Feasibility of Telementoring as an Intraoperative Time-out Tool during Laparoscopic Cholecystectomy for Prevention of Biliovascular Injuries.

Laparoscopic cholecystectomy is commonly performed procedure for gallbladder diseases. Biliovascular injuries are well known complications and various standard and safe strategies have been developed for safe cholecystectomy. Intraoperative time out is one of the strategies where two or more surgeons stop during surgery before dividing any structure in Calot's triangle. COVID-19 pandemic has expanded the horizon of telesurgery, teleconsultation, use of artificial intelligence and robotics in surgical training and execution. Easily available mobile applications like Facebook messenger, WhatsApp and Viber can be used for intraoperative time-out during difficult cholecystectomy with expert surgeon outside the vicinity of theatre. Such tools are cost effective and definitely boost the confidence of surgeons during surgery in case of any complexity, or help in stopping the procedure and in timely referral. Keywords: Cholecystectomy; laparoscopy; telementoring.

Acute pancreatitis: an opportunity for gastroenterology hospitalists?

Acute pancreatitis (AP) is the third most frequent cause of hospital admissions for digestive disorders in the US and Europe after digestive bleeding and cholelithiasis/cholecystitis. The incidence of AP ranges from 15 to 100 cases per 100,000 inhabitants per year, and has been steadily increasing in recent years. In Spain, the reported incidence is 72 patients per 100,000 inhabitants per year. The most frequent cause is biliary lithiasis (50 %-60 % of cases); fortunately, 80 % of patients have only mild symptoms-as defined by the revised Atlanta Classification-and progress favorably, although mortality rate is 4.2 %. Clinical guidelines explicitly indicate that laparoscopic cholecystectomy should be performed during the first 48-72 hours or at the time of hospital admission in mild cases of biliary origin.

Effect of Stellate Ganglion Block Combined with Lidocaine at Different Concentrations for Preemptive Analgesia on Postoperative Pain Relief and Adverse Reactions of Patients Undergoing Laparoscopic Cholecystectomy.

Objective: To explore the effect of stellate ganglion block (SGB) combined with lidocaine at different concentrations for preemptive analgesia on postoperative pain relief and adverse reactions of patients undergoing laparoscopic cholecystectomy (LC). Methods: Ninety patients undergoing LC in our hospital from June 2019 to June 2020 were selected as the subjects and were randomly divided into group A (30 cases), group B (30 cases), and group C (30 cases), all patients received SGB, and 10 mL of lidocaine at concentrations of 0.25%, 0.5%, and 0.75% was, respectively, administered to patients in groups A, B, and C, so as to compare the analgesic effect, adverse reactions, and clinical indicators among the three groups. Results: At T 1 and T 2, group C obtained obviously lower NRS scores than groups A and B (P < 0.001); compared with groups A and B, group A had obviously higher onset time (P < 0.001) and significantly lower duration (P < 0.001); no obvious differences in the hemodynamic indexes among the groups were observed (P > 0.05); group C obtained obviously higher BCS score than groups A and B; and the total incidence rate of adverse reactions was obviously higher in group C than in groups A and B (P < 0.05). Conclusion: Performing SGB combined with 0.5% lidocaine to patients undergoing LC achieves the optimal analgesic effect; such anesthesia plan can effectively stabilize patients' hemodynamics, present higher safety, and promote the regulation of the body internal environment. Further research will be conducive to establishing a better anesthesia plan for such patients.