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Biomedical subjects

V Paolucci

Publications and source records attributed to V Paolucci.

At least 37 records · Page 2Linked to original sources
PubMed1997

Exposure of the operative field in laparoscopic surgery.

Endoscopic surgery, as a result of over 90 years of investigation, has now become the most innovative part of general surgery; every procedure in the thoracic and abdominopelvic cavity, intraperitoneal or extraperitoneal, has been reviewed for feasibility. The basic principles in the management of surgical patients, however, have not changed: adequate exposure and good lighting remain important and may become more important with endoscopic techniques. Historical review shows the dependence of advances in laparoscopy upon technical development in the field of intraabdominal exposure as the result of two objectives: namely abdominal wall displacement and bowel retraction.

Animals↗
PubMed1997

Systems and instruments for laparoscopic surgery without pneumoperitoneum.

The insufflation of carbon dioxide into the peritoneal cavity is a routine technique of abdominal exposure in laparoscopic surgery. Because of adverse physiological effects and technical disadvantages of the pneumoperitoneum, alternative methods of abdominal wall lifting have been explored recently. Two groups of retraction systems exist: intraabdominal lifting and subcutaneous lifting of the abdominal wall. Some systems require additional pneumoperitoneum, because the extent of intraabdominal exposure is not sufficient. Other systems are working completely without gas insufflation. Two systems combine abdominal wall lifting with pressure on the internal organs. Every method allows the use of standard laparoscopic instruments, which originally were designed for a regular pneumoperitoneum. The use of a low-pressure pneumoperitoneum in combination with mechanical augmentation of the peritoneal cavity reduces physiological disadvantages of laparoscopy. But technical advantages, such as combination of laparoscopic and open techniques, can be realized only without gas insufflation. Conventional instruments have been designed to fit the ergonomical needs of isopneumic laparoscopy and to be employed with simple valveless cannulae.

Humans↗
PubMed1997

The phagocytosis activity during conventional and laparoscopic operations in the rat. A preliminary study.

BACKGROUND: Numerous experimental and clinical investigations indicate that the mononuclear phagocyte system (MPS) has a relevant function in terms of physiological defense against tumor metastasis and bacterial infection. Consequently, a point of major interest is the influence of surgical techniques on the MPS function. METHOD: The model investigation examines the phagocytosis activity of the rat's MPS during conventional fundoplication (group 1, n = 10), laparoscopic fundoplication using a pneumoperitoneum (group 2, n = 10), and gasless laparoscopic fundoplication (group 3, n = 10). The MPS function is evaluated by an intravascular carbon clearance test (G. Biozzi). RESULTS: The fastest carbon elimination half-life was found in group 3. By way of contrast, there was a significant increase of carbon half-life in group 2 (p < 0.005). Even group 1 caused less MPS depression (p < 0.1) than group 2. CONCLUSION: Gasless laparoscopic procedures have a favorable effect on phagocytosis activity. The CO2 pneumoperitoneum seems to be the main reason for a decreased antigen elimination in laparoscopic treatments.

Animals↗
PubMed1997

[Initial experiences with the modular retraction system (VarioLift) for laparoscopic surgery without pneumoperitoneum].

The VarioLift system is an alternative method for abdominal wall lifting to create sufficient intra-abdominal space and adequate laparoscopic exposure to the operating field. The installation of a CO2 pneumoperitoneum is not necessary, which means that technical disadvantages, systemic and local physiological effects, or complications related to gas insufflation are not relevant when this method is used. The surgeon is allowed to combine the advantages of endoscopic surgery, such as magnified video-endoscopic visualisation, with well-known open surgical techniques to create a symbiosis of prove methods.

Equipment Design↗
PubMed1996

Experiences with percutaneous endoscopic gastrostomy.

Today the procedure of choice for long-term enteral tube feeding in patients with prolonged swallowing difficulties or inabilities is percutaneous endoscopic gastrostomy (PEG). The primary indications are head and neck cancers, neurologic dysphagia, cancer cachexia, and obstruction of the esophagus and pharynx with enough space for an endoscopic procedure. This technique requires no general anesthesia and is possible in patients with contraindications to surgical gastrostomy. Between September 1994 and April 1995 a total of 115 patients underwent PEG placement attempts. We employed the pull-technique with 15-Freka PEG tubes. The average procedure time, including esophagogastroduodenoscopy, was 17 minutes. In nine cases PEG insertion was impossible owing to severe obstruction of the esophagus. In 46 (40%) patients local abdominal pains started on the first or second postoperative day; 7 of these patients required surgical consultation, and no further intervention was needed. In only one patient was there a serious complication that required surgical intervention: a presumed perforation that turned out to have no correlate upon review. All patients received single-shot antibiotic prophylaxis; and only in those patients with abdominal symptoms do we recommend a prolonged antibiosis. The abdominal symptoms reported were due to a slight leak of gastric fluid causing a topical peritonitis, which required no further treatment. In our experience PEG is a useful alternative to surgical gastrostomy. The simplicity of this procedure leads to low complication rates, short hospitalization, and is possible on an outpatient basis. It is cost-efficient and has a much better psychological tolerance than nasogastric tubes.

Adult↗
PubMed1996

[Instruments for gasless laparoscopic surgery].

Specially designed instruments for laparoscopic surgery with a pneumoperitoneum are expensive and delicate, and surgeons are initially not familiar with their handling. Beside restrictions of the surgeon's intraabdominal range of motion they lead to a loss of tactile sensation. In gasless laparoscopic procedures not only special laparoscopic instruments, but the standard conventional instruments, used in open surgery, can also be employed with simple valveless trocars. Still using these instruments can put up some difficulties, because ergonomic factors were not considered in their development. With regard to the instrument's length, shape and joint-position we developed a special instrument-set under the ergonomic criteria of gasless laparoscopy.

Equipment Design↗
PubMed1996

[Endosonographic anatomy of the pelvic floor].

With the aim of gaining a precise anatomical view of the anal canal, of the pelvic floor and his pathological changes, endorectal sonography was performed in 188 patients with carcinoma of the rectum without infiltration of the sphincter muscles. Based on our photographic material we designed a sonographic "map" of the pelvic floor. Transducer: Endo-P-Sonde, Siemens, with 5, 6 and 7, 5 MHz frequence and the possibility to obtain longitudinal and transversal sections. The following muscles were constantly seen: sphincter ani internus et externus, levator ani, obturator internus, ischiocavernosus, transversus perinei prof. et sup. and thereby ischiorectal and pelvirectal fossa were defined. On the basis of these exact knowledges diagnosis and therapy of perianal abscesses and fistulas can be improved.

Anal Canal↗
PubMed1995

Gasless laparoscopy in abdominal surgery.

Pneumoperitoneum, as a necessary precondition of laparoscopic procedures, represents a restriction of the surgeon's freedom of movement and can lead to rare but typical complications. We describe our first experiences with laparoscopic surgery without using pneumoperitoneum. Under direct vision and digital control a fan-formed wall retractor, which is attached to an electric lift arm, is introduced into the abdominal cavity. After raising the abdominal wall, the scope is introduced through the same access and the laparoscopic procedure can be started without the technical and physiopathological problems which may occur using a pneumoperitoneum. In this gasless laparoscopic procedure, simple valveless trocars and instruments can be used. Furthermore, an unlimited suction can be obtained without a loss of exposure. During anesthesia, neither increased ventilation nor increased ventilation pressure is necessary, and the surgeon has increased freedom of action. Not only special laparoscopic instruments, but the conventional instruments, used in open surgery, can also be employed in gasless laparoscopy. In this way we performed gasless laparoscopic surgery on 54 patients: cholecystectomy (n = 37), abdominal exploration for NSAP (n = 5) or tumor staging (n = 4), fenestration of liver cysts (n = 5), and appendectomy (n = 3). We did observe three wound infections as related complications. Six times, we had to change the surgical procedure. Compared to the traditional procedure with a CO2 pneumoperitoneum, the results of the first gasless procedures demonstrate potential advantages.

Abdomen↗
PubMed1995

[The 100th birthday of Heinz Kalk. A breakthrough in laparoscopy].

The method of laparoscopy, mainly being introduced as a diagnostic tool, has developed into an important therapeutic procedure during the last decade. This development is associated with the name of the German gastroenterologist Heinz Kalk. Born in Frankfurt/Main in 1895 he first published about laparoscopy in 1929 and also designed a new laparoscope with a prograde optic. He realized the great value of laparoscopy in the differential diagnosis of liver diseases. During the 40's Kalk introduced laparoscopically guided liver biopsy and was involved to a great extent in research of hepatic diseases, especially Hepatitis epidemica. The work of Kalk was of decisive influence for the development of laparoscopy in Europe. In 1949 he became chief of the Department of Internal Medicine of Kassel's hospital "Stadtkrankenhaus", making it one of the most interesting places to be in for hepatologists and laparoscopically working internists. Heinz Kalk died in 1973.

Animals↗
PubMed1995

The gasless laparoscopic cholecystectomy.

The pneumoperitoneum, generally used for all laparoscopic procedures, can lead to specific disadvantages and result in complications, and it furthermore represents a restriction of the surgeon's freedom of movement. In July, 1993 we started doing laparoscopic surgery without the pneumoperitoneum. Under direct vision and digital control, a fan-shaped wall retractor, which is attached to an electric lift arm, is introduced into the abdominal cavity. After raising the abdominal wall, the scope is introduced through the same access and the laparoscopic procedure can be started without the technical and pathophysiological problems which may occur when using a pneumoperitoneum. In this gasless laparoscopic procedure, simple valveless trocars and instruments can be used. During anaesthesia, neither an increased ventilation nor an enlarged ventilation pressure is necessary in this way we performed gasless laparoscopic cholecystectomy in 50 patients. We observed 5 wound infections as related complications. We had to change the surgical procedure seven times. The retraction technique creates a sufficient but not optimal exposure to the gallbladder. Intraoperative changes of the instruments, suction and specimen removal appeared easier. Both conventional and laparoscopic surgical instruments were introduced through the valveless trocars. Our experience demonstrates the practicability of this technique and potential advantages.

Cholecystectomy, Laparoscopic↗
PubMed1995

[Disposable versus reusable instruments in laparoscopic surgery--a controlled study].

The instruments for laparoscopic surgery are usually available in a disposable and in a reusable type. We performed a prospective, randomized study, based on the most frequent laparoscopic operation, the cholecystectomy, in order to directly quantify and compare the advantages and disadvantages of both types of instruments. 158 patients, who planned to undergo a cholecystectomy, were randomly distributed into two groups. 80 patients (group A) underwent surgery with reusable instruments and 78 patients (group B) with disposable instruments. We investigated the following parameters and compared them for both groups: length of operation, complications, conversion rate to open surgery, subjective postoperative pain, length of inability to work, technical problems during operation, postoperative hospitalization time, satisfaction of operating room personnel. The analysis of the results demonstrates no difference in the postoperative hospitalization time, in the postoperative complication rate, subjective pain sensation and postoperative inability to work. Differences in favour for the group of patients, operated with disposable instruments, were found in the conversion rate, in the length of operation and, statistically significant, in the amount of intraoperative problems, caused by instrument-technical reasons. Even if considering the greater expenses in time and personnel costs, operations with reusable instruments are in average 1015 DM cheaper.

Adolescent↗
PubMed1994

Laparoscopic drainage of a lymphocele after renal transplantation.

Lymphoceles are a well-known complication of renal transplantation, with incidence rates up to 18%. The management of symptomatic lymphocele remains controversial. We report the case of a lymphocele which was successfully drained into the peritoneal cavity using laparoscopic surgery.

Drainage↗
PubMed1994

[Potentially dangerous moments in use of esophageal balloon tamponade. 4 case reports with critical analysis of the literature].

In general, balloon tamponade is still part of the therapy of bleeding esophageal varices, despite effective sclerotherapy. Four case reports demonstrate that the application of balloon tamponade may be associated with severe complications. Moreover, a critical analysis of the literature shows a very different handling with respect to volume of gastric balloon, duration of blockade and traction to the tube. To prevent serious side effects, a safe way is described in detail when using balloon tamponade.

Aged↗
PubMed1994

[Gasless laparoscopic cholecystectomy].

The pneumoperitoneum as a precondition of laparoscopic procedures represents a restriction of the surgeons freedom of movement and causes rare but typical complications. In July 1993 we started doing laparoscopic cholecystectomy without using a pneumoperitoneum. Under direct vision and digital control the retractor blades are introduced into the abdominal cavity via minilaparotomy. The retractor is attached to an electrically powered mechanical arm and raised. The scope is introduced through the same access and the laparoscopic cholecystectomy can be performed using the established technique without instilling a pneumoperitoneum. Both conventional and laparoscopic surgical instruments were introduced through valveless trocars and unlimited suction without loss of gas and exposure is possible. Metabolic and hemodynamic alterations associated with the intraperitoneal insufflation of carbon dioxide are omitted. So far we did gasless laparoscopic cholecystectomy in 22 patients. We didn't see any related complications. Four times we had to change the surgical procedure. In comparison to the traditional laparoscopic cholecystectomy with a CO2-pneumoperitoneum the results of the first gasless procedures demonstrate possible advantages.

Adult↗
PubMed1994

[Color doppler ultrasound in intensive care monitoring after liver transplantation].

The aim of this study was to investigate whether vascular complications after liver transplantation can be diagnosed prior to their clinical and/or biochemistral appearance. Therefore color coded ultrasonography was performed daily in 22 liver patients with altogether 27 transplanted organs. We found 2 arterial thromboses, one partial thrombosis of the portal vein and one thrombosis of the lower vena cava and another two stenoses of the lower vena cava. Angiography was performed in all patients with positive findings after duplex-sonography, except in the 2 patients with cava stenosis. In our experience angiography can be avoided in all patients after a normal duplex-sonogram. However, the early diagnosis of vascular complications prior to the manifestation of a dysfunction of the transplant could not be reached in this study.

Adult↗
PubMed1992

[Primary open therapy of acute necrotizing pancreatitis by the "open abdomen"].

There is no agreement about a conservative surgical strategy in the therapy of acute necrotizing pancreatitis yet. This report describes our experience with "open packing" laparostomy. This procedure is only performed when renal and pulmonary insufficiency is proceeding, despite optimal conservative treatment. Since 1986 15 patients were treated in this manner. Three compartments are established: an upper compartment (stomach, liver, spleen--covered by the omentum majus, which is dissected from the colon transversum); a lower compartment (small bowel--covered by the left colon) and the mid compartment that permanently opens the bursa omentalis and the left retrocolic space. Initially a careful necrosectomy is performed, followed by a tamponade. At the intensive care unit changing of the tamponade and lavage of the bursa omentalis was done every day. So far two patients have died pursuing this therapeutic regimen.

Abdomen↗