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Mini-Laparoscopic Cholecystectomy with Intraoperative Cholangiogram for Symptomatic Cholelithiasis (Gallstones) - Extended
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.

"Laparoscopic Placement of a
Peritoneal Dialysis Catheter"

Houston Methodist DeBakey Heart & Vascular Center, presents a cardiovascular procedure featuring Eric K. Peden, MD, Shri Timbalia, MD, and Kenneth Livingston as they demonstrate “Laparoscopic Placement of a
Peritoneal Dialysis Catheter".

Surgery: Eric K. Peden, MD, Shri Timbalia, MD, and Kenneth Livingston
Narration: Kenneth Livingston

** This medical education program may contain graphic content. **
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A pilonidal sinus (PNS) is a small cyst or abscess that occurs in the cleft at the top of the buttocks. A PNS usually contains hair, dirt, and debris. It can cause severe pain and can often become infected. If it becomes infected, it may ooze pus and blood and have a foul odor. A PNS is a condition that mostly affects men and is also common in young adults. It’s also more common in people who sit a lot, like cab drivers.

Mesenteric Vessel Ligation

Initially, lead poisoning can be hard to detect — even people who seem healthy can have high blood levels of lead. Signs and symptoms usually don't appear until dangerous amounts have accumulated. Lead poisoning symptoms in children Signs and symptoms of lead poisoning in children include: Developmental delay Learning difficulties Irritability Loss of appetite Weight loss Sluggishness and fatigue Abdominal pain Vomiting Constipation Hearing loss Seizures Eating things, such as paint chips, that aren't food (pica) Lead poisoning symptoms in newborns Babies exposed to lead before birth might: Be born prematurely Have lower birth weight Have slowed growth Lead poisoning symptoms in adults Although children are primarily at risk, lead poisoning is also dangerous for adults. Signs and symptoms in adults might include: High blood pressure Joint and muscle pain Difficulties with memory or concentration Headache Abdominal pain Mood disorders Reduced sperm count and abnormal sperm Miscarriage, stillbirth or premature birth in pregnant women Causes Lead is a metal that occurs naturally in the earth's crust, but human activity — mining, burning fossil fuels and manufacturing — has caused it to become more widespread. Lead was also once used in paint and gasoline and is still used in batteries, solder, pipes, pottery, roofing materials and some cosmetics. Lead in paint Lead-based paints for homes, children's toys and household furniture have been banned in the United States since 1978. But lead-based paint is still on walls and woodwork in many older homes and apartments. Most lead poisoning in children results from eating chips of deteriorating lead-based paint. Water pipes and imported canned goods Lead pipes, brass plumbing fixtures and copper pipes soldered with lead can release lead particles into tap water. Lead solder in food cans, banned in the United States, is still used in some countries. Other sources of lead exposure Lead sometimes can also be found in: Soil. Lead particles from leaded gasoline or paint settle on soil and can last years. Lead-contaminated soil is still a major problem around highways and in some urban settings. Some soil close to walls of older houses contains lead. Household dust. Household dust can contain lead from lead paint chips or from contaminated soil brought in from outside. Pottery. Glazes found on some ceramics, china and porcelain can contain lead that can leach into food served or stored in the pottery. Toys. Lead is sometimes found in toys and other products produced abroad. Cosmetics. Tiro, an eye cosmetic from Nigeria, has been linked to lead poisoning. Herbal or folk remedies. Lead poisoning has been linked to greta and azarcon, traditional Hispanic medicines, as well as some from India, China and other countries. Mexican candy. Tamarind, an ingredient used in some candies made in Mexico, might contain lead. Lead bullets. Time spent at firing ranges can lead to exposure. Occupations. People are exposed to lead and can bring it home on their clothes when they work in auto repair, mining, pipe fitting, battery manufacturing, painting, construction and certain other fields

COPD stands for chronic obstructive pulmonary (lung) disease. COPD is a term applied to a family of diseases that includes emphysema, chronic bronchitis, and emphysema due to alpha-1 antitrypsin deficiency. COPD usually progresses gradually, causing limited airflow in and out of the lungs. COPD adds to the work of the heart. Diseased lungs might reduce the amount of oxygen that goes to the blood. High blood pressure in blood vessels from the heart to the lungs makes it difficult for the heart to pump. Lung disease can also cause the body to produce too many red blood cells, which might make the blood thicker and harder to pump.

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It can treat spider veins and tiny varicose veins just under the skin's surface. ... (If you have poor blood circulation feeding these tiny veins, the larger "feeder" vein must first be treated with surgery, endovenous laser or radiofrequency treatment, or sclerotherapy.) Endovenous laser treatment.

Hemodialysis Machine Setup

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