ABSTRACT
PURPOSE: To evaluate a new, low-cost, reusable balloon trocar device for dissection of the preperitoneal space during endoscopic surgery.METHODS:Twenty swine (weight: 15-37 kg) were randomized to two groups, according to whether the preperitoneal space was created with a new balloon device manufactured by Bhio-Supply (group B) or with the commercially available OMSPDB 1000(r) balloon device manufactured by Covidien (group C). Quality and size of the created preperitoneal space, identification of anatomic structures, balloon dissection time, total procedure time, balloon resistance and internal pressure after insufflation with 300 mL of ambient air, balloon-related complications, and procedure cost were assessed.RESULTS:No significant differences in dissection time, total procedure time, or size of the created preperitoneal space were found between the groups. Balloons in group B had a significantly higher internal pressure compared to balloons in group C. None of the balloons ruptured during the experiment. Three animals in group C had balloon-related peritoneal lacerations. Despite a higher individual device cost, group B had a lower procedure cost over the entire experiment.CONCLUSION:The new balloon device is not inferior to the commercially available device in terms of the safety and effectiveness for creating a preperitoneal space in swine.
Subject(s)
Animals , Dissection/instrumentation , Insufflation/instrumentation , Laparoscopy/economics , Laparoscopy/instrumentation , Peritoneal Cavity/surgery , Abdominal Wall/surgery , Cost-Benefit Analysis , Dissection/economics , Equipment Design/economics , Insufflation/economics , Models, Animal , Random Allocation , Reproducibility of Results , Swine , Time FactorsABSTRACT
PURPOSE: For patients with neuromuscular disease, air stacking, which inflates the lungs to deep volumes, is important for many reasons. However, neuromuscular patients with severe glottic dysfunction or indwelling tracheostomy tubes cannot air stack effectively. For these patients, we developed a device that permits deep lung insufflations substituting for glottic function. MATERIALS AND METHODS: Thirty-seven patients with bulbar-innervated muscle weakness and/or tracheostomies were recruited. Twenty-three had amyotrophic lateral sclerosis, and 14 were tetraplegic patients due to cervical spinal cord injury. An artificial external glottic device (AEGD) was used to permit passive deep lung insufflation. In order to confirm the utility of AEGD, vital capacity, maximum insufflation capacity (MIC), and lung insufflation capacity (LIC) with AEGD (LICA) were measured. RESULTS: For 30 patients, MICs were initially zero. However, with the use of the AEGD, LICA was measurable for all patients. The mean LICA was 1,622.7+/-526.8 mL. Although MIC was measurable for the remaining 7 patients without utilizing the AEGD, it was significantly less than LICA, which was 1,084.3+/-259.9 mL and 1,862.9+/-248 mL, respectively (p<0.05). CONCLUSION: The AEGD permits lung insufflation by providing deeper lung volumes than possible by air stacking.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Forced Expiratory Flow Rates/physiology , Insufflation/instrumentation , Neuromuscular Diseases/physiopathology , Ventilators, Mechanical , Vital Capacity/physiologyABSTRACT
Este capitulo describe los fundamentos e indicaciones del equipo electromecánico de tos asistida, in-exsufflator, en pacientes con enfermedades neuromusculares u otras condiciones que comprometen la eficacia en la remoción de las secreciones traqueobronquiales relacionadas a mecanismos de tos ineficiente. Se señalan los criterios de selección para la entrega de esta terapia kinésica y el funcionamiento básico de este dispositivo. Además se propone un protocolo complementario de manejo kinésico para pacientes neuromusculares usuarios de asistencia ventilatoria no invasiva e invasiva.
Subject(s)
Humans , Child , Neuromuscular Diseases/physiopathology , Neuromuscular Diseases/rehabilitation , Neuromuscular Diseases/therapy , Respiratory Insufficiency/therapy , Insufflation/instrumentation , Positive-Pressure Respiration/instrumentation , Algorithms , Respiratory Insufficiency/physiopathology , Respiratory Insufficiency/rehabilitation , Insufflation/methods , Physical Therapy Modalities , Patient Selection , Respiration, Artificial , Respiratory Therapy/methods , Cough/physiopathologyABSTRACT
Objective - To verify the efficacy and safety of compressed air to produce pneumoperitoneum for laparoscopic surgery in pigs for a training program of residence. Methods - Dalland pigs weighing 15-17kg underwent general anethesia and mechanical ventilation. They were divided in 3 groups: A - (38) the pneumoperitnoneum was established with an automatic COZ insufflator, B - (7) as in A except the C02 gas was changed by compressed air, and C - (11) abdomen insufflation was obtained with compressed air directly from hospital pipe network system. Intra-abdominal pressure in all groups was kept between 12 and 15 mmHg. The laparoscopic procedures performed were distributed proportionally among groups: 20 bilateral nephrectomy, 20 dismembered pyeloplasty and 16 partial nephrectomy. Arterial blood sampling for gasometry was obtained before and 2h after establishment of pneumoperitoneum in 5 pigs of group C. Results - The cost of 25 4,5kg COZ container used in group A was R$ 3,150.00 (U$ 1,050.00). The mean length time of surgeries in groups A, B and C were respectively: 181±30rnin, 196±39min e 210±47min (p>0.05). Respiratory alkalosis occurred in 3 out of 5 pigs of group C. No animal exhibited signs of gas embolism or died during surgery. Conclusion - The use of compressed air for laparoscopy in pigs was safe, reduced costs and did not require the use of an automatic gas insufflator.
Subject(s)
Animals , Carbon Dioxide/administration & dosage , Insufflation/instrumentation , Laparoscopy , Models, Animal , Pneumoperitoneum/pathology , Internship and Residency , Nephrectomy , SwineABSTRACT
É indiscutível a importância de um pneumoperitônio eficiente para a realização segura da cirurgia videolaparoscópica. A avançada tecnologia moderna proporcionou o desenvolvimento de insufladores eletro-eletrônicos muito eficientes, porém de elevado custo. Este trabalho tem o objetivo de apresentar um modelo alternativo de insuflador eletro-mecânico para uso principalmente em videocirurgia experimental, de baixo custo e de grande eficiência. Este modelo é capaz de proporcionar um pneumoperitônio com controle permanente da pressão intracavitária desejada e reposição adequada em tempo hábil das eventuais perdas pressóricas. O sistema é perfeitamente adequado à cirurgia videolaparoscópica experimental em cadáver humano e em animais de laboratório, podendo ainda seu uso ser expandido a alguns procedimentos cirúrgicos in vivo
Subject(s)
Insufflation/instrumentation , Pneumoperitoneum , Video-Assisted Surgery/instrumentationABSTRACT
La invaginación intestinal es una causa frecuente de dolor abdominal y de abdomen agudo en la infancia. Debe sospecharse en cuadros de dolor y/o distensión abdominal, vómitos, ante la palpación de una masa abdominal y ante la presencia de deposiciones líquidas con aspecto de jalea de grosellas. La radiografía simple de abdomen junto con la ecografía muestra hallazgos característicos que permiten establecer el diagnóstico. Se describe el método radiológico de desinvaginación neumática de la invaginación. Se describe equipamiento "ad-Hoc" que ha demostrado ser útil en el procedimiento. Por el riesgo de recidiva los pacientes desinvaginados deben controlarse clínica y radiológicamente por 48 horas. 10 por ciento de las invaginaciones son secundarias a un factor anatómico predisponente, lo que debe sospecharse ante recurrencias y en niños mayores
Subject(s)
Humans , Insufflation/methods , Intussusception/therapy , Insufflation/instrumentation , Intussusception/diagnosis , Intussusception , Radiography, AbdominalABSTRACT
Objetivo. Revisar la historia del neumoperitoneo, su evollución hasta nuestros días, describir las diversas técnicas, así como las complicaciones y por último hacer reflexiones de las técnicas y sus alternativas. Sede Hospital de tercer nivel de atención. Método. Se realizó la recopilación de la información en la literatura médica internacional del neumoperitoneo: su historia, técnica, y complicaciones (31 referencias). Resultados. Existen tres técnicas principales para realizar el neumoperitoneo: la cerrada, la técnina de Hasson y la inserción directa del primer trócar sin neumoperitoneo. Se describen cada una de ellas, y se comentan las complicaciones simples y graves. Conclusión. La técnica cerrada es la más usada, pero es la que tiene más complicaciones. La técnica de Hasson tiene indicación precisa en todo pacientes en que no se pueda realizar la técnica cerrada. La inserción directa del primer trócar sin neomoperitoneo es una excelente alternativa. El autor de este artículo la recomienda como primera opción