Navegando por Palavras-chave "Pneumoperitoneum, Artificial"
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- ItemAcesso aberto (Open Access)Criação do pneumoperitônio mediante punção com agulha de Veress no hipocôndrio esquerdo: ensaio clínico, prospectivo e randomizado(Colégio Brasileiro de Cirurgiões, 2005-10-01) Azevedo, Otávio Cansanção [UNIFESP]; Azevedo, João Luiz Moreira Coutinho [UNIFESP]; Sorbello, Albino Augusto; Godoy, Antônio Cláudio de; Menezes, Francisco Julimar Correia de [UNIFESP]; Aguiar-Yamaguchi, Gilmara Silva [UNIFESP]; Hospital do Servidor Público; Universidade Federal de São Paulo (UNIFESP); CNPq; UNIFES; Hospital do Servidor Público Setor de VideocirurgiaBACKGROUND: In the creation of the pneumoperitoneum with the Veress neddle, all reported incidents occurred during the puncture in the midline of the abdomen. Albeit rare, such type of incident has a high mortality rate as it normally severs the large vessels. The objective of this research is to test the efficacy of a safer alternative method of puncture in the left hipocondrium. METHODS: Sixty two patients, distributed randomly into two groups were studied. Group HE: puncture in the left hipocondrium (n = 30), and Group LM: puncture in the medline of the abdomen (n = 32). An evaluation was carried out of the results of the tests as to the positioning of the needle, the number of failed attempts to access the peritoneal cavity and the time taken for the creation of the pneumoperitoneum. Real flows, intraperitoneal pressure, and injected volumes were recorded at 20 second intervals, until pressure had reached 12mmHg. RESULTS: The results of the test regarding the positioning of the Needle were equally positive. There were two unsuccessful attempts at piercing in Group LM and one in Group HE. The time taken for the creation of the pneumoperitoneum was on average of 3 minutes and 46 seconds for Group HE and of 4 minutes and 2 seconds for Group LM. The average measures recorded regarding flow, pressure and volume were equivalent in each Group, respectively. The statistical analysis has demonstrated that piercing of the left hypocondrium was as effective in the creation of the pneumoperitoneum as it was the case as regards the piercing of the medium line of the abdomen. CONCLUSION: The left hipocondrium must be the preferred place for the puncture with the Veress needle so as to create the artificial pneumoperitoneum by the closed technique, as it entails a smaller risk.
- ItemAcesso aberto (Open Access)Effects of increased intra-abdominal pressure on the healing process after surgical stapling of the stomach of dogs(Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia, 2007-10-01) Chaves Jr, Nilson; Magalhães, Luciene de Tassis; Colleoni Neto, Ramiro [UNIFESP]; Del Grande, José Carlos [UNIFESP]; University Severino Sombra Medical School; Universidade Federal de São Paulo (UNIFESP)PURPOSE: To assess the initial healing after surgical stapling of the stomach using a linear cutting stapler and creating pneumoperitoneum (12-14 mmHg) for 60 minutes or 120 minutes, and compare it with the healing of a staple line not submitted to increased pressure. METHODS: A total of 30 dogs were divided into three groups of 10 animals each: Group I (control group - surgical stapling), Group II (surgical stapling and increased intra-abdominal pressure for 60 minutes) and Group III (surgical stapling and increased intra-abdominal pressure for 120 minutes). All dogs were maintained under general anesthesia for two hours after surgical stapling. Seven days after surgery, the area around the staple line was macroscopically and microscopically examined. RESULTS: The macroscopic examination of the samples (n = 30) did not show dehiscence, fistula or abscess. Adhesions between the omentum and the staple line were observed in all animals of Groups II and III (n = 20), which were significantly different from Group I (p = 0.008*). The histopathological analysis showed normal healing up to day 7 in the control animals (n = 10). When these results were compared with those of Groups II and III (n = 20), non-parametric tests revealed that there was a significant difference with regard to certain parameters of the early stages of healing, such as fibroblast migration (p = 0.011*), edema (p < 0.001*) and congestion (p = 0.011*). These alterations affected reepithelization (p < 0.001*), and consequently the late stages of healing. CONCLUSIONS: Each group showed different healing stages, and the healing process was delayed in the groups submitted to increased pressure, especially in the group submitted to increased pressure for longer time.
- ItemAcesso aberto (Open Access)Evaluation of tests performed to confirm the position of the Veress needle for creation of pneumoperitoneum in selected patients: a prospective clinical trial(Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia, 2006-12-01) Azevedo, Otávio Cansanção [UNIFESP]; Azevedo, João Luiz Moreira Coutinho [UNIFESP]; Sorbello, Albino Augusto; Miguel, Gustavo Peixoto Soares [UNIFESP]; Wilson Junior, Jorge Luis [UNIFESP]; Godoy, Antônio Cláudio de; Universidade Federal de São Paulo (UNIFESP); HSPE Service of Surgical Gastroenterology Division of Laparoscopy; HSPE Service of Surgical GastroenterologyPURPOSE: To evaluate tests performed to confirm the position of the Veress needle inserted into the left hypochondrium for creation of pneumoperitonium. METHODS: One hundred patients were submitted to laparoscopic procedure with left hypochondrium puncturing. Needle positioning tests were evaluated. The aspiration test was considered positive when organic material was aspirated; the injection test was considered positive when no increased resistance to liquid injection was observed; the recovery test was considered positive when the liquid injected was not recovered; the saline drop test was considered positive when drops of saline in the syringe disappeared quickly; the initial intraperitoneal pressure test was considered positive when pressure levels were £ 8 mmHg. A positive aspiration test indicated iatrogenic injury, whereas a positive result in any of the other tests indicated that the tip of the needle was correctly positioned in the peritoneal cavity. Sensitivity (SE), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) of the tests were calculated by correlating results considered true positives (a), false positives (b), false negatives (c) and true negatives (d), according to the formulas: SE = [a/(a + c)] x 100; SP = [d/(b + d)] x 100; PPV = [a/(a + b)] x 100; NPV = [d(c + d)] x 100. RESULTS: With regard to the aspiration test, SE and PPV were not applicable, SP was 100% and NPV was 100%. With regard to the injection test, SE was 0%, SP was 100%, PPV was inexistent and NPV was 90%. Both recovery and saline drop tests yielded the following results: SE was 50%, SP was 100%, PPV was 100% and NPV was 94.7%. The initial intraperitoneal pressure test yielded the following results: SE, SP, PPV and NPV were 100%. CONCLUSIONS: When inserting the Veress needle into the left hypochondrium, a negative aspiration test guarantees the absence of iatrogenic injury; the injection test is not reliable to determine incorrect needle positioning, but it accurately detects correct needle positioning; recovery and saline drop tests are not reliable to determine correct needle positioning, but they accurately detect incorrect needle positioning; the initial intraperitoneal pressure test is reliable to determine both correct and incorrect needle positioning, and proved to be the most reliable of the tests analyzed.
- ItemAcesso aberto (Open Access)Evaluation of the positioning of the tip of the Veress needle during creation of closed pneumoperitoneum in pigs(Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia, 2006-02-01) Azevedo, João Luiz Moreira Coutinho [UNIFESP]; Guindalini, Rodrigo Santa Cruz [UNIFESP]; Sorbello, Albino Augusto [UNIFESP]; Silva, Cássio Edvan Paulino da [UNIFESP]; Azevedo, Otávio Cansanção [UNIFESP]; Aguiar-Yamaguchi, Gilmara Silva [UNIFESP]; Menezes, Francisco Julimar Correia de [UNIFESP]; Delorenzo, Aline [UNIFESP]; Pasqualin, Rubens Campana [UNIFESP]; Kozu, Fábio Okutani [UNIFESP]; EAES; Universidade Federal de São Paulo (UNIFESP); HSPE Division of LaparoscopyPURPOSE: Erroneous punctures and insufflations are frequent with the use of the Veress needle. Mistaken injections of gas in the preperitoneal space are not rare. The purpose of this research is to evaluate the correct positioning of the tip of the needle during creation of pneumoperitoneum. METHODS: The needle was inserted into the peritoneal cavity. Tests to assess the positioning of the needle tip were carried out. Pressure, flow rate and volume were periodically recorded and the needle was removed, being immediately reinserted into the right hypochondrium and placed in the preperitoneal space. RESULTS: The liquid flow test was always positive in the peritoneal cavity. No resistance to saline injection into the peritoneal cavity was observed, but increased resistance to saline injection into the preperitoneal space was observed in 45.5% of the cases. Some saline was recovered in 63.5% of the cases in the peritoneal cavity, and in 54.5% in the preperitoneal space. Saline drop test was positive in 66.6% of the cases in the peritoneal cavity and in 45.5% in the preperitoneal space. In the peritoneal cavity, initial pressure lower than 5 mm Hg was observed, and this pressure gradually increased during 123 seconds until reaching 15 mm Hg. In the preperitoneal space, initial pressure was 15 mm Hg. CONCLUSIONS: Aspiration, liquid flow and saline drop tests are important, whereas recovery test is inconclusive. Initial pressure of approximately 5 mm Hg indicates that the tip of the needle is in the peritoneal cavity. The peritoneal cavity should hold ten times as much volume of gas as the preperitoneal space. The increase in pressure and volume in the peritoneal cavity can be predicted by statistics.
- ItemAcesso aberto (Open Access)Punção com agulha de Veress no hipocôndrio esquerdo para a criação do pneumoperitônio: valor diagnóstico das provas de posicionamento da agulha em pacientes não selecionados(Colégio Brasileiro de Cirurgiões, 2011-02-01) Becker Junior, Otávio Monteiro; Azevedo, João Luiz Moreira Coutinho [UNIFESP]; Azevedo, Otávio Cansanção [UNIFESP]; Hypólito, Octávio Henrique Mendes; Miyahira, Susana Abe [UNIFESP]; Miguel, Gustavo Peixoto Soares [UNIFESP]; Machado, Afonso Cesar Cabral Guedes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Federal do Espirito Santo Departamento de CirurgiaObjective: To assess the effectiveness of the Veress needle puncture in the left hypochondrium and the accuracy of the tests described for the intraperitoneal correct positioning of the tip of the Veress needle in an unselected population. Methods: Ninetyone patients consecutively scheduled for Videolaparoscopy had the abdominal wall punctured in the left hypochondrium. There were no exclusion criteria. The patients received general anesthesia and mechanical ventilation according to the protocol. After puncturing five tests were used to confirm the positioning of the needle tip within the peritoneal cavity: aspiration test - AT; resistance to infusion - Pres; recovery of the infused fluid - Prec, dripping test - DT, and test of initial intraperitoneal pressure - IIPP. The test results were compared with results from literature for groups with defined exclusion criteria. The results were used for calculating sensitivity (S) specificity (E), positive predictive value (PPV) and negative predictive value (NPV). Inferential statistical methods were used to analyze the findings. Results: There were 13 failures. AT had E = 100% and NPV 100%. Pres had S = 100%, E = 0; PPV = 85.71%; NPV does not apply. Prec: S = 100%, E = 53.84%, PPV = 92.85%, NPV = 100%. DT: S = 100%, E = 61.53%, PPV = 93.97% NPV 100%. In IIPP, S, E, PPV and NPV were 100%. Conclusion: The puncture in the left hypochondrium is effective and the performed tests guide the surgeon regardless of sex, BMI, or previous laparotomy.
- ItemAcesso aberto (Open Access)Veress needle insertion in the left hypochondrium in creation of the pneumoperitoneum(Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia, 2006-10-01) Azevedo, Otávio Cansanção [UNIFESP]; Azevedo, João Luiz Moreira Coutinho [UNIFESP]; Sorbello, Albino Augusto; Miguel, Gustavo Peixoto Soares [UNIFESP]; Guindalini, Rodrigo Santa Cruz [UNIFESP]; Godoy, Antônio Cláudio de; Universidade Federal de São Paulo (UNIFESP); Hospital of the State of São PauloPURPOSE: To test the efficacy of the puncture in the left hypochondrium as an alternative method. METHODS: Sixty-two patients randomly distributed into two groups were studied: Group LH, puncture in the left hypochondrium (n=30), and Group ML, puncture in the abdominal midline (n=32). The following were assessed: needle positioning tests, number of failed attempts at needle insertion, and time needed for creation of pneumoperitoneum. Gas flow, volume and intraperitoneal pressure were recorded at every 20 seconds, until a 12 mmHg pressure was reached inside the peritoneal cavity. RESULTS: A similar number of positive results for the needle positioning tests were observed in both groups. Two failed attempts to reach the peritoneal cavity were observed in Group ML and one in Group LH. The time necessary for the creation of pneumoperitoneum was on average 3 minutes and 46 seconds for Group LH, and 4 minutes and 2 seconds for Group ML. Average gas flow, volume and pressure were equivalent for both groups. CONCLUSION: Puncture in the left hypochondrium was as effective as puncture in the abdominal midline for the creation of pneumoperitoneum.