Abdominal wall paresis as a complication of laparoscopic surgery

Purpose: Abdominal wall nerve injury as a result of trocar placement for laparoscopic surgery is rare. We intend to discuss causes of abdominal wall paresis as well as relevant anatomy. Methods: A review of the nerve supply of the abdominal wall is illustrated with a rare case of a patient presenting with paresis of the internal oblique muscle due to a trocar lesion of the right iliohypogastric nerve after laparoscopic appendectomy. Results: Trocar placement in the upper lateral abdomen can damage the subcostal nerve (Th12), caudal intercostal nerves (Th7-11) and ventral rami of the thoracic nerves (Th7-12). Trocar placement in the lower abdomen can damage the ilioinguinal (L1 or L2) and iliohypogastric nerves (Th12-L1). Pareses of abdominal muscles due to trocar placement are rare due to overlap in innervation and relatively small sizes of trocar incisions. Conclusion: Knowledge of the anatomy of the abdominal wall is mandatory in order to avoid the injury of important structures during trocar placement

Exact and Approximate Analysis of Multi-Echelon, Multi-Indenture Spare Parts Systems with Commonality

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Effects of TVE application during 70% hepatectomy on regeneration capacity of rats

WOS: 000227650100022PubMed: 15734492Background For adequate control of excess bleeding during liver resection, total vascular exclusion (TVE) is preferred by surgeons, especially when the tumor is located in the posterior liver lobes or near the cava. To the authors' knowledge, the effects of TVE technique on the postoperative liver regeneration process have not thus far been evaluated yet in the literature. This study was planned to compare the effects of liver resections performed either with portal pedicle clamping or with TVE on the regeneration process. Materials and methods. Seventy percent hepatectomy was performed with portal pedicle clamping (n = 10, Group A) or with TVE (n = 10, Group B) in rats. At 48 h after resection, sampling was performed for the measurement of serum transaminase, alkaline phosphatase (ALP), tissue malondialdehyde (AIDA), and glutathione (GSH) levels. Liver regeneration rate, proliferating cell nuclear antigen (PCNA) labeling, and mitotic indices were also evaluated. Results. Liver injury determinants (serum transaminases, ALP, and tissue MDA levels) were found significantly higher in group B than in group A. Liver regeneration rate, liver GSH levels, PCNA labeling index, and mitotic index were significantly lower in group B than in group A. Conclusions. The injury during TVE seems to be greater than during resection with portal pedicle clamping. The negative effect of this oxidative damage may influence the regenerative capacity of the remnant liver tissue. (c) 2004 Elsevier Inc. All rights reserved

Evaluation of liver damage after application of TVE in the rat model

WOS: 000234412900103PubMed: 16387167Introduction. The aim of this study was to investigate the effects of total vascular exclusion (TVE) on the liver during the early period of reperfusion. Materials and methods. Forty Wistar-Albino rats were divided into four groups. Portal pedicle clamping (groups 1 and 2) or TVE (groups 3 and 4) were applied for 10 minutes. Samples were collected at the time of clamp release (groups 1 and 3) and at 30 minutes of reperfusion (groups 2 and 4). We examined oxidative injury to and histopathology of the liver. Results. Oxidative stress was more prominent with TVE application. Significant alterations were shown in hepatic superoxide dismutase, catalase, glutathione, and glutathione S-transferase levels. The levels of malondialdehyde and myeloperoxidase were not altered significantly. Conclusion. Inflow-outflow occlusion of the liver causes more oxidative stress compared with inflow occlusion