1/11. Long distance telementoring. A novel tool for laparoscopy aboard the USS Abraham Lincoln.BACKGROUND: As general surgeons perform a growing number of laparoscopic operations in increasingly specialized environments, the ability to obtain expert advice during procedures becomes more important. Technological advances in video and computer communications are enabling surgeons to procure expertise quickly and efficiently. In this article, we present laparoscopic procedures completed through an intercontinental telementoring system and the first telementored laparoscopic procedures performed aboard a naval vessel. methods: Video, voice, and data streams were linked between the USS Abraham Lincoln aircraft Carrier Battlegroup cruising the pacific ocean and locations in maryland and california, creating the Battlegroup telemedicine (BGTM) system. Three modes of BGTM communication were used: intraship, ship to ship, and ship to shore. RESULTS: Five laparoscopic inguinal hernia repairs were completed aboard the Lincoln under telementoring guidance from land-based surgeons thousands of miles away. In addition, the BGTM system proved invaluable in obtaining timely expertise on a wide variety of surgical and medical problems that would otherwise have required a shore visit. CONCLUSIONS: Successful intercontinental laparoscopic telementoring aboard a naval vessel was accomplished using "off-the-shelf" components. In many instances, the high risk and cost of transporting patients to land-based facilities was averted because of the BGTM system. Also, the relationship between the on-site and telementoring surgeon was critical to the success of this experiment. Long-distance telementoring is an invaluable tool in providing instantly available expertise during laparoscopic procedures.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/11. Fatal carbon dioxide embolism as an unreported complication of retroperitoneoscopy.Retroperitoneoscopy has gained popularity because it offers a safe alternative to the more debilitating open approach and avoids postoperative ileus. However, this type of procedure carries certain disadvantages in terms of intraperitoneal effusions and hemodynamic changes. Major complications are exceptional. We describe the case of a 52-year-old man who died of carbon dioxide embolism during elective totally extraperitoneal (TEP) inguinal hernioplasty for symptomatic left indirect inguinal hernia. With the patient under general anesthesia, the retroperitoneal space was gained through a 1. 5-cm incision made below the umbilicus. During the dissection, the patient collapsed and could not be resuscitated. At autopsy, air bubbles were admixed with blood in the epicardial veins, but no injury to vessels was demonstrated. We conclude that carbon dioxide embolism usually is caused by direct puncture of major vessels during intra-abdominal procedures. However, when this complication occurs during retroperitoneoscopy, it seems related to pressure-forced entry of carbon dioxide into the venous plexus.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/11. Laparoscopic management of spermatic cord entrapment after laparoscopic inguinal herniorrhaphy.spermatic cord entrapment is an unusual complication of inguinal herniorrhaphy. The case of a 52-year-old man who presented with severe pain along the left spermatic cord and testicle, varicocele, and dyspareunia after a laparoscopic bilateral inguinal hernia repair performed elsewhere is reported. Medical treatment failed, and laparoscopic exploration showed the vas deferens and spermatic vessels entrapped by a mesh slit that was pulling the genital branch of the genitofemoral nerve. The vas deferens and spermatic vessels were released, neurotomy of the affected nerve branch was performed, and a new mesh was positioned in the residual space. The patient's pain disappeared completely after the surgery and the varicocele decreased progressively. The patient remains asymptomatic at 1-year follow-up. laparoscopy might be the approach of choice to treat some of the complications of laparoscopic hernia repair, not only because it allows better observation of the anatomic structures, but also because the surgical therapy can be done with minimal tissue damage compared to the traditional approach.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/11. Retroperitoneal liposarcoma presenting a indirect inguinal hernia.A 60-year-old man was admitted to our hospital with a right inguinal swelling that had been growing in size without any pain for 7 months. We diagnosed the growth as a right inguinal hernia and operated on him. The growth, however, was found to be a tumor it situated along the spermatic cord and testicular vessels. We diagnosed it as a lipoma. The tumor was resected near part of the internal inguinal ring. Histopathological diagnosis showed well-differentiated liposarcoma of the sclerosing type. Postoperative computed tomography (CT) revealed a large residual tumor in the retroperitoneum. We believed that the tumor was a retroperitoneal liposarcoma and that it developed in the inguinal region. The residue of the liposarcoma was resected onto the right inguinal tract. A periodic follow up has been performed and no evidence of recurrence or metastasis has been seen in the 4 years and 9 months since the second surgery. No adjuvant therapy was performed. Inguinal liposarcomas are relatively rare and in most cases these tumors are thought to originate in the spermatic cord. The origin of the tumor is believed to be the retroperitoneum.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
5/11. Pulmonary hemorrhage in association with negative pressure edema in an intubated patient.Negative pressure pulmonary edema due to upper airway obstruction following extubation is a well-recognized problem. However, frank pulmonary hemorrhage as a manifestation of upper airway obstruction is uncommon. We report a case of significant pulmonary hemorrhage and negative pressure pulmonary edema in an intubated patient. bronchoscopy showed a collection of blood in the right lower lobe of the lungs, suggesting a localized source of bleeding. There have been two previously reported cases of pulmonary hemorrhage after upper airway obstruction. One suggested that the bleeding was due to damage to the pulmonary capillaries, the other that it was due to disruption of the bronchial vessels. We feel that in our case there was some indication that the pulmonary bleeding was a result of bronchial vessel damage. A number of factors might have been involved in its development, including negative pulmonary pressure, recent respiratory tract infection, and positive airways pressure (due to coughing).- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/11. Testicular proximity can induce gubernaculum formation after delivery.PURPOSE: This paper presents the hypothesis that after delivery as late as 38 weeks' gestation, a testis placed near the internal ring can induce the formation of a gubernaculum and undergo a belated but otherwise normal descent. methods: Two boys with a gastroschisis were each born with one of their testes prolapsed through the defect. The testis was sutured just lateral to the deep inferior epigastric vessels at the time of the primary closure of the gastroschisis. RESULTS: One boy born at 34 weeks had his left testis prolapsed through a left-sided gastroschisis defect. At 3 months, he was admitted to the hospital with a large left inguinal hernia. The repair was complicated by the presence of a large mass of jellylike tissue extending through the internal ring to the upper scrotum. A second boy was born at 38 weeks' gestation. The testis made its way uneventfully into the right hemiscrotum by 10 months of age. CONCLUSION: These cases suggest that testicular proximity is a critical factor in the formation of the gubernaculum and that the testis can induce the formation of the gubernaculum as late as 38 weeks gestation.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
7/11. Iliac arterial thrombosis after inguinal hernia repair.Vascular complications after inguinal hernia repair have been well documented. To our knowledge, all previously reported cases have been due to direct injury or compression of the vessels during the repair. We present the first case of thrombosis of the left common iliac artery after inguinal herniorrhaphy that was not due to direct injury or compression of the artery. Special coagulation testing revealed that the patient was a heterozygous carrier of the factor v R506Q (Leiden) mutation. This mutation is the most common cause of familial thrombophilia (hypercoagulable disorder) and is a known risk factor for venous thromboembolism. However, the association of this mutation with arterial thrombosis is less certain. patients with thrombosis of the iliofemoral artery or vein after inguinal herniorrhaphy should be considered for special coagulation testing because of potentially important differences in anticoagulant treatment of the affected patient and for genetic counseling of potentially affected family members.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
8/11. Irreducible inguinal hernia due to crossed testicular ectopia in an infant.The usual presentation of crossed testicular ectopia (CTE) is that of inguinal hernia with contralateral absent testis. We report on a 10-month-old infant with CTE, which presented as irreducible inguinal hernia. diagnosis was made during surgery, as the child underwent an emergency operation for repair of his irreducible right inguinal hernia. A normal-sized and normal-shaped testis was found in the hernial sac with its blood vessels and vas deferens. A herniotomy with fixation of the ectopic gonad to the opposite hemiscrotum was done. The child remained asymptomatic 1 year postoperatively. Crossed testicular ectopia in infancy may present as irreducible hernia, requiring urgent surgery.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
9/11. Femoral hernia in children: an infrequent problem revisited.Femoral hernias are of very rare occurrence at any age, but are exceedingly rare in the pediatric population. A 10-year survey, 1979-1989, of our experience with pediatric hernias produced a total of 1,134 inguinal hernias and 6 femoral hernias, supporting an incidence of 0.5% for femoral hernias in our population. The correct diagnosis was made in only two cases preoperatively. These two patients had undergone inguinal herniorrhaphies less than 6 months prior to presenting with recurrent groin masses. Femoral hernias were most frequently misdiagnosed as inguinal hernias. Inclusion of this entity in the differential diagnosis of groin masses, an accurate preoperative physical exam, and a careful surgical exploration will allow one to make the correct diagnosis and prevent unnecessary reoperations. In addition, early recurrence of a groin mass after inguinal exploration and herniorrhaphy should make one suspicious of a femoral hernia. At surgery, our recommendations include a simple infra-inguinal exploration medial to the femoral vessels when an inguinal hernia is unexpectedly not found at groin exploration and a Cooper's ligament repair when a femoral hernia is encountered. All six cases in our review were repaired with Cooper's ligament repair without complication.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
10/11. Ischaemic strictures of the small intestine in nigeria.Eleven specimens of small intestinal strictures were seen at the pathology Department of the University of benin teaching Hospital, benin City, nigeria, during a period of two and a half years. Eight of them were ischaemic in origin and the clinical and pathological features of these eight cases are described. In five of the cases, the ischaemia could be related to inguinal hernia, with herniorrhaphy a few weeks before surgery for stricture in four cases. The most important factor in making a clinical or pathological diagnosis of ischaemic stricture of the small intestine appears to be awareness of the condition. The importance is emphasised of studying the mesentery, with particular attention to lymph nodes and blood vessels, before making a final diagnosis on intestinal lesions.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
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