Abstract:

Forced-air warming is known as an effective procedure in prevention and treatment of perioperative hypothermia. Hypothermia is associated with disturbances of coagulation, raises postoperative oxygen consumption by shivering, increases cardiac morbidity, leads to a higher incidence of wound infection, and prolongs hospital stay. Additionally, preoperative local warming reduces the incidence of wound infection after clean surgery. In an animal experiment it has been demonstrated that even during large abdominal operations the major source of heat loss was the skin. Although evaporation accounted for the largest heat loss from the abdominal cavity, it was a minor source due to the smaller heat losing area. As a consequence, reduction of heat loss from the skin is the most promising approach to avoid hypothermia. During abdominal surgery and lower-limb surgery, the use of upper blankets is favourable. The use of upper-body blankets implies a reduction of heat loss in a relevant area and, furthermore, a heat gain. The covered area is approximately 0.35 m², or approximately 15%-20% of body surface. The heat balance in this area can be changed by 46.1W to 55.0W by forced-air warming systems with upper body blankets. Depending on the surgical procedure and resulting fluid demand, forced-air warming with upper-body blankets—in combination with insulation and fluid warming—is an effective method to prevent perioperative hypothermia.

Authors:

Thorsten Perl, M.D.; Anselm Bräuer, M.D., D.E.A.A.; Michael Quintel, M.D., Ph.D., University of Göttingen, Göttingen, Germany

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Abstract:

The purpose of this chapter is to introduce the beginning surgeon ultrasonographer to the use of ultrasound during laparoscopic surgery. The authors routinely use ultrasound in the intraoperative, endoscopic, and office settings. The importance of ultrasound in the various surgical specialties is well documented in the literature. Since the introduction of minimally invasive techniques to General Surgery, many advanced applications of ultrasonography have been developed. Confident examinations of intraabdominal anatomy, pathologic conditions, and therapeutic procedures can readily be performed. In this chapter, a comprehensive introduction to laparoscopic ultrasound is presented to the practicing General Surgeon. The basic equipment requirements and setup are explained. Fundamental techniques of laparoscopic ultrasound examination are described. The authors' method of screening for common bile duct stones during routine laparoscopic cholecystectomy is illustrated. Examination of the normal biliary tree with helpful hints is presented. The authors' systematic technique of visualizing the normal liver parenchyma is described. Common benign and malignant findings are elucidated. A brief synopsis of pancreatic ultrasonography with attention to pathologic findings is provided. Uses of ultrasound in unanticipated situations are introduced. With perseverance, the reader will discover that laparoscopic ultrasound skills can be readily attained.

Authors:

Anand C. Patel, M.D.; Maurice E. Arregui, M.D., F.A.C.S., St. Vincent's Hospital, Indianapolis, IN

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Abstract:

Diagnostic validity of sentinel node (SN) mapping has been recently introduced into the field of various solid tumors, including gastrointestinal (GI) cancer. In gastric cancer, acceptable detection rates of SNs, as well as sensitivity in detecting micrometastasis based on SN status, was reported using the dye-guided method, as well as the radio-guided method. Gastric cancer is currently one of the suitable targets of SN navigation surgery among visceral tumors. Despite the multi-directional and complicated lymphatic flow from gastric mucosa, the anatomical situation of the stomach is relatively suitable for SN mapping in comparison with organs embedded in closed spaces, such as the esophagus and rectum. In particular, clinically T1N0 gastric cancer seems to be a good entity for which to try to modify the therapeutic approach. From the data reported in the literature, micro-metastases tend to be limited within the sentinel basins in cT1N0 gastric cancer. Sentinel basins are, therefore, good targets of selective lymphadenectomy for cT1N0 gastric cancer with the potential risk of micrometastasis. Furthermore, laparoscopic local resection is theoretically feasible for curative treatment of SN negative early gastric cancer. For laparoscopic application of SN mapping of gastric cancer, a radio-guided method is essential. Although recent single institutional studies support the validity of the SN concept, a multi-centric prospective validation study based on a standardized protocol is essential for further clinical application. Currently, two major well-designed clinical trials of SN mapping for gastric cancer open surgery have been initiated in Japan. Radio-guided SN mapping for gastric cancer has a great potential to provide a new paradigm shift for surgical management of an early gastric cancer.

Authors:

Yuko Kitagawa, M.D., Ph.D., F.A.C.S.; Masaki Kitajima, M.D., Ph.D., F.A.C.S., Keio University School of Medicine, Tokyo, Japan

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Abstract:

Intra-abdominal abscesses are one of the major complications that occur after Gastrointestinal Surgery. Therapeutic modalities include drainage and irrigation. This study describes the development of a new drainage and continuous irrigation system that results in less skin irritation and reduced dressing changes. This system involved the use of the Surgidrain open top™ (ALCARE, Tokyo, Japan), which consists of a sealing sheet with a drainage lumen and plastic cap. A double-lumen tube was inserted into the abscess cavity through a slit in the plastic cap. The abscess cavity could, therefore, be irrigated continuously through one lumen of the double-lumen tube, and most of the fluid could be drained through the second lumen of the double-lumen tube. Overflow fluid was drained through the Surgidrain open topTM drainage lumen. This system enabled better protection against skin complications and the ability to easily flush the abscess intermittently.

Authors:

Michiya Kobayashi, M.D., Ph.D.; Takehiro Okabayashi, M.D.; Tsutomu Namikawa, M.D., Ph.D.; Ken Okamoto, M.D.; Keijiro Araki, M.D., Ph.D., Kochi Medical School, Nankoku, Japan

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Abstract:

The exclusive charge-coupled device (CCD) camera system for the endoscope and electronic fiberscopes are in widespread use. However, both are usually stationary in an office or examination room, and a wheeled cart is needed for mobility. The total costs of the CCD camera system and electronic fiberscopy system are at least US $10,000 and US $30,000, respectively. Recently, the performance of audio and visual instruments has improved dramatically, with a concomitant reduction in their cost. Commercially available CCD video cameras with small monitors have become common. They provide excellent image quality and are much smaller and less expensive than previous models. The authors have developed adaptors for the popular mini-digital video (mini-DV) camera. The camera also provides video and acoustic output signals; therefore, the endoscopic images can be viewed on a large monitor simultaneously. The new system (a mini-DV video camera and an adaptor) costs only US $1,000. Therefore, the system is both cost-effective and useful for the outpatient clinic or casualty setting, or on house calls for the purpose of patient education. In the future, the authors plan to introduce the clinical application of a high-vision camera and an infrared camera as medical instruments for clinical and research situations.

Authors:

Koichi Tsunoda, M.D., National Institute of Sensory Organs, Tokyo Medical Center, Tokyo, Japan; Atsunobu Tsunoda, M.D., Tokyo Medical and Dental University, Tokyo, Japan; ShinnIchi Ishimoto, M.D., National Hospital Organization Tokyo Medical Center, Tokyo, Japan; Satoko Kimura, M.D., National Hospital Organization Tokyo Medical Center, Tokyo, Japan

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