scholarly journals Advanced laparoscopic surgery: our initial experience at Nepal Medical College

2016 ◽  
Vol 18 (3) ◽  
pp. 17
Author(s):  
Dr Nishes ◽  
Dr Subash ◽  
Prof Pranil
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Laparoscopic Surgery ◽  
Standard Of Care ◽  
Operative Management ◽  
Rapid Expansion ◽  
Resource Poor Setting ◽  
Laparoscopic Technique ◽  
Medical College ◽  
Laparoscopic Procedures ◽  
Laparoscopic Techniques

If we consider the last century of history of surgery, few advances can be compared to the changes engendered by the introduction of minimally invasive surgery, which in the last decade has represented a revolution in surgical practice and patient care. Since 1987, when the first laparoscopic cholecystectomy was performed, laparoscopic procedures have been the standard of care for many routine diagnostic and therapeutic procedures. Laparoscopic techniques have become an integral part of the operative management in virtually every realm of general surgery. The success of the laparoscopic technique has been due mainly to patient demand, which has contributed to a rapid expansion in the number of laparoscopic procedures performedThe benefits conferred to patients by less invasive procedures like decreased pain, and shorter recovery time have to be weighed against overzealous application and the problems created by the lack of familiarity with new techniques and instruments. Basic laparoscopic procedures include laparoscopic cholecystectomy, laparoscopic appendectomy, and diagnostic laparoscopy. All other laparoscopic operations are defined as “advanced”. Learning curve and added expenses have been prohibitative in development of advanced laparoscopic surgery in resource poor setting like ours. However, advance laparoscopic surgery is here to stay. We must therefore have a concentrated effort to move towards offering these facilities to our patients.Despite the initial hiccups, some advanced laparoscopic surgeries are being performed and at Nepal Medical College, moving a step closer towards the gold standards in surgical management. Surgeons from various units and subspecialties work together and help each other and utilize each other’s limited experience. This spirit has been a great help to reach our way to develop ourselves despite our technical limitations. Our experience is limited but the outcomes so far are encouraging and we have tried to highlight the significance of framework. There is a long road ahead but a hood beginning is more than half done.

scholarly journals AUDIT OF EVOLVING ROLES OF LAPAROSCOPY IN THE CURRENT SURGICAL PRACTICE AT CHRIS HANI BARAGWANATH ACADEMIC HOSPITAL: A 5 YEAR REVIEW

2021 ◽  
Vol 8 (5) ◽  
pp. 16-24
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Laparoscopic Surgery ◽  
Standard Of Care ◽  
Descriptive Statistics ◽  
Academic Hospital ◽  
Surgical Practice ◽  
The Past ◽  
Wide Range ◽  
Accepted Standard ◽  
The Mean

Background: Laparoscopic surgery (LS) is gaining momentum and has revolutionised the practice of surgery. Over the past thirty years, LS has been used to manage a wide range of surgical pathologies and has become a recognised and generally accepted standard of care. Aim: The aim of this study is to describe the evolution of LS in selected procedures.. Methods: Data were collected from theatre registries. Statistical analysis was performed using the software IMB SPSS. The data were analysed using descriptive statistics of mean and standard deviation for age, and percentage and frequencies for categories of variables . Results: Of the 3745 patients involved in the study, 59.1% were males and 40.9% were females. The mean age of the patients was 35.17±17.30 years. Laparoscopic surgery was represented in 43.2% of the procedures, with laparoscopic appendicectomy (46.73%) and laparoscopic cholecystectomy (32.69%) being the most commonly performed procedures.. Twenty-five adrenalectomies were performed over the study period, and of those 12 (52%) were performed laparoscopically. All the thymectomies (12) were performed thoracoscopically, with one conversion. Conclusion: The findings of this study suggest that there has been an increase in the overall incidence of laparoscopic surgery in selected procedures at CHBAH.

scholarly journals Management of Symptomatic Renal Cysts by Laparoscopy: Our Initial Experience

2020 ◽  
Vol 21 (2) ◽  
pp. 137-139
Author(s):  
Mohammad Mahfuzur Rahman Chowdhury ◽  
AKM Shahadat Hossain ◽  
Rifat Zaman ◽  
Prodyut Kumar Saha ◽  
Hafiz Al Asad ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Hospital Stay ◽  
Renal Cysts ◽  
Standard Of Care ◽  
Drain Tube ◽  
College Hospital ◽  
Medical College ◽  
Cyst Recurrence ◽  
The Mean

Introduction and objective: Over the last decade laparoscopic surgery has been popularized and developed to such an extent that it can be considered gold standard for many types of procedures in urology. Currently the majority of operations in urologic field can be performed by laparoscopy. This is because it is as effective as open surgery, but associated with less postoperative pain, shorter hospital stay, faster recovery and has better cosmetic result. The aim of the study is to evaluate the results of our experience of treating symptomatic renal cysts by laparoscopy. Materials and methods: This prospective study was conducted from January 2015 to December 2017 in the Department of Urology in a single unit of Dhaka Medical College Hospital. All the patients were admitted through out-patient department. Among them those who fulfilled the criteria were selected for laparoscopic surgery. All patients were diagnosed by ultrasonography and computed tomography to determine the Bosniak classification of the cyst & informed written consent was taken. Total five laparoscopic decortication of renal cysts were performed and the results of our experience were compared with data from published article. Pain and cyst recurrence were assessed during the follow-up. Results: Our study described the results of 05 laparoscopic decortication of renal cysts. All procedures were completed successfully by transperitoneal approach, with no major intraoperative and postoperative complications. There was a placement of drain tube in one patient. The mean (range) operative duration was 68 (40–110) min, affected by the site and number of cysts decorticated. The mean post operative hospital stay was 1.8 (1- 3) days. All patients were symptom-free and no sign of recurrence during the follow-up. Conclusion: Laparoscopic decortication of symptomatic renal cysts should be the standard of care and it is feasible with conventional laparoscopic instruments and gives a better cosmetic outcome. Bangladesh Journal of Urology, Vol. 21, No. 2, July 2018 p.137-139

scholarly journals EXPERIENCE OF LAPAROSCOPIC SURGERY IN PREGNANT PATIENTS SAFETY OF LAPAROSCOPIC SURGERY IN PREGNANT PATIENTS

1969 ◽  
Vol 3 (2) ◽  
pp. 335-337
Author(s):  
MUHAMMAD ASLAM RAI
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Laparoscopic Surgery ◽  
General Anesthesia ◽  
Pregnant Women ◽  
Acute Cholecystitis ◽  
Maternal Death ◽  
Laparoscopic Appendectomy ◽  
Safety And Efficacy ◽  
Laparoscopic Procedures ◽  
Antibiotic Cover

OBJECTIVES: Laparoscopic surgery is well established in general patients but its safety and efficacy inpregnant patients isstill debated especially in emergency situation.METHODS: This study was conducted at Rai Medical Complex, Sargodha as prospective single centrestudy for all pregnant patients in need of laparoscopic appendectomy and cholecystectomy for acuteappendicitis and acute cholecystitis respectively from April 2009 to December,2011 .After routinepreoperative assessment, all were operated under general anesthesia with antibiotic cover, foure porttechnique for lap. chole. And three port technique for lap. appendectomy were used. Peri-operativemorbidity and mortality for the mother and fetus were evaluated at Rai Medical Complex, Sargodha from2009 to 2011.RESULTS:32 patients underwent laparoscopic procedures. 18 had laparoscopic cholecystectomy and 14laparoscopic appendectomies. No maternal death and no loss of fetus.CONCLUSION: Laparoscopic cholecystectomy and appendectomy appears to be as safe as in opensurgery in pregnant women.

scholarly journals Cost Effective Cholecystectemy in A Rural Tertiary Care Hospital

2017 ◽  
Vol 7 (1) ◽  
pp. 20-22
Author(s):  
Md Shahinur Rahman ◽  
SM Rezaul Islam ◽  
Kamal Pasha ◽  
Md Rashed Alam Chowdhury ◽  
Debabrata Paul ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Laparoscopic Surgery ◽  
Hospital Stay ◽  
Open Cholecystectomy ◽  
Gallstone Disease ◽  
Cost Effective ◽  
Care Hospital ◽  
Total Cost ◽  
Medical College ◽  
Significant Difference

Background: Laparoscopic cholecystectomy is an accepted alternative to open cholecystectomy. This study was aimed to compare the results of laparoscopic and open cholecystectomy with respect to duration of operation, complications, hospital stay and cost.Materials and Methods: This was a prospective type of study. 200 patients of gallstone disease were randomly selected. 100 patients underwent laparoscopic cholecystectomy and 100 underwent open cholecystectomy from July 2014 to June 2015 in surgery units of Jahurul Islam Medical College Hospital. Data regarding age, sex, operation time, complications, hospital stay and total cost were collected from patient and from hospital record. Then we compared the data of laparoscopic and open cholecystectomy.Results: We found that mean operating time for laparoscopic cholecystectomy was 45 minutes and for open cholecystectomy was 60 minutes.There is no significant difference in incidence of complications between open and laparoscopic procedure. In our study, mean postoperative hospital stay for laparoscopic surgery was 3.5 days and in open cholecystectomy was 6 days. In this study total cost of laparoscopic surgery is less than open surgery though operation team charge is more in laparoscopic surgery.Conclusion: Laparoscopic cholecystectomy is a safe and cost effective alternative to open cholecystectomy.Anwer Khan Modern Medical College Journal Vol. 7, No. 1: Jan 2016, P 20-22

scholarly journals Laparoscopic Surgery in a Developing Country in East Africa: An Audit at the Initial Part of a Surgeons’ Learning Curve

2020 ◽  
pp. 66-73
Author(s):  
Richard Wismayer
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Laparoscopic Surgery ◽  
East Africa ◽  
Developing Country ◽  
Initial Period ◽  
Operating Time ◽  
Early Discharge ◽  
Laparoscopic Appendicectomy ◽  
Laparoscopic Procedures ◽  
Surgical Access

Background: In many surgical conditions, laparoscopic surgery has been used for surgical access. In the West, laparoscopic cholecystectomy is the gold standard treatment for           cholecystitis. On the other hand controversy has been generated with laparoscopic appendicectomy due to the cost, time consuming nature of the procedure, together with many trocar sites which in all approximate to the length of an open appendicectomy incision. The purpose of this study is to audit the initial laparoscopic units experience in a developing country in East Africa. Methods: This was a retrospective study conducted in the Department of Surgery. All patients that consented to laparoscopic cholecystectomy and laparoscopic appendicectomy over the initial period of 13 months were included in this study. Results: A total of thirty (30) patients consented to having laparoscopic surgery; Ten (10) patients consented to laparoscopic cholecystectomies with a male:female ration of 1:2.33 and twenty (20) patients consented to laparoscopic appendicectomies with a male:female ratio of 1:1.2. The mean operating time was 58.5 minutes for laparoscopic cholecystectomy and 40.45 minutes for laparoscopic appendicectomy. The duration of post-operative admission ranged from 3 days to 5 days with a mean duration of 4.2 days for laparoscopic cholecystectomy and from 2 days to 5 days with a mean of 2.65 days for laparoscopic appendicectomy. No complications were reported apart from spinal headache in 2 patients (2.6%) out of the total laparoscopic procedures. There were no readmissions over the one month of follow up. Conclusions: Laparoscopic cholecystectomy and laparoscopic appendicectomy allows for early discharge and is safe. In Uganda, the low incidence of cholecystitis compared to the higher incidence of appendicitis, supports the adoption of laparoscopic appendicectomy compared to cholecystectomy for hand and eye coordination training. The surgeons’ initial cases of laparoscopic procedures have demonstrated an adequate level of safety which supports laparoscopic appendicectomy to acquire the basic laparoscopic surgery skills.

Association between Socioeconomic Factors and Postoperative Complications of Cholecystectomy

2021 ◽  
pp. 1-13
Author(s):  
Herman Romero Ramírez ◽  
Norma Muñoz Albán ◽  
Consuelo Albán Meneses ◽  
Alicia Escobar Torres
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Complications ◽  
Socioeconomic Factors ◽  
Control Variable ◽  
Laparoscopic Technique ◽  
Safe Operation ◽  
Conventional Surgery ◽  
Socioeconomic Characteristics ◽  
Dependent Variables ◽  
Education Levels

The article´s goal isto determine if socioeconomic factors influence the postoperative complications of cholecystectomy. For this, the observational study was defined, analytical and quantitative study was conducted in 100 patients who underwent cholecystectomy. A logistic regression model was applied in which risk factors, socioeconomic characteristics, along with a control variable, were incorporated as variables. Three models were run with alternative dependent variables that are delimited by the type of postoperative complication recorded. The results found showed that women show a higher risk of presenting complications after cholecystectomy, the same occurs in older patients. Likewise, the risk is much lower in people with higher education levels and in patients who underwent laparoscopic cholecystectomy, they only have a 5% risk of presenting complications. Postoperative complications after cholecystectomy are minimized by using the laparoscopic technique and socioeconomic factors would influence the risk of suffering postoperative complications after said surgery, which makes laparoscopic cholecystectomy a safe operation with many other benefits and advantages over traditional or conventional surgery.

Iatrogenic Bile Duct Injury. A Significant Surgical Problem. Assessment of Treatment Outcomes in the Department's Own Material

2015 ◽  
Vol 86 (12) ◽  
Author(s):  
Adam Bobkiewicz ◽  
łukasz Krokowicz ◽  
Tomasz Banasiewicz ◽  
Tomasz Kościński ◽  
Maciej Borejsza-Wysocki ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Retrospective Analysis ◽  
Bile Duct Injury ◽  
Clinical Symptoms ◽  
Open Cholecystectomy ◽  
Multidisciplinary Treatment ◽  
Laparoscopic Technique ◽  
Primary Surgery ◽  
Iatrogenic Bile Duct Injury

AbstractIatrogenic bile duct injuries (BDI) are still a challenging diagnostic and therapeutic problem. With the introduction of the laparoscopic technique for the treatment of cholecystolithiasis, the incidence of iatrogenic BDI increased.was a retrospective analysis of 69 patients treated at the department due to iatrogenic BDI in the years 2004-2014.. In this paper, we presented the results of a retrospective analysis of 69 patients treated at the Department due to iatrogenic BDI in the years 2004-2014. The data were analysed in terms of age, sex, type of biliary injury, clinical symptoms, the type of repair surgery, the time between the primary surgery and the BDI management, postoperative complications and duration of hospital stay.. 82.6% of BDI occurred during laparoscopic cholecystectomy, 8.7% occurred during open cholecystectomy, whereas 6 cases of BDI resulted from surgeries conducted for other indications. In order to assess the degree of BDI, Bismuth and Neuhaus classifications were used (for open and laparoscopic cholecystectomy respectively). 84.1% of patients with confirmed BDI, were transferred to the Department from other hospitals. The average time between the primary surgery and reoperation was 6.2 days (SD 4). The most common clinical symptom was biliary fistula observed in 78.3% of patients. In 28 patients, unsuccessful attempts to manage BDI were made prior to the admission to the Department in other centres. The repair procedure was mainly conducted by laparotomy (82.6%) and by the endoscopic approach (15.9%). Hepaticojejunostomy was the most common type of reconstruction following BDI (34.7%).. The increase in the rate of iatrogenic bile duct injury remains a challenging surgical problem. The management of BDI should be multidisciplinary treatment. Referring patients with both suspected and confirmed iatrogenic BDI to tertiary centres allows more effective treatment to be implemented.

Frequency of port site infection following gall bladder removal through Epigastric vs Umbilical port.

2021 ◽  
Vol 28 (03) ◽  
pp. 277-281
Author(s):  
Bushra Shaikh ◽  
Imamuddin Baloch ◽  
Azhar Ali Shah ◽  
Abdul Sami Mirani ◽  
Parkash Lal Lund ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Wound Infection ◽  
Port Site ◽  
Site Infection ◽  
College Hospital ◽  
Medical College ◽  
Duration Of Surgery ◽  
Group A ◽  
Group B

Objective: To compare the frequency of port site wound infection following gall bladder removal through umbilical and epigastric port in laparoscopic cholecystectomy. Study Design: Randomized Control Trial. Setting: Surgical Unit 2, Ghulam Muhammad Mahar Medical College, hospital Sukkur. Period: 1st November 2019 to 30th October 2020. Material & Methods: All cases who underwent four port laparoscopic cholecystectomy were enrolled in two groups. All procedures were performed under general anesthesia. As the last event of surgery gall bladder was retrieved in a glove bag through umbilical port in group A and through epigastric port in group B, both under direct camera vision. Wound infection was considered if there was 3 to 5 grade of wound according to Southampton wound grading system (Figure-1) on 5th postoperative day. All demographics and outcome variables were recorded. Results: Age ranged from 20 to 60 years with mean age of 38.875±8.11 years, BMI 29.973±5.12 Kg/m2, duration of surgery 50.656±8.41 mins and Southampton score was 1.044±1.07 in Group A and mean age of 38.560±6.23 years, BMI 27.437±5.04 Kg/m2, duration of surgery 48.920±8.67 mins and Southampton score was 0.856±0.92 in Group B. In group A, 18 (5.7%)patients developed port site wound infection in contrast to 5 (1.6%) patients in group B (P= 0.006). Conclusion: We conclude that epigastric port retrieval of gall bladder following laparoscopic cholecystectomy results in less port site infection.

scholarly journals Delayed Perforation of the Large Bowel due to Thermal Injury during Laparoscopic Cholecystectomy

2005 ◽  
Vol 33 (3) ◽  
pp. 360-363 ◽  
Author(s):  
A Polychronidis ◽  
AK Tsaroucha ◽  
AJ Karayiannakis ◽  
S Perente ◽  
E Efstathiou ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Laparoscopic Surgery ◽  
Large Bowel ◽  
Thermal Injury ◽  
Clinical Signs ◽  
Exploratory Laparotomy ◽  
Hepatic Flexure ◽  
Temporary Ileostomy ◽  
Delayed Perforation

We report a case of delayed perforation of the large bowel because of thermal injury during a laparoscopic cholecystectomy. A 78-year-old male with symptomatic cholelithiasis underwent a difficult laparoscopic cholecystectomy because of multiple adhesions resulting from two previous cholecystitis episodes. The patient recovered well after surgery and was discharged on post-operative day 2. On postoperative day 10, the patient returned to the hospital with peritonitis. An exploratory laparotomy revealed perforation of the wall of the hepatic flexure of the large bowel, which was centred in a necrotic area 1 cm in diameter. The perforation was sutured and a temporary ileostomy performed, which was closed at a later date. The patient was doing well at a 10-month follow-up review. A delayed rupture of any part of the bowel after laparoscopic surgery can be potentially fatal if not treated during an emergency exploratory laparotomy, even if the clinical signs are not severe.

Urologic laparoscopic surgery: Light and shade

1995 ◽  
Vol 62 (1_suppl) ◽  
pp. 80-84
Author(s):  
G. Breda ◽  
P. Silvestre ◽  
L. Gherardi ◽  
A. Giunta ◽  
A. Tamai ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Minimally Invasive ◽  
Surgical Approach ◽  
World Wide ◽  
Critical Evaluation ◽  
Minimally Invasive Technique ◽  
Laparoscopic Technique ◽  
Invasive Technique

— Analysing material and world-wide urologic laparoscopie surgery experience, the Authors try to define, also according to their experience, the indications for which the laparoscopic technique is established and well accepted and, on the contrary, those which are still controversial. Critical evaluation about laparoscopic surgery indications are often supported by the costs of the “minimally invasive” technique compared to the traditional surgical approach.

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