Purpose: To report a novel technique of laparoscopic 10 mm Single Port Access IntraPeritoneal Onlay Mesh (SPA-IPOM) using bioresorbable composite mesh fixed with Endoclose suture (percutaneous subcutaneous suture) in ...Purpose: To report a novel technique of laparoscopic 10 mm Single Port Access IntraPeritoneal Onlay Mesh (SPA-IPOM) using bioresorbable composite mesh fixed with Endoclose suture (percutaneous subcutaneous suture) in 3 cases of bilateral inguinal hernia. Methods: Laparoscopic SPA-IPOM is done through a 10 mm trocar with one 10 mm instrument that has 5 mm optical lens and 5 mm channel for grasper. After inserting 10 mm trocar at umbilicus using semi-open technique, intraperitoneal anatomical landmark of inguinal her-nia is identified. A 10 × 15 cm pre-tied bioresorbable composite mesh is then placed to cover hernia defect and all three potential area of indirect, direct and femoral hernia. Using Endoclose? needle, each pair of pre-tied sutures is retrieved percutaneously through a needle wound and extracorporeal tied with knot in subcutaneous space. After the upper half of mesh is sutured to the posterior surface of abdominal wall, the lower half of mesh is fixed by hernia tacker to Symphysis Pubis, Cooper Ligament and Iliopubic tract. Re-sults: Three men, average 48 year olds were operated by laparoscopic 10 mm SPA-IPOM for bilateral in-guinal hernia repair using bioresorbable composite mesh. Average operative time was 36 minutes. No imme-diate complication. All patients were discharge on the 2nd post-operative day and average 6 months follow up has no recurrence. Conclusions: Laparoscopic SPA-IPOM is an optional operation and is much easier to be performed. Benefits include operative time saving, cosmesis, early discharge and early return to work. Bio-resorbable composite mesh prevents bowel adhesion, however, is much more expensive. Long term follow up study for complications and recurrence is needed.展开更多
Objective: A comparative study of the audiovisual, multimedia, informed consent procedure enhancing the satisfaction and comprehension in laparoscopic cholecystectomy patients within the contexts of the Thai culture. ...Objective: A comparative study of the audiovisual, multimedia, informed consent procedure enhancing the satisfaction and comprehension in laparoscopic cholecystectomy patients within the contexts of the Thai culture. Methods: A prospective, comparative trial was done in patients undergoing laparoscopic cholecystectomies at the HRH Princess Maha Chakri Sirindhorn Medical Center in Thailand. Before the procedure, all patients who met the selection criteria and agreed to participate in the study by signing the proper consent forms were placed into 2 groups. G1 (group 1) was informed with the standard verbal informed consent and G2 (group 2) was informed with audiovisual multimedia in the form of a DVD in collaboration with the standard, verbal, informed consent procedure. The patients were interviewed by a nurse, using a checklist type of questionnaire, as to their satisfaction and comprehension of the procedure on the day of discharge. Results: In the period of June 2010 through December 2010, 60 patients undergoing laparoscopic cholecystectomies and who had met the conditions of research were included in our study. There were 30 patients in each group. The average satisfaction score in G1 was 3.12 out of a total of 5 and in G2 was 4.51 of 5 (P < 0.001). The percentage of patients that had an understanding of the operative information: 1) Understood ≥ 50% of information;G1 was at 13.33% and G2 was at 70.00%;2) comprehension of 1% - 49% of the information;G1 was at 20.00% and G2 was at 26.67%;3) No comprehension;G1 was measured at 66.67% and G2 was at 3.33%. The subgroup included the analysis of 7 items of information (operative indications, operative process, operative results, possible complications, wound care, diet, conditions for returning to work) and these were understood at a higher level in G2 than those in G1 (P < 0.001). Conclusions: In the context of the Thai culture;high technology, audiovisual multimedia combined with the standard, verbal, informed consent process enhanced the satisfaction and the comprehension of patients undergoing a laparoscopic cholecystectomy. Audiovisual multimedia should have the appropriate content, be clear, comprehensive and should include images and the voice of the surgeon who will be performing the operation to help the patient feel confident in the surgeon and in their decision to proceed with the surgery. Providing information in DVD form will benefit patients as they can examine it by themselves in the comfort of their home before the surgery and review the material as many times as may be required to provide a full understanding.展开更多
文摘Purpose: To report a novel technique of laparoscopic 10 mm Single Port Access IntraPeritoneal Onlay Mesh (SPA-IPOM) using bioresorbable composite mesh fixed with Endoclose suture (percutaneous subcutaneous suture) in 3 cases of bilateral inguinal hernia. Methods: Laparoscopic SPA-IPOM is done through a 10 mm trocar with one 10 mm instrument that has 5 mm optical lens and 5 mm channel for grasper. After inserting 10 mm trocar at umbilicus using semi-open technique, intraperitoneal anatomical landmark of inguinal her-nia is identified. A 10 × 15 cm pre-tied bioresorbable composite mesh is then placed to cover hernia defect and all three potential area of indirect, direct and femoral hernia. Using Endoclose? needle, each pair of pre-tied sutures is retrieved percutaneously through a needle wound and extracorporeal tied with knot in subcutaneous space. After the upper half of mesh is sutured to the posterior surface of abdominal wall, the lower half of mesh is fixed by hernia tacker to Symphysis Pubis, Cooper Ligament and Iliopubic tract. Re-sults: Three men, average 48 year olds were operated by laparoscopic 10 mm SPA-IPOM for bilateral in-guinal hernia repair using bioresorbable composite mesh. Average operative time was 36 minutes. No imme-diate complication. All patients were discharge on the 2nd post-operative day and average 6 months follow up has no recurrence. Conclusions: Laparoscopic SPA-IPOM is an optional operation and is much easier to be performed. Benefits include operative time saving, cosmesis, early discharge and early return to work. Bio-resorbable composite mesh prevents bowel adhesion, however, is much more expensive. Long term follow up study for complications and recurrence is needed.
文摘Objective: A comparative study of the audiovisual, multimedia, informed consent procedure enhancing the satisfaction and comprehension in laparoscopic cholecystectomy patients within the contexts of the Thai culture. Methods: A prospective, comparative trial was done in patients undergoing laparoscopic cholecystectomies at the HRH Princess Maha Chakri Sirindhorn Medical Center in Thailand. Before the procedure, all patients who met the selection criteria and agreed to participate in the study by signing the proper consent forms were placed into 2 groups. G1 (group 1) was informed with the standard verbal informed consent and G2 (group 2) was informed with audiovisual multimedia in the form of a DVD in collaboration with the standard, verbal, informed consent procedure. The patients were interviewed by a nurse, using a checklist type of questionnaire, as to their satisfaction and comprehension of the procedure on the day of discharge. Results: In the period of June 2010 through December 2010, 60 patients undergoing laparoscopic cholecystectomies and who had met the conditions of research were included in our study. There were 30 patients in each group. The average satisfaction score in G1 was 3.12 out of a total of 5 and in G2 was 4.51 of 5 (P < 0.001). The percentage of patients that had an understanding of the operative information: 1) Understood ≥ 50% of information;G1 was at 13.33% and G2 was at 70.00%;2) comprehension of 1% - 49% of the information;G1 was at 20.00% and G2 was at 26.67%;3) No comprehension;G1 was measured at 66.67% and G2 was at 3.33%. The subgroup included the analysis of 7 items of information (operative indications, operative process, operative results, possible complications, wound care, diet, conditions for returning to work) and these were understood at a higher level in G2 than those in G1 (P < 0.001). Conclusions: In the context of the Thai culture;high technology, audiovisual multimedia combined with the standard, verbal, informed consent process enhanced the satisfaction and the comprehension of patients undergoing a laparoscopic cholecystectomy. Audiovisual multimedia should have the appropriate content, be clear, comprehensive and should include images and the voice of the surgeon who will be performing the operation to help the patient feel confident in the surgeon and in their decision to proceed with the surgery. Providing information in DVD form will benefit patients as they can examine it by themselves in the comfort of their home before the surgery and review the material as many times as may be required to provide a full understanding.
