essential instruments in laparoscopic and robotic surgery

... entry into the Gerota fascia is helpful in positively identifying the perirenal fat Placing the camera and instrument in the opening and moving them in opposite directions enlarges the window ... following are robotic instruments that are used, ing three robotic 8-mm ports: robotic Maryland bipolar includ-Minimally Invasive Renal Recipient Surgery Akshay Sood, Wooju Jeong, Mahendra Bhandari, ... allow the surgery to remain purely retroperitoneal Alternatives include a mini–flank incision by connecting two of the port-site incisions or creating a mini–Pfannenstiel incision and a small

Ngày tải lên: 21/01/2020, 23:42

... Biopsy Minimally Invasive Renal Recipient Surgery Co-Director of Robotic SurgeryWashington University Institute for Minimally Invasive SurgeryDivision of Urologic SurgeryDepartment of SurgeryWashington ... experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein In using such in-formation or methods they should be mindful of their own safety and ... Wisconsin School of Medicine and Public HealthProfessor and ChairmanDepartment of UrologyUniversity of Wisconsin Hospital and Clinics Madison, Wisconsin Stapling and Reconstruction Yasser A Noureldin,

Ngày tải lên: 22/01/2020, 23:21

... barrier against infection and invading connective tissue There are still very few studies applying the methods of tissue engineering to produce tracheal replacements and to regen-examine these in vitro ... recognized as promising implant material through war - wounded pilots in World War II: Soft tissue and eye injuries induced by and containing small fractions of bursting windows of airplane cockpits ... these in vitro and in vivo Studies introduced by Vacanti et al in 1994 were trend - setting where constructs based on polyglycolic acid and inhabited by bovine chondrocytes and tracheal epithelial

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 Stroma ... 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 3 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

... Chan and Lin (123) examined 45 patients with intersphincteric fistulas and showed low preoperative resting pres- sure to be the only independent factor predicting postoperative incontinence. In ... healed in 8 weeks. Incontinence was seen in 6% of patients postoperatively, and recurrence was seen in 7%. Carcinoma Associated with Fistula-In-Ano In rare instances, patients with long-standing ... practiced in most instances, taking extreme care to pro- tect the sphincter. When in doubt, one cannot be faulted for simply draining the suppurative process by placing a draining seton. Any acute infectious

Ngày tải lên: 05/07/2014, 16:20

... be blinded second-ary to the use of ointment in the placebo group and injection in the toxin group.(61) It is unclear whether clinicians who were grading fissure healing were blinded to randomized ... sus-tained decrease in mean anal resting pressure (MARP) when BT is injected into the internal anal sphincter This sustained reduction in MARP is in contrast to the short-lived relaxation seen in ... who were injected with the toxin showed a significant decrease in anal resting pressure from baseline Complications included minor bleeding but did not result in any cases of incontinence to

Ngày tải lên: 05/07/2014, 16:20

... (51) in 1832, and its association to sweat glands in the skin was described by Vernuil (52) in 1864 These glands are found prima-rily in the groin and axilla, which are the most common sites of involvement ... infection Topical clindamycin was shown in one double-blind randomized trial of 30 patients to be of benefit in controlling infection.(63) Systemic antibiotics are rarely indicated, except in ... useful in controlling local infection, though this also does not excise the disease and therefore has no benefit in preventing recurrence Excision of the diseased skin, including skin appendages and

Ngày tải lên: 05/07/2014, 16:20

... patients, and patients with neurologic disorders Presenting symptoms are usually referable to the prolapse itself Additional presenting complaints include constipation, straining, inconti-nence, and ... incontinence occurs in 60–80% of patients, and a frank discussion should ensue regard-ing expected surgical outcomes with regard to continence Most large series show improvement in fecal incontinence ... prolapse and intussusception In Beck DE Handbook of colorectal surgery 2nd edition Marcel Dekker: New York, 2003, 301–24 With permission.) (D) (E) Trang 5improved outcomes in colon and rectal surgery

Ngày tải lên: 05/07/2014, 16:20

... history and physical examination and CT scan findings Second, what is the feasibility and indication for operation versus medical therapy? With the advent and availability of CT scanning and its ... operation contin-ues to be the standard of care Pain is a valuable indicator for the patient’s recovery, and pro-vides a marker for evaluation Attempts at initiating PO intake and switching antibiotic ... scoring systems have been evaluated in attempts to pre-dict outcome and risk in patients undergoing both elective and emergent colon resection for diverticulitis With an increasing interest in

Ngày tải lên: 05/07/2014, 16:20

... safe in the early postcolectomy period? Am Surgeon 1991; 57: 734–36. 49. Chassin JL, Rifkind KM, Turner JW. Errors and pitfalls in stapling gastrointestinal tract anastomoses. Surg Clin N Am ... complications (including defecatory, urinary and sexual dys- function, and fecal incontinence). Although such techniques are well-accepted treatment modalities, the search for less invasive and less ... imply involvement of the anal sphincters or pelvic floor, precluding a sphincter-preserving operation. Patients with fecal incontinence should be identified in the preoperative workup since

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