Insufflation in minimally invasive surgery: Is there any advantage in staying low?

Minimally invasive repair of esophageal atresia with tracheoesophageal fistula (EA/TEF) and congenital diaphragmatic hernia (CDH) is feasible and confers benefits compared to thoracotomy or laparotomy. However, carbon dioxide (CO2) insufflation can lead to hypercapnia and acidosis. We sought to determine the effect of lower insufflation pressures on patients' surrogate markers for CO2 absorption — arterial partial pressure of CO2 (PaCO2), end tidal CO2 (EtCO2) and pH.
Source: Journal of Pediatric Surgery - Category: Surgery Authors: Source Type: research

Related Links:

Daniel J. IkensonSome people talk about trade as though it were an end in itself. It ’s not. Trade is a means to an end.We trade so that we can specialize. We specialize so that we can produce more. We produce more so that we can consume and save more. That is how we create wealth and raise living standards. Just like electricity or machinery or expertise, trade is a tool we use to leverage our physical, mental, and creative abilities to obtain more efficiently more of the things we need and want. When we remove barriers to trade, we create greater scope for specialization, which means we can produce more v...
Source: Cato-at-liberty - Category: American Health Authors: Source Type: blogs
CONCLUSION: The combined use of US and SPET/CT has incremental value in accurately localizing PA over either technique alone. In the preoperative assessment of patients with PHPT combination of imaging methods allows selection of patients who would be suitable for minimally invasive surgery. PMID: 32222728 [PubMed - as supplied by publisher]
Source: Hellenic Journal of Nuclear Medicine - Category: Nuclear Medicine Tags: Hell J Nucl Med Source Type: research
Purpose of review Macrophages play an important role in regulating homeostasis, kidney injury, repair, and tissue fibrogenesis. The present review will discuss recent advances that explore the novel subsets and functions of macrophage in the pathogenesis of kidney damage and hypertension. Recent findings Macrophages differentiate into a variety of subsets in microenvironment-dependent manner. Although the M1/M2 nomenclature is still applied in considering the pro-inflammatory versus anti-inflammatory effects of macrophages in kidney injury, novel, and accurate macrophage phenotypes are defined by flow cytometric marke...
Source: Current Opinion in Nephrology and Hypertension - Category: Urology & Nephrology Tags: RENAL IMMUNOLOGY AND PATHOLOGY: Edited by Agnes B. Fogo Source Type: research
Purpose of review The recent years have been marked by the publication of several articles highlighting the pathophysiological role of glomerular parietal epithelial cells (PEC) and refining their phenotypic heterogeneity. Recent findings The present review synthetizes recent findings on (i) the potential regenerative role of PEC in glomerular diseases, and (ii) the mechanisms and signaling of leading to PEC pathogenic involvement in crescentic glomerulonephritis (CGN) and focal segmental glomerulosclerosis (FSGS). Summary The debate is still open regarding the podocyte regenerative properties of PEC in glomerular ...
Source: Current Opinion in Nephrology and Hypertension - Category: Urology & Nephrology Tags: RENAL IMMUNOLOGY AND PATHOLOGY: Edited by Agnes B. Fogo Source Type: research
Purpose of review Despite improvements in acute kidney injury (AKI) detection, therapeutic options to halt the progression of AKI to chronic kidney disease (CKD) remain limited. In this review, we focus on recent discoveries related to the pathophysiology of the AKI to CKD continuum, particularly involving the renal tubular epithelial cells, and also discuss related ongoing clinical trials. While our focus is on injured renal tubular epithelial cells as initiators of the cascade of events resulting in paracrine effects on other cells of the kidney, the summation of maladaptive responses from various kidney cell types ult...
Source: Current Opinion in Nephrology and Hypertension - Category: Urology & Nephrology Tags: RENAL IMMUNOLOGY AND PATHOLOGY: Edited by Agnes B. Fogo Source Type: research
Purpose of review The sensitivity of semen analysis for detection of infertility remains low. Many factors not measured in traditional semen analysis may contribute to male factor infertility. DNA fragmentation, oxidative stress, and sperm aneuploidy are three factors that may contribute further information to the evaluation when semen analysis is inconclusive. Recent findings DNA fragmentation measures the destruction of and failure to repair damage to DNA. Increased DNA fragmentation has been used as a marker for oxidative stress as well as toxic exposure. The oxidative stress adduct measures DNA aberrations, which ...
Source: Current Opinion in Urology - Category: Urology & Nephrology Tags: GENDER MEDICINE, INFERTILITY AND ERECTILE FUNCTION: Edited by Ryan Flannigan and Ranjith Ramasamy Source Type: research
AbstractBackground/purposeThe volume –outcome relationship and optimal surgical volumes for repair of congenital anomalies in neonates is unknown.MethodsA retrospective study of infants who underwent diaphragmatic hernia (CDH), gastroschisis (GS), and esophageal atresia/tracheoesophageal fistula (EA/TEF) repair at US hospitals using the Kids ’ Inpatient Database 2009–2012. Distribution of institutional volumes was calculated. Multi-level logistic/linear regressions were used to determine the association between volume and mortality, length of stay, and costs.ResultsTotal surgical volumes were 1186 for CDH...
Source: Pediatric Surgery International - Category: Surgery Source Type: research
Summary BackgroundIntraoperative hypercapnia and acidosis have been associated with thoracoscopic repair of both congenital diaphragmatic hernia and esophageal atresia/tracheoesophageal fistula. AimThe aim of the present study was to investigate whether thoracoscopic repair of congenital diaphragmatic hernia or esophageal atresia/tracheoesophageal fistula was associated with acidosis and hypercapnia in a large group of neonates, and to analyze the effects of acidosis and hypercapnia on early postoperative outcomes. MethodsWe reviewed the charts of neonates who underwent open or thoracoscopic congenital diaphragmatic hernia...
Source: Pediatric Anesthesia - Category: Anesthesiology Authors: Tags: RESEARCH REPORT Source Type: research
ConclusionsTo the best of our knowledge, the following case report describes for the first time the possible association between CDH and EoE.  Given the increasing reported prevalence of EoE in children with congenital gastrointestinal malformations, EoE should be rule out also in CDH survivors.
Source: Italian Journal of Pediatrics - Category: Pediatrics Source Type: research
Laparoscopic and thoracoscopic surgery have gradually become accepted diagnostic and therapeutic modalities in the management of neonatal surgical conditions. In the hands of experienced surgeons, minimally invasive surgery (MIS) has reduced the need for open procedures. In children younger than 1 year, the advantages of MIS are evident in avoiding the sequelae of open surgery. MIS has shown outcomes comparable to those with open surgery. The recent literature in the PubMed database was reviewed, using the keywords "minimally invasive surgery," "neonatology," "pediatric surgery," "laparos...
Source: NeoReviews recent issues - Category: Pediatrics Authors: Tags: Pediatric Drug Labeling Update Articles Source Type: news
More News: Atresia | Congenital Diaphragmatic Hernia | Congenital Diaphragmatic Hernia Repair | Esophageal Atresia | Gastroschisis Repair | Hernia Repair | Laparotomy | Minimally Invasive Surgery | Pediatric Hernia | Pediatric Hernia Repair | Pediatrics | Surgery | Thoracotomy | Tracheo-Esophageal Fistula