Optimizing working space in laparoscopy: CT-measurement of the effect of neuromuscular blockade and its reversal in a porcine model

Vlot, John; Specht, Patricia A.C.; Wijnen, René; Rosmalen, Joost van; Mik, Egbert G.; Bax, Klaas M. A.

doi:10.1007/s00464-014-3927-6

Cited by 6 publications

(4 citation statements)

References 30 publications

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“…The total volume, including ipsilateral and contralateral sides, and the ipsilateral volume based on the mid‐sagittal plane as the medial border were measured. Inadvertently selected gas regions in the intestines were excluded with visual inspection before volume computation . Maximum linear dimensions (maximum dorsoventral diameter [height] and maximum transverse diameter [width]) were measured on transverse images at the levels of the 2nd to 4th lumbar vertebrae—a potential working region in adrenalectomy or nephrectomy (Fig ).…”

Section: Methodsmentioning

confidence: 99%

“…Inadvertently selected gas regions in the intestines were excluded with visual inspection before volume computation. 14,15 Maximum linear dimensions (maximum dorsoventral diameter [height] and maximum transverse diameter [width]) were measured on transverse images at the levels of the 2nd to 4th lumbar vertebrae-a potential working region in adrenalectomy or nephrectomy (Fig 3). Measurements were performed separately for the left and right retroperitoneal spaces based on the mid-sagittal plane as the medial border, because retroperitoneoscopic procedures would be performed in the left or right side of the space individually.…”

Section: Outcome Measuresmentioning

confidence: 99%

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Retroperitoneal Laparoscopy in Dogs: Access Technique, Working Space, and Surgical Anatomy

Jeong

Lim

et al. 2016

Veterinary Surgery

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ObjectiveTo develop and describe a laparoscopic retroperitoneal access technique, investigate working space establishment, and describe the surgical anatomy in the retroperitoneal space as an initial step for clinical application of retroperitoneal laparoscopy in dogs.Study DesignCadaveric and experimental study.AnimalsCadaveric (n=8) and healthy (n=6) adult dogs.MethodsThe retroperitoneal access technique was developed in 3 cadavers based on the human technique and transperitoneal observation. Its application and working space establishment with carbon dioxide (CO2) insufflation alone was evaluated in 5 cadavers by observing with a transperitoneal telescope and in 6 live dogs by repeated computed tomography (CT) scans at pressure of 0, 5, 10, and 15 mmHg. Recordings of retroperitoneoscopy as well as working space volume and linear dimensions measured on CT images were analyzed.ResultsRetroperitoneal access and working space establishment with CO2 insufflation alone were successfully performed in all 6 live dogs. The only complication observed was in 1 dog that developed subclinical pneumomediastinum. As pressure increased, working space was established from the ipsilateral to the contralateral side, and peritoneal tearing eventually developed. Working space volume increased significantly from 5 mmHg and linear dimensions increased significantly from 0 to 10 mmHg. With pneumo‐retroperitoneum above 5 mmHg, retroperitoneal organs, including kidneys and adrenal glands, were easily visualized.ConclusionThe retroperitoneal access technique and working space establishment with CO2 insufflation starting with 5 mmHg and increasing to 10 mmHg provided adequate working space and visualization of retroperitoneal organs, which may allow direct access for retroperitoneal laparoscopy in dogs.

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Section: Methodsmentioning

confidence: 99%

Section: Outcome Measuresmentioning

confidence: 99%

Retroperitoneal Laparoscopy in Dogs: Access Technique, Working Space, and Surgical Anatomy

Jeong

Lim

et al. 2016

Veterinary Surgery

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“…The small anatomical size of the feline thorax and abdomen, and the resulting limited working space for manipulation of instruments within the body cavity can be difficult to overcome. Even with the advent of smaller telescopes and instrumentation, manipulation in the abdominal or thoracic cavity remains challenging and various experimental techniques have been evaluated to address this difficulty for use in human patients 1,9–14 . While some laparoscopic instruments can be ordered in varying lengths, the lengths of available cannulas remain relatively constant from 5–8.3 cm.…”

Section: Introductionmentioning

confidence: 99%

“…Even with the advent of smaller telescopes and instrumentation, manipulation in the abdominal or thoracic cavity remains challenging and various experimental techniques have been evaluated to address this difficulty for use in human patients. 1,[9][10][11][12][13][14] While some laparoscopic instruments can be ordered in varying lengths, No financial support was provided…”

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confidence: 99%

3D printed cannulas for use in laparoscopic surgery in feline patients: A cadaveric study and case series

2022

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ObjectiveTo evaluate custom 3D printed laparoscopic cannulas (3DPC) in a feline cadaveric abdominal surgery model and report their use in two live feline subjects.Study designExperimental cadaver study, live subject case series.AnimalsTen feline cadavers; two feline subjects.MethodsCustom 3DPCs were initially modeled in a PLA filament material and then created in an autoclavable dental resin for use in live patients. The surgery time, number of surgical collisions and cannula complications were recorded during cadaver procedures before and after use of 3DPCs. Cannula complications were recorded during live procedures and patients were followed to suture removal to record any incisional complications.ResultsThere was a significant reduction in mean surgical time (125.6 vs. 95.2 min, p = 0.03), mean number of instrument collisions (6.8 vs. 2.6, p = 0.03), and mean number of cannula complications (10 vs. 2.2, p = 0.03) with the use of only 3DPCs during the procedure. During the live procedures the use of the 3DPCs was successful and no postoperative complications occurred at the incision sites.ConclusionThe use of customized 3DPCs may improve surgical dexterity and decrease complications in advanced procedures and was not associated with any clinical complications in two cats. The use of 3DPCs in veterinary medicine may allow for wider practice of laparoscopic techniques in small animals.

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Clinical pharmacology and efficacy of sugammadex in the reversal of neuromuscular blockade

Schaller

Lewald

2016

Expert Opinion on Drug Metabolism & Toxicology

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After approval in Europe in 2008 and Asia in 2010, sugammadex has recently been approved in the USA and Canada. This will open the field for further research especially for the use in special patient populations and specific diseases. Due to its pharmacodynamic profile, sugammadex in combination with rocuronium might have the potential to displace succinylcholine as the gold standard muscle relaxant for rapid sequence inductions. The use of rocuronium or vecuronium with the potential to reverse its action with sugammadex seems to be safe in patients with impaired neuromuscular transmission, i.e. (neuro)muscular diseases including myasthenia gravis. Data from long-term use of sugammadex is not yet available. Evidence towards an economic advantage of using sugammadex, justifying the relatively high costs for an anesthesia-related drug, is missing.

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Optimizing working space in laparoscopy: CT-measurement of the effect of neuromuscular blockade and its reversal in a porcine model

Abstract: This experimental study confirms the results from several clinical studies that NMB does not influence laparoscopic working space. Studies dealing with working space during laparoscopy should take note of pre-stretching bias.

Cited by 6 publications

References 30 publications

Retroperitoneal Laparoscopy in Dogs: Access Technique, Working Space, and Surgical Anatomy

Retroperitoneal Laparoscopy in Dogs: Access Technique, Working Space, and Surgical Anatomy

3D printed cannulas for use in laparoscopic surgery in feline patients: A cadaveric study and case series

Clinical pharmacology and efficacy of sugammadex in the reversal of neuromuscular blockade

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