Safe Introduction of Ancillary Trocars

Tinelli, Andrea; Gasbarro, Nicola; Lupo, Pietro; Malvasi, Antonio; Tsin, Daniel A.; Dávila, Fausto; Domı́nguez, Gema; Mettler, Liselotte; Wetter, Paul Alan

doi:10.4293/108680812x13427982376464

Cited by 20 publications

(6 citation statements)

References 15 publications

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“…Here, minimally invasive techniques provide enhanced recovery following surgery by preventing surgery-related trauma, preventing surgical pain and decreasing the length of hospital stay. Several new methods that are shown to enhance procedure safety, including inferior epigastric artery damage during the introduction of ancillary trocars in gynaecologic laparoscopic procedures, have also been established recently [7, 8]. We believe that the results of the current study are more valuable in terms of achieving ERAS.…”

Section: Discussionmentioning

confidence: 82%

Semi-Fowler positioning in addition to the pulmonary recruitment manoeuvre reduces shoulder pain following gynaecologic laparoscopic surgery.

Katılmış

Yılmaz

2019

Videosurgery and Other Miniinvasive Techniques

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IntroductionThe semi-Fowler position, defined as a body position at 30° head-of-bed elevation, has been shown to increase intra-abdominal pressure.AimTo investigate the impact of semi-Fowler positioning in addition to the pulmonary recruitment manoeuvre (PRM) on post-laparoscopic shoulder pain.Material and methodsOne hundred and six patients (mean age: 43 ±12 years) undergoing gynaecologic laparoscopic surgery (LS) were included. The patients were divided into three groups: group 1 consisted of patients receiving PRM in the neutral position, group 2 comprised patients receiving PRM in the semi-Fowler position, and patients in the control group received neither PRM nor additional positioning. Information concerning wound and shoulder pain (post-laparoscopic shoulder pain – PLSP) at postoperative 6, 12 and 24 h was recorded using a visual analogue scale (VAS) for each patient.ResultsThe PLSP scores at postoperative 6 h (5.71 ±0.86, 5.28 ±0.84 and 6.61 ±0.91, respectively, p < 0.001), 12 h (4.41 ±0.83, 4.01 ±0.82 and 5.32 ±0.97, respectively, p < 0.001), and 24 h (3.24 ±0.78, 2.44 ±0.73 and 4.34 ±0.85, respectively, p < 0.001) were significantly different among the groups, the lowest being in those who received PRM in addition to semi-Fowler positioning.ConclusionsSemi-Fowler positioning in addition to PRM significantly reduces post-laparoscopic shoulder pain. We assume that the benefit gained using the semi-Fowler positioning is mainly derived from its potential to better evacuate the remaining abdominal gas following LS.

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Section: Discussionmentioning

confidence: 82%

Semi-Fowler positioning in addition to the pulmonary recruitment manoeuvre reduces shoulder pain following gynaecologic laparoscopic surgery.

Katılmış

Yılmaz

2019

Videosurgery and Other Miniinvasive Techniques

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“…Yellow Island is more easily observable in obese patients. The IEA and other major blood vessels are almost never present in the yellow island and hence is an advisable area for secondary trocar insertion, especially obese patients [9]. It is imperative to avoid injury to the IEA during laparoscopy not only to prevent hemorrhage but also for the sequelae resulting from IEA injury.…”

Section: Discussionmentioning

confidence: 99%

“…Hence from the findings in our present study, the recommended port site for secondary trocar insertion is at a distance [6 cm from the midline superior to the ASIS in normal weight patients and at a distance[9 cm from the midline at the plane of umbilicus. The use of smaller trocars [5] and trocars with conical tips [9] for lateral placement can also minimize the risk of vessel injury. Tinelli et al, suggested that trocars should be placed in the 'yellow island' which is an accumulation of subperitoneal adipose tissue found at the lateral third of a line between the anterior superior iliac spine and the umbilicus.…”

Section: Discussionmentioning

confidence: 99%

Topography of inferior epigastric artery relevant to laparoscopy: a CT angiographic study

et al. 2015

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“…Laparoscopic procedures have become more frequent in the last decades. In this regard, laparoscopic gynecologic surgery is one of the most well-known procedures [1][2][3]. Carbon dioxide (CO 2 ) insufflation induces pneumoperitoneum, which along with hypercapnia can cause unfavorable hemodynamic effects due to catecholamine and vasopressin release.…”

Section: Introductionmentioning

confidence: 99%

Effects of ultrasound guided ganglion stellate blockade on intraoperative and postoperative hemodynamic responses in laparoscopic gynecologic surgery.

Rahimzadeh

Mahmoudi²,

Khodaverdi

et al. 2019

Videosurgery and Other Miniinvasive Techniques

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Introduction: Laparoscopic gynecologic surgery is one of the most well-known procedures. Pneumoperitoneum with carbon dioxide insufflation can cause unfavorable hemodynamic effects due to catecholamine and vasopressin release. Aim: To examine the effects of stellate ganglion block on hemodynamic response and postoperative pain. Material and methods: In a prospective double blinded randomized parallel study we included 40 patients with ASA physical status I and II, aged between 18 and 50 years with a gynecologic problem candidate for laparoscopic surgery under general anesthesia. The patients were randomly divided into two groups. Fifteen minutes before anesthesia induction, the patients underwent ultrasound guided stellate ganglion block with 10 ml of lidocaine 1% and the control group underwent stellate ganglion block using 10 ml of distilled water as placebo. After induction of general anesthesia, systolic and diastolic blood pressure and heart rate were recorded, especially after blowing of CO 2 gas, the position change, depletion of CO 2 , and tracheal extubation in recovery. The postoperative pain was calculated using the visual analogue scale (VAS) at three times (0, 30, and 24 h after surgery). Results: Our results showed that mean systolic and diastolic blood pressure and heart rate did not show any significant difference at the measurement times (p > 0.05), and mean VAS of patients in the two groups was significantly different for the three measurement times except 24 h after surgery (p < 0.05). Conclusions: Stellate ganglion block before laparoscopic gynecologic surgery has no significant effect on intraoperative and postoperative hemodynamic responses; however, it can decrease VAS in the early postoperative period.

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Safe Introduction of Ancillary Trocars

Abstract: The authors describe 2 steps useful to avoid iatrogenic injury during introduction of laparoscopic ancillary trocars.

Cited by 20 publications

References 15 publications

Semi-Fowler positioning in addition to the pulmonary recruitment manoeuvre reduces shoulder pain following gynaecologic laparoscopic surgery.

Semi-Fowler positioning in addition to the pulmonary recruitment manoeuvre reduces shoulder pain following gynaecologic laparoscopic surgery.

Topography of inferior epigastric artery relevant to laparoscopy: a CT angiographic study

Effects of ultrasound guided ganglion stellate blockade on intraoperative and postoperative hemodynamic responses in laparoscopic gynecologic surgery.

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