جستجوی مقالات مرتبط با کلیدواژه « Laparoscopy » در نشریات گروه « پزشکی »

Due to the associated hypertension and cardiovascular disease in patients with ESRD hemodynamic changes during operations are detrimental and may be life-threatening. Therefore, hemodynamic stability is an important criterion in selecting the anesthetic approach.

72 ASA class III/IV, ESRD Patients were studied in randomized double blind clinical trial. They were divided into two groups by four-block randomization. A group of patients were induced and maintained by etomidate and second of patients were induced by Na thiopental and maintained by isoflurane. Systolic, diastolic and mean arterial blood pressure and heart rate were measured at interval of pre and post induction, postintubation, pre and post abdominal insufflation during and at the end of surgery and in recovery. The total BP modulators were recorded and postoperative nausea and vomiting was registered in the recovery. Data were analyzed by STATA version 12.

There was no significant difference in physical characteristics between two groups. There was no statistical difference between the groups in SBP and HR (P>0.05), although DBP fluctuation>20% at interval postinduction and prior to abdominal insufflation during surgery and at the end of surgery, was significantly higher in the isoflurane group of patients. (P=0.004, 0.001, 0.003 and 0.009, respectively). Also, the MAP fluctuation at interval of post induction, preinsufflation and at the end of surgery was significantly higher in isoflurane of patients. (P=0.04, 0.001, and 0.02, respectively).

The group anesthetized with isoflurane had a higher hemodynamic fluctuation, compared to the group anesthetized with etomidate. As hemodynamic changes are critical in patients with ESRD, etomidate is a more appropriate anesthetic choice for implantation of peritoneal dialysis catheter by laparoscopic approach.

The current study aims to investigate the superior mesh fixation</strong> method, single absorbable tacker versus conventional method, in patients undergoing bilateral inguinal hernia repair through the laparoscopic total abdominal preperitoneal (TAPP) approach.

The current randomized clinical trial has been conducted on 81 patients undergoing bilateral hernia repair through TAPP. The patients were randomly assigned into one of the mesh fixation groups including single absorbabletacker (Group S) (n = 41) and conventional method (Group C) (n = 40). All  atients were assessed during the hospital stay and 1 month postoperatively to assess the surgery?associated complications and days for return to daily activity. Eura?Hs questionnaire was applied to assess the quality of life (QOL) after hernia surgery during 12?month follow?up. </strong>

The duration of bilateral inguinal hernia operation (P = 0.067), postoperative urinary catheterization (P = 0.813), and hospital stay duration (P = 0.779) did not differ between the groups; whereas Group C significantly required a longer time for returning to daily activity (P < 0.001). Only a patient in Group Crepresented hematoma (P = 0.494). Seroma incidence was not statistically  ifferent between the two groups (P = 0.712). Postoperative pain was statistically less in Group S (P < 0.001 for all the assessments). Postoperative QOL within a year after hernia repair revealed an insignificant difference between the groups in general (P > 0.05); however, a pain subscale was significantly less in Group S (P = 0.002).

 Based on the findings of this study, a single absorbable tacker was generally superior to the conventional method considering its less pre- and postoperative complications. However, the two methods did not differ regarding 1?year follow?up QOL.

Background &  Establishing a consensus on the appropriate use of prophylactic antibiotics in elective laparoscopic procedures for benign gynecological conditions would be beneficial. The necessity of preventive antibiotics during laparoscopy for uncomplicated gynecologic conditions is currently being debated. This study aims to ascertain the need for prophylactic antibiotics in preventing early post-surgery infections and febrile morbidity in elective laparoscopic surgery for benign gynecologic conditions.Materials &  One hundred women who underwent uncomplicated laparoscopic surgeries were studied for four years. Participants were randomly divided into two groups, and demographic data and postoperative outcomes were analyzed. Infections at the surgical site, fever, urinary tract infections, and respiratory infections were the outcomes studied. The studied variables and the post-operative outcomes assessed did not vary between the two groups. Routine use of antibiotics in laparoscopic gynecologic surgery may not be necessary, as postoperative infection rates remain low even in cases where antibiotics are not administered.

Currently, patients diagnosed with gastric cancer typically undergo surgical or laparoscopic examination to assess the presence of metastasis.

This study involved 35 candidates for gastric adenocarcinoma surgery, consisting of 21 males and 14 females from medical centers in Rasht, Iran, in 2021. Patients reported initial complaints such as abdominal pain, nausea, weight loss, loss of appetite, and anemia. All data was analyzed using SPSS version 21.

Peritoneal lavage cytology results indicated 14 positive cases and 21 negative cases for peritoneal metastasis, while laparoscopic examination during surgery showed 12 positive cases and 23 negative cases. There was concordance between the two methods in 23 cases regarding the presence or absence of peritoneal metastasis, while 12 cases showed inconsistency. Specifically, five cases had negative peritoneal lavage cytology and positive laparoscopic examination, and seven had positive peritoneal lavage cytology and negative laparoscopic examination. Although peritoneal lavage cytology aligned with intraoperative findings regarding patient feasibility.

The study illustrated that solely on peritoneal lavage cytology results is not enough for determining peritoneal invasion in patients with gastric cancer.

Endometriosis is a multifocal gynecologic disorder during the fertility period in women. Magnetic resonance imaging (MRI) is an important diagnostic modality for this disease and can be used either alone or along with transvaginal ultrasonography.

This study aims to compare the accuracy of pelvis MRI in pelvic deep endometriosis with laparoscopic findings in women referred to Shahid Sadoughi hospital in one year.

This cross-sectional study was conducted on 40 women suspicious of endometriosis who referred to Shahid Sadoughi hospital, Yazd, Iran from November 2020-2021. Based on clinical findings and history, participants were referred to the imaging center for pelvic MRI. Finally, the results of MRI and diagnostic laparoscopy were compared with pathologic findings.

The sensitivity and specificity of MRI for pelvic endometriosis were 94.8% and 20%, respectively. Also, the positive predictive value and negative predictive value of MRI were 90.2% and 33.3%, respectively.

Laparoscopy is still the gold standard of endometriosis diagnosis, but MRI with susceptibility-weighted imaging sequence is the best noninvasive diagnostic method.

Pnuemoperitonium in laparoscopy is associated with cardiorespiratory changes. Combination of epidural with General anaesthesia (GA) will offer benefit of hemodynamic control and perioperative analgesia. We aimed to study the efficacy of Combined Epidural- General Anaesthesia (CEGA) with pre-emptive activation over general anaesthesia in laparoscopic cholecystectomies.

In this prospective double blind –randomised study, 90 surgical inpatients were studied in two study groups. Group GE-(n=45) received Lumbar Epidural analgesia with ropivacaine 0.2% along with GA and Group G (n=45) received only GA. Heart rate (HR), Mean arterial Pressure (MAP), systolic blood pressure (SBP), diastolic blood pressure (DBP), Capnogram (ETCO2), saturation (spo2), VAS score, Ramsay sedation score, requirement of propofol, muscle relaxants and analgesics were studied.

Statistical analysis was carried out with SPSS version 20. Statistical value of p<0.05 was considered significant. We noted significant difference in MAP, SBP, DBP, muscle relaxants, Propofol, Fentanyl and lesser pain scores in Group GE than Group G i.e (p<0.001).

Combination of epidural and general anaesthesia technique with pre emptive activation has the benefit of better control of hemodynamics .It reduced requirements of analgesics and anaesthetic drugs and had faster recovery with less post operative pain in laparoscopic cholecystectomies.

Patients can experience nausea and vomiting as one of the most common complications of laparoscopic cholecystectomy. Nausea and vomiting increase the risk of aspiration of stomach contents into the lungs. This study was conducted to determine the effectiveness of pulmonary recruitment maneuver and supplemental oxygen therapy and their combination on the rate of nausea and vomiting in patients undergoing laparoscopic cholecystectomy surgery.

Methods & Materials: 

This is a four-group, double-blind, 2x2 factorial clinical trial in which, 100 eligible patients were assigned to three intervention groups (pulmonary recruitment maneuver group, supplemental oxygen therapy group, pulmonary recruitment maneuver group with supplemental oxygen therapy) and one control group using simple random sampling. Data were collected using a demographic questionnaire and the Rhodes Nausea and Vomiting Severity Questionnaire. Data were analyzed using SPSS version 16.0 with significance level of less than 0.05.

There was a statistically significant difference in the mean scores of nausea, vomiting, and the final score of the nausea-vomiting criterion within 12 hours after the operation among the four groups (p<0.05). However, no significant statistical difference was seen when comparing the mean scores of nausea and vomiting criteria during 24 hours after the operation (p>0.05).

Implementing the combined method as well as pulmonary recruitment maneuver alone were more successful in managing laparoscopy-

Surgical treatment of recurrent gastroesophageal reflux disease (GERD) negatively affects patients’ quality of life (QoL). Determination of risk factors is essential when considering a surgical approach. The present study aimed to evaluate short-term and long-term outcomes of primary laparoscopic Nissen fundoplication (LNF) and open Nissen fundoplication (ONF), as well as the risks of laparoscopic redo fundoplication. A retrospective cohort observational study was conducted from 2010 to 2021 at the National Research Center of Surgery (Almaty, Kazakhstan). Depending on the type of primary GERD surgical correction, 475 patients were stratified into two groups, namely LNF (n=117) and ONF (n=358). The outcomes and associated complications of LNF and ONF surgeries were assessed. The odds ratio of recurrent GERD in terms of risk factors was analyzed as well as post-intervention QoL. Postoperative complications in ONF surgery were 2.7-fold higher than in LNF (P=0.0001). Moreover, intra-operative complications were higher with ONF surgery (7.7%) than with LNF (1.4%) (P=0.002). In cases with persistent clinical manifestations, the rate of redo fundoplication was the same after failed primary LNF and ONF. The risk factors associated with recurrent GERD, leading to redo fundoplication, were obesity (OR=2.16, P=0.473) and male sex (OR=3.0, P=0.272). One-year after LNF, 88.7% of the patients were satisfied with the outcome of the surgery. Recurrent symptoms of GERD and the rate of redo fundoplication were associated with obesity and the male sex. Obesity was the main risk factor, necessitating stringent selection of patients for surgical management of the disease.

Pain control and stabilizing hemodynamic indices are serious medical challenges, especially in anesthesia. Laparoscopic surgery is increasing in the world, and cholecystectomy surgery is no exception.

This study investigated the effect of intravenous (IV) magnesium sulfate injection on intraoperative end-tidal CO2 (ETCO2) levels and postoperative pain in laparoscopic cholecystectomy.

This is a clinical trial. The sample size was calculated to be 64 people who were selected among the patients who were candidates for laparoscopic surgery by convenience sampling. They were randomly assigned to intervention and control groups. The intervention group received magnesium sulfate (50 mg/kg) and normal saline (100 mL) within 1 h. The control group only received normal saline (100 mL). Systolic and diastolic blood pressures, ETCO2 level, heart rate, arterial oxygen saturation, pain level, and narcotic analgesics in recovery were measured 2, 6, 12, and 24 h after surgery. The data were analyzed using 1-way analysis of variance (ANOVA) and repeated measures analysis.

The mean of systolic blood pressure and ETCO2 during recovery in the intervention group were less than the control group (P = 0.029andP = 0.015). In the intervention group, analgesic consumption in recoveryand6hafter surgery was less than the control group (P < 0.001). The mean pain score in the intervention group in recovery and 2, 6 (P < 0.001), and 12 h (P = 0.038) after surgery was significantly lower than the control group.

Magnesium sulfate can be a suitable and safe supplement to reduce pain after surgery and reduce the use of narcotics. The current conclusion should be investigated on a larger scale of patients, with extended monitoring for postoperative pain over a longer period of time.

 Endometriosis is a common and benign disease of the female genital system, which is often seen in reproductive age and leads to infertility, dysmenorrhea, and dyspareunia. The aim of this study is to investigate the anatomical location and characteristics of endometriosis lesions in laparoscopic surgery.

 In this cross-sectional study, 557 endometriosis patients who referred to the gynecology department of Shohadaye-Tajrish Hospital and underwent laparoscopic surgery during 2016-2021 were evaluated. Statistical analysis of data was done using SPSS software version 24.P-value less than 0.05 was considered statistically significant level.

 The results of this study show that the highest anatomical distribution of endometriosis lesions was ovarian endometriosis, and the lowest was vagina. Also, the highest rate of surface lesions is uterus and bladder, and the lowest is superficial lesions of the cul-de-sac cyst.

Our results demonstrate that the distribution of endometriosis lesions is asymmetric.

The effect of laparoscopic ovarian drilling (LOD) before in vitro fertilization/ intracytoplasmic sperm injection (IVF/ICSI) cycles on pregnancy outcomes is an unclear and challenging subject.

To evaluate the impact of LOD before IVF/ICSI cycles on controlled ovarian stimulation and pregnancy outcomes in polycystic ovary syndrome (PCOS) women with a history of more than 2 IVF failures.

In this randomized clinical trial, women with PCOS diagnosis who referred to Arash Women's hospital, Tehran, Iran for IVF/ICSI cycle from August 2015-January 2018 were evaluated. Eligible participants were allocated into 2 groups randomly (n = 17/each group). The participants in the LOD group (intervention) were treated with laparoscopic couture, and after one month, they underwent IVF/ICSI cycles using the gonadotropin-releasing hormone antagonist protocol. The control group had no intervention. The oocyte and embryo qualities, ovarian hyperstimulation syndrome rate, the rates of chemical and clinical pregnancy and early miscarriage, live birth, and pregnancy complications, were compared between groups.

Finally, 34 participants were evaluated. The controlled ovarian stimulation outcomes were similar between groups. The ovarian hyperstimulation syndrome rate in the LOD group was significantly lower than in the control group (p = 0.04). One case of spontaneous pregnancy was reported in the LOD group. No significant difference was observed between groups in clinical pregnancy, miscarriage, and live birth rates. The rates of pregnancy complications (gestational diabetes mellitus, preeclampsia, and preterm birth) were similar between groups.

Performing LOD before IVF/ICSI cycles did not improve the pregnancy outcomes in PCOS women, a clinical trial with a larger sample size is needed to prove these results.

Presacral or retrorectal tumors are rare, usually asymptomatic, and diagnosed accidentally during physical examinationor imaging. Symptomatic tumors may present with perianal pain, bowel dysfunction, and urinary symptoms dueto the mass compression or invasion of the surrounding tissues and organs. Surgical resection is the first choice fortreating presacral tumors. Clinicians should choose surgical procedures based on the location and size of the tumors.We presented a 43-year-old woman who suffered from pelvic pain and primary infertility from two years ago. A largemass between the posterior vaginal wall and the rectum was found on recto-vaginal examination. Magnetic resonanceimaging (MRI) revealed a large 120×115 mm benign multiloculated cystic mass. Eventually, the mass was removedthrough laparoscopic surgery. The pathology report indicated a carcinoid tumor (grade I) with no lymphovascularinvasion. Thus, presacral tumors are resectable through laparoscopy with lower complications than open surgery.

Very often the patients who undergo laparoscopic surgery suffer from shoulder pain (SP). As a result, different studies have been conducted to mitigate shoulder pain following laparoscopic surgery. This systematic review aims to investigate the efficacy of different interventions in mitigating laparoscopy-induced SP.

In this systematic review, relevant articles were included using ISI, PubMed, MEDLINE, etc., from 2009 to 2020. Medical Subject Headings (Mesh) of Laparoscopic Surgical Procedures, Surgery Laparoscopic, Laparoscopic Assisted, Shoulder Pain, randomized controlled trial, and clinical trial were searched for eligible studies. Random effect model and standardized mean difference (SMD) index were applied to combine the studies and perform a meta-analysis.

A total sample of 11,024 was obtained for 10 selected studies. Results from intraoperative intervention demonstrate that the mean VAS (visual analog scale) scores were 1.46(CI 95%: -0.32, 3.24) and 1.87(CI 95%:0.79, 2.94) in the intervention and control groups, respectively six hours after surgery. The mean VAS scores were 2.06(CI 95%: 0.91, 3.20) and 2.35 (CI 95%: 0.57, 4.13) in the intervention and control groups, respectively, twelve hours after surgery. 24 hours following surgery; the mean VAS scores were 0.96(CI 95%: -0.21, 2.13) and 1.27(CI 95%: 0.33, 2.21) in the intervention and control groups, respectively.

The results of this meta-analysis demonstrate that intraoperative interventions, such as Peritoneal Suction Drainage, injection of Intraperitoneal Hydrocortisone with Bupivacaine, and warm and humidified insufflation carbon dioxide, can reduce the severity of SP in patients with LS. In addition, clinical trials with different interventions are needed to compare the efficacy and find effective interventions for SP management in patients with LS.

A vesicovaginal fistula (VVF) is a debilitating condition for women in terms of both its personal and social impacts. A reported transperitoneal laparoscopic approach to treatment has some limitations such as risk of intra-peritoneal organ injury and unnecessary bladder dissection. We here report on our experiences with an extraperitoneal transvesicoscopic approach to a VVF repair, which overcomes these drawbacks.

Seven VVF patients were treated using the transvesicoscopic approach. Under general anesthesia, patients were placed in the dorsal lithotomy position. The VVF orifice was obstructed via the vaginal canal using a Foley catheter. The bladder was then filled with normal saline under cystoscopic inspection, and a 5 mm trocar was inserted into it at the suprapubic area. The bladder wall was next fixed to the anterior abdominal wall. Thereafter, two 3 mm ports were punctured at the interspinous skin crease allowing the fistula margin to be cut and sutured in layers.

Six of the study subjects in whom we attempted a transvesicoscopic repair of VVF had undergone a hysterectomy due to myoma and one had an intraabdominal abscess removal with Behcet's disease. One myoma patient who had a preexisting vesicoperitoneal fistula was converted to an open transabdominal VVF repair. The mean age of the 6 remaining patients was 46.0 ± 7.2 years (range, 35-57). The mean operation time was 273 ± 40.6 minutes (range, 223-323). There was no instances of significant pain or other immediate complications. Five patients showed no recurrence of the fistula during the follow-up period (8.7 ± 5.1 months).

A transvesicoscopic approach is an effective modality for the repair of a VVF that is more minimally invasive and has a lower morbidity than a transabdominal procedure.

Various newer generations of Supraglottic Airway Devices (SAD) with improved designs and performance are available for use by anaesthesiologist. We conducted the present study to compare 3rd generation SAD Baska Mask with 2nd generation SAD I-gel with the aim of comparing their clinical performance in terms of insertion parameters and oropharyngeal leak pressure in short laparoscopic gynaecological surgeries in adult females.

80 adult female patients were randomly allocated to either Baska Mask (n=40) or I-gel (n=40) groups. Insertion characteristics that included number of attempts, mean insertion time and manipulation frequency were recorded and compared. Oropharyngeal leak pressure was measured just after insertion of device and after 5 min of creating pneumoperitoneum in both devices and were compared.

Baska Mask insertion was successfully achieved in first attempt in 38/40 patients in Baska group vs 35/40 patients in I-gel group. Mean oropharyngeal leak pressure (OLP) in Baska Mask versus I-gel just after insertion was (29.24±4.20cm H20 vs 26.33±2.51cm H2O, P=0.003) whereas it was (29.42±2.70 vs 26.18±2.54 cm H2O) after 5 min of creating pneumoperitoneum. Both groups were comparable in terms of removal characteristics and postoperative laryngopharyngeal airway morbidities.

Baska Mask provided more effective ventilation in terms of greater oropharyngeal leak pressure as compared to I-gel. However Baska Mask was more difficult to insert and the incidence of postoperative laryngopharyngeal morbidity was higher in case of Baska Mask.