The first real-time uorescence confocal microlaparoscope has been de- veloped that provides instant in vivo cellular images, comparable to those provided by histology, through a nondestructive procedure. The device in- cludes an integrated contrast agent delivery mechanism and a computerized depth scan system. The instrument uses a fiber bundle to relay the image plane of a slit-scan confocal microlaparoscope into tissue. The confocal laparoscope was used to image the ovaries of twenty-one patients in vivo using uorescein sodium and acridine orange as the uorescent contrast agents. The results indicate that the device is safe and functions as designed. A Monte Carlo model was developed to characterize the system performance in a scattering media representative of human tissues. The results indicate that a slit aperture has limited ability to image below the surface of tissue. In contrast, the results show that multi-pinhole apertures such as a Nipkow disk or a linear pinhole array can achieve nearly the same depth performance as a single pinhole aperture. The model was used to determine the optimal aperture spacing for the multi-pinhole apertures. The confocal microlaparoscope represents a new type of in vivo imaging device. With its ability to image cellular details in real time, it has the potential to aid in the early diagnosis of cancer. Initially, the device may be used to locate unusual regions for guided biopsies. In the long term, the device may be able to supplant traditional biopsies and allow the surgeon to identify early stage cancer in vivo.

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.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 5 uppsatser.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2005. / Härtill 6 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 4 uppsatser.

Thesis (M.App.Sc.) - Carleton University, 2007. / Includes bibliographical references (p. 82-89). Also available in electronic format on the Internet.

Ο στόχος της εργασίας αυτής είναι η κατασκευή και ο έλεγχος ενός λαπαροσκοπικού εργαλείου με πλεονάζοντες βαθμούς ελευθερίας (ΒΕ). Ο βραχίονας αποτελείται από συνδεδεμένα τμήματα ή «σπονδύλους» που ενεργοποιούνται από καλώδια Ni-Ti, γνωστά και ως Shape Memory Alloys, που λειτουργούν ως δυαδικοί ενεργοποιητές με 2 καταστάσεις. Έτσι, εξασφαλίζεται η επαναληψιμότητα στις κινήσεις του βραχίονα και δεν απαιτούνται αισθητήρες για τη θέση των αρθρώσεων. Κάθε σπόνδυλος αποτελείται από 3 ενεργούς πρισματικούς ενεργοποιητές (SMA) τοποθετημένους έτσι ώστε να σχηματίζουν ένα τρίποδο, το οποίο παρέχει 3 ΒΕ σε κάθε άρθρωση (δύο περιστροφικούς και ένα μεταφορικό). Η ανεξάρτητη ενεργοποίηση κάθε άρθρωσης γίνεται από μικροελεγκτές που επικοινωνούν με το πρωτόκολλο I2C και είναι τοποθετημένοι στο εσωτερικό κάθε συνδέσμου. Θα παρουσιαστούν διάφορα ζητήματα σχεδιασμού, η κινηματική και η προσομοίωση του εργαλείου, καθώς και ένα αρχικό πείραμα. / The subject of this work is the development of a prototype hyper-redundant laparoscopic tool. The manipulator consists of cascaded modules which are powered by Shape Memory Alloy wires (NiTi), acting as binary actuators with two stable states. As a result, the repeatability of the manipulator’s movement is ensured, alleviating the need for sensing of the manipulator’s joint-positions. Each module is composed of three active prismatic actuators in a tripod configuration providing a 3-DOF (two rotational and one translational) maneuverability for each joint. I2C-networked microcontrollers activate the individual tendon in each joint. Certain design aspects as well as the kinematics of the binary manipulator are presented followed by simulation and experimental studies on the laparoscopic tool prototype.

INTRODUCTION: There currently exists a wide variation in anesthesia perioperative management for pediatric patients undergoing laparoscopic appendectomy. The purpose of this retrospective chart review is to compare outcome indicators by using patient demographics. This study aims to establish evidence based guidelines for safe, efficient and effective anesthetic management for patients undergoing laparoscopic appendectomies by analyzing selected outcome indicators and metrics in relation to Surgical-End-to-Transport (SET) time: defined as the time from the end of surgical time until the patient is ready to exit the operating room. METHODS: After institutional review board approval, all laparoscopic appendectomies performed from 2012 through 2014 (n=790) were queried. Using the median SET time of 14 minutes, two groups were established as follows: Group A (n=431), SET time between 0 and 14 minutes, and Group B (n=338), SET time of 14 minutes and longer. Bivariate and multivariate logistic regression models were used to compare readmissions by American Society of Anesthesiologists (ASA) status and reports of high pain with PACU (Post-Anesthesia Care Unit) duration, gender, age, and surgical duration using IBM SPSS Statistics (version 21.0, IBM, Armonk, NY). RESULTS: To limit confounding variables, patients over the age of 21 and those assigned an ASA Physical Status Classification 3 or 4 were excluded. Remaining cases (n=769) were then used to calculate readmission incidence. The median SET time for the study population was 14 minutes, while the median surgical and PACU durations were 58 minutes and 59 minutes, respectively. The readmission incidence rate was 300 per 10,000 (n=23, 3%). The study population consisted of 56% males and 44% females. Females had a higher incidence of readmission (n=13, 3.8%) than males (n=10, 2.3%), while males had longer SET times than females (Group A Males 52.33% vs. Group B Males 60.30%, p=0.0276). There was no difference in readmission incidence rates between ASA I (n=473) and ASA II (n=296) patients (ASA I readmits 3.2 % vs. ASA II readmits 2.7%, p=.711). Patients who reported high postoperative pain (n=75) were more than twice as likely to be readmitted than patients who did not report high pain (p=.071). Ethnicity frequencies were collected as follows: 60.3% White, 6.8% Black or African American, 3.6% Asian, and 29.1% Other. DISCUSSION: Males had significantly longer durations in SET times, and they experienced fewer readmissions than females. There were no significant findings related to the ethnic demographics. Further analysis identifying intraoperative and postoperative anesthesia management for both groups will be performed. This study was subject to the following limitations: retrospective design, incomplete data acquisition, and inconsistent EMR documentation. The correlations and results are preliminary in nature and will serve as a framework for future analyses.

BACKGROUND: Bariatric surgery is an effective weight loss treatment modality for people with morbid obesity, however, there may be a negative impact on postoperative bone health. This review summarizes changes of different bone mineral density dual-energy x-ray absorptiometry measurements, with specific attention to the laparoscopic sleeve gastrectomy and the roux-en-y gastric bypass. METHODS: PubMed and the Cochrane Library searches yielded 156 articles published before November 2017. The articles were evaluated based on the following inclusion criteria: focus on laparoscopic sleeve gastrectomy or roux-en-y gastric bypass and bone health, written in English, full-length article, studied participants for one-to-two years, and included statistical measurements. RESULTS: Of the 156 studies that were initially screened, 16 full-length articles were included in the final analysis. The articles described a lower loss of bone density at the lumbar spine, femoral neck, forearm, and total hip after laparoscopic sleeve gastrectomy when compared to roux-en-y gastric bypass, however, these studies lack statistical power due to the small sample sizes of less than 10 participants. CONCLUSION: The number of bariatric surgeries continues to increase worldwide, however, the literature provides limited studies that evaluate the effects of bariatric surgery on bone health, more than two-years postoperative. Further study is necessary to determine the mechanisms of bone loss after bariatric surgery, with great attention to differences in bone health between sexes.

A cirurgia laparoscópica requer a criação de um espaço de trabalho intraabdominal, através do pneumoperitônio, e para isto utiliza-se o dióxido de carbono (CO2). As alterações sistêmicas relacionadas ao sistema respiratório ocorrem pelo aumento da pressão intra-abdominal, resultando em diminuição da complacência pulmonar, atelectasia, hipercarbia e hipóxia. A insuflação de CO2 com pressões intraabdominais acima de 8 mmHg produz alterações hemodinâmicas significantes, caracterizadas por decréscimo do débito cardíaco, elevação da pressão arterial. Para que a homeostase hemodinâmica e respiratória seja mantida são necessários protocolos anestésicos adequados e métodos de ventilação mecânica como, por exemplo, a pressão expiratória final positiva final (PEEP). O presente trabalho teve por objetivo avaliar e comparar quatro protocolos anestésicos e ventilatórios distintos em cadelas submetidas à ovariohisterectomia videolaparoscópica eletiva, com uso de pneumoperitônio com CO2 e 12 mmHg de pressão intra-abdominal, sob anestesia geral total intravenosa. Para isso, 16 caninos foram distribuídos em quatro grupos: no grupo 1 (Zeepbloq) os animais receberam atracúrio (0,5 mg.kg-1), propofol (5 mg.kg-1) e fentanil (2 mcg.kg-1), todos em bolus, por via intravenosa, e seguiu-se com infusão contínua de atracúrio (0,5 mg.kg-1/hora), propofol (0,4 mg.kg-1/minuto) e fentanil (2 mcg.kg-1/hora) por bomba de infusão, e não foi realizada PEEP; no grupo 2 (Peepbloq) administrou-se o mesmo protocolo anestésico, porém realizou-se a PEEP de 10 cm de água; no grupo 3 (Zeep) os animais receberam o mesmo protocolo anestésico, com exceção bloqueador neuromuscular, e não foi realizada PEEP; no grupo 4 (PEEP) os indivíduos receberam o mesmo protocolo do grupo 3, porém realizou-se PEEP. Para o procedimento cirúrgico foi realizado pneumoperitônio de 12 mmHg com CO2 com duração variável. Foram avaliadas as seguintes variáveis: pressão arterial média, freqüência respiratória, saturação de oxigênio na hemoglobina, pressão parcial de dióxido de carbono expirado, freqüência cardíaca, eletrocardiografia e tempo do procedimento anestésico, do pneumoperitônio. Para hemogasometria foi realizada a coleta de sangue arterial, sendo obtidas variáveis de pH, pressão parcial de O2 e CO2, bicarbonato, CO2 total, excesso/déficit de bases e saturação arterial de oxigênio na hemoglobina. Não foram observados valores que representassem diferença estatística significativa entre os grupos (p<0,05). No entanto, houve diferença significativa (p<0,05) entre momentos avaliados a para pressão arterial de oxigênio, a pressão arterial média e a temperatura, independente do protocolo empregado. Ambos os protocolos empregados, anestésico e de ventilação, foram satisfatórios e, de acordo com a metodologia empregada, pode-se concluir que animais submetidos à ventilação com PEEP não apresentaram benefícios significativos quando comparados com animais ventilados com ZEEP, independente do uso ou não de bloqueador neuromuscular. / The laparoscopic surgery requires the creation of a space in the abdominal cavity through pneumoperitoneum and that using the carbon dioxide (CO2). The systemic changes related to the respiratory system occur by increased intra-abdominal pressure, resulting in decreased lung compliance, atelectasis, hypercarbia and hypoxia. The CO2 insufflation with intra-abdominal pressure over 8 mmHg produces significant hemodynamic changes, characterized by decreased cardiac output, blood pressure elevation. For the hemodynamic and respiratory homeostasis is maintained anesthetic protocols are necessary and appropriate methods of mechanical ventilation, such as the positive end-expiratory pressure (PEEP). This study aimed to evaluate and compare four different protocols anesthetics and ventilatory in female dogs submitted to ovariohysterectomy videolaparoscopic elective, with the use of pneumoperitoneum with CO2 and 12 mmHg of intra-abdominal pressure, under general anesthesia total intravenous. A total of 16 dogs were distributed into four groups: in group 1 (Zeepbloq) the animals received atracurium (0.5 mg.kg-1), propofol (5 mg.kg-1) and fentanyl (2 mcg . kg-1), all bolus, intravenously, and followed up with continuous infusion of atracurium (0.5 mg.kg-1/hour), propofol (0.4 mg.kg-1/minute) and fentanyl (2 mcg.kg-1/hour) by infusion pump, and was not held PEEP, in group 2 (Peepbloq) administered to the same protocol anesthetic, but was held on PEEP of 10 cm of water, in group 3 (Zeep) the animals received the same protocol anesthetic, except neuromuscular blocker, and was not held PEEP, and in group 4 (PEEP) individuals received the same protocol as the group 3, but was held PEEP. For the surgical procedure was performed abdominal pressure of 12 mmHg with CO2. We evaluated the following variables: mean arterial pressure, respiratory rate, oxygen saturation in hemoglobin, end tidal of carbon dioxide expired, heart rate, electrocardiography and time of the anesthetic procedure and of the pneumoperitoneum. Arterial blood was sampled for arterial blood gas analyses, and variables obtained from pH, arterial pressure of CO2 and O2, bicarbonate, CO2 total, balance of bases and arterial oxygen saturation in hemoglobin. There were no evaluate parameters that represented statistically significant difference between groups (p <0.05). However, there was a significant difference (p <0.05) between moments evaluated for the blood pressure of oxygen, the mean blood pressure and temperature, independent of protocol employee. Both protocols employees, anaesthetic and ventilation, were satisfactory and in accordance with the methodology employed, we can conclude that animals treated with ventilation PEEP did not show significant benefits when compared with animals ventilated with ZEEP, regardless of whether or not to use atracurium.