Endoscopic surgery and allied technologies最新文献_第2页

Principles of development and design of microsystems. 微系统的开发和设计原理。

Endoscopic surgery and allied technologies Pub Date : 1995-08-01

B Wagner

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Haemodynamic changes during laparoscopic cholecystectomy in the high-risk patient. 高危患者腹腔镜胆囊切除术时血流动力学的改变。

Endoscopic surgery and allied technologies Pub Date : 1995-08-01

R Stuttmann, C Vogt, E Eypasch, M Doehn

{"title":"Haemodynamic changes during laparoscopic cholecystectomy in the high-risk patient.","authors":"R Stuttmann, C Vogt, E Eypasch, M Doehn","doi":"","DOIUrl":"","url":null,"abstract":"Although laparoscopic cholecystectomy (LC) has become the standard surgical procedure for the treatment of gall stones, the question has still to be answered whether it is safe for critically ill patients with cardiac disease. 20 ASA-class III/IV patients were monitored during LC by means of a Swan-Ganz catheter. Commencement of anaesthesia led to a significant decrease of mean arterial pressure, cardiac index, stroke volume index and left ventricular stroke work index. Increasing intra-abdominal pressure by insufflation of CO2 and surgical stimuli during gall bladder dissection induced an increase of pulmonary arterial occlusion pressure mean pulmonary artery pressure and central venous pressure (p = 0.05). Mean arterial pressure, cardiac index, stroke volume index and left ventricular stroke work index remained below pre-induction values (p < 0.05). In 13 patients with high filling pressures the administration of nitroglycerine improved all parameters. In the post-anaesthetic care unit all parameters had returned towards baseline. In conclusion, LC may lead to temporary myocardial insufficiency. Nevertheless, LC seems to be safe provided that pathological alterations are recognised and treated.","PeriodicalId":79337,"journal":{"name":"Endoscopic surgery and allied technologies","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1995-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19814220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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Helium insufflation in laparoscopic surgery. 腹腔镜手术中的氦气充气。

Endoscopic surgery and allied technologies Pub Date : 1995-08-01

G P Naude, F S Bongard

{"title":"Helium insufflation in laparoscopic surgery.","authors":"G P Naude, F S Bongard","doi":"","DOIUrl":"","url":null,"abstract":"Carbon dioxide is the most commonly used gas for abdominal insufflation in laparoscopy today. Due to the solubility of carbon dioxide large volumes are absorbed into the circulation causing a high PCO2 and a low pH (respiratory acidosis). Carbon dioxide is also stored in several sites in the body and is released at the conclusion of the procedure prolonging the respiratory acidosis when the patient is least able to cope with this additional burden. Cardiac effects of CO2 consist of a lowering of the arrhythmia threshold, increased blood pressure, pulse and cardiac output. At a sustained high level this can lead to cardiac depression and death. These effects are particularly prone to occur in cardiac and respiratory cripples. Other gases that have been used include air, oxygen, nitrous oxide and nitrogen. Their use has been discontinued because of the danger of embolism. Air, oxygen and nitrous oxide are also not safe to use in the presence of electrosurgical instruments thereby limiting their usefulness even further. Helium has been proposed as a very promising alternative to CO2. In the laboratory and in a clinical trial, helium has not produced the respiratory acidosis associated with CO2 insufflation. This is further evidence that the acidosis is not primarily due to elevation of the diaphragm and consequent increased dead space, but to the large amount of CO2 that is absorbed directly from the peritoneal cavity. Helium would seem to be the gas of choice at this time as it comes close to fitting the criteria for an ideal insufflating gas. Helium is clear and colorless, allowing unimpeded vision to the operator. It is non toxic, not flammable or explosive and can be safely used with electrocautery and laser. Helium is easy to handle and not very soluble which decreases the amount absorbed from the peritoneal cavity and consequently the amount used. That which is absorbed is quickly cleared by the lungs. Helium is metabolically inactive (in contrast to CO2) and does not interfere with normal metabolic processes. In view of this promising initial work, further studies are indicated.","PeriodicalId":79337,"journal":{"name":"Endoscopic surgery and allied technologies","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1995-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19814222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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OREST II--ergonomic workplace and systems platform for endoscopic technologies. OREST II——人体工程学工作场所和内窥镜技术系统平台。

Endoscopic surgery and allied technologies Pub Date : 1995-08-01

M O Schurr, G Buess

{"title":"OREST II--ergonomic workplace and systems platform for endoscopic technologies.","authors":"M O Schurr, G Buess","doi":"","DOIUrl":"","url":null,"abstract":"Endoscopic interventions require a multitude of technical devices, like gas-insufflators, cameras, light sources, high-frequency scalpels and others. The devices available today represent stand-alone \"function-insulas\" from the view-point of systems technique. They have to be placed in the operating theatre and set-up right before each specific intervention. From each of these single devices supplies, cables and hoses lead to the body of the patient and have to be connected on both sides within the sterile and the non-sterile field. This not only requires a long setup time in the OR but also restricts the mobility of the operative personnel. Besides the ergonomic and the hygienic weakness of the contemporary solution, significant functional problems limit the efficiency of the OR environment. One of the major drawbacks lies in the lack of direct control of the devices by the surgeon and the confusing display of parameters and technical status. Against this background the systematic revision of the current endo-surgical workplace appears to be a major requirement for further technical and surgical progress. As a result of close cooperation between surgeons and engineers a systems workplace for minimally invasive surgery, OREST, has been developed and clinically tested. It integrates all devices into a mobile cabinet. The single devices are connected to a central computer and can be remote controlled directly by the surgeon from the table. A special display continuously informs about the system status. The lines and cables are guided into the sterile field by means of a swivel arm from one side of the patient. Multi-plugs are used to connect all lines at a central terminal within the sterile area. Clinical application of the first prototype OREST I started in 1993. OREST II is now available as a series product. Further development is focused on the integration of advanced sub-systems like tactile devices and advanced vision system.","PeriodicalId":79337,"journal":{"name":"Endoscopic surgery and allied technologies","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1995-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19814224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Disposable and reusable trocars. 一次性和可重复使用套管针。