Re: Laparoscopic chicken
From: Garry E. Siegel, M.D. (garrys@mindspring.com)
Sat Feb 2 19:17:17 2008
Actually, I've done direct entry with the visual obturator (Ethicon) a
couple of times and it has been easy.
My series of two!
Garry
At Sat, 2 Feb 2008, Richard Kaplan wrote:
>
>I used the LUQ to place the verres needle a few times in my residency.
>About 5 years ago I had a patient with previous surgery who I felt would be
>a good candidate and the procedure went very well. 48 hours later she
>presented to the ER with sudden onset abdomenal pain. It turns out that
>with the patient preped and draped I misjudged the midclavicular line and
>place the verres too medially. I created a subcapsular liver hematoma that
>ruptured 48 hours later. I may be the only one anatomically challanged
>enough to make this mistake but if I ever got up the nerve to try the LUQ
>placement again I would mark the spot before the patient is draped.
>
>--
>Richard Kaplan
>
>>>----- Original Message -----
>From: "Garry E. Siegel, M.D." <garrys@mindspring.com>
>To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@mail.obgyn.net>
>Sent: Saturday, February 02, 2008 6:46 PM
>Subject: Re: Laparoscopic chicken
>
>> Interestingly, when I went to a conference in September on pelvic
>> surgery, one of the fine speakers, Andrew Sokol, said that 20% of all
>> patients who've had abdominal surgery would have adhesions, and he
>> advocated the left upper quadrant approach for the first port.
>>
>> Well, around 25% of people have had C Sections these days, so should we
>> go in the LUQ for someone having, say, an LTL a few years after one or
>> two sections?
>>
>> Garry
>>
>> At Sat, 2 Feb 2008, Douglas Krell wrote:
>>>
>>>Both Excel and Visiport are Ethicon products.
>>>The Excel trocars have spring loaded blades.
>>>The Visiport trocars have the little plastic wings at the tip, and the
>>>scope goes
>>>right inside of it so that you watch on monitor as the tip penetrates all
>>>the layers.
>>>
>>>I use the visiport all the time now.
>>>I can attest to the fact that if you have a piece of bowel adherent right
>>>under the umbilicus
>>>The visiport gives you a nice view of the bowel lumen.
>>>
>>>I agree with you Garry. It would take a major study powered to show the
>>>difference
>>>in injury rates. Perhaps you could study laparoscopies done on patients
>>>with previous
>>>midline incisions.
>>>
>>>Right now, I tend to prefer the Visiport, but if the scrub tech opens
>>>Excels by mistake, I don't throw 'em all out.
>>>I usually open a Verres needle and proceed. Surgery is dangerous
>>>business, but if it's done for a
>>>good reason and patients are well informed, we each take calculated risks
>>>that are actually
>>>quite low.
>>>
>>>--
>>>Douglas Krell MD
>>>
>>>> Date: Sat, 2 Feb 2008 16:19:50 -0600
>>>> From: garrys@mindspring.com
>>>> To: ob-gyn-l@mail.obgyn.net
>>>> Subject: Re: Laparoscopic chicken
>>>>
>>>> Very well said. I'm not sure that you can really know when you're about
>>>> to hit something, but inherently it seems like a visual port is a good
>>>> idea.
>>>>
>>>> Studies have been done and the rate of injury is about the same
>>>> regardless of entry type, likely because it would take a huge study to
>>>> show a significant difference.
>>>>
>>>> Garry
>>>>
>>>> >Glen
>>>> >
>>>> >I remember trying something similar called VisiPort a long time ago.
>>>> >I
>>>> >heard that people had saw all layers of the abdomen before they entered
>>>> >into the
>>>> >intestinal lumen. What is my point? No matter what you use, the
>>>> >initial
>>>> >entry is always a dangerous business.
>>>> >
>>>> >Allan
>>>>
>>>> --
>>>> Garry E. Siegel, M.D.
>>>> Private Practice
>>>> Roswell, GA
>>>
>> --
>> Garry E. Siegel, M.D.
>> Private Practice
>> Roswell, GA
>>
--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA
