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Biomedical subjects

L K Nathanson

Publications and source records attributed to L K Nathanson.

27 records · Page 2Linked to original sources
PubMed1991

Laparoscopic cholecystectomy: the Dundee technique.

A total of 61 patients was subjected to laparoscopic cholecystectomy. The procedure was completed in 60 cases and converted to open operation in one (2 per cent). The morbidity rate was low (total 7 per cent, major 2 per cent, blood transfusion rate 5 per cent). The median duration of the laparoscopic cholecystectomy with cholangiography was 135 min (range 65-270 min). The operation took less time to complete in patients with functioning gallbladders than in those with non-functioning fibrotic organs (median 120 versus 175 min). The majority of patients required opiate analgesia despite infiltration of the stab wounds with bupivacaine. The mean (s.d.) hospital stay was 2.9 (1.5) days. The median time to resume work or full activity after discharge was 11 days.

Adult↗
PubMed1991

Laparoscopic ligamentum teres (round ligament) cardiopexy.

A technique of laparoscopic ligamentum teres cardiopexy for reflux oesophagitis unresponsive to medical treatment is described. The procedure has been performed on five patients and on postoperative testing has been shown to achieve competence of the lower oesophageal sphincter by lengthening of the intra-abdominal segment, accentuation of the angle of His and elevation of the pressure in the high pressure zone. All the patients have been relieved of their symptoms by the operation and have not sustained any adverse effects but the follow-up period is short.

Adult↗
PubMed1991

Ligation of the structures of the cystic pedicle during laparoscopic cholecystectomy.

Advances in optics, endotelevision monitoring, and instrumentation have led to the development of laparoscopic cholecystectomy. As in the open, standard operation, the crucial step is the dissection of the cystic pedicle containing the respective duct, artery, and lymph node. All the groups involved in laparoscopic cholecystectomy have to date opted for the use of applicators to clip the cystic duct and artery. As there are intrinsic disadvantages to the use of clips, we report an alternative method which involves ligation of these structures using the Roeder slip knot with dry chromic catgut. The safety margin of this knot was initially tested in vitro using a Instrom tensiometer. Under these experimental conditions, the Roeder slip knot tied with #0 dry chromic catgut ligature started to yield at 225 g. As the estimated tension on the cystic duct (1.1 g) and a 4-mm artery (6.0 g) in vivo is well below this figure, the safety of this knot with dry catgut in clinical practice is beyond question. The technique of Roeder slip-loop knotting was used to ligate the cystic artery and duct in a consecutive series of 80 patients undergoing laparoscopic cholecystectomy. This clinical experience has confirmed its safety and ease of execution. The particular advantages of Roeder loop ligation include execution through a 5.5-mm cannula and accurate placement of the knot. In addition, the technique requires less length of mobilized duct and artery, which is an important practical consideration in patients with a fibrosed gallbladder and shortened cystic pedicle.

Cholecystectomy↗
PubMed1991

Videothoracoscopic ligation of bulla and pleurectomy for spontaneous pneumothorax.

A thoracoscopic technique to ligate pleural bullae and perform parietal pleurectomy is described. The procedure has been performed on 2 patients, allowing definitive treatment of recurrent spontaneous pneumothoraces. Both patients have been cured of their problem and benefited from the decreased trauma of access by reduced postoperative pain, rapid recovery, and decreased scarring of the skin.

Adult↗
PubMed1991

Safety of vessel ligation in laparoscopic surgery.

Laparoscopic ligaturing entails the use of the Roeder knot which is fashioned outside the abdomen, slipped along the ligature to the intended site and locked in place. The safety of the one-way Roeder slip knot in securing blood vessels and the tension a vessel ligature has to withstand were investigated ex vivo. Ligature tension was measured using perfused blood vessels in a test rig. From these data the ligature tension exerted by vessels up to 3 mm diameter at 150 mm Hg pressure was observed to be less than 5 grams. The relationship between ligature tension (T) and intravascular pressure (p), radius of the vessel (r) and radius of the vessel at the point of ligature (delta) is expressed by the formula: T = 3/2 pr delta. A good correlation between values for ligature tension derived from this formula and those observed in the test rig confirmed the validity of this equation for the calculation of approximate ligature tension. Catgut sutures tied with Roeder knots were subjected to strain gauge distraction under different conditions. The tension required to induce reverse slipping of the Roeder knot fashioned from 0/chromic catgut had a median value of 1125 (225-2700) grams weight. Thus in laparoscopic surgery the Roeder knot with dry chromic catgut has a substantial safety factor ratio of 55:1 in ligation of vessels up to 3 mm diameter.

Blood Pressure↗
PubMed1991

Laparoscopic cardiomyotomy for achalasia.

A technique of laparoscopic cardiomyotomy is described. The procedure has been performed in a patient with manometrically confirmed classical achalasia with complete relief of episodic total dysphagia and no untoward symptoms including reflux. The procedure was followed by minimal postoperative discomfort and the patient was discharged on the third postoperative day. Laparoscopic cardiomyotomy has the advantage of diminished surgical trauma with accelerated recovery, constitutes definitive therapy comparable to standard myotomy, and by being less disruptive of the lower oesophageal fixation it is prone to precipitate gastro-oesophageal reflux.

Adult↗
PubMed1990

Laparoscopic repair/peritoneal toilet of perforated duodenal ulcer.

Laparoscopic techniques have been refined to the point where exposure, haemostasis and tissue approximation by suture approach those obtained at open access surgery. We report a patient with acute perforation of an ulcer in the first part of the duodenum who was successfully treated by laparoscopic oversewing and omental patching. The clinical indications for contemplating use of laparoscopic surgery for acute ulcer perforation, techniques employed and the areas for potential improvement of instruments, needles and sutures are discussed.

Adult↗
PubMed1989

Surgery for thyroglossal cysts: Sistrunk's operation remains the standard.

Surgical techniques for thyroglossal cysts still vary considerably. In this review, one-third of patients treated by simple cyst excision had recurrence and this operation cannot be recommended. There should be consensus that excision of the mid-portion of the hyoid bone be performed routinely. However, variations have been described in the syprahyoid dissection. The present review indicated that the classic Sistrunk operation provided the lowest rate of recurrence and should remain the standard procedure.

Adolescent↗