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Ginekologia Polska 2022Morcellation is an integral part of laparoscopic procedures related to uterine fibroids, which consist of the mechanical fragmentation of the tumor and its extraction...
OBJECTIVES
Morcellation is an integral part of laparoscopic procedures related to uterine fibroids, which consist of the mechanical fragmentation of the tumor and its extraction outside the abdominal cavity. To avoid the risk of tissue dissemination, special extraction systems have been developed, which allow morcellation of the specimen under visual control and its removal without contact with the abdominal organs. The aim of the paper is to compare the two systems for laparoscopic morcellation.
MATERIAL AND METHODS
The study included 33 premenopausal women with symptomatic leiomyomas or adenomyosis, who were qualified for laparoscopic surgery with contained power morcellation. Patients were allocated alternately to a different tissue extraction system's group. According to the study protocol, selected operative parameters were prospectively recorded. Finally, an assessment of bag use was performed. The data was statistically analyzed.
RESULTS
There were significant differences between the two tested systems in terms of introducing and positioning the bag, its removal from the peritoneal cavity, as well as optic trocar insertion and establishing the pseudo-peritoneum.
CONCLUSIONS
Despite the minor design differences and some ergonomic aspects, both presented systems proved to be safe and feasible tools for laparoscopic contained morcellation. This technique both reduces the risk of tissue dissemination and preserves the advantages of minimal invasiveness.
Topics: Humans; Female; Uterine Neoplasms; Uterine Myomectomy; Morcellation; Leiomyoma; Laparoscopy; Hysterectomy; Peritoneum
PubMed: 35315008
DOI: 10.5603/GP.a2022.0001 -
Asian Journal of Surgery Dec 2022
Topics: Humans; Fibromatosis, Aggressive; Neoplasm Recurrence, Local; Abdominal Cavity
PubMed: 35750612
DOI: 10.1016/j.asjsur.2022.06.026 -
Medicine Aug 2023Follicular dendritic cell sarcoma (FDCS) is a rare mesenchymal tumor that typically develops in lymph nodes; it is clinically uncommon and has only occasionally been...
RATIONALE
Follicular dendritic cell sarcoma (FDCS) is a rare mesenchymal tumor that typically develops in lymph nodes; it is clinically uncommon and has only occasionally been documented in cases of soft tissue, liver and spleen, and retroperitoneum; it is also extremely uncommon to develop in the stomach.
PATIENT CONCERNS
A 64-year-old woman who discovered a lump in her left upper abdomen 6 months prior and was taken to the hospital due to excruciating abdominal pain.
DIAGNOSIS
An abdominal computed tomography scan showed a soft tissue mass around the cardia. The immunohistochemical and postoperative histopathology results were compatible with FDCS.
INTERVENTIONS
The patient underwent "radical total gastrectomy and esophagojejunostomy" (Roux-Y anastomosis).
OUTCOMES
The patient recovered well 2 months after surgery.
LESSONS
We report a case of FDCS occurring in the stomach and abdominal cavity, which was unique in terms of clinical location, clinical presentation, and imaging signs. This case report aims to enhance clinicians' understanding and diagnosis of FDCS in the stomach and abdominal cavity and reduce the rate of clinical misdiagnosis.
Topics: Humans; Female; Middle Aged; Dendritic Cell Sarcoma, Follicular; Stomach; Abdomen; Abdominal Cavity; Gastrectomy
PubMed: 37543831
DOI: 10.1097/MD.0000000000034289 -
Scientific Reports May 2022Early recognition of elevated intraabdominal pressure (IAP) in critically ill patients is essential, since it can result in abdominal compartment syndrome, which is a...
Early recognition of elevated intraabdominal pressure (IAP) in critically ill patients is essential, since it can result in abdominal compartment syndrome, which is a life-threatening condition. The measurement of intravesical pressure is currently considered the gold standard for IAP assessment. Alternative methods have been proposed, where IAP assessment is based on measuring abdominal wall tension, which reflects the pressure in the abdominal cavity. The aim of this study was to evaluate the feasibility of using patch-like transcutaneous sensors to estimate changes in IAP, which could facilitate the monitoring of IAP in clinical practice. This study was performed with 30 patients during early postoperative care. All patients still had an indwelling urinary catheter postoperatively. Four wearable sensors were attached to the outer surface of the abdominal region to detect the changes in abdominal wall tension. Additionally, surface EMG was used to monitor the activity of the abdominal muscles. The thickness of the subcutaneous tissue was measured with ultrasound. Patients performed 4 cycles of the Valsalva manoeuvre, with a resting period in between (the minimal resting period was 30 s, with a prolongation as necessary to ensure that the fluid level in the measuring system had equilibrated). The IAP was estimated with intravesical pressure measurements during all resting periods and all Valsalva manoeuvres, while the sensors continuously measured changes in abdominal wall tension. The association between the subcutaneous thickness and tension changes on the surface and the intraabdominal pressure was statistically significant, but a large part of the variability was explained by individual patient factors. As a consequence, the predictions of IAP using transcutaneous sensors were not biased, but they were quite variable. The specificity of detecting intraabdominal pressure of 20 mmHg and above is 88%, with an NPV of 96%, while its sensitivity and PPV are currently far lower. There are inherent limitations of the chosen preliminary study design that directly caused the low sensitivity of our method as well as the poor agreement with the gold standard method; in spite of that, we have shown that these sensors have the potential to be used to monitor intraabdominal pressure. We are planning a study that would more closely resemble the intended clinical use and expect it to show more consistent results with a far smaller error.
Topics: Abdomen; Abdominal Cavity; Abdominal Muscles; Abdominal Wall; Humans; Intra-Abdominal Hypertension; Reproducibility of Results
PubMed: 35585106
DOI: 10.1038/s41598-022-12388-x -
Scientific Reports Feb 2016The peritoneum plays an essential role in preventing abdominal frictions and adhesions and can be utilized as a dialysis membrane. Its physiological ultrastructure,...
The peritoneum plays an essential role in preventing abdominal frictions and adhesions and can be utilized as a dialysis membrane. Its physiological ultrastructure, however, has not yet been studied systematically. 106 standardized peritoneal and 69 omental specimens were obtained from 107 patients (0.1-60 years) undergoing surgery for disease not affecting the peritoneum for automated quantitative histomorphometry and immunohistochemistry. The mesothelial cell layer morphology and protein expression pattern is similar across all age groups. Infants below one year have a thinner submesothelium; inflammation, profibrotic activity and mesothelial cell translocation is largely absent in all age groups. Peritoneal blood capillaries, lymphatics and nerve fibers locate in three distinct submesothelial layers. Blood vessel density and endothelial surface area follow a U-shaped curve with highest values in infants below one year and lowest values in children aged 7-12 years. Lymphatic vessel density is much lower, and again highest in infants. Omental blood capillary density correlates with parietal peritoneal findings, whereas only few lymphatic vessels are present. The healthy peritoneum exhibits major thus far unknown particularities, pertaining to functionally relevant structures, and subject to substantial changes with age. The reference ranges established here provide a framework for future histomorphometric analyses and peritoneal transport modeling approaches.
Topics: Adolescent; Adult; Child; Child, Preschool; Epithelium; Female; Humans; Infant; Lymphatic Vessels; Male; Membrane Glycoproteins; Middle Aged; Peritoneum; Young Adult
PubMed: 26905058
DOI: 10.1038/srep21344 -
Anaesthesiology Intensive Therapy 2014The recent definitions on intra-abdominal pressure (IAP), intra-abdominal volume (IAV) and abdominal compliance (Cab) are a step forward in understanding these important... (Review)
Review
The role of abdominal compliance, the neglected parameter in critically ill patients - a consensus review of 16. Part 2: measurement techniques and management recommendations.
The recent definitions on intra-abdominal pressure (IAP), intra-abdominal volume (IAV) and abdominal compliance (Cab) are a step forward in understanding these important concepts. They help our understanding of the pathophysiology, aetiology, prognosis, and treatment of patients with low Cab. However, there is still a relatively poor understanding of the different methods used to measure IAP, IAV and Cab and how certain conditions may affect the results. This review will give a concise overview of the different methods to assess and estimate Cab; it will list important conditions that may affect baseline values and suggest some therapeutic options. Abdominal compliance (Cab), defined as a measure of the ease of abdominal expansion, is measured differently than IAP. The compliance of the abdominal wall is only a part of the total abdominal pressure-volume (PV) relationship. Measurement or estimation of Cab is difficult at the bedside and can only be done in a case of change (removal or addition) in IAV. The different measurement techniques will be discussed in relation to decreases (ascites drainage, haematoma evacuation, gastric suctioning) or increases in IAV (gastric insufflation, laparoscopy with CO₂ pneumoperitoneum, peritoneal dialysis). More specific techniques using the interactions between the thoracic and abdominal compartment during positive pressure ventilation will also be discussed (low flow PV loop, respiratory IAP variations, respiratory abdominal variation test, mean IAP and abdominal pressure variation), together with the concept of the polycompartment model. The relation between IAV and IAP is linear at low IAV and becomes curvilinear and exponential at higher volumes. Specific conditions in relation to increased (previous pregnancy or laparoscopy, gynoid fat distribution, ellipse-shaped internal abdominal perimeter) or decreased Cab (obesity, fluid overload, android fat distribution, sphere-shaped internal abdominal perimeter) will be discussed as well as their impact on baseline IAV, IAP, reshaping capacity and abdominal workspace volume. Finally, we suggest possible treatment options in situations of unadapted IAV according to existing Cab, which results in high IAP. A large overlap exists between the treatment of patients with abdominal hypertension and those with low Cab. The Cab plays a key role in understanding the deleterious effects of unadapted IAV on IAP and end-organ perfusion and function. If we can identify patients with low Cab, we can anticipate and select the most appropriate surgical treatment to avoid complications such as IAH or ACS.
Topics: Abdominal Cavity; Case Management; Compliance; Consensus; Critical Illness; Humans; Monitoring, Physiologic; Pressure
PubMed: 25432559
DOI: 10.5603/AIT.2014.0063 -
Asian Journal of Surgery Nov 2022
Topics: Abdominal Cavity; Echinococcosis; Humans
PubMed: 35643904
DOI: 10.1016/j.asjsur.2022.05.074 -
Polski Przeglad Chirurgiczny Sep 2018Leaving surgical instruments in the patient's body is one of the most difficult situations in the professional career of an operator and it can also have severe...
Leaving surgical instruments in the patient's body is one of the most difficult situations in the professional career of an operator and it can also have severe consequences for the patient. Contrary to world literature, there are no reports of such incidents in Polish publications. Lack of such reports creates an illusion that leaving surgical instruments in the patient's body does not happen in Poland, which is an unsubstantiated thesis. This paper presents two cases of leaving hemostats in the abdominal cavity. According to the authors, similar publications may facilitate critical assessment of the existing rules for inspecting instruments and surgical material by surgical teams. Importantly, confirming the compliance of instruments and material by surgical nurses is not the only criterion of assessment in this matter for the operator.
Topics: Abdominal Cavity; Female; Foreign Bodies; Humans; Male; Medical Errors; Middle Aged; Poland; Surgical Instruments; Treatment Outcome
PubMed: 30652687
DOI: 10.5604/01.3001.0012.6199 -
Neurogastroenterology and Motility Dec 2019Some patients complain that eating lettuce, gives them gas and abdominal distention. Our aim was to determine to what extent the patients' assertion is sustained by... (Comparative Study)
Comparative Study
BACKGROUND
Some patients complain that eating lettuce, gives them gas and abdominal distention. Our aim was to determine to what extent the patients' assertion is sustained by evidence.
METHODS
An in vitro study measured the amount of gas produced during the process of fermentation by a preparation of human colonic microbiota (n = 3) of predigested lettuce, as compared to beans, a high gas-releasing substrate, to meat, a low gas-releasing substrate, and to a nutrient-free negative control. A clinical study in patients complaining of abdominal distention after eating lettuce (n = 12) measured the amount of intestinal gas and the morphometric configuration of the abdominal cavity in abdominal CT scans during an episode of lettuce-induced distension as compared to basal conditions.
KEY RESULTS
Gas production by microbiota fermentation of lettuce in vitro was similar to that of meat (P = .44), lower than that of beans (by 78 ± 15%; P < .001) and higher than with the nutrient-free control (by 25 ± 19%; P = .05). Patients complaining of abdominal distension after eating lettuce exhibited an increase in girth (35 ± 3 mm larger than basal; P < .001) without significant increase in colonic gas content (39 ± 4 mL increase; P = .071); abdominal distension was related to a descent of the diaphragm (by 7 ± 3 mm; P = .027) with redistribution of normal abdominal contents.
CONCLUSION AND INFERENCES
Lettuce is a low gas-releasing substrate for microbiota fermentation and lettuce-induced abdominal distension is produced by an uncoordinated activity of the abdominal walls. Correction of the somatic response might be more effective than the current dietary restriction strategy.
Topics: Abdominal Cavity; Abdominal Wall; Adult; Animals; Anthropometry; Biofeedback, Psychology; Cattle; Diagnosis, Differential; Diaphragm; Digestion; Dilatation, Pathologic; Electromyography; Feces; Female; Fermentation; Flatulence; Gases; Gastrointestinal Microbiome; Humans; In Vitro Techniques; Lactuca; Meat; Middle Aged; Muscle Contraction; Phaseolus; Saline Solution; Tomography, X-Ray Computed; Young Adult
PubMed: 31402544
DOI: 10.1111/nmo.13703 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Jan 2020The incidence of abdominal wall hematomas increased after the introduction of anticoagulant and antiplatelet drugs in clinical practice. These patients are usually old,...
BACKGROUND
The incidence of abdominal wall hematomas increased after the introduction of anticoagulant and antiplatelet drugs in clinical practice. These patients are usually old, and they have more than one comorbidity. Most spontaneous hematomas tend to limit itself and conservative treatment with close follow up is usually enough, but surgery is an option that should be decided critically. Unnecessary surgical interventions could worsen the situation. The present study aims to analyze the results of patients under anticoagulant/antiplatelet treatment and with spontaneous abdominal wall hematomas from surgeons' perspective.
METHODS
This is a retrospective study that the medical records of 43 patients who were under anticoagulant/antiplatelet therapy and consulted our general surgery clinic because of the spontaneous abdomen and abdominal wall hematoma between January-2016 and September-2018 were reviewed.
RESULTS
The findings showed that most of the cases were presented with abdominal pain. Thirty of these patients were female (69.7%). The mean age was 69.32 years. More than half of the patients (58.1%) were referred from the emergency department. All of the cases were under anticoagulant and antiplatelet treatment for several reasons. With presenting signs and symptoms and after evaluation of laboratory tests, computed tomography was performed to 30 patients (69.7%) as an initial test. USG and MRI were the other methods used. The most common diagnosis was rectus sheath hematoma (n=16; 37.2%) and followed by intestinal and colon wall, lumbar, psoas, pelvic and retroperitoneal hematoma in decreasing order. Among 43 patients, 39 patients (90.6%) followed with conservative treatment and two patients were treated with transcatheter arterial embolization. Two patients (4.6%) were died on day 1 and 11 after diagnosis. No surgery needed for all patients.
CONCLUSION
Early recognition, hospitalization of risky patients, close follow-up of hemodynamic parameters, patients' response to conservative treatment and minimal invasive methods are key points. Conservative care is the choice of treatment, but surgery must always keep in mind in hemodynamic unstable patients.
Topics: Abdominal Cavity; Aged; Anticoagulants; Female; Hematoma; Humans; Male; Platelet Aggregation Inhibitors; Retrospective Studies; Surgeons
PubMed: 31942735
DOI: 10.14744/tjtes.2019.32485