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Gynaecological Laparoscopy (gynaecological + laparoscopy)
Selected AbstractsInfluence of anaesthesia resident training on the duration of three common surgical operationsANAESTHESIA, Issue 6 2009R. Hanss Summary We investigated the influence of resident training on anaesthesia workflow of three standard procedures , laparoscopic cholecystectomy, diagnostic gynaecological laparoscopy and transurethral prostate gland resection (TURP) , comparing 259 non-emergency resident vs 341 consultant cases from 20 German hospitals. Each hospital provided 10 random cases for each procedure, yielding 600 cases for analysis. Standard time intervals as documented in the hospital information system were: ,Case Time' (the time from the start of anaesthesia induction to discharge of the patient to the recovery area) and ,Anaesthesia Control Time' (which was the Case Time minus the time from the start of surgery to the end of surgical closure). Case Time was significantly shorter for consultants in all three procedures (p < 0.05, analysis of variance) and Anaesthesia Control Time shorter for consultants only in gynaecological laparoscopy and TURP. Patient comorbidity, patient age and geographical location of the hospital were not influential factors in the analysis of variance. We conclude that resident training significantly increases duration of elective operative times. [source] Evaluation of pelvic wedge for gynaecological laparoscopyANAESTHESIA, Issue 10 2008P. Kundra Summary Seventy-eight ASA 1 and 2 women scheduled for elective diagnostic laparoscopy under general anaesthesia were randomly allocated into two groups. Patients were either positioned with a 20° Trendelenberg tilt (group T) or with a wedge placed under the pelvis (group W). A standard general anaesthetic technique was used in all patients. The endoscopic view of pelvic organs was graded on a four-point scale by the operating surgeon. Heart rate (HR), mean arterial pressure (MAP), SpO2, and peak airway pressure (Paw) were continuously measured. Significantly more patients (77%) in group W had grade 1 view (clear view of pelvic organs without additional manoeuvres) when compared with group T (46%). Mean Paw increased significantly in group T when compared with group W. The use of a pelvic wedge provides a better view of pelvic viscera than 20° Trendelenberg tilt during gynaecological laparoscopy. [source] The oesophageal,tracheal Combitube Small AdultÔAn alternative airway for ventilatory support during gynaecological laparoscopyANAESTHESIA, Issue 7 2000T. Hartmann Airway management during gynaecological laparoscopy is complicated by intraperitoneal carbon dioxide inflation, Trendelenburg tilt, increasing airway pressures and pulmonary aspiration risk. We investigated whether the oesophageal,tracheal Combitube 37 Fr SAÔ is a suitable airway during laparoscopy. One hundred patients were randomly allocated to receive either the Combitube SAÔ (n = 49) or tracheal intubation (n = 51). Oesophageal placement of the Combitube was successful at the first attempt [16 (3) s]. Peak airway pressures were 25 (5) cmH2O. An airtight seal was obtained using air volumes of 55 (13) ml (oropharyngeal balloon) and 10 (1) ml (oesophageal cuff). Significant correlations were observed between patient's height and weight and the balloon volumes necessary to produce a seal. Similar findings were recorded for the control group, with tracheal intubation being difficult in three patients. The Combitube SAÔ provided a patent airway during laparoscopy. Non-traumatic insertion was possible and an airtight seal was provided at airway pressures of up to 30 cmH2O. [source] Is it necessary to catheterise the bladder routinely before gynaecological laparoscopic surgery?AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 5 2005Kwok Keung TANG Abstract Background:, Catheterisation of the bladder was routinely performed before gynaecological laparoscopy, but such an established practice is not evidence based and may lead to an increase in postoperative urinary symptoms and urinary tract infection. Aims:, To compare routine urethral catheterisation and non-catheterisation before laparoscopic surgery with respect to bladder injury, postoperative urinary symptoms and urinary tract infection (UTI). Methods:, This was a prospective, double blind randomised study. All women undergoing gynaecological laparoscopy, both elective and emergency, were invited to participate in the study. Cases involving bladder dissection, second trimester pregnancy and those who could not void preoperatively were excluded. Patients were randomly allocated to catheterise group and non-catheterise group. Requirement of catheterisation in the non-catheterise group, bladder injury, postoperative catheterisation, urinary symptoms and UTI were studied. Results:, Two hundrend and seventy-nine women were recruited of whom 262 were suitable for final analysis. Each group contained 131 cases. Patient characteristics and operative parameters were comparable in both groups. There was no bladder injury. Four percent of the women in the non-catheterise group needed catheterisation and catheterisation was significantly associated with surgery longer than 90 min (P < 0.001). Postoperative UTI was insignificantly reduced in the non-catheterised group. When postoperative urinary symptoms and urinary tract infections were studied as a composite outcome, they were statistically significantly reduced in the non-catheterise group (P = 0.017). Conclusions:, The policy of non-catheterisation before gynaecological laparoscopic surgery is safe and feasible. Although the reduction in UTI is insignificant, the overall postoperative urinary problems (urinary symptoms or UTI) are reduced significantly. [source] | ||||||||||