What are the contraindications to laparoscopic surgery? Absolute contraindications include the patient’s inability to tolerate general anesthesia or pneumoperitoneum, usually caused by advanced cardiopulmonary disease. Relative contraindications include coagulopathy and portal hypertension. The most important relative contraindication is lack of surgeon experience. The ability to safely create working space and the judgment to convert to …
What are the advantages of laparoscopic surgery compared with open procedures? Laparoscopic surgery is less invasive than open surgery, resulting in less trauma to tissue and organs. Respiratory function is less impaired and recovery is improved compared with open surgery. Animal and human studies have shown that laparoscopic surgery preserves immune function. Clinically, this translates …
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When did laparoscopic surgery become an accepted surgical option? Laparoscopic surgery has been explored since 1901, but did not fully develop until the late twentieth century. Dr. Kurt Semm, a German gynecologist, performed the first laparoscopic appendectomy in 1983. George Berci was one of the first general surgeons to champion laparoscopic surgery, but initially met …
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What does the field of minimally invasive surgery include? Minimally invasive surgery encompasses laparoscopic surgery and endoscopic surgery. Almost any procedure that can be done in an open fashion can now be performed laparoscopically. Currently, natural orifice transluminal endoscopic surgery and robotic surgery are further expanding and refining the field of minimally invasive surgery.
How to treat an asymptomatic patient with a renal stone 1 to 2 cm in size? Treatment of the asymptomatic patient with a 1- to 2-cm renal stone is a toss-up. Each expert has an opinion based on the experience of the local medical community. Many asymptomatic stones can be monitored without intervention, other than …
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How to treat a symptomatic patient with a renal stone 1 to 2 cm in size? Apply the therapeutic options in question 31. About 10% to 20% of all kidney stones require surgical removal because of size and symptoms. Many urologists treat symptomatic patients with 1 to 2 cm calcium stones in the renal pelvis …
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Why are thiazide diuretics the first line drug therapy for hypercalciuria induced nephrolithiasis? Thiazides are the first-line therapy because they increase proximal (indirectly) and distal (directly) tubular reabsorption of calcium. However, thiazides can cause depletion of potassium and citrate, which should be replaced with potassium citrate. Avoid triamterene, which can cause kidney stones. If potassium …