Gynecologic Laparoscopy. A Review Article

Ohlgisser, M; Sorokin, Yoram; Heifetz, M

doi:10.1097/00006254-198507000-00001

Cited by 47 publications

(8 citation statements)

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“…General anaesthesia with muscle paralysis, tracheal intubation and IPPV is the preferred technique. 1,76 Muscle paralysis reduces the lAP needed for the same degree of abdominal distension under tension pnem~ peritoneum. 77 This improves surgical exposure while minimising the adverse effects of tension pneumoperitoneum.…”

Section: Anaesthetic Techniquesmentioning

confidence: 99%

Anaesthesia for Laparoscopic General Surgery

Chui

Gin

1993

Anaesth Intensive Care

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Laparoscopic surgery minimises postoperative morbidity. Patient benefits include reduction in postoperative pain, better cosmetic result and quicker return to normal activities. Hospital stay is shortened resulting in a reduction in overall medical cost. The intraoperative requirements of laparoscopic surgery however can lead to serious physiological changes and complications. While there is a low but definite perioperative mortality rate associated with minor gynaecologic laparoscopic procedures, laparoscopic general surgical procedures are performed on older patients and patients with acute surgical conditions and are likely to be associated with a higher incidence of perioperative complications. The major problems during laparoscopic surgery are related to the cardiopulmonary effects of pneumoperitoneum, systemic carbon dioxide absorption, extra peritoneal gas inSUfflation, venous gas embolism and unintentional injuries to intra-abdominal structures. An appraisal of the potential problems is essential for optimal anaesthetic care of patients undergoing laparoscopic surgery. Appropriate anaesthetic techniques and monitoring facilitate surgery and allow early detection and reduction of complications. The need for rapid recovery and short hospital stay impose additional demands on the anaesthetist for skiltjul practice.

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Section: Anaesthetic Techniquesmentioning

confidence: 99%

Anaesthesia for Laparoscopic General Surgery

Chui

Gin

1993

Anaesth Intensive Care

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“…Establishment of pneumoperitoneum with the VN may be associated with a recognized incidence of complications such as preperitoneal insufflation which makes the procedure more difficult and time-consuming [10] .…”

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confidence: 99%

Direct Trocar versus Veress Needle Entry for Laparoscopy: A Randomized Clinical Trial

Zakherah¹

2010

Gynecol Obstet Invest

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Aims: To compare direct trocar (DT) to Veress needle (VN) entry for the creation of pneumoperitoneum during laparoscopy with regard to the duration of the procedure, volume of gas used, ease of performance, and frequency of complications. Design: A randomized clinical trial. Subjects and Methods: One thousand patients scheduled to undergo diagnostic laparoscopy were recruited for the study. They were randomly allocated to either DT entry (group A, n = 500) or VN (group B, n = 500) for pneumoperitoneum. The laparoscopic procedures were performed by the same surgeon. Outcomes: The duration of the procedure, volume of gas consumption, ease of performance and frequency of complications were analyzed. Results: Patients in the 2 groups had similar demographic characteristics. The mean duration of the procedure was significantly shorter in group A (2.2 ± 0.7 min, 95% CI 2.14–2.26) than in group B (8.2 ± 1.4 min, 95% CI 8.08–8.32; p < 0.0001). The mean gas consumption was significantly less in group A (2.6 ± 0.9 liters, 95% CI 2.52–2.68) than in group B (8.4 ± 2.6 liters, 95% CI 8.17–8.63; p < 0.0001). No major complications in both groups were encountered. Minor complications were significantly less in group A (0.4%, 95% CI 0.77–3.23) than in group B (14%, 95% CI 10.96–17.04; p < 0.0001). Conclusions: DT entry is a safe alternative to the VN entry technique for the creation of pneumoperitoneum. Such an approach has further advantages such as less cost and instrumentation and rapid creation of pneumoperitoneum.

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“…Many surgeons prefer to use CO2 for pneumoperitoneum during laparoscopic cholecystectomy because of its higher solubility in blood than nitrous oxide [10] and a lower frequency of venous air embolism. However, peritoneal insufflation with CO2 often brings about unfavorable effects, such as hypercarbia and high peak airway pressure.…”

Section: Discussionmentioning

confidence: 99%