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Besson J, Brissot H, Azoulay F, Benzimra P, Fritz J. Spontaneous cecal perforation in a cat diagnosed with ultrasonography. Vet Radiol Ultrasound 2024; 65:275-278. [PMID: 38459956 DOI: 10.1111/vru.13355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 02/17/2024] [Accepted: 02/22/2024] [Indexed: 03/11/2024] Open
Abstract
An 8-year-old cat was presented for an acute history of anorexia, marked abdominal pain, and hyperthermia. Ultrasonography showed a cecal perforation with focal steatitis and adjacent free gas bubbles, consistent with focal peritonitis. Surgery confirmed the imaging findings. An enterectomy was performed with the removal of the cecum and ileocolic valve, and anastomosis between the ileum and colon was performed. Histology revealed transmural enteritis and chronic severe pyogranulomatous peritonitis with intralesional plant fragments.
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Affiliation(s)
- Julie Besson
- Department of Imaging, Azurvet Veterinary Specialists Centre, Saint-Laurent-du-Var, France
| | - Hervé Brissot
- Department of Soft Tissue Surgery, Azurvet Veterinary Specialists Centre, Saint-Laurent-du-Var, France
| | - Florian Azoulay
- Department of Imaging, Azurvet Veterinary Specialists Centre, Saint-Laurent-du-Var, France
| | | | - Julien Fritz
- Department of Imaging, Azurvet Veterinary Specialists Centre, Saint-Laurent-du-Var, France
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2
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Maina RM, Rader C, Kypa J, Asahngwa C, Jasmin HM, Zalamea NN, Nelson JS, Altomar JL, Owens MB, Muenyi CS, Foretia DA. Chemotherapy-associated pneumoperitoneum in cancer patients: a scoping review. Ann Med Surg (Lond) 2024; 86:2828-2835. [PMID: 38694333 PMCID: PMC11060304 DOI: 10.1097/ms9.0000000000001998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/14/2024] [Indexed: 05/04/2024] Open
Abstract
Background The presence of air in the peritoneal cavity (pneumoperitoneum) is often secondary to perforated viscus. Emergent operative intervention is typically warranted in non-cancer patients. Cancer patients present a unique challenge as they have an increased risk of pneumoperitoneum due to local tumour invasion, radiation therapy, and frequent endoscopic procedures. There is a paucity of literature on the management of patients undergoing chemotherapy who present with pneumoperitoneum. The authors conducted a scoping review to identify and synthesize preliminary evidence on the presentation, management, and outcomes of this patient population. Materials and methods A scoping review of cases of pneumoperitoneum in cancer patients from 1990 to 2022 was conducted using the Arksey and O'Malley five-stage approach. Inclusion criteria were a known diagnosis of cancer, chemotherapy within 6 months of presentation, and imaging confirmation of pneumoperitoneum. The authors' exclusion criteria were cancer diagnosis at the time of presentation, perforation secondary to local cancer invasion, and last chemotherapy session greater than 6 months prior to presentation. Results Thirty-four cases (8 paediatric, 26 adults) were identified. The median time from the last chemotherapy treatment to presentation with pneumoperitoneum was 14 days. Twenty-one patients were managed operatively, and 13 were managed non-operatively. The most common source of perforation was multiple sites along the bowel. Thirty-day mortality was 33.3% for the operative cohort and 23.1% for the non-operative group. Conclusions Pneumoperitoneum in cancer patients remains a highly morbid condition with a mortality rate of approximately 30%, regardless of the treatment approach. Non-operative management should be pursued whenever possible.
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Affiliation(s)
| | | | | | - Constantine Asahngwa
- Division of Health Policy and Research, Nkafu Policy Institute, Yaoundé, Cameroon
| | | | - Nia N. Zalamea
- Department of Surgery
- General Surgery Research Group
- Global Surgery Institute, University of Tennessee Health Science Center, Memphis, TN
| | | | | | | | | | - Denis A. Foretia
- Department of Surgery
- General Surgery Research Group
- Global Surgery Institute, University of Tennessee Health Science Center, Memphis, TN
- Division of Health Policy and Research, Nkafu Policy Institute, Yaoundé, Cameroon
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3
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Mori T, Sato H, Okada F, Asayama Y. Spontaneous Pneumoperitoneum. Intern Med 2024:3527-24. [PMID: 38569900 DOI: 10.2169/internalmedicine.3527-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Affiliation(s)
- Takaaki Mori
- Department of Radiology, Oita Prefectural Hospital, Japan
| | - Haruka Sato
- Department of Radiology, Oita Prefectural Hospital, Japan
| | - Fumito Okada
- Department of Radiology, Oita Prefectural Hospital, Japan
| | - Yoshiki Asayama
- Department of Radiology, Oita University Faculty of Medicine, Japan
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4
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Chandramohan D, Konda R, Pujari A, Avula S, Palleti SK, Jena N, Naik R, Bali A. Acute kidney injury after robot-assisted laparoscopic prostatectomy: A meta-analysis. Int J Med Robot 2024; 20:e2630. [PMID: 38567745 DOI: 10.1002/rcs.2630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 03/20/2024] [Accepted: 03/25/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND We investigated the rates of acute kidney injury (AKI) post robot-assisted laparoscopic prostatectomy (RALP). METHODS A comprehensive search was conducted to identify studies that reported the rates of AKI post-RALP. A random effects model was used, and the pooled rates of AKI were calculated. RESULTS We identified 10 studies with 60,937 patients to be included. The mean age was 65.1 years. The mean anaesthesia time was 234.3 min (95% CI: 177.8-290.9). The mean operation time was 212.2 min (95% CI: 188.7-235.6). The mean estimated blood loss was 314.1 mL (95% CI: 153-475.3). The mean intraoperative IV fluids administered were 1985 mL (95% CI: 1516.3-2453.7). The pooled rate of AKI post RALP was 7.2% (95% CI 19-23.9). CONCLUSIONS The rates of AKI after RALP are significant. Further studies are needed to detect the risk factors for AKI and to determine the rates of chronic kidney disease post-RALP.
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Affiliation(s)
- Deepak Chandramohan
- Department of Internal Medicine/Nephrology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Raghunandan Konda
- Department of Internal Medicine/Nephrology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ashwini Pujari
- Department of Internal Medicine/Nephrology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sreekant Avula
- Department of Internal Medicine/Endocrinology, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Sujith Kumar Palleti
- Department of Internal Medicine/Nephrology, Louisiana State University, Shreveport, Louisiana, USA
| | - Nihar Jena
- Department of Internal Medicine/Cardiovascular Medicine, Trinity Health Oakland/Wayne State University, Pontiac, Michigan, USA
| | - Roopa Naik
- Department of Medicine, Geisinger Health, Wilkes-Barre, Pennsylvania, USA
| | - Atul Bali
- Department of Medicine, Geisinger Health, Wilkes-Barre, Pennsylvania, USA
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5
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Peták F, Südy R, Diaper J, Fontao F, Bizzotto D, Dellacà RL, Habre W, Schranc Á. Benefits of intratracheal and extrathoracic high-frequency percussive ventilation in a model of capnoperitoneum. J Appl Physiol (1985) 2024; 136:928-937. [PMID: 38420682 DOI: 10.1152/japplphysiol.00881.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/29/2024] [Accepted: 02/20/2024] [Indexed: 03/02/2024] Open
Abstract
Abdominal inflation with CO2 is used to facilitate laparoscopic surgeries, however, providing adequate mechanical ventilation in this scenario is of major importance during anesthesia management. We characterized high-frequency percussive ventilation (HFPV) in protecting from the gas exchange and respiratory mechanical impairments during capnoperitoneum. In addition, we aimed to assess the difference between conventional pressure-controlled mechanical ventilation (CMV) and HFPV modalities generating the high-frequency signal intratracheally (HFPVi) or extrathoracally (HFPVe). Anesthetized rabbits (n = 16) were mechanically ventilated by random sequences of CMV, HFPVi, and HFPVe. The ventilator superimposed the conventional waveform with two high-frequency signals (5 Hz and 10 Hz) during intratracheal HFPV (HFPVi) and HFPV with extrathoracic application of oscillatory signals through a sealed chest cuirass (HFPVe). Lung oxygenation index ([Formula: see text]/[Formula: see text]), arterial partial pressure of carbon dioxide ([Formula: see text]), intrapulmonary shunt (Qs/Qt), and respiratory mechanics were assessed before abdominal inflation, during capnoperitoneum, and after abdominal deflation. Compared with CMV, HFPVi with additional 5-Hz oscillations during capnoperitoneum resulted in higher [Formula: see text]/[Formula: see text], lower [Formula: see text], and decreased Qs/Qt. These improvements were smaller but remained significant during HFPVi with 10 Hz and HFPVe with either 5 or 10 Hz. The ventilation modes did not protect against capnoperitoneum-induced deteriorations in respiratory tissue mechanics. These findings suggest that high-frequency oscillations combined with conventional pressure-controlled ventilation improved lung oxygenation and CO2 removal in a model of capnoperitoneum. Compared with extrathoracic pressure oscillations, intratracheal generation of oscillatory pressure bursts appeared more effective. These findings may contribute to the optimization of mechanical ventilation during laparoscopic surgery.NEW & NOTEWORTHY The present study examines an alternative and innovative mechanical ventilation modality in improving oxygen delivery, CO2 clearance, and respiratory mechanical abnormalities in a clinically relevant experimental model of capnoperitoneum. Our data reveal that high-frequency oscillations combined with conventional ventilation improve gas exchange, with intratracheal oscillations being more effective than extrathoracic oscillations in this clinically relevant translational model.
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Affiliation(s)
- Ferenc Peták
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Roberta Südy
- Unit for Anesthesiological Investigations, Department of Acute Medicine, University of Geneva, Geneva, Switzerland
| | - John Diaper
- Unit for Anesthesiological Investigations, Department of Acute Medicine, University of Geneva, Geneva, Switzerland
| | - Fabienne Fontao
- Unit for Anesthesiological Investigations, Department of Acute Medicine, University of Geneva, Geneva, Switzerland
| | - Davide Bizzotto
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Raffaele L Dellacà
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Walid Habre
- Unit for Anesthesiological Investigations, Department of Acute Medicine, University of Geneva, Geneva, Switzerland
| | - Álmos Schranc
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
- Unit for Anesthesiological Investigations, Department of Acute Medicine, University of Geneva, Geneva, Switzerland
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Pecorella G, De Rosa F, Licchelli M, Panese G, Carugno JT, Morciano A, Tinelli A. Postoperative cognitive disorders and delirium in gynecologic surgery: Which surgery and anesthetic techniques to use to reduce the risk? Int J Gynaecol Obstet 2024. [PMID: 38557928 DOI: 10.1002/ijgo.15464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 02/13/2024] [Accepted: 02/25/2024] [Indexed: 04/04/2024]
Abstract
Despite their general good health, an increasing proportion of elderly individuals require surgery due to an increase in average lifespan. However, because of their increased vulnerability, these patients need to be handled carefully to make sure that surgery does not cause more harm than good. Age-related postoperative cognitive disorders (POCD) and postoperative delirium (POD), two serious consequences that are marked by adverse neuropsychologic alterations after surgery, are particularly dangerous for the elderly. In the context of gynecologic procedures, POCD and POD are examined in this narrative review. The main question is how to limit the rates of POCD and POD in older women undergoing gynecologic procedures by maximizing the risk-benefit balance. Three crucial endpoints are considered: (1) surgical procedures to lower the rates of POCD and POD, (2) anesthetic techniques to lessen the occurrence and (3) the identification of individuals at high risk for post-surgery cognitive impairments. Risks associated with laparoscopic gynecologic procedures include the Trendelenburg posture and CO2 exposure during pneumoperitoneum, despite statistical similarities in POD and POCD frequency between laparoscopic and laparotomy techniques. Numerous risk factors are associated with surgical interventions, such as blood loss, length of operation, and position holding, all of which reduce the chance of complications when they are minimized. In order to emphasize the essential role that anesthesia and surgery play in patient care, anesthesiologists are vital in making sure that anesthesia is given as sparingly and quickly as feasible. In addition, people who are genetically predisposed to POCD may be more susceptible to the disorder. The significance of a thorough strategy combining surgical and anesthetic concerns is highlighted in this article, in order to maximize results for senior patients having gynecologic surgery.
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Affiliation(s)
- Giovanni Pecorella
- Department of Gynecology, Obstetrics and Reproduction Medicine, Saarland University, Homburg, Germany
| | - Filippo De Rosa
- Department of Anesthesia and Intensive Care, and CERICSAL (CEntro di RIcerca Clinico SALentino), "Veris delli Ponti Hospital", Scorrano, Lecce, Italy
| | - Martina Licchelli
- Department of Obstetrics and Gynecology, and CERICSAL (CEntro di RIcerca Clinico SALentino), "Veris delli Ponti Hospital", Scorrano, Lecce, Italy
| | - Gaetano Panese
- Department of Obstetrics and Gynecology, and CERICSAL (CEntro di RIcerca Clinico SALentino), "Veris delli Ponti Hospital", Scorrano, Lecce, Italy
| | - Josè Tony Carugno
- Obstetrics and Gynecology Department, Minimally Invasive Gynecology Division, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Andrea Morciano
- Panico Pelvic Floor Center, Department of Gynecology and Obstetrics, Pia Fondazione "Card. G. Panico", Tricase, Lecce, Italy
| | - Andrea Tinelli
- Department of Obstetrics and Gynecology, and CERICSAL (CEntro di RIcerca Clinico SALentino), "Veris delli Ponti Hospital", Scorrano, Lecce, Italy
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7
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Giuffrida M, Biolchini F, Capelli P, Banchini F, Perrone G. Botulinum Toxin and Progressive Pneumoperitoneum in Loss of Domain Ventral Hernias: A Systematic Review. J Abdom Wall Surg 2024; 3:12650. [PMID: 38572390 PMCID: PMC10990139 DOI: 10.3389/jaws.2024.12650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 03/06/2024] [Indexed: 04/05/2024]
Abstract
Introduction: Preoperative progressive pneumoperitoneum (PPP) and botulinum toxin A (BTX) have been used together in the preoperative preparation of patients with loss of domain hernias. This study aims to evaluate the efficacy and safety of the combined use of PPP and BTX. Methods: A systematic electronic search was performed according to the PRISMA criteria. A literature search of scientific articles was conducted up to December 2023. Articles were chosen based on the reference to BTX and PPP in loss of domain ventral hernias with a defect width greater than 10 cm before surgery. The GRADE methodology and the modified Newcastle-Ottawa scale were used to assess the quality of the studies. Results: The research yielded seven articles, with 217 patients analysed in total. BTX was performed 29.5 ± 1.7 days before surgery and PPP was inflated 14.8 ± 5.8 days before surgery. PPP complications were reported in 25.6% of patients, The average reduction of the volume of hernia (VH)/volume of the abdominal cavity (VAC) ratio was 7.6% (range 0.9%-15%). Only 40 patients (18.4%) required a PCS or TAR to repair the loss of domain hernias. The SSI and SSO rates were 17.5% and 26.2%, respectively. No differences in SSI and SSO rates were found between the different repair techniques. The recurrence rate was 5.9% (13/217). Recurrence was significantly higher in patients who underwent IPOM repair than other techniques (p < 0.001). Conclusion: BTX and PPP may be useful tools for the management of loss of domain hernias presenting lower SSI and SSO. The combination of BTX and PPP reduces the use of more invasive repair techniques.
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Affiliation(s)
- Mario Giuffrida
- Department of General Surgery, Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | - Federico Biolchini
- General Surgery Unit, Department of Surgery, Azienda USL—IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Patrizio Capelli
- Department of General Surgery, Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | - Filippo Banchini
- Department of General Surgery, Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | - Gennaro Perrone
- Department of Emergency Surgery, Parma University Hospital, Parma, Italy
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8
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Patel V, Dabek RJ, Araim F, Patel S, Kang TJ. Delayed Pneumoperitoneum After Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement: A Case Report. Cureus 2024; 16:e57134. [PMID: 38681402 PMCID: PMC11055601 DOI: 10.7759/cureus.57134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2024] [Indexed: 05/01/2024] Open
Abstract
When used for a selected patient population, percutaneous endoscopic gastrostomy (PEG) can provide enteral nutrition percutaneous endoscopic gastrostomy (PEG) safely. PEG tubes generally possess a very low chance of life-threatening complications but due to the patient population that requires PEG tubes, a delayed diagnosis of minor complications could be fatal. In this study, we present a case of delayed pneumoperitoneum, discovered weeks after our patient underwent PEG placement for enteral nutritional needs. The patient recovered without the need for operative intervention. The development of a pneumoperitoneum in the setting of recent PEG needs a thorough clinical evaluation, and caution must be taken before immediately proceeding to operative exploration.
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Affiliation(s)
- Vaidehi Patel
- General Surgery, Ascension Saint Agnes Hospital, Baltimore, USA
| | - Robert J Dabek
- General Surgery, Ascension Saint Agnes Hospital, Baltimore, USA
| | - Fawaz Araim
- General Surgery, Ascension Saint Agnes Hospital, Baltimore, USA
| | - Shirali Patel
- General Surgery, Ascension Saint Agnes Hospital, Baltimore, USA
| | - Thomas J Kang
- General Surgery, Ascension Saint Agnes Hospital, Baltimore, USA
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9
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Ippolito A, Mulier J, Hahn M, Wenzel M, Mandel P, Flinspach AN, Wenger KJ. Moderate Intra-Abdominal Pressure Levels in Robot-Assisted Radical Prostatectomy Seem to Have No Negative Impact on Clinical Outcomes. J Clin Med 2024; 13:1202. [PMID: 38592056 PMCID: PMC10932126 DOI: 10.3390/jcm13051202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/27/2024] [Accepted: 02/06/2024] [Indexed: 04/10/2024] Open
Abstract
Introduction: Radical prostatectomy is increasingly performed laparoscopically with robot assistance (RALRP). RALRP, as with all laparoscopic procedures, requires a pneumoperitoneum, which might result in peritoneal inflammatory response reactions and postoperative pain. The aim of this retrospective single-centre study was to analyse the effects of a pneumoperitoneum during RARLP on clinical outcomes. Methods: All patients who underwent robot-guided prostatectomy in our clinic were included, with the exception of patients who were converted to open prostatectomy. C-reactive protein was used as a marker for the primary outcome, namely the postoperative inflammatory response. Intra-abdominal pressure (IAP) was evaluated as a potential factor influencing inflammation. In addition, the waist-hip ratio was used to estimate the amount of visceral adipose tissue, and the administration of dexamethasone was considered as a factor influencing inflammation. The Visual Analogue Scale (VAS) was used to determine postoperative pain. Patients were consecutively recruited between 1 September 2020 and 31 March 2022. Results: A total of 135 consecutive patients were included. The median waist-hip ratio was 0.55. The median duration of the pneumoperitoneum was 143 min. The median values of the average and maximum IAP values were 10 mmHg and 15 mmHg, respectively. The mean CRP of the first postoperative day was 6.2 mg/dL. The median VAS pain level decreased from 2 to 1 from the first to the third postoperative day. On the first postoperative day, 16 patients complained of shoulder pain. In addition, 134 patients were given some form of opioid pain treatment following surgery. Conclusion: We could not identify any relevant associations between the duration and IAP of the pneumoperitoneum and the indirect markers of inflammation or indicators of pain, or between the latter and the amount of visceral adipose tissue. In addition, we found no significant effect of the administration of dexamethasone on postoperative inflammation. The results point to a noninferior tolerability of moderate pressure during the procedure compared to the commonly utilised higher pressure, yet this must be confirmed in randomised controlled trials.
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Affiliation(s)
- Angelo Ippolito
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe-University Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt am Main, Germany
| | - Jan Mulier
- Department of Anaesthesiology, Intensive Care and Reanimation, AZ Sint Jan Brugge, 8000 Bruges, Belgium
- Department of Anesthesiology, KULeuven, 3000 Leuven, Belgium
- Department of Anesthesiology, UGhent, 9000 Ghent, Belgium
| | - Marta Hahn
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe-University Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt am Main, Germany
| | - Mike Wenzel
- Department of Urology, University Hospital Frankfurt, Goethe-University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Philipp Mandel
- Department of Urology, University Hospital Frankfurt, Goethe-University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Armin N. Flinspach
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe-University Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt am Main, Germany
| | - Katharina J. Wenger
- Institute of Neuroradiology, University Hospital Frankfurt, Goethe-University Frankfurt, 60528 Frankfurt am Main, Germany
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Mazzinari G, Rovira L, Albers-Warlé KI, Warlé MC, Argente-Navarro P, Flor B, Diaz-Cambronero O. Underneath Images and Robots, Looking Deeper into the Pneumoperitoneum: A Narrative Review. J Clin Med 2024; 13:1080. [PMID: 38398395 PMCID: PMC10889570 DOI: 10.3390/jcm13041080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/05/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024] Open
Abstract
Laparoscopy offers numerous advantages over open procedures, minimizing trauma, reducing pain, accelerating recovery, and shortening hospital stays. Despite other technical advancements, pneumoperitoneum insufflation has received little attention, barely evolving since its inception. We explore the impact of pneumoperitoneum on patient outcomes and advocate for a minimally invasive approach that prioritizes peritoneal homeostasis. The nonlinear relationship between intra-abdominal pressure (IAP) and intra-abdominal volume (IAV) is discussed, emphasizing IAP titration to balance physiological effects and surgical workspace. Maintaining IAP below 10 mmHg is generally recommended, but factors such as patient positioning and surgical complexity must be considered. The depth of neuromuscular blockade (NMB) is explored as another variable affecting laparoscopic conditions. While deep NMB appears favorable for surgical stillness, achieving a balance between IAP and NMB depth is crucial. Temperature and humidity management during pneumoperitoneum are crucial for patient safety and optical field quality. Despite the debate over the significance of temperature drop, humidification and the warming of insufflated gas offer benefits in peritoneal homeostasis and visual clarity. In conclusion, there is potential for a paradigm shift in pneumoperitoneum management, with dynamic IAP adjustments and careful control of insufflated gas temperature and humidity to preserve peritoneal homeostasis and improve patient outcomes in minimally invasive surgery.
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Affiliation(s)
- Guido Mazzinari
- Perioperative Medicine Research Group, Health Research Institute la Fe, Avenida Fernando Abril Martorell 106, 46026 Valencia, Spain; (P.A.-N.); (O.D.-C.)
- Department of Anesthesiology, La Fe University Hospital, Avenida Fernando Abril Martorell 106, 46026 Valencia, Spain
- Department of Statistics and Operational Research, University of Valencia, Calle Doctor Moliner 50, 46100 Burjassot, Spain
| | - Lucas Rovira
- Department of Anesthesiology, Consorcio Hospital General Universitario de Valencia, Av. de les Tres Creus, 2, L’Olivereta, 46014 València, Spain; (L.R.); (B.F.)
| | - Kim I. Albers-Warlé
- Department of Colorectal Surgery, La Fe University Hospital, Avenida Fernando Abril Martorell 106, 46026 Valencia, Spain;
- Department of Anesthesiology, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Michiel C. Warlé
- Departments of Surgery, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands;
| | - Pilar Argente-Navarro
- Perioperative Medicine Research Group, Health Research Institute la Fe, Avenida Fernando Abril Martorell 106, 46026 Valencia, Spain; (P.A.-N.); (O.D.-C.)
| | - Blas Flor
- Department of Anesthesiology, Consorcio Hospital General Universitario de Valencia, Av. de les Tres Creus, 2, L’Olivereta, 46014 València, Spain; (L.R.); (B.F.)
| | - Oscar Diaz-Cambronero
- Perioperative Medicine Research Group, Health Research Institute la Fe, Avenida Fernando Abril Martorell 106, 46026 Valencia, Spain; (P.A.-N.); (O.D.-C.)
- Department of Anesthesiology, La Fe University Hospital, Avenida Fernando Abril Martorell 106, 46026 Valencia, Spain
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11
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Takahashi K, Ohyama H, Ohno I, Takiguchi Y, Kato N. Asymptomatic Pneumoperitoneum With a Large Amount of Gas Appeared During Endoscopic Ultrasound-Guided Biliary Drainage. Cureus 2024; 16:e54330. [PMID: 38500944 PMCID: PMC10944802 DOI: 10.7759/cureus.54330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 03/20/2024] Open
Abstract
We report a case in which a large amount of intraperitoneal free gas developed during endoscopic ultrasound-guided biliary drainage with the rendezvous technique. A 62-year-old woman presented with obstructive jaundice caused by a pancreatic head tumor. Endoscopic retrograde cholangiopancreatography was attempted but failed due to difficulty cannulating the bile duct. Consequently, endoscopic ultrasound-guided hepaticogastrostomy was performed using a fully covered metal stent. Subsequently, the rendezvous technique was employed to access the biliary system and perform an endoscopic sphincterotomy. Finally, a fully covered metal stent was placed transpapillary. Fluoroscopic imaging during the procedure revealed a large amount of gas between the liver and diaphragm. Despite the pneumoperitoneum, the patient experienced no abdominal pain or fever. One week later, a computed tomography scan confirmed the disappearance of free air in the intraperitoneal cavity. The patient's subsequent clinical course remained uneventful, and she was discharged from the hospital. This case highlights the potential for pneumoperitoneum to develop during endoscopic ultrasound-guided biliary drainage, particularly when using the rendezvous technique. It is crucial to differentiate this finding from gastrointestinal perforation based on clinical presentation and imaging features.
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Affiliation(s)
- Koji Takahashi
- Department of Gastroenterology, Chiba University, Chiba, JPN
| | - Hiroshi Ohyama
- Department of Gastroenterology, Chiba University, Chiba, JPN
| | - Izumi Ohno
- Department of Gastroenterology, Chiba University, Chiba, JPN
| | | | - Naoya Kato
- Department of Gastroenterology, Chiba University, Chiba, JPN
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12
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Kumar S, Dubey IB, Aggarwal VC, Soni RK. Evaluation of Open (Hasson's) and Closed (Veress) Technique of Intraperitoneal Access for Creation of Pneumoperitoneum in Laparoscopic Surgery. Cureus 2024; 16:e54770. [PMID: 38524074 PMCID: PMC10961137 DOI: 10.7759/cureus.54770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 03/26/2024] Open
Abstract
Background The creation of pneumoperitoneum is the first step in any laparoscopic surgery. There are various methods of creating pneumoperitoneum which can be divided into open or closed methods. The closed method involves the blind insertion of the Veress needle into the peritoneal cavity. The open technique involves making an incision and then dissecting the fascia to the peritoneal cavity to introduce the cannula under direct vision. This study was conducted to evaluate the safety and efficacy of open (Hasson's) and closed (Veress) techniques of intraperitoneal access for the creation of pneumoperitoneum in laparoscopic surgery. Material and methods The study was conducted in the Department of General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi. This was a prospective observational study and a total of 100 patients of laparoscopic surgeries fulfilling inclusion criteria were included in the study - 50 patients in group A undergoing the open method of creating pneumoperitoneum and 50 patients in group B undergoing the closed method of creating pneumoperitoneum were evaluated for the study period of 18 months from October 2020 through June 2022. Results The mean time to create pneumoperitoneum was 5.3 ± 1.41 minutes in the open method and 6.21 ± 1.36 minutes in the closed method. The mean time for umbilical port closure in our study was 7.33 ± 1.66 in the open group and 8.86 ± 2.19 in the closed group. In our study, there was no vascular or visceral injury noted in either of the methods used for the creation of pneumoperitoneum. Post-operative complications were almost equal in both the groups. Conclusions Both open and closed methods of intraperitoneal access are safe and effective for the creation of pneumoperitoneum during abdominal laparoscopy. The open method of creating pneumoperitoneum in laparoscopic surgery is a quicker method for the creation of pneumoperitoneum as compared to the closed method of intraperitoneal access.
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Affiliation(s)
- Saakshie Kumar
- Department of General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Indu B Dubey
- Department of General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Vridhi Chand Aggarwal
- Department of General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Rajesh K Soni
- Department of General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
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Bedard M, McInnis M, Banton K. Spontaneous pneumoperitoneum presenting as an acute abdomen. J Surg Case Rep 2024; 2024:rjae049. [PMID: 38370600 PMCID: PMC10873165 DOI: 10.1093/jscr/rjae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 01/19/2023] [Indexed: 02/20/2024] Open
Abstract
Most cases of pneumoperitoneum with associated peritonitis are due to perforation of a hollow viscus. In cases where hollow viscus perforation is not the cause, the pneumoperitoneum is classified as spontaneous and typically can be further subcategorized into thoracic, abdominal, gynecologic, and idiopathic categories. Spontaneous pneumoperitoneum is classically seen in asymptomatic patients, however in a small number of cases patients can present with a concomitant peritonitis. This case report presents a patient that had signs of sepsis and peritonitis with moderate pneumoperitoneum on computed tomography (CT) imaging but was found to have no perforated hollow viscus after an extensive operative and non-operative work up.
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Affiliation(s)
- Megan Bedard
- Trauma/Acute Care Surgery, Swedish Medical Center, Englewood, CO 80113, United States
| | - Madison McInnis
- Trauma/Acute Care Surgery, Swedish Medical Center, Englewood, CO 80113, United States
| | - Kaysie Banton
- Trauma/Acute Care Surgery, Swedish Medical Center, Englewood, CO 80113, United States
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14
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Mohd Hanapiah F, Ismail ZKA, Puteh O, Aziz ME. Computed Tomography Findings in a Case of Uterine Rupture as a Complication of Pyometra. Cureus 2024; 16:e53154. [PMID: 38420051 PMCID: PMC10901036 DOI: 10.7759/cureus.53154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2024] [Indexed: 03/02/2024] Open
Abstract
Uterine rupture in the setting of pyometra is a rare occasion, with an incidence of less than 0.5%. The clinical manifestation of a perforated pyometra is non-specific; therefore, it can mimic many other causes of acute abdomen, such as perforated viscus, acute appendicitis, or diverticulitis, which poses unique challenges to diagnosis solely based on clinical information. We reviewed a case of an elderly postmenopausal lady who presented with a sudden onset of generalized abdominal pain, preceded by fever and vomiting. Physical examination revealed a distended abdomen with clinical signs of peritonism. She was initially diagnosed with possible obstructed gastrointestinal carcinoma by clinical examination, with the differential diagnosis of diverticular abscess. Eventually, further abdominal and pelvic contrast-enhanced computed tomography (CECT) study revealed a pyometra with uterine rupture, complicated with pneumoretroperitoneum and pneumoperitoneum. This case emphasizes the value of a CT scan in establishing an accurate diagnosis and early detection of life-threatening complications, such as uterine rupture, as in this case.
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Affiliation(s)
| | | | - Othman Puteh
- Radiology, Universiti Sains Malaysia School of Medical Sciences, Kubang Kerian, MYS
| | - Mohd Ezane Aziz
- Radiology, Universiti Sains Malaysia School of Medical Sciences, Kubang Kerian, MYS
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15
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Chien AL, Doppalapudi SK, Pfail JL, Lee G, Mikhail M, Ahuja B, Tito ET, Shah U, Barone J, Ahmed H, Elsamra S. Comparison of a Valveless Trocar System and Conventional Insufflation in Pediatric Urologic Surgery. J Endourol 2024; 38:47-52. [PMID: 37819689 DOI: 10.1089/end.2023.0181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Abstract
Background: Conventional operative insufflation uses a one-way trocar to handle instruments while maintaining pneumoperitoneum. In 2007, the AirSeal® valveless trocar insufflation system was introduced, which maintains stable pneumoperitoneum while continuously evacuating smoke. Although this device has been validated in adult patients, it has not been extensively validated in the pediatric population. Materials and Methods: A retrospective cohort study of pediatric urology patients aged 0 to 21 who underwent laparoscopic pyeloplasty between March 2016 and October 2021 was performed. Intraoperative physiologic parameters, procedure characteristics, postoperative outcomes, and demographics of each patient in whom either AirSeal insufflation system (AIS) or conventional insufflation system (CIS) was utilized were obtained from hospital records. Data were compared across the AIS and CIS cohorts. The primary outcomes were intraoperative anesthetic and physiologic parameters, including end tidal carbon dioxide, oxygen saturation, body temperature, positive inspiratory pressure, systolic blood pressure, and heart rate. Results: There were no significant differences in the anesthetic and physiologic parameters in the AIS and CIS groups. In addition, no differences in demographics, procedural characteristics, or complication rates were found between the cohorts. Conclusion: The AirSeal valveless trocar insufflation system demonstrates comparable intraoperative anesthetic and physiologic outcomes compared to conventional one-way valve insufflation in pediatric laparoscopic pyeloplasty. Certain surgeon-related qualitative metrics are underappreciated in this study, however, including improved visualization with vigorous suctioning and pressure maintenance with frequent instrument exchanges. Surgeon experience may mask the benefits of these characteristics as it pertains to quantitative surgical outcomes such as estimated blood loss, operative time, and perioperative complications.
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Affiliation(s)
- Austin L Chien
- Division of Urology, Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Sai Krishnaraya Doppalapudi
- Division of Urology, Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - John L Pfail
- Division of Urology, Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Grace Lee
- Division of Urology, Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Mark Mikhail
- Division of Urology, Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Brittany Ahuja
- Department of Anesthesiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Emmanuel Tadjou Tito
- Department of Anesthesiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Usman Shah
- Department of Anesthesiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Joseph Barone
- Bristol-Myers Squibb Children's Hospital at Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Haris Ahmed
- Bristol-Myers Squibb Children's Hospital at Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Sammy Elsamra
- Division of Urology, Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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16
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Vuong RQ, Liechty ST, Nicoara MD. Emphysematous changes in pneumoperitoneum and tension pneumothorax following robot-assisted bronchoscopy: a case report. J Surg Case Rep 2024; 2024:rjad732. [PMID: 38250129 PMCID: PMC10799245 DOI: 10.1093/jscr/rjad732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Pneumoperitoneum is most commonly caused by perforation of a hollow viscus but can also result as an extension of pneumothorax and/or pneumomediastinum. We present a case of pneumoperitoneum preceded by intraprocedural hemoptysis and tension pneumothorax that developed during transbronchial needle aspiration using robot-assisted flexible bronchoscopy. After stabilization and management of the pneumothorax, diagnostic laparoscopy was performed and revealed no evidence of diaphragmatic or intra-abdominal perforation but showed diffuse emphysematous changes in the gastrohepatic ligament, small and large bowel mesentery, and preperitoneal space. These findings suggest the implication of subserosal and preperitoneal emphysema as the pathophysiological mechanism of pneumoperitoneum and pneumothorax complicating bronchoscopy procedures.
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Affiliation(s)
- Richard Q Vuong
- Undergraduate Medical Education, Larner College of Medicine at the University of Vermont, Burlington, VT 05405, United States
| | - Shawn T Liechty
- Department of General Surgery, Danbury Hospital, Danbury, CT 06810, United States
| | - Michael D Nicoara
- Department of General Surgery, Danbury Hospital, Danbury, CT 06810, United States
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17
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Awe AM, Burke LM, Long M, Natarajan B, Overby DW, Campbell S. Idiopathic Spontaneous Pneumoperitoneum and Call for a Multi-Institutional Database. ACG Case Rep J 2023; 10:e01208. [PMID: 38025844 PMCID: PMC10651345 DOI: 10.14309/crj.0000000000001208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Idiopathic spontaneous pneumoperitoneum (ISP) refers to intraperitoneal air of unknown origin when other more common etiologies such as traumatic, intrathoracic, and gynecologic etiologies have been excluded. We present a case of a 42-year-old woman with insignificant history presenting with ISP who underwent exploratory laparoscopy and thorough diagnostic workup that was ultimately unrevealing. This case report adds to the existing literature of ISP, and the authors recommend initiating a multi-institutional database to improve our understanding of ISP and contribute to developing consensus guidelines for presumed ISP.
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Affiliation(s)
- Adam M. Awe
- Department of Surgery, University of North Carolina, Chapel Hill, NC
| | - Lauren M.B. Burke
- Department of Radiology, University of North Carolina, Chapel Hill, NC
| | - Millie Long
- Division of Gastroenterology, Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - Brahma Natarajan
- Division of Gastroenterology, Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - David W. Overby
- Department of Surgery, University of North Carolina, Chapel Hill, NC
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18
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Kim YJ, Kim BR, Kim HW, Jung JY, Cho HY, Seo JH, Kim WH, Kim HS, Hwangbo S, Yoon HK. Effect of driving pressure-guided positive end-expiratory pressure on postoperative pulmonary complications in patients undergoing laparoscopic or robotic surgery: a randomised controlled trial. Br J Anaesth 2023; 131:955-965. [PMID: 37679285 DOI: 10.1016/j.bja.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Individualised positive end-expiratory pressure (PEEP) improves respiratory mechanics. However, whether PEEP reduces postoperative pulmonary complications (PPCs) remains unclear. We investigated whether driving pressure-guided PEEP reduces PPCs after laparoscopic/robotic abdominal surgery. METHODS This single-centre, randomised controlled trial enrolled patients at risk for PPCs undergoing laparoscopic or robotic lower abdominal surgery. The individualised group received driving pressure-guided PEEP, whereas the comparator group received 5 cm H2O fixed PEEP during surgery. Both groups received a tidal volume of 8 ml kg-1 ideal body weight. The primary outcome analysed per protocol was a composite of pulmonary complications (defined by pre-specified clinical and radiological criteria) within 7 postoperative days after surgery. RESULTS Some 384 patients (median age: 67 yr [inter-quartile range: 61-73]; 66 [18%] female) were randomised. Mean (standard deviation) PEEP in patients randomised to individualised PEEP (n=178) was 13.6 cm H2O (2.1). Individualised PEEP resulted in lower mean driving pressures (14.7 cm H2O [2.6]), compared with 185 patients randomised to standard PEEP (18.4 cm H2O [3.2]; mean difference: -3.7 cm H2O [95% confidence interval (CI): -4.3 to -3.1 cm H2O]; P<0.001). There was no difference in the incidence of pulmonary complications between individualised (25/178 [14.0%]) vs standard PEEP (36/185 [19.5%]; risk ratio [95% CI], 0.72 [0.45-1.15]; P=0.215). Pulmonary complications as a result of desaturation were less frequent in patients randomised to individualised PEEP (8/178 [4.5%], compared with standard PEEP (30/185 [16.2%], risk ratio [95% CI], 0.28 [0.13-0.59]; P=0.001). CONCLUSIONS Driving pressure-guided PEEP did not decrease the incidence of pulmonary complications within 7 days of laparoscopic or robotic lower abdominal surgery, although uncertainty remains given the lower than anticipated event rate for the primary outcome. CLINICAL TRIAL REGISTRATION KCT0004888 (http://cris.nih.go.kr, registration date: April 6, 2020).
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Affiliation(s)
- Yoon Jung Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Bo Rim Kim
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Hee Won Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ji-Yoon Jung
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hye-Yeon Cho
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jeoung-Hwa Seo
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Won Ho Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hee-Soo Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Suhyun Hwangbo
- Department of Genomic Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyun-Kyu Yoon
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
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19
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Vandana P, Ananya N, Muralikrishna D, Ponduru S, Renganathan V, Gopinath R. Analgesic efficacy of intra-peritoneal instillation of dexamethasone and bupivacaine versus bupivacaine following laparoscopic cholecystectomy - A randomised, double-blind controlled study. Indian J Anaesth 2023; 67:999-1003. [PMID: 38213679 PMCID: PMC10779981 DOI: 10.4103/ija.ija_275_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 01/13/2024] Open
Abstract
Background and Aims Laparoscopy is associated with acute pain. We compared the effectiveness of intra-peritoneal dexamethasone with bupivacaine versus bupivacaine in patients undergoing laparoscopic cholecystectomy for postoperative analgesia. Methods This randomised study was conducted after approval from the institutional ethics committee and 84 patients were randomly allocated into bupivacaine with dexamethasone group (BD) (received 40 mL of 0.25% bupivacaine with 16 mg dexamethasone), and bupivacaine group (BB) (received 40 mL of 0.25% bupivacaine intra-peritoneally). Data analysis was done using R version 4.2.1. The visual analogue scale (VAS) score, total rescue analgesic dose, and time required for the first analgesic between groups were compared using the Wilcoxon rank sum test or t-test appropriately. Results VAS score was significantly lower in the BD group compared to the BB group until 2 h post-operatively with a mean difference of - 1.0 (95% confidence interval [CI] -1.5, -0.53), P < 0.001. The total rescue analgesic dose consumed was lower in the BD group (60.71 mg [29.80]) compared to the BB group (73.20 mg [11.57]) with a mean difference of - 12.5 mg (95% CI - 22.3, -2.68), P = 0.013. In addition, the time taken for the requirement of the first rescue analgesic was significantly longer in the BD group (417.1 min [276.0]) compared to the BB group (219.4 min [226.1]) with a mean difference of 197.7 (95% CI 75, 320), P = 0.002. Conclusion Intra-peritoneal instillation of 16 mg dexamethasone with 0.25% bupivacaine in laparoscopic cholecystectomy significantly reduces post-operative pain and requirement of rescue analgesic compared to 0.25% bupivacaine alone.
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Affiliation(s)
- Pakhare Vandana
- Department of Anaesthesia, ESIC Medical College and Hospital, Hyderabad, Telangana, India
| | - Nanda Ananya
- Department of Anaesthesia, ESIC Medical College and Hospital, Hyderabad, Telangana, India
| | - D Muralikrishna
- Department of Anaesthesia, ESIC Medical College and Hospital, Hyderabad, Telangana, India
| | - Supraja Ponduru
- Department of Anaesthesia, ESIC Medical College and Hospital, Hyderabad, Telangana, India
| | - Vyshnavi Renganathan
- Department of Anaesthesia, ESIC Medical College and Hospital, Hyderabad, Telangana, India
| | - Ramchandran Gopinath
- Department of Anaesthesia, ESIC Medical College and Hospital, Hyderabad, Telangana, India
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20
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Yazicioglu MB, Eraldemir FC, Gunes A, Turgut HT, Ciftci A. What is the ideal preconditioning time to reduce laparoscopic-induced oxidative stress? J Minim Access Surg 2023; 19:529-534. [PMID: 37843161 PMCID: PMC10695311 DOI: 10.4103/jmas.jmas_345_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 05/06/2023] [Accepted: 07/03/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction Ischaemic preconditioning is the most effective method for the prevention of ischaemic-reperfusion injury; however, no study has examined the question of the ideal time for ischaemic preconditioning. Patients and Methods The patients were divided into five groups, each group including of 20 patients. The precondition was applied as 1, 5, 10 and 15 min in Groups I, II, III and IV and Group V was the control group. Repeated blood samples were taken to measure the total antioxidant status (TAS), total oxidant status and oxidative stress index (OSI) values, just before insufflation, at the end of the operation and at 6 and 24 h of the post-operative period. Results A significant difference was observed between the TAS values at the end of the operation and at the sixth post-operative time of the four groups (P = 0.001, 0.000, 0.001, 0.019 and 0.033, respectively). Furthermore, a significant difference was observed between TAS values at the post-operative 24th h of Group III and Group V, and also a significant difference was observed between the OSI values at the post-operative 6th h of Groups III and V. Conclusion The low OSI and TAS values may interpret as a low degree of oxidative damage. The OSI values at the post-operative 6 h of Groups I and II were lower than those of other groups. We accept this result as low oxidative damage.
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Affiliation(s)
- Murat Burc Yazicioglu
- Department of General Surgery, Kocaeli Derince Training and Research Hospital, University of Health Science, Kocaeli, Turkey
| | - Fatma Ceyla Eraldemir
- Department of Biochemistry, School of Medicine, University of Kocaeli, Kocaeli, Turkey
| | - Abdullah Gunes
- Department of General Surgery, Kocaeli Derince Training and Research Hospital, University of Health Science, Kocaeli, Turkey
| | - Hamdi Taner Turgut
- Department of General Surgery, Kocaeli Derince Training and Research Hospital, University of Health Science, Kocaeli, Turkey
| | - Ali Ciftci
- Department of General Surgery, Kocaeli Derince Training and Research Hospital, University of Health Science, Kocaeli, Turkey
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Gautam N, Harjai M, Sharma P, Rai S, Tripathi M, Malviya D, Singh AK. Anaesthetic Management and Physiologic Effects of Pneumoperitoneum in Patients With Chronic Obstructive Pulmonary Disease Undergoing Laparoscopic Cholecystectomy. Cureus 2023; 15:e46458. [PMID: 37927662 PMCID: PMC10623486 DOI: 10.7759/cureus.46458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 11/07/2023] Open
Abstract
OBJECTIVE This study aimed to assess the physiological changes and clinical outcomes in patients with chronic obstructive pulmonary disease (COPD) undergoing laparoscopic cholecystectomy. METHODS This prospective cohort study included 50 patients of the American Society of Anesthesiology (ASA) physical status I and II with mild to moderate COPD (Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage I-II) scheduled for laparoscopic cholecystectomy. We monitored heart rate, mean arterial pressure, end-tidal carbon dioxide (EtCO2), arterial carbon dioxide (PaCO2), and bicarbonate (HCO3) levels at baseline, 30 minutes after induction or 15 minutes post-insufflation, 15 minutes post-deflation, and 60 minutes post-operative. Perioperative complications and post-operative recovery characteristics were also observed. Descriptive statistics were used to summarise the demographic and clinical characteristics of the patients. The correlation between HCO3 and EtCO2 was plotted on a scatterplot, and Pearson's correlation 'r' was calculated. The changes in physiological parameters over time were analysed using a paired t-test. A p-value of less than 0.05 is considered statistically significant. RESULTS We observed a statistically significant but transient increase in heart rate, mean arterial pressure, and EtCO2 at 30 minutes after induction or 15 minutes post-insufflation, which returned to baseline levels within 15 minutes of deflation. Similarly, arterial CO2 and bicarbonate levels were also significantly increased at 15 minutes post-insufflation, yet remained within the normal physiological range. The study reported no serious perioperative complications, and all patients had an uneventful recovery. CONCLUSION While patients with mild to moderate COPD can experience transient physiological changes during laparoscopic cholecystectomy, these changes are generally well-tolerated and not associated with adverse clinical outcomes. Therefore, laparoscopic cholecystectomy can be considered a safe procedure in these patients. Future research should focus on the implications and safety of this procedure in patients with severe COPD.
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Affiliation(s)
- Neeraj Gautam
- Critical Care, Sir Ganga Ram Hospital, New Delhi, IND
| | - Mamta Harjai
- Anesthesiology and Critical Care, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND
| | - Parul Sharma
- Anesthesiology and Critical Care, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND
| | - Sujeet Rai
- Anesthesiology and Critical Care, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND
| | - Manoj Tripathi
- Anesthesiology and Critical Care, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND
| | - Deepak Malviya
- Anesthesiology and Critical Care, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND
| | - Arvind Kumar Singh
- Community Medicine, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND
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22
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Chiumello D, Coppola S, Fratti I, Leone M, Pastene B. Ventilation strategy during urological and gynaecological robotic-assisted surgery: a narrative review. Br J Anaesth 2023; 131:764-774. [PMID: 37541952 DOI: 10.1016/j.bja.2023.06.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/11/2023] [Accepted: 06/14/2023] [Indexed: 08/06/2023] Open
Abstract
Robotic-assisted surgery has improved the precision and accuracy of surgical movements with subsequent improved outcomes. However, it requires steep Trendelenburg positioning combined with pneumoperitoneum that negatively affects respiratory mechanics and increases the risk of postoperative respiratory complications. This narrative review summarises the state of the art in ventilatory management of these patients in terms of levels of positive end-expiratory pressure (PEEP), tidal volume, recruitment manoeuvres, and ventilation modes during both urological and gynaecological robotic-assisted surgery. A review of the literature was conducted using PubMed/MEDLINE; after completing abstract and full-text review, 31 articles were included. Although different levels of PEEP were often evaluated within a protective ventilation strategy, including higher levels of PEEP, lower tidal volume, and recruitment manoeuvres vs a conventional ventilation strategy, we conclude that the best PEEP in terms of lung mechanics, gas exchange, and ventilation distribution has not been defined, but moderate PEEP levels (4-8 cm H2O) could be associated with better outcomes than lower or highest levels. Recruitment manoeuvres improved intraoperative arterial oxygenation, end-expiratory lung volume and the distribution of ventilation to dependent (dorsal) lung regions. Pressure-controlled compared with volume-controlled ventilation showed lower peak airway pressures with both higher compliance and higher carbon dioxide clearance. We propose directions to optimise ventilatory management during robotic surgery in light of the current evidence.
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Affiliation(s)
- Davide Chiumello
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy; Department of Health Sciences, University of Milan, Milan, Italy; Coordinated Research Center on Respiratory Failure, University of Milan, Milan, Italy.
| | - Silvia Coppola
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy; Department of Health Sciences, University of Milan, Milan, Italy; Coordinated Research Center on Respiratory Failure, University of Milan, Milan, Italy
| | - Isabella Fratti
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Marc Leone
- Department of Anesthesia and Intensive Care, Aix Marseille University, Assistance Publique Hôpitaux Universitaires de Marseille, Marseille, France; Centre for Nutrition and Cardiovascular Disease (C2VN), INSERM, INRAE, Aix Marseille University, Marseille, France
| | - Bruno Pastene
- Department of Anesthesia and Intensive Care, Aix Marseille University, Assistance Publique Hôpitaux Universitaires de Marseille, Marseille, France; Centre for Nutrition and Cardiovascular Disease (C2VN), INSERM, INRAE, Aix Marseille University, Marseille, France
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23
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Cairl NS, Sharp VL. Pneumoperitoneum Secondary to Necrotic Intra-abdominal Lymph Node. Cureus 2023; 15:e47871. [PMID: 38022375 PMCID: PMC10681116 DOI: 10.7759/cureus.47871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2023] [Indexed: 12/01/2023] Open
Abstract
Pneumoperitoneum is often treated as a surgical emergency as the most common etiology is perforated hollow viscus. Here, we present the case of a man in his 70s who presented to the emergency department with fever and abdominal pain. On physical exam, he was diffusely tender in the bilateral lower quadrants with guarding. Imaging demonstrated moderate volume pneumoperitoneum. On review of his imaging, the pneumoperitoneum was centered around a 7 cm necrotic lymph node. Repeat CT scan with positive oral (PO) and rectal contrast demonstrated no extraluminal contrast extravasation, but air bubbles were seen extending from the necrotic lymph node into the lower abdominal cavity. He underwent CT-guided drain placement and was started on antibiotics, and improved without surgical intervention. In stable patients presenting with pneumoperitoneum and known intra-abdominal lymphadenopathy, perforated viscus should be ruled out prior to surgical intervention, and necrotic intra-abdominal lymph node should be considered as a differential diagnosis.
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Affiliation(s)
- Nicholas S Cairl
- General Surgery, Trinity Health Ann Arbor Hospital, Ann Arbor, USA
| | - Victoria L Sharp
- Trauma, Acute, and Critical Care Surgery, Trinity Health Ann Arbor Hospital, Ann Arbor, USA
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24
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Jain N, Hernandez E, Wu A. Insufflation via a peritoneal dialysis catheter is a safe way to achieve pneumoperitoneum: a case report. J Surg Case Rep 2023; 2023:rjad599. [PMID: 37942341 PMCID: PMC10629866 DOI: 10.1093/jscr/rjad599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 10/10/2023] [Indexed: 11/10/2023] Open
Abstract
A 66-year-old female with a preoperative high index hostile abdomen was incidentally found to have a right T1a 16 mm renal cell carcinoma mass. She safely underwent robot assisted partial nephrectomy after her peritoneal dialysis catheter was alternatively used for insufflation. This adjustment in technique reduced risk related morbidity and possible conversion to open laparotomy.
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Affiliation(s)
- Neil Jain
- Department of Urology, Texas Tech University Health Sciences Center, Lubbock, TX, United States
| | - Evan Hernandez
- Department of Urology, Texas Tech University Health Sciences Center, Lubbock, TX, United States
| | - Amy Wu
- Department of Urology, Texas Tech University Health Sciences Center, Lubbock, TX, United States
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25
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Maina RM, Rader CA, Kypa J, Jasmin HM, Asahngwa C, Muenyi CS, Foretia DA. Management and outcomes of chemotherapy-associated pneumoperitoneum in cancer patients: a scoping review protocol. Int J Surg Protoc 2023; 27:16-19. [PMID: 38045559 PMCID: PMC10688533 DOI: 10.1097/sp9.0000000000000007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 05/01/2023] [Indexed: 12/05/2023] Open
Abstract
Introduction Pneumoperitoneum - free air within the peritoneal cavity - is often the result of bowel perforation, though other causes include residual postprocedural or postoperative air and barotrauma. In non-cancer patients, operative intervention is often required. Cancer patients, on the other hand, present a unique set of challenges as they usually have elevated risk of pneumoperitoneum from local radiation therapy, frequent endoscopic procedures, and tumor invasion. Factors such as malnutrition, neutropenia, chemotherapy, and steroid use make emergent surgery tenuous in cancer patients. There is a paucity of published literature on the management of pneumoperitoneum in patients actively undergoing chemotherapy. The main objective of this scoping review is to assess the presentation, management, and subsequent outcomes of this unique patient population. Materials and Methods The authors will utilize the framework for performing scoping reviews as outlined by Arksey and O'Malley. They will perform the search for articles in three electronic databases (i.e. SCOPUS, PubMed, Embase) and relevant gray literature. Only articles available in English and published between 1999 and 2022 will be included. Inclusion criteria will be a known diagnosis of cancer, chemotherapy within 6 months of presentation, and imaging confirmation of pneumoperitoneum. Exclusion criteria will be cancer diagnosis at the time of presentation, perforation secondary to cancer itself, and chemotherapy greater than 6 months prior to presentation. A tailored extraction frame to extract relevant information from published articles that meet our inclusion criteria. The data using both descriptive statistics and thematic analysis of the main study questions. Ethics and Dissemination Since the authors will not be collecting primary data, formal ethical approval is not required. They study findings will be disseminated through abstracts, conference presentations, and peer-reviewed publications.
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Affiliation(s)
| | | | | | | | - Constantine Asahngwa
- Division of Health Policy and Research, Nkafu Policy Institute, Yaoundé, Cameroon
| | | | - Denis A. Foretia
- Department of Surgery
- Center for Multicultural and Global Health
- Global Surgery Institute, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Division of Health Policy and Research, Nkafu Policy Institute, Yaoundé, Cameroon
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26
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Rajekar H. Pneumoperitoneum Due to Ruptured Gas Forming Candida Liver Abscess. J Clin Exp Hepatol 2023; 13:921-922. [PMID: 37693273 PMCID: PMC10482987 DOI: 10.1016/j.jceh.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/17/2023] [Accepted: 03/03/2023] [Indexed: 09/12/2023] Open
Affiliation(s)
- Harshal Rajekar
- Manipal Hospital, Kharadi, Pune, India
- Inamdar Hospital, Wanowrie, Pune, India
- Rao Nursing Home, Bibwewadi, Pune, India
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27
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Al Shamousi K, Kashoob MS, Lal J, Al-Busafi SA. Pneumoperitoneum After Jejunostomy Tube Placement Managed by Needle Decompression: A Case Report. Cureus 2023; 15:e44027. [PMID: 37753043 PMCID: PMC10519442 DOI: 10.7759/cureus.44027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 09/28/2023] Open
Abstract
Percutaneous endoscopic feeding tube placement is a commonly performed procedure in patients who cannot take food by mouth. While it is considered a safe and effective method of providing nutritional support, like any medical procedure, it can lead to complications. Feeding tube placement, including percutaneous endoscopic jejunostomy (PEJ), is associated with several complications, including bleeding, site infection, aspiration, buried bumper, tube dislodgement, and pneumoperitoneum. We report a case of a 20-year-old male with multiple medical issues who underwent a PEJ that was complicated by bowel distension. The patient developed tension pneumoperitoneum post-procedure, which was treated with a bedside needle decompression. This case report highlights the significance of promptly recognizing and intervening in complications that may arise during a frequently performed medical procedure, PEJ tube placement, to prevent serious consequences, including bowel ischemia.
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Affiliation(s)
- Khalid Al Shamousi
- Gastroenterology Unit, Department of Medicine, Sultan Qaboos University Hospital and College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, OMN
| | | | - Jawahir Lal
- Gastroenterology Unit, Department of Medicine, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, OMN
| | - Said A Al-Busafi
- Gastroenterology Unit, Department of Medicine, Sultan Qaboos University Hospital and College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, OMN
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28
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Murata Y, Matsuo Y, Hiraoka E. Successful Conservative Management of Emphysematous Cystitis With Pneumoperitoneum: A Case Report and Literature Review. Cureus 2023; 15:e43769. [PMID: 37727168 PMCID: PMC10506864 DOI: 10.7759/cureus.43769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2023] [Indexed: 09/21/2023] Open
Abstract
Emphysematous cystitis is a rare type of urinary tract infection that is characterized by the accumulation of gas within the walls and lumen of the urinary bladder. In rarer instances, pneumoperitoneum may accompany emphysematous cystitis. When pneumoperitoneum is suspected through imaging studies in patients with emphysematous cystitis, surgical abdominal exploration is frequently performed considering the possibility of bladder perforation or coexistence of intestinal perforation. We successfully managed a case of emphysematous cystitis accompanied with pneumoperitoneum conservatively. A 90-year-old woman hospitalized with a gastric ulcer developed abrupt lower abdominal pain and hematuria. Contrast-enhanced CT revealed gas within the bladder wall, which was consistent with emphysematous cystitis, and pneumoperitoneum. No obvious bowel or bladder perforation was observed in the CT scan. Regarding her high surgical risk and clinical stability, surgical abdominal exploration was not performed, and she was managed conservatively with urethral catheter placement and antibiotics. She recovered with the treatment, and CT imaging obtained on day 18 demonstrated resolution of the bladder wall emphysema and no signs of pneumoperitoneum. We performed a literature review using MEDLINE and Japana Centra Revuo Medicina Web and confirmed 13 previously reported cases of emphysematous cystitis and pneumoperitoneum. Based on the review of these 13 cases and our case, it is difficult to predict the presence of bladder perforation solely based on peritoneal signs in physical findings or ascites on CT scans. Therefore, it would be preferable to perform surgical abdominal exploration to make a definite diagnosis and select an appropriate treatment. However, the fact that at least eight out of the 10 cases managed conservatively survived suggests that there is a specific clinical entity among patients who present with emphysematous cystitis and pneumoperitoneum that can be safely managed conservatively. Further accumulation of cases and research is necessary to determine which cases can be treated conservatively.
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Affiliation(s)
- Yurie Murata
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, JPN
- Department of Cardiology, Iwakuni Medical Center, Iwakuni, JPN
| | - Yuichiro Matsuo
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, JPN
- Department of Clinical Epidemiology and Health Economics, The University of Tokyo, Tokyo, JPN
| | - Eiji Hiraoka
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, JPN
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29
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Brusasco C, Tavazzi G, Cucciolini G, Di Nicolò P, Wong A, Di Domenico A, Germinale F, Dotta F, Micali M, Coccolini F, Santori G, Dazzi F, Introini C, Corradi F. Perioperative Renal Ultrasonography of Arterio-to-Venous Coupling Predicts Postoperative Complications after Major Laparoscopic Urologic Surgery. J Clin Med 2023; 12:5013. [PMID: 37568415 PMCID: PMC10419452 DOI: 10.3390/jcm12155013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/20/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
Point-of-care ultrasonography (POCUS) with concomitant venous and arterial Doppler assessment enables clinicians to assess organ-specific blood supply. To date, no studies have investigated the usefulness of including a comprehensive perioperative POCUS assessment of patients undergoing major laparoscopic surgery. The primary aim of the present study was to evaluate whether the combined venous and arterial renal flow evaluation, measured at different time points of perioperative period, may represent a clinically useful non-invasive method to predict postoperative acute kidney injury (AKI) after major laparoscopic urologic surgery. The secondary outcome was represented by the development of any postoperative complication at day 7. We included 173 patients, subsequently divided for analysis depending on whether they did (n = 55) or did not (n = 118) develop postoperative AKI or any complications within the first 7 days. The main results of the present study were that: (1) the combination of arterial hypoperfusion and moderate-to-severe venous congestion inferred by POCUS were associated with worst outcomes (respectively, HR: 2.993, 95% CI: 1.522-5.884 and HR: 8.124, 95% CI: 3.542-18, p < 0.001); (2) high intra-operative abdominal pressure represents the only independent determinant of postoperative severe venous congestion (OR: 1.354, 95% CI: 1.017-1.804, p = 0.038); (3) the overall number of complications relies on the balance between arterial inflow and venous outflow in order to ensure the adequacy of peripheral perfusion; and (4) the overall reliability of splanchnic perfusion assessment by Doppler is high with a strong inter-rater reliability (ICC: 0.844, 95% CI: 0.792-0.844). The concomitant assessment of arterial and venous Doppler patterns predicts postoperative complications after major laparoscopic urologic surgery and may be considered a useful ultrasonographic biomarker to stratify vulnerable patients at risk for development of postoperative complications.
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Affiliation(s)
- Claudia Brusasco
- Anaesthesia and Intensive Care Unit, E.O. Ospedali Galliera, Mura della Cappuccine 14, 16128 Genoa, Italy;
| | - Guido Tavazzi
- Unit of Anesthesia and Intensive Care, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy;
| | - Giada Cucciolini
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (G.C.); (F.D.)
| | - Pierpaolo Di Nicolò
- Nephrology and Dialysis Unit, S. Maria della Scaletta Hospital, 40026 Imola, Italy;
| | - Adrian Wong
- Department of Critical Care, King’s College Hospital, London SE5 9RS, UK;
| | - Antonia Di Domenico
- Urology Unit, E.O. Ospedali Galliera, 16128 Genoa, Italy; (A.D.D.); (F.G.); (F.D.); (C.I.)
| | - Federico Germinale
- Urology Unit, E.O. Ospedali Galliera, 16128 Genoa, Italy; (A.D.D.); (F.G.); (F.D.); (C.I.)
| | - Federico Dotta
- Urology Unit, E.O. Ospedali Galliera, 16128 Genoa, Italy; (A.D.D.); (F.G.); (F.D.); (C.I.)
| | - Marco Micali
- Anaesthesia and Intensive Care Unit, E.O. Ospedali Galliera, Mura della Cappuccine 14, 16128 Genoa, Italy;
| | - Federico Coccolini
- General, Emergency and Trauma Surgery, Pisa University Hospital, 56100 Pisa, Italy;
| | - Gregorio Santori
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy;
| | - Federico Dazzi
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (G.C.); (F.D.)
| | - Carlo Introini
- Urology Unit, E.O. Ospedali Galliera, 16128 Genoa, Italy; (A.D.D.); (F.G.); (F.D.); (C.I.)
| | - Francesco Corradi
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (G.C.); (F.D.)
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30
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Park SE, Hong TH. Gasless robotic single-port cholecystectomy using the DaVinci SP system: A feasible way to minimise surgical derangement while obtaining critical view of safety. Int J Med Robot 2023:e2547. [PMID: 37493205 DOI: 10.1002/rcs.2547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/25/2023] [Accepted: 06/27/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND The aim of this study was to present our initial experience of gasless robotic single-port cholecystectomy (RSPC). METHODS We reviewed 48 patients who underwent gasless RSPC with a da Vinci SP Robotic Surgical System. Demographic data, intra-operative results, and postoperative outcomes were evaluated. RESULTS Gasless RSPC was successfully performed in 48 of 53 patients. Five patients had conversion to standard pressure pneumoperitoneum due to insufficient surgical space (n = 3), GB perforation (n = 1), or bleeding during surgery (n = 1). The mean whole operation time was 53.6 ± 17.2 min. No patients complained of postoperative shoulder pain or had any postoperative complications. The average hospital stay was 2.1 ± 0.3 days. CONCLUSION Gasless RSPC is feasible and safe. The unique features of an SP robotic platform allow surgeons to perform safely in an incapacious surgical space. However, this procedure is currently only possible for highly selected patients.
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Affiliation(s)
- Sung Eun Park
- Division of Hepato-biliary and Pancreas Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Tae Ho Hong
- Division of Hepato-biliary and Pancreas Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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31
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Soheilipour M, Momenzadeh M, Aria A, Saghar F, Tabesh E. A Case of Pneumoperitoneum after Colonoscopy without Frank Perforation. Adv Biomed Res 2023; 12:177. [PMID: 37694258 PMCID: PMC10492600 DOI: 10.4103/abr.abr_376_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/27/2022] [Accepted: 01/01/2023] [Indexed: 09/12/2023] Open
Abstract
Benign pneumoperitoneum can happen after colonoscopy, which shows itself as free air in the abdomen without symptoms or pneumoperitoneum without peritonitis. In this case, we reported a rare case of an elderly man who had acute abdominal stiffness after colonoscopy and observation of free air under the diaphragm that no perforation was observed in the intestine during laparoscopy and only one tiny intestinal tumor was randomly reported. There is no consensus on the treatment of pneumoperitoneum after colonoscopy. Patients with peritonitis benefit from laparoscopy but patients with micro perforation and asymptomatic patients benefit from intravenous antibiotic treatment and bowel rest.
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Affiliation(s)
- Maryam Soheilipour
- Isfahan Gastroenterology and Hepatology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahnaz Momenzadeh
- Department of Clinical Pharmacy and Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, Isfahan, Iran
| | - Amir Aria
- Department of Internal Medicine, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Saghar
- Isfahan Gastroenterology and Hepatology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elham Tabesh
- Isfahan Gastroenterology and Hepatology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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32
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Kamal M, Chawriya SK, Kumar M, Kaloria N, Sharma A, Bhatia P, Singariya G, Paliwal B. Effect of sevoflurane, propofol and propofol with dexmedetomidine as maintenance agent on intracranial pressure in the Trendelenburg position during laparoscopic surgeries. J Anaesthesiol Clin Pharmacol 2023; 39:474-481. [PMID: 38025555 PMCID: PMC10661639 DOI: 10.4103/joacp.joacp_511_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 04/16/2022] [Accepted: 04/21/2022] [Indexed: 12/01/2023] Open
Abstract
Background and Aim Pneumoperitoneum (PP) and the Trendelenburg position (TP) in laparoscopic surgeries are associated with rise in intracranial pressure (ICP). The optic nerve sheath diameter (ONSD) is a surrogate marker of ICP. The study aimed to evaluate the effect of sevoflurane, propofol and propofol with dexmedetomidine as maintenance agent on ICP in TP during laparoscopic surgeries. Material and Methods A total of 120 American Society of Anesthesiologists (ASA) physical status I/II patients, aged 18-65 years were randomly allocated into three groups: sevoflurane as group S, propofol as group P, and propofol with dexmedetomidine as group PD. The intra-abdominal pressure (IAP) was kept in the range of 12-14 mmHg and TP varied between 15°- 45° angle. The primary objective was comparison of ICP and secondary objectives were IOP, intraoperative hemodynamic and postoperative recovery characteristics among groups. The ONSD and IOP were measured in both eyes 10 min after endotracheal intubation (T0), 5 min after CO2 insufflation (T1), 5 min after TP (T2) and 5 min after deflation of gas (T3). The data were analyzed by using the Statistical Package for Social Sciences version 23. Results ONSD and IOP at T1 and T2 were significantly higher than T0 in all groups, but no significant difference was found among the intergroup groups. Significantly lower heart rate and mean blood pressure were observed in PD group at T1 and T2 compared to group S and group P. Conclusion The rise in ICP was comparable among sevoflurane, propofol, and propofol-dexmedetomidine combination as a maintenance agent during laparoscopic surgeries in TP.
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Affiliation(s)
- Manoj Kamal
- Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sanjeev Kumar Chawriya
- Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Mritunjay Kumar
- Anaesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Narendra Kaloria
- Anaesthesiology and Critical Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ankur Sharma
- Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pradeep Bhatia
- Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Geeta Singariya
- Department Anaesthesiology and Critical Care, Dr. S N Medical College, Jodhpur, Rajasthan, India
| | - Bharat Paliwal
- Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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33
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Ramos PV, Oliveira AM, Simas Â, Rocha Vera Cruz M. COVID-19: A Possible Cause of Spontaneous Pneumoperitoneum. J Crit Care Med (Targu Mures) 2023; 9:192-197. [PMID: 37588186 PMCID: PMC10425923 DOI: 10.2478/jccm-2023-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 06/10/2023] [Indexed: 08/18/2023] Open
Abstract
Introduction Pneumoperitoneum is the presence of air within the peritoneal cavity and is mostly caused by organ rupture. Spontaneous pneumoperitoneum accounts 5% to 15% of the cases and occurs in the absence of organ damage. The pulmonary origin of pneumoperitoneum is unusual, and probably associated with mechanical ventilation and alveolar leak. In patients with coronavirus disease 2019 (COVID-19) there are some reports of air leak, like pneumothorax, pneumomediastinum, pneumoperitoneum, and subcutaneous emphysema. Case presentation We present the case of a 70-year-old man with COVID-19 pneumonia admitted to the Intensive Care Unit (ICU). Since admission he was on Non-Invasive Ventilation (NIV), without improvement, needing Invasive Mechanical Ventilation (IMV) due to severe respiratory failure. Five days after IMV despite protective lung ventilation, massive spontaneous subcutaneous emphysema, pneumomediastinum and pneumoperitoneum were diagnosed. Besides initial conservative management 12 hours later, the patient developed abdominal compartment syndrome requiring percutaneous needle decompression. Conclusions Pneumoperitoneum can be considered a rare complication of COVID-19 pneumonia and its management, resulting not only from the viral pulmonary but also from secondary causes. Conservative management should be usually enough. However, in the presence of abdominal compartment syndrome prompt recognition and treatment are crucial and eventually lifesaving.
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Affiliation(s)
| | - Ana Maria Oliveira
- Intensive Care Unit, Hospital de Vila Franca de Xira, Vila Franca de Xira, Portugal
| | - Ângela Simas
- Intensive Care Unit, Hospital de Vila Franca de Xira, Vila Franca de Xira, Portugal
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34
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Söyler Y, Uzel Şener M, Öztürk A. An unusual, life-threatening complication of EBUS-TBNA: Pneumoperitoneum. Lung India 2023; 40:353-355. [PMID: 37417089 PMCID: PMC10401984 DOI: 10.4103/lungindia.lungindia_58_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/22/2023] [Accepted: 03/31/2023] [Indexed: 07/08/2023] Open
Abstract
Endobronchial ultrasound-guided with transbronchial needle aspiration (EBUS-TBNA) is a safe procedure. We present an unusual life-threatening complication after EBUS-TBNA in a 43-year-old female. She underwent EBUS-TBNA for enlarged lymph nodes evaluation. After EBUS-TBNA, a progressively worsening abdominal distension was observed. In computed tomography, subcutaneous emphysema, bilateral pneumothorax, pneumomediastinum and pneumoperitoneum were detected. This complication was successfully treated with chest tube insertion and bedside abdominal decompression. Even though EBUS-TBNA is considered to bear a low risk, the possibility of complication occurrence must be taken into account and clinicians must be more cautious about pulmonary barotrauma, especially when EBUS-TBNA is performed.
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Affiliation(s)
- Yasemin Söyler
- Department of Interventional Pulmonology, Ankara Ataturk Sanatorium Training and Research Hospital, Ankara, Turkey
| | - Melahat Uzel Şener
- Department of Interventional Pulmonology, Ankara Ataturk Sanatorium Training and Research Hospital, Ankara, Turkey
| | - Ayperi Öztürk
- Department of Interventional Pulmonology, Ankara Ataturk Sanatorium Training and Research Hospital, Ankara, Turkey
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Singh RJ, Suman BK, Sinha AK, Kumar B. Neonatal Sigmoid Colon Perforation in Low Anorectal Malformation. J Indian Assoc Pediatr Surg 2023; 28:342-344. [PMID: 37635885 PMCID: PMC10455714 DOI: 10.4103/jiaps.jiaps_36_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 04/07/2023] [Accepted: 04/13/2023] [Indexed: 08/29/2023] Open
Abstract
Anorectal malformations (ARMs) are common congenital anomalies in neonates. Colonic perforation is very rare in ARMs. Delay in diagnosis of neonate with ARM results in colonic perforations and life-threatening morbidity. Colonic perforation due to ARM may not be completely avoided; however, early diagnosis and management are essential in assuring better outcomes.
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Affiliation(s)
| | | | | | - Bindey Kumar
- Department of Pediatric Surgery, AIIMS, Patna, Bihar, India
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Batth SK, Singh G. Air Will Find a Way: A Case Report and Literature Review on Tracheostomy-Induced Ectopic Air. Cureus 2023; 15:e42446. [PMID: 37637541 PMCID: PMC10449268 DOI: 10.7759/cureus.42446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 08/29/2023] Open
Abstract
Tracheostomy can lead to various complications, one of which is ectopic air in different compartments of the body. Here, we present a rare case of tracheostomy-induced ectopic air: a combination of subcutaneous emphysema, pneumomediastinum, and pneumoperitoneum. This case also presents a literature review on some of the common mechanisms responsible for pneumomediastinum following tracheostomy and the mechanism of pneumoperitoneum following pneumomediastinum. Tracheal injury, tube-related complications, and alveolar rupture are common mechanisms that can lead to pneumomediastinum and subcutaneous emphysema after tracheostomy. Air can then dissect into the abdomen leading to pneumoperitoneum. Knowledge of the anatomic or embryologic development of the thoracoabdominal continuum can help understand the spread of air from one compartment to another. Investigation as simple as a chest X-ray, along with clinical features, can help identify these complications and be used to monitor the course.
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Affiliation(s)
- Simrat K Batth
- Medicine, Elmhurst Hospital Centre (Icahn School of Medicine at Mount Sinai), New York, USA
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Joseph A, Theerth KA, Karipparambath V, Palliyil A. Effects of pneumoperitoneum and Trendelenburg position on intracranial pressure and cerebral blood flow assessed using transcranial doppler: A prospective observational study. J Anaesthesiol Clin Pharmacol 2023; 39:429-434. [PMID: 38025577 PMCID: PMC10661629 DOI: 10.4103/joacp.joacp_531_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/14/2022] [Accepted: 05/15/2022] [Indexed: 12/01/2023] Open
Abstract
Background and Aims Laparoscopic lower abdominal surgeries involve carbon dioxide (CO2) insufflation and Trendelenburg position. The raised intra-abdominal pressure can increase intracranial pressure (ICP) and alter cerebral blood flow. This study was conducted to determine the effect of pneumoperitoneum and Trendelenburg position on ICP and cerebral perfusion pressure (CPP) measured using transcranial Doppler (TCD). Material and Methods A prospective observational study was conducted in 43 patients of either sex, aged between 18 and 60 years with American Society of Anesthesiologists physical status I and II, undergoing elective laparoscopic surgery in Trendelenburg position. After standard anesthesia induction, pneumoperitoneum was created to facilitate surgery, maintaining an intra-abdominal pressure of 10-15 mmHg and Trendelenburg position of 25°-30°. End-tidal carbon dioxide (EtCO2) was maintained between 30 and 35 mmHg. The ICP was assessed non-invasively using TCD-based diastolic flow velocities (FVd) and pulsatility index (PI) of middle cerebral artery. Data was represented as mean ± standard deviation and compared using paired t test. A P value of < 0.05 was considered significant. Results Mean ICPPI at baseline was 14.02 ± 0.89 mmHg which increased to 14.54 ± 1.21 mmHg at pneumoperitoneum and Trendelenburg position (P = 0.005). Mean ICPFVd at baseline was 6.25 ± 2.47 mmHg which increased to 8.64 ± 3.79 mmHg at pneumoperitoneum and Trendelenburg position (P < 0.001). There was no statistically significant change in the CPP or mean arterial pressure values intraoperatively. Conclusions Laparoscopic procedures with CO2 pneumoperitoneum in Trendelenburg position increase ICP as measured using TCD ultrasonography. The CPP was not significantly altered when EtCO2 was maintained in the range of 30-35 mmHg.
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Affiliation(s)
- Anu Joseph
- Department of Anaesthesia and Critical Care, Medical Trust Hospital, Ernakulam, Kerala, India
| | - Kaushic A. Theerth
- Department of Anaesthesia and Critical Care, Medical Trust Hospital, Ernakulam, Kerala, India
| | - Vinodan Karipparambath
- Department of Anaesthesia and Critical Care, Medical Trust Hospital, Ernakulam, Kerala, India
| | - Aruna Palliyil
- Department of Anaesthesia and Critical Care, Medical Trust Hospital, Ernakulam, Kerala, India
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Bickerton M, Dawson S, Sharma M, Roberts RL. Needle decompression of tension pneumoperitoneum as a resuscitative measure prior to induction of general anaesthesia. Anaesth Rep 2023; 11:e12237. [PMID: 37396689 PMCID: PMC10313220 DOI: 10.1002/anr3.12237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2023] [Indexed: 07/04/2023] Open
Affiliation(s)
- M. Bickerton
- Department of AnaesthesiaSunderland Royal HospitalSunderlandUK
| | - S. Dawson
- Department of AnaesthesiaSunderland Royal HospitalSunderlandUK
| | - M. Sharma
- Department of General SurgerySunderland Royal HospitalSunderlandUK
| | - R. L. Roberts
- Department of AnaesthesiaSunderland Royal HospitalSunderlandUK
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Tavares IT, Rivero R, Sales‐Luís JP, Vaudano CG, Correia SD, Corbera JA, Jaber JR. Premedication with acetazolamide: Is its use for postoperative pain and stress control after laparoscopic ovariectomy in dogs ruled out? Vet Med Sci 2023; 9:1114-1123. [PMID: 36952262 PMCID: PMC10188092 DOI: 10.1002/vms3.1115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/19/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Studies in human medicine have concluded that acetazolamide reduces pain associated with carbon dioxide insufflation during laparoscopic surgery. However, there are no published reports regarding the use of acetazolamide for this purpose in companion animals, despite the increasing popularity of laparoscopic techniques in veterinary medicine due to their advantages over open surgeries. OBJECTIVES Thirty mixed-breed female dogs were included in the study and randomly assigned to one of three groups: OVE (median celiotomy ovariectomy; n = 10), OVEL (laparoscopic ovariectomy, n = 10) and OVELA (laparoscopic ovariectomy with acetazolamide preoperative administration; n = 10). Experienced surgeons performed all procedures, and the anaesthetic and analgesic protocols were identical for all animals. Acetazolamide was administered orally (at a dose of 25 mg/kg) 2 h prior to induction in the OVELA group. Postoperative pain was evaluated using serum cortisol, salivary cortisol, and the University of Melbourne Pain Scale (UMPS) Score. RESULTS Any statistical differences were observed in the UMPS scores when the OVELA group was compared to the OVEL group at 1 h after surgery (p = 0.515), 12 h (p = 0.375) and 24 h (p = 0.242). Animals undergoing open surgery (OVE group) had significantly higher pain scores at all times after surgery when compared with OVEL and OVELA groups. A high positive correlation (r = 0.792; p = 0.01) was found between serum and saliva cortisol concentrations. Mean saliva cortisol concentration was not significantly lower for the OVELA group compared to the other groups. CONCLUSIONS This study found evidence that preoperative administration of acetazolamide may be beneficial in managing postoperative pain in dogs after laparoscopic surgeries. However, further research with a larger sample size is needed to confirm this and to determine if acetazolamide should be included in a multimodal postoperative analgesia protocol for laparoscopic ovariectomy in dogs.
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Affiliation(s)
- Inês T. Tavares
- Faculty of Veterinary MedicineLusófona UniversityLisbonPortugal
| | - Ramón Rivero
- Faculty of Veterinary MedicineUniversidad Autónoma de Ciudad JuárezCiudad JuarezMéxico
| | - José P. Sales‐Luís
- Faculty of Veterinary MedicineUniversidade de LisboaAvenida da Universidade TécnicaLisbonPortugal
| | | | - Sérgio D. Correia
- COPELABSDepartamento de ArquiteturaUniversidade Lusofóna de Humanidades e TecnologiasLisbonPortugal
- VALORIZACentro de Investigação para a Valorização de Recursos EndógenosPolytechnic Institute of PortalegrePortalegrePortugal
| | - Juan Alberto Corbera
- Hospital Clínico Veterinario ULPGCFacultad de VeterinariaInstituto Universitario de Investigaciones Biomédicas y SanitariasUniversidad de Las Palmas de Gran CanariaArucasSpain
| | - Jose Raduan Jaber
- Facultad de VeterinariaDepartamento de MorfologíaUniversidad de Las Palmas de Gran CanariaArucasSpain
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Reijnders-Boerboom GT, Albers KI, Jacobs LM, van Helden E, Rosman C, Díaz-Cambronero O, Mazzinari G, Scheffer GJ, Keijzer C, Warlé MC. Low intra-abdominal pressure in laparoscopic surgery: a systematic review and meta-analysis. Int J Surg 2023; 109:1400-1411. [PMID: 37026807 PMCID: PMC10389627 DOI: 10.1097/js9.0000000000000289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 02/03/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Guidelines do not provide clear recommendations with regard to the use of low intra-abdominal pressure (IAP) during laparoscopic surgery. The aim of this meta-analysis is to assess the influence of low versus standard IAP during laparoscopic surgery on the key-outcomes in perioperative medicine as defined by the StEP-COMPAC consensus group. MATERIALS AND METHODS We searched the Cochrane Library, PubMed, and EMBASE for randomized controlled trials comparing low IAP (<10 mmHg) with standard IAP (10 mmHg or higher) during laparoscopic surgery without time, language, or blinding restrictions. According to the PRISMA guidelines, two review authors independently identified trials and extracted data. Risk ratio (RR), and mean difference (MD), with 95% CIs were calculated using random-effects models with RevMan5. Main outcomes were based on StEP-COMPAC recommendations, and included postoperative complications, postoperative pain, postoperative nausea and vomiting (PONV) scores, and length of hospital stay. RESULTS Eighty-five studies in a wide range of laparoscopic procedures (7349 patients) were included in this meta-analysis. The available evidence indicates that the use of low IAP (<10 mmHg) leads to a lower incidence of mild (Clavien-Dindo grade 1-2) postoperative complications (RR=0.68, 95% CI: 0.53-0.86), lower pain scores (MD=-0.68, 95% CI: -0.82 to 0.54) and PONV incidence (RR=0.67, 95% CI: 0.51-0.88), and a reduced length of hospital stay (MD=-0.29, 95% CI: -0.46 to 0.11). Low IAP did not increase the risk of intraoperative complications (RR=1.15, 95% CI: 0.77-1.73). CONCLUSIONS Given the established safety and the reduced incidence of mild postoperative complications, lower pain scores, reduced incidence of PONV, and shorter length of stay, the available evidence supports a moderate to strong recommendation (1a level of evidence) in favor of low IAP during laparoscopic surgery.
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Affiliation(s)
| | - Kim I. Albers
- Departments of Anesthesiology
- Surgery, Radboudumc, Nijmegen, The Netherlands
| | | | | | | | - Oscar Díaz-Cambronero
- Department of Anesthesiology, La Fé University and Polytechnic Hospital, Valencia, Spain
| | - Guido Mazzinari
- Department of Anesthesiology, La Fé University and Polytechnic Hospital, Valencia, Spain
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Goswami KK, Kumar R, Goswami SK. Pneumoperitoneum in a Patient With COVID-19 and Acute Respiratory Distress Syndrome Without Pneumothorax. Cureus 2023; 15:e39593. [PMID: 37384070 PMCID: PMC10294590 DOI: 10.7759/cureus.39593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2023] [Indexed: 06/30/2023] Open
Abstract
We present a case report of pneumoperitoneum, pneumomediastinum, and subcutaneous emphysema in a patient with COVID-19 pneumonia-causing acute respiratory distress syndrome (ARDS) without any pneumothorax occurring. Pneumothorax, pneumomediastinum, and subcutaneous emphysema are known complications of barotrauma due to positive pressure from mechanical ventilation which is necessary for patients suffering from a severe case of COVID-19. In our literature search, we could not find any reported case of pneumoperitoneum without pneumothorax occurring. Our case is an important addition to the literature presenting a rare complication of mechanical ventilation in patients with ARDS.
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Affiliation(s)
- Kartik K Goswami
- College of Medicine, California Northstate University College of Medicine, Elk Grove, USA
| | - Rakesh Kumar
- Pulmonary and Critical Care Medicine, Stockton Pulmonary Doctors, Stockton, USA
| | - Sanjeev K Goswami
- Pulmonary and Critical Care Medicine, St. Joseph's Medical Center, Stockton, USA
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Obeidat N, Heilat G, Ajam T, Al-Zoubi H. Perforated Stress Ulcer of the Duodenum: a Case of an Unexpected Diagnosis in a COVID-19 Patient Following Dilatation and Curettage Procedure. Med Arch 2023; 77:155-157. [PMID: 37260798 PMCID: PMC10227846 DOI: 10.5455/medarh.2023.77.155-157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 02/12/2023] [Indexed: 06/02/2023] Open
Abstract
Background Stress ulcers in the upper gastrointestinal tract can arise from pathologies related to erosive or inflammatory insults in critically ill patients. The relationship between stressful bodily events and the ischemia and perforation of stress ulcers is poorly understood. Objective We present a case of perforated stress ulcer following an abortion that was treated by dilatation and curettage (D&C) and complicated by a coronavirus disease 2019 (COVID-19) infection. Case presentation A 40-year-old lady presented to the emergency room complaining of diffuse abdominal pain, she was recently diagnosed with an incomplete abortion and managed via a D&C procedure in an external hospital. A computed tomography (CT) scan was done at our center for the abdomen and pelvis, showing extensive pneumoperitoneum, which brought the radiologist's attention to suspect a small bowel perforation presumably accompanying a uterine perforation secondary to the D&C. There were no obvious signs of pelvic small bowel perforation in the initial CT images. The perforated duodenal stress ulcer was diagnosed the next day by a new CT scan following oral contrast ingestion and managed surgically by repair and omental patch, and no other bowel perforations were found upon surgical exploration. After the surgery, the patient was diagnosed with COVID-19, and her clinical status deteriorated gradually during the following week, and she passed away from a cardiac arrest. Conclusion It is unclear whether septic abortion or COVID-19 has resulted in stress ulcer perforation in our patient. This case report highlights the importance of raising early suspicion in the diagnosis of stress ulcer perforation in critically ill patients to reduce the risk of morbidity and mortality.
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Affiliation(s)
- Naser Obeidat
- Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ghaith Heilat
- Department of Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Tarek Ajam
- Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Hamzeh Al-Zoubi
- Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Agarwal PK, Golmei J, Goyal R, Maurya AP. Comparison Between Closed and Open Methods for Creating Pneumoperitoneum in Laparoscopic Cholecystectomy. Cureus 2023; 15:e35991. [PMID: 36911586 PMCID: PMC10004421 DOI: 10.7759/cureus.35991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2023] [Indexed: 03/12/2023] Open
Abstract
Background: To study the efficacy of closed and open methods for creating pneumoperitoneum in laparoscopic cholecystectomy by comparing the two in terms of their outcome and complication. Study Design: Single-centre, prospective, observational study. Materials and study: Purposive sampling method where the inclusion criteria were all patients with cholelithiasis who were advised and consented to laparoscopic cholecystectomy of age 18-70 years were included in the study group. Exclusion criteria include patients with a paraumbilical hernia, a history of upper abdominal surgery, uncontrolled systemic illness, and local skin infection. Sixty cases of cholelithiasis satisfying exclusion and inclusion criteria who underwent elective cholecystectomy during the study period were included. Thirty-one of these cases underwent the closed method, while in the remaining 29 patients open method was adopted. Cases in which pneumoperitoneum created by closed technique were grouped as group A and those by open technique as group B. Parameters comparing the safety and efficacy of the two methods were studied. The parameters were access time, gas leak, visceral injury, vascular injury, need for conversion, umbilical port site hematoma, umbilical port site infection, and hernia. Patients were assessed on the first postoperative day, the seventh postoperative day, and then two months after surgery. Some follow-ups were done telephonically. Results: Out of 60 patients, 31 underwent the closed method, while 29 underwent the open method. Minor complications like gas leak during the procedure was observed more in the open method. The mean access time in the open-method group was less than in the closed-method group. Other complications like visceral injury, vascular injury, need for conversion, umbilical port site hematoma, umbilical port site infection, and hernia were not observed in either group during the allocated follow-up period in the study. Conclusion: Open technique for pneumoperitoneum is as safe and effective as the closed technique.
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Affiliation(s)
- Puneet K Agarwal
- General Surgery, All India Institute of Medical Sciences Bhopal, Bhopal, IND
| | - Jason Golmei
- General Surgery, All India Institute of Medical Sciences Bhopal, Bhopal, IND
| | - Richa Goyal
- Obstetrics and Gynecology Surgery, Dr. Agarwal Clinic, Jalesar, IND
| | - Ajeet P Maurya
- General Surgery, All India Institute of Medical Sciences Bhopal, Bhopal, IND
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Lombardo AM, Gundeti MS. Review of robot-assisted laparoscopic surgery in management of infant congenital urology: Advances and limitations in utilization and learning. Int J Urol 2023; 30:250-257. [PMID: 36520939 DOI: 10.1111/iju.15105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 11/14/2022] [Indexed: 12/23/2022]
Abstract
As robotic-assisted (RAL) surgery expanded to treat pediatric congenital disease, infant anatomy and physiology posed unique challenges that prompted adaptations to the technology and surgical technique, which are compiled and reviewed in this manuscript. From the beginning, collaboration with anesthesia is critical for a safe, efficient case including placement of an endotracheal tube rather than a laryngeal mask (LMA) and placement of a nasogastric tube and/or rectal tube to relieve distended stomach or bowel, respectively. Furthermore, end-tidal CO2 (EtCO2 ) is important for monitoring and predicting the effects of pneumoperitoneum on caridiovascular physiology, incranial pressure, and risk of acidosis and hypercarbia. Positioning can further exacerbate these effects and affect intra-abdominal working space. For infant robotic pyeloplasty and heminephrectomy, a "beanbag" is commonly used for stabilization in the lateral decubitus position. We advise against the use of a "baby bump" because it brings the bowels and vasculature more anterior than expected. Pnuemoperitoneum pressure of 8-10 mmHg during port placement maximizes safety, but thereafter, the pneumoperitoneum pressure can be minimized to 6-8 mmHg during the procedure without compromising the visual field. Port sites should be marked after insufflation, followed by the open Hasson technique for peritoneal access and port placement under direct vision with intussusception of the trocars to avoid vascular or bowel injury. Additional tips can be obtained through this manuscript, immersive fellowships, and mini-fellowships. Ulitmately, infant robotic surgery has the potential to benefit many children but is presently limited by the lack of pediatric-specific robotic technology and its associated costs.
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Affiliation(s)
- Alyssa M Lombardo
- The University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Mohan S Gundeti
- The University of Chicago Comer Children's Hospital, Chicago, Illinois, USA
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Kim MK, Jeon TY, Kim K, Kim YJ, Yoo SY, Kim JH, Chang YS, Lee S, Seo JM, Moon SH. Clinical Outcome of Ultrasound-Detected Perforated Necrotizing Enterocolitis without Radiographic Pneumoperitoneum in Very Preterm Infants. J Clin Med 2023; 12. [PMID: 36902593 DOI: 10.3390/jcm12051805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 02/14/2023] [Accepted: 02/22/2023] [Indexed: 03/08/2023] Open
Abstract
OBJECTIVES To investigate the clinical outcomes of ultrasound (US)-detected perforated necrotizing enterocolitis (NEC) without radiographic pneumoperitoneum in very preterm infants. METHODS In this single-center retrospective study, very preterm infants who underwent a laparotomy for perforated NEC during their neonatal intensive care unit stay were classified into two groups according to the absence or presence of pneumoperitoneum on radiographs (the case versus the control groups). The primary outcome was death before discharge, and the secondary outcomes included major morbidities and body weight at 36 weeks postmenstrual age (PMA). RESULTS Of the 57 infants with perforated NEC, 12 (21%) had no pneumoperitoneum on the radiographs and were diagnosed with perforated NEC on the US. In the multivariable analyses, the primary outcome of death before discharge was significantly lower in infants with perforated NEC without radiographic pneumoperitoneum than in those with perforated NEC and radiographic pneumoperitoneum (8% [1/12] vs. 44% [20/45]; adjusted odds ratio [OR], 0.02; 95% confidence interval [CI], 0.00-0.61; p = 0.025). The secondary outcomes (short bowel syndrome, total parenteral nutrition dependence for 3 months or more, the length of their hospital stay, a bowel stricture requiring surgery, sepsis after the laparotomy, acute kidney injury after the laparotomy, and body weight at 36 weeks PMA) did not differ significantly between the two groups. CONCLUSIONS Very preterm infants with US-detected perforated NEC without radiographic pneumoperitoneum had a lower risk of death before discharge than those with perforated NEC and radiographic pneumoperitoneum. Bowel USs may have a potential role in surgical decision-making in infants with advanced NEC.
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Deng Z, Zhu H, Du W, Zhang H. Abdominal infection combined with pneumoperitoneum after renal transplantation: A case report. Medicine (Baltimore) 2023; 102:e32836. [PMID: 36749270 PMCID: PMC9901997 DOI: 10.1097/md.0000000000032836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Abdominal infection combined with pneumoperitoneum after renal transplantation is rare, clinically confusing, and easily misdiagnosed by physicians as gastrointestinal perforation. PATIENT CONCERNS A 54-year-old man experienced abdominal pain and distension together with signs of peritoneal irritation after cadaveric renal transplantation. CT and standing abdominal plain film showed a large pneumoperitoneum in the abdominal cavity and the patient underwent an exploratory laparotomy but no gastrointestinal perforation was found. DIAGNOSIS No gastrointestinal perforation was found during the operation. In the search for the infectious agent, ascites culture was negative while next-generation sequencing was positive, suggesting the presence of intestinal flora ectopic to abdominal infection with anaerobic respiration fermentation leading to large amounts of gas. INTERVENTIONS The patient underwent exploratory laparotomy without gastrointestinal perforation, and then underwent abdominal lavage, placed abdominal drainage tube, and conducted culture and next-generation sequencing examination of ascites. OUTCOMES Postoperative symptoms were relieved and intestinal function recovered. After 3 months of outpatient follow-up, the patient had stable transplanted kidney function and was in good spirits and sleeping well, with a good appetite, soft and regular stools, no abdominal pain and distension, and no fever. CONCLUSION Patients after kidney transplantation should be wary of abdominal infection being misdiagnosed as gastrointestinal perforation.
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Affiliation(s)
- Zhiming Deng
- Organ Transplantation Department, The First People’s Hospital of Changde City, Changde, China
| | - Huachen Zhu
- Organ Transplantation Department, The First People’s Hospital of Changde City, Changde, China
| | - Wei Du
- Organ Transplantation Department, The First People’s Hospital of Changde City, Changde, China
| | - Hongwei Zhang
- Organ Transplantation Department, The First People’s Hospital of Changde City, Changde, China
- *Correspondence: Hongwei Zhang, Organ Transplantation Department, The First People’s Hospital of Changde City, # 818 Renmin Middle Road, Changde, Hunan 415003, China (e-mail: )
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Kotek J, Dušek T, Sirový M, Odložilová Š, Kašparová P, Čečka F. Pneumatosis cystoides intestinalis as a rare cause of non-surgical pneumoperitoneum. Rozhl Chir 2023; 102:214-218. [PMID: 37527949 DOI: 10.33699/pis.2023.102.5.214-218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
Pneumoperitoneum as a finding on imaging examinations is not always a sign of acute abdomen due to gastrointestinal perforation. These findings must be viewed in connection with the clinical condition and personal history of each patient because they may also indicate a non-surgical or spontaneous pneumoperitoneum. This condition is repeatedly described but very often neglected. This paper presents the case report of a patient with non-surgical pneumoperitoneum where, despite proceeding according to the guidelines, no expected intra-abdominal pathology explaining the patient's problems was found.
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Muacevic A, Adler JR, Shah S, Hussain S, Shah V, Hussain A, Ijaz HM, Rahim M. A Rare Presentation of Congenital Chilaiditi Syndrome: Symptomatic Hepatobowel Entrapment. Cureus 2023; 15:e33714. [PMID: 36788833 PMCID: PMC9922167 DOI: 10.7759/cureus.33714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/12/2023] [Indexed: 01/15/2023] Open
Abstract
The displacement and trapping of the colon between the liver and the right hemidiaphragm are known as the Chilaiditi sign or syndrome. The Chilaiditi sign presents in an asymptomatic patient, while Chilaiditi syndrome presents with symptoms such as abdominal pain, distension, and constipation, in addition to complications such as perforation, volvulus, and bowel obstruction. It is often misdiagnosed as pneumoperitoneum or free air under the diaphragm and liver, often seen on the abdomen and chest radiography. It more commonly presents in males than in females. Here, we present the case of a 37-year-old female who reported abdominal pain and persistent constipation. An abdominal CT scan showed entrapment of a bowel segment, which is referred to as the Chilaiditi sign. The patient's presentation with hepatobowel entrapment and persistent gastrointestinal symptoms was diagnosed as Chilaiditi syndrome. This presentation entails a conservative management approach. The aim of this report is to educate about the rare occurrence of Chilaiditi sign and Chilaiditi syndrome as a differential diagnosis to often misdiagnosed critical conditions such as pneumoperitoneum and intestinal perforation. Correctly identifying these patients will reduce overtreatment and help improve outcomes.
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Horák P, Peregrinová M, Erbenová A, Žižková T, Fulík J, Fanta J. Pneumoperitoneum, pneumomediastinum and subcutaneous emphysema following argon plasma coagulation treatment of colonic angioectasia. Rozhl Chir 2023; 102:130-133. [PMID: 37344207 DOI: 10.33699/pis.2023.102.3.130-133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
INTRODUCTION The paper presents unusual symptoms as a complication of therapeutic colonoscopy. CASE REPORT A 70-year-old polymorbid female patient in chronic dialysis program underwent argon plasma coagulation treatment of leaking angioectasias in the cecum and ascending colon. Shortly after the procedure she presented with shortness of breath and subcutaneous emphysema of the neck which was initially misdiagnosed as swelling. Further tests revealed pneumoperitoneum, subcutaneous emphysema and pneumomediastinum. Considering the high risks for our patient (comorbidities, obesity), a laparoscopic approach was indicated. During laparoscopy neither peritonitis nor intestinal perforation were found. The patient recovered without complications after further complex treatment. CONCLUSION Shortness of breath and subcutaneous emphysema are not typically among the first symptoms of colonoscopic perforation. Our case confirms that we should bear this complication in mind and when suspected, the diagnostic process should be started without delay.
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Abstract
Background The creation of the pneumoperitoneum is the first step for any minimally invasive surgical procedure. Although rare, iatrogenic vascular or visceral injuries are reported and they are mainly related to the insertion of the first trocar. The Open Veress Assisted (OVA) technique allows a safe maneuver of the first trocar in order to minimize the risk of intraoperative complications during positioning of the first trocar. The purpose of this study was to describe the OVA technique and discuss the use in our current surgical practice. Patients and Methods Each step of OVA technique is described in the text. A retrospective review of prospectively maintained institutional databases was performed to report clinical outcomes related to OVA technique use. Results Between December 2018 and July 2021 OVA technique was used in a total of 324 laparoscopic procedures categorized in 259 colorectal resection and 24 subtotal or total gastrectomies. No intraoperative and postoperative complications related to creation of the peritoneum occurred. Conclusion OVA technique can be considered a safe alternative procedure for laparoscopic entry. By avoiding potentially dangerous insertion-related forces, this technique can be used even in previously operated patients, when the first trocar needs to be positioned away from the umbilicus or abdominal scar.
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Affiliation(s)
- Roberto Peltrini
- Department of Public Health, School of Medicine, University of Naples, Naples, Italy
| | - Marcello De Luca
- Department of Public Health, School of Medicine, University of Naples, Naples, Italy
| | - Ruggero Lionetti
- Department of Public Health, School of Medicine, University of Naples, Naples, Italy
| | - Umberto Bracale
- Department of Public Health, School of Medicine, University of Naples, Naples, Italy
| | - Francesco Corcione
- Department of Public Health, School of Medicine, University of Naples, Naples, Italy
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