The aim of this study was to compare two ovariectomy techniques (conventional vs laparoscopic) in bitches planning determine which procedure offers the lowest hemodynamic changes, painful stimuli, stress and inflammatory changes in trans and post-operative period. For the experiment were used 17 young mongrel bitches (12,58 ± 4,29 months), weighting 10.16 ± 0,69kg. Animals were placed into two groups according to the technique applied. In the first group (eight animals), ovariectomy (OV) was done by retro-umbilical celiotomy (GC) and in the second group (nine animals), by laparoscopy two-portal access (GV). For the assessment of analgesia were measured hemodynamic parameters (heart rate, respiratory rate, systolic arterial pressure, medium arterial pressure, diastolic arterial pressure, central venous pressure and cardiac output), and used three pain scales as follows: visual analogue (VAS), the University of Melbourne and the scale consists of Glasgow. To evaluate the stress and inflammatory changes were evaluated different parameters (C-reactive protein, cortisol, protein electrophoresis and acetylcholinesterase determination). In both procedures (GV and GC) there were no trans or post-operative complications. This study found that two-portal laparoscopic ovariectomy provides smaller and shorter pain stimuli that conventional ovariectomy when considering the following times and pain scales (two hours after surgery in Melbourne and the scale of 12 and 24 hours postoperative VAS), as well as in assessing the methods used to analyze the inflammatory response and stress, laparoscopic technique provided a lower elevation and a more rapid decline in the levels of C-reactive protein, mainly from six up to 72 hours after surgery, that the conventional technique. / O objetivo deste estudo foi comparar duas técnicas de ovariectomia (convencional vs laparoscópica) em cadelas, buscando determinar qual procedimento oferece menores alterações hemodinâmicas, estímulos dolorosos, estresse e alterações inflamatórias nos períodos trans e pós-operatório. Para o experimento foram utilizadas 17 cadelas jovens (12,58 ± 4,29 meses), sem raça definida, com peso médio de 10,16 ± 0,69kg. Os animais foram alocados em dois grupos, de acordo com a técnica operatória aplicada. No primeiro grupo (oito animais), a ovariectomia (OV) foi efetuada por celiotomia retro-umbilical (GC) e, no segundo grupo (nove animais), pela técnica de videolaparoscopia por dois portais (GV). Para a avaliação hemodinâmica foram aferidos parâmetros FC, , PAS, PAM, PAD, pressão venosa central e débito cardíaco e, para a avaliação álgica, foram empregadas três escalas de dor: visual analógica (EVA), da universidade de Melbourne, e a composta de Glasgow. Para avaliação do estresse e das alterações inflamatórias, foram avaliados diferentes parâmetros: cortisol, proteína C reativa, eletroforese de proteínas e acetilcolinesterase. Em ambos procedimentos (GV e GC) não ocorreram complicações trans ou pós-operatórias. Concluiu-se que a técnica de ovariectomia videolaparoscópica por dois portais propiciou estímulo álgico de menores magnitude e duração que a ovariectomia convencional ao se considerar os seguintes tempos e escalas de dor (duas horas de pós-operatório na escala de Melbourne e nas 12 e 24 horas de pós-operatório na EVA). Ademais, a técnica videolaparoscópica propiciou menor elevação e declínio mais rápido nos níveis séricos de proteína C reativa, sobretudo a partir de seis até 72 horas de pós-operatório, em relação à técnica convencional.

Au cours des dernières décennies, la chirurgie mini invasive a progressivement gagné en popularité face à la chirurgie ouverte, grâce à de meilleurs bénéfices cliniques. Cependant, ce type d'intervention introduit une perte de vision directe sur la scène pour le chirurgien. L'introduction de la réalité augmentée en chirurgie mini invasive semble être une solution viable afin de remédier à ce problème et a donc été activement considérée par la recherche. Néanmoins, augmenter correctement une scène laparoscopique reste difficile à cause de la non-rigidité des tissus et organes abdominaux. En conséquence, la littérature ne fournit pas d'approche satisfaisante à la réalité augmentée en laparoscopie, car de telles méthodes manquent de précision ou requièrent un équipement supplémentaire, contraignant et onéreux. Dans ce contexte, nous présentons un nouveau paradigme à la réalité augmentée en chirurgie laparoscopique. Se reposant uniquement sur l'équipement standard d'une salle opératoire hybride, notre approche peut fournir la relation statique entre l'endoscope et un scan intraopératoire 3D. De nombreuses expériences sur un motif radio-opaque montrent quantitativement que nos augmentations sont exactes à moins d'un millimètre près. Des tests sur des données in vivo consolident la démonstration du potentiel clinique de notre approche dans plusieurs cas chirurgicaux réalistes. / Over the past decades, minimally invasive surgery has progressively become more popular than open surgery thanks to greater clinical benefits. However, this kind of intervention introduced a loss of direct vision upon the scene for the surgeon. Introducing augmented reality to minimally invasive surgery appears to be a viable solution to alleviate this drawback and has thus been an attractive topic for the research community. Yet, correctly augmenting a laparoscopic scene remains challenging, due to the non-rigidity of abdominal tissues and organs. Therefore, the literature does not report a satisfactory approach to laparoscopic augmented reality, as such methods lack accuracy or require expensive and impractical additional equipment. In light of this, we present a novel paradigm to augmented reality in abdominal minimally invasive surgery. Based only on standard hybrid operating room equipment, our approach can provide the static relationship between the endoscope and an intraoperative 3D scan. Extensive experiments on a radio-opaque pattern quantitatively show that the accuracy of our augmentations is less than one millimeter. Tests on in vivo data further demonstrates the clinical potential of our approach in several realistic surgical cases.

Der chronische Unterbauchschmerz stellt den behandelnden Arzt vor erhebliche differentialdiagnostische Probleme. Die vorgestellte Studie soll den Wert der Laparoskopie im diagnostischen Konzept aufzeigen. Dazu führten wir zwischen Oktober 1993 und Juni 1998 bei 100 Patienten mit der klinischen Diagnose «chronischer Unterbauchschmerz» eine Laparoskopie durch. Bei 14 Patienten ließ sich ein morphologisches Korrelat unabhängig von der Appendix finden. 86 Patienten wurden appendektomiert, wobei die histologische Untersuchung des Präparats in 82 Fällen (95,3%) einen pathologischen Befund aufwies. 80 Patienten (93%) blieben auch während der Nachuntersuchungen beschwerdefrei. Die Laparoskopie stellt ein sicheres Verfahren zur Diagnostik und Behandlung chronischer Unterbauchschmerzen dar. Bei fehlendem Korrelat für die Beschwerden sollte in gleicher Sitzung die laparoskopische Appendektomie durchgeführt werden. / The differential diagnosis chronic lower abdominal pain can be problematic, and this symptom may lead to several diagnostic procedures. The purpose of this study was to evaluate the usefulness of laparoscopy in the diagnostic concept. From October 1993 to June 1998 we performed 100 laparoscopies in patients with chronic or recurrent lower abdominal pain. In 14 patients we found a substrate for the reported pain, which was independent of the appendix. In 86 patients we performed an appendectomy. In 62 of the specimens (95.3%) the histological study showed pathological findings. 80 patients (93%) reported no further complaints during follow-up. Laparoscopy is a safe procedure for diagnostics and treatment of patients with chronic lower abdominal pain. If no other explanation for the symptoms is found, laparoscopic appendectomy should be performed. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Bakgrund: PONV står för postoperative nausea and vomiting och är ett vanligt problem som drabbar cirka 25–30% av patienterna som genomgår ett kirurgiskt ingrepp under generell anestesi. Vid PONV är det vanligt med både illamående och kräkningar, vilket leder till obehag hos patienten som lider av dessa symtom. Vårdtiden kan bli upp till dubbelt så lång på den postoperativa avdelningen för de patienter som lider av PONV med samtida smärta postoperativt jämfört med de som inte gör det. Syfte: Att beskriva vilka icke-farmakologiska åtgärder som sjuksköterskan kan använda sig av för att lindra PONV i samband med laparoskopisk kirurgi och i vilken utsträckning de lindrar. Metod: Forskningsdesignen som användes var en beskrivande litteraturöversikt inkluderande 11 vetenskapliga randomiserade kontrollerade studier publicerade år 2009–2019. Resultat: De icke-farmakologiska åtgärder som identifierades var akupressur, elektrisk stimulering, preoperativ dryck och musik. Akupressur, elektrisk stimulering och musik visade sig överlag ha en signifikant antiemetisk effekt främst under den tidiga postoperativa perioden hos patienter som genomgått laparoskopisk kirurgi, medan effekten av preoperativ dryck inte kunde klargöras. Slutsats: Akupressur, elektrisk stimulering och musik som icke-farmakologiska åtgärder mot PONV kan lindra och minska lidandet för patienten under det första postoperativa dygnet efter laparoskopisk kirurgi. Effekten av preoperativ dryck på PONV kan inte helt klargöras då inkluderade studier gav två varierande utfall. Sammanfattningsvis är musik och elektrisk stimulering kostnadseffektiva åtgärder som till viss del praktiskt kan tillämpas för att lindra PONV efter laparoskopisk kirurgi, där musik dessutom kan främja delaktigheten i vården för patienten och minska beroendet av sjuksköterskan. Nyckelord: Postoperativt illamående och kräkning, icke-farmakologiska åtgärder, sjuksköterska, laparoskopi. / Background: PONV stands for postoperative nausea and vomiting and is a common problem affecting about 25-30% of patients undergoing a surgical procedure under general anesthesia. At PONV, both nausea and vomiting are common, leading to discomfort in the patient suffering from these symptoms. The duration of care can be up to twice as long in the postoperative ward for patients suffering from PONV with contemporary pain post-operatively, compared to those who do not. Purpose: To describe what non-pharmacological interventions the nurse can use to relieve PONV in connection with laparoscopic surgery and to what extent they relieve. Method: The researchdesign used was a descriptive literature review including 11 scientific randomized control trials published in 2009–2019. Results: The non-pharmacological interventions identified were acupressure, electrical stimulation, preoperative drinking and music. Acupressure, electrical stimulation and music were generally found to have a significant antiemetic effect, especially during the early postoperative period, in patients who underwent laparoscopic surgery. The effect of preoperative drink could not be clarified. Conclusion: Acupressure, electrical stimulation, and music as non-pharmacological interventions against PONV can relieve and reduce the patient's suffering during the first postoperative day after laparoscopic surgery. The effect of preoperative drinking on PONV cannot be fully elucidated as included studies yielded two different outcomes. In summary, music and electrical stimulation are cost-effective interventions that can, to some extent, be practically applied to relieve PONV after laparoscopic surgery, in which music can further promote participation in patient care and reduce dependence on the nurse. Keywords: Postoperative nausea and vomiting, non-pharmacological interventions, nurse, laparoscopic

No description available.

No description available.

Background and objectives: TISSIUM light-activated adhesive was investigated as an alternative to tissue-penetrating products to fix meshes in intraperitoneal laparoscopic ventral hernia repair. The objective of this study was to ensure efficient polymer light activation through commercial meshes and to assess the acute and chronic fixation strength of the light-activated adhesive in a porcine model in comparison to commercial fixation products. Methods: A spectroscopic analysis was conducted on the light-activated adhesive through three different meshes (1, 2, and 3) to quantify the acrylate conversion associated with the level of polymer cross-linking. Two setups were implemented: a static (light source fixed over a drop of polymer) and a dynamic (light source rotated around a pattern of polymer to mimic the surgical procedure). Hernia defects were created in porcine models and repaired either using the light-activated adhesive or a commercial product (A, B, C, and D) to fix a mesh. For each tested condition, the acute and chronic (3 months) fixation strength performances were assessed using burst ball and t-peel mechanical tests. Results: The light activation proved to be effective (more than 90% of the acrylates converted) in static in 7 seconds through the three meshes and in dynamic between 3 min and 5 min 32 sdepending on the considered mesh. In a burst ball test, the light-activated adhesive reached between 42 and 84% of the commercial products’ acute performance with the three meshes (between 75,9 and 95,9 N) and reached 88% of the commercial product A’s chronic performance with mesh 1 (610,1 N). A t-peel test demonstrated similar strength of ingrowth for the repairs using the light-activated adhesive or the commercial product A at the 3-month timepoint with mesh 1 (2,55 and 2,37 N/cm respectively). Conclusions: Data suggest the light-activated adhesive has the potential to be used in intraperitoneal laparoscopic ventral hernia repair. In a reasonable time, the adhesive is efficiently light-activated through commercial meshes. The light-activated adhesive’s performances to fix commercial meshes, both acute and chronic, are similar to commercial products, but with a strong advantage of not being tissue penetrating.

Introduction: During laparoscopic surgery, surgeons may experience prolonged periods without fluid intake, which might impact surgical performance, yet there are no objective data investigating this issue. Therefore, the aim of this study was to elucidate the effect of prolonged dehydration on laparoscopic surgical performance and tissue handling. - Methods: A total of 51 laparoscopic novices participated in a single-center, open-label, prospective randomized cross-over trial. All participants were trained to proficiency using a standardized laparoscopic training curriculum. Afterward, all participants performed four different laparoscopic tasks twice, once after 6 h without liquid intake (dehydrated group) and once without any restrictions (control group). Primary endpoints were tissue handling defined by force exertion, task time, and error rate. The real hydration status was assessed by biological parameters, like heart rate, blood pressure, and blood gas analysis. - Results: 51 laparoscopic novices finished the curriculum and completed the tasks under both hydrated and dehydrated conditions. There were no significant differences in mean non-zero and peak force between the groups. However, dehydrated participants showed significantly slower task times in the Peg transfer task (hydrated: 139.2 s vs. dehydrated: 147.9 s, p = 0.034) and more errors regarding the precision in the laparoscopic suture and knot task (hydrated: 15.7% accuracy rate vs. dehydrated: 41.2% accuracy rate, p < 0.001). - Conclusion: Prolonged periods of dehydration do not appear to have a substantial effect on the fundamental tissue handling skills in terms of force exertion among surgical novices. Nevertheless, the observed impact on speed and precision warrants attention.

Background: Colorectal cancer (CRC) is one of the most common types of cancer in Western civilization and responsible for a high number of yearly deaths. Long-term outcome is influenced by many factors, potentially including socioeconomic aspects like income, education, and employment. Furthermore, annual surgical case volume plays a major role in achieving good oncological results. In our retrospective study, we evaluated the effect of socioeconomic deprivation and hospital volume on overall survival (OS) in the federal state of Saxony, Germany. Methods: All patients with CRC who underwent surgery in Saxony, Germany between 2010 and 2020 and were living in Saxony at the time of diagnosis were included in our retrospective analysis. Uni- and multivariate analyses were conducted considering age, sex, tumor localization, UICC tumor stage, surgical approach (open/laparoscopic), number of resected lymph nodes, adjuvant chemotherapy, year of surgery, and hospital case volume. In addition, our model was adjusted for social disparity using the German Index of Socioeconomic Deprivation (GISD). Results: A total of 24,085 patients were analyzed (15,883 with colon cancer and 8,202 with rectal cancer). Age, sex, UICC tumor stage and tumor localization were distributed as expected for CRC. Median overall survival time was 87.9 months for colon cancer and 110.0 months for rectal cancer. Univariate analysis revealed laparoscopic surgery (colon and rectum P < 0.001), high case volume (rectum: P = 0.002) and low levels of socioeconomic deprivation (colon and rectum P < 0.001) to be significantly associated with better survival. In multivariate analyses, the associations of laparoscopic surgery (colon: HR = 0.76, P < 0.001; rectum: HR = 0.87, P < 0.01), and mid-low to mid-high socioeconomic deprivation (colon: HR = 1.18–1.22, P < 0.001; rectum: HR = 1.18–1.36, P < 0.001–0.01) remained statistically significant. Higher hospital case volume was associated with better survival only in rectal cancer (HR = 0.89; P < 0.01). Conclusion: In Saxony, Germany, better long-term survival after CRC surgery was associated with low socioeconomic deprivation, laparoscopic surgery and partly with high hospital case volume. Thus, there is a need to reduce social differences in access to high-quality treatment and prevention and increase hospital patient volume.

Esse estudo teve como objetivos identificar os diagnósticos de enfermagem presentes em pacientes em pós-operatório imediato de colecistectomia, submetidos à anestesia geral com base na Taxonomia II da North American Nursing Diagnoses Association (NANDA) e no Modelo Conceitual de Horta; analisar os diagnósticos de enfermagem presentes nesses pacientes em relação aos fatores relacionados, características definidoras e fatores de risco e em relação ao seu estabelecimento e resolução no pós-operatório imediato; dentre os pacientes estudados que apresentaram o Diagnóstico de Enfermagem de Dor aguda, identificar as manifestações de dor apresentadas no pós-operatório imediato e compará-las com as características definidoras apresentadas pela NANDA e por outras literaturas. Para a etapa de coleta de dados, foi elaborado e validado um instrumento de coleta de dados com base no Modelo Conceitual de Wanda Horta. Foram avaliados 15 pacientes adultos no período pós-operatório imediato de colecistectomia laparoscópica, durante o período de setembro de 2004 a janeiro de 2005, no Centro de Recuperação Pós-anestésica do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo. Para o estabelecimento dos diagnósticos de enfermagem, utilizou-se um modelo de processo raciocínio diagnóstico, sendo esses nomeados de acordo com a Taxonomia II da NANDA. Foram identificados nove diferentes diagnósticos de enfermagem: Integridade tissular prejudicada (100%), Risco para infecção (100%), Percepção sensorial perturbada (100%), Risco para aspiração (100%), Risco para função respiratória alterada (80%), Hipotermia (60%), Risco para temperatura corporal desequilibrada (40%), Nutrição desequilibrada: mais do que as necessidades corporais (33,3%) e Dor aguda (26,7%). Para cada diagnóstico foram identificados e discutidos os fatores relacionados e características definidoras. Os pacientes que manifestaram o diagnóstico de enfermagem de Dor aguda apresentaram as seguintes características definidoras: relato verbal, evidência observada, expressão facial e comportamento de defesa. Observamos que todas essas manifestações são características definidoras apresentadas pela NANDA (2002) para esse diagnóstico. Em relação ao seu estabelecimento e resolução no pós-operatório imediato, os diagnósticos de enfermagem Risco para aspiração, Percepção sensorial perturbada e Hipotermia foram resolvidos em 50 minutos após a sua identificação. Para os diagnósticos de Risco para função respiratória alterada, Risco para temperatura corporal desequilibrada e Dor aguda, o tempo médio de resolução foi de 63,7, 77,5 e 36 minutos, respectivamente. Destacamos que os diagnósticos de Integridade tissular prejudicada, Risco para infecção e Nutrição desequilibrada: mais do que as necessidades corporais estiveram presentes desde a admissão do paciente no Centro de recuperação pós-anestésica até o momento da alta do paciente. / This study aimed to identify what nursing diagnoses are present in patients who had been submitted to general anesthesia during the immediate post-operative period after cholecystectomy, based on North American Nursing Diagnoses Association (NANDA) Taxonomy II and on Horta?s Conceptual Model; to analyze the nursing diagnoses that were present in these patients in terms of related factors, defining characteristics and risk factors, as well as with respect to their development and solution in the immediate post-operative period; to identify, among those study participants who presented the Nursing Diagnosis of Acute pain, the pain manifestations they presented during the immediate post-operative period and to compare them with the defining characteristics presented by NANDA and other literature sources. With a view to data collection, we elaborated and validated a data collection instrument on the basis of Wanda Horta?s Conceptual Model. 15 adult patients were evaluated in the immediate post-operative period after laparoscopic cholecystectomy, between September 2004 and January 2005, at the Post-Anesthesia Recovery Center of the University of São Paulo at Ribeirão Preto Medical School Hospital das Clínicas. The nursing diagnoses were established by means of a diagnostic reasoning process model, and were named in accordance with NANDA Taxonomy II. We identified nine different nursing diagnoses: Impaired tissue integrity (100%), Risk for infection (100%), Sensory perception alterations (100%), Risk for aspiration (100%), Risk for altered respiratory function (80%), Hypothermia (60%), Risk for imbalanced body temperature (40%), Altered nutrition: more than body needs (33,3%) and Acute pain (26,7%). For each diagnosis, we identified and discussed the related factors and defining characteristics. Patients with the nursing diagnosis of Acute pain presented the following defining characteristics: verbal report, observed evidence, facial expression and defense behavior. We observe that all of these manifestations are defining characteristics NANDA (2002) presented for this diagnosis. With respect to their development and solution during the immediate post-operative period, the nursing diagnoses Risk for aspiration, Sensorial perception alterations and Hypothermia were solved within 50 minutes after their identification. For the diagnoses Risk for altered respiratory function, Risk for imbalanced body temperature and Acute pain, average solution time was 63.7, 77.5 and 36 minutes, respectively. We highlight that diagnoses of Impaired skin integrity, Risk for infection and Unbalanced nutrition: more than body requirements were present from the patient admission on Post anesthesia Care Unit until the patient?s discharge.