Fitoussi, R. Article Article Outline. Access to the text HTML. Access to the PDF text. Recommend this article. Save as favorites. Access to the full text of this article requires a subscription. If you are a subscriber, please sign in 'My Account' at the top right of the screen. Patient positioning in laparoscopic surgery: Tricks and tips.
Agostini, N. Laparoscopy plays a prominent role in urology. Current residents finish their training with considerable exposure to the techniques, and a plethora of courses educate physicians already in practice. Alternatives to standard laparoscopy, including hand assistance and robotic assistance, further enhance capabilities. Laparoscopy with pneumoperitoneum exposes the patient to physiologic challenges that differ from that of open surgery, but can be met successfully with proper preparation and awareness Ost et al, As intra-abdominal pressure increases with pneumoperitoneum, the systemic vascular resistance increases and venous return decreases.
Risks and contraindications for laparoscopic surgery
A small increase in intra-abdominal pressure augments venous return and cardiac output. As intra-abdominal pressure rises, the increase in resistance exceeds the increase in pressure, and venous return and cardiac output fall Figure 9—1. This transition point occurs at a lower intra-abdominal pressure in the hypovolemic compared with the normovolemic state. Given normovolemia, an intra-abdominal pressure of 15 mm Hg is associated with tolerable reduction of cardiac output. Reduction of venous return and cardiac output during laparoscopy.
Advanced Laparoscopic Surgery - Techniques and Tips | Namir Katkhouda | Springer
J Urol ; Aug; 2 Pt 1 The absorption of insufflated carbon dioxide CO 2 has direct cardio-inhibitory effects, but CO 2 also stimulates the sympathetic nervous system. If acidosis develops then there are parasympathetic effects as well. Moderate hypercapnia excess CO 2 in blood produces an increase in cardiac output and blood pressure and a decrease in systemic vascular resistance, which counteract the effect of intra-abdominal pressure.
Overall, an intra-abdominal pressure of 15 mm Hg and moderate hypercapnia in healthy patients produce a hyperdynamic state increased central venous pressure, systemic vascular resistance, heart rate, and blood pressure without significant alteration of cardiac output Junghans et al, The cardiovascular complications of laparoscopy include tension pneumoperitoneum, cardiac dysrhythmias, fluid overload, and venous thrombosis. Volume status must be optimized to prevent tension pneumoperitoneum at lower pressures.
In general, the intra-abdominal pressure should be kept below 15—20 mm Hg. Tachycardia and ventricular extrasystoles due to hypercapnia are usually benign, but fatal dysrhythmias can occur with very high arterial partial pressure of CO 2 PaCO 2. Vagal stimulation by peritoneal distention can produce bradydysrhythmias Valentin et al, A fine needle biopsy was performed, which was suggestive of a paraganglioma. Medical treatment with Doxazosine 44mg qd was required for the adequate control of hypertension, and surgical excision was required.
A laparoscopic lateral transabdominal approach was chosen, to displace the hepatoduodenal ligament and allow for a wide access to the inferior vena cava. The operative time was 75 minutes. The patient recovered with no complications and was discharged on postoperative day 3. Her symptoms recovered and she was found with normal metanephrines at follow-up. Retroperitoneal adrenalectomy for colon cancer metastasis: a live demonstration.
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Laparoscopic adrenalectomy is considered to be the standard of care for the surgical excision of the adrenal gland. Transperitoneal and retroperitoneal approaches are the two major laparoscopic routes to the adrenal gland. Although the transperitoneal approach is used more widely, the retroperitoneal approach offers distinct advantages which make it a valuable alternative route to the adrenal gland. This video describes a retroperitoneal laparoscopic adrenalectomy for colon cancer metastasis in a year-old patient who underwent a left colectomy 3 years earlier.
When and how to perform a safe direct entry of a laparoscopic trocar.
In this video, we show the indications, technique and contraindications of direct port entry in laparoscopic surgery. Although this way of entry is not popular, recent data show that there are no differences in terms of safety for a way of entry i. We also discuss some hints and tips and tricks to use when performing this entry technique.
Arcuate ligament syndrome: laparoscopic approach. Median arcuate ligament syndrome is caused by the extrinsic compression of the celiac trunk by the median arcuate ligament, prominent fibrous bands, and peri-aortic nodal tissue.
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In many cases, it is asymptomatic, even though postprandial abdominal pain or, during exercise, nauseas, vomiting, and weight loss could be found. Doppler ultrasound and angiotomography are used for diagnosis while arteriography is the gold standard. Only symptomatic patients might require surgical treatment, and the laparoscopic approach has been proposed as a safe and effective technique. We present a case of laparoscopic approach for the treatment of arcuate ligament syndrome. Laparoscopic ileo-caecal resection for appendicular mucocele. This video demonstrates a laparoscopic ileocecal resection using a medial approach in a patient with appendicular mucocele.
The mesentery is divided using ligasure. The anastamosis is performed extracorporeally.
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