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Re: Laparoscopic chicken From: Garry E. Siegel, M.D. (garrys@mindspring.com) Sat Feb 2 16:45:21 2008 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Richard Kaplan: "Re: Laparoscopic chicken" Previous message: R. Daniel Braun: "Re: endometriosis?" In reply to: Douglas Krell: "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 Next message: Richard Kaplan: "Re: Laparoscopic chicken" Previous message: R. Daniel Braun: "Re: endometriosis?" In reply to: Douglas Krell: "Re: Laparoscopic chicken"

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