Management of patients after laparoscopic procedures

Blencowe, Natalie S; Waldon, Richard; Vipond, M N

doi:10.1136/bmj.k120

Cited by 20 publications

(26 citation statements)

References 17 publications

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“…for cutting, manipulation, and closing) and each can be reused 30 times instead of ten, then in the potential situation that one in three laparoscopic surgeries (i.e. 7.5 million procedures annually) in 2025 is performed using articulating instruments [35, 36], a minimum of 1.5 million Instruments would be saved from disposal each following year.…”

Section: Discussionmentioning

confidence: 99%

A new modular mechanism that allows full detachability and cleaning of steerable laparoscopic instruments

et al. 2019

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Background Ever since the introduction of laparoscopic surgery, researchers have been trying to add steerability to instruments to allow the surgeon to operate with better reachability and less tissue interaction force. Traditional solutions to introduce this often use a combination of springs, cables, pulleys, and guiding structures, resulting in instruments that cannot be properly cleaned and thus are very costly to manufacture and maintain. The aim of the study is to develop a novel affordable, sustainable, cableless, and fully steerable laparoscopic grasper, and to test its ease of assembly, disassembly, and use. Methods A set of requirements was defined to ensure that the instrument can be handled efficiently at the sterilization unit and in the operating room. Based on these, a multisteerable, cableless 5 mm laparoscopic instrument that operates based on shaft rotations was developed. To test its assembly and disassembly, ten participants were asked to fully dismantle the instrument and reassemble it a total of 60 times. In addition, ten medical students were asked to use the grasper in the ForceSense box-trainer system on a newly developed 3D pick-and-place task, to determine the control effort based on learning curves of steering errors, task time, instrument path length, and maximum tissue interaction force. Results All important design requirements were met. The recorded data indicates that ten engineering students were able to fully dismantle and reassemble the instrument shaft in 12 s (SD7) and 65 s (SD43) seconds at the sixth attempt. The learning-curve data indicates that three attempts were needed before the ten medical students started to use all steering functions. At the sixth attempt, on average only 1.25 (SD0.7) steering errors were made. The steepest slope in the learning curves for steering errors, path length, and task time was experienced during the first three attempts. In respect of the interaction force, no learning effect was observed. Conclusion The multi-DOF (degree of freedom) cableless grasper can be assembled and disassembled for cleaning and sterilization within an acceptable time frame. The handle interface proved to be intuitive enough for novices to conduct a complex 3D pick-and-place task in a training setting. Electronic supplementary material The online version of this article (10.1007/s00464-019-06849-0) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

A new modular mechanism that allows full detachability and cleaning of steerable laparoscopic instruments

et al. 2019

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“…These symptoms should subside within 24 hours, but if pain worsens thereafter, intra-abdominal complications must be excluded. 40 Benefits of optimising analgesia include earlier mobilisation (decreasing VTE risk and pulmonary complications), improved sleep, higher patient satisfaction and fewer delayed discharges. Multimodal analgesia improves pain relief, while reducing the side-effects of individual agents.…”

Section: Postoperative Analgesiamentioning

confidence: 99%

“…Pragmatic advice is, 'if it hurts, don't do it'; patients should notice a daily improvement in the activities they can undertake without pain. 40 Time until return to work depends on the patient's operation and occupation: 2 weeks of leave from a sedentary job after laparoscopy usually suffices. For 2 weeks postoperatively, patients should avoid lifting anything heavier than a full kettle and any considerable pushing and pulling activities (e.g.…”

Section: Early Mobilisationmentioning

confidence: 99%

“…Although desirable, passing urine and flatus and tolerating oral intake are not prerequisites for discharge. 40 Prescribe a softening laxative (e.g. docusate) to take until their first bowel movement.…”

Section: Advice Upon Dischargementioning

confidence: 99%

“…The pace of resumption of normal activities postoperatively depends on the operation performed. Pragmatic advice is, ‘if it hurts, don’t do it’; patients should notice a daily improvement in the activities they can undertake without pain 40 . Time until return to work depends on the patient’s operation and occupation: 2 weeks of leave from a sedentary job after laparoscopy usually suffices.…”

Section: Postoperative: In the Recovery Bay And/or Wardmentioning

confidence: 99%

See 2 more Smart Citations

Life in the laparoscopic fast lane: evidence‐based perioperative management and enhanced recovery in benign gynaecological laparoscopy

Bryant‐Smith¹,

As‐Sanie

Lloyd

et al. 2021

The Obstetric & Gynaecologis

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Enhanced recovery after surgery (ERAS) protocols aim to shorten the length of hospital stay and expedite recovery, without increasing complications or readmission rates. Implementation of ERAS protocols should be evidence-based, including when applied to pre-admission clinic (including preoperative investigations), fasting, antibiotic prophylaxis, thromboprophylaxis, analgesia, expeditious removal of urinary catheters and early mobilisation. Learning objectivesTo understand evidence-based perioperative management of patients undergoing laparoscopic procedures for benign gynaecological indications. To appraise critically the judicious ordering of preoperative investigations.To understand the importance of preoperatively assessing and managing each patient's risk of venous thromboembolism. To understand the key components of perioperative management that decrease surgical site infection(s). Ethical issuesPreoperative patient education is a vital component of perioperative management; written materials should be prepared in languages other than English to enable all patients to benefit from the ERAS approach. A balance must be found between applying ERAS protocols as a checklist to ensure all aspects of patient care have been considered and tailoring those protocols to each patient's individual needs.

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Nondestructive optical feedback systems for use during infrared laser sealing of blood vessels

Giglio

Fried

2022

Lasers Surg Med

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High-power infrared lasers are capable of sealing blood vessels during surgery. A real-time diagnostic feedback system utilizing diffuse optical transmission is characterized by nondestructive identification of vessel seals. Materials and Methods: For real-time diffuse optical transmission experiments, two approaches were studied. First, a low-power (1.2 mW) visible aiming beam (635 nm) was used for diagnostics, co-aligned with the therapeutic high-power infrared beam (1470 nm). Second, the 1470 nm beam was used simultaneously for both therapy and diagnostics. For both studies, the 1470-nm laser delivered 5 W for 5 seconds for unsuccessful seals (control) versus 30 W for 5 seconds for successful seals, using a linear beam profile (8.4 × 2 mm). Diffuse optical transmission signals were correlated with vessel burst pressures measured using a standard burst pressure setup. Results: Diffuse optical transmission studies using the low-power, 635-nm aiming beam were promising. A decrease in the visible transmitted signal of 59 ± 11% was measured for successful seals versus 23 ± 8% for failed seals (p = 5.4E−8). The use of the high-power, 1470-nm infrared laser for simultaneous therapeutics and diagnostics proved inconsistent and unreliable, due in part to the dynamic and rapid changes in water content and absorption during the seal. Conclusions: A low-power, visible aiming beam, integrated with the therapeutic high-power infrared diode laser, may be used as a real-time diagnostic system for indicating successful laser seals, based on significant changes in optical scattering and diffuse optical transmission between native and coagulated compressed vessels. With further development, this simple and inexpensive optical feedback system may be integrated into a laparoscopic device for laser de-activation upon successful vessel sealing.

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Management of patients after laparoscopic procedures

Cited by 20 publications

References 17 publications

A new modular mechanism that allows full detachability and cleaning of steerable laparoscopic instruments

A new modular mechanism that allows full detachability and cleaning of steerable laparoscopic instruments

Life in the laparoscopic fast lane: evidence‐based perioperative management and enhanced recovery in benign gynaecological laparoscopy

Nondestructive optical feedback systems for use during infrared laser sealing of blood vessels

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