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Shelley B, Glass A, Keast T, McErlane J, Hughes C, Lafferty B, Marczin N, McCall P. Perioperative cardiovascular pathophysiology in patients undergoing lung resection surgery: a narrative review. Br J Anaesth 2023; 130:e66-e79. [PMID: 35973839 PMCID: PMC9875905 DOI: 10.1016/j.bja.2022.06.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/15/2022] [Accepted: 06/25/2022] [Indexed: 01/28/2023] Open
Abstract
Although thoracic surgery is understood to confer a high risk of postoperative respiratory complications, the substantial haemodynamic challenges posed are less well appreciated. This review highlights the influence of cardiovascular comorbidity on outcome, reviews the complex pathophysiological changes inherent in one-lung ventilation and lung resection, and examines their influence on cardiovascular complications and postoperative functional limitation. There is now good evidence for the presence of right ventricular dysfunction postoperatively, a finding that persists to at least 3 months. This dysfunction results from increased right ventricular afterload occurring both intraoperatively and persisting postoperatively. Although many patients adapt well, those with reduced right ventricular contractile reserve and reduced pulmonary vascular flow reserve might struggle. Postoperative right ventricular dysfunction has been implicated in the aetiology of postoperative atrial fibrillation and perioperative myocardial injury, both common cardiovascular complications which are increasingly being appreciated to have impact long into the postoperative period. In response to the physiological demands of critical illness or exercise, contractile reserve, flow reserve, or both can be overwhelmed resulting in acute decompensation or impaired long-term functional capacity. Aiding adaptation to the unique perioperative physiology seen in patients undergoing thoracic surgery could provide a novel therapeutic avenue to prevent cardiovascular complications and improve long-term functional capacity after surgery.
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Affiliation(s)
- Ben Shelley
- Department of Cardiothoracic Anaesthesia and Intensive Care, Golden Jubilee National Hospital, Glasgow, Scotland, UK; Anaesthesia, Perioperative Medicine and Critical Care Research Group, University of Glasgow, Glasgow, Scotland, UK.
| | - Adam Glass
- Department of Cardiothoracic Anaesthesia and Intensive Care, Golden Jubilee National Hospital, Glasgow, Scotland, UK; School of Anaesthesia, Northern Ireland Medical and Dental Training Agency, Belfast, Northern Ireland, UK
| | - Thomas Keast
- Department of Cardiothoracic Anaesthesia and Intensive Care, Golden Jubilee National Hospital, Glasgow, Scotland, UK; Anaesthesia, Perioperative Medicine and Critical Care Research Group, University of Glasgow, Glasgow, Scotland, UK
| | - James McErlane
- Department of Cardiothoracic Anaesthesia and Intensive Care, Golden Jubilee National Hospital, Glasgow, Scotland, UK; Anaesthesia, Perioperative Medicine and Critical Care Research Group, University of Glasgow, Glasgow, Scotland, UK
| | - Cara Hughes
- Department of Cardiothoracic Anaesthesia and Intensive Care, Golden Jubilee National Hospital, Glasgow, Scotland, UK; Anaesthesia, Perioperative Medicine and Critical Care Research Group, University of Glasgow, Glasgow, Scotland, UK
| | - Brian Lafferty
- Department of Cardiothoracic Anaesthesia and Intensive Care, Golden Jubilee National Hospital, Glasgow, Scotland, UK; Anaesthesia, Perioperative Medicine and Critical Care Research Group, University of Glasgow, Glasgow, Scotland, UK
| | - Nandor Marczin
- Division of Anaesthesia Pain Medicine and Intensive Care, Department of Surgery and Cancer, Imperial College London, London, UK; Department of Anaesthesia and Critical Care, Harefield Hospital, Royal Brompton & Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, London, UK; Department of Anaesthesia and Intensive Care, Semmelweis University, Budapest, Hungary
| | - Philip McCall
- Department of Cardiothoracic Anaesthesia and Intensive Care, Golden Jubilee National Hospital, Glasgow, Scotland, UK; Anaesthesia, Perioperative Medicine and Critical Care Research Group, University of Glasgow, Glasgow, Scotland, UK
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Apinyachon W, Thamnoranart M, Lavanrattanakul P, Sangasilpa I, Suragul W. Endotracheal intubation of patients in left semi-prone position before endoscopic retrograde cholangiopancreatography: A randomised controlled study. Indian J Anaesth 2022; 66:700-706. [PMID: 36437969 PMCID: PMC9698292 DOI: 10.4103/ija.ija_165_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 10/05/2022] [Accepted: 10/07/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND AIMS Endoscopic retrograde cholangiopancreatography (ERCP) is generally performed with the patient in the left semi-prone position. The patients are usually intubated in the supine position and subsequently turned to the left semi-prone position. This turning procedure may cause the injuries to the patient or unstable haemodynamics. Previous studies show that the success rates of intubation in the lateral position are comparable to that of intubation in the supine position, even so, there are some difficulties. Therefore, this study is aimed to investigate the effect of the semi-prone position on the success rate of intubation. METHODS This randomised controlled trial included 88 patients aged 18 to 80 years with an American Society of Anesthesiologists physical status (ASA PS) of I-III with no predicted difficult intubation, and who were undergoing ERCP. The subjects were randomly assigned to be intubated in the supine or semi-prone position. The 44 patients in the supine group were intubated in the supine position. The other 44 patients were intubated in the semi-prone position. The primary outcome was the success rate of the first intubation attempt. RESULTS There were no differences between the two groups in age, ASA PS and preoperative airway characteristics. Endotracheal intubation was successful in all patients with the first intubation attempt successful in 43 patients (97.7%) in the supine group and 42 (95.5%) in the semi-prone group (P = 0.556). CONCLUSION For patients undergoing ERCP, the success rate of endotracheal intubation in the left semi-prone position was comparable to that in the supine position.
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Affiliation(s)
- Worapot Apinyachon
- Department of Anaesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Methinee Thamnoranart
- Department of Anaesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Phisut Lavanrattanakul
- Department of Anaesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Inthuon Sangasilpa
- Department of Anaesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wikran Suragul
- Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand,Address for correspondence: Dr. Wikran Suragul, Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand, 270 Rama 6 Road, Phayathai, Ratchathewi, Bangkok - 10400, Thailand. E-mail:
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Right Kidney Position for Laparoscopic Liver Resection of Tumors Located in the Posterosuperior Region. SURGICAL LAPAROSCOPY, ENDOSCOPY & PERCUTANEOUS TECHNIQUES 2022; 32:621-626. [PMID: 36130715 DOI: 10.1097/sle.0000000000001081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 02/15/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Laparoscopic liver resection (LLR) for tumors located in posterosuperior (PS) region of the liver (segment 7 or 8) is extremely challenging. Several techniques have been proposed; however, no standard procedure has yet been established. The aim of this study was to present and discuss the usefulness of the right kidney position as a unique idea of surgical position in LLR for tumors located in the PS region. MATERIALS AND METHODS For the right kidney position, the patient lay on the operating table in the left lateral decubitus position with the body bent so that the kidney rest (approximately the level of the twelfth rib) was elevated to extend the surgical area. The surgeon was positioned on the right or left side of the patient according to the situation during operation. An intercostal port was not used in any of the cases. The operating table was liberally rotated as per the surgeon's preference. The liver was mobilized by dividing the right triangular and coronary ligaments. Full mobilization of the right liver was not routinely performed. Liver transection was performed under intermittent inflow occlusion in all cases. RESULTS Thirteen patients with tumors located in the PS region underwent LLR in the right kidney position at Shinshu University Hospital between June 2019 and May 2021. Of the 13 patients, 11 patients underwent limited liver resection and two underwent anatomic liver resection of segment 8. The right kidney position enables the surgeon to secure a wider surgical field under the dome and prevent the camera and forceps from hitting the ilium and interfering with the operation, and the surgical device can easily reach the lesion under the dome because of the migration to the caudal side of the liver. No patients required blood transfusion or conversion to open liver resection. The median surgical margin was 6 mm (range 0 to 9 mm). CONCLUSIONS The right kidney position is useful, especially for the resection of tumors located in the PS region of the liver.
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Ghanem MA, El-Hefnawy AS. Cardiopulmonary effects of prolonged surgical abdominal retractors application during general anesthesia: a prospective observational comparative study. Braz J Anesthesiol 2021; 73:291-300. [PMID: 34298077 DOI: 10.1016/j.bjane.2021.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 04/25/2021] [Accepted: 06/20/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Increasing abdominal pressures could affect pulmonary compliance and cardiac performance, a fact based on which the aim of the present study to detect the cardiopulmonary burden of multiple retractors application during supine versus lateral abdominal surgeries. We hypothesized that surgical ring multiple retractors application would affect the pulmonary and cardiac functions during both lateral and supine abdominal surgeries. METHODS Prospective observational comparative study on forty surgical patients subdivided into two groups twenty each, comparing pulmonary compliance and cardiac performance before, during and after retractors application, group (S) supine position cystectomy surgery, and group (L) lateral position nephrectomy surgery under general anesthesia, Composite 1ry outcome; dynamic compliance C-dyn and cardiac index CI and Other outcome variables ICON cardio-meter were also recorded. RESULTS C-dyn and C-stat were significantly decreased late during retractor application in lateral compared to supine surgery with significant decrease compared to basal values all over the surgical time. CI was significantly increased after retractor removal in both of the study groups compared to basal values. PAWP was significantly increased in -lateral compared to supine surgery -with significant increase compared to basal value all over the surgical time in both of the study groups. significant increase in DO2I compared to basal value during both supine and lateral positions. CONCLUSION Surgical retraction results in a short-lived significant decreases in lung compliance and cardiac output particularly during the lateral-kidney position than the supine position compliance.
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Affiliation(s)
- Mohamed A Ghanem
- Mansoura University, Faculty of Medicine, Anesthesia Department, Anesthesia and Surgical Intensive Care, Almançora, Egypt.
| | - Ahmed S El-Hefnawy
- Mansoura University, Faculty of Medicine, Urology Surgery, Urology and Nephrology Center, Almançora, Egypt
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Thomas AS, Moorthy RK, Raju K, Lakshmanan J, Joy M, Mariappan R. Measurement of non-invasive blood pressure in lateral decubitus position under general anaesthesia - Which arm gives more accurate BP in relation to invasive BP - dependent or non-dependent arm? Indian J Anaesth 2020; 64:631-636. [PMID: 32792741 PMCID: PMC7413357 DOI: 10.4103/ija.ija_125_20] [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] [Received: 03/01/2020] [Revised: 05/03/2020] [Accepted: 05/14/2020] [Indexed: 12/18/2022] Open
Abstract
Background and Aims: Non-invasive blood pressure (NiBP) varies with the arm and body position. In the lateral decubitus position (LDP), the non-dependent arm reads lower, and the dependent arm reads higher pressure. We aimed to study the correlation between the NiBP and invasive arterial blood pressure (ABP) as anaesthesia progressed and its correlation in different BP ranges. Methods: American Society of Anesthesiologists (ASA I–III) patients, between 18–70 years undergoing neurosurgical procedures in the LDP were studied. All were anaesthetised using a standard protocol, positioned in the LDP. NiBP was measured every 15 min in both dependent and non-dependent arms and correlated with the ABP. Results: Intra-class correlation (ICC) done between the dependent arm NiBP and ABP showed good correlation for mean and systolic BP and moderate correlation for diastolic BP. ICC was 0.800, 0.846 and 0.818 for mean and 0.771, 0.782, 0.792 for systolic BP at 15 min, 1 h, and 2 h, respectively. The ICC between the non-dependent arm NiBP and the invasive ABP showed poor correlation for all BP (systolic, diastolic and mean). As anaesthesia progressed, the mean difference between the NiBP and the ABP decreased in the dependent arm and increased in the non-dependent arm. The strength of agreement between the NiBP and the ABP in various BP ranges showed moderate correlation for the dependent arm NiBP (0.45–0.54) and poor correlation (0.21–0.38) for the non-dependent arm. Conclusion: The NiBP of the dependent arm correlated well with ABP in LDP under general anaesthesia (GA). It is better to defer measuring NiBP in the non-dependent arm as the correlation with ABP is poor.
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Affiliation(s)
- Anju S Thomas
- Department of Anaesthesia, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ranjith K Moorthy
- Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Krishnaprabhu Raju
- Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Melvin Joy
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ramamani Mariappan
- Department of Anaesthesia, Christian Medical College, Vellore, Tamil Nadu, India
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Otaola-Arca H, Petros-Franco A, Moraga-Sanz Á, Vargas É, Herranz-Yagüe JA, Vidal-Mora I, Rodríguez-Carlín A, Castillo-Cádiz O. WITHDRAWN: Rhabdomyolysis after robotic partial nephrectomy. Case series and review of associated factors. Actas Urol Esp 2020:S0210-4806(20)30005-X. [PMID: 32204945 DOI: 10.1016/j.acuro.2020.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 01/13/2020] [Indexed: 11/24/2022]
Affiliation(s)
- H Otaola-Arca
- Departamento de Urología, Clínica INDISA, Santiago, Chile.
| | | | - Á Moraga-Sanz
- Departamento de Urología, Hospital Universitario de Getafe, Getafe, Madrid, España
| | - É Vargas
- Departamento de Urología, Hospital Nacional Hipólito Unanue, El Agustino, Perú
| | - J A Herranz-Yagüe
- Departamento de Urología, Hospital Universitario de Fuenlabrada, Madrid, España
| | - I Vidal-Mora
- Departamento de Urología, Clínica INDISA, Santiago, Chile
| | | | - O Castillo-Cádiz
- Departamento de Urología, Clínica INDISA, Santiago, Chile; Facultad de Medicina, Universidad Andrés Bello, Santiago, Chile
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Rojas J, Familiari F, Bitzer A, Srikumaran U, Papalia R, McFarland EG. Patient Positioning in Shoulder Arthroscopy: Which is Best? JOINTS 2019; 7:46-55. [PMID: 31879731 PMCID: PMC6930847 DOI: 10.1055/s-0039-1697606] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 08/06/2019] [Indexed: 11/24/2022]
Abstract
When performing diagnostic and surgical arthroscopic procedures on the shoulder, the importance of patient positioning cannot be understated. The optimum patient positioning for shoulder arthroscopy should enhance intraoperative joint visualization and surgical accessibility while minimizing potential perioperative risk to the patient. Most shoulder arthroscopy procedures can be reliably performed with the patient either in the lateral decubitus (LD) or beach chair (BC) position. Although patient positioning for shoulder arthroscopy has been subject of controversy, there is no conclusive evidence to suggest superiority of one position versus another. Each position offers advantages and disadvantages and surgeon's experience and training are pivotal on selecting one position versus another. Regardless of the position, a proper positioning of the patient should provide adequate access to the joint while minimizing complications. The purpose of this review is to summarize setup and technical aspects, the advantages and disadvantages, and the possible complications of the LD and BC positions in shoulder arthroscopy.
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Affiliation(s)
- Jorge Rojas
- Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, United States
| | - Filippo Familiari
- Department of Orthopaedic and Trauma Surgery, "Villa del Sole" Clinic, Catanzaro, Italy
| | - Alexander Bitzer
- Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, United States
| | - Uma Srikumaran
- Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, United States
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Edward G McFarland
- Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, United States
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Asida SM, Badawy M. Effect of low tidal volume during general anesthesia for urological procedures on lung functions. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2015.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Salah M. Asida
- Departments of Anesthesia, Qena Faculty of Medicine , South Valley University , Egypt
| | - M.Sh. Badawy
- Departments of Chest Diseases, Qena Faculty of Medicine , South Valley University , Egypt
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Ghabra H, Smith SA. Anesthesia for Urological Procedures. Anesthesiology 2018. [DOI: 10.1007/978-3-319-74766-8_76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Jin Y, Ying J, Zhang K, Fang X. Endotracheal intubation under video laryngoscopic guidance during upper gastrointestinal endoscopic surgery in the left lateral position: A randomized controlled trial. Medicine (Baltimore) 2017; 96:e9461. [PMID: 29384933 PMCID: PMC6392790 DOI: 10.1097/md.0000000000009461] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Patients undergoing upper gastrointestinal endoscopic surgeries are generally placed in the left lateral position and require endotracheal intubation to maintain airway patency. We conducted a prospective, randomized, controlled study to evaluate the feasibility of intubation under video laryngoscopic guidance in the left lateral position during upper gastrointestinal endoscopic surgery. METHODS We compared the data of patients (n = 120) who underwent intubation under video laryngoscopic guidance in the supine or left lateral position. Patients in Group S (n = 59) were initially placed in the supine position and then shifted to the left lateral position after airway establishment. Patients in Group L (n = 61) were placed in the left decubitus position during both induction and intubation. Laryngoscopic view, intubation time, success rate, hemodynamic changes, adverse effects, and complications of intubation were compared between the groups. RESULTS The 2 groups showed no difference in terms of time required for intubation (Group L, 23.95 ± 4.43 seconds and Group S, 23.44 ± 4.78 seconds; P = .545) and number of intubation attempts. Further, the overall rate of intubation success was 100% in both groups. However, Group S exhibited significant hemodynamic changes during shift of decubitus (P < .001) and severe sore throat (P = .030). The incidences of other adverse effects such as productive cough, dryness of mouth, hoarseness, oral mucosal injury, dental injury, and hypoxia in the 2 groups were comparable. CONCLUSION We concluded that intubation in the lateral position under video laryngoscopic guidance is safe and feasible performed in the left lateral position and prevents the hemodynamic change and sore throat resulting from change in decubitus.
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Affiliation(s)
- Yue Jin
- Department of Anesthesiology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Jing Ying
- Department of Anesthesiology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
- Department of Anesthesiology, Ningbo Hospital of Zhejiang University, Ningbo, China
| | - Kai Zhang
- Department of Anesthesiology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Xiangming Fang
- Department of Anesthesiology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
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Hypotension in the Right Lateral Position Secondary to Inferior Vena Cava Abnormality. ACTA ACUST UNITED AC 2015; 5:103-5. [PMID: 26361387 DOI: 10.1213/xaa.0000000000000195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Surgical positioning is accompanied by numerous anesthetic considerations, particularly its potential effects on the cardiovascular, respiratory, and nervous systems. Clinical studies have shown that lateral positioning does not affect hemodynamics; however, with the addition of trunk flexion, there is a decrease in cardiac output, which may be secondary to caval compression. In this report, we describe a unique case of hypotension that arose in a patient positioned only in the right lateral decubitus position with flexion and that was exacerbated by an abnormally narrow inferior vena cava.
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Spruit RJ, Schwarte LA, Hakenberg OW, Scheeren TWL. Association of intraoperative tissue oxygenation with suspected risk factors for tissue hypoxia. J Clin Monit Comput 2013; 27:541-50. [DOI: 10.1007/s10877-013-9460-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 03/22/2013] [Indexed: 01/07/2023]
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Samir EM, Rizk SN, Abdou SA. Influence of intraoperative fluid administration on creatine kinase, and its effect on kidney function after laparoscopic nephrectomy. EGYPTIAN JOURNAL OF ANAESTHESIA 2012. [DOI: 10.1016/j.egja.2012.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Enas M. Samir
- Kasr El Aini, Faculty of Medicine , Cairo University , Egypt
| | - Sherry N. Rizk
- Kasr El Aini, Faculty of Medicine , Cairo University , Egypt
| | - Samar A. Abdou
- Kasr El Aini, Faculty of Medicine , Cairo University , Egypt
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Robotic-assisted resection of isolated paraaortic lymph node recurrence with right lateral decubitus position. J Robot Surg 2012; 7:205-7. [DOI: 10.1007/s11701-012-0350-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Accepted: 03/20/2012] [Indexed: 10/28/2022]
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Ilies C, Ludwigs J, Gruenewald M, Thee C, Hanf J, Hanss R, Steinfath M, Bein B. The effect of posture and anaesthetic technique on the surgical pleth index. Anaesthesia 2012; 67:508-513. [DOI: 10.1111/j.1365-2044.2011.07051.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
| | - J. Ludwigs
- Medical Student, Christian‐Albrechts‐University, Kiel, Germany
| | | | | | - J. Hanf
- Medical Student, Christian‐Albrechts‐University, Kiel, Germany
| | | | - M. Steinfath
- Professor of Anaesthesia and Chair, Department of Anaesthesia and Intensive Care Medicine, University‐Hospital Schleswig‐Holstein, Campus Kiel, Germany
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Sahu S, Goyal V, Dhiraaj S, Kishore K, Singh PK. A very common case become rare: Anesthetic considerations of lepromatous leprosy. Anesth Essays Res 2011; 5:207-10. [PMID: 25885391 PMCID: PMC4173396 DOI: 10.4103/0259-1162.94783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Leprosy or Hansen's disease is very uncommon in developed countries. More than 80% of the world's cases occurs and still reported from developing countries. But nowadays due to increase in international affairs, medical tourism, globalization and immigration, there is increasing possibility to find patients anywhere, which require anesthesia for surgical interventions. Leprosy is a chronic infectious disease caused by Mycobacterium leprae and involves mainly skin, peripheral nervous system, upper respiratory tract, eyes and testes. Anesthetic consideration is focused mainly on complications related to leprosy like cardiac or respiratory dysautonomia, autonomic dysfunctions and side effects which are related to drug therapy and are challenging. There can be drug-related hepatitis and renal insufficiency in these patients. We report the anesthetic management of a patient with lepromatous leprosy who had undergone laparoscopic radical nephrectomy for renal cell carcinoma under general anesthesia.
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Affiliation(s)
- Sandeep Sahu
- Department of Anaesthesiology and Intensive Care, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Vipin Goyal
- Department of Anaesthesiology and Intensive Care, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjay Dhiraaj
- Department of Anaesthesiology and Intensive Care, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kamal Kishore
- Department of Anaesthesiology and Intensive Care, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - P K Singh
- Department of Anaesthesiology and Intensive Care, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Siepe M, Rüegg DM, Giraud MN, Python J, Carrel T, Tevaearai HT. Effect of acute body positional changes on the haemodynamics of rats with and without myocardial infarction. Exp Physiol 2008; 90:627-34. [PMID: 15849229 DOI: 10.1113/expphysiol.2005.030148] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In humans, the lateral recumbent position has a beneficial effect on haemodynamics. If this effect is substantial in small animals too, there is a risk of misinterpretation in preclinical investigations. Therefore, the aim of this study was to analyse the impact of acute changes in body position on haemodynamics in rats. Healthy rats (n=21) and rats post myocardial infarction (n=20) were randomly positioned supine, prone, or on the right or left side. In each position, we measured haemodynamic parameters by pressure-tip catheter and thermodilution. We found that left ventricular contractility (dP/dtmax) was significantly elevated in both lateral positions as compared to the supine position in healthy rats. In healthy rats and following infarction, cardiac index (CI) and stroke volume index (SVI) were significantly higher in both lateral positions as compared to the supine or prone position. Of importance, if SVI values in the supine position in healthy rats (0.095 +/- 0.003 ml (100 g)(-1)) are compared to SVI values measured in different positions after myocardial infarction, the SVI can be either significantly lower in the supine (0.084 +/- 0.003 ml (100 g)(-1)) or significantly higher in the left lateral position (0.105 +/- 0.003 ml (100 g)(-1)). We conclude that post myocardial infarction and in healthy control rats, important haemodynamic values are increased in lateral positions as compared to prone or supine positions. Analysing haemodynamic data in rats may therefore result in misinterpretation if the body position is inconsistent.
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Affiliation(s)
- Matthias Siepe
- Clinic for Cardiovascular Surgery, DKF MEM C-812, Murtenstrasse 35, 3010 Bern, Switzerland.
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Mertens zur Borg IRAM, Di Biase M, Verbrugge S, Ijzermans JNM, Gommers D. Comparison of three perioperative fluid regimes for laparoscopic donor nephrectomy : A prospective randomized dose-finding study. Surg Endosc 2007; 22:146-50. [PMID: 17522928 PMCID: PMC2169269 DOI: 10.1007/s00464-007-9391-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2007] [Revised: 02/05/2007] [Accepted: 02/23/2007] [Indexed: 11/30/2022]
Abstract
Background Pneumoperitoneum (PP), as used for laparoscopic procedures, impairs stroke volume, renal blood flow, glomerular filtration rate and urine output. This study investigated whether perioperative fluid management can abolish these negative effects of PP on hemodynamics. Methods Twenty-one patients undergoing laparoscopic donor nephrectomy (LDN) were randomized into three groups: group 1 received overnight infusion and received a bolus of colloid before induction of anesthesia, followed by a bolus just before PP; group 2 received overnight infusion and a colloid bolus before anesthesia; group 3 served as controls and received only infusion during operation. All three groups received the same total amount of crystalloids and colloids until nephrectomy. Data analysis of the donor included; mean arterial pressure (MAP), stroke volume (SV), left ventricular ejection time (LVETc), perioperative urine output and renal function measured as the creatinine clearance (CrCl) until one-year post-operative. Results SV was significantly higher in group 1 compared to controls for all measurements. In the control group SV significantly decreased after changing from the supine to lateral position whereas there was no change in SV in both pre-hydrated groups. In all groups, MAP decreased after induction of anesthesia, and restored to pre-anesthetic values during PP. CrCl decreased in the control group during PP, but not in the other groups. From two days postoperative, CrCl was comparable between the three study groups. Conclusion Overnight infusion and a bolus of colloid just before PP attenuate hemodynamic compromise from PP.
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Shaikh S, Nabi G, McClinton S. Risk factors and prevention of rhabdomyolysis after laparoscopic nephrectomy. BJU Int 2006; 98:960-2. [PMID: 17034598 DOI: 10.1111/j.1464-410x.2006.06454.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Shafaque Shaikh
- Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
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21
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Rehman J, Boglia J, Chughtai B, Sukkarieh T, Khan SA, Lewis R, Darras F, Wadhwa NK, Samadi DB, Waltzer WC. High Body Mass Index in Muscular Patients and Flank Position Are Risk Factors for Rhabdomyolysis: Case Report after Laparoscopic Live-Donor Nephrectomy. J Endourol 2006; 20:646-50. [PMID: 16999617 DOI: 10.1089/end.2006.20.646] [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: 12/22/2022] Open
Abstract
BACKGROUND AND PURPOSE Rhabdomyolysis is well known after traumatic crush injuries or ischemia involving muscles. Postoperatively, it most likely is secondary to surgical positioning and patient muscle mass. We report a case after laparoscopic live-donor nephrectomy. CASE REPORT A muscular 35-year-old man underwent elective left laparoscopic live-donor nephrectomy in a 70 degrees flank position with four ports. He was in the right-side lying position with hip flexion (flank position) for approximately 4 hours. A kidney bridge had been placed between the iliac crest and the rib cage. Postoperatively, the patient had light-pinkish urine and low urine output. There was marked induration of the buttocks and significant pedal and scrotal edema. With judicious use of alkalinization and diuretics, the patient did not require dialysis, and renal function returned to base level by postoperative day 20. The recipient of the kidney had a normal postoperative course. CONCLUSION Rhabdomyolysis is a syndrome of muscle necrosis and release of intracellular components into the circulation. Acute renal failure secondary to myoglobinuria is a common complication. We currently use little flexion of the table during donor nephrectomy and bring the table to a neutral position immediately after kidney retrieval. Postoperatively, one needs a high index of suspicion for rhabdomyolysis to avoid or at least promptly recognize this rare but potentially serious condition after any operation lasting >or=4 hours.
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Affiliation(s)
- Jamil Rehman
- Department of Urology, SUNY-Stony Brook University Health Sciences Center, School of Medicine, Stony Brook, New York 11794-8093, USA.
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22
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Irvine J, Aho T, Davidson P, Searle M. Rhabdomyolysis following laparoscopic radical nephrectomy: A case to heighten awareness. Nephrology (Carlton) 2006; 11:282-4. [PMID: 16889565 DOI: 10.1111/j.1440-1797.2006.00578.x] [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] [Indexed: 11/30/2022]
Abstract
Rhabdomyolysis, myoglobinuria and acute renal failure are rare complication of surgery. Long operative time, increased body mass, lateral decubitus positioning and extracellular volume depletion may predispose to this condition. The authors describe the case of a 70-year-old man with renal cell carcinoma who underwent a laparoscopic right radical nephrectomy in the lateral decubitus position. His postoperative course was complicated by acute renal failure due to rhabdomyolysis. Heightened awareness, early recognition and treatment of this condition are important, particularly as laparoscopic nephrectomy is becoming a common procedure for living donor transplantation.
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Affiliation(s)
- John Irvine
- Department of Nephrology, Christchurch Public Hospital, Private Bag, Christchurch, New Zealand.
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Affiliation(s)
- Dong Hoon Lim
- Department of Urology, College of Medicine, Chosun University, Gwangju, Korea
| | - Joon Rho
- Department of Urology, College of Medicine, Chosun University, Gwangju, Korea
| | - Chul Sung Kim
- Department of Urology, College of Medicine, Chosun University, Gwangju, Korea
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Shiraishi K, Eguchi S, Mohri J, Kamiryo Y. Hand-Assisted Laparoscopic Radical Nephrectomy. Surg Laparosc Endosc Percutan Tech 2005; 15:216-9. [PMID: 16082309 DOI: 10.1097/01.sle.0000174555.25167.12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Transperitoneal and retroperitoneal approaches have been introduced to perform hand-assisted laparoscopic radical nephrectomy. The efficacy and convalescence of both approaches were compared. Of 26 patients with renal cell carcinoma, 14 patients were treated by the transperitoneal approach and 12 by the retroperitoneal approach at the same institution. The mean operative time by transperitoneal approach was significantly shorter than retroperitoneal approach (236.4 and 280.0 minutes, respectively, P < 0.05), but there is a steeper learning in retroperitoneal approach. A significant increase in operative time was required with an increase in specimen weight (r = 0.591, P < 0.05). There were no differences in patient demographic, operative, and convalescence data between the both groups. Hand-assisted laparoscopic radical nephrectomy is safe by either the transperitoneal or the retroperitoneal approach. Making enough retroperitoneal space for the hand and instrument enables us to use the retroperitoneal approach readily. Patients with abundant fatty tissues around the kidney should be treated by the transperitoneal approach.
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Affiliation(s)
- Koji Shiraishi
- Department of Urology, Saiseikai Shimonoseki General Hospital, Shimonoseki, Yamaguchi, Japan.
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25
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Abstract
Laparoscopy for urological surgery is a relatively recent surgical innovation. Some centres have substantial experience of single operations, but very few have experience with a comprehensive range. Our programme began with nephrectomy and pyeloplasty, and has expanded to provide for a living related kidney donor programme and for other procedures usually conducted open. Recently, it has included prostate and bladder cancer surgery. The learning curve and implications for anaesthesia are described on the basis of the experience of one anaesthetist with 124 patients. Perioperative care issues, in common with other abdominal laparoscopic procedures, relate to operating positions, the consequences of carbon dioxide under pressure in the abdomen and postoperative analgesia. There is only a small requirement for regional anaesthesia supplementation and invasive analgesia. The corporate laparoscopic cholecystectomy experience was used as the foundation for anaesthesia and to delineate specific organ system issues and any interventions. Significant differences were found in the spectrum of the urological patient population and comorbidity, notably renal function or dysfunction, and complications.
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Affiliation(s)
- I D Conacher
- Freeman Hospitals Trust, Newcastle upon Tyne, UK.
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26
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Mertens zur Borg IRAM, Lim A, Verbrugge SJC, IJzermans JNM, Klein J. Effect of intraabdominal pressure elevation and positioning on hemodynamic responses during carbon dioxide pneumoperitoneum for laparoscopic donor nephrectomy: a prospective controlled clinical study. Surg Endosc 2004; 18:919-23. [PMID: 15108115 DOI: 10.1007/s00464-003-8817-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2003] [Accepted: 10/02/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND Carbon dioxide (CO2) pneumoperitoneum (PP) increases mean arterial blood pressure (MAP) and systemic vascular resistance (SVR) but decreases stroke volume (SV) and cardiac output (CO). This study evaluated the hemodynamic effects of elevated intraabdominal pressure (IAP) occurring during laparoscopic donor nephrectomy (LDN). METHODS Twenty-two patients undergoing LDN were investigated and hemodynamic parameters, P(v)CO2) (carbon dioxide partial pressure), and VCO2 (carbon dioxide production) were monitored during the procedure. Before and after PP, IAP was raised from 12 to 20 mmHg and the hemodynamic effects were measured every 30 s. RESULTS During IAP of 12 mmHg and stable serum CO2, there was no change in SV compared to preinsufflation levels. When IAP was elevated from 12 to 20 mmHg, SV initially decreased (p < 05), followed by an increase in MAP and SVR (p < 0.05). CONCLUSION This study shows that with the fluid and ventilation protocol used, PP has no significant effect on SV at an IAP of 12 mmHg, whereas increasing IAP to 20 mmHg does. In this study, the hemodynamic effects induced by CO2 PP of 12 mmHg are not due to changes in serum CO2. Compression of the venous system during a PP of 20 mmHg reduces preload, with an subsequent increase in SVR.
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Affiliation(s)
- I R A M Mertens zur Borg
- Department of Anesthesiology, Erasmus University Medical Center, P.O. Box 2040, 3000, Rotterdam, CA, The Netherlands.
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27
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Abstract
Rhabdomyolysis is a postoperative complication that may result in acute renal failure owing to excessive myoglobinuria. After uncomplicated laparoscopic left transperitoneal donor nephrectomy, a 32-year-old man developed anuric acute renal failure secondary to postoperative rhabdomyolysis that required intermittent hemodialysis for 2 weeks. The presumed risk factors in this case were the patient's high body mass index, intraoperative flank position with flexion, a solitary kidney, and the duration of surgery. Our current surgical technique has been modified to drop the kidney bridge early, immediately after visualization of the hilum.
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Affiliation(s)
- Wayne Kuang
- Section of Laparoscopic and Minimally Invasive Surgery, Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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28
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Matin SF, Gill IS. Laparoscopic radical nephrectomy: retroperitoneal versus transperitoneal approach. Curr Urol Rep 2002; 3:164-71. [PMID: 12084210 DOI: 10.1007/s11934-002-0030-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Laparoscopic radical nephrectomy can be efficaciously performed by either the transperitoneal or the retroperitoneal laparoscopic approach. The primary indication for selecting one approach over another has historically depended on the individual surgeon's experience and training. With either technique, laparoscopy adheres to established surgical oncologic principles of wide specimen mobilization and early vascular control. This article reviews the history, contraindications, anatomic considerations, patient preparation, and surgical technique of these two laparoscopic approaches. A salient summary of the worldwide experience with these procedures is presented, as well as a brief synopsis of controversial arguments favoring specimen morcellation versus intact extraction.
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Affiliation(s)
- Surena F Matin
- Section of Laparoscopic and Minimally Invasive Surgery, Urological Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, OH 44195, USA
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MATIN SURENAF, NOVICK ANDREWC. RENAL DYSFUNCTION ASSOCIATED WITH STAGED BILATERAL PARTIAL NEPHRECTOMY: THE IMPORTANCE OF OPERATIVE POSITIONING. J Urol 2001. [DOI: 10.1016/s0022-5347(05)66549-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- SURENA F. MATIN
- From the Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - ANDREW C. NOVICK
- From the Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio
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30
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RENAL DYSFUNCTION ASSOCIATED WITH STAGED BILATERAL PARTIAL NEPHRECTOMY: THE IMPORTANCE OF OPERATIVE POSITIONING. J Urol 2001. [DOI: 10.1097/00005392-200103000-00034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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