JSLS : Journal of the Society of Laparoendoscopic Surgeons
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Loss of visualization of the surgical field due to pneumoperitoneum deflation when CO2 insufflator cylinders become empty can occur at key moments during laparoscopic surgery. The purpose of this study was to examine the incidence of intraoperative cylinder exhaustion in the United Kingdom, determine its impact on patient safety, and design and test a novel device to minimize the phenomenon. ⋯ Eighty-five percent of the U.K. surgeons surveyed reported loss of surgical visualization at critical times during laparoscopic surgery, caused by the decrease in pneumoperitoneum during CO2 cylinder exchange. Eighty-four percent said that the process contributed to the surgeon's stress, and 63% said that a device that maintains uninterrupted pneumoperitoneum would reduce the risk of intraoperative complications. In our locale, a timed cylinder exchange was, on average, 30 times quicker with the novel dual valve than by conventional cylinder exchange (mean conventional exchange time, 61.3 ± 7.3 s vs. novel device, 2.0 ± 0.2 s; P ≤ .0001) and could be performed just as rapidly by staff unfamiliar with the device (2.2 ± 0.3 s vs. 1.9 ± 0.4 s P = .1945). We suggest that this simple, low-cost system could be developed for use in a clinical setting to enhance patient safety.
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There is a wide variation of reported incidence of small bowel obstruction (SBO) after laparoscopic Roux-en-Y gastric bypass (LGB). There is also wide variation in technique, not only in placement of the Roux limb, but also regarding closure or nonclosure of the mesenteric defects. The objective of this study was to examine the incidence and characteristics of SBO after antecolic antegastric bypass with nonclosure of the mesenteric defect of the jejunojejunal anastomosis. ⋯ SBO after LGB is a relatively common complication. The incidence of SBO from IH with nonclosure of the mesenteric defect is similar to that in other series where the defect is closed. Regardless of the cause of the SBO, operative treatment of the patient who has a gastric bypass remains the definitive standard and should not be delayed.
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The purpose of this study was to compare the total hospital costs associated with elective laparoscopic and open inguinal herniorrhaphy. ⋯ In the setting of a Canadian academic hospital, when considering the repair of an elective unilateral inguinal hernia, the OR and total hospital costs of open surgery were significantly lower than for the laparoscopic techniques. There was no statistical difference between OR and total hospital costs when comparing open surgery and laparoscopic techniques for the repair of bilateral inguinal hernias. Given the perioperative benefits of laparoscopy, further studies incorporating hernia-specific outcomes are necessary to determine the cost-effectiveness of each approach and to define the optimal treatment strategy.
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Limited data are available comparing epidural and patient-controlled analgesia in site-specific colorectal surgery. The aim of this study was to evaluate 2 modes of analgesia in patients undergoing laparoscopic right colectomy (RC) and low anterior resection (LAR). ⋯ Epidural analgesia was associated with a faster return of bowel function in the laparoscopic LAR group but not the RC group. Epidural analgesia was superior to patient-controlled analgesia in controlling postoperative pain but was inadequate in 28% of patients and needed the addition of patient-controlled analgesia.
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The loss of an instrument during a surgical procedure is a potentially dangerous medical event. Retained surgical needles are reported to cause chronic pain, chronic irritation, and organ injury. Surgical needles lost during minimally invasive surgery are particularly difficult to retrieve because of their diminutive size and the camera's limited visual field, often prompting protracted recovery attempts that can add to surgical costs. Few detailed recommendations exist for the recovery of a misplaced needle. ⋯ On the basis of survey results and current literature, our protocol incorporates a camera survey of the abdomen, intraoperative fluoroscopic radiography, port inspection, and a quadrant-based systematic visual search for the recovery of needles lost during minimally invasive surgery.