Multi-stream saline-jet dissection using a simple irrigation system defines difficult tissue planes.

INTRODUCTION: Single-stream hydro-jet dissection is increasingly used in various laparoscopic procedures, but its use requires special equipment. We describe a simple method for using an irrigation system for saline-jet tissue dissection as a useful adjunct prior to adhesiolysis. MATERIAL AND METHODS: Intraabdominal adhesions prolong laparoscopic procedures, because tissue planes are difficult to identify. We performed multi-jet saline dissection (MSSJ) between 2000 and 2009 in more than 500 patients during laparoscopy involving hernias, gallbladders, appendices, and intestinal obstructions. We use a standard suction irrigation probe, which is attached to a 1-liter saline bag with an inflatable cuff around to create a pressure of 250mm Hg to 300mm Hg. In effect, this is the standard setup generally used for irrigation. After using saline dissection, tissue planes can be better defined and the structures can then be separated. RESULT AND DISCUSSION: Using this method, we have successfully identified tissue planes in spite of dense adhesions, and our conversion rates to open have been reduced dramatically. This method is relatively safer than other modalities of tissue dissection, such as diathermy, ultrasonic, blunt or sharp dissection. The disadvantage is that with tissues saturated with saline it becomes more difficult to use diathermy hemostasis. Care has to be exercised in monitoring the temperature and volume of the fluid used.

Methicillin-resistant Staphylococcus aureus: an update.

Methicillin-resistant Staphylococcus aureus (MRSA) is a serious threat to patients in health care facilities and the community. A MRSA infection can be much more severe than other bacterial infections and can be life-threatening. Resistance to common antibiotics makes treating MRSA costly and difficult. Prolonged hospitalization requiring specialized IV antibiotics also has cost implications. Treatment of MRSA can include use of antibiotics; topical therapies such as honey, topical silver, and gentian violet; and bacteriophages. Research is being conducted on new antibiotics and a MRSA vaccine.

Surgical vacuum drains: types, uses, and complications.

High- and low-pressure vacuum drains are commonly used after surgical procedures. High-pressure vacuum drains (ie, sealed, closed-circuit systems) are efficient and allow for easy monitoring and safe disposal of the drainage. Low-pressure vacuum drains use gentle pressure to evacuate excess fluid and air, and are easy for patients to manage at home because it is easy to reinstate the vacuum pressure. Perioperative nurses should be able to identify the various types of commonly used drains and their surgical applications. Nurses should know how to care for drains, how to reinstate the vacuum pressure when necessary, and the potential complications that could result from surgical drain use.

Umbrella and roll-up techniques of mesh insertion for laparoscopic hernia repair: a comparative study.

BACKGROUND: Deploying a mesh during laparoscopic hernia repair can be difficult and possibly challenging for a trainee surgeon. METHODS: A novel method of mesh insertion by folding the mesh like the fabric of an umbrella and loading it into the 10-mm cannula for delivery into the peritoneal cavity is described. This method uses the inherent ability of meshes to spring back into shape. In this study on 30 patients who underwent transabdominal preperitoneal hernia repair, the umbrella method of mesh insertion was compared with the traditional roll up type of mesh insertion in terms of easiness mesh deployment and operating time. In bilateral procedures, each side was considered as a separate operation. RESULTS: The operative time for the mesh insertion was reduced slightly (6 min), from 18 min for the roll-up technique to 12 min for the umbrella technique. CONCLUSION: The umbrella method has a distinct advantage over the roll-up technique, in which unrolling of the mesh is done in a plane parallel to the mesh. This may explain the time saved, as demonstrated in this pilot study.

Novel methods of closing 10-mm laparoscopic port-site wounds.

Ten-millimeter ports are often used in laparoscopic surgery. Closure of these port sites can be difficult. In this article, we describe two novel methods of closing 10-mm laparoscopic port-site wounds, which are simple, effective, easy, and do not require any special instruments.

Use of drains in surgery: a review.

Drains have been used in surgery for several years to remove body fluids thereby preventing the accumulation of serous fluid and improving wound healing. Drains may be classified as closed or open systems, and active or passive depending on their intended function. Closed vacuum drains apply negative suction in a sealed environment, producing apposition of tissues and thus promoting healing. Correct assessment of clinical indications might reduce unnecessary usage. This article will introduce the principles and practice of various types of drains and highlight the importance of understanding how surgical drains promote quality patient care.

"Spaghetti technique"-novel technique to facilitate laparoscopic appendicectomy and cholecystectomy.

Long appendices and gallbladders may be difficult to remove during laparoscopy. In this report, we describe a novel technique by which the gallbladder or appendix is held at the tip with a grasper and rolled on to it like "spaghetti." We found this technique very useful in improving the traction and stability of the organs in order to facilitate dissection.

Easy way of gluing the skin of surgical wounds.

BACKGROUND: Cyanoacrylate glue is commonly used for approximation of skin after various surgical procedures. METHOD: We have written this illustrated article to educate junior doctors without any practical experience in using tissue glue. DISCUSSION: The advantages of gluing the skin are that it is quick, saves theatre time, cheap, no stitches to remove and is waterproof. The disadvantage being it can be messy if not applied correctly.

Nasogastric tubes. 1: Insertion technique and confirming the correct position.

This is the first in a two-part unit on nasogastric tube management. It discusses the indications, patient preparation, insertion technique and various methods of confirming the tube's position. According to the National Patient Safety Agency, 11 deaths and one case of serious harm occurred due to misplaced nasogastric feeding tubes over a two-year period. It is therefore vital for staff inserting these tubes to know both the correct insertion methods and the procedure for verifying their correct intragastric positioning.

Nasogastric tubes. 2: Risks and guidance on avoiding and dealing with complications.

This is the second of a two-part unit on nasogastric tube management. Part 1 explored the indications, patient preparation, insertion technique and methods of verifying correct intragastric position. This focuses on complications related to nasogastric tubes.