<b><i>Introduction:</i></b> The Soloassist® system is a joystick-guided robotic scope holder. We evaluated the efficacy of Soloassist in laparoscopic surgery. <b><i>Methods:</i></b> We investigated operative time, blood loss, set-up time, length of hospital stay, and the number of participating surgeons in laparoscopic cholecystectomy cases before and after the introduction of Soloassist. Furthermore, we evaluated these factors in each group of 20 elective and emergency cholecystectomy cases by single surgeon after matching their background. To evaluate the performance level of operating Soloassist, we divided the operative field into three areas. Then we counted the frequency of energy device activation in initially 10 cases by a single surgical resident and observed its change. <b><i>Results:</i></b> The number of participating surgeons was significantly less and postoperative hospital days were fewer in the Soloassist group. There was no significant difference between set-up time and blood loss both in elective and emergency cases. The total number of energy device activations and that in the dangerous area decreased in accordance with the experience. <b><i>Conclusion:</i></b> Considering our results and previous reports, the combination use of an ideal active scope holder and a commercially available 3D scope is currently considered the best approach in laparoscopic surgery. In the near future, development of active scope holders might play an important role in laparoscopic surgery.
An 81 year old man was admitted to hospital with pulmonary Mycobacterium tuberculosis infection and was treated with rifampicin (RFP), isoniazid (INH), and ethambutol (EB). On day 9 he developed fever and dyspnoea. Chest radiographs showed new infiltration shadows in the right lung. Bronchoalveolar lavage (BAL) was performed and increased numbers of lymphocytes were recovered. Drug induced pneumonitis was suspected so the antituberculous regimen was discontinued and methylprednisolone was administered. The symptoms and infiltration shadows improved. INH and EB were reintroduced without any recurrence of the abnormal shadows. T cell subsets in the BAL fluid and a positive lymphocyte stimulation test for RFP suggest that RFP induced pneumonitis may be related to a complex immunological response. R ifampicin (RFP) is an important drug in the treatment of tuberculosis and is used in multidrug regimens. Side effects from RFP are common and include hepatitis, fever, and blood disorders.1 However, RFP induced pneumonitis is rare and we are aware of only one previously reported case. 2We report a patient with a severe pulmonary infiltration probably resulting from a delayed type immune reaction to RFP. CASE REPORTAn 81 year old man was admitted to hospital with fever and a productive cough in February 1999. His past history was remarkable for pulmonary tuberculosis at the age of 35. On physical examination his blood pressure was 146/96 mm Hg and the pulse rate was 82 beats/min. Coarse inspiratory crackles were noted over the left lung fields. Cardiac examination was normal and no lymph nodes were palpable. A chest radiograph revealed infiltrates in the left upper lung and a pleural effusion in the left lower lung (fig 1). The white blood cell (WBC) count was 6070/µl with 74.8% neutrophils, 19.1% lymphocytes, 5.1% monocytes, 0.7% eosinophils, and 0.3% basophils. C reactive protein (CRP) was 1.1 g/dl. Arterial blood gas analysis gave PaO 2 8.5 kPa, PaCO 2 5.2 kPa, and pH 7.45. Acid-fast bacilli were detected in the sputum (Gaffky 2) and the culture yielded Mycobacterium tuberculosis.Beginning on day 2, RFP (0.3 g/day), isoniazid (INH, 0.3 g/ day), and ethambutol (EB, 0.5 g/day) were administered and the pleural effusion was drained. After administration of these drugs the symptoms diminished gradually. On day 9 the patient developed fever and dyspnoea. At this time a chest radiograph and CT scans showed new interstitial shadows in the right lung (fig 2). The WBC count increased to 13 540/µl with 81.0% neutrophils, 5.5% lymphocytes, 11.0% monocytes, and 2.5% eosinophils. The CRP concentration was 17.4 g/dl. Arterial blood gas analysis gave PaO 2 9.5 kPa, PaCO 2 6.0 kPa, pH 7.39 (on nasal oxygen at a rate of 8 l/min). Bronchoalveolar lavage (BAL) was performed using 100 ml of a sterile saline solution (30% recovery). The BAL fluid contained 82.9% lymphocytes, 13.6% neutrophils, and 3.5% macrophages. The CD4/CD8 ratio of the BAL fluid lymphocytes was 10.5. A presumptive diagnosis of drug induced pneumonitis was made and the ...
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