The Experts below are selected from a list of 11838 Experts worldwide ranked by ideXlab platform
Matthew J. Martin - One of the best experts on this subject based on the ideXlab platform.
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evaluation of a novel thoracic entry device versus needle decompression in a tension pneumothorax swine model
American Journal of Surgery, 2018Co-Authors: John Kuckelman, Matthew J. Martin, Mike Derickson, Cody J Phillips, Morgan R Barron, Shannon T Marko, Matthew J EckertAbstract:Abstract Introduction Tension pneumothorax (tPTX) remains a major cause of preventable death in trauma. Needle decompression (ND) has up to a 60% failure rate. Methods Post-mortem swine used. Interventions were randomized to 14G-needle decompression (ND, n = 25), bladed Trocar with 36Fr cannula (BTW, n = 16), bladed Trocar alone (BTWO, n = 16) and surgical thoracostomy (ST = 11). Simulated tPTX was created to a pressure(p) of 20 mmHg. Results Success (p Conclusion Bladed Trocars can safely and effectively tPTX with a significantly higher success rates than needle decompression.
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standard laparoscopic Trocars for the treatment of tension pneumothorax a superior alternative to needle decompression
Journal of Trauma-injury Infection and Critical Care, 2014Co-Authors: Quinton Hatch, Mia Debarros, Eric K Johnson, Kenji Inaba, Matthew J. MartinAbstract:BACKGROUND Needle thoracostomy (NT) is a commonly taught intervention for tension pneumothorax (tPTX) but has a high failure rate. We hypothesize that standard 5-mm laparoscopic Trocars may be a safe and more effective alternative. METHODS Thirty episodes of tPTX and 27 episodes of tension-induced pulseless electrical activity (PEA) were induced in five adult swine using thoracic CO2 insufflation via balloon Trocar. Tension was defined as a 50% decrease in cardiac output. Chest decompression was performed with 5-mm laparoscopic Trocars for the treatment of both tPTX with hemodynamic compromise and tension-induced PEA. The lungs and heart were inspected and graded at necropsy for Trocar-related injury. Results were also compared with success rates with NT in the same model. RESULTS The placement of a 5-mm Trocar rapidly and immediately relieved tension physiology in 100% of the cases. Mean arterial pressure, cardiac output, central venous pressure, and pulmonary capillary wedge pressure all returned to baseline within 1 minute of Trocar placement. Adequate perfusion was restored in 100% of tension-induced PEA cases within 30 seconds of Trocar placement. There was no evidence of Trocar-related heart or lung damage in any of the experimental animals at necropsy (mean injury scores, 0 for both). Five-millimeter Trocars significantly outperformed standard NT for both tPTX and tension-induced PEA arrest. CONCLUSION tPTX and tension-induced PEA can be safely and effectively treated with chest decompression using 5-mm laparoscopic Trocars. This technique may serve as a more rapid and reliable alternative to needle decompression.
Cheng-hsi Chang - One of the best experts on this subject based on the ideXlab platform.
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differentiation of skin incision and laparoscopic Trocar insertion via quantifying transient bradycardia measured by elecTrocardiogram
Journal of Clinical Monitoring and Computing, 2020Co-Authors: Cheng-hsi Chang, Yue-lin Fang, Yu-jung Wang, Yu-ting LinAbstract:Most surgical procedures involve structures deeper than the skin. However, the difference in surgical noxious stimulation between skin incision and laparoscopic Trocar insertion is unknown. By analyzing instantaneous heart rate (IHR) calculated from the elecTrocardiogram, in particular the transient bradycardia in response to surgical stimuli, this study investigates surgical noxious stimuli arising from skin incision and laparoscopic Trocar insertion, and their difference. Thirty-five patients undergoing laparoscopic cholecystectomy were enrolled in this prospective observational study. Sequential surgical steps including umbilical skin incision (11 mm), umbilical Trocar insertion (11 mm), xiphoid skin incision (5 mm), xiphoid Trocar insertion (5 mm), subcostal skin incision (3 mm), and subcostal Trocar insertion (3 mm) were investigated. IHR was derived from elecTrocardiography and calculated by the modern time-varying power spectrum. Similar to the classical heart rate variability analysis, the time-varying low frequency power (tvLF), time-varying high frequency power (tvHF), and tvLF-to-tvHF ratio (tvLHR) were calculated. Prediction probability (PK) analysis and global pointwise F-test were used to compare the statistical performance between indices and the heart rate readings from the patient monitor. Analysis of IHR showed that surgical stimulus elicits a transient bradycardia, followed by the increase of heart rate. Transient bradycardia is more significant in Trocar insertion than skin incision (p < 0.001 for tvHF). The IHR change quantifies differential responses to different surgical intensity. Serial PK analysis demonstrates de-sensitization in skin incision, but not in laparoscopic Trocar insertion. Quantitative indices present the transient bradycardia introduced by noxious stimulation. The results indicate different effects between skin incision and Trocar insertion.
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Differentiation of skin incision and laparoscopic Trocar insertion via quantifying transient bradycardia measured by elecTrocardiogram
arXiv: Quantitative Methods, 2019Co-Authors: Cheng-hsi Chang, Yue-lin Fang, Yu-jung Wang, Yu-ting LinAbstract:Background. Most surgical procedures involve structures deeper than the skin. However, the difference in surgical noxious stimulation between skin incision and laparoscopic Trocar insertion is unknown. By analyzing instantaneous heart rate (IHR) calculated from the elecTrocardiogram, in particular the transient bradycardia in response to surgical stimuli, this study investigates surgical noxious stimuli arising from skin incision and laparoscopic Trocar insertion. Methods. Thirty-five patients undergoing laparoscopic cholecystectomy were enrolled in this prospective observational study. Sequential surgical steps including umbilical skin incision (11 mm), umbilical Trocar insertion (11 mm), xiphoid skin incision (5 mm), xiphoid Trocar insertion (5 mm), subcostal skin incision (3 mm), and subcostal Trocar insertion (3 mm) were investigated. IHR was derived from elecTrocardiography and calculated by the modern time-varying power spectrum. Similar to the classical heart rate variability analysis, the time-varying low frequency power (tvLF), time-varying high frequency power (tvHF), and tvLF-to-tvHF ratio (tvLHR) were calculated. Prediction probability (PK) analysis and global pointwise F-test were used to compare the performance between indices and the heart rate readings from the patient monitor. Results. Analysis of IHR showed that surgical stimulus elicits a transient bradycardia, followed by the increase of heart rate. Transient bradycardia is more significant in Trocar insertion than skin incision. The IHR change quantifies differential responses to different surgical intensity. Serial PK analysis demonstrates de-sensitization in skin incision, but not in laparoscopic Trocar insertion. Conclusions. Quantitative indices present the transient bradycardia introduced by noxious stimulation. The results indicate different effects between skin incision and Trocar insertion.
Yu-ting Lin - One of the best experts on this subject based on the ideXlab platform.
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differentiation of skin incision and laparoscopic Trocar insertion via quantifying transient bradycardia measured by elecTrocardiogram
Journal of Clinical Monitoring and Computing, 2020Co-Authors: Cheng-hsi Chang, Yue-lin Fang, Yu-jung Wang, Yu-ting LinAbstract:Most surgical procedures involve structures deeper than the skin. However, the difference in surgical noxious stimulation between skin incision and laparoscopic Trocar insertion is unknown. By analyzing instantaneous heart rate (IHR) calculated from the elecTrocardiogram, in particular the transient bradycardia in response to surgical stimuli, this study investigates surgical noxious stimuli arising from skin incision and laparoscopic Trocar insertion, and their difference. Thirty-five patients undergoing laparoscopic cholecystectomy were enrolled in this prospective observational study. Sequential surgical steps including umbilical skin incision (11 mm), umbilical Trocar insertion (11 mm), xiphoid skin incision (5 mm), xiphoid Trocar insertion (5 mm), subcostal skin incision (3 mm), and subcostal Trocar insertion (3 mm) were investigated. IHR was derived from elecTrocardiography and calculated by the modern time-varying power spectrum. Similar to the classical heart rate variability analysis, the time-varying low frequency power (tvLF), time-varying high frequency power (tvHF), and tvLF-to-tvHF ratio (tvLHR) were calculated. Prediction probability (PK) analysis and global pointwise F-test were used to compare the statistical performance between indices and the heart rate readings from the patient monitor. Analysis of IHR showed that surgical stimulus elicits a transient bradycardia, followed by the increase of heart rate. Transient bradycardia is more significant in Trocar insertion than skin incision (p < 0.001 for tvHF). The IHR change quantifies differential responses to different surgical intensity. Serial PK analysis demonstrates de-sensitization in skin incision, but not in laparoscopic Trocar insertion. Quantitative indices present the transient bradycardia introduced by noxious stimulation. The results indicate different effects between skin incision and Trocar insertion.
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Differentiation of skin incision and laparoscopic Trocar insertion via quantifying transient bradycardia measured by elecTrocardiogram
arXiv: Quantitative Methods, 2019Co-Authors: Cheng-hsi Chang, Yue-lin Fang, Yu-jung Wang, Yu-ting LinAbstract:Background. Most surgical procedures involve structures deeper than the skin. However, the difference in surgical noxious stimulation between skin incision and laparoscopic Trocar insertion is unknown. By analyzing instantaneous heart rate (IHR) calculated from the elecTrocardiogram, in particular the transient bradycardia in response to surgical stimuli, this study investigates surgical noxious stimuli arising from skin incision and laparoscopic Trocar insertion. Methods. Thirty-five patients undergoing laparoscopic cholecystectomy were enrolled in this prospective observational study. Sequential surgical steps including umbilical skin incision (11 mm), umbilical Trocar insertion (11 mm), xiphoid skin incision (5 mm), xiphoid Trocar insertion (5 mm), subcostal skin incision (3 mm), and subcostal Trocar insertion (3 mm) were investigated. IHR was derived from elecTrocardiography and calculated by the modern time-varying power spectrum. Similar to the classical heart rate variability analysis, the time-varying low frequency power (tvLF), time-varying high frequency power (tvHF), and tvLF-to-tvHF ratio (tvLHR) were calculated. Prediction probability (PK) analysis and global pointwise F-test were used to compare the performance between indices and the heart rate readings from the patient monitor. Results. Analysis of IHR showed that surgical stimulus elicits a transient bradycardia, followed by the increase of heart rate. Transient bradycardia is more significant in Trocar insertion than skin incision. The IHR change quantifies differential responses to different surgical intensity. Serial PK analysis demonstrates de-sensitization in skin incision, but not in laparoscopic Trocar insertion. Conclusions. Quantitative indices present the transient bradycardia introduced by noxious stimulation. The results indicate different effects between skin incision and Trocar insertion.
Ninh T Nguyen - One of the best experts on this subject based on the ideXlab platform.
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single laparoscopic incision transabdominal surgery sleeve gastrectomy
Obesity Surgery, 2008Co-Authors: Kevin M Reavis, Marcelo W Hinojosa, Brian R Smith, Ninh T NguyenAbstract:Laparoscopic sleeve gastrectomy has recently been added to the list of appropriate weight loss operations presently performed by bariatric surgeons. The sleeve gastrectomy is routinely performed using five and up to seven laparoscopic Trocars with enlargement of one of the Trocar sites for extraction of the gastric specimen. We describe a case of laparoscopic sleeve gastrectomy performed through a single laparoscopic incision.
Daniele Matera - One of the best experts on this subject based on the ideXlab platform.
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single incision laparoscopic cholecystectomy surgery without a visible scar
Surgical Endoscopy and Other Interventional Techniques, 2009Co-Authors: R M Tacchino, Francesco Greco, Daniele MateraAbstract:Laparoscopic cholecystectomy has been recognized since 1992 as the gold standard procedure for gallbladder surgery. The authors propose a single-incision laparoscopic (SILS) cholecystectomy as a step toward less invasive surgical procedures. A single intraumbilical 12-mm incision is made, and the umbilicus is pulled out, exposing the fascia. Pneumoperitoneum is induced with the Versastep Veress access needle. A 5-mm Trocar then is introduced, and the abdominal cavity is explored with a 5-mm 30° optic. Second and third Trocars are introduced respectively at the left and right sides, near the first Trocar. Two sutures are used to suspend the gallblabber and to ensure optimal exposure of the Triangle of Calot. Dissection is performed as a normal retrograde cholecystectomy using an Endoshear roticulator in the left Trocar and an Endograsp roticulator in the right hand. The cystic artery and cystic duct are clipped separately with a standard 5-mm clip applier and then excised. The gallbladder is removed through the umbilical incision. Of the 12 patients who underwent SILS cholecystectomy without major complications, 8 had previously undergone other laparoscopic surgeries. The body mass index (BMI) exceeded 35 in three cases. Operative time decreased and stabilized from the first 3-h SILS cholecystectomy to approximately 50 min after the first five cases. At this writing, the authors find SILS cholecystectomy to be feasible, safe, and effective.
