essential instruments in laparoscopic and robotic surgery

... against infection and invading connective tissue There are still very few studies applying the methods of tissue engineering to produce tracheal replacements and to examine these in vitro and in ... this technique and bearing in mind the contraindications, more than 90% of the children can nowadays be extubated without problems In spite of the progress, in children undergoing single-step surgical ... intubation over several days as an intratracheal splinting An external splinting by metallic microplates in the surgical tracheal reconstruction was described first time by Zalzal and Deutch in...

Ngày tải lên: 25/10/2013, 08:20

... gastrointestinal (GI) bleeding 122 gastrointestinal obstruction 341 gastrointestinal scintigraphy 121–2 Gastrointestinal Tumor Study Group and North Central Cancer Treatment Group 308 Gatrointestinal ... percutaneous abscess drainage (PAD) 122–3 radiofrequency ablation (RFA) 123 intestinal stomas 349 intraabdominal hemorrhage 323–4 intraabdominal infections 29 percutaneous drainage 29 intraoperative anastomosis ... Lee index leucovorin 300 levamisole 300 lidocaine 19 life-threatening injuries 389 LigaSure™ Vessel Sealing System 291 LigaSure™ 172 Ligation of Intersphincteric Fistula Tract (LIFT) 189 linaclotide...

Ngày tải lên: 05/07/2014, 16:20

... xi   Preexisting conditions Eric L Marderstein, Siyamek Neragi-Miandoab, and Conor P Delaney   Preoperative bowel preparation David A Margolin and Sean Mayfield 14   Anesthesia and intraoperative ... conditions M Benjamin Hopkins and Alan E Timmcke 154 16 Quality and outcome measures Janak A Parikh, Sushma Jain, Marcia L McGory, and Clifford Y Ko 159 17 Hemorrhoidal surgery Dan R Metcalf and Anthony ... L Bohl and Alan J Herline 199 21 Surgery for pilonidal disease and hidradenitis suppurativa Paula I Denoya and Eric G Weiss 215 22 Surgical treatment of fecal incontinence Ann C Lowry and Dimitrios...

Ngày tải lên: 05/07/2014, 16:20

... is indicated in patients having intermediate risk surgery with one or more clinical risk factors or any patient having vascular surgery It is not indicated in patients for low-risk surgery or intermediate ... hypoalbuminemia and anemia resulting in poor wound healing and increased risk of complications Krysa et al describe a high instance of anastamotic leak in these patients (70) Decreased leukocyte and ... is common following major surgery and the preoperative hemoglobin level predicts postoperative mortality.(9) A baseline hemoglobin level in patients who are undergoing major surgery that is expected...

Ngày tải lên: 05/07/2014, 16:20

... preparation in elective colon and rectal surgery include decreasing the bacterial count in the colon, decreasing the wound infection rate, decreasing the rate of anastomotic leaks, improving interoperative ... unfortunately, there was no real improvement in infectious  complications.(6) Dearing in 1951 and Poth in 1960 tied tetracycline and neomycin respectively with only minimal improvement.(7, 8) It was not ... than 150 randomized controlled trials performed (Table 2.1 and 2.2) Finally in 1998, Song and colleagues, in a landmark review in the British Journal of Surgery, codified modern practice and confirmed...

Ngày tải lên: 05/07/2014, 16:20

... exclude mesenteric blood vessels within the intestinal clamp Gingerly inserting appropriately sized intraluminal staplers prevents inadvertent splitting and tearing of bowel ends to be anastomosed ... outcomes in colon and rectal surgery Figure 4.3  Treatment algorithm for dealing with intraabdominal and pelvic abscesses therapy, the presence of adverse intraoperative events, and male sex were independent ... exist: making decisions based upon intraoperative findings versus tailoring treatment based upon clinical condition and improvement of the patient One prospective randomized trial looked at minimum...

Ngày tải lên: 05/07/2014, 16:20

... bleeding time include garlic, ginkgo, ginseng, capsaicin, fish oil, ginger, and vitamin E.(2) In general, these agents  other intraoperative challenges are adequate exposure, working suction, and ... and result in profuse bleeding The veins retract into the sacral foramen, which is problematic In contrast to injury to the iliac vein, packing the pelvis in the case of presacral vein injury may ... sacrum and injuring the underlying presacral vein These avalvular veins communicate with the internal vertebral venous system through the basivertebral vein This system can attain high pressures and...

Ngày tải lên: 05/07/2014, 16:20

... Additionally, failure to inject the ink compound into the submucosal tissue plane can result in dissemination of the ink and imprecise localization or intraperitoneal injection Although this presents ... with definitive intraoperative localization Techniques that have been described to minimize this occurrence include injecting saline to develop the submucosal plane before injection of ink.(56) ... is failure of complete abdominal wall healing following abdominal surgery, resulting in a myofascial defect The reported incidence of incisional hernias in the literature varies from 9–19% They...

Ngày tải lên: 05/07/2014, 16:20

... failure and chest pain Leaking patients may also fail to clinically progress or recover within a usual timeframe, have increasing narcotic demands, or have decreased urine output requiring fluid ... recurrent cancer, inflammatory bowel disease, and radiation injury and must be thoroughly investigated  diagnosis and treatment While most strictures are likely incidental findings, certain patients ... reversal in the future.(4, 6, 17) The main criticism of leaving a leaking anastomosis in place is that luminal contents proximal to the anastomosis may provide an ongoing source of contamination and...

Ngày tải lên: 05/07/2014, 16:20

... nursing support, and surgical intervention contribute to driving up overall healthcare system costs In simple terms, our skin and mucosal lining remain the p ­ rimary defense mechanisms against infectious ... demonstrating no decrease in infectious complications, while increasing the rates of nausea, pain, and noncompliance.(34, 35) Yet, other authors including a large prospective randomized trial and metaanalysis ... drainage In a study comparing catheter removal at and days following rectal resection, Benoist and colleagues found urinary tract infections to be increased in those patients with catheters in...

Ngày tải lên: 05/07/2014, 16:20

... explicit and well-defined standards for care They support introduction of evidence-based medicine and use of clinical guidelines thus reducing variations in patient care and improving clinical ... pathway involved mobilization of patients on the day of surgery, administering cisapride and magnesium, and allowing free fluid intake on evening of surgery, among numerous other inter­ entions instituted ... short incisions, minimally invasive surgery, nonopiod pain management, no ­ outine use of drains and nasogastric tubes, early removal of r bladder catheters, standard laxatives and prokinetics, and...

Ngày tải lên: 05/07/2014, 16:20

... fecal incontinence scores, and quality of life.(35–37) These benefits were seen in both the treatment and control groups indicating the role of patient motivation and ongoing medical involvement in ... outcomes in colon and rectal surgery Global deficiencies or thinning of the sphincters rather than defects are more difficult to define with AUS The internal sphincter is normally between to mm Since ... of symptoms In a large prospective study Lieberman et al evaluated 90 incontinent patients, including males with a specific goal at determining what impact physiology testing including manometry...

Ngày tải lên: 05/07/2014, 16:20

... thickening and pericolic fat stranding confined to the radiation port area Chronic radiation injury to 24 months after treatment appears as mucosal thickening with prominent stranding in expanded ... shows wall thickening and marked irregularity of the remaining mucosa in the ascending and descending colon (arrows) an acute inflammatory condition is less likely Fat stranding that is disproportionately ... thickening (>3 cm) that is asymmetric, nodular, and lobulated in contour with narrowing of the intestinal lumen The combination of a paucity of pericolonic fat stranding with the short segment of involvement...

Ngày tải lên: 05/07/2014, 16:20

... thickening, “thumbprinting”, inflammation of pericolic fat, and pneumatosis (air in the bowel wall).(152) Small Bowel Obstruction Accuracy of Diagnosis and Causes of SBO CT has gained favor as the initial ... Studies Examination Technique Benefits and Limitations Small Bowel Follow Through (SBFT) Patient drinks barium while a series of supine abdominal films are obtained until the terminal ileum and cecum ... fibrosis and progressive thickening of the bowel wall that narrows the terminal ileum, producing the “string sign” in the submucosa As the ulcerations enlarge, inflammatory psuedopolyps (islands...

Ngày tải lên: 05/07/2014, 16:20

... detecting gastrointestinal bleeding interventional radiology Figure 11.58  A and 11.58B Lower Gastrointestinal Bleeding Figure 11.58A shows a single image of a Tc-99m red blood cell scintigram ... the skin and the lesion.(277) Disadvantages of CT include increased cost, ionizing radiation, and longer procedure times Complications of abdominal, liver, or lung biopsy include bleeding, introducing ... accurate imaging modality in determining the extent of local invasion of rectal cancer.(253) EUS can delineate the components of the intestinal wall Images typically consist of five rings of different...

Ngày tải lên: 05/07/2014, 16:20

... & Rectal Surgery Lippincott Williams & Wilkins, 1996: 69–70 268 Darcy M Clinical management of gastrointestinal bleeding In: Murphy TP, Benenati JF, Kaufman JA, eds Patient Care in Interventional ... decrease the incidence of postpolypectomy bleeding.(27) During the technique of taking a large polyp, some endoscopists use a saline intermucosal lift or an epinephrine solution injection into the ... preparation are known as saline laxatives and include those containing magnesium cations or phosphate anions Salt-based agents work by exerting a hyperosmotic effect in the intestines The poorly absorbed...

Ngày tải lên: 05/07/2014, 16:20

... minimizing morbidity and mortality and maximizing outcomes in laparoscopic colorectal surgery centers around a number of technical considerations, including trocar placement, use of instruments, and ... principles, just as in open surgery, is paramount, and the dangers of sacrificing these principles in the name of a minimally invasive approach are obvious The importance of rigorously testing ... laparoscopy itself—including insufflation needle or trocar injury, air embolism, arrhythmias, CO2 intolerance, and subcutaneous emphysema and those related to laparoscopic colorectal surgery in particular...

Ngày tải lên: 05/07/2014, 16:20

... debridement, unroofing of ulcerative cavities, and steroid injection into the cavity Complications of surgery include prolonged drainage, poor wound healing, incontinence, and superinfections Treatment ... screening in women Screening should include identifying risk factors such as human immunodeficiency virus (HIV) status, history of anal warts, and history of anal pain and bleeding Pap testing using ... the data in light of your formal training and clinical experience in considering or making a diagnosis Patient signs and symptoms are innumerable You must have s ­ pecifics For example, in one...

Ngày tải lên: 05/07/2014, 16:20

... to the following four purchasing principles in buying healthcare for their enrollees: •• Educating and informing enrollees about the safety, quality and affordability of health care and the importance ... within 24 hours prior to surgery to 24 hours S after surgery   Intra- or postoperative pulmonary embolism (PE) diagnosed during index hospitalization and within 30 days of surgery (OUTCOME)   Intra- ... quality and outcome measures as described in this chapter may only be in its infancy As data systems become increasingly powerful and sophisticated, and as evidence in the literature continues...

Ngày tải lên: 05/07/2014, 16:20

... of continence in patients before surgery Soiling and fecal leakage are the chief impairments of continence resulting from internal anal sphincter damage Treatment for soiling and leakage includes ... anorectal procedure including rubber band ligation and excisional hemorrhoidectomy Classic findings include anorectal pain, fever, and difficulty  with urination A high index of suspicion is ... mucosa and reconstruction, which usually requires flaps Fecal Incontinence Incontinence of feces results chiefly from damage to the internal anal sphincter during hemorrhoidectomy.(72) The internal...

Ngày tải lên: 05/07/2014, 16:20