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Lim H, Kim E, Kim SY, Kim JY, Jung Y, Lee T, Kim N, Tae K. Detection of increased intracranial pressure in trans-oral robotic thyroidectomy using optic nerve sheath diameter measurement. Head Neck 2023; 45:329-336. [PMID: 36333967 DOI: 10.1002/hed.27234] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 10/20/2022] [Accepted: 10/25/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND During transoral robot-assisted thyroidectomy, there is a risk of increasing intracranial pressure because the site of CO2 insufflation is narrow and close to the brain. METHODS We analyzed the pre- to post-CO2 neck insufflation change in the optic nerve sheath diameter during transoral robot-assisted thyroidectomy. Changes in vital-signs, airway pressure, and arterial carbon dioxide pressure were analyzed along with postoperative complications. RESULTS Among the 30 participants, the post-CO2 inflation mean optic nerve sheath diameter (5.64 ± 0.54 mm) was higher than the pre-induction diameter (4.81 ± 0.37 mm) with a mean difference of 0.83 (95% CI, 0.69-0.97; p < 0.001), but returned to baseline after CO2 deflation in most cases. One participant had sustained increased optic nerve sheath diameter (6.35 mm) associated with severe new-onset postoperative headache. CONCLUSION Transient elevation in the intracranial pressure during low-pressure CO2 neck insufflation in the transoral robot-assisted thyroidectomy did not appear to adversely affect patients.
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Affiliation(s)
- Hyunyoung Lim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Eugene Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Soo Yeon Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Ji-Yoon Kim
- Department of Anesthesiology and Pain Medicine, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Yundo Jung
- Department of Anesthesiology and Pain Medicine, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Tagkeun Lee
- Department of Anesthesiology and Pain Medicine, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Nayeon Kim
- Department of Anesthesiology and Pain Medicine, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Kyung Tae
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
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2
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Kajiwara M, Nakashima R, Yoshimura F, Hasegawa S. Impact of AirSeal ® insufflation system on respiratory and circulatory dynamics during laparoscopic abdominal surgery. Updates Surg 2022; 74:2003-2009. [PMID: 36173530 PMCID: PMC9521008 DOI: 10.1007/s13304-022-01386-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/16/2022] [Indexed: 12/05/2022]
Abstract
The effect of the AirSeal® insufflation system on hemodynamic parameters, especially end-tidal carbon dioxide (EtCO2), during laparoscopic abdominal surgery remains unclear. This retrospective single-center study included 333 consecutive patients who underwent laparoscopic hepatectomy (n = 43), gastrectomy (n = 69), colectomy (n = 137), or proctectomy (n = 84) using the AirSeal®. Patient demographics and intraoperative hemodynamic parameters, such as EtCO2, peripheral capillary oxygen saturation (SpO2), and arterial systolic blood pressure (ABP), were collected and analyzed. EtCO2 was evaluated during the entire operative period (whole period) as well as the pneumoperitoneum period until specimen removal (pneumoperitoneum period). We defined “positive respiratory and circulatory responses” (positive responses) as a decrease in EtCO2 ≥ 3 mmHg in addition to decreases in SpO2 ≥ 3% and ABP ≥ 10 mmHg simultaneously, which suggest possible carbon dioxide (CO2) embolism. The median EtCO2 values of hepatectomy, gastrectomy, colectomy, and proctectomy in the whole period/pneumoperitoneum period were 37.3/37.4, 37.1/37.3, 37.4/37.9, and 38.2/38.4 mmHg, respectively. The EtCO2 of proctectomy was significantly higher than that of gastrectomy during the whole and pneumoperitoneum periods (P < 0.05). In contrast, the EtCO2 of hepatectomy was comparable to that of the other three surgeries in the whole and pneumoperitoneum periods. Meanwhile, nine (2.7%; eight hepatectomies and one proctectomy) patients showed positive responses, and one who underwent a partial hepatectomy developed a clinically manifested CO2 embolism. Positive responses occurred during venous exposure or bleeding in all nine cases. Although the EtCO2 of hepatectomy was comparable to that of the other surgeries using the AirSeal®, laparoscopic hepatectomy showed a tendency of CO2 embolism. Thus, a secure and careful surgical approach is mandatory for laparoscopic hepatectomy using the AirSeal® insufflation system.
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Affiliation(s)
- Masatoshi Kajiwara
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 810-0180, Japan.
| | - Ryo Nakashima
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 810-0180, Japan
| | - Fumihiro Yoshimura
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 810-0180, Japan
| | - Suguru Hasegawa
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 810-0180, Japan
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Guilbaud T, Cermolacce A, Berdah S, Birnbaum DJ. New 5-mm laparoscopic pneumodissector device to improve laparoscopic dissection: an experimental study of its safety in a swine model. Surg Endosc 2022; 36:2712-2720. [PMID: 34981235 DOI: 10.1007/s00464-021-08953-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 12/06/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND To improve the laparoscopic surgical dissection, the aim of the study was to assess the safety of burst of high-pressure CO2 using a 5-mm laparoscopic pneumodissector (PD) operating at different flow rates and for different operating times regarding the risk of gas embolism (GE) in a swine model. METHODS The first step was to define the settings use of the PD device ensuring no GE. Successive procedures were conducted by laparotomy: cholecystectomy, the PD was placed 10 mm deep in the liver and the PD was directly introduced into the lumen of the inferior vena cava. Different PD flow rates of 5, 10, and 15 mL/s were used. The second step was to assess the safety of the device (PD group) during a laparoscopic dissection task (cystic and hepatic pedicles dissection, cholecystectomy and right nephrectomy) in comparison with the use of a standard laparoscopic hook device (control group). PD flow rate was 10 mL/s and consecutive burst of high-pressure CO2 was delivered for 3-5 s. RESULTS In the first step (n = 17 swine), no GE occurred during cholecystectomy regardless of the PD flow rate used. When the PD was placed in the liver or into the inferior vena cava, no severe or fatal GE occurred when a burst of high-pressure CO2 was applied for 3 or 5 s with PD flow rates of 5 and 10 mL/s. In the second step (PD group, n = 10; control group, n = 10), no GE occurred in the PD group. The use of the PD did not increase operative time or blood loss. The quality of the dissection was significantly improved compared to the control group. CONCLUSIONS The 5-mm laparoscopic PD appears to be free from CO2 GE risk when consecutive bursts of high-pressure CO2 are delivered for 3-5 s with a flow rate of 10 mL/s.
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Affiliation(s)
- Théophile Guilbaud
- Center for Surgical Teaching and Research (CERC), Aix-Marseille University, Marseille, France. .,Department of Digestive Surgery, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, Chemin des Bourrely, 13015, Marseille, France.
| | - Alexia Cermolacce
- Center for Surgical Teaching and Research (CERC), Aix-Marseille University, Marseille, France
| | - Stéphane Berdah
- Center for Surgical Teaching and Research (CERC), Aix-Marseille University, Marseille, France.,Department of Digestive Surgery, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, Chemin des Bourrely, 13015, Marseille, France
| | - David Jérémie Birnbaum
- Center for Surgical Teaching and Research (CERC), Aix-Marseille University, Marseille, France.,Department of Digestive Surgery, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, Chemin des Bourrely, 13015, Marseille, France
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4
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Jin YN, Feng H, Wang ZY, Li J. Analysis of the Risk Factors for Hypotension in Laparoscopic Hiatal Hernia Repair. Int J Gen Med 2021; 14:5203-5208. [PMID: 34512003 PMCID: PMC8423486 DOI: 10.2147/ijgm.s327259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/16/2021] [Indexed: 11/23/2022] Open
Abstract
Objective This study aimed to investigate the risk factors for hypotension in patients undergoing laparoscopic hiatal hernia repair. Methods The clinical data of patients who underwent laparoscopic repair of a hiatal hernia in the Beijing Chao-Yang Hospital of Capital Medical University between February 2018 and January 2021 were retrospectively collected, and their perioperative data were obtained by querying the electronic medical record system. The patients were divided into two groups—a hypotension group and a normal group—based on the occurrence of intraoperative hypotension, which was defined as a mean arterial pressure <65 mmHg and lasting ≥1 minute during the operation. The variables with a P value ≤0.1 in univariate regression analysis and clinically considered relevant variables were included in multivariate regression analysis in order to screen the risk factors for hypotension in these patients. Results A total of 114 patients were included in the analysis. The incidence of hypotension was 54.4%. Old age was identified as the only risk factor for hypotension during hiatal hernia surgery. Conclusion Old age is the only risk factor for intraoperative hypotension in patients undergoing laparoscopic hiatal hernia repair.
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Affiliation(s)
- Ya-Nan Jin
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Hao Feng
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Zhen-Yuan Wang
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Jie Li
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China
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Short-Term Outcome of Laparoscopic Surgery in Elderly Colorectal Cancer Patients. Int Surg 2021. [DOI: 10.9738/intsurg-d-15-00108.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We aimed to evaluate the short-term outcome of colorectal resection in very elderly patients, aged 85 years or older. As the population ages, the number of elderly patients with colorectal cancer (CRC) is increasing in Japan. At this time, it is unclear whether or not laparoscopic colorectal resection is safe for this very elderly patient population. From January 2005 to November 2014, a total of 20 patients aged 85 years or older underwent laparoscopic colorectal resection at Osaka University Hospital. Pre- and postoperative clinical data and outcomes were collected retrospectively. There were no intraoperative or postoperative deaths. In 2 cases, the laparoscopic procedure was converted to open surgery. Postoperative complications occurred in 6 patients. Two patients developed an infection at the surgical site. Among the 4 patients who underwent low anterior resection (LAR), 2 experienced postoperative anastomotic leakage. Two other patients developed a lung infection and urinary tract infection, respectively. Laparoscopic colectomy for very elderly patients with CRC appears to involve tolerable risk. However, special caution is advisable for patients who may undergo LAR.
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Han Q, Wang B, Xu A. Use of intraoperative ultrasonography for identification and management of pneumothorax caused by iatrogenic diaphragm defect: a case report and literature review. J Int Med Res 2020; 48:300060519898048. [PMID: 31964200 PMCID: PMC7113711 DOI: 10.1177/0300060519898048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Transthoracic ultrasound has been widely accepted for the evaluation of many thoracic diseases, including pleural effusion, atelectasis, pneumothorax, and pneumonia with subpleural effusion. Application of ultrasonography for the diagnosis of pneumothorax is an effective and timely intraoperative technique. We herein present a patient who developed pneumothorax following diaphragmatic injury during laparoscopic cholecystectomy. The pneumothorax was rapidly identified by bedside ultrasound. The compressed lung was successfully re-expanded using positive end-expiratory pressure (PEEP) ventilation under real-time ultrasound monitoring, and closed thoracic drainage was avoided. Therefore, the correct use of ultrasound can identify the adequate PEEP level that is able to promote resolution of pneumothorax induced by diaphragmatic injury.
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Affiliation(s)
- Qiang Han
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Beibei Wang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Aijun Xu
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
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Fromer IR, Horvath B, Prielipp RC, Kloesel B. Vascular Air Emboli During the Perioperative Period. CURRENT ANESTHESIOLOGY REPORTS 2020. [DOI: 10.1007/s40140-020-00407-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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8
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De Cassai A, Boetto R, Gabellini G, Cillo U. Massive Carbon Dioxide Embolism During Laparoscopic Liver Resection: A Case Report. Cureus 2019; 11:e5075. [PMID: 31516785 PMCID: PMC6721901 DOI: 10.7759/cureus.5075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Carbon dioxide embolism during laparoscopic surgery is a serious and life-threatening complication. The overall incidence of embolism during laparoscopic surgery is low (0.15%). Although the potential fatal consequences of this complication are reported in literature, a well-documented report of the effect of massive CO2 embolism during laparoscopic liver resection on cardiovascular, respiratory and encephalographic parameters does not exist. The authors describe a well-documented case of massive carbon dioxide embolism during laparoscopic liver resection suspected by both hemodynamic instability and elevation of EtCO2 and confirmed by arterial blood gas. The surgeon's rapid closure of the vascular breach resulted in an overall improvement of the patient's vital signs without further consequences. Our case report shows the cardiovascular, respiratory and encephalographic effects of a massive carbon dioxide embolism and highlights the importance of a strict cooperation between the surgeon and the anesthesiologist and the importance for a prompt treatment when massive carbon dioxide embolism occurs.
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Affiliation(s)
| | - Riccardo Boetto
- Surgical, Oncological and Gastroenterological Sciences, Hepatobiliary Surgery and Liver Transplantation Unit, Padova University Hospital, Padova, ITA
| | - Giulia Gabellini
- Medicine/ Section of Anesthesiology and Intensive Care, Padova University Hospital, Padova, ITA
| | - Umberto Cillo
- Surgical, Oncological and Gastroenterological Sciences, Hepatobiliary Surgery and Liver Transplantation Unit, Padova University Hospital, Padova, ITA
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9
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Huntington CR, Prince J, Hazelbaker K, Lopes B, Webb T, LeMaster CB, Huntington TR. Safety first: significant risk of air embolism in laparoscopic gasketless insufflation systems. Surg Endosc 2019; 33:3964-3969. [DOI: 10.1007/s00464-019-06683-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 01/23/2019] [Indexed: 01/05/2023]
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10
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Cole WC, Mayo JS, Yheulon CG. Pericarditis as a Result of Pneumomediastinum after Uncomplicated Laparoscopic Totally Extraperitoneal Inguinal Hernia Repair. Am Surg 2017. [DOI: 10.1177/000313481708300605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- William C. Cole
- General Surgery Tripler Army Medical Center Honolulu, Hawaii
| | - John S. Mayo
- General Surgery Tripler Army Medical Center Honolulu, Hawaii
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11
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Kaneko H, Otsuka Y, Kubota Y, Wakabayashi G. Evolution and revolution of laparoscopic liver resection in Japan. Ann Gastroenterol Surg 2017; 1:33-43. [PMID: 29863134 PMCID: PMC5881311 DOI: 10.1002/ags3.12000] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 02/15/2017] [Indexed: 12/21/2022] Open
Abstract
Due to important technological developments and improved endoscopic techniques, laparoscopic liver resection (LLR) is now considered the approach of choice and is increasingly performed worldwide. Recent systematic reviews and meta‐analyses of observational data reported that LLR was associated with less bleeding, fewer complications, and no oncological disadvantage; however, no prospective randomized trials have been conducted. LLR will continue to evolve as a surgical approach that improves patient's quality of life. LLR will not totally supplant open liver surgery, and major LLR remains to be technically challenging procedure. The success of LLR depends on individual learning curves and adherence to surgical indications. A recent study proposed a scoring system for stepwise application of LLR, which was based on experience at high‐volume Japanese centers. A cluster of deaths after major LLR was sensationally reported by the Japanese media in 2014. In response, the Japanese Society of Hepato‐Biliary‐Pancreatic Surgery conducted emergency data collection on operative mortality. The results demonstrated that mortality was not higher than that for open procedures except for hemi‐hepatectomy with biliary reconstruction. An online prospective registry system for LLR was established in 2015 to be transparent for patients who might potentially undergo treatment with this newly developed, technically demanding surgical procedure.
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Affiliation(s)
- Hironori Kaneko
- Division of General and Gastroenterological Surgery Department of Surgery Toho University Faculty of Medicine Tokyo Japan
| | - Yuichiro Otsuka
- Division of General and Gastroenterological Surgery Department of Surgery Toho University Faculty of Medicine Tokyo Japan
| | - Yoshihisa Kubota
- Division of General and Gastroenterological Surgery Department of Surgery Toho University Faculty of Medicine Tokyo Japan
| | - Go Wakabayashi
- Division of General and Gastroenterological Surgery Department of Surgery Toho University Faculty of Medicine Tokyo Japan.,Department of Surgery Ageo Central General Hospital Saitama Japan
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12
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Atkinson TM, Giraud GD, Togioka BM, Jones DB, Cigarroa JE. Cardiovascular and Ventilatory Consequences of Laparoscopic Surgery. Circulation 2017; 135:700-710. [DOI: 10.1161/circulationaha.116.023262] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Although laparoscopic surgery accounts for >2 million surgical procedures every year, the current preoperative risk scores and guidelines do not adequately assess the risks of laparoscopy. In general, laparoscopic procedures have a lower risk of morbidity and mortality compared with operations requiring a midline laparotomy. During laparoscopic surgery, carbon dioxide insufflation may produce significant hemodynamic and ventilatory consequences such as increased intraabdominal pressure and hypercarbia. Hemodynamic insults secondary to increased intraabdominal pressure include increased afterload and preload and decreased cardiac output, whereas ventilatory consequences include increased airway pressures, hypercarbia, and decreased pulmonary compliance. Hemodynamic effects are accentuated in patients with cardiovascular disease such as congestive heart failure, ischemic heart disease, valvular heart disease, pulmonary hypertension, and congenital heart disease. Prevention of cardiovascular complications may be accomplished through a sound understanding of the hemodynamic and physiological consequences of laparoscopic surgery as well as a defined operative plan generated by a multidisciplinary team involving the preoperative consultant, anesthesiologist, and surgeon.
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Affiliation(s)
- Tamara M. Atkinson
- From Knight Cardiovascular Institute (T.M.A., G.D.G.), Department of Anesthesiology and Perioperative Medicine (B.M.T.), Oregon Health and Science University, Portland; Division of Cardiology, Portland VA Medical Center, Oregon (T.M.A., G.D.G.); and Beth Israel Deaconess Medical Center, Harvard University, Boston, MA (D.B.J.)
| | - George D. Giraud
- From Knight Cardiovascular Institute (T.M.A., G.D.G.), Department of Anesthesiology and Perioperative Medicine (B.M.T.), Oregon Health and Science University, Portland; Division of Cardiology, Portland VA Medical Center, Oregon (T.M.A., G.D.G.); and Beth Israel Deaconess Medical Center, Harvard University, Boston, MA (D.B.J.)
| | - Brandon M. Togioka
- From Knight Cardiovascular Institute (T.M.A., G.D.G.), Department of Anesthesiology and Perioperative Medicine (B.M.T.), Oregon Health and Science University, Portland; Division of Cardiology, Portland VA Medical Center, Oregon (T.M.A., G.D.G.); and Beth Israel Deaconess Medical Center, Harvard University, Boston, MA (D.B.J.)
| | - Daniel B. Jones
- From Knight Cardiovascular Institute (T.M.A., G.D.G.), Department of Anesthesiology and Perioperative Medicine (B.M.T.), Oregon Health and Science University, Portland; Division of Cardiology, Portland VA Medical Center, Oregon (T.M.A., G.D.G.); and Beth Israel Deaconess Medical Center, Harvard University, Boston, MA (D.B.J.)
| | - Joaquin E. Cigarroa
- From Knight Cardiovascular Institute (T.M.A., G.D.G.), Department of Anesthesiology and Perioperative Medicine (B.M.T.), Oregon Health and Science University, Portland; Division of Cardiology, Portland VA Medical Center, Oregon (T.M.A., G.D.G.); and Beth Israel Deaconess Medical Center, Harvard University, Boston, MA (D.B.J.)
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Comparison of the impact of prolonged low-pressure and standard-pressure pneumoperitoneum on myocardial injury after robot-assisted surgery in the Trendelenburg position: study protocol for a randomized controlled trial. Trials 2016; 17:488. [PMID: 27724965 PMCID: PMC5057242 DOI: 10.1186/s13063-016-1609-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 09/17/2016] [Indexed: 11/10/2022] Open
Abstract
Background Robot-assisted laparoscopic radical prostatectomy and robot-assisted radical cystectomy have gradually become the preferred choices for urologists as they allow surgeons to perform complex procedures more precisely and effectively. The pneumoperitoneum, which is normally applied in these surgeries to provide visual clarity and space to perform the procedure, may cause hemodynamic disturbance, potentially myocardial injury. Thus surgeons have recently considered opting for the low-pressure pneumoperitoneum to lower this negative impact. Herein we describe a protocol for a clinical trial to compare the impact of prolonged low-pressure and standard-pressure pneumoperitoneum on myocardial injury after robot-assisted surgery. Methods/design This study is designed to be a bicenter clinical trial. In total 280 patients scheduled to undergo robot-assisted laparoscopic radical prostatectomy or robot-assisted radical cystectomy will be enrolled and randomized into two groups, with standard- (12–16 mmHg) and low-pressure (7–10 mmHg) pneumoperitoneum, respectively. Troponin T will be measured as the primary endpoint to assess the extent of myocardial injury. Nt-proBNP and hemodynamic indexes will also be recorded for further analysis. Discussion The significance of this study is emphasized by the fact that there are few studies that have focused on the impact of prolonged pneumoperitoneum on myocardial injury, which is relevant to postoperative mortality. We hope that the conclusions drawn from this study could provide reference and basis to the future of the pneumoperitoneum in clinical practice. Trial registration Registered at https://www.clinicaltrials.gov with the Identifier NCT02600481 on November 5, 2015 Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1609-5) contains supplementary material, which is available to authorized users.
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Hu JJ, Liu YH, Yu CJ, Jialielihan N. Correlation between CO2 storage at the last minute of gas insufflation and area of retroperitoneal lacuna during retroperitoneal laparoscopic radical nephrectomy. BMC Anesthesiol 2016; 16:42. [PMID: 27449256 PMCID: PMC4957877 DOI: 10.1186/s12871-016-0208-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 07/13/2016] [Indexed: 11/20/2022] Open
Abstract
Background Adequate operation interspace is the premise of laparoscopy, and carbon dioxide (CO2) was an ideal gas for forming lacuna. A retroperitoneal space is used to form operation interspace in retroperitoneal laparoscopic radical nephrectomy by making ballooning, and the retroperitoneal space has no relative complete and airtight serous membrane, therefore CO2 absorption may be greater in retroperitoneal than transperitoneal laparoscopic radical nephrectomy. Excess CO2 absorption may induce hypercapnemia and further cause physiopathological change of respiratory and circulatory system. Therefore, exact evaluation of amount of CO2 which is eliminated from body via minute ventilation is important during retroperitoneal laparoscopic radical nephrectomy. The aim of the paper is to study the correlation between CO2 storage at the last minute of gas insufflation and area of retroperitoneal lacuna during retroperitoneal laparoscopic radical nephrectomy. Methods Forty ASA I/II patients undergoing retroperitoneal laparoscopic radical nephrectomy were enrolled. CO2 storage at the last minute of gas insufflation and area of a retroperitoneal lacuna were observed. Linear correlation and regression were performed to determine the correlation between them. Results There was positive correlation between CO2 storage at the last minute of gas insufflation and area of retroperitoneal lacuna (r = 0.880, P = 0.000), and the equation of linear regression was y = −83.097 + 0.925x (R2 = 0.780, t = 11.610, P = 0.000). Conclusions Amount of CO2 which is eliminated from body via mechanical ventilation could be calculated by measuring the area of retroperitoneal lacuna during retroperitoneal laparoscopic radical nephrectomy, and an anesthetist should be aware of the size of lacuna to predict high CO2 storage at the last minute of gas insufflation.
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Affiliation(s)
- Jian-Jun Hu
- Anesthesia Department of Xinjiang Medical University Affiliated Tumor Hospital, No. 789, Suzhoudong Road, Urumqi, 830011, Xinjiang, China
| | - Ya-Hua Liu
- Anesthesia Department of Xinjiang Medical University Affiliated Tumor Hospital, No. 789, Suzhoudong Road, Urumqi, 830011, Xinjiang, China
| | - Chan-Juan Yu
- Anesthesia Department of Xinjiang Medical University Affiliated Tumor Hospital, No. 789, Suzhoudong Road, Urumqi, 830011, Xinjiang, China
| | - Nuerbolati Jialielihan
- Anesthesia Department of Xinjiang Medical University Affiliated Tumor Hospital, No. 789, Suzhoudong Road, Urumqi, 830011, Xinjiang, China.
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15
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Kranz J, Anheuser P, Hampel C, Steffens J. [General and method-specific complications of sacrocolpopexy]. Urologe A 2015; 54:337-41. [PMID: 25700860 DOI: 10.1007/s00120-014-3683-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Sacrocolpopexy has remained standard procedure for correction of pelvic organ prolapse regardless of the affected compartment. Assuming the appropriate indication, it is characterized by an excellent long-term cure rate. Asymptomatic pelvic organ prolapse is no indication for surgery and should not be corrected in view of possible complications. This article summarizes general and method-specific complications of sacrocolpopexy, identifies causes, and allows error management to be tailored to each individual patient to increase treatment and outcome quality.
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Affiliation(s)
- J Kranz
- Klinik für Urologie und Kinderurologie, St.-Antonius Hospital, Akademisches Lehrkrankenhaus der RWTH Aachen, Dechant-Deckers-Straße 8, 52249, Eschweiler, Deutschland,
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Davarcı I, Karcıoğlu M, Tuzcu K, İnanoğlu K, Yetim TD, Motor S, Ulutaş KT, Yüksel R. Evidence for negative effects of elevated intra-abdominal pressure on pulmonary mechanics and oxidative stress. ScientificWorldJournal 2015; 2015:612642. [PMID: 25685845 PMCID: PMC4320804 DOI: 10.1155/2015/612642] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 12/29/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To compare the effects of pneumoperitoneum on lung mechanics, end-tidal CO2 (ETCO2), arterial blood gases (ABG), and oxidative stress markers in blood and bronchoalveolar lavage fluid (BALF) during laparoscopic cholecystectomy (LC) by using lung-protective ventilation strategy. MATERIALS AND METHODS Forty-six patients undergoing LC and abdominal wall hernia (AWH) surgery were assigned into 2 groups. Measurements and blood samples were obtained before, during pneumoperitoneum, and at the end of surgery. BALF samples were obtained after anesthesia induction and at the end of surgery. RESULTS Peak inspiratory pressure, ETCO2, and pCO2 values at the 30th minute were significantly increased, while there was a significant decrease in dynamic lung compliance, pH, and pO2 values in LC group. In BALF samples, total oxidant status (TOS), arylesterase, paraoxonase, and malondialdehyde levels were significantly increased; the glutathione peroxidase levels were significantly decreased in LC group. The serum levels of TOS and paraoxonase were significantly higher at the end of surgery in LC group. In addition, arylesterase level in the 30th minute was increased compared to baseline. Serum paraoxonase level at the end of surgery was significantly increased when compared to AWH group. CONCLUSIONS Our study showed negative effects of pneumoperitoneum in both lung and systemic levels despite lung-protective ventilation strategy.
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Affiliation(s)
- I Davarcı
- Department of Anesthesiology, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - M Karcıoğlu
- Department of Anesthesiology, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - K Tuzcu
- Department of Anesthesiology, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - K İnanoğlu
- Department of Anesthesiology, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - T D Yetim
- Department of Thoracic Surgery, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - S Motor
- Department of Biochemistry, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - K T Ulutaş
- Department of Biochemistry, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - R Yüksel
- Department of Biochemistry, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
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Abstract
New additional risks factors that may act to increase the risk of subcutaneous emphysema include total gas volume, gas flow rate, valveless trocar systems, and robotic fulcrum forces. Background: Subcutaneous emphysema and gas extravasation outside of the peritoneal cavity during laparoscopy has consequences. Knowledge of the circumstances that increase the potential for subcutaneous emphysema is necessary for safe laparoscopy. Methods: A literature review and a PubMed search are the basis for this review. Conclusions: The known risk factors leading to subcutaneous emphysema during laparoscopy are multiple attempts at abdominal entry, improper cannula placement, loose fitting cannula/skin and fascial entry points, use of >5 cannulas, use of cannulas as fulcrums, torque of the laparoscope, increased intra-abdominal pressure, procedures lasting >3.5 hours, and attention to details. New additional risk factors acting as direct factors leading to subcutaneous emphysema risk and occurrence are total gas volume, gas flow rate, valveless trocar systems, and robotic fulcrum forces. Recognizing this spectrum of factors that leads to subcutaneous emphysema will yield greater patient safety during laparoscopic procedures.
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Affiliation(s)
- Douglas E Ott
- Biomedical Engineering, Mercer University, 109 Preston Court, Macon GA 31210, USA.
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Visser F, Heine M, Levin AI, Coetzee AR. Pneumopericardium:two case reports and a review. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2014. [DOI: 10.1080/22201173.2008.10872544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Otsuka Y, Katagiri T, Ishii J, Maeda T, Kubota Y, Tamura A, Tsuchiya M, Kaneko H. Gas embolism in laparoscopic hepatectomy: what is the optimal pneumoperitoneal pressure for laparoscopic major hepatectomy? JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2013; 20:137-40. [PMID: 23001192 DOI: 10.1007/s00534-012-0556-0] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Laparoscopic hepatectomy (LH) has become popular as a surgical treatment for liver diseases, and numerous recent studies indicate that it is safe and has advantages in selected patients. Because of the magnified view offered by the laparoscope under pneumoperitoneal pressure, LH results in less bleeding than open laparotomy. However, gas embolism is an important concern that has been discussed in the literature, and experimental studies have shown that LH is associated with a high incidence of gas embolism. Major hepatectomies are done laparoscopically in some centers, even though the risk of gas embolism is believed to be higher than for minor hepatectomy due to the wide transection plane with dissection of major hepatic veins and long operative time. At many high-volume centers, LH is performed at a pneumoperitoneal pressure less than 12 mmHg, and reports indicate that the rate of clinically severe gas embolism is low. However, more studies will be necessary to elucidate the optimal pneumoperitoneal pressure and the incidence of gas embolism during LH.
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Affiliation(s)
- Yuichiro Otsuka
- Department of Surgery, Toho University Faculty of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541 Japan.
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Kim HY, Choi YJ, Yu HN, Yoon SZ. Optimal carbon dioxide insufflation pressure during robot-assisted thyroidectomy in patients with various benign and malignant thyroid diseases. World J Surg Oncol 2012; 10:202. [PMID: 23017080 PMCID: PMC3506561 DOI: 10.1186/1477-7819-10-202] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 09/13/2012] [Indexed: 11/10/2022] Open
Abstract
Background Currently, data are not available concerning a safe insufflation pressure that provides a proper view of the surgical field without adverse metabolic and hemodynamic changes in humans undergoing the robot-assisted thyroidectomy bilateral axillo-breast approach (BABA) using the da Vinci robotic surgical system. The purpose of this study was to determine the optimal carbon dioxide (CO2) insufflation pressure in patients with various benign and malignant thyroid diseases when using the da Vinci robotic surgical system. Methods A total of 32 patients underwent thyroid surgery at 6 (n = 15), 9 (n = 15), and 12 (n = 2) mmHg. The partial pressure of carbon dioxide (PaCO2), pH, cardiac output, heart rate, and mean arterial pressure were measured at baseline, 30 min and 1, 1.5, and 2 hours after CO2 insufflation, and 30 min after desufflation. Results CO2 insufflation of 12 mmHg caused severe facial subcutaneous emphysema, hypercarbia, and acidosis during robot-assisted thyroidectomy with BABA. The study was stopped before completion for the patients’ safety in accordance with the study protocol. Applying 6- or 9- mmHg of CO2 insufflation pressure caused increases in PaCO2 and decreases in arterial pH. However, vital signs were stable and pH and PaCO2 were within the physiologic range during the surgery in the 6- and 9-mmHg groups. Conclusions We propose that a CO2 insufflation pressure under 10 mmHg in robot-assisted thyroidectomy with BABA is the optimal insufflation pressure for patient safety.
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Affiliation(s)
- Hoon Yub Kim
- Department of Surgery, College of Medicine, Korea University, Seoul, South Korea
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21
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Qiu JG, Wu H, Jiang H, Huang JW, Pankaj P, Xu YL, Wang JZ, Zeng Y. Laparoscopic fenestration vs open fenestration in patients with congenital hepatic cysts: A meta-analysis. World J Gastroenterol 2011; 17:3359-65. [PMID: 21876626 PMCID: PMC3160542 DOI: 10.3748/wjg.v17.i28.3359] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Revised: 11/15/2010] [Accepted: 11/22/2010] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine whether the outcomes of laparoscopic fenestration (LF) were superior to open fenestration (OF) for congenital liver cysts.
METHODS: Comparative studies published between January 1991 and May 2010 on Medline (Ovid), Emsco, PubMed, Science Direct; Cochrane Reviews; CNKI; Chinese Biomedical Database, VIP and other electronic databases were searched. Randomized controlled trials (RCTs) and retrospective case-control studies on the management of congenital hepatic cysts were collected according to the pre-determined eligibility criteria to establish a literature database. Retrieval was ended in May 2010. Meta-analysis was performed using RevMan 5.0 software (Cochrane library).
RESULTS: Nine retrospective case-control studies involving 657 patients, comparing LF with OF were included for the final pooled analysis. The meta-analysis results showed less operative time [mean difference (MD): -28.76, 95% CI: -31.03 to 26.49, P < 0.00001]; shorter hospital stay (MD: -3.35, 95% CI: -4.46 to -2.24, P < 0.00001); less intraoperative blood loss (MD: -40.18, 95% CI: -52.54 to -27.82, P < 0.00001); earlier return to regular diet (MD: -29.19, 95% CI: -30.65 to -27.72, P < 0.00001) and activities after operation (MD: -21.85, 95% CI: -31.18 to -12.51, P < 0.0001) in LF group; there was no significant difference between the two groups in postoperative complications (odds ratio: 0.99, 95% CI: 0.41 to 2.38, P = 0.98) and cysts recurrence rates.
CONCLUSION: The short-term outcomes of LF for patients with congenital hepatic cysts were superior to open approach, but its long-term outcomes should be verified by further RCTs and extended follow-up.
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Srivastava A, Niranjan A. Secrets of safe laparoscopic surgery: Anaesthetic and surgical considerations. J Minim Access Surg 2011; 6:91-4. [PMID: 21120064 PMCID: PMC2992667 DOI: 10.4103/0972-9941.72593] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Accepted: 01/06/2010] [Indexed: 02/07/2023] Open
Abstract
In recent years, laparoscopic surgery has gained popularity in clinical practice. The key element in laparoscopic surgery is creation of pneumoperitoneum and carbon dioxide is commonly used for insufflation. This pneumoperitoneum perils the normal cardiopulmonary system to a considerable extent. Every laparoscopic surgeon should understand the consequences of pneumoperitoneum; so that its untoward effects can be averted. Pneumoperitoneum increases pressure on diaphragm, leading to its cephalic displacement and thereby decreasing venous return, which can be aggravated by the position of patient during surgery. There is no absolute contraindication of laparoscopic surgery, though we can anticipate some problems in conditions like obesity, pregnancy and previous abdominal surgery. This review discusses some aspects of the pathophysiology of carbon dioxide induced pneumoperitoneum, its consequences as well as strategies to counteract them. Also, we propose certain guidelines for safe laparoscopic surgery.
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Affiliation(s)
- Arati Srivastava
- Department of Anaesthesiology, Subharti Medical College, Meerut, India
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Walsh CA, Pistilli M, Karantanis E. Cardiac arrhythmias and gynaecological laparoscopy: a reminder. J OBSTET GYNAECOL 2010; 30:878-9. [PMID: 21126142 DOI: 10.3109/01443615.2010.518260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- C A Walsh
- Department of Urogynaecology, St George Hospital, University of New South Wales, Sydney, Australia.
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24
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Effects of CO2 insufflation on cerebrum during endoscopic thyroidectomy in a porcine model. Surg Endosc 2010; 25:1495-504. [DOI: 10.1007/s00464-010-1425-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Accepted: 09/27/2010] [Indexed: 12/30/2022]
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25
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Hong JY, Oh YJ, Rha KH, Park WS, Kim YS, Kil HK. Pulmonary edema after da Vinci-assisted laparoscopic radical prostatectomy: a case report. J Clin Anesth 2010; 22:370-2. [PMID: 20650386 DOI: 10.1016/j.jclinane.2009.05.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2008] [Revised: 05/07/2009] [Accepted: 05/27/2009] [Indexed: 11/19/2022]
Affiliation(s)
- Jeong-Yeon Hong
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 120-749 Seoul, South Korea
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26
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Fors D, Eiriksson K, Arvidsson D, Rubertsson S. Gas embolism during laparoscopic liver resection in a pig model: frequency and severity. Br J Anaesth 2010; 105:282-8. [PMID: 20621927 DOI: 10.1093/bja/aeq159] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Laparoscopic liver surgery is evolving rapidly. Carbon dioxide embolism is a potential complication. The aim of this work was to study the frequency and severity of gas embolism (GE) during laparoscopic liver lobe resection in a pig model and the resulting cardiovascular and respiratory changes. METHODS Fifteen anaesthetized piglets underwent laparoscopic left liver lobe resection. Haemodynamic and respiratory variables were monitored, including systemic and pulmonary arterial pressures, end-tidal CO2, and pulmonary dead space. Online blood gas monitoring and a transoesophageal echocardiography (TOE) were used. GE was graded semi-quantitatively as grade 0 (none), grade 1 (minor), or grade 2 (major), depending on the TOE results. RESULTS In 10 of 15 piglets, GE occurred. In total, 33 separate episodes of GE were recorded. All 13 episodes of grade 2 and three of grade 1 were serious enough to cause mainly respiratory, but also haemodynamic effects. Mostly, grade 1 GE caused only minor respiratory or haemodynamic changes. Most variables were affected during grade 2 GE; the most important were Pa(o(2)), Pa(co(2)), end-tidal CO2, Vd/Vt, and mean pulmonary arterial pressure. CONCLUSIONS GE occurred frequently during laparoscopic liver resection in this experimental study. Approximately half of the embolisms were serious enough to cause respiratory or haemodynamic disturbances or both. Pending further human studies, a combination of several monitoring techniques, with narrow limits for the alarm settings, will ensure correct interpretation of the complex physiological response to GE and reveal it early enough to alert the anaesthetist and the surgeon to the ongoing problem.
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Affiliation(s)
- D Fors
- Department of Surgical Sciences/Anaesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden.
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27
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Abstract
BACKGROUND The concept of balloon laparoscopy (B-LSC) pursues the simplification of conventional diagnostic laparoscopy (LSC). The pneumoperitoneum is replaced by a transparent balloon, which is positioned in front of the optical system. It shall be shown that with this arrangement diagnostic LSC can be performed outside of the operating room without requiring general anesthesia. METHODS An inflatable balloon was developed for a 30 degrees /3.5-mm rod lens. Intra-abdominally the balloon was expanded to a diameter of 30 mm by air insufflation, and B-LSC was performed. Twelve patients were examined in general anesthesia before laparoscopic surgery. Twelve patients were subjected to B-LSC fully awake or with sedation (midazolam or propofol/S-ketamine) as a "second-look" procedure by way of a flexible trocar (port) left in the abdominal wall at the end of previous operation. Eight patients have been first provided with a trocar under sedation (midazolam or propofol/S-ketamine) combined with local anesthesia, and B-LSC was performed before laparoscopic surgery. RESULTS On a scale of 1-5, the general impression was rated 1.9, the navigability to the different abdominal organs 2.5, the resolution 1.5, the stability of the system optic/trocar 2.1, the suitability of the balloon format 1.9, and the stability of the balloon against lateral shear forces 2.4. The degree of painfulness of the examination was rated 2.8, the tolerance of the port 1.4, and the degree of painfulness of trocar placement at 2.5. On a scale of 1 to 3, the strain of the abdominal musculature was rated 1.4 and the obstruction by adhesions 1.7. DISCUSSION B-LSC is technically practicable with good imaging qualities and without requiring pneumoperitoneum. It is tolerated in great extent under slight sedation and particularly well under deep sedation. The procedure is suitable for diagnostics of unclear abdominal conditions, as a second-look LSC and also as a staging LSC.
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Affiliation(s)
- Michael Volland
- Department of General and Visceral Surgery, Sana-Hospital Gerresheim, Düsseldorf, Germany.
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Salihoglu Z, Demiroluk S, Demirkiran O, Cakmakkaya S, Aydogan F, Carkman S, Kose Y. The effects of pneumothorax on the respiratory mechanics during laparoscopic surgery. J Laparoendosc Adv Surg Tech A 2008; 18:423-7. [PMID: 18503378 DOI: 10.1089/lap.2007.0097] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Pneumothorax is rare but can be a severe complication of laparoscopic surgery. Diagnosis of pneumothorax in laparoscopy includes the sudden increase in end-tidal carbon dioxide (EtCO(2)) with a decrease in compliance and an abnormal increase in airway pressure. By these case reports, we recommend the simultaneous monitoring of airway pressures, dynamic compliance, and particularly, EtCO(2) for an immediate diagnosis and prompt treatment of pneumothorax.
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Affiliation(s)
- Ziya Salihoglu
- Department of Anesthesia, Istanbul University, Cerrahpasa Medical School, Istanbul, Turkey.
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29
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Huang YY, Wu HL, Tsou MY, Zong HJ, Guo WY, Chan KH, Ting CK. Paradoxical carbon dioxide embolism during pneumoperitoneum in laparoscopic surgery for a huge renal angiomyolipoma. J Chin Med Assoc 2008; 71:214-7. [PMID: 18436506 DOI: 10.1016/s1726-4901(08)70107-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
We present a case of paradoxical gas embolism during CO2 insufflation in laparoscopic nephrectomy for a huge renal angiomyolipoma. Paradoxical CO2 embolism in the left heart chambers without demonstrable intracardiac right-to-left shunt was detected by transesophageal echocardiography (TEE). The surgical procedure was stopped immediately, but the patient recovered with mild neurologic deficit. We speculate that rapid pneumoperitoneum introduction pushed CO2 into the abnormal vasculature of the angiomyolipoma, which communicates with the systemic vascular system, causing pseudoaneurysm formation. Follow-up abdominal computed tomography showed a new pseudoaneurysm inside the tumor. If intracardiac right-to-left shunt is excluded for the reason of paradoxical gas existence, there remains extracardiac right-to-left shunt, with transpulmonary passage of the venous emboli being the most likely mechanism. In fact, the cause of paradoxical gas embolism in this case remains unknown. Therefore, laparoscopic surgery for huge angiomyolipoma should be performed with extreme caution; an open procedure may be considered as an alternative.
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Affiliation(s)
- Yu-Yin Huang
- Department of Anesthesiology, Cheng-Hsin Rehabilitation Medical Center, Taipei, Taiwan, R.O.C
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Effectiveness of colorectal laparoscopic surgery on patients at high anesthetic risk: an intervention cohort study. Int J Colorectal Dis 2008; 23:101-6. [PMID: 17917734 DOI: 10.1007/s00384-007-0368-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2007] [Indexed: 02/04/2023]
Abstract
AIMS The aim of the study was to assess the effectiveness of laparoscopic colorectal surgery in patients at high preoperative anesthetic risk because of associated pathologies. MATERIALS AND METHODS From January 2003 until January 2005, 116 patients were systematically assigned at a ratio of 1:1 to one of two groups: laparoscopy surgery (n=59, of which 31 were American Society of Anesthesiologists score [ASA] I-II [L1] and 28 ASA III-IV [L2]) or open surgery (n=57, of which 30 were ASA I-II [O1] and 27 ASA III-IV [O2]). Data on patient demographics and clinical and anesthetic variables were collected prospectively. Informed consent was obtained from the patients, and approval was obtained from the designated review board of the institution involved. RESULTS The number of minor anesthetic complications during surgery was higher in L2 patients. No differences were observed in blood gas parameters studied during surgery (pCO(2), pH, and pO(2)/FiO(2)). Transfusion rates in the laparoscopy group at greater anesthetic risk (L2) were lower than those of the high-risk conventional surgery group (O2; 21.4 vs 63%, P<0.02). Duration of stay in the surgical recovery room and the inpatient ward were also shorter in the L2 group than in the O2 group (8.7+/-4.5 vs 12.2+/-6 days, P=0.02). There was no difference in perioperative clinical variables between laparoscopy groups (L1, L2). CONCLUSION Postoperative recovery of ASA III-IV patients is better after laparoscopic surgery for colorectal cancer, at the expense of a higher rate of minor anesthetic occurrences during surgery.
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Min SK, Kim JH, Lee SY. Carbon dioxide and argon gas embolism during laparoscopic hepatic resection. Acta Anaesthesiol Scand 2007; 51:949-53. [PMID: 17635400 DOI: 10.1111/j.1399-6576.2007.01361.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
During laparoscopic hepatic resection, an abrupt decrease in FE'CO(2) (from 28 mmHg to 9 mmHg) associated with near cardiac arrest occurred concomitantly with hepatic vein laceration and the use of an argon beam coagulator system. During venous gas embolism, transesophageal echocardiography (TEE) proved the transpulmonary passage of the gas. In the post-operative period, the patient developed pulmonary edema and made a full recovery after 5 days. This is a case report of a possible paradoxic carbon dioxide (CO(2)) and argon gas embolism by transpulmonary passage during laparoscopic hepatic resection.
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Affiliation(s)
- S K Min
- Department of Anesthesiology and Pain Medicine, Ajou University, School of Medicine, Suwon, Korea
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Druckrey-Fiskaaen KT, Janssen MWW, Omidi L, Polze N, Kaisers U, Nur I, Goldberg E, Bokel G, Hauss J, Schön MR. Laparoscopic spray application of fibrin sealant effects on hemodynamics and spray efficiency at various application pressures and distances. Surg Endosc 2007; 21:1750-9. [PMID: 17318690 DOI: 10.1007/s00464-007-9235-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Revised: 11/07/2006] [Accepted: 11/25/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Laparoscopic resections of parenchymal organs are increasingly performed. However, little is known about the effects of laparoscopic fibrin sealant spray applications on intraabdominal pressure (IAP) and hemodynamics. METHODS Cardiac and pulmonary monitoring was performed via two central venous pressure lines in the thoracic and abdominal vena cava, a pulmonary artery catheter, and a peripheral artery line. Air was sprayed into the abdomen at pressures of 2, 3, and 4 bar for 30 s. According to the group, a valve on a trocar was open or closed. To optimize fibrin sealant application, the sealant was sprayed at three different application pressures (2, 2.5, and 3 bar) and distances (2, 3.5, and 5 cm). RESULTS All spray simulations caused a significant increase in the IAP. During the first 10 s of spraying, the IAP increase was 5 mmHg or less, but rose rapidly during the last 20 s of spraying. The IAP increase resulted in decreased pulmonary compliance. Pulmonary resistance and the central venous pressures of both the thoracic and abdominal vena cava increased. At application pressures of 3 and 4 bar, the IAP increase was greater than 2 bar of pressure, reaching IAP values exceeding 35 mmHg. Spray mist formation was primarily dependent on application pressure, whereas clot formation and surface coverage depended on both application pressure and distance. The best results were achieved with an application pressure of 2.5 bar and a distance of 5 cm from the surface. CONCLUSIONS This study shows that fibrin sealants can be used safely in laparoscopic procedures. Keeping the spray periods short and allowing air to escape from the abdomen can minimize the IAP increase. According to our results, a laparoscopic spray application of fibrin sealant should start with an insufflation pressure of 10 mmHg, an application pressure of 2.5 bar, and an application distance of 5 cm with a valve on the trocar left open.
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Affiliation(s)
- K T Druckrey-Fiskaaen
- Department of Visceral, Transplantation, Thoracic, and Vascular Surgery, Universität Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
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Kurosaki I, Yamamoto S, Kitami C, Yokoyama N, Nakatsuka H, Kobayashi T, Watanabe T, Oya H, Sato Y, Hatakeyama K. Video-assisted living donor hemihepatectomy through a 12-cm incision for adult-to-adult liver transplantation. Surgery 2006; 139:695-703. [PMID: 16701104 DOI: 10.1016/j.surg.2005.12.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2005] [Revised: 12/01/2005] [Accepted: 12/02/2005] [Indexed: 12/16/2022]
Abstract
OBJECTIVES There has been remarkable progress in recent technical innovations for laparoscopic hepatectomy. However, a laparoscopic procedure rarely has been indicated for donation of the liver in living-related liver transplantation (LRLT). Here, we described the technique and the outcome of video-assisted donor hepatectomy (VADH) for adult-to-adult LRLT. METHODS For 13 donors in adult-to-adult LRLT, 3 types of major hepatectomy--right hemihepatectomy (3), and left hemihepatectomy, with or without the caudate lobe (10)--were performed through video-assisted procedures; surgical manipulation via ports or via a 12-cm incision and viewing through a laparoscope or through incision were combined and used. RESULTS VADH was completed in 13 donors, with a median operation time of 363 +/- 33 minutes and a median blood loss of 302 +/- 191 mL. No complications specific to video-assisted procedures, postoperative bile leak, or bleeding were observed. The restoration of the liver function was smooth, and the use of an analgesic (median: 1.2 times) was reduced, compared with the historical control (median: 3.8 times) that underwent a standard donation of the liver. Currently, all donors are healthy and have returned to their previous activities. The grafts have been functioning well, excluding 3 recipients who succumbed to serious complications unrelated to the video-assisted procedure. CONCLUSION We have shown a new method of VADH through a 12-cm laparotomy for adult-to-adult LRLT. This technique is as feasible as standard open donor hepatectomy, with less pain and with improved postoperative symptoms.
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Affiliation(s)
- Isao Kurosaki
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Japan.
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Meier T, Leibecke T, Eckmann C, Gosch UW, Grossherr M, Bruch HP, Gehring H, Leonhardt S. Electrical impedance tomography: changes in distribution of pulmonary ventilation during laparoscopic surgery in a porcine model. Langenbecks Arch Surg 2006; 391:383-9. [PMID: 16555085 DOI: 10.1007/s00423-006-0034-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2005] [Accepted: 01/29/2006] [Indexed: 11/24/2022]
Abstract
BACKGROUND Because of the creation of a pneumoperitoneum, impairment of ventilation is a common side-effect during laparoscopic surgery. Electrical impedance tomography (EIT) is a method with the potential for becoming a tool to quantify these alterations during surgery. We have studied the change of regional ventilation during and after laparoscopic surgery with EIT and compared the diagnostic findings with computed tomography (CT) scans in a porcine study. MATERIALS AND METHODS After approval by the local animal ethics committee, six pigs were included in the study. Two laparoscopic operations were performed [colon resection (n=3) and fundoplicatio (n=3)]. The EIT measurements (6th parasternal intercostal space) were continuously recorded by an EIT prototype (EIT Evaluation Kit, Dräger Medical, Lübeck, Germany). To verify ventilatory alterations detected by EIT, a CT scan was performed postoperatively. RESULTS Ventilation with defined tidal volumes was significantly correlated to EIT measurements (r2=0.99). After creation of the pneumoperitoneum, lung compliance typically decreased, which agreed well with an alteration of the distribution of pulmonary ventilation measured by EIT. Elevation of positive end-inspiratory pressure reopened non-aerated lung areas and showed a recovery of the regional ventilation measured by EIT. Additionally, we could detect pulmonary complications by EIT monitoring as verified by CT scans postoperatively. CONCLUSION EIT monitoring can be used as a continuous non-invasive intraoperative monitor of ventilation to detect regional changes of ventilation and pulmonary complications during laparoscopic surgery. These EIT findings indicate that surgeons and anesthetists may eventually be able to optimize ventilation directly in the operating theatre.
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Affiliation(s)
- T Meier
- Department of Anesthesiology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
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Unsal MA, Imamoğlu M, Cay A, Kadioglu M, Aydin S, Ulku C, Kesim M, Alver A, Bozkaya H. Acute alterations in biochemistry, morphology and contractility of rat isolated urinary bladder via increased intra-abdominal pressure. Gynecol Obstet Invest 2006; 61:179-87. [PMID: 16462142 DOI: 10.1159/000091273] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2005] [Accepted: 12/04/2005] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To determine the acute effects of increased intra-abdominal pressure (IAP) on the biochemistry, morphology and contractility of the rat isolated urinary bladder using an experimental laparoscopy model. METHODS We divided 24 adult female Sprague-Dawley rats into three groups. The control group (group I) was not subjected to increased IAP. In groups II and III, IAPs of 10 and 20 mm Hg, respectively, were established by carbon dioxide pneumoperitoneum for 60 min. Thirty minutes after desufflation, the rat urinary bladder dome was removed for in vitro pharmacological investigation, measurement of malondialdehyde (MDA) levels and histopathological examination. Statistical comparisons between groups were performed. RESULTS Tissue MDA levels in groups II and III were significantly higher than in the control group. In group II, only the lamina propria was significantly damaged. However, the epithelium, lamina propria, and serosa were significantly damaged in group III. Acetylcholine potentiated contractions in both IAP groups. Increased responses to electrical field stimulation in the IAP groups were significant only in group II. CONCLUSIONS In this experimental model, 10 and 20 mm Hg of IAP induced by pneumoperitoneum increased MDA levels and caused important changes in the morphology and contractile response of the urinary bladder.
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Affiliation(s)
- Mesut A Unsal
- Department of Obstetrics and Gynecology, Karadeniz Technical University, Faculty of Medicine, Trabzon, Turkey.
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Jersenius U, Fors D, Rubertsson S, Arvidsson D. The effects of experimental venous carbon dioxide embolization on hemodynamic and respiratory variables. Acta Anaesthesiol Scand 2006; 50:156-62. [PMID: 16430535 DOI: 10.1111/j.1399-6576.2006.00933.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Laparoscopic liver resection is a relatively new surgical procedure. Carbon dioxide (CO2) pneumoperitoneum and laparoscopic liver dissection are recognized as risk factors for CO2 embolism to the pulmonary circulation. The embolization can be difficult to detect and can theoretically increase peri-operative morbidity. The aim of this study was to evaluate the cardiopulmonary effects in a pig model during a time period of 4 h after an experimental CO2 embolization. METHODS Eleven piglets were anesthesized. Nine were embolized with a single intravenous injection of 0.4 ml/kg CO2 and two served as controls. Respiratory and cardiovascular variables, including pulmonary artery pressure and cardiac output, were monitored for 4 h after embolization, and arterial blood gases were monitored on-line. RESULTS The embolized piglets had an increase in ventilatory dead space, pulmonary vascular resistance and pulmonary artery pressure and a decrease in cardiac output that lasted throughout the 4-h observation time. The mean arterial pressure and heart rate were unchanged. An early sign of embolization was a rapid fall in end-tidal CO2 and P(a)O2 and a rise in P(a)CO2. CONCLUSION Negative changes in cardiopulmonary physiology persisted for at least 4 h after a single intravenous CO2 injection, in spite of this gas being highly soluble in blood. This is a more prolonged influence of CO2 embolization than previously described. Extensive monitoring for early detection of an embolization may be recommended to limit morbidity in patients undergoing laparoscopic liver surgery.
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Affiliation(s)
- U Jersenius
- Section of Surgery, Department of Molecular Medicine and Surgery, Karolinska University Hospital Solna, Karolinska Institute, Stockholm, Sweden.
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Hanly EJ, Bachman SL, Marohn MR, Boden JH, Herring AE, De Maio A, Talamini MA. Carbon dioxide pneumoperitoneum–mediated attenuation of the inflammatory response is independent of systemic acidosis. Surgery 2005; 137:559-66. [PMID: 15855930 DOI: 10.1016/j.surg.2005.01.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND The purpose of this study was to determine if systemic acidosis induced by peritoneal absorption of carbon dioxide (CO2 ) during laparoscopy plays a role in CO2 pneumoperitoneum-mediated attenuation of the acute phase inflammatory response associated with perioperative sepsis. The influence of hepatic polymorphonuclear (PMN) leukocyte infiltration on this phenomenon was also investigated. METHODS Forty-five rats were randomized into 5 groups: anesthesia control, open cecal ligation and puncture (OCLP), laparoscopic cecal ligation and puncture using helium for insufflation (He LCLP), LCLP using CO2 with continued spontaneous ventilation (LCLP-SV), and LCLP using CO2 with intubation and positive pressure ventilation (LCLP-PPV). RESULTS After 30 minutes, arterial blood gas parameters remained normal in control, OCLP rats, and He LCLP rats, while CO2 LCLP-SV rats developed significant hypercarbic acidosis. This acidosis was corrected in CO2 LCLP-PPV rats ( P < .0001 vs CO2 LCLP-SV for both). Expression of the rat acute phase gene alpha 2 -macroglobulin was greater after OCLP and He LCLP than after either CO2 LCLP-SV or CO2 LCLP-PPV ( P < .0001 vs either CO2 OCLP-SV for both). However, levels of alpha 2 -macroglobulin were not significantly different between the acidotic (LCLP-SV) and normocarbic (LCLP-PPV) CO2 groups. Infiltration of the hepatic parenchyma by PMNs did not differ significantly between groups. CONCLUSIONS CO2 insufflation-induced systemic acidosis is not responsible for the reduction in the acute phase inflammatory response observed in laparoscopic animal models of sepsis. Hepatic PMN infiltration also does not appear to mediate this effect.
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Affiliation(s)
- Eric J Hanly
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Altindis M, Yilmaz S, Polat C, Serteser M. Sequential periods of preconditioning decrease laparoscopy-related elevations in hepatic TNF-alpha and IL-6 levels in rats. J Laparoendosc Adv Surg Tech A 2005; 14:380-3. [PMID: 15684786 DOI: 10.1089/lap.2004.14.380] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Laparoscopy induces an ischemia/reperfusion (I/R) injury that elicits the production of inflammatory cytokines. The aim of this study was to test whether laparoscopic preconditioning (LP) could change hepatic inflammatory response. MATERIALS AND METHODS Twenty-four male Spraque Dawley rats were assigned into one of three experimental groups: the control group (C) was subjected to sham operation; the I/R group was subjected to 60 minutes of pneumoperitoneum followed by 45 minutes of desufflation; and the ischemic preconditioning (IP) group was subjected to preconditioning prior to the induction of I/R. Preconditioning was defined as two cycles of 5 minutes of pneumoperitoneum followed immediately by 5 minutes of desufflation. Hepatic tumor necrosis factor alpha (TNF-alpha) and interleukin (IL)-6 levels were evaluated as an inflammatory response. RESULTS Hepatic TNF-alpha levels increased in the I/R group compared with the C group (9.64 +/- 0.77 pg/mg protein vs. 6.53 +/- 0.48 pg/mg protein, P < 0.01). The decreased TNF-alpha levels in the IP group were not statistically significant when compared to the I/R group (8.09 +/- 0.74 pg/mg protein). Hepatic IL-6 levels increased in the I/R group compared to the C group (4.17 +/- 0.31 pg/mg protein vs. 2.93 +/- 0.20 pg/mg, P < 0.05). IP reduced the hepatic IL-6 levels significantly compared to the I/R group (3.31 +/- 0.22 pg/mg protein vs. 4.17 +/- 0.31 pg/mg protein, P <0.05). CONCLUSION Laparoscopy induces cytokine response in various organs including the liver. LP could alter the production of cytokines prior to sustained laparoscopic procedures. Preconditioning may be advisable, especially for elderly or other patients with hepatic, renal, or cardiac dysfunction. Further studies are needed to adapt this concept to clinical settings.
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Affiliation(s)
- Mustafa Altindis
- Department of Microbiology, Afyon Kocatepe University School of Medicine, Afyon, Turkey
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Abstract
From its first use as a diagnostic tool, urologic laparoscopy has developed into a complex therapy for both benign and malignant disease. Most procedures are still performed at large centers with experienced laparoscopists but nonacademic urologists are starting to gain the necessary training and skills. With the clear advantage that laparoscopy shows over open procedures in terms of decreased perioperative morbidity and quicker recovery times, patients are increasingly asking for this approach. The urologic community must meet this challenge and train future urologists to meet the expected demand.
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Affiliation(s)
- Grant D Taylor
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9110, USA
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Chen CH, Cheng TC. Transoesophageal echocardiography shows high risk of gas embolism during laparoscopic hepatic resection under carbon dioxide pneumoperitoneum (Br J Surg 2002; 89: 870-876). Br J Surg 2003; 90:488. [PMID: 12673758 DOI: 10.1002/bjs.4194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Schmandra TC, Mierdl S, Bauer H, Gutt C, Hanisch E. Transoesophageal echocardiography shows high risk of gas embolism during laparoscopic hepatic resection under carbon dioxide pneumoperitoneum. Br J Surg 2002; 89:870-6. [PMID: 12081736 DOI: 10.1046/j.1365-2168.2002.02123.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The ultrasonically activated scalpel (UAS) enables safe and effective laparoscopic tissue dissection, making hepatic resection feasible. This study compared blood loss and risk of gas embolism using the UAS during open hepatic resection and laparoscopic hepatic resection. METHODS Female pigs were divided into two groups for laparoscopic (n = 7) and open (n = 5) left hepatic lobectomy. The UAS was used for both tissue cutting and coagulation. Laparoscopic liver resection was performed under carbon dioxide pneumoperitoneum (intraperitoneal pressure 12 mmHg). During surgery animals were monitored haemodynamically by an arterial line and Swan-Ganz catheter. Two-dimensional transoesophageal echocardiography (2D-TEE) was used to detect gas emboli with special attention to the right atrium and ventricle. Gas emboli were graded according to size, and correlated with haemodynamic and blood gas data. RESULTS During open and laparoscopic hepatic resection the UAS resulted in minimal blood loss and effective tissue dissection. No air embolism was seen during open surgery. With laparoscopic hepatic resection 2D-TEE revealed gas embolism in all animals. Gas embolism was accompanied by cardiac arrhythmia in four of seven animals. No direct correlation was observed between embolism episodes and blood gas variables. There were no deaths after episodes of embolization. A significant decrease in arterial partial pressure of oxygen was seen at the end of the laparoscopic procedure in all animals. CONCLUSION The UAS causes minimal blood loss during both open and laparoscopic hepatic resection. Laparoscopic liver dissection under carbon dioxide pneumoperitoneum carries a high risk of gas embolism.
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Affiliation(s)
- T C Schmandra
- Department of Surgery, Johann Wolfgang Goethe University Hospital, Theodor Stern Kai 7, 60590 Frankfurt am Main, Germany.
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Erkan N, Gokmen N, Goktay AY, Erbayraktar S, Taplu A, Tokgoz Z, Astarcioglu I. Effects of CO2 pneumoperitoneum on the basilar artery. Surg Endosc 2001; 15:806-11. [PMID: 11443458 DOI: 10.1007/s004640090007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2000] [Accepted: 11/22/2000] [Indexed: 11/25/2022]
Abstract
BACKGROUND Laparoscopic surgery provides many benefits to the patients. The purpose of this study was to evaluate cerebral blood flow changes and the possibility of ischemia-reperfusion injury occurring during carbon dioxide (CO(2)) pneumoperitoneum. METHODS Forty-eight New Zealand white rabbits were divided into four experimental and two control groups. Rabbits were subjected to CO(2) pneumoperitoneum with an intraabdominal pressure of 8 and 15 mmHg for 60 or 180 min as designed for experimental groups. We then assessed the changes in physiological and transcranial Doppler ultrasonographic parameters, as well as brain malondialdehyde levels. RESULTS Transcranial Doppler sonography of the basilar artery revealed elevated mean velocity and decreased resistance index and pulsatility index values with the longer-duration and higher-pressure CO(2) pneumoperitoneum. However, there were no statistically significant difference in m alondialdehyde values. CONCLUSION Elevated intraabdominal pressure by CO(2)-pneumoperitoneum, which does not lead to ischemia-reperfusion injury of the brain tissue, results in increased cerebral blood flow and reduced cerebrovascular resistance as an autoregulatory cerebral answer for CO(2).
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Affiliation(s)
- N Erkan
- Department of General Surgery, Dokuz Eylul University Medical School Hospital, 35350 Uckuyular, Izmir, Turkey.
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Irwin MG, Ng JK. Transoesophageal acoustic quantification for evaluation of cardiac function during laparoscopic surgery. Anaesthesia 2001; 56:623-9. [PMID: 11437761 DOI: 10.1046/j.1365-2044.2001.01981.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pneumoperitoneum may be poorly tolerated in patients with marginal cardiopulmonary function. Transoesophageal echocardiography is a relatively non-invasive technique that can track changes in left ventricular cavity area using acoustic quantification and has been found to provide a reliable, real-time estimation of left ventricular function. We evaluated mid-papillary fractional area change during pneumoperitoneum in 17 healthy adult patients (group 1) and 17 with hypertension and/or ischaemic heart disease (group 2) undergoing laparoscopic cholecystectomy. Peritoneal insufflation led to significant (p < 0.01) decreases in fractional area change and an increase in mean blood pressure. There was no significant change in heart rate. Patients with cardiovascular disease who had a > 30% decrease in fractional area change following carbon dioxide insufflation (group 2B) were given an intravenous infusion of glyceryl trinitrate. In groups 1 and 2A, fractional area change improved slightly with head-up tilt and continued to improve over the course of surgery. Glyceryl trinitrate led to a significant increase in fractional area change and a decrease in mean blood pressure back to baseline values. We conclude that peritoneal insufflation of carbon dioxide results in a significant increase in cardiac workload that is well tolerated in patients with no cardiovascular disease. Coexisting cardiovascular disease can result in even more pronounced impairment of cardiac function, which may not be predictable by clinical assessment or adequately determined by routine monitoring. We recommend the use of transoesophageal acoustic quantification as a monitor in these patients and the administration of glyceryl trinitrate to ameliorate myocardial stress.
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Affiliation(s)
- M G Irwin
- Department of Anaesthesiology, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Room 424, Block K, Pokfulam Road, Hong Kong, China.
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Kozar RA, Kaplan LJ, Cipolla J, Meija J, Haber MM. Laparoscopic repair of traumatic diaphragmatic injuries. J Surg Res 2001; 97:164-71. [PMID: 11341794 DOI: 10.1006/jsre.2001.6131] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Laparoscopy has been proposed as a diagnostic and potentially therapeutic modality for penetrating diaphragmatic lacerations. The purpose of this study was to assess the technical feasibility and strength of various laparoscopic repairs of diaphragmatic injuries. METHODS Swine underwent either open suture repair or laparoscopic repair by staple, suture, or patch technique of a 2-cm laceration to both the right and the left muscular or tendinous diaphragmatic leaflets. Six weeks after operation, diaphragms were harvested for either histologic analysis or bursting strength measurements. RESULTS All methods of repair proved technically feasible. There was no significant difference in bursting strength measurements between treatment groups. Bursting was due to tissue failure either at or adjacent to the repair site. Histologic analysis confirmed healing of all specimens with the laparoscopic patch technique inciting less inflammation and greater fibroblastic proliferation than the other techniques. CONCLUSIONS Laparoscopic repair of diaphragmatic lacerations can be accomplished using any of the currently available techniques. Laparoscopic stapling, suturing, or patch techniques all result in complete healing with a strong and durable repair. When selecting a particular technique, familiarity of the surgeon should be used as a guideline.
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Affiliation(s)
- R A Kozar
- Department of Surgery, Houston School of Medicine, University of Texas, 77030, USA.
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Abstract
This article provides an overview of the current role of laparoscopic surgery in older patients. A retrospective review and analysis of the recent English-language literature on laparoscopic procedures with special attention devoted to those articles focused on geriatric patients was performed. Laparoscopic surgery has rapidly become the fastest-growing discipline within the surgical arena and new applications for laparoscopy continue to be reported. The primary benefits to patients of these developments are smaller scars, decreased postoperative pain, and more-rapid return to normal activity. As society ages, more older patients will present with pathology amenable to laparoscopic intervention. Several aspects of laparoscopy impose unique physiologic stresses and, as such, may alter surgical risk to the geriatric patient. In addition, older patients often have delayed surgical interventions because of more-conservative medical management or unusual symptomatology, which may further complicate the laparoscopic approach. These limitations may alter the risk-to-benefit ratio of laparoscopic versus open procedures. Despite this lack of elucidation of full-risk profiles, laparoscopic approaches should be considered regardless of a patient's age.
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Affiliation(s)
- D T Efron
- Departments of Surgery, Johns Hopkins Bayview Medical Center and The Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
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Figueiras Ramos B, Corona Martínez L, Bembibre Taboada R, Soler Morejón C, Rocha Hernández J, Fonseca Hernández M, Hernández Rodríguez Y. Valoración evolutiva de la presión intraabdominal en pacientes con cirugía abdominal. Estudio clínico observacional. Med Intensiva 2001. [DOI: 10.1016/s0210-5691(01)79681-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
An unexpected death is described that was caused by gas embolism that occurred during oxygen-ozone (O2/O3) therapy administered by autohemotransfusion for psoriasis. This unusual complication suggests the necessity of investigating benefits and adverse effects of medical ozone application.
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Affiliation(s)
- D Marchetti
- Institute of Forensic Medicine, S. Cuore University, Rome, Italy
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Peppriell JE, Bacon DR. Acute abdominal compartment syndrome with pulseless electrical activity during colonoscopy with conscious sedation. J Clin Anesth 2000; 12:216-9. [PMID: 10869921 DOI: 10.1016/s0952-8180(00)00140-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report an episode of acute abdominal compartment syndrome, with pulseless electrical activity, in a patient undergoing colonoscopic examination of a recently constructed mucus fistula. Associated clinical features of this acute abdominal compartment syndrome (tension pneumoperitoneum) were abdominal distention, which was very impressive, cardiopulmonary arrest, severe cyanosis, and progressive bradycardia.In general, increased intraabdominal pressure can have numerous adverse physiologic effects, which may include decreased cardiac output, altered ventilation-perfusion relationships, and decreased venous return. The magnitude of each effect likely depends on the magnitude of the increased intraabdominal pressure. Success with initial resuscitation efforts should not diminish further vigilance with these patients, as other problems may be discovered.
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Affiliation(s)
- J E Peppriell
- Department of Anesthesiology, State University of New York at Buffalo, Buffalo, NY, USA.
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Start RD, Cross SS. Acp. Best practice no 155. Pathological investigation of deaths following surgery, anaesthesia, and medical procedures. J Clin Pathol 1999; 52:640-52. [PMID: 10655984 PMCID: PMC501538 DOI: 10.1136/jcp.52.9.640] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The pathological investigation of deaths following surgery, anaesthesia, and medical procedures is discussed. The definition of "postoperative death" is examined and the classification of deaths following procedures detailed. The review of individual cases is described and the overall approach to necropsy and interpretation considered. There are specific sections dealing with the cardiovascular system (including air embolism, perioperative myocardial infarction, cardiac pacemakers, central venous catheters, cardiac surgery, heart valve replacement, angioplasty, and vascular surgery); respiratory system (postoperative pneumonia, pulmonary embolism, pneumothorax); central nervous system (dissection of cervical spinal cord), hepatobiliary and gastrointestinal system; musculoskeletal system; and head and neck region. Deaths associated with anaesthesia are classified and the specific problems of epidural anaesthesia and malignant hyperthermia discussed. The article concludes with a section on the recording of necropsy findings and their communication to clinicians and medicolegal authorities.
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Affiliation(s)
- R D Start
- Department of Histopathology, Chesterfield and North Derbyshire Royal Hospital NHS Trust, Calow, UK
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Cheong MA, Kim YC, Park HK, Cho SY, Yeom JH, Shin WJ, Lee DH, Kim HS. Paroxysmal tachycardia and hypertension with or without ventricular fibrillation during laparoscopic adrenalectomy: two case reports in patients with noncatecholamine-secreting adrenocortical adenomas. J Laparoendosc Adv Surg Tech A 1999; 9:277-81. [PMID: 10414546 DOI: 10.1089/lap.1999.9.277] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We present two cases of sudden unanticipated cardiovascular complications in patients with noncatecholamine-secreting adrenocortical adenomas during laparoscopic adrenalectomy. In the first case, the patient developed paroxysmal tachycardia and hypertension followed by ventricular fibrillation shortly after clipping of the adrenal vein. In the second case, the patient suffered hypertension and bigeminy during manipulation of the adrenal gland just around the adrenal vein. Awareness of such complications during either conventional or laparoscopic adrenalectomy is important even if the operation is performed in a patient with an apparently noncatecholamine-secreting adrenocortical adenoma.
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Affiliation(s)
- M A Cheong
- Department of Anesthesiology, Hanyang University Kuri Hospital, Kuri-city, Kyunggi-do, Korea
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