each method has inherent advantages and disadvantages. Nuclear scintigraphy is simple and noninvasive, but high rates of false localization have led most clinicians to insist on confirmation of the bleeding site by another method before considering surgical intervention. Angiography is very specific, but is invasive and not as sensitive as nuclear scintigraphy. Colonoscopy is sensitive and specific, and can offer therapeutic value but can be technically challenging in the face of acute lower gastrointestinal hemorrhage. These strategies and the evidence behind them are discussed.

scholarly journals African experiences of laparoscopic hysterectomy about a continuous series of 52 cases by the same practitioner: indications, surgical procedures and complications

2018 ◽  
Vol 7 (3) ◽  
pp. 789
Author(s):  
Koffi Abdoul Koffi ◽  
Kacou Edele Aka ◽  
Minata Fomba ◽  
Konan Seni ◽  
Apollinaire Horo ◽  
...  
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Average Length ◽  
Laparoscopic Approach ◽  
Length Of Hospital Stay ◽  
Laparoscopic Hysterectomy ◽  
Pelvic Surgery ◽  
Continuous Series ◽  
Average Size ◽  
A Prospective Study

Background: Laparoscopy is a modern surgical technique that began in 1940 with Raoul Palmer. The present study aimed to analyse the results of a fifty-two-laparoscopic hysterectomy performed.Methods: A prospective study over a period of seven years from 1st January 2010 to 31st December 2015. A total of 52 patients who underwent a laparoscopic hysterectomy were recruited at the teaching hospital of Yopougon-Abidjan.Results: The mean age was 50.2 years (±3.9 years) (36-62 years). The average parity was 3. Few patients had undergone anterior pelvic surgery for either myomectomy or caesarean section. Uterine fibroid was the major surgical indication with a rate of 61.54%. The average size of the uterus was 12 cm (8-18 cm). Total hysterectomies type II and III with or without adnexectomy were essentially performed with rates of 28.85% and 32.69%, respectively. Sometimes it was associated with a lymphadenectomy or a colpo-suspension. The average length of a hysterectomy is 170 minutes (87-385 minutes). Four cases of laparo-conversions have been noted. Blood loss was approximately 95 ml (±12 ml) with a maximum of 300 ml. The complications were mainly two digestive wounds and a bladder fistula. The average length of hospital stay is three days apart from any complication.Conclusions: The laparoscopic approach is less painful, is associated with less blood loss, shorter hospital stay, faster recovery, fewer complications, and better care. A training period of surgeons associated with the equipment of the health structures is necessary to popularize this procedure surgical.

Retrospective Validation of an Algorithmic Treatment Pathway for Necrotizing Pancreatitis

2019 ◽  
Vol 85 (8) ◽  
pp. 840-847
Author(s):  
Ryan C. Pickens ◽  
Jesse K. Sulzer ◽  
Allyson Cochran ◽  
Dionisios Vrochides ◽  
John B. Martinie ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Pancreatic Necrosis ◽  
Surgical Intervention ◽  
Necrotizing Pancreatitis ◽  
Laparoscopic Approach ◽  
High Volume ◽  
Evidence Based ◽  
Robot Assisted ◽  
Delayed Treatment ◽  
Open Necrosectomy

The role of surgical intervention for necrotizing pancreatitis has evolved; however, no widely accepted algorithm has been established to guide timing and optimal modality in the minimally invasive era. This study aimed to retrospectively validate an established institutional timing- and physiologic-based algorithm constructed from evidence-based guidelines in a high-volume hepatopancreatobiliary center. Patients with necrotizing pancreatitis requiring early (≤six weeks from symptom onset) or delayed (>six weeks) surgical intervention were reviewed over a four-year period (n = 100). Early intervention was provided through laparoscopic drain-guided retroperitoneal debridement (n = 15) after failed percutaneous drainage unless they required an emergent laparotomy (due to abdominal compartment syndrome, bowel necrosis/perforation, or hemorrhage) after which conservative, sequential open necrosectomy was performed (n = 47). Robot-assisted (n = 16) versus laparoscopic (n = 22) transgastric cystgastrostomy for the delayed management of walled-off pancreatic necrosis was compared, including patient factors, operative characteristics, and 90-day clinical outcomes. Major complications after early debridement were similarly high (open 25% and drain-guided 27%), yet 90-day mortality was low (open 8.5% and drain-guided 7.1%). Patient and operative characteristics and 90-day outcomes were statistically similar for robotic versus laparoscopic transgastric cystogastrostomy. Our evidence-based algorithm provides a stepwise approach for the management of necrotizing pancreatitis, emphasizing minimally invasive early and late interventions when feasible with low morbidity and mortality. Robot-assisted transgastric cystogastrostomy is an acceptable alternative to a laparoscopic approach for the delayed treatment of walled-off pancreatic necrosis.

Evaluation of Patient Feedback following Laparoscopic Cholecystectomy based on Information Described in the Informed Consent form Developed by the Association of Polish Surgeons

2015 ◽  
Vol 87 (11) ◽  
Author(s):  
Piotr Misiak ◽  
Sławomir Jabłoński ◽  
Jerry Lazarek ◽  
Katarzyna Malinowska ◽  
Edyta Santorek-Strumiłło ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Informed Consent ◽  
Surgical Intervention ◽  
Small Sample Size ◽  
Laparoscopic Approach ◽  
Invasive Procedure ◽  
Small Sample ◽  
Consent Form ◽  
Patient Feedback ◽  
Informed Consent Form

AbstractThe cholecystectomy procedure is the most routinely performed intervention in general surgery. The current international gold standard is via the laparoscopic approach. It is a safe, minimally-invasive procedure; however, it is associated with complications in 1% of cases.was to analyze patient feedback, by means of a survey, to determine how much knowledge patients possessed about their disease state and proposed surgical intervention, based primarily on information contained within the informed consent form developed by the Association of Polish Surgeons.This study involved the participation of 51 patients who underwent laparoscopic cholecystectomy, indicated by a diagnosis of gallstones, in the years 2014 and 2015.Despite having signed the informed consent form, there was considerable variation among the responses given to the survey by the 51 patients in this study. Some patients’ responses were tangential to the questions asked; many patients did not respond to any of the sub points.Given that this study is based on a small sample size of patients, it must be presumed that the process by which the patient declares his or her informed consent requires further consideration with respect to the means by which it is obtained. The authors of this study thus recommend that multimedia resources be harnessed as part of the process of obtaining the informed consent of patients prior to surgical intervention.

scholarly journals Laparoscopic Distal Pancreatectomy with or without Preservation of the Spleen for Solid Pseudopapillary Neoplasm

2015 ◽  
Vol 2015 ◽  
pp. 1-16 ◽  
Author(s):  
Tomohide Hori ◽  
Toshihiko Masui ◽  
Toshimi Kaido ◽  
Kohei Ogawa ◽  
Kentaro Yasuchika ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Distal Pancreatectomy ◽  
Surgical Simulation ◽  
Laparoscopic Approach ◽  
Preoperative Assessment ◽  
Laparoscopic Distal Pancreatectomy ◽  
Surgical Instruments ◽  
Safe Procedure ◽  
Splenic Preservation ◽  
Solid Pseudopapillary Neoplasm

Solid pseudopapillary neoplasm (SPN) is a rare tumor of the pancreas. Laparoscopic distal pancreatectomy (DP) is a feasible and safe procedure, and successful spleen preservation rates are higher using a laparoscopic approach. We hypothesized that certain patients with SPN would be good candidates for laparoscopic surgery; however, few surgeons have reported laparoscopic DP for SPN. We discuss the preoperative assessment and surgical simulation for two SPN cases. A simulation was designed because we consider that a thorough preoperative understanding of the procedure based on three-dimensional image analysis is important for successful laparoscopic DP. We also discuss the details of the actual laparoscopic DP with or without splenic preservation that we performed for our two SPN cases. It is critical to use appropriate instruments at appropriate points in the procedure; surgical instruments are numerous and varied, and surgeons should maximize the use of each instrument. Finally, we discuss the key techniques and surgical pitfalls in laparoscopic DP with or without splenic preservation. We conclude that experience alone is inadequate for successful laparoscopic surgery.

scholarly journals Experience in the implementation of the single subtotal hysterectomy laparoscopic approach

2016 ◽  
Vol 65 (1) ◽  
pp. 43-47
Author(s):  
Igor O Marinkin ◽  
Vasily A Odintsov ◽  
Andrei I Shevela ◽  
Vladimir V Anischenko
Keyword(s):  
Single Port ◽  
Surgical Techniques ◽  
Laparoscopic Approach ◽  
Economic Feasibility ◽  
Safe Method ◽  
Advantages And Disadvantages ◽  
Single Port Surgery ◽  
Subtotal Hysterectomy ◽  
Cosmetic Effect ◽  
Comparison Of The Results

A comparison of the results of subtotal hysterectomy performed by various surgical procedures (SILS, laparoscopy). Indications for these types of surgical techniques, identified the advantages and disadvantages of each method of economic feasibility. It is shown that single-port surgery is characterized by the best cosmetic effect and less postoperative pain than with classical laparoscopy. It defines the single-port surgery as a safe method of choice for endoscopic treatment of uterine pathology.

scholarly journals The total laparoscopic hysterectomy - a modern route of hysterectomy. Is there a benefit?

2005 ◽  
Vol 54 (5S) ◽  
pp. 24a-24a
Author(s):  
В. Holthaus ◽  
A. Kletsel ◽  
А. Mosel ◽  
R. A. Regidor
Keyword(s):  
Postoperative Complications ◽  
Hospital Stay ◽  
Laparoscopic Approach ◽  
Laparoscopic Hysterectomy ◽  
Total Laparoscopic Hysterectomy ◽  
Short Hospital Stay ◽  
Female Patients ◽  
Benign Disorders

Objective: Total laparoscopic hysterectomy - a suitable approach to hysterectomy compared to the abdominal way. Introduction.Hysterectomy is the most frequent surgery performed on female patients (approximately 70,000 per year in Germany). In more than 90% of the cases, it is indicated for benign disorders. In 1996 about 8% of the operation were done by laparoscopy, in 2002 it was done in about 12% of the cases. Only a very few recent publications focuses on per- and postoperative complications of the total laparoscopic hysterectomy. The advantage of the laparoscopic approach has been mainly associated with a short hospital stay and a quick convalescence. The object of this study was to list the advantage and the complications of the laparoscopic hysterectomy.

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