Researchers conducted a prospective randomized controlled clinical trial at Bern University Hospital in Switzerland to compare a laparoscopic procedure with a mini-laparotomy for insertion of a peritoneal catheter during ventriculoperitoneal (VP) shunt surgery. The deciding factor was the rate of shunt malfunction. Although overall shunt failure rates did not differ substantially between patients in the two surgery groups, the authors identified a significant reduction in the rate of distal (abdominal) shunt failure in patients in whom laparoscopy was used. Detailed findings of the clinical trial are reported and discussed in "Laparoscopically assisted ventriculoperitoneal shunt placement: a prospective randomized controlled trial" by Philippe Schucht, MD, Vanessa Banz, MD, PhD, and colleagues, published today online, ahead of print, in the Journal of Neurosurgery Background: Hydrocephalus is a condition in which there is excessive accumulation of cerebrospinal fluid (CSF) in chambers of the brain known as ventricles. If left uncorrected, the excess CSF can exert pressure on critical brain structures, causing the patient to experience cognitive, visual, or motor deficits; seizures; or even death. Ventriculoperitoneal (VP) shunts are frequently placed to redirect excess CSF away from the brain and into the peritoneal cavity in the abdomen, where the body can absorb it. Most VP shunts consist of a catheter that is placed in one of the ventricles in the brain, a one-way valve that draws excess CSF away from the ventricles, and a second catheter placed under the skin that carries this excess fluid down to the peritoneal cavity.

Laparoscopy is a form of minimally invasive or keyhole surgery. In this type of surgery, a surgeon can examine the inside of the abdomen or pelvis using small incisions to insert tools and instruments. A laparoscope, which has a camera and light at the tip is passed through the incision and used to relay images of the internal structures to a TV monitor. This type of surgery is preferred over traditional open surgery, which requires a large incision in the abdomen to expose the internal organs. Laparoscopy is associated with less pain, bleeding and scarring, a faster recovery time and a shorter hospital stay. The tools used in laparoscopic surgery have been studied and refined over the decades. One example is the TransEnterix which was approved by the U.S. Food and Drug Administration in October 2009. It has a SPIDER surgical system that uses flexible instruments and requires only one incision to be made in the belly button area. This allows for rapid healing after the operation. The system was developed by Dr. Richard Stac from Duke University. Other electronic tools have been developed in recent years to help surgeons optimize the surgical process. Features of these developments include visual magnification to improve the quality of images on the viewing screen; simulators that surgeons can use to practice procedures and hone their surgical skills; stabilization to eliminate vibration caused by machinery or shaking hands; and the reduced number of incisions required to operate successfully.

Recently, the nation's first high-definition digital integrated laparoscopic operating room was officially launched at the Guangdong Provincial People's Hospital. The operating room is used by specialists. The operating room is equipped with a variety of gastrointestinal surgery-specific laparoscopic equipment and a set of remote consultation terminals. The well-equipped operation room makes gastrointestinal surgery more refined and humanized. According to Lin Feng, director of the Department of Gastrointestinal Surgery at the hospital, the biggest difference between the operating room and the traditional operating room is that all medical equipment can be organically linked with the physician through a centralized control system. As long as the doctor can complete the operation of surgical instruments, access to patient information, remote consultation and other tasks through the touch screen. The reporter saw five screens hanging in different positions in the operating room. Its video communication system is linked to more than 1,180 operations such as Japan, the United States, and the United Kingdom. During the operation, if the surgeon encounters a problem, he can call the Internet phone at any time to ask for [foreign aid" or [help the other operating room". In addition, domestic experts only need to open the terminal at the place covered by the cell phone signal, input the surgical machine number of the operating room, and insert a 3G network card to view the operation status of the surgical image and various machines in real time and perform the surgery. Real-time remote guidance.

Laparoscopic surgery can be widely used in the comprehensive treatment of tumors. Beijing Cancer Hospital General Surgery successfully performed laparoscopic radical resection for an 88-year-old man. This is by far the oldest patient to be treated with laparoscopic surgery in the hospital. It is noteworthy that Su Xiangqian, an associate professor of the Beijing Cancer Hospital General Surgery for this patient, took the lead in applying laparoscopic techniques to the comprehensive treatment of tumors in the oncology hospital. In the past two years, laparoscopic radical colorectal cancer has been successfully cured. Surgery, gastric stromal tumor resection, liver tumor resection, intraperitoneal hyperthermic perfusion chemotherapy, abdominal mass biopsy, middle and low rectal cancer radiotherapy before the transfer, cholecystectomy and castration surgery, etc., increased for cancer patients The opportunity to cure. He believes: "Laparoscopy will play an increasingly important role in the comprehensive treatment of tumors, especially in elderly patients." ■The scope of application of laparoscopic surgery is expanding According to Associate Professor Su Xiangqian, laparoscopic technique is a great technological revolution in the field of surgery in the 20th century. Since the first French doctors used laparoscopic techniques to complete cholecystectomy in 1987, laparoscopic techniques have rapidly spread throughout the world. After nearly 20 years of development, laparoscopic techniques have been widely used in general surgery, urology and gynecology, and become the representative of minimally invasive surgery. Laparoscopic surgery in China has a history of more than ten years. From the initial cholecystectomy to the present, it has been successfully applied to the diagnosis and treatment of abdominal diseases such as stomach, colorectal, hepatobiliary and pancreas. Laparoscopic sur

The US Food and Drug Administration has recommended that the use of uterine smashers in laparoscopic uterine myomectomy and hysterectomy may cause unknown tumors to spread in the abdominal cavity, leading to an increased risk of disease. This proposal has caused tremendous repercussions and discussions. At one time, there were different opinions and no one. And our experts suggest that, just like the usual sterility awareness during surgery, everyone should also establish a sense of no tumor, this consciousness should be implemented in the whole process of preoperative diagnosis, intraoperative operation and postoperative care. The US Food and Drug Administration (FDA) recently recommended that the use of uterine pulverizers in laparoscopic myomectomy and hysterectomy may cause unknown tumors to spread in the abdominal cavity, leading to an increased risk of disease. instrument. The FDA has asked manufacturers to inspect the label of the relevant equipment (tissue pulverizer) and is considering adding a "black box" warning - this is the strongest warning the FDA can issue. This proposal has caused tremendous repercussions and discussions. At one time, there were different opinions and no one. So, what is the pulverizer used in laparoscopic surgery, and how much risk it has, should we stop laparoscopic surgery to avoid risk? the reason Smashing can cause tumor spread "Minimally invasive surgery is the general trend of surgical development and the pursuit of goals." Xiu Dianrong, director of the Third Hospital of Peking University, said in an interview with the reporter of the Chinese Journal of Science. Laparoscopic surgery is a newly developed minimally invasive treatment method. Compared with traditional surgery, it is very popular among patients, especially after surgery, which has small scars and meets aesthetic requirements. Young patients are more w

According to foreign media reports, a former British soldier has become the first patient in the UK to undergo laparoscopic kidney transplantation. Brian Blanchard suffers from kidney failure and needs to be maintained by dialysis. Last month, the doctor performed a kidney transplant with laparoscopic surgery. There are two breakthroughs in this technology. One is that the transplanted organ comes from his sister Pam Marphett. The doctor takes out the donated kidney through her groin instead of the traditional abdomen, leaving almost no postoperative scars. Another breakthrough was that the removed kidney implanted in Brian's body had less than 2.5 inches of incision in the abdomen. Previously, the size of the incision for a kidney transplant was 10 inches. Surgeons say the new technology lays the foundation for safer transplants and allows patients to recover faster. Advances in technology have made laparoscopic kidney transplantation possible. Professor Pranjal Modi from Royal Liverpool Hospital in India initiated a minimally invasive surgery in 2010 to remove the kidneys from the navel without scar endoscopy. He successfully performed 172 minimally invasive procedures in Ahmedabad, northern India. But the operation has never been done elsewhere. Professor Modi is also proficient in organ harvesting from the groin. The purpose of both endoscopic techniques is to allow patients to recover as quickly as possible, reducing the risk of postoperative pain and infection and allowing patients to be discharged as soon as possible. The doctor not only avoided a major surgical incision for Brian, but also avoided new scars. The doctor performed a kidney transplant through his old appendicitis surgical scar.

On the morning of May 30, in the integrated operating room of the new comprehensive ward building of Ruijin Hospital, Professor Zheng Minhua, director of the Department of Gastrointestinal Surgery/Shanghai Minimally Invasive Surgery Clinical Medicine, successfully implemented a 3D laparoscopic right colon for an 82-year-old female patient. Radical radical surgery, and for the first time with virtual reality technology (VR) to achieve a panoramic view of surgery and laparoscopic VR live broadcast, the onlookers feel the immersive surgery through the phone and eye mask. This is the first live broadcast of virtual reality 3D laparoscopic surgery in China. On the morning of June 3 (Tomorrow), the official release of the panoramic +3D laparoscopic VR operation will be held at Ruijin Hospital. This may change the way minimally invasive surgery and surgical teaching. What is the difference between VR live broadcasts? VR live broadcast is one of the more widely used applications in virtual reality (VR) technology. It can be completely recorded on the first scene by 360 degrees through a special panoramic camera. Transfer to the cloud, and then through the special APP or WeChat web-side video player combined with the existing simple virtual reality device to achieve VR surgery live. In the past, minimally invasive surgery was observed and observed. Only the images under the endoscope could be seen. The low-grade doctors who could not visit the scene could hardly understand the mystery and skills in difficult surgery. The emergence of VR live broadcasts has solved these dilemmas. The viewers can see the live video of the panoramic video through the comput

Xinhua News Agency, Shenzhen, November 27th, the reporter learned from the 2017 World Medical Robot Conference held in Shenzhen that the domestically assisted abdominal surgery robot is expected to be mass-produced in three years. According to Sun Lining, deputy director of the State Key Laboratory of Robotics and Systems, medical robots, especially surgical robots, are the [rich and handsome" in the field of robotics. The technical thresholds and R&D and manufacturing costs are high. At present, there are already many research teams in China that are working on the development of surgical robots, and have developed a complementary laparoscopic surgical robot system with independent intellectual property rights. In addition to individual high-precision core components, the system's main hardware, software, materials and system design are independently developed by our research team. Sun Lining said that after the domestically-assisted laparoscopic surgery robot is on the market, the consumables can also be made domestically, and the surgery cost will be greatly reduced, so more patients can enjoy this high-end medical service. "Domestic scientists are still working on developing intelligent surgical robots that can sense the doctor's intentions." Sun Lining said that it is expected that the energy production of domestically assisted laparoscopic surgery robots will be on the market in about three years. (Reporter Bao Xiaojing Xiao Sisi)

According to foreign media reports, a former British soldier has become the first patient in the UK to undergo laparoscopic kidney transplantation. Brian Blanchard suffers from kidney failure and needs to be maintained by dialysis. Last month, the doctor performed a kidney transplant with laparoscopic surgery. There are two breakthroughs in this technology. One is that the transplanted organ comes from his sister Pam Marphett. The doctor takes out the donated kidney through her groin instead of the traditional abdomen, leaving almost no postoperative scars. Another breakthrough was that the removed kidney implanted in Brian's body had less than 2.5 inches of incision in the abdomen. Previously, the size of the incision for a kidney transplant was 10 inches. Surgeons say the new technology lays the foundation for safer transplants and allows patients to recover faster. Advances in technology have made laparoscopic kidney transplantation possible. Professor Pranjal Modi from Royal Liverpool Hospital in India initiated a minimally invasive surgery in 2010 to remove the kidneys from the navel without scar endoscopy. He successfully performed 172 minimally invasive procedures in Ahmedabad, northern India. But the operation has never been done elsewhere. Professor Modi is also proficient in organ harvesting from the groin. The purpose of both endoscopic techniques is to allow patients to recover as quickly as possible, reducing the risk of postoperative pain and infection and allowing patients to be discharged as soon as possible. The doctor not only avoided a major surgical incision for Brian, but also avoided new scars. The doctor performed a kidney transplant through his old appendicitis surgical scar.

Minimally invasive laparoscopic surgery into the 3D era Ruijin Hospital takes the lead in three-dimensional field of vision operation, superior visual effects bring greater safety In the busy and nervous operating room, the surgeons wore "3D sunglasses". The two doctors held the robotic arm and looked up the movement in the patient's abdominal cavity on the display. Different from the past, on this display labeled "3DHD", the abdominal organs and blood vessels are well-defined, just like watching a 3D movie. Yesterday morning, in the operating room of Shanghai Ruijin Hospital, doctors were giving an 84-year-old woman a bowel cancer radical surgery. This is the second patient who has undergone 3D high-definition laparoscopic surgery in China. It was here five days ago and completed the first 3D high-definition laparoscopic surgery in China. The application of 3D high-definition technology to the clinic is regarded by the international medical community as the future of minimally invasive surgery visualization. Its superior visual effect means faster and more accurate surgical operation, less complications and higher safety. New problems after not "opening" "Can you give me a pair of glasses to see the effect? Well, the vision is really different! If used for our pelvic lymphadenectomy, the effect must be very good, the traditional screen is two-dimensional, can not see clearly." 8 am yesterday , Ruijin Hospital Branch, Shanghai Mini-invasive Surgery Clinical Medical Center, a holistic operating room, just an empty obstetrician and gynecologist came to observe the "new weapon" - 3D minimally invasive laparoscopic surgery. Technological advances always make surgeons eager to try. Today, laparoscopic surgery is always clos

Laparoscopic surgery depends on access. Trocars and ports serve as conduits for cameras; grasping, dissecting, cutting and sealing instruments; mesh positioners; staplers and a host of other devices reaching in to treat the otherwise untouchable surgical site in the abdominal cavity. The narrower instruments and smaller incision sizes that support minimally invasive surgery shrink the necessary diameter of these access ports and, consequently, their impact on surgical patients' tissue, a benefit which sparked the concept of single-incision laparoscopy, in which one port does the job. But as surgical techniques and surgical access have miniaturized, a single port now has to play many roles. Simply delivering access isn't enough: Ports must offer other functional advantages as well, as surgical innovators and medical device manufacturers have recently realized. For example, one access device manufacturer also offers a way to ensure predictable incision closing outcomes. When is a port not a port? When it's actually 3 or more ports. Or when it's also an insufflation device. Or when it's part of a multi-tasking laparoscopic management system. Among the recent developments to hit the access market: a reusable trocar, designed to be as easy to take apart and clean as it is easy on your supply budget;

Success in the rapidly growing endoscopic spine surgery (ESS) space often comes down to striking a delicate balance between two sometimes disparate factors: Your surgeons` preferences and your vendor relationships. [You need to find the right surgeons who are willing to work with you to use the lowest-cost option with the highest quality of service," says Prashanth Bala, MS, MHA, vice president for ASC operations at Shields Health with direct oversight of strategy and operations for New England Surgical Suites (NESS) in Natick, Mass., a collaboration among Shields Health, Reliant Medical Group and several private practice physicians. [Without this balance, you`re going to either have quality issues because the surgeons aren`t going to be comfortable with the products you give them, or you`re going to lose money on every case you do because you bought something that`s too expensive and your surgery center is going to lose money. Threading that needle and finding the right surgeons and the right vendor partner is key." Mr. Bala should know - he says his NESS center began performing ESS cases in April of this year and is currently the only surgery center in the state of Massachusetts doing so. That exclusivity is likely to end in the near future with a surge in endoscopic spine cases expected and a growth rate of outpatient spine as high as 30% by 2026 according to some estimates. Minimal incision, reduced tis

The day before I spoke with Peter Kim, MD, an orthopedic hand surgery specialist in the Boston area, he performed a unilateral endoscopic carpal tunnel release on a friend and colleague, another orthopedic surgeon. The surgery took place on Monday. Dr. Kim`s coworker was seeing patients by that Wednesday and operating again on Thursday - a mere three days after undergoing the minimally invasive surgical procedure. Not long before he operated on that orthopedic surgeon, Dr. Kim performed a bilateral case on a plastic surgeon. [Surgery was performed on a Thursday, she spoke at the podium on Friday and then operated on Monday," he says of the case. These recoveries are impressive by any standard, but as Dr. Kim points out, impressive is the norm when you`re performing endoscopic carpal tunnel release surgery the right way. [One true advantage of that procedure is an early return to work, particularly if you have bilateral carpal tunnel syndrome," he says, adding that the effectiveness and safety of the endoscopic procedure is noteworthy compared to the gold standard: open carpal tunnel release surgery. Mischaracterizations and misnomers Although the endoscopic approach is very popular among both surgeons and patients, it could be even more widespread if there weren`t still lingering misconceptions about its safety, according to Dr. Kim. He says one reason why the uptake of this procedure is a bit lower is tha

Surgical site infections (SSIs), among the most common complications in health care, are responsible for delayed wound healing, hospital readmissions and other health ramifications. A study recently published in JAMA Network found that 0.5% to 3% of patients undergoing surgery will experience an infection at or adjacent to the surgical site. Proper, methodical wound care is your best defense against SSIs and other complications. Expedited healing Thanks to advanced wound care products such as dressings, topical agents and active wound care devices, surgical staff can now choose from a variety of options designed to speed up the healing process and minimize the risk of infection. [To get the best results in wound healing, you must first consider your patient," says Jay Calvert, MD, a board-certified plastic surgeon with offices in Beverly Hills and Newport Beach, Calif. [Look at their risk of wound breakdown, and consider factors such as whether they are physiologically stable and practice good nutrition." Dr. Calvert also recommends assessing each patient`s wound healing ability through a detailed history, physical exam and laboratory examination of their blood chemistry, such as albumin and pre-albumin levels.

Seeing clearly Years ago, high definition (HD) was all the rage. But technology is advancing so rapidly that, in the operating room, HD is now actually considered low resolution. 4K is now the baseline resolution we aim for anytime we build out or install systems. 4K provides enhanced color, sharpness and clarity that offers surgeons visualization advantages without the multimillion-dollar price tag that comes with a robotic platform. The potential of 3D imaging has always been of interest, but it hasn`t exactly taken off yet. It was very gimmicky when it was first demoed. The cameras were larger, the optics were not as clear, and the technology required the surgeon to wear 3D goggles that were usually inconvenient and, depending upon the axis by which they looked to, the screen would change the optical resolution. Some companies are still developing 3D imaging technology, but many surgeons who are interested in 3D moved over to the robotics space. Pieces of the puzzle The camera head is a key piece of the broader imaging puzzle. With laparoscopy equipment, you have the camera head that you hold in your hand, and then you attach a detachable lens to it - just like you would a camera. There are different angles and different shapes of lenses, like a 30-degr

If you give a patient the choice between a one-and-a-half-centimeter incision on the crease in their wrist with a speedy recovery prognosis or a four-to-five centimeter opening on the palm of their hand that takes a little longer to heal, they`ll naturally gravitate toward that smaller incision and quicker recovery. At least that`s been the experience of Philip C. Marin, MD, a double board-certified plastic, reconstructive and hand surgeon in Pueblo, Colo., who has done more than 5,000 carpal tunnel procedures over the last 25 years. Around 95% of those cases were endoscopic carpal tunnel procedures - the one with that tiny one-and-a-half-centimeter scar - and the bulk of the patients who come to see him are there due to word of mouth. [Most of the patients that come in have met a patient of mine who had the endoscopic technique, and they really liked the results," says Dr. Marin. [The endoscopic technique is usually what they have on their mind in the first place." Though he does explain both options to prospective surgical patients and occasionally performs open cases, Dr. Marin says it generally only occurs if there`s something inside the carpal tunnel that needs to be cleaned out or it there`s severe synovitis, something that only occurs in only a handful of approximately 250 annual carpal tunnel cases he performs. Single vs. double port While the endoscopic release can be performed either via a single

The chief questions that you have to address in dealing with laparoscopic electrosurgery safety are who's at risk of being burned and how significant that risk is. The answer to the former is your patients. And to the latter: very significant. Every time a surgeon steps on the monopolar foot pedal during laparoscopy, the possibility of a potentially fatal stray electrosurgical burn exists. Further, surgical facilities themselves may be at significant risk of being burned - albeit in a different sense. The laparoscopic surgery subgroup of the Association of Trial Lawyers was founded in 1994 on a belief that laparoscopy is an area ripe for liability claims. In 1995, Tony Tsarouhas, Esq., a founding member, said that the group had 'identified stray electrosurgery current during laparoscopy as a promising basis' for malpractice cases. Despite these two powerfully motivating factors - patient safety and practitioner and facility liability - only about one in 20 U.S. hospitals is taking advantage of the fail-safe technology that exists to eliminate the possibility of such burns, according to an industry source. When sparks fly Two phenomena can let electrical current come in contact with non-target tissue during electrosurgery and result in potentially fatal burns. The first is insulation failure. Manufacturers of conventional instruments warn that when insulation fails, it pos

Laparoscopic colorectal surgery got off to a slow start in the 1990s because of concerns that the "little sticks" made it more difficult for the surgeon to effectively remove enough cancerous tissue and lymph nodes, compared to open surgery, as well as concerns over post-operative ileus, which can last 24 hours to a week. But experts we talked to say laparoscopy in colorectal surgery is making a comeback, thanks to better equipment, more positive evidence from clinical studies and more experienced colorectal surgeons. Here are seven signs pointing to colorectal surgeons doing more laparoscopic procedures. 1. Keyhole surgery is here to stay. Since minimally invasive techniques have been taught in medical schools for more than a dozen years, a whole generation of surgeons is comfortable with laparoscopy. Older surgeons are catching up and realizing that they get better results through smaller holes. But often the more complicated cases are passed on to younger surgeons, says Eric Haas, MD, FACS, program director of minimally invasive colon and rectal surgery at the University of Texas at Houston, who five years ago founded Colorectal Surgical Associates in Houston, which specializes in minimally invasive approaches to colorectal disease. 2. Hands-on laparoscopy is catching on. Hand-assisted laparoscopy, using laparoscopic instruments and a camera as well as a hand through a larger incision, is becoming more common. For some surgeons, it's a way to transition from open surgery, reduce procedure time or manage complications. David Rosenfeld, MD, a c

Are automatic laparoscopic suturing devices worth the expense? The question is easy, but depending on whom you ask, the answers are considerably more complex and sometimes paradoxical - as is often the case when considering costs in relation to the benefits devices provide. 'They are efficient and technically very good, as far as the function of the devices goes, and they are certainly technically easier,' says Sabi S. Kumar, MD, of the NorthCrest Medical Center in Springfield, Tenn., and a member of the clinical faculty at Vanderbilt University in Nashville, Tenn. 'But the cost is definitely a problem.' For Dr. Kumar, who is already equipped with the confidence years of experience brings, the tradeoff doesn't warrant the expense. 'I have looked at all of them and I do manual tying,' he says. 'I don't use them.' But others say expense can be a motivating factor rather than a deterrent. James Presthus, MD, of Minnesota Gynecology and Surgery in Edina, Minn., says that, while he is equally confident in his ability to do things the old-fashioned way, the devices are potential cost-cutters. 'When I started doing laparoscopic procedures, I learned conventional instrumentation,' he says. But today, if he can get a stitch done faster with a device than with his hands, he'll go with the device. How do you know whet

Minimally invasive surgery is tough on surgeons, who constantly struggle to manage the technique's inherent challenges: access to the abdominal cavity, and clear views of tissue and anatomy. Luckily, newer laparoscopes offer promising solutions. Here are some of the latest improvements and the impact they can have on surgical visualization: High-definition video. One of the first big improvements was the development of the 5mm deflectable HD laparoscope with a charge-coupled device (CCD) at the tip, says Sharona Ross, MD, director of minimally invasive surgery and surgical endoscopy at Florida Hospital's Southeastern Center for Digestive Disorders and Pancreatic Cancer, Advanced Minimally Invasive and Robotic Surgery in Tampa. "Having the CCD image sensor at the tip delivers a brighter, larger depth-of-field picture, and it has a focus-free operation," she says. "It was also very advantageous cost-wise, because it removed the rod lens system, which reduces repair costs. The fact that it's autoclavable also reduces costs." Improved ergonomics. The all-in-one design of the deflectable tip laparoscope, with its integrated light cable and camera system, also represents an ergonomic improvement. "Eliminating the (external) light source coming in at 90 degrees from the actual shaft of the camera was very useful, especially for single-incision laparoscopy," says Dr. Ross, "because you can lean it down and parallel to the patient's body. It lets you have more range of motion for the other instruments." Bariatric length. Another step forward, says Dr. R

When it comes to patient safety and surgeon comfort, gasless laparoscopy is my preferred method of GYN surgery. Not only does the gasless method eliminate the dangers of CO2 gas, but it also lets your docs use the conventional instruments of laparotomy for better tactile sense. How? By combining the fundamentals of minimally invasive technique with the conventions of open surgery. Here's how it works: Instead of insufflating the abdominal cavity, the surgeon inserts a special lift system via a small cut in the lower umbilicus and raises the abdominal wall mechanically. By not having to insufflate, the surgeon can use instruments for open conventional laparotomy, get a similar view into the abdominal cavity as that afforded by laparoscopy with gas and still get to use patient-friendly minimally invasive techniques. Interested in the technique for your facility? Here are the four key benefits to gasless laparoscopy. 1 Eliminate side effects of CO2 Endoscopic technique means good results for the patient: smaller scars, less pain and faster recovery. But CO2 gas, one of the necessities of this technique, is a patient safety risk. When performing endoscopic procedures, the surgeon needs to insufflate the abdominal cavity with carbon dioxide in order to obtain a sufficient workspace and view of the surgical field. The cold gas causes considerable build-up of pressure in the abdominal cavity and reduces the body temperature; these factors cause the patient pain that, in som

Minimally invasive surgery for a burst appendix is more successful and less costly in the long run than traditional open appendectomy, according to a new study in the Annals of Surgery. Researchers found that laparoscopic appendectomy is superior or comparable to open appendectomy in terms of several surgical outcome measures for both uncomplicated and complicated appendicitis. They also found that laparoscopy could save thousands of dollars for some patients, when all costs - including doctors' fees, hospital fees and readmissions - are considered. Appendectomy is one of the most common surgeries in the U.S., with some 750,000 procedures done every year. Researchers looked back at some 40,000 such surgeries performed at dozens of U.S. academic medical centers - about 14,000 open procedures and 26,000 laparoscopic ones. For uncomplicated cases of appendicitis, in which the appendix is still intact, the cost for the 2 types of surgery came out about the same, at slightly more than $7,800. When the appendix had burst, however, the open surgery was considerably more expensive. On average, it cost $17,594, compared to $12,125 for the laparoscopic surgery. Patients who had the laparoscopic procedures also had lower death rates, at 0.07% versus 0.17%, fewer readmissions and a slightly shorter stay at the hospital.

Surgeons prefer laparoscopic hernia repair for much the same reasons patients do: less post-op pain and quicker recoveries. With careful case costing, lap hernia can also be profitable. We talked to David Moody, RN, BA, administrator of the Knightsbridge Surgery Center in Columbus, Ohio, to find out the keys to adding this minimally invasive technique to your facility. 1. Plan for a long learning curve Knightsbridge, which hosts a variety of procedures ranging from colorectal to orthopedic surgeries, added lap hernias about 3 years ago. There is a significant learning curve associated with the technique, he says, and it takes a while for surgeons to get comfortable with the intricate movement of instruments it demands. He estimates that surgeons are truly at ease and expertly skilled at performing lap hernia after performing about 100 cases. "Every hernia is different. But once surgeons get comfortable, many feel they would rather do lap if they have a choice," says Mr. Moody. From an administrator's standpoint, the key to negotiating the long learning curve is preaching patience among your surgeon group, he says. Remind your docs that the eventual payoff is improved patient outcomes and short case times (about 1 hour). Mr. Moody advises, however, to initially block out at least 90 minutes per procedure as surgeons get a feel for the challenging technique. 2. You'll need a pair of extra hands for the camera In addition to a scrub nurse and a circulator, lap hernia requires an additional staffer to hold and operate the camera that g

Despite its minimalist approach and more rapid healing, laparoscopic surgery still imparts varying degrees of difficult post-op pain for patients. Here are tips for managing patients' pain throughout their procedures so that they'll be more comfortable post-op. Get to the root The source of post-operative pain is generally due to one of these factors: skin incision or external wound, trocar or instrument violation of underlying muscular planes, and residual CO2 from operative abdominal insufflation. Although the bowels don't respond to manipulation with 'sharp' pain symptoms, other internal organs (such as the spermatic cord, ovaries and fallopian tubes) will demonstrate significant pain in response to surgical insult. But you can effectively limit post-operative pain in laparoscopic surgery with the techniques routinely applied to any type of surgery. These include the judicious use of intraoperative local anesthesia (preferably early rather than later in the operation) by the surgeon to block pain at the source. There is also the option of administering narcotics to the patient (either from the anesthesiologist during the surgery or the PACU nurse in the recovery room). Most anesthesia providers have gotten away from the use of narcotics in outpatients altogether, minimizing respiratory depression and post-op nausea, and facilitating a faster recovery room throughput. Further, the small wounds heal more quickly