Mini-Laparoscopic Cholecystectomy with Intraoperative Cholangiogram for Symptomatic Cholelithiasis (Gallstones) - Standard
Authors: Brunt LM1, Singh R1, Yee A2
Published: September 26, 2017

AUTHOR INFORMATION
1 Department of Surgery, Washington University, St. Louis, Missouri
2 Division of Plastic and Reconstructive Surgery, Washington University, St. Louis, Missouri

DISCLOSURE
No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication.

ABSTRACT
Minimal invasive laparoscopic cholecystectomy is the typical surgical treatment for cholelithiasis (gallstones), where patients present with a history of upper abdominal pain and episodes of biliary colic. The classic technique for minimal invasive laparoscopic cholecystectomy involves four ports: one umbilicus port, two subcostal ports, and a single epigastric port. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) has instituted a six-step strategy to foster a universal culture of safety for cholecystectomy and minimize risk of bile duct injury. The technical steps are documented within the context of the surgical video for (1) achieving a critical view of safety for identification of the cystic duct and artery, (2) intraoperative time-out prior to management of the ductal structures, (3) recognizing the zone of significant risk of injury, and (4) routine intraoperative cholangiography for imaging of the biliary tree. In this case, the patient presented with symptomatic biliary colic due to a gallstone seen on the ultrasound in the gallbladder. The patient was managed a mini-laparoscopic cholecystectomy using 3mm ports for the epigastric and subcostal port sites with intraoperative fluoroscopic cholangiogram. Specifically, the senior author encountered a tight cystic duct preventing the insertion of the cholangiocatheter and the surgical video describes how the author managed the cystic duct for achieving a cholangiogram, in addition to the entire technical details of laparoscopic cholecystectomy.

Genital warts are soft growths that appear on the genitals. Genital warts are a sexually transmitted infection (STI) caused by certain strains of the human papillomavirus (HPV). These skin growths can cause pain, discomfort, and itching. They are especially dangerous for women because some types of HPV can also cause cancer of the cervix and vulva.

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Management of postpartum hemorrhage at vaginal delivery. The approach to treatment of postpartum hemorrhage (PPH) differs somewhat depending on the cause and whether hemorrhage occurs after a vaginal birth or after a cesarean delivery.

This is the first video of 5, where Mike teamed up with Graham from On Your Marks Fitness and Coaching to show us some exercises to strengthen our muscles, and improve our soccer game! Make sure your feet are planted safely or held by a friend, and keep your back straight, and over your knees. Use the swiss ball to keep you steady, and SQUEEZE those muscles! Check us out on Social Media! Facebook: https://www.facebook.com/striveptandperformance/ Instagram: https://www.instagram.com/striveptandperf/ Twitter: https://twitter.com/StrivePTandPerf Blog: http://www.strivept.ca/blog

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Ganglion cysts are the most common mass or lump in the hand. They are not cancerous and, in most cases, are harmless. They occur in various locations, but most frequently develop on the back of the wrist. These fluid-filled cysts can quickly appear, disappear, and change size.

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According to a Danish study , frequent sex may help prevent pre-eclampsia. Researchers believe it's because of a protein found in sperm that can regulate the body's immune system. Yet because the cause of preeclampsia is unknown, it's important to keep your prenatal visits and talk to your doctor about your risk.

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In this video, we show a sports hernia self treatment we give many of our clients. It is not the only part of treatment. Grabbing the skin around the region of the groin strain can reduce pain and stiffness with turning and twisting. Sports hernias are often misdiagnosed with hip labrum tears, hip impingement, adductor tendonitis and abdominal strains.

Option 1: Groin On-Demand Webinar https://bit.ly/37thtNF
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Sports Hernia Diagnosis

What Is A Sports Hernia?

A sports hernia is tearing of the transversalis fascia of the lower abdominal or groin region. A common misconception is that a sports hernia is the same as a traditional hernia. The mechanism of injury is rapid twisting and change of direction within sports, such as football, basketball, soccer and hockey.

The term “sports hernia” is becoming mainstream with more professional athletes being diagnosed. The following are just to name a few:

Torii Hunter
Tom Brady
Ryan Getzlaf
Julio Jones
Jeremy Shockey
If you follow any of these professional athletes, they all seem to have the same thing in common: Lingering groin pain. If you play fantasy sports, this is a major headache since it seems so minor, but it can land a player on Injury Reserve on a moments notice. In real life, it is a very frustrating condition to say the least. It is hard to pin point, goes away with rest and comes back after activity, but is hardly painful enough to make you want to stop. It lingers and is always on your mind. And if you’re looking for my step-by-step sports hernia rehab video course here it is.

One the best definitions of Sport hernias is the following by Harmon:
The phenomena of chronic activity–related groin pain that it is unresponsive to conservative therapy and significantly improves with surgical repair.”

This is truly how sports hernias behave in a clinical setting. It is not uncommon for a sports hernia to be unrecognized for months and even years. Unlike your typical sports injury, most sports medicine offices have only seen a handful of cases. It’s just not on most doctors’ radar. The purpose of this article is not only to bring awareness about sports hernias, but also to educate.

Will you find quick fixes in this article for sports hernia rehab?
Nope. There is no quick fix for this condition, and if someone is trying to sell you one, they are blowing smoke up your you-know-what.

Is there a way to decrease the pain related to sports hernias?
Yes. Proper rehab and avoidance of activity for a certain period of time will assist greatly, but this will not always stop it from coming back. Pain is the first thing to go and last thing to come. Do not be fooled when you become pain-free by resting it. Pain is only one measure of improvement in your rehab. Strength, change of direction, balance and power (just to name a few) are important, since you obviously desire to play your sport again. If you wanted to be a couch potato, you would be feeling better in no time. Watching Sports Center doesn’t require any movement.

Why is this article so long?
There is a lot of information on sports hernias available to you on the web. However, much of the information is spread out all over the internet and hard for athletes to digest due to complicated terminology. This article lays out the foundational terminology you will need to understand what options you have with your injury. We will go over anatomy, biomechanics, rehab, surgery, and even the fun facts. The information I am using is from the last ten years of medical research, up until 2016. We will be making updates overtime when something new is found as well. So link to this page and share with friends. This is the best source for information on sports hernias you will find.

Common Names (or Aliases?) for Sports Hernias
Sportsman’s Hernia
Athletic Pubalgia
Gilmore’s Groin
How Do You Know If You Have A Sports Hernia?
Typical athlete characteristics:
Male, age mid-20s

#sportsherniadiagnosisselftreatment #sportshernia #california

How do you assess cerebellar function? Ask them to do this as fast as possible while you slowly move your finger. Repeat the test with the other hand. Perform the heel-to-shin test. Have the patient lying down for this and get them to run the heel of one foot down the shin of the other leg, and then to bring the heel back up to the knee and start again.

Laparoscopic Appendicectomy is a surgical technique which is used to remove inflamed appendix through laparoscopic surgery. Max Hospital presents a special surgical demonstration on Laparoscopic Appendicectomy. Watch this video and get an idea how the surgery is performed.

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A video showing the romberg reflex test

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Laparoscopic inguinal hernia repair in Qatar by Dr. Al-Emadi

A video showing the inspection of the nose