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Mary, 51 years

of prov. Bergamo

"live as challenging

daily Sla"

editorial @ Bergamonews

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File di prova

E 'can be downloaded and viewed a small test file to see some of the contents of the book "Tools of the Operating Room.
You can download it from this URL

would be important for me to have your opinion and a review, possibly with an e- mail (borgio3@supereva.it).

Thanks :-)

Skin Moles Condition_symptoms

Enucleazione di neoplasia renale

patient about 65 years of medium build, diabetic. exophytic lesion presents the renal surface approximately midway between the two poles of the kidneys.

The project consisted of enucleation surgery, laparotomy, the tumor also involving the kidney fat adjacent to the tumor.

Container

• Base per interventi chirurgici maggiori
• Divaricatore Omni Track
• Strumentario per chirurgia vascolare

Teleria

• Set per l'allestimento di un campo quadrangolare comprendente l'intera estensione addominale ed i fianchi della paziente

Fili di Sutura e Lame

• Lama da 20 per la laparotomia e da 10 per l'eventuale resezione della neoplasia
• Intrecciato, riassorbibile USP 1 per chiusura laparotomia
• Monofilamento, assorbibile, atraumatico USP 3/0 con ago 26 mm. per sutura della braccia renale a fini emostatici
• Filo per il fissaggio del drenaggio
• Prolene 4/0 August 22 to suture vascular

Garrison

• full vacuum

bed and supine positions

• right arm abducted to arterial and venous access
• bladder catheterization, CVC and SNG to be removed at the end of intervention
Description of

1. engraving xipho sottombelicale
2. -positioning retractor OmniTract (four valve wall plus a wide spatula to displacement of the coil ileal and spleen) in a single block
3. mobilization of the spleen, the splenic flexure of the colon and the pancreatic tail (Mattox maneuver) with Ligasure, bipolar, anatomical long, pad mounted and clamp ring
4. palpation of the lesion for localization
5. Opening of the renal capsule and perirenal fat and creating windows of access to the lesion, with bipolar, long
6. anatomical engraving with perilesional electric scalpel about 2 cm from the lesion.
7. Application of hemostatic sutures, and completion of the enucleation of the lesion with electric cautery and bipolar
8. Careful hemostasis of the renal breccia and application of pressure point on the edges of the excision
9. washing the peritoneal cavity with warm saline groundwater
10. Application of TachoSil (hemostatic) and shrink the gap kidney.
11. Positioning drainage laminar split into left renal loggia and its mounting
12. count of instrument and the closure of access garzame
13. (fascia and muscle)

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Emicolectomia e Nefrectomia destre

patient 59 years old, medium build, 80 Kg weight around. Good condition.
tumor of the right colon at the hepatic flexure and cancer of the right kidney. A number of lymph node metastases.

The operating table was to make the first right hemicolectomy, enclosing the surgical specimen in a endobag, before moving to the right nephrectomy, removing both anatomical parts and then proceed to the ileo-colic anastomosis latero-lateral, all in laparoscopic.

• Container Container Container
• standard laparoscopic conversion laprotomica

Instruments extra

• Thermos
• needle holder
• clipper + video clip big Haemo-lock

Wire Suture & Blades

• Lama 10 x 20 x 1 and 1 for open-access laparoscopy and laparotomy pubic service
• atraumatic braided absorbable 3 / 0 for anastomosis and closing the gap peritoneal
• 0 monofilament absorbable August 26 suprapubic laparotomy for closure of the peritoneum
• braided absorbable atraumatic Aho 0 5 / 8 x 3 for closing the laparotomy
• range of skin-absorbable 3 / 0

• Endo GIA staplers Covidien + Refills endogenous 45 and 60 Blue section of colon anastomosis and packaging
• Refills White 30 mm. vascular section of the renal vein

Garrison

• Trocar 10 x 2 + 1 spindle
• Trocar 5 x 2 + 1 spindle
• Covidien Trocar 15 mm. dell'endobag big step for
• Copritelecamera
• Ligasure 5
• September disposable suction pump for irrigation + Cable MTP
• bag from washing 2000 ml.
• 500-ml bag of saline with 10 ml of Poviderm
• laminar Drainage + bag collection

bed and Positions

• lithotomy position with a thickness on the right side of the patient to highlight the lumbar
• initial horizontal leveling then progressive moderate left lateralization
• right arm abducted to venous access
• Cushion Pak Vac Vacuum and patient positioned on the extreme left edge of the bed
• Monitor places the head and right side of the patient. Touchscreen instrument side cover with a sterile operation of cameras, recordings and accessories from room
• Three surgeons at the patient's left, for the time colic, operator between the legs for the time renal
• Instrument and anastomotic end of the lower right

Description of variables and

1. Positioning of trocars: 10 umbilical, 10 in left hypochondriac region, 5 in the left lower quadrant, 5 in the right hypochondriac region
2. Exploring the repertoire of the cavity and marked with the tumor, with two
3. Johannes Treitz and Repertoire of the loop of the repertoire of vascular elements with Ligasure and Johanne (before patch)
4. Chamber of vascular elements with Clips violet (photo) Ligasure and (photo)
5. Given the many lymph node metastases present, the surgeon proceeded to dissect the first transverse colon (endogenous Covidien with charging 60 Blue) and then managed to unplugged the hepatic flexure of the colon and to effect the posting of the same shower right parieto-colic. All with bipolar Ligasure (second patch)
6. section of the loop ileostomy to about 2 cm from the ileocecal valve with charging 60 with endogenous Covidien Blu
7. placement of suprapubic trocar Covidien 15 mm. dell'endobag and introduction of 15 mm. Insertion of the same anatomical part and its repositioning in the right iliac fossa of the right ureter
8. Search with Ligasure Bipolar and, to be used as a marker for the detection of vascular elements (right renal artery and vein)
9. Section ureter after application of clips Haemo-Lock 10 mm. and section with Ligasure
10. vsscolari Identification of the elements. Section on the left main renal artery, with the use of Haemo-Lock Clips 10 mm. and section with Ligasure.
    The renal vein was conspicuous dimensions so that, after her finding with Vesseloop set with red clip, the surgeon has dissected with endogenous Covidien charging with 30 mm vascular.
11. Isolation and mobilization of the right kidney with perirenal fat and capsule, with Ligasure, Johanne and Bipolar
12. Inserting new EndoBag large and "capture" of the kidney.
13. Minilaparatomia suprapubic and extraction of the two anatomical parts with the help of pliers ring
14. single layer closure of the peritoneal (0 monofilament absorbable August 26) of minilaparatomia
15. Recovery Room and peritoneal removal of the gauze.
    During the operation one of these Garzino (from 7.5 mm x 7.5 mm) has migrated into the region left parieto-colic, managing to disguise themselves.
    The ability of these principals to take very small and apparently migrate into regions not affected by abdominal surgical operations - per share of flows abdominal surgical actions and the repositioning of the patient - must insist on the maintenance a high level of attention.
    After a thorough search, has been removed. Be careful!
16. Packaging ileo-colic anastomosis latero-lateral
    1. Application of first countertraction
    2. Inserting gauze Poviderm
    3. Execution of two Tomie - with scissors - on the ileal and colonic loops for introduction of the stapler
    4. Insertion of the stapler (Covidien with endogenous charging Blue 45 mm.) packaging and the anastomosis
    5. extraction and control of haemostasis endoluminal stapler
    6. Closing the gap with anastomotic points braided absorbable 3 / 0 Aug. 26 mm. length of about 18 cm.
17. hemostasis control, peritoneal toilet, laminar positioning of drainage in the right renal loggia
18. count of instruments and garzame
19. Removing trocars and closing of the accesses.

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Un retrovirus all'origine della forma

sporadica di Sla
In una percentuale di pazienti agisce

l'enzima trascrittasi inversa

Acid Reflux More Condition_treatment

Protesi per Ernie e Laparoceli

are very many other action taken for the repair of abdominal wall defects, iatrogenic origin or not.
Whatever the intervention to be performed and whatever the technique used, the instrument should first carefully read the leaflet of the prosthesis that will be used and to know the following:

1. Type of prosthesis

• Absorbable , partially absorbable, nonabsorbable
  assorbibilisi prosthesis in use or you can use wire crimps or absorbable. In the partially absorbable and nonabsorbable implants are used wire crimps or not absorbable.
  absorbable implants may need to be subjected to immersion in a specific solution for better handling and adaptation to the surface.
• Transparent, Opaque
  transparent implants allow the surgeon to better control the positioning of the prosthesis to the defect to be corrected, which can not happen with those opaque. Typically, the transparent part of a substance is absorbed long stay.
• Shaped ,
  non-shaped implants can be shaped for application to specific laterality (in laparoscopic inguinal hernia) or have a form for which you can direct them as needed (prosthesis with ellipsoidal shape where you can exploit the larger diameter and smaller).
  implants shaped and unshaped not be used as the manufacturer and can not be cut. Those can be shaped to be adjusted before and during the placement and fixation.
• Double surface, surface Mono
  double surface implants are typically equipped with a porous surface / cross-linked be applied to the fascial surface of the abdominal wall and a smooth and soft as to leave contact with the bowel loops.
  The smooth surface should always be kept intact and must be properly identified especially if the implant is transparent or translucent. The porous surface
  / crosslinked strongly stimulates the scarring process and production of fibrous tissue. For this reason, the malposition should be avoided at all costs for which the reticulated surface is in contact with the abdominal viscera. This could cause very dangerous phenomena adhesions.
  monostructural implants, both surfaces have cured, and then impossible to leave contact with the intenstinali alliances. Pears to be applied to the inner surface of the abdominal wall must be inserted into a peritoneal pocket, so that the loops do not come into contact with the prosthesis. The tool then must prepare the tools for the creation of the pocket and its closure after setting of the prosthesis.
• be shaped, unshaped
  non-shaped implants can not be upgraded and should be useful choices in size to cover the defect.
  be shaped implants can be cut to be adapted to specific locations. The prosthesis should not be shaped cut with thermal devices, but with very sharp scissors. The waste must be removed immediately from field to avoid an accidental retention.
• Synthetic, Biological
  synthetic prostheses are those with the greatest use because of the relatively low cost and the almost total anallergenicità. Those are intended to more fully integrate biological tissue as possible. The former do not require special treatment prior to their placement, while the second is often accompanied by pre-treatment necessary so that they can be adapted and positioned to the fullest. Generally, biological implants have a very high cost and may face rejection.

2. Warnings Warnings

in the use of a prosthesis of the abdominal wall are:

1. that the package is complete, both the external and internal
2. Check the expiry date and dimensional data of the prosthesis
3. Remove the prosthesis directly from the server room to
4. Handle the prosthesis with gloves clean and free talcum powder, to prevent them trapped in the mesh of the prosthesis
5. The prosthesis of the abdominal wall should be used with the best conditions of sterility on non-contaminated. The contamination can cause an infection that prevents the prosthesis from taking root.
6. implants of abdominal wall should not be used in children and pregnant women, where the abdominal area can avere trasformazioni dimensionali.
7. Nel posizionamento di una protesi in videolaparoscopia, è necessario che sia posizionato un trocar di almeno 10 mm. di diametro per consentire alla protesi di entrare in cavità.

3. Preparazione delle protesi

La preparazione di una protesi di parete dipende dalla tecnica impiegata per il suo posizionamento. In chirurgia open la protesi viene generalmente posizionata come si presenta all'apertura della confezione, o può subire delle sagomature relative al luogo nel quale verrà posizionata.
Nella chirurgia videolaparoscopica la protesi non viene solitamente sagomata, ma arrotolata per poter passare attraverso il trocar.
Le protesi sintetiche non necessitano pre-wetting, but instead may be marked for orientation. E 'dermographic can use a pen or a suture.
biological or partially absorbable implants undergo a pre-wetting that restore softness and flexibility. It is used in normal saline to 9% or Ringer lactate solution, or indicated by the manufacturer. Wetting can be performed within the blister where the prosthesis is retained and can last a few seconds.
If the prosthesis should be rolled to pass through a find, this is then grasped with forceps and Johanne introduced.

4. Positioning of the prosthesis implants can

be positioned and then fixed, or can be placed with a fixing point which then allows a subsequent shaping. The important thing is that the prosthesis is well spread over the surface, avoiding the production of folds. If the prosthesis is a double surface is crucial that these be placed conveniently.
to attach the prosthesis can be used wires not absorbable, monofilament mainly because of their elasticity and smoothness. In laparoscopic surgery are used for fixing crimp in various shapes and may be nonabsorbable or absorbable. During their placement is made a counter that allows them to penetrate deep into the thickness of the wall.
If you have used cross-linked implants without a smooth surface, the surgeon first makes a pocket of peritoneal chamber, then placed and fixed the prosthesis and finally closes the peritoneal pocket with wires or crimp.

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Non siamo eroi, vogliamo «solo»

vincere la guerra per la vita

Sono parole di Salvatore Usala, sardo, malato di SLA

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died last night in Rome Hospice Antea

the actress Anna Maria Torniai.

Born in Florence October 20, 1931,

had 79, and two were suffering from ALS.

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Plastica per laparocele sovrapubico

Patient 73, female, previously operated for hysterectomy.
size 15x15 cm wall defect. Location
deli operators:
- First operator to the left
- Cameraman to the left of the previous
- Instrument to the right patient at the end of the lower
position for display
- the main to the right of the patient at the hip
- the second left for the instrumentalist
bladder catheter (CH 16) Socks
antitrombo

Wire Suture & Blades

• Blade 10 x 1 for normal access
• Blade 11 x 1 for entry needle Bercy
• absorbable 3 / 0 x 1 for cute
• Prolene 0 or 1 x 2 if you need to reduce the defect before placing the prosthesis
• spinal needle Black defining the perimeter of the defect

Garrison

• Copritelecamera
• dermographic pencil for marking the perimeter of the defect
• 1 x 10 ml syringe for local anesthesia (Naropin 10)
• Naropin 10 x 1 flc
• Prosthetics dedicated high softness and adaptability ETHICON ® PhisioMESH ™
• Protak 5mm (30 points)

Annotations

• control column video
• when applying the fixing points of the prosthesis, it is necessary to lower the intra-abdominal pressure of 8 mm / Hg

bed and Positions

• supine, arms abduced
• patient on board left / right of the bed according to the position of surgeon
• Once the pneumoperitoneum, the patient was placed in moderate Trendelenburg and lateralized by the operator

Description of

1. Access supra-umbilical, with trocar 10, the optical input (scalpel, two Halstead, scissors, Halstead, tobacco pouch, trocar)
2. Inflation at 3 liters / min and patient positioning
3. pararectal additional access right and esinistro


4. Exploration of the peritoneal cavity, defect isolation, lysis of peritoneal adhesions with bipolar scissors and Johanne. Dissection of the bladder and placement of the prosthesis after the bladder was inflated with 200 ml. Sol of FIS. catheter through the hemostasis control
6. Delimitation of the perimeter with spinal needle and pencil dermographic. Measurement of larger diameters. Preliminary Correction of the defect with prolene needle Bercy and 0
7. Change gloves
8. Preparation of the implant (depending on the surgeon's choice) and insertion through a trocar 10.
9. Lowering of intra-abdominal pressure of 8 mm.Hg.
10. positioning and deployment of the prosthesis, along the lines indicated by the prosthesis, with the help of two Johanne.
11. prosthesis fixation points Protak
12. count of instruments and garzame
13. deli access closure after infiltration Naropin 10 1 fl.

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Il Libro è arrivato!

After an anxious wait of about 15 days, came the physical preview of the book and I really say that I like. It 's simple, without any special frills, but good.
pages and images are well printed, though in black and white, are very crisp and clear.
A lot of work, available for those working or intending to work in the operating room and a unique tool that was missing from the nursing profession.

For those interested and have 50 euros to spend, can purchase the work at Lulu.com, a this address. Thank you :-)

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MANDURIA: 6 cases of ALS

in less than

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IN A POPULATION OF ABOUT 30,000

POPULATION

A GIVEN FOUR

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the story of a young

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DuodenoCefaloPancreasectomia

male patient of 74 years in good physical condition. Type 2 diabetes.
diagnosis of cancer of the head of the pancreas infiltrating the duodenum.
The surgeon asked to perform a laparoscopy to detect any signs of peritoneal carcinomatosis.
Supine position, arms abduced, covered for temperature management placed on the lower limbs and heater liquids.
right subclavian central venous access in both peripheral venous access support.
invasive continuous blood pressure monitoring and central venous oppression.
bladder catheter attached to the nose and SNG.

-
Laparoscopic Instruments - Instruments for open abdominal surgery
- a self-retaining Retractor fixing the bed
- Container for vascular surgery

1. OPenlaparoscopy with two access points for trocar 10. After
2. the progressive induction of the pneumoperitoneum, not evedenziati signs of peritoneal metastases of its gross
3. We proceed to perform median xipho-pubic laparotomy.
4. After ligation (laces 2 / 0) and the section of the round ligament, we proceed to place the self-retaining retractor paddles with four wall and a spatula to lift the liver and expose the subhepatic region.
5. The surgeon obtains the pancreatic head cancer invading the duodenum and then proceed with the posting coloepiploico bipolar electric scalpel and scissors is then performed
6. the mobilization of the duodenum with extensive Kocher maneuver, and with bipolar scissors
7. is isolated on the superior mesenteric vein and portal vein vesseloop red on red vesseloop
8. The pancreas is then underpass with a yellow vesseloop
9. are linked to the right gastroepiploic artery and vein with long strings of 2 / 0 and, similarly, is linked to the artery and vein is then dissected
10. pyloric duodenum with the use of a GIA
11. Isolation and section 80 of the 'bonds of gastroduodenal artery with 2 / 0
12. is then dissected the first loop ileostomy, with GIA 80 , which is mobilized
13. lymphadenectomy is then performed of the superior mesenteric artery, with bipolar, metal clips and scissors.
14. cholecystectomy is performed by anterograde and the section of the bile duct at the level of common hepatic duct, with scalpel
15. the pancreas is then dissected with a scalpel and made the pancreaticoduodenectomy enbloc with the bile duct and gallbladder
16. extemporaneous histological examination is performed on the margin of section biliary , pancreatic and duodenal ulcers, who were negative for malignancy pancrteatico The body is mobilized with bipolar and scissors, and starts the infusion of somatostatin
17. is then cannulated Diotto of Wirsung with 20G cannula.
18. Pancreogastroanastomosi termino-lateral
    • are two points of absorbable monofilament applied to the back of the stomach and the other two points on the front, at the same level.
    • gastrotomy is performed between the two points, on both sides of the stomach. On the back is passed pancreatic stump, which is placed through the anterior gastrotomy.
    • The pancreas is attached to the remaining points of the gastric mucosa with non-absorbable monofilament 3 / 0 to sutures around the entire perimeter
    • When you close the gastrotomy front atraumatic monofilament absorbable 4 / 0, in two-layer anastomosis on
    • pancreogastrica, are applied to the fixing points and consolidation in monofilament 3 / 0 non-absorbable, face back or stomach.
19. Anastomosis duodenodigiunale-to-end user in a single layer with atraumatic monofilament absorbable 4 / 0 and with the same wire is performed end-to-side anastomosis epaticodigiunale manual
20. two drains are placed in laminar panncreo-gastric bypass anastomosis and the subhepatic region sull'anastomosi hepatic-jejunal.

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Esofagectomia

male patient of 60 years, with obvious emaciation, partially offset by total parenteral nutrition. Heavy smoker and alcoholic.
Body lean and no previous intervention.
table top
right thoracotomy to perform an atypical lung resection to assess the nature of a right upper lobe pulmonary nodule. Se all'esame estemporaneo fosse stato positivo per metastasi del carcinoma esofageo, l'intervento si sarebbe concluso, altrimenti si sarebbe proceduto ad esofagectomia del terzo distale dell'esofago, con anastomosi esofago-gastrica termino-terminale toracica.
Strumentario
Container per chirurgia toracica
Container per chirurgia addominale
Divaricatore autostatico OmniTack
Due drenaggi toracici CH 32 + raccordo a 'Y' per la connessione a Pleurevac Sahara
Surgiclip per la legatura dei vasi esofagei e dei vasi linfatici
GIA 80 + ricariche per la resezione polmonare atipica
Vesseloop blu per la repertazione esofagea
Drenaggio peritoneale + raccoglitore
Occorrente per Digiunostomia
Shopping Cart
surgery only for the three phases of the chest, abdominal and thoracic
single count of gauze, needles and sharp
Patient Positioning Chest
For phase 1 and 2, the patient was positioned in left lateral decubitus position, with marked hyperextension ribs. For stage abdominal
the patient was positioned supine with left upper limb abducted by venous and arterial. Practiced
bladder catheterization and a CVC inserted in right jugular. Description of

• I ran the surgical scrub at 7.45, while the anesthesiologist introduced the epidural catheter for analgesia postoperatively.
• I have prepared a single shopping cart for the duration of the intervention.
• skin incision of right posterolateral thoracotomy, partial section of the trapezius muscle and application of large rib-spreader. With tongs
• chiurgo the ring has exposed the area to be resected lung
• pulmonary resections with two charges of around 80
• Enter the anatomical part for extemporaneous histological examination, which proved negative.
• isolation of the esophagus with bipolar and anatomical
• Repertoire esophagus on Vesseloop blue vein ligation
• Azigos drawstring braided absorbable USP 0
• Completion isolation until the esophageal diaphragmatic jatus
• Temporary closure of the thoracotomy and application of steridrape.

• Repositioning the patient in the supine position
• laparotomy xipho sottombelicale
• -positioning retractor Omnitrack
• gastric mobilization and partial vascular isolation with conservation gsstroepiploica left and right. This phase was carried out with Ligasure 10, and bipolar scissors
• expansion of digital jatus diaphragmatic
• Cholecystectomy
• closure of the abdomen

• Repositioning the patient in left lateral decubitus position as described in step previous year.
• Reopening of thoracotomy
• repositioning of the stomach in the chest cavity, passing by esophageal jatus, with the help of pliers ring
• section upstream of the esophagus azigos streak with two straight enterostati
• Packaging of tobacco pouch on the stump proximal esophagus with monofilament 2 / 0 non-absorbable
• attaching the brush head of a circular EEA stapler 25 and close the tobacco pouch
• gastrotomy in the gastric body for the passage of the suture, with two landmarks in monofilament absorbable 3 / 0. Section between the two points with a low potential electric scalpel
• insertion of the suture and leakage of the spur on the posterior gastric
• reunification of the machine and packaging of esophageal-gastric anastomosis termino-lateral
• reinforcement of the anastomosis with monofilament absorbable 4 / 0 and application of the parietal pleura anastomosis for protection as determined by the same wire
• placement of drainage tubes and soft closing of the thoracotomy

intervention Duration: 8 hours

Thanks to my colleague Stephen Cardinals, who continued the operation in the afternoon and completed the above description and colleague Susan Pogliani for technical support.

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Il libro sarà in tutte le librerie

italiane dal 15 febbraio 2011

PREMIO EUROPEO PER IL
GIORNALISMO SULLA SALUTE:

Ferraris Gianluca and Ilaria Molinari

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L 'Asl Guidonia - Rome -

leave without assistance

a patient suffering from ALS

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Anonymous offers € 3,000 for Umberta

suffering from ALS

SOLIDARITY '. Continue aid for the woman to 59 years suffering from ALS, which risked eviction from his home in Via Galilei because he could not pay the rent

The considerable amount sent in an envelope in the establishment of Brescia today Commotion Anastasia's daughter: "A completely unexpected support"

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The Institute of Higher Education

R . Olevano of Descartes Romano

open registrations for the training course

for professional

family assistance with specific skills

for neurodegenerative diseases.

The course is free and funded by

Lazio a valere sul

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Immagine dal libro

This is a picture that shows how the book is coming:



what do you think?

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L'AISLA chiede chiarimenti sullo

stanziamento di 100 milioni di euro

in favore della ricerca

e dell'assistenza ai malati SLA

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How to read the mail "in touch" computer-free and

When you make a charge online or for other reasons such as answering machine messages we are sent a text message from the cryptic text: "Shop 3 E-mail received on the Call ... In 4133 or go to Contact."

Access "in touch" access to the coast Portale3 (9Cento on page!) And Cham 4133 number costs the same as a call to mobile phone 3. Both solutions presumably useless to read a message I seem unacceptable.

I've wondered for months how to do it. I even asked the assistance of three without getting an answer. Looking on the internet yesterday I found what I was looking at this post .

system to read the mail of three and FREE computer is:

1) Go Find http://webmail.tre.it
2) Enter your phone number with the number in front of 39 (and then becomes a 393.5553333 393 935 553 333)
3) The password is the PIN of the SIM. If you lost you can recover from the Customer Support page .

messages in the shop three are all equal among them, those of the secretariat have in the sender's phone number who called you and you will find the wav file as an attachment with the message was recorded.

I hope it's useful for those who still seek the solution! Of course, if the three information call center operators of this procedure would have been better.

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Resezione della via biliare principale ed anastomosi epatico-digiunale

male patient of 73 years, with cancer of the common bile duct.
Supine position, left limb abducted by venous, arterial catheter, pulse oximetry digital. Central venous catheter and epidural catheter for analgesia. Heater air cushion.

1. engraving subcostal right extends to a brief portion of subcostal left.
2. section and ligation of the round ligament and placement of self-retaining retractor Omnitrack.
3. Section
4. mobilization of the falciform ligament of liver section with various liver ligaments and positioning of two flannels back to the liver to expose the organ.
5. Detachment of the gallbladder with bipolar scissors
6. intraoperative cholangiography, which shows the extent of the disease.
8. Isolation of the hepatic hilum and the bile duct, until it forks right and left hepatic duct with bipolar scissors and metal clips. Vesseloop finding with red and yellow elements hilar of the liver.
9. Isolation of biliary tract disease, which includes the section between the two branches of the liver and the region just distal to the insertion of the cystic duct.
10. positioning the proximal and distal colon cancer than with absorbable monofilament August 13
11. Chamber of right and left hepatic duct resection
12. sick of the way with a scalpel
13. extemporaneous histological examination of the margins of section
14. closure of the stump with choledochal string absorbable 3 / 0 suture and
15. conjunction of the two hepatic ducts with points absorbable monofilament 5 / 0 August 13.
16. Removal of 1 liver segment with bipolar irrigation
17. Definition and choice of the loop with which package jejunal anastomosis termino-lateral liver and fasting.
18. Packaging transmesocolica window for the passage of the loop that will go to the bilio-digestive anastomosis
19. section of the loop with GIA 80 e affondamento del moncone distale con riassorbibile monofilamento 4/0 ago 26
20. Confezionamento di anastomosi epatico-digiunale, su tutori tubolari in silastic fissati con punti riassorbibili, con riassorbibile monofilamento 4/0 ago 26, dopo avere asportato l'eccesso di mucosa dell'ansa digiunale con bisturi elettrico. La sutura viene effettuata a punti staccati, non annodati, fino a completamento del perimetro anastomotico. La legatura avviene al termine, mentre i punti vengono repertati con pinze Mosquito e separati con garze 10x10.
21. Al termine della anastomosi, vengono applicati punti di sutura per la pessi dell'ansa digiunale, in modo da evitare la trazione su di essa.
22. Confezionamento dell'anastomosi digiuno-digiunale end-to-side in a single layer with monofilament absorbable 4 / 0 August 26
23. wash the peritoneal cavity with copious amounts of Fis Sol.
24. Positioning drainage laminar split.
25. closure of the abdominal wall layers. Interesting

the final count: 40
flannels laparotomy
35 gauze needles
72
10x10 3 bladed scalpel
The surgery lasted about 5 hours.

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Assistenza Chirurgica - Il Libro

here is the index of the book I'm finishing in recent weeks, dedicated mainly to surgery and will go on sale in late February of this year.
Take a look at the topics on this channel and stay tuned for news and pictures.

1. The critical area
2. Professionalism
3. Responsibility
4. The Law
5. The Code of Ethics
6. The surgical care

6.1 Operators 6.2 The Operational Plans
7. The training course
8. The Operating Room
9. The surgical table 9.1
surgical instruments
9.2 The staplers
9.3 needles and flutes
9.4 The sutures

9.6 9.5 The Gauze drains
Manager 9.7
of instrument 10. The Instrument electro 10.1
List controllo
 10.2 Funzionamento
 10.3 Precauzioni e avvertenze
11. Le Posizioni del pazientepaziente
12. L'Intervento Chirurgico.....
 12.1 I tempi chirurgicipreliminari
 12.3 Preparazione
 12.4 Conduzione dell'interventoOpen
 13.1 Appendicectomia
 13.2 Amputazione del retto sec. Miles
 13.3 Colecistectomia
 13.4 DuodenoCefaloPancreasectomia
 13.5 Emicolectomia destra
 13.6 Emicolectomia sinistra
 13.7 Epatectomia
 13.8 Ernioplastica inguinale
 13.9 Gastrectomia Total pulmonary lobectomy

13.10 13.11 13.12 mediastinotomy
Pericardiotomia
hernia
13:14 13:13 Plastic Plastic peristomal hernia
13:15 13:16
pneumonectomy for resection of the rectum anterior
13:17 13:18
recanalization of gastric resection surgery sec. Hartmann
saphenectomy
13:19 13:20 13:21
Splenectomy Thyroidectomy and / or parathyroidectomy
14. Laparoscopic surgery / thoracoscopic
14.1 The Instrument electronic / electro
14.2 The laparoscopic Instruments / thoracoscopic
14.3 The positions of the patient
14.4 Management of laparoscopic instruments / thoracoscopic
14.5. Appendectomy Removal
14.6 / 14.7 enucleation of ovarian cysts
Bullectomia pulmonary
Cholecystectomy
14.9 14.8 14.10
right hemicolectomy hemicolectomy left inguinal hernioplasty

14:11 14:12 14:13 Mediastinoscopy
Nephrectomy pancreatectomy body
14:14 / 14:16 codalaparocele
atypical gastric resection gastric
14:17 sec. Billroth 2
14:18 14:19 Splenectomy
SurrenectomiaToracoscopia
15. Orthopaedics and Traumatology
15.1 The fracture surgery
15.2 The O / T
15.2.1 The Instrument O / Tprotesico
15.2.3 The means of osteosynthesis
15.3 The positions of pazienteinterventiclavicola
15.4.2 Fractures of the humeral head fractures of the humerus

15.4.3 15.4.4 15.4.5
fractures of distal humerus fractures Fractures of the olecranon
15.4.6 15.4.7 Glyph
radial head fractures and radio 15.4.8
ulna fractures of carpal and metacarpal fractures of the phalanges of
15.4.9 manobacino
hip endoprostheses
15.4.11 15.4.12 15.4.13
pertrochanteric Fractures Fractures of the femur Fractures of the patella

15.4.14 15.4.15 15.4.16
fractures of the proximal tibial fractures of tibiacaviglia
15.4.18 fracture of tarsal and metatarsal
16. Urgency and emergency
17. History of Surgery
Dictionary
Bibliography