New advantageous tool in single incision laparoscopic cholecystectomy: the needle grasper

Introduction: During single-incision laparoscopic cholecystectomy (SILC), the gallbladder is suspended with stitches, resulting in perforation risk and difficulty in exploration. Aim: We used the needle grasper in SILC to hang and manipulate the gallbladder. Material and methods : Sixty-five patients (43 female, 22 male) who underwent SILC between December 2013 and December 2014 were analyzed retrospectively for patient demographics, duration of operation, laparotomy or conventional laparoscopy necessity, drain use, complications, and hospital stay periods. To place the SILC port (Covidien, Inc.), the needle grasper was inserted at the right upper abdominal quadrant without an incision to hang and manipulate the gall-bladder. Results : The mean age was 47.9 ±13.068 years; the mean body mass index (BMI) was 26.94 ±3.913 kg/m2. ASA scores were 1, 2, and 3. Two patients with high BMI with additional trocar use were excluded. The operations were completed without any additional trocar in 59 patients. The mean operation time was 89 ±22.41 min. Eighteen patients required a drain; all were discharged after drain removal. One patient needed re-hospitalization and percutaneous drainage and was discharged on the 9th day. Fifty-three patients were discharged on the 1st post-operative day. Eleven patients with drains were discharged on the 2nd day, and 1 was discharged on the 7th day. The mean hospital stay period was 1.26 ±0.815 days. Conclusions : The main difficulty of SILC is to manipulate hand tools because the triangulation principle of laparoscopy use is not possible in SILC. Inserting a needle grasper into the abdominal cavity at the right subcostal area to manipulate the gallbladder helps and does not leave a visible scar

Laparoscopic Abdominal Surgery Under Regional Anesthesia: A Retrospective Evaluation

Aim: Laparoscopic abdominal surgical procedures are usually performed under general anesthesia. In this retrospective study, we aimed to evaluate laparoscopic surgical operations performed with regional anesthesia. Methods: We performed a retrospective chart review of 171 laparoscopic surgery patients including laparoscopic cholecystectomy (LC), laparoscopic appendectomy (LA) and laparoscopic totally extraperitoneal (TEP) inguinal hernia repair under regional anesthesia from May 2014 to July 2016. Demographic data, type of anesthesia and surgery, American Society of Anesthesiologist (ASA) physical status score, length of procedure, co-existing disease, peroperative and postoperative side effects, postoperative surgical-site pain, and patient satisfaction were recorded. Results: Peroperative side effects were abdominal pain/discomfort (18.7%), shoulder pain (13.5%), anxiety (7.6%) and hypotension (3.5%). Postoperative side effects were shoulder pain (8.7%), urinary retention (7%), headache (6.4%), nausea and vomiting (2.3%). In the first six hours after the surgery, no patients had surgical site pain requiring analgesic treatment. Patient satisfaction was sufficient in 97.7% of patients. Conclusion: Regional anesthesia is an effective and safe anesthesia technique in LC, LA and laparoscopic TEP inguinal hernia repair due to good postoperative pain control, minimal side effects, high patients satisfaction rates and absence of intubation-related complications

A comparison of propofol and midazolam/meperidine sedation in upper gastrointestinal endoscopy

Introduction : There is increasing interest in sedation for upper gastrointestinal endoscopy (UGE). Prospective randomized studies comparing sedation properties and complications of propofol and midazolam/meperidine in upper gastrointestinal endoscopy (UGE) are few. Aim: To compare propofol and midazolam/meperidine sedation for UGE in terms of cardiopulmonary side effects, patient and endoscopist satisfaction and procedure-related times. Material and methods: This was a prospective, randomized, double-blind study of propofol versus midazolam and meperidine in 100 patients scheduled for diagnostic upper gastrointestinal endoscopy. The patients were divided into propofol and midazolam/meperidine groups. Randomization was generated by a computer. Cardiopulmonary side effects (hypotension, bradycardia, hypoxemia), procedure-related times (endoscopy time, awake time, time to hospital discharge), and patient and endoscopist satisfaction were compared between groups. Results: There was no significant difference between the groups with respect to the cost, endoscopy time, or demographic and clinical characteristics of the patients. Awake time and time to hospital discharge were significantly shorter in the propofol group (6.58 ±4.72 vs. 9.32 ±4.26 min, p = 0.030 and 27.60 ±7.88 vs. 32.00 ±10.54 min, p = 0.019). Hypotension incidence was significantly higher in the propofol group (12% vs. 0%, p = 0.027). The patient and endoscopist satisfaction was better with propofol. Conclusions : Propofol may be preferred to midazolam/meperidine sedation, with a shorter awake and hospital discharge time and better patient and endoscopist satisfaction. However, hypotension risk should be considered with propofol, and careful evaluation is needed, particularly in cardiopulmonary disorders

Two-port laparoscopic appendectomy assisted with needle grasper comparison with conventional laparoscopic appendectomy

Purpose: The 2-port laparoscopic appendectomy technique (TLA) is between the conventional 3-port and single-port laparoscopic appendectomy surgeries. We compared postoperative pain and cosmetic results after TLA with conventional laparoscopic appendectomy (CLA) by a 3-port device

New advantageous tool in single incision laparoscopic cholecystectomy: the needle grasper

Introduction: During single-incision laparoscopic cholecystectomy (SILC), the gallbladder is suspended with stitches, resulting in perforation risk and difficulty in exploration

Laparoscopic cholecystectomy under spinal-epidural anesthesia vs. general anaesthesia: a prospective randomised study

Purpose: Laparoscopic cholecystectomy (LC) is usually performed under the general anesthesia (GA). Aim of the study is to investigate the availability, safety and side effects of combined spinal/epidural anesthesia (CSEA) and comparison it with GA for LC

New advantageous tool in single incision laparoscopic cholecystectomy: the needle grasper

Introduction: During single-incision laparoscopic cholecystectomy (SILC), the gallbladder is suspended with stitches, resulting in perforation risk and difficulty in exploration. Aim: We used the needle grasper in SILC to hang and manipulate the gallbladder. Material and methods : Sixty-five patients (43 female, 22 male) who underwent SILC between December 2013 and December 2014 were analyzed retrospectively for patient demographics, duration of operation, laparotomy or conventional laparoscopy necessity, drain use, complications, and hospital stay periods. To place the SILC port (Covidien, Inc.), the needle grasper was inserted at the right upper abdominal quadrant without an incision to hang and manipulate the gall-bladder. Results : The mean age was 47.9 ±13.068 years; the mean body mass index (BMI) was 26.94 ±3.913 kg/m2. ASA scores were 1, 2, and 3. Two patients with high BMI with additional trocar use were excluded. The operations were completed without any additional trocar in 59 patients. The mean operation time was 89 ±22.41 min. Eighteen patients required a drain; all were discharged after drain removal. One patient needed re-hospitalization and percutaneous drainage and was discharged on the 9th day. Fifty-three patients were discharged on the 1st post-operative day. Eleven patients with drains were discharged on the 2nd day, and 1 was discharged on the 7th day. The mean hospital stay period was 1.26 ±0.815 days. Conclusions : The main difficulty of SILC is to manipulate hand tools because the triangulation principle of laparoscopy use is not possible in SILC. Inserting a needle grasper into the abdominal cavity at the right subcostal area to manipulate the gallbladder helps and does not leave a visible scar

Is there any effect of pneumoperitoneum pressure on coagulation and fibrinolysis during laparoscopic cholecystectomy?

Background Laparoscopic cholecystectomies (LC) are generally performed in a 12 mmHg-pressured pneumoperitoneum in a slight sitting position. Considerable thromboembolism risk arises in this operation due to pneumoperitoneum, operation position and risk factors of patients. We aim to investigate the effect of pneumoperitoneum pressure on coagulation and fibrinolysis under general anesthesia. Material and Methods Fifty American Society of Anesthesiologist (ASA) I–III patients who underwent elective LC without thromboprophlaxis were enrolled in this prospective study. The patients were randomly divided into two groups according to the pneumoperitoneum pressure during LC: the 10 mmHg group (n = 25) and the 14 mmHg group. Prothrombin time (PT), thrombin time (TT), International Normalized Ratio (INR), activated partial thromboplastin time (aPTT) and blood levels of d-dimer and fibrinogen were measured preoperatively (pre), one hour (post1) and 24 h (post24) after the surgery. Moreover, alanine amino transferase, aspartate amino transferase and lactate dehydrogenase were measured before and after the surgery. These parameters were compared between and within the groups. Results PT, TT, aPTT, INR, and D-dimer and fibrinogen levels significantly increased after the surgery in both of the groups. D-dimer level was significantly higher in 14-mmHg group at post24. Conclusion Both the 10-mmHg and 14-mmHg pressure of pneumoperitoneum may lead to affect coagulation tests and fibrinogen and D-dimer levels without any occurrence of deep vein thrombosis, but 14-mmHg pressure of pneumoperitoneum has a greater effect on D-dimer. However, lower pneumoperitoneum pressure may be useful for the prevention of deep vein thrombosis

Profile of Patients with Acute Poisoning and Factors Effecting Prognosis: A Retrospective Analysis in the Intensive Care

Aim: The aim of this study was to retrospectively analyse demographic and epidemiologic characteristics, clinical course, laboratory results and prognosis of patients who were admitted to Haseki Training and Research Hospital Intensive Care Unit due to intoxication between 24.11 2007 and 21.02.2013. Methods: We evaluated age, gender, types of intoxication (accident, suicide), etiology, length of stay, mortality rate, duration of mechanical ventilation, and blood pressure, heart rate and symptoms at the time of admission. Patients who took multiple drugs were recorded. Liver and kidney function tests, blood glucose, complete blood count parameters, electrolytes and arterial blood gas values at the time of admission were evaluated. Results: A total of 59 cases of intoxication were studied. 59.7% of patients were male, 42.4% were female. The mean age was 32±13 years. 86.4% of cases occurred due to suicide attempts and 13.6%, accidentally. In our study, it was found that the most common intoxication agents were paracetamol and amitriptyline, and the most common cause of death was methyl alcohol intoxication. Conclusion: Our results showed that a significant portion of the intoxication cases admitted to the intensive care unit were young adults who attempted suicide by overdosing on drugs. (The Me­di­cal Bul­le­tin of Ha­se­ki 2014; 52: 29-33