Laparoscopic Abdominal Surgery Research Articles

Evaluation of cardiorespiratory parameters in dogs undergoing laparoscopic versus open gonadectomy with spontaneous ventilation anaesthesia: a pilot study

This pilot study aims to compare cardiorespiratory parameters in female dogs that underwent either laparoscopic or open elective gonadectomy with spontaneous ventilation anaesthesia. Records of 77 client-owned female dogs were reviewed. Patients were divided into two groups: laparoscopic surgery (L group, n 47) and open abdominal surgery (O group, n 30). The end-tidal carbon dioxide, respiratory rate, oxygen saturation, heart rate, non-invasive arterial blood pressure and length of procedure were recorded and statistically evaluated. Once normality of the sample data has been assessed, equality between the groups was analysed with two-sample Student’s or Welch’s t-test, whether the hypothesis of variance equality, through an F-test, was verified or not. A value of p <0.05 was considered statistically significant. No statistically significant difference was found between groups regarding the end-tidal carbon dioxide, oxygen saturation, respiratory rate, heart rate, systolic and medium arterial pressure values. Mean diastolic pressure was lower in the L group. The procedure length between the two groups was statistically different: laparoscopy was shorter than open surgery. In spontaneously ventilating female dogs, the cardiorespiratory parameters evaluated seem not to be affected by the presence of pneumoperitoneum when intrabdominal pressure is kept between 8 and 10 mmHg. The pilot nature of the study and the shorter laparoscopic surgery length could bias these results. However, in the author’s opinion, these findings confirm the interest of laparoscopy and the small impact of this mini-invasive technique in healthy patients.

Factors Influencing Satisfaction with Patient-Controlled Analgesia Among Postoperative Patients Using a Generalized Ordinal Logistic Regression Model

The purpose of this study was to identify the factors affecting the satisfaction with patient-controlled analgesia (PCA) of patients using a generalized ordinal logistic regression model and to evaluate the difference in results of the ordinal regression from those of binary regression. The study design involved secondary analysis of electronic medical records from a single tertiary care hospital in Seoul, Korea. It included 2,409 patients treated with PCA for postoperative pain management after open or laparoscopic abdominal surgery. Binary logistic regression and generalized ordinal logistic regression were used to identify factors affecting satisfaction. Binary logistic regression analysis showed that there was insufficient information for analysis. Generalized ordinal logistic regression revealed that sex, age, pain, PCA usage, and side-effects were common factors affecting PCA satisfaction. However, the effect of some factors affecting PCA satisfaction differed with the level of satisfaction. In open surgery patients, the effect of pain at 6hours after surgery was significantly greater in the group with lower satisfaction. While, in the laparoscopic surgery patients, the effect of pain at 6-24hours after surgery was significantly greater in the group with lower satisfaction. Generalized logistic regression may be an appropriate statistical method for analyzing ordinal data. Degree of postoperative pain and assessment interval are the most important factors associated with PCA satisfaction. Because the factors affecting PCA satisfaction were different for the two types of abdominal surgeries, customizing PCA to individual patients may potentially improve pain management and consequently increase PCA satisfaction.

The Use of Massage Therapy as a Nonpharmacological Approach to Relieve Postlaparoscopic Shoulder Pain: a Pediatric Case Report

Postlaparoscopic shoulder pain (PLSP) has been well documented to effect patients following an abdominal or thoracic laparoscopic surgery. PLSP is characterized by referred pain that can occur both unilaterally or bilaterally, and is typically caused by phrenic nerve irritation. Current literature has focused on pharmacological treatment; however, there is limited evidence for the use of nonpharmacological management of PLSP in the pediatric population. This retrospective case report study explores the use of a single-session massage therapy treatment for a 17-year-old patient with PLSP following laparoscopic abdominal surgery. Therapy intervention included a 25 min Swedish massage involving the effected shoulder with an emphasis on passive touch to the shoulder and at the level of the diaphragm. Pain was assessed using the Visual Analog Scale (VAS) pre- and postintervention. Following therapy the patient reported 0/10 pain. This case report provides evidence for the use of massage therapy treatment as a noninvasive, nonpharmacological approach to reducing or eliminating PLSP in a pediatric patient.

Assessment of Port Site Complication in Laparoscopic Abdominal Surgery

Abstract Background Rapid expansion in the volume and complexities of laparoscopic surgeries has been accompanied by complications, many of which can be directly attributed to abdominal access with laparoscopic trocars including visceral injury, vascular injuries, air embolism, subcutaneous emphysema, port site infections, incisional hernia and metastasis occurred post operatively. Objectives This study aimed to detect the different port site complications encountered in laparoscopic abdominal surgery in terms of incidence and management. Patients and Methods This study was conducted in the surgical operating theatre of Ain-Shams University Hospitals (Demerdash and Ain Shams University Specialized Hospital), Cairo, Egypt, from January 2018 till July 2018. Results In this study complications occurred in 37 cases out of the 400 cases (Study subjects). The incidence of port site complications in our study was 9.25%. Vessel injury occurred in 19 out of the 400 cases with incidence 4.75%. Port site infection occurred in 11 out of the 400 cases with incidence 2.75%. Visceral injury occurred in 4 out of the 400 cases with incidence 1%. Port site hernia occurred in 3 out of the 400 case with incidence 0.75%. Conclusion Study incorporated 400 subjects operated for different indications laparoscopically and patients developing any kind of complications were recorded and analyzed. The results showed 3(0.75%) port site hernias, 11(2.75%) port site infections,19 (4.75%) vessel injury, 4 (1%) visceral injury and no port site metastasis was detected.

The effect of Nursing Intervention Protocol About Laparoscopic Urological Surgery on Nurse’s Performance and Patient Outcome

Laparoscopy is a surgical procedure that allows for visualization of the abdominal cavity through a small incision. The aim of this study was to assess the effect of nursing Intervention Protocol about laparoscopic urological surgery on nurse‟s Performance and Patient outcome. Research design: A Quasi experimental research design was used to conduct this study. Setting: The study was carried out at urological operating room in urology and nephrology hospital. Sample: All available nurses (17) and 60 patients were included in this study. Tools of data collection were nurse‟s knowledge assessment questionnaire method, nurse's practice observational checklist, and Patient assessment sheet. Results: A positive correlation between nurses‟ knowledge and practice regarding urologic abdominal laparoscopic surgery. There was a statistically significant difference between both times of follow-up regarding incidence of complications. Conclusion: The nurse‟s knowledge and performance about laparoscopic surgery were limited. Recommendations: Improve level of professional nurses „performance through attending scientific meetings, conferences and well-structured training programs should be offered to the nurses for maintain high-quality of care.

Transversus Abdominis Plane Block Reduced Early Postoperative Pain after Robot-assisted Prostatectomy: a Randomized Controlled Trial

Analgesic effect of transversus abdominis plane block (TAP block) in lower major abdominal laparoscopic surgery with about 5 cm of maximum surgical scar has been controversial. We hypothesized that TAP block has benefits, so the analgesic effect of TAP block after robot-assisted laparoscopic prostatectomy (RALP) was evaluated. One hundred patients were enrolled in this prospective, double-blinded, randomized study. Standardized general anesthesia with wound infiltration on camera port and fentanyl dose limit of 3 µg/kg was provided. Ultrasound-guided, single-shot subcostal TAP block with either 0.375% ropivacaine (Ropivacaine group, 48 patients) or normal saline (Control group, 52 patients) was performed by anesthesiologist in charge (34 anesthesiologists) after surgical procedure. Pain score using numerical rating scale (NRS) and postoperative intravenous fentanyl were evaluated for the first 24 postoperative hours. Median values (interquartile range) of NRS scores when the patients were transferred to post-anesthesia care unit (PACU) were 5 (2–7) in Ropivacaine group and 6 (4–8) in Control group at rest (P = 0.03), 5 (2–8) in Ropivacaine group and 7 (5–8) in Control group during movement (P < 0.01). These significant differences disappeared at the time of discharging PACU. Fentanyl doses for the first 24 postoperative hours were 210 µg (120–360) in Ropivacaine group and 200 µg (120–370) in Control group (P = 0.79). These results indicated that subcostal TAP block by anesthesiologists of varied level of training reduced postoperative pain immediate after RALP. TAP block had fundamental analgesic effect, but this benefit was too small to reduce postoperative 24-hour fentanyl consumption.

Effect of Automatic Recruitment Maneuver on Peroperative Lung Mechanics of Obese Laparoscopic Abdominal Surgery Patients

Effect of Automatic Recruitment Maneuver on Peroperative Lung Mechanics of Obese Laparoscopic Abdominal Surgery Patients

Enhanced Recovery After Surgery in Pediatric and Adolescent Gynecology: A Pilot Study.

Enhanced recovery after surgery (ERAS) protocols have been successfully implemented in adult gynecology as well as adult and pediatric colorectal and urologic surgery with reduction in narcotic use, complications, return to the system (RTS), length of stay (LOS), and improved patient satisfaction. There are no studies evaluating the use of ERAS in pediatric and adolescent gynecology (PAG). The goals of this study are to present initial patient outcomes using ERAS in PAG patients undergoing intra-abdominal gynecologic surgery to prove efficacy, patient satisfaction, and decreased narcotic use. As a quality improvement measure in perioperative care, an ERAS protocol including preoperative, intraoperative, and postoperative components and a follow-up patient telephone call for pain assessment was implemented for all intra-abdominal gynecologic procedures. A retrospective study on implementation of ERAS components, outcomes, and patient satisfaction was then performed in participants meeting inclusion criteria. Large academic children's hospital. Patients <25years of age who underwent laparoscopic (LSC) or open abdominal (XLAP) gynecologic surgery using an ERAS protocol by the PAG service over a 12-month period. An ERAS protocol including preoperative, intraoperative, and postoperative components and follow-up patient telephone call for pain assessment was implemented for all major gynecologic surgeries performed by the PAG service. Patient satisfaction with the perioperative ERAS protocol along with components including pain management, narcotic use, LOS, RTS, and postoperative complications for various intra-abdominal gynecologic procedures. A total of 40 participants met inclusion criteria for the study. Thirty-four (85%) participants underwent LSC procedures and six (15%) underwent XLAP. Of the LSC patients, 95% were discharged on postoperative day 0, and all XLAP patients and one LSC patient were discharged on postoperative day 1. In all, 95% of patients were discharged from the hospital requiring only non-narcotic ERAS medications. There were no readmissions or postoperative complications. All patients were satisfied with their postoperative pain control at their follow-up telephone call and clinic visit. Implementation of a pediatric-specific ERAS protocol in children and adolescents undergoing gynecologic surgery is feasible and safe, and leads to less narcotic use without an increase in complications or decrease in patient satisfaction.

Morbidity and Mortality of Single Incision Cholecystectomy: Results of a 3-Year Register Analysis

Two decades ago, single-incision surgery was established as a new concept in minimally invasive surgery. Single incision cholecystectomy is the most frequently performed procedure in clinical routine. Most of the results have been based on randomised trials. Large prospective multicentre observational datasets from clinical routine do not exist. This analysis of clinical health service research is based on the SILAP study (single-incision multiport/single port laparoscopic abdominal surgery study). The data of the register were collected in 47 hospitals in the period of 2012 to 2014. Overall morbidity and mortality were the primary outcome. Multiple linear and logistic regression analyses were performed. Statistical significance was set at p < 0.05. Data from 975 patients in clinical routine with single incision cholecystectomy were collected. Intraoperative complications were recorded in 3.2% of cases. Bile duct injuries were registered in 0.1% of cases. Postoperative complications were detected in 3.7% of cases. The mortality rate was 0.2%.The median operating time dropped from 60.0 to 51.5 min (p < 0.001) during the study. The use of an extra trocar was necessary in 10.3% of cases. Conversion to open surgery was performed in 0.7% of cases. Body mass index (p = 0.024), male gender (p = 0.012) and operating time (p < 0.001) had a significant effect on intraoperative complications in multivariate analysis. Classification of ASA III (p = 0.001) and modification or conversion of single incision technique (p = 0.001) were significantly associated with postoperative complications. The register analysis of the prospective multicentre data shows that single incision cholecystectomy is feasible in clinical routine even outside the selective criteria of randomised studies. The only limitation is a BMI > 30 kg/m2 which has a significant influence on the intraoperative rate of complications in mild adverse events.

Low intra-abdominal pressure and deep neuromuscular blockade laparoscopic surgery and surgical space conditions: A meta-analysis.

Background:Low intra-abdominal pressure (IAP) and deep neuromuscular blockade (NMB) are frequently used in laparoscopic abdominal surgery to improve surgical space conditions and decrease postoperative pain. The evidence supporting operations using low IAP and deep NMB is open to debate.Methods:The feasibility of the routine use of low IAP +deep NMB during laparoscopic surgery was examined. A meta-analysis is conducted with randomized controlled trials (RCTs) to compare the influence of low IAP + deep NMB vs. low IAP + moderate NMB, standard IAP +deep NMB, and standard IAP + moderate NMB during laparoscopic procedures on surgical space conditions, the duration of surgery and postoperative pain. RCTs were identified using the Cochrane, Embase, PubMed, and Web of Science databases from initiation to June 2019. Our search identified 9 eligible studies on the use of low IAP + deep NMB and surgical space conditions.Results:Low IAP + deep NMB during laparoscopic surgery did not improve the surgical space conditions when compared with the use of moderate NMB, with a mean difference (MD) of −0.09 (95% confidence interval (CI): −0.55–0.37). Subgroup analyses showed improved surgical space conditions with the use of low IAP + deep NMB compared with low IAP + moderate NMB, (MD = 0.63 [95% CI:0.06–1.19]), and slightly worse conditions compared with the use of standard IAP + deep NMB and standard IAP + moderate NMB, with MDs of −1.13(95% CI:−1.47 to 0.79) and −0.87(95% CI:−1.30 to 0.43), respectively. The duration of surgery did not improve with low IAP + deep NMB, (MD = 1.72 [95% CI: −1.69 to 5.14]), and no significant reduction in early postoperative pain was found in the deep-NMB group (MD = −0.14 [95% CI: −0.51 to 0.23]).Conclusion:Low IAP +deep NMB is not significantly more effective than other IAP +NMB combinations for optimizing surgical space conditions, duration of surgery, or postoperative pain in this meta-analysis. Whether the use of low IAP + deep NMB results in fewer intraoperative complications, enhanced quality of recovery or both after laparoscopic surgery should be studied in the future.

Comparison of ultrasound-guided and laparoscopic-assisted transversus abdominis plane block for postoperative analgesia in laparoscopic abdominal surgery

Comparison of ultrasound-guided and laparoscopic-assisted transversus abdominis plane block for postoperative analgesia in laparoscopic abdominal surgery

Risk of postoperative complications and recovery in laparoscopic versus open abdominal and plastic surgery in Asir, Saudi Arabia

Risk of postoperative complications and recovery in laparoscopic versus open abdominal and plastic surgery in Asir, Saudi Arabia

A comparative study of prophylaxis of post operative nausea and vomiting (PONV) with intravenous ondasetron, granisetron and palonosetron in patients undergoing laparoscopic abdominal and gynaecological surgeries under general anaesthesia

A comparative study of prophylaxis of post operative nausea and vomiting (PONV) with intravenous ondasetron, granisetron and palonosetron in patients undergoing laparoscopic abdominal and gynaecological surgeries under general anaesthesia

A COMPARATIVE STUDY OF PULMONARY FUNCTION TEST IN LAPAROTOMY AND LAPAROSCOPIC SURGERIES

Background and Aims- Respiratory complications account to majority of post-operative outcomes after abdominal surgeries. Data on exact prevalence and probability after different surgeries is scanty. Aim of our study is to evaluate pre and post operative differences objectively by using spirometry in patients undergoing upper abdominal laparoscopic and laparotomy surgeries. Methods- Seventy-one patients consecutively undergoing surgeries were enrolled, of which 36 underwent laparoscopic and rest open laparotomy. Patients were subjected to spirometry pre and post operatively, and FVC, FEV1, FEV1/FVC, VC were calculated. This cross sectional data was analysed using paired “t” test, Students “t” test and Chi square. Results- Preoperative FEV1,ERV, TLC, PEFR were significantly better in laparotomy than laparoscopic group (p value &lt;0.05). Age, sex and BMI were not significant determinants. Post operatively the laparoscopic group had better outcomes than laparotomy group. The exact mechanisms were not known but minimal scar length, lesser damage to diaphragm and muscles, younger age of patients in laparoscopic group and early postoperative rehabilitation could be possible explanations Conclusions- Present study demonstrates that laparoscopic surgeries has less adverse effects on postoperative pulmonary function than laparotomy surgeries. This may correlate with lower post op respiratory complications in laparoscopy group

Relationship Between Preoperative Anxiety and Postoperative Nausea/Vomiting in Patients Undergoing Laparoscopic Abdominal Surgery: Mediating Effect of Postoperative Pain

Relationship Between Preoperative Anxiety and Postoperative Nausea/Vomiting in Patients Undergoing Laparoscopic Abdominal Surgery: Mediating Effect of Postoperative Pain

Effects of laparoscopy and laparotomy on stress and hemodynamics in experimental sepsis model in rats

Aim: Laparoscopic abdominal surgery leads to reduced inflammatory response compared with laparotomy. However, there is controversial approaches are present in abdominal diseases complicated by diffuse or localized peritonitis. Materials and Methods: Experimental cecal ligation and puncture method is used in the study. A total of 24 rats were used in the study. We divided all rats randomly four groups: control, sepsis, laparotomy and laparoscopy. After sepsis model was applied, we took blood samples and lung and liver samples as well. In plasma samples we determined 8-OHdG, 3-Nitrotyrosine, HNE, PGF-2 via ELISA methods. The tissue samples were analyzed since the amount of blood samples were inadequate in all subjects. We measured MPO activity to assess the neutrophil infiltration rates. Results: 3-NT mean values in laparotomy and laparoscopy groups were found to be almost the same while the difference between sepsis and laparoscopy groups was statistically significant (p =0.015) and decreased in the group undergoing laparoscopy. MPO levels obtained in rats underwent laparoscopy in liver tissue were found to be lower when compared with control and laparotomy groups and the difference between them was statistically significant. Also, MPO levels was found higher in sepsis laparotomy model as compared sepsis laparoscopy models. Conclusion: Laparoscopy is accepted as golden standard in several elective procedures, since it is less stressful. Our results indicate that laparoscopy is superior to laparotomy in terms of inflammatory response in sepsis and should be preferred in septic patients.

Effect of pneumoperitoneum on dynamic variables of fluid responsiveness (Delta PP and PVI) during Trendelenburg position.

Background and Aims:Pulse pressure variation (ΔPP) is considered as one of the best predictors of fluid responsiveness in patients under mechanical ventilation. Pleth Variability Index (PVI) has been proposed as a noninvasive alternative. However, pneumoperitoneum has been recently suggested as a limitation to their interpretation. The aim of this study was to compare changes in ΔPP and PVI related to autotransfusion associated with a Trendelenburg maneuver before and during pneumoperitoneum.Methods:50 patients undergoing elective abdominal laparoscopic surgery were enrolled in this prospective observational study. All patients were equipped with an invasive radial artery catheter and a PVI probe. After obtaining a stable signal with both ΔPP and PVI, baseline values were recorded, before and after head-down tilts of 10°, with or without abdominal insufflation (10-12 mmHg). All measurements were made before any fluid challenge under standardized anaesthesia, while patients were paralyzed and mechanically ventilated with 8 mL/kg tidal volume.Results:Changes in ΔPP and PVI associated with the Trendelenburg maneuver before and after insufflation of the pneumoperitoneum were significantly different (P < 0.001). In baseline conditions, the Trendelenburg maneuver was associated with a significant decrease in heart rate while mean arterial pressure remained unchanged. Both ΔPP and PVI decreased. After insufflation of the pneumoperitoneum, the Trendelenburg maneuver was associated with a significant decrease in heart rate and ΔPP and an increase in mean arterial pressure while PVI remained unchanged.Conclusion:Pneumoperitoneum did not alter the response of ΔPP to autotransfusion associated with the Trendelenburg maneuver, which was not the case for the PVI. This latter decreased during Trendelenburg maneuver performed alone and remained unchanged during Trendelenburg maneuver performed after insufflation of the pneumoperitoneum.

Effect of different types of laryngeal mask airway placement on the right internal jugular vein: A prospective randomized controlled trial.

BACKGROUNDIn recent years, with the popularity of laryngeal mask airway (LMA) for the management of clinical anesthesia, the influence of the LMA on the position and blood flow of the internal jugular vein (IJV) has attracted an increasing amount of attention.AIMTo investigate the effect of placement of different types of LMA (Supreme LMA, Guardian LMA, I-gel LMA) on the position and blood flow of the right IJV.METHODSThis was a prospective randomized controlled trial. A total of 102 patients aged 18-75 years who were scheduled to undergo laparoscopic abdominal surgery with general anesthesia were randomly assigned to three groups: Supreme LMA (group 1), Guardian LMA (group 2), and I-gel LMA (group 3) groups. The main indicator was the overlap index (OI) of IJV and the common carotid artery (CCA) at the high, middle, and low points before and after the placement of the LMA. The second indicators were the proportion of ultrasound-simulated needle crossing the IJV and CCA, and the cross-sectional area and blood flow velocity of the IJV before and after placement of the LMA at the middle point.RESULTSData from 100 patients were included in the statistical analysis. The OI increased significantly after placement of the LMA in the three groups at the three points (P < 0.01), except group 2 at the low point. In group 2 and group 3, the OI was lower than that in group 1 after LMA insertion at the high point (P < 0.0167). At the middle point, after LMA insertion, the proportion of simulated needle crossing the IJV significantly decreased in all three groups (P < 0.05), and the proportion in group 2 was higher than that in group 3 (P < 0.0167). The proportion of simulated needle crossing the CCA or both the IJV and CCA significantly increased in group 1 and group 2 (P < 0.05), which increased with no statistical significance in group 3. After LMA insertion, the cross-sectional area of ​​the IJV significantly increased, while the blood flow velocity significantly decreased (P < 0.01). There was no significant difference among the three groups.CONCLUSIONThe placement of Supreme, Guardian, and I-gel LMA can increase the OI, reduce the success rate of IJV puncture, increase the incidence of arterial puncture, and cause congestion of IJV. Type of LMA did not influence the difficulty of IJV puncture. Therefore when LMA is used, ultrasound is recommended to guide the IJV puncture.

Bilateral single-injection erector spinae plane block versus intrathecal morphine for postoperative analgesia in living donor laparoscopic hepatectomy: a randomized non-inferiority trial

BackgroundIntrathecal morphine (ITM) provides effective postoperative analgesia in living donor hepatectomy but has significant adverse effects. Studies support the efficacy of erector spinae plane (ESP) blocks in laparoscopic abdominal surgery;...

Ureter Identification In an Inflammatory Pig Model Using a Novel Near-Infrared Fluorescent Dye.

Ureters are at risk of injury in settings of inflammation and distorted anatomy. The use of a fluorescent dye can improve intraoperative ureteral identification without the need for any additional invasive procedures. Our team has previously described the development of a preclinical ureter-specific dye, UL-766, tested in a rat model. Here, we present the use of the fluorescent dye during laparoscopy to assist in ureteral identification in a swine model with an inflamed abdomen; the results of this study serve as proof of feasibility for use in the setting of tissue edema and erythema. With institutional approval, two 20-25 kg pigs underwent abdominal surgery with the use of a Food and Drug Administration-approved fluorescence laparoscopic system. Using standard laparoscopy, inflammation was induced with sharp and blunt dissection and irritation was induced with gauze. The animals were allowed to recover and returned to the operating room after 7 days. Images of the inflamed right retroperitoneum, with fluorescence imaging, turned on, were taken before and after intravenous injection of the novel fluorescent dye at 120 μg/kg. The time until fluorescence visualization of the ureters was measured, and the fluorescent signal was measured for up to 4 hours from the time of the initial dye injection. Partial and complete transection of ureteral injuries was made by scissors and monitored under both standard video and fluorescence laparoscopy. Inflammation reduced the certainty of ureter identification by white light alone. Despite surrounding tissue erythema and edema, ureteral visualization under fluorescence laparoscopy was achieved within 5-10 minutes after dye injection. The fluorescent signal remained visible for at least 4 hours after injection, and the fluorescent dye showed a partial ureteral injury that would not have been observed under standard laparoscopy. UL-766 is a preclinical fluorescent dye useful for the intraoperative identification of the ureters and ureteral injuries in an inflamed abdomen. With the acquisition of additional preclinical data, this novel dye can be a valuable tool during laparoscopic abdominal and pelvic surgeries. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.