Can bile duct injuries be prevented? A new technique in laparoscopic cholecystectomy

Over the last decade, laparoscopic cholecystectomy has gained worldwide acceptance and considered to be as "gold standard" in the surgical management of symptomatic cholecystolithiasis. However, the incidence of bile duct injury in laparoscopic cholecystectomy is still two times greater ...compared to classic open surgery. The development of bile duct injury may result in biliary cirrhosis and increase in mortality rates. The mostly blamed causitive factor is the misidentification of the anatomy, especially by a surgeon who is at the beginning of his learning curve. Biliary tree injuries may be decreased by direct coloration of the cystic duct, ductus choledochus and even the gall bladder. Methods gall bladder fundus was punctured by Veress needle and all the bile was aspirated. The same amount of fifty percent methylene blue diluted by saline solution was injected into the gall bladder for coloration of biliary tree. The dissection of Calot triangle was much more safely performed after obtention of coloration of the gall bladder, cystic duct and choledocus. Results Between October 2003 and December 2004, overall 46 patients (of which 9 males) with a mean age of 47 (between 24 and 74) underwent laparoscopic cholecystectomy with methylene blue injection technique. The diagnosis of chronic cholecystitis (the thickness of the gall bladder wall was normal) confirmed by pre-operative abdominal ultrasonography in all patients. The diameters of the stones were greater than 1 centimeter in 32 patients and calcula of various sizes being smaller than 1 cm. were documented in 13 cases. One patient was operated for gall bladder polyp (our first case). Successful coloration of the gall bladder, cystic duct and ductus choledochus was possible in 43 patients, whereas only the gall bladder and proximal cystic duct were visualised in 3 cases. In these cases, ductus choledochus visibility was not possible. None of the patients developed bile duct injury. Conclusion The number of bile duct injuries related to anatomic misidentification can be decreased and even vanished by using intraoperative methylene blue injection technique into the gall bladder fundus intraoperatively.

A video showing how to insert an intravenous line also called intravenous drip

A patient suffering from Trigeminal Neuralgia (extreme facial pain) has breakthrough neurosurgery, microvascular decompression, to resolve the pain & restore quality of life.~ Detroit Medical Center

Hip Dislocation Reduction

living with chronic fatigue syndrome

A discussion and demonstration of suturing techniques with Lee Dresang, MD from the University of Wisconsin Department of Family Medicine

Source ABC7, 24 November 2009 An initial single-arm Phase II trial (ACT II) has reported promising preliminary data in 23 patients who received CDX-110 vaccine. Median time to disease progression was 16.6 months and estimated median overall survival was 33.1 months. This compared favorably with data for a historical control group in which median time to progression was 6.4 months and median overall survival was 15.2 months. The study was sponsored by Celldex Therapeutics Inc. of Phillipsburg, NJ

Revision knee replacement is peformed by Dr.Venkatachalam for lack of mobility. Infection. aseptic loosening are frequent causes requiring a revision. Madras Joint replacement center performs primary and revision knee replacements in a super specialty hospital in Chennai, India. Dr.Venkatachalam, the chief orthopedic surgeon is UK board certified.

@http://www.doctorsgate.blogspot.com/
A video shows description of keratoacanthoma with multiple pictures.For more images,Diagrams, MNEMONICS , ALGORITHMS ..join us on http://www.doctorsgate.blogspot.com/

الدكتور إياس الموسى من عمان، الاردن، يتحدث عن خفقان القلب، ما هي أعراضه، أسبابه وكيفية علاجه.
العديد من الأسئلة التي ترد إلى موقع الطبي تتعلق بخفقان وتسارع القلب. الدكتور إياس يشرح بإسهاب عن هذه المشكلة السائدة

USMLE Step 2 CS - Bloody Urine This is just preview video. To get full access please visit our website : www.usmletutoring.com

A video showing Embryo and Fetal Development

Carpal Tunnel Syndrom 3D Animation

Histology of Elastic Cartilage

Giving Medications Through a Running IV Line

Lower Face Lift Awake Plastic Surgery

Eye Exam of Premature Baby

Robot Flies Like a Bird

Coronary Artery Atherosclerosis

Yoga for Healthy Joint