Paraoesophageal Hernia - Forum

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John Dissector

Re: Paraoesophageal Hernia - Ärzteforum

Post#11 »

I'm surprised at your comparison of apples and oranges! I described removal of ovaries in post menopausal women when you are already in the abdomen doing an open laparotomy for something else, and the patient has consented to this, NOT operating for the sole purpose of removing normal ovaries thru a laparoscope--at least not in my hands. Also--this type of biased statement in which the very occurrence of a complication is used as the sole basis of criticizing the operation is a classic ploy tfor the agenda-advancers, but doesn't hold water--by this logic, your next suture line dehiscence following a stapled colectomy can be held up to show "See--we shouldn't be doing stapled colectomies", and your next pulmonary embolus following a lap cholecystectomy can be used to say "See, we shouldn't be doing lap choles"--etc, etc, etc Every procedure risks complications, and the more you do the more will occur, so the mere occurrence of that complication should never be used in and of itself to justify abolishing the operation--if that's all you've got to justify your stance, it says something about your stance! Also, the fact that one surgeon does it badly can not justify the generalization that this applies to all surgeons doing a procedure. It's a given that no operation is justified unless you can do it within acceptable bounds of safety--but I don't think even you would demand a 0% rate of morbidity and mortality before a procedure could be justified. We'd all be out of business!


Scalpel

Re: Paraoesophageal Hernia - Ärzteforum

Post#12 »

Billroth wrote:No thank the Lord! I have heard of this but never seen it.
It appears that the disposable trocar with "safety shield" (USSC) was inserted once 3 litres had been put in even though the pressure remained rather low. The scrub nurse quietly told me that the trocar entry was "a bit forceful!!" Once the cannula was in place, the trocar was removed followed by "a gush of blood" which was interpreted as "having hit a small vessel in the abdo wall" No intrabdominal bleeding was noted, and they proceeded with whatever they do to endometriosis of the ovary. On the way out they noted a small haematoma over the sacral promontory, and called me while they opened.
This time we lost about 3 litres. Last time the injury was not recognised until awake in recovery - 13 litres!


About a year ago I was called from the end of a breast biopsy to the OR where a GYN had just done a tubal. They couldn't find him and the patient was crashing. He also had used a USSC Safety Shield after insufflating with a Verres needle. The trocar had almost completely transected the left iliac artery. She survived, actually did quite well and didn't even sue anybody.

I use only Ethicon's Optiview (5 mm) device for entering the abdominal cavity. Can't remember the last time I used a Hassan--it's been years, I'm sure. Back in the old days while we still using 10 mm scopes, I used VisiPorts from USSC. I like Ethicon's device much better, and you don't have any fascial holes to sew up.

Grandpa Phil

Re: Paraoesophageal Hernia - Ärzteforum

Post#13 »

Maybe I'm an old fart but the Hasson entry hasn't slowed me down. It has illuminated me with an index of safety, inserted under direct vision "the safety way"...I don't find it a hardship at the end of the case to formally close the umbo aperture, taking less than a minute's time. Again, it seems like there are two kinds of laparoscopists, as there are two kinds of women....those who have never cooked with gas, and are afraid of trying it, and those who have and would never try anything else.

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