Laparoscopic Cholecystectomy Surgery Research Articles

Automated Stand-alone Surgical Safety Evaluation for Laparoscopic Cholecystectomy (LC) using Convolutional Neural Network and Constrained Local Models (CNN-CLM)

In this golden age of rapid development surgeons realized that AI could contribute to healthcare in all aspects, especially in surgery. The aim of the study will incorporate the use of Convolutional Neural Network and Constrained Local Models (CNN-CLM) which can make improvement for the assessment of Laparoscopic Cholecystectomy (LC) surgery not only bring opportunities for surgery but also bring challenges on the way forward by using the edge cutting technology. The problem with the current method of surgery is the lack of safety and specific complications and problems associated with safety in each laparoscopic cholecystectomy procedure. When CLM is utilize into CNN models, it is effective at predicting time series tasks like identifying the sequence of events in the Laparoscopic Cholecystectomy (LC). This study will contribute to show the effectiveness of CNN-CLM approach on laparoscopic cholecystectomy, which will frequently focus on surgical computer vision analysis of surgical safety and related applications. The method of study is deep learning based CNN-CLM to better detect nominal safety as well as unsafe practices around the critical view of safety and AI-based grading scale. The general design flow of AI-recognition of surgical safety is firstly collecting safety surgical videos for frame segmenting and phase according to the image context by surgeon reviewer by CNN-CLM. For this advance research, the dataset is splatted into three main parts where 70% of which is used for training, 15% of which is used for testing and the rest for the cross validation, to achieve the accuracy up to 98.79% of this specific research. For result part, different metrics of CNN-CLM to evaluate the performance of the proposed model of safety in surgery. The study uses one of the top three performing methods CNN-CLM for the evaluation yields and anatomical structures in laparoscopic cholecystectomy surgery.

Ultrasound guided erector spinae plane block versus quadratus lumborum block for post-operation analgesia in laparoscopic cholecystectomy surgeries: A randomized controlled trial

Background: An effective interfascial plane block for laparoscopic (lap) cholecystectomy and other abdominal procedures is the Quadratus Lumborum Block type II (QLB-II). The erector spinae plane block (ESPB), which is guided by ultrasound (US), is a recently described interfascial plane block that is gaining popularity. This research aims to evaluate the relative effectiveness of ultrasound ESPB and US QLB in the treatment of immediate post-operation pain following lap cholecystectomy.Methods: Sixty cases (21-65 years old, from both sexes) having elective lap cholecystectomy were enrolled in this prospective randomized double-blind research. The cases were randomly classified into three equal groups, C group: received general anesthesia (GA) only, ESPB: received GA and bilateral US ESPB and QLB: received GA and bilateral US QLB.Results: Duration of performing block was significantly less in group ESPB versus group QLB. Intraoperative heart rate and mean arterial pressure were significantly less after incising the skin, at 30 min in ESPB and QLBs versus group C. Total fentanyl dosage and morphine dosage in 1st 1 day were significantly less in group ESPB and QLB versus group C. NRS at 6, 24 hour was significantly less in ESPB and QLBs versus group C. First time to call for analgesic requirement was significantly delayed in the ESPB and QLBs versus the C group. Conclusions: The ESPB is as efficient as posterior QLB to provide effective analgesia as comparable results of lower NRS, intraoperative fentanyl and post-operation opioid dosage, delayed first time to call for analgesic requirement and is lower side effects versus control in cases undergoing elective laparoscopic cholecystectomy.

Comparison of the effectiveness of transversus abdominis plane block with laparoscopy or ultrasonography in laparoscopic cholecystectomy operations.

This study aims to compare the effectiveness of the Transversus Abdominis Plane (TAP) block applied to reduce postoperative pain in laparoscopic cholecystectomy surgery by ultrasonography (USG) and laparoscopy. A total of 170 patients who underwent laparoscopic cholecystectomy were divided into three groups. Group L received TAP block by laparoscopy, Group U received TAP block by USG, and the control group (Group C) did not receive TAP block. Bilateral subcostal 15 mL 0.5% bupivacaine was used for the TAP block. We recorded patients' demographic data and hemodynamic parameters, surgery time, anesthesia time, time of first postoperative analgesic need, visual analog scale (VAS) scores, time to first flatulence and stool, degree of nausea-vomiting, and the Turkish Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R-T) scores. We observed no statistically significant differences between the groups in terms of age, gender, or American Society of Anesthesiologists scores, and body mass index was higher in Group U compared to the other groups (p<0.05). The VAS score was significantly higher in the control group at all times compared to the other two groups (p<0.001). VAS measurements were higher in Group U at postoperative 1st and 12th h compared to Group L (p<0.001). Surgery time and anesthesia time were significantly different between the groups (p=0.001). Group C showed high VAS scores, high pain severity by APS-POQ-R-T at the 24th postoperative hour, and low sleep quality and patient satisfaction. For laparoscopic cholecystectomy surgery, applying TAP block with the help of USG is effective in postoperative pain management. Applying TAP block with laparoscopy is easy since it does not require additional preparation or equipment during the procedure and may be preferred in the absence of a USG device.

A Case of Delayed Recovery of Navel Wound Healing after Laparoscopic Surgery for Cholecystectomy Successfully Treated with a Kampo Formulation Senkinnaitakusan

A Case of Delayed Recovery of Navel Wound Healing after Laparoscopic Surgery for Cholecystectomy Successfully Treated with a Kampo Formulation Senkinnaitakusan

Intraperitoneal instillation of levobupivacaine plus dexmedetomidine versus ropivacaine plus dexmedetomidine for post-operative analgesia in patients undergoing laparoscopic cholecystectomy

Introduction: Laparoscopic procedures have many advantages over open procedures, such as less haemorrhage, better cosmetic results, less post-operative pain and shorter recovery time, leading to a shorter hospital stay and less expenditure. Hence, the present study was undertaken for comparing the effect of intraperitoneal installation of levobupivacaine (L-B) plus dexmedetomidine versus ropivacaine plus dexmedetomidine for post-operative analgesia in patients undergoing laparoscopic cholecystectomy (LC). Materials and Methods: This was a prospective randomized study conducted in our hospital on 60 American Society of Anaesthesiologists grade I or II patients of either sex, aged 18–55 years, scheduled to undergo LC surgery under general anaesthesia. All patients were randomly divided into two groups of 30 each: Group 1: Patients were given 20 ml of 0.5% L-B plus 0.25-μg/kg dexmedetomidine intraperitoneally after gallbladder removal, and Group 2: Patients were given 20 ml of 0.5% ropivacaine plus 0.25-mg/kg dexmedetomidine intraperitoneally after gallbladder removal. Post-operatively, the patients were assessed for pain utilizing a visual analogue scale (VAS). VAS was graded on a scale of 0–10. VAS was recorded at 0, 1, 8, 12 and 24 h post-operatively and compared. Results: Mean time to first analgesic requirement among patients of Group 1 and Group 2 was 365.1 min and 297.2 min, respectively, which shows a statistically significant longer post-operative analgesic effect in Group 1 patients. While comparing VAS at different time intervals in between the two study groups, all the readings were comparable. The difference was found to be non-significant in the two groups (P > 0.05). Nausea and vomiting were seen in two patients in Group 1 and three patients in Group 2. Complications were noted in <10% of the patients in both groups. Conclusion: Intraperitoneal instillation of local anaesthetic solution in LC provides effective post-operative analgesia, and analgesia provided by L-B plus dexmedetomidine is better than ropivacaine plus dexmedetomidine.

Can intra-operative methylprednisolone application be effective for post-operative pain, nausea and vomiting in laparoscopic cholecystectomy operations?

Background/Aim: Post-operative nausea, vomiting (PONV), and pain are common symptoms after laparoscopic cholecystectomy (LC) that is performed under general anesthesia. These symptoms lead to prolongation of post-operative recovery and hospital stay. In this study, the efficacy of intra-operative methylprednisolone (MP) administration on post-operative pain and PONV was investigated in patients undergoing LC under general anesthesia. Methods: This study was conducted at Uşak University Faculty of Medicine Hospital. Patients who underwent LC under general anesthesia between 01.11.2018 and 01.06.2019 were evaluated using the prospective cohort method. While intra-operative MP was administered to one group of patients who underwent LC (MP group), MP was not administered to the second group (non-MP). The pain was evaluated using the Visual Analog Scale (VAS) while PONV was evaluated with the Verbal Descriptive Scale (VDS in patients at post-operative hours 0, 1, 2, 6, 12, 18, and 24. On the first post-operative day, patient satisfaction was assessed. Results: The study cohort consisted of 76 patients. The VAS was used to measure post-operative pain, and it was discovered that the MP group had significantly reduced VAS values at post-operative hours 0, 1, 2, 6, 12, 18, and 24 (P &lt; 0.001). In the VDS evaluation, no difference between the two groups only at post-operative hour 12 (P = 0.52) was found, while the VDS value was found to be lower in the MP group than in the non-MP group at post-operative hours 0, 1, 2, 6, 18, and 24 (P ˂ 0.001). The mean total analgesic use at post-operative hour 48 was 69.08 (26.91) mg in the MP group and 96.71 (42.38) mg in the non-MP group. The difference was statistically significant (P ˂ 0.001). Conclusion: PONV and discomfort incidence decreased after intra-operative MPadministration. The decrease in these symptoms was positively reflected in post-operativepatient satisfaction.

The evaluation of the analgesic effect of intraperitoneal bupivacaine versus bupivacaine with neostigmine on postoperative pain in laparoscopic cholecystectomy: a randomized controlled double-blinded study

BackgroundThis study aimed to compare the duration of postoperative analgesia using intraperitoneal bupivacaine plus neostigmine or bupivacaine alone. In this randomized controlled trial, we included 56 adult patients scheduled for elective laparoscopic cholecystectomy operation. Patients were randomly allocated into two groups bupivacaine group (B group) who received 50 ml bupivacaine 0.25% alone and bupivacaine-neostigmine group (BN group) who received 500 μg neostigmine added to 50 ml bupivacaine 0.25%. The study drug was instilled intraperitoneal according to group allocation before the start of the surgery. Primary outcome was the duration of analgesia. Other outcome included total dose of postoperative analgesic consumption and postoperative nausea and vomiting.ResultsPatients in BN group showed longer duration of analgesia after surgery and longer time for 1st analgesic dose than the patients in B group. Total dose of postoperative pethidine and the incidence of postoperative nausea and vomiting were lower in number in the BN group than in the B group.ConclusionsIntraperitoneal instillation of neostigmine as an adjunct to bupivacaine in elective laparoscopic cholecystectomy increased the duration of postoperative analgesia. Also, it might reduce postoperative pain and analgesic requirements as compared to bupivacaine 0.25% alone.Trial registrationName of the registry: Clinical trialClinical Trial registration number: NCT04244097Date of registration: 28 January 2020URL of trial registry record: https://clinicaltrials.gov/ct2/show/NCT04244097

The effect of paravertebral block as a part of multimodal analgesia for laparoscopic cholecystectomy surgery

Aims: In laparoscopic cholecystectomy surgery (LCS), for anesthesiologist and surgeons postoperative analgesia method is still problem. The aim of this study is to evaluate the effect of preoperative paravertebral block (PVB) application as a part of multimodal analgesia on postoperative pain management in this surgery.&#x0D; Methods: In this prospective, randomized, single blinded study, over 18 years old, 70 (ASA I-II) patients who underwent elective LCS were included. In the control group, analgesia was managed with only traditional multimodal analgesia methods, while ultrasound- guided PVB (20 ml of 0.5% bupivacaine,T7 level) was added to multimodal anagesia in the study group. Postoperative pain reduction was evaluated using VAS at 1, 6, 12 and 24 hours postoperatively, and morphine consumption amount was caLCSulated with IV patient-controlled analgesia in the postoperative period.&#x0D; Results: Demographic data were similar in both groups. VAS scores at 1 and 6 hours were statistically significantly lower in the PVB group (p&lt;0.05). When evaluated in terms of morphine consumption, it was observed that significantly less morphine was consumed in the PVB group compared to the control group in the first 24-hour period (p&lt; 0.001). Shoulder pain was seen only in 3 patients in the control group.&#x0D; Conclusions: In LCS, it was observed that PVB application under the guidance of US increased the effectiveness of multimodal anagesia and decreased postoperative morphine consumption. In addition, problems such as postoperative nausea, vomiting and shoulder pain were less common.

Use of prospective video analysis to understand the impact of technical difficulty on operative process during laparoscopic cholecystectomy.

An understanding of the impact of operative difficulty on operative process in laparoscopic cholecystectomy is lacking. The aim of the present study was to prospectively analyse digitally recorded laparoscopic cholecystectomy to assess the impact of operative technical difficulty on operative process. Video of laparoscopic cholecystectomy procedures performed at Christchurch Hospital, NZ and North Shore Private Hospital, Sydney Australia were prospectively recorded. Using a framework derived from a previously published standard process video was annotated using a standardized template and stratified by operative grade to evaluate the impact of grade on operative process. 317 patients had their laparoscopic cholecystectomy operations prospectively recorded. Seventy one percent of these videos (n=225) were annotated. Single ICC of operative grade was 0.760 (0.663-0.842 p<0.010). Median operative time, rate of operative errors significantly increased and rate of CVS decreased with increasing operative grade. Significant differences in operative anatomy, operative process and instrumentation were seen with increasing grade. Operative technical difficulty is accurately predicted by operative grade and this impacts on operative process with significant implications for both surgeons and patients. Consequently operative grade should be documented routinely as part of a culture of safe laparoscopic cholecystectomy.

Transversus Abdominis Plane Block as a Strategy for Effective Pain Management in Patients with Pain during Laparoscopic Cholecystectomy: A Systematic Review.

Laparoscopic cholecystectomy (LC), unlike laparotomy, is an invasive surgical procedure, and some patients report mild to moderate pain after surgery. Transversus abdominis plane (TAP) block has been shown to be an appropriate method for postoperative analgesia in patients undergoing abdominal surgery. However, there have been few studies on the efficacy of TAP block after LC surgery, with unclear information on the optimal dose, long-term effects, and clinical significance, and the analgesic efficacy of various procedures, hence the need for this review. Five electronic databases (PubMed, Academic Search Premier, Web of Science, CINAHL, and Cochrane Library) were searched for eligible studies published from inception to the present. Post-mean and standard deviation values for pain assessed were extracted, and mean changes per group were calculated. Clinical significance was determined using the distribution-based approach. Four different local anesthetics (Bupivacaine, Ropivacaine, Lidocaine, and Levobupivacaine) were used at varying concentrations from 0.2% to 0.375%. Ten different drug solutions (i.e., esmolol, Dexamethasone, Magnesium Sulfate, Ketorolac, Oxycodone, Epinephrine, Sufentanil, Tropisetron, normal saline, and Dexmedetomidine) were used as adjuvants. The optimal dose of local anesthetics for LC could be 20 mL with 0.4 mL/kg for port infiltration. Various TAP procedures such as ultrasound-guided transversus abdominis plane (US-TAP) block and other strategies have been shown to be used for pain management in LC; however, TAP blockade procedures were reported to be the most effective method for analgesia compared with general anesthesia and port infiltration. Instead of 0.25% Bupivacaine, 1% Pethidine could be used for the TAP block procedures. Multimodal analgesia could be another strategy for pain management. Analgesia with TAP blockade decreases opioid consumption significantly and provides effective analgesia. Further studies should identify the long-term effects of different TAP block procedures.

Case Report on Choledocholithiasis with ERCP with thrombosis of the portal vein, splenic vein, superior mesenteric vein with systemic

Background: Cholelithiasis, one of the most common medical conditions leading to surgical intervention, affects approximately 10 % of the adult population in the United States. Choledocholithiasis develops in about 10%-20% of patients with gallbladder stones and the literature suggests that at least 3%-10% of patients undergoing cholecystectomy will have common bile duct (CBD) stones. Case Presentation: A 48-year female was admitted to the tertiary care hospital Wardha in the female medicine ward, with the primary complaint of abdominal pain, back pain, nausea, vomiting, fever, bloating in the abdomen, constipation. No medical history such as diabetes mellitus, No significant history. Physical examination and systemic examination were done. The patient's general appearance is not good, she was undernourished, the patient is not active and very dull nature, not maintained hygiene and personal grooming Conservative. Haemoglobin 10 gm%, WBC Count 5000 cells /mm³, RBC Count 20000- 40000 IgM and IgG cells /mcL test both positive, platelets count 12000 cells / mm³, endoscopic retrograde cholangiopancreatography for confirming the diagnosis Choleodolithiasis with ERCP with thrombosis of the portal vein, splenic vein, superior mesenteric vein with systemic. Computed tomography and Magnetic resonance imaging, urine culture, and complete blood count were done and which were abnormal. The patient was transfused to the surgery ward for surgical management. Patient managed with the surgery of laparoscopic cholecystectomy surgery help to remove gallstones and also managed with medical management given to patient antibiotics, analgesics, antacids, and other supportive measures. Conclusion Due to conservative management and quality of nursing care, the patient's condition was stable and had no active complaints at present hence the patient is being discharged.

Ultrasound-guided bilateral modified-thoracoabdominal nerve block through a perichondrial approach (M-TAPA) in patients undergoing laparoscopic cholecystectomy: a randomized double-blind controlled trial

BackgroundModified thoracoabdominal nerve block through the perichondrial approach (M-TAPA) is a new technique that provides effective analgesia of the anterior and lateral thoracoabdominal walls by administering local anesthesia only to the underside of the perichondral surface. The primary purpose of the present study was to investigate the postoperative analgesic efficacy of M-TAPA block performed before surgery in patients undergoing laparoscopic cholecystectomy (LC).MethodThe present study was designed as a double-blind, randomized, controlled, prospective study. A total of 68 patients were included in the study. In group M-TAPA, M-TAPA block was performed bilaterally after the induction of general anesthesia. No block was performed on the group control. The postoperative pain scores, analgesic use in the first 24 h, antiemetic consumption, sedation, postoperative nausea and vomiting (PONV), and Quality of Recovery-40 (QoR-40) scores were recorded.ResultsPain scores were significantly lower in group M-TAPA than in the group control, both during resting and motion at all times (p < 0.001 at each time point). The total amount of tramadol consumed in the first 24 h was lower in group M-TAPA [median 100 mg, min-max (0-200)] than in the group control (P < 0.001). Postoperative median QoR-40 scores were higher in group M-TAPA compared with the group control (P < 0.001). There were no differences between the groups in terms of other results.ConclusionAfter the LC surgery, ultrasound-guided M-TAPA block reduced postoperative pain scores and tramadol consumption effectively. It was observed that the quality of recovery was also higher because QoR-40 scores were higher.

Association between intraoperative ketamine and the incidence of emergence delirium in laparoscopic surgeries: an observational study

BackgroundEmergence Delirium (ED) is an essential condition in the immediate postoperative period. Systematic review and meta-analysis of randomized controlled trials have concluded that the effect of ketamine on postoperative delirium remains unclear. The present study sought to evaluate if the intraoperative use of ketamine for postoperative analgesia is associated with postoperative ED in laparoscopic surgeries. MethodsA prospective observational study was performed in the PostAnesthetic Care Unit (PACU) to evaluate patients who had undergone laparoscopic surgery under a rigid intraoperative anesthesia protocol from July 2018 to January 2019. Patients submitted to laparoscopic surgery for cholecystectomy, oophorectomy, or salpingectomy with a score ≥1 on the Richmond Assessment Sedation Scale (RASS) or ≥2 on the Nursing Delirium Screening Scale (Nu-DESC) were considered to have ED. t-test, Chi-Square test or Fisher's exact tests were used for comparison. ResultsOne hundred and fifteen patients were studied after laparoscopic surgery. Seventeen patients (14.8%) developed ED, and the incidence of ED in patients who received ketamine was not different from that of other patients (18.3% vs. 10.6%, p = 0.262). Patients with ED had more postoperative pain and morphine requirement at the PACU (p = 0.005 and p = 0.025, respectively). Type of surgery (general surgery, OR = 6.4, 95% CI 1.2‒35.2) and postoperative pain (OR = 3.7, 95% CI 1.2‒11.4) were risk factors for ED. ConclusionIn this study, no association was found between ED and intraoperative administration of ketamine in laparoscopic surgeries. Type of surgery and postoperative pain were risk factors for ED.

Evidence-based surgery for laparoscopic cholecystectomy

BackgroundLaparoscopic cholecystectomy is frequently performed for acute cholecystitis and symptomatic cholelithiasis. Considerable variation in the execution of key steps of the operation remains. We conducted a systematic review of evidence regarding best practices for critical intraoperative steps for laparoscopic cholecystectomy. MethodsWe identified 5 main intraoperative decision points in laparoscopic cholecystectomy: (1) number and position of laparoscopic ports; (2) identification of cystic artery and duct; (3) division of cystic artery and duct; (4) indications for subtotal cholecystectomy; and (5) retrieval of the gallbladder. PubMed, EMBASE, and Web of Science were queried for relevant studies. Randomized controlled trials and systematic reviews were included for analysis, and evidence quality was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation framework. ResultsFifty-two articles were included. Although all port configurations were comparable from a safety standpoint, fewer ports sometimes resulted in improved cosmesis or decreased pain but longer operative times. The critical view of safety should be obtained for identification of the cystic duct and artery but may be obtained through fundus-first dissection and augmented with cholangiography or ultrasound. Insufficient evidence exists to compare harmonic-shear, clipless ligation against clip ligation of the cystic duct and artery. Stump closure during subtotal cholecystectomy may reduce rates of bile leak and reoperation. Use of retrieval bag for gallbladder extraction results in minimal benefit. Most studies were underpowered to detect differences in incidence of rare complications. ConclusionKey operative steps of laparoscopic cholecystectomy should be informed by both compiled data and surgeon preference/patient considerations.

Multiple instance convolutional neural network for gallbladder assessment from laparoscopic images.

We present an artificial intelligence framework for vascularity classification of the gallbladder (GB) wall from intraoperative images of laparoscopic cholecystectomy (LC). A two-stage Multiple Instance Convolutional Neural Network is proposed. First, a convolutional autoencoder is trained to extract feature representations from 4585 patches of GB images. The second model includes a multi-instance encoder that fetches random patches from a GB region and outputs an equal number of embeddings that feed a multi-input classification module, which employs pooling and self-attention mechanisms, to perform prediction. The evaluation was performed on 234GB images of low and high vascularity from 68 LC videos. Thorough comparison with various state-of-the-art multi-instance and single-instance learning algorithms was performed for two experimental tasks: image- and video-level classification. The proposed framework shows the best performance with accuracy 92.6%-93.2% and F1 93.5%-93.9%, close to the agreement of two expert evaluators (94%). The proposed technique provides a novel approach to classify LC operations with respect to the vascular pattern of the GB wall.

Implementation of enhanced recovery protocols reduces opioid use in pediatric laparoscopic cholecystectomy surgery.

Enhanced recovery protocols [ERPs] standardize care and have been demonstrated to improve surgical quality in adults. We retrospectively compared outcomes before and after implementation of ERPs in children undergoing elective laparoscopic cholecystectomy [ELC] surgery. A pediatric-specific ERP was implemented for children undergoing ELC at one [C1] of the two Pediatric Surgical Centers in July 2016. We retrospectively reviewed 606 patients undergoing ELC between July 2014 and December 2019. Of these, 206 patients underwent ELC prior to ERP implementation [Pre-ERP] were compared to 400 patients undergoing ELC managed in the post-ERP implementation period (between January 2017 and December 2019), 21 of which were managed by enhanced recovery protocol. Primary Outcomes included immediate peri-operative and post-operative narcotic use in mean morphine equivalents [MME], narcotics at discharge, complications, nurse calls and returns to system [RTS]. There was a significant decrease in opioid use both post-operatively and at time of discharge in the ERP managed cohort. The MME use during the post-operative period was 0.85 in the in ERP-compliant patients compared to 6.40 in the non-compliant group (p < 0.027). Eighty-six percent of ERP-compliant patients in the study required no narcotics at discharge, which was statistically significant when compared to ERP non-compliant cohort (p < 0.0001). There was also no change in RTS, nurse calls or complications. In addition, in the post-ERP period (2017-2019), a dominant proportion of patients at C1 partially complied with the ERP, resulting in a statistically significantly decrease of opioid use between sites in the post-op period (6.54 vs 10.57 MME) post-ERP (p < 0.001). Similar effects were noted in discharge narcotics. The use of pediatric-specific ERP in children undergoing ELC is safe, effective, and provides compassionate pain control while leading to a reduction in opioid use peri-operatively and at discharge. This improvement occurred without changes in RTS, nursing calls or complications. Level III; Retrospective study.

The Effect of Dexmedetomidine on Attenuation of Per-operative Hemodynamic Changes During Laparoscopic Cholecystectomy

Background: Dexmedetomidine is a newer adjuvant anesthetic agent which is gaining its popularity day by day in our perspective. As an anaesthetic adjuvant dexmedetomidine has been shown to provide good perioperative haemodynamic stability during laparoscopic surgeries. But still it is to be judged its efficacy as adjuvant agent in our aspect. Objective: To observe the haemodynamic effects of intravenous dexmedetomidine during laparoscopic cholecystectomy. Methods: Eighty(80) patients (ASA grade l and ll) who underwent laparoscopic cholecystectomy surgery were randomly selected and were scrutinized according to eligibility criteria.The selected patients were divided into two groups on even and odd number basis. Even number Group A (n=40): received a bolus dose of I.V dexmedetomidine 1μg/kg over 10 minutes before induction of Anesthesia and then I.V infusion of 0.5 μg/kg/hr as a maintenance infusion and odd number Group B(n=40): received a bolus dose of same volume of normal saline before induction of Anesthesia and infusion was continued during surgery. General anesthesia was administered in all patients using fentanyl, thiopentone, succinylcholine, nitrous oxide in oxygen, halothane and muscle relaxation maintained with vecuronium bromide. A pre-tested, observation based, peer-reviewed data collection sheet was prepared before study. Results: Intra-operative mean Heart rate of Group B patients were more higher than those of Group A patients and showed statistically significant differences (P=0.003). Mean arterial pressure of Group B patients were far more higher than Group A patients in different events of peroperative period which is statistically significant (P=0.001). Mean diastolic blood pressure in Group B was significantly higher than that of Group A (P=0.0001). Conclusion: Dexmedetomidine is an effective drug that can be used as adjunctive infusion in general anesthesia in an intention to stable the hemodynamic profile in the peroperative period of different surgeries. Specially in laparoscopic cholecystectomy some patients with cardiac risk become vulnerable after CO2 gas in sufflation which can be properly managed using Dexmedetomidine. J Shaheed Suhrawardy Med Coll 2021; 13(1): 26-32

Determining a Method to Minimize Pain After Laparoscopic Cholecystectomy Surgery.

Although many studies have investigated control of postoperative pain, inadequacy of treatment still remains. In this study, we aimed to identify a method with the capacity to minimize abdominal and right shoulder pain after laparoscopic cholecystectomy. A total of 684 subjects, 77% (n=527) female and 23% (n=157) male, were included in this study. A T-drain was prescribed for patients requiring bile duct exploration and patients with acute cholecystitis were excluded from the study. Subjects were classified into groups as follows: Group 1: control group without drain and intraperitoneal analgesics; Group 2: a drain was placed but no intraperitoneal analgesic was applied; Group 3: no drain was placed and intraperitoneal subhepatic bupivacaine was applied; and Group 4: drain was placed and intraperitoneal subhepatic bupivacaine was applied. Parietal pain and visceral pain were evaluated with visual analog scale (VAS). A drain was present in 51.9% (n=355) of the cases. A statistically significant difference was found between the preoperative pulse rate measurements of the cases according to the groups ( P =0.009; <0.01). Subhepatic bupivacaine was administered in 50.1% (n=355) of the cases. A statistically significant difference was found between the second, fourth, sixth, 12th, and 24th hour VAS scores of the cases according to the groups [2h VAS scores (mean±SD): Group 1: 3.58±1.07, Group 2: 3.86±1.12, Group 3: 1.20±0.67, and Group 4: 1.50±1.21 ( P <0.001)]; [4h VAS scores (mean±SD): Group 1: 2.55±1.26, Group 2: 2.87±1.14, Group 3: 1.66±1.06, and Group 4: 2.02±1.23 ( P <0.001)]; [6h VAS scores (mean±SD): Group 1: 2.50±0.91, Group 2: 2.53±1.14, Group 3: 1.66±1.06, and Group 4: 2.02±1.23 ( P <0.001)]; [12h VAS scores (mean±SD): Group 1: 3.24±1.2, Group 2: 3.49±1.14, Group 3: 2.83±0.98, and Group 4 : 2.99±1.36 ( P <0.001)]; and [24h VAS scores (mean±SD): Group 1: 3.75±0.99, Group 2: 4.01±0.91, Group 3: 3.61±1.34, and Group 4: 4.01±1.08 ( P <0.001)]. Bupivacaine spraying reduces postoperative abdominal pain, while drain placement minimizes shoulder pain by reducing CO 2 remaining under the diaphragm.

Chemical composition of smoke produced by open versus laparoscopic surgery for cholecystectomy.

Smoke produced by traditional open surgery (TOS) has long been considered hazardous to medical staff. Compared with TOS, minimally invasive surgery under carbon dioxide pneumoperitoneum is associated with a faster recovery and less wound pain. However, the impact of oxygen-deficient environment on the chemical contents of smoke has not been comprehensively assessed. This research evaluated the chemical composition and volatile organic compound (TVOC) level in smoke produced by open cholecystectomy (OC) versus laparoscopic cholecystectomy (LC) for gallbladder diseases. Smoke samples were collected and analyzed via gas chromatography-mass spectrometry. Chemical compounds were further grouped according to molecular weight and toxicity. Compared with the OC, LC had significantly higher halocarbon and TVOC levels but lower cycloalkene and aldehyde levels. No halocarbons were isolated from OC specimens. When stratified based on molecular weight, LC had a bimodal pattern (i.e., high levels of small-sized [<60 Da] and large-sized [>120 Da] compounds). There was no difference in terms of toxicity types, incidence, and severity associated with detected compounds between two groups. LC is associated with a higher TVOC level and proportion of low- and high-molecular-weight organic compounds. Further strategies of evacuating these health hazards and preventing smoke leakage through trocars should be considered.

Effect of Guided Imagery Meditation During Laparoscopic Cholecystectomy on Reducing Anxiety: A Randomized Controlled Trial

BackgroundUp to 90% of patients still experience pain after abdominal surgery, which also affects their physical recovery and psychological anxiety. AimTo evaluate the effects of guided imagery meditation on ameliorating anxiety, improving the quality of sleep, and relieving postoperative pain in patients after laparoscopic cholecystectomy surgery. MethodIn the general surgical ward of a teaching hospital, patients were randomly assigned to usual care (n = 34) and guided imagery meditation intervention (n = 34) groups, using the method. The measuring outcomes included their anxiety score, quality of sleep, and pain control. ResultsIn terms of the anxiety difference, the experimental group scored 0.42 (standard deviation [SD] = 0.97), while the control group scored 4.79 (SD = 7.56), which indicates a statistically significant difference (F = 8.04, p = .01, partial eta2 = 0.11). In terms of quality of sleep, the mean score of the experimental group was 2.67 (SD = 1.96), while the control group scored 7.55 (SD = 3.81), which indicates a significant difference (F = 39.99, p = .001, partial eta2 = 0.39). The mean of the degree of postoperative pain was 2.11 points (SD = 1.39), and the score of the control group was 4.00 points (SD = 1.62), which indicates a significant difference (p = .001). ConclusionsGuided imagery meditation is a simple, non-invasive, non-pharmacologic intervention measure. It can reduce anxiety and postoperative pain, and improve the quality of sleep. Thus, it should be promoted in clinical practice.