RESUMEN
BACKGROUND: Laparoscopic resections of parenchymal organs are increasingly performed. However, little is known about the effects of laparoscopic fibrin sealant spray applications on intraabdominal pressure (IAP) and hemodynamics. METHODS: Cardiac and pulmonary monitoring was performed via two central venous pressure lines in the thoracic and abdominal vena cava, a pulmonary artery catheter, and a peripheral artery line. Air was sprayed into the abdomen at pressures of 2, 3, and 4 bar for 30 s. According to the group, a valve on a trocar was open or closed. To optimize fibrin sealant application, the sealant was sprayed at three different application pressures (2, 2.5, and 3 bar) and distances (2, 3.5, and 5 cm). RESULTS: All spray simulations caused a significant increase in the IAP. During the first 10 s of spraying, the IAP increase was 5 mmHg or less, but rose rapidly during the last 20 s of spraying. The IAP increase resulted in decreased pulmonary compliance. Pulmonary resistance and the central venous pressures of both the thoracic and abdominal vena cava increased. At application pressures of 3 and 4 bar, the IAP increase was greater than 2 bar of pressure, reaching IAP values exceeding 35 mmHg. Spray mist formation was primarily dependent on application pressure, whereas clot formation and surface coverage depended on both application pressure and distance. The best results were achieved with an application pressure of 2.5 bar and a distance of 5 cm from the surface. CONCLUSIONS: This study shows that fibrin sealants can be used safely in laparoscopic procedures. Keeping the spray periods short and allowing air to escape from the abdomen can minimize the IAP increase. According to our results, a laparoscopic spray application of fibrin sealant should start with an insufflation pressure of 10 mmHg, an application pressure of 2.5 bar, and an application distance of 5 cm with a valve on the trocar left open.
Asunto(s)
Abdomen/cirugía , Presión Sanguínea , Adhesivo de Tejido de Fibrina/administración & dosificación , Laparoscopía , Nebulizadores y Vaporizadores , Animales , Presión , PorcinosRESUMEN
A skin closing system formed like a zipper (MEDIZIP) was tested in a total of 75 operated patients. The handling, wound healing, and scar formation at two and six to eight weeks postoperatively were evaluated. The time required for closing of the skin was on average 2.3 min. The ease of handling during operation and wound inspections was rated very good to good in 88% and 86%, respectively. Cosmetically and therapeutically, the results of scar formation are of high quality. The comfort of the skin closure was evaluated by the patients as pleasant, the assessment of the scars was positive.