Biomedical subjects

E K Tsoi

Publications and source records attributed to E K Tsoi.

9 recordsLinked to original sources

PubMed1996

Videothoracoscopy an effective method for evaluating and managing thoracic trauma patients.

BACKGROUND: The objective of this study was to assess the diagnostic and therapeutic effectiveness of videothoracoscopy in thoracic trauma patients. METHODS: The design was a retrospective review. The setting was a major trauma center at an urban county hospital. Forty-one hemodynamically stable patients sustaining thoracic trauma were reviewed (34 penetrating and 7 blunt injuries). In the acute setting (< 24 h), videothoracoscopy was used for continued bleeding(6) and suspected diaphragmatic injury(17). Thoracoscopy was used in delayed settings (> 24 h) for treatment of thoracic trauma complications(18) including clotted hemothorax(14), persistent air leak(1), widened mediastinum(1), and suspected diaphragmatic injury(2). RESULTS: The average Injury Severity Score (ISS) of these patients was 18.9 +/- 10.0. Three of 6 patients (50%) with continued bleeding were successfully treated thoracoscopically. Nine of 10 (90%) diaphragmatic injuries were confirmed by thoracoscopy, and 7 of these 9 patients (77%) were repaired thoracoscopically. Thirteen of 14 patients (93%) with clotted hemothoraces and one with a persistent air leak were treated successfully using thoracoscopy. An aortic injury was ruled out in one patient. CONCLUSIONS: Videothoracoscopy is a safe, accurate, minimally invasive, and potentially cost-effective method for the diagnosis and therapeutic management of thoracic trauma patients.

Adolescent↗

PubMed1995

Isopneumic laparoscopy in general surgery and trauma: an update.

The purpose of this study was to assess the capability of a retractor system that permits laparoscopic surgery without carbon dioxide pneumoperitoneum and to determine if the system facilitates the use of traditional surgical instruments during minimally invasive surgery. This study was performed at a university-affiliated county hospital (Alameda County Medical Center, Highland General Hospital campus) in Oakland, California. The study design was prospective evaluation with data collection. Eighty-eight isopneumic laparoscopic procedures were performed between July 1992 and October 1993. A planar abdominal wall distention system consisting of an intra-abdominal fan retractor and an electrically powered mechanical arm was used to provide exposure. Conventional surgical instruments as well as laparoscopic instruments were used in each case. Laparoscopy without pneumoperitoneum was used in the evaluation of 43 patients with abdominal trauma (gunshot wound, 18; stab wound, 19; blunt trauma, 6). The need for formal abdominal exploration was obviated in 35 of 43 (81%) cases. Repair of three enterotomies, four diaphragmatic lacerations, and one gastric perforation was performed with conventional instruments. Isopneumic laparoscopic techniques were also used for cholecystectomy (n = 36), diagnosis laparoscopy (n = 4), appendectomy (n = 3), sigmoidopexy (n = 1), and closure of a perforated duodenal ulcer (n = 1). Abdominal exposure approximating that obtained by pneumoperitoneum was obtained in 37 of 45 cases. One major (trocar tip enterotomy) and two minor complications (superficial wound infection) occurred in this group of patients. The ability to use traditional surgical instruments was advantageous in several cases. Laparoscopic surgical procedures can be performed without pneumoperitoneum in the majority of cases. The ability to use conventional surgical instruments is an advantage of this technique. Further improvements in abdominal wall distention systems and modifications of existing surgical instruments are required to further expand the role of isopneumic laparoscopy.

Abdominal Injuries↗

PubMed1994

Laparoscopic surgery without pneumoperitoneum. A preliminary report.

Laparoscopic surgery using pneumoperitoneum to create an operating field is known to have cardiopulmonary side effects. Conventional laparoscopic techniques require operating in a sealed environment. In July 1992, we initiated an investigation of the use of an electric-powered abdominal-wall lifter to expose an operating field. In our preliminary study, we have successfully completed 16 of 20 cases (80%) using this method of exposure. One trocar-related small-bowel injury was recognized immediately and repaired uneventfully. Two patients with dense adhesions made laparoscopic cholecystectomy impossible. One case of laparoscopic cholecystectomy was completed by conversion to pneumoperitoneum. Conventional instruments can be used through small incisions. Digital examination of abdominal contents can be achieved through the periumbilical incision or through other small incisions with the guidance of this retractor; this is superior to pneumoperitoneum since the surgeon can use more than just visual examination of intraabdominal pathology in laparoscopic surgery.

Adult↗

PubMed1994

Gasless laparoscopy using a planar lifting technique.

In clinical use, the mechanical lifting technique has demonstrated the ability to displace the abdominal wall and create a useful cavity for visualization and surgical manipulation. By forming a planar ceiling, as opposed to the domed ceiling of conventional pneumoperitoneum, the abdominal organs are brought into closer proximity of the surgeon. Instrument length may be shortened, imparting greater surgical control. Without the necessity for gas sealing, entry portals are simplified. Conventional instruments (right angle clamps) may be introduced through the fan retractor insertion sites or by way of separate stab incisions. The planar lifting technique has the potential for simplifying laparoscopy and restoring instrument control to the operating surgeon.

Abdominal Muscles↗

PubMed1993

Gasless laparoscopy and conventional instruments. The next phase of minimally invasive surgery.

OBJECTIVE: To assess the capability of a retractor system that permits laparoscopic surgery without pneumoperitoneum and to determine if the system facilitates the use of conventional surgical instruments during minimally invasive surgery. DESIGN: Prospective evaluation and data collection with review. SETTING: University-affiliated county hospital. PATIENTS: Twenty-nine male and 29 female subjects evaluated prospectively via 27 trauma-related and 31 elective procedures. METHODS: Fifty-eight laparoscopic procedures were performed between July 1992 and February 1993 with a system consisting of an intra-abdominal fan retractor and an electrically powered mechanical arm using conventional surgical and laparoscopic instruments. RESULTS: Gasless laparoscopy was used in the evaluation of 27 patients with abdominal trauma (11 gunshot wounds, 11 stab wounds, and five blunt injuries). The need for celiotomy was obviated in 20 (74%) of 27 cases. Three enterotomies, two diaphragmatic lacerations, and one gastric perforation were repaired with conventional instruments. Gasless laparoscopic techniques were also used in cholecystectomy (n = 26), diagnostic laparoscopy (n = 3), and appendectomy (n = 2). Exposure similar to that obtained by pneumoperitoneum was obtained in 30 (97%) of 31 cases. One major (trocar tip enterotomy) and two superficial wound infections occurred in this group. The ability to use conventional surgical instruments was advantageous in several cases. CONCLUSIONS: Comparable exposure was achieved in this cohort of patients with gasless laparoscopy. The use of conventional surgical instruments provides an advantage with this technique. Further improvements in abdominal wall lift systems and modification of existing surgical instruments may expand the role of gasless laparoscopy.

Abdominal Injuries↗

PubMed1993

The success of duplex ultrasonographic scanning in diagnosis of extremity vascular proximity trauma.

OBJECTIVE: To determine if duplex ultrasonographic scanning is diagnostically equivalent to arteriography and/or operative exploration in the diagnosis of extremity vascular proximity trauma. DESIGN: A prospective evaluation comparing duplex scanning with arteriography or operative exploration in 50 patients. Subsequently, duplex scanning was used alone for 175 extremity vascular proximity injuries, with other diagnostic methods used when injury was indicated on the duplex scan. SETTING: A busy urban trauma center. PATIENTS: Consecutive sample of 200 patients with 225 extremity injuries. SELECTION CRITERIA: Vascular proximity injury or diminished strength of the extremity pulse. MAIN OUTCOME MEASURES: The presence or absence of vascular proximity injury confirmed on angiography and/or operative exploration. RESULTS: Duplex scanning had 100% sensitivity and 100% specificity compared with arteriography and/or operative exploration in the first 50 cases. In the remaining 175 cases of extremity trauma, vascular injuries were diagnosed with duplex scanning alone. Duplex scanning detected 18 injuries, 17 of which were confirmed by correlation with arteriograms and/or operative exploration. One false-positive result--spasm of the superficial femoral artery--was found on arteriography. Seven unsuspected venous injuries were also diagnosed. CONCLUSIONS: Duplex scanning is a noninvasive, safe, effective method for the initial evaluation of potential extremity vascular proximity injury. It has replaced arteriography in the initial diagnosis of extremity vascular proximity trauma by our trauma service.

Angiography↗

PubMed1993

Preliminary report on videothoracoscopy in the evaluation and treatment of thoracic injury.

A prospective trial of videothoracoscopy was conducted at an urban trauma center between February 1992 and February 1993 to determine the efficiency of this less invasive method of evaluation and treatment. Twenty-four consecutive patients with chest trauma (penetrating, n = 22; blunt, n = 2) were examined thoracoscopically for clotted hemothorax that otherwise would have been treated with thoracotomy (n = 9), suspected diaphragmatic injury (n = 10), and continued bleeding (n = 5). To ensure maximal exposure, general anesthesia with a double-lumen endotracheal tube was used in each patient. Clotted hemothorax was successfully evacuated in eight of nine patients (89%). Diaphragmatic laceration was suspected in 10 patients (2 abnormal chest radiographs, 8 proximity penetrating wounds) and confirmed thoracoscopically in 5. In four patients, diaphragmatic lacerations were successfully repaired with thoracoscopic techniques. Five patients underwent thoracoscopy for continued hemorrhage (greater than 1,500 mL per 24 hours) after tube thoracostomy. Intercostal artery injury was confirmed in all patients, and diathermy provided hemostasis in three patients without thoracotomy. No complications occurred. These data suggest the following: (1) Videothoracoscopy is an accurate, safe, and minimally invasive method for the assessment of diaphragmatic injuries, control of continued chest wall bleeding, and early evacuation of clotted hemothorax. (2) This technique should be used more frequently in patients with thoracic trauma. (3) Technical advances may expand the therapeutic role of thoracoscopy.

Adolescent↗

PubMed1993

Laparoscopically guided blood salvage and autotransfusion in splenic trauma: a case report.

Salvage of intraperitoneal blood with autotransfusion is a well-accepted practice. Laparoscopic examination is gaining popularity and holds diagnostic promise for the evaluation of trauma patients. We describe herein the successful combination of these techniques in a patient who sustained blunt abdominal trauma, facilitating splenic salvage, autotransfusion, and avoidance of laparotomy.

Abdominal Injuries↗

PubMed1983

Heparin-induced thrombocytopenia, thrombosis, and hemorrhage.

Sixty-two patients with a heparin-induced thrombocytopenia are reported. Clinical manifestations of this disorder include hemorrhage or, more frequently, thromboembolic events in patients receiving heparin. Laboratory testing has revealed a falling platelet count, increased resistance to heparin, and aggregation of platelets by the patient's plasma when heparin is added. Immunologic testing has demonstrated the presence of a heparin-dependent platelet membrane antibody. The 20 deaths, 52 hemorrhagic and thromboembolic complications, and 21 surgical procedures to manage the complications confirm the seriousness of the disorder. Specific risk factors have not been identified; therefore, all patients receiving heparin should be monitored. If the platelet count falls to less than 100,000/mm3, while the patient is receiving heparin, platelet aggregation testing, using the patient's plasma, is indicated. Management consists of cessation of heparin, platelet anti-aggregating agents, and alternate forms of anticoagulation when indicated.

Adult↗