Hasil Pencarian  ::  Simpan CSV :: Kembali

"[ABSTRAKLatar Belakang : Laparoskopi kolesistektomi saat ini menjadi pilihan utama kasus batu kandung empedu simtomatik. Walaupun minimal, laporan mengenai nyeri abdomen dan nyeri bahu masih dirasakan pascalaparoskopi kolesistektomi. Nyeri ini muncul segera setelah operasi dan dapat bertahan selama 3 hari. Penelitian ini bertujuan untuk mengetahui efektivitas instilasi ropivakain 0.375% intraperitonium sebagai ajuvan terapi nyeri pascalaparoskopi kolesistektomi. Metode : Penelitian ini adalah uji klinik acak tersamar ganda yang dikerjakan di Instalasi Bedah Pusat RSCM pada bulan November 2014 sampai April 2015. Subjek yang memenuhi kriteria dibagi menjadi kelompok ropivakain (R) (n=35) mendapat 40 mL ropivakain 0.375% dan kelompok NaCl (N) (n=33) mendapat 40 mL NaCl 0.9%. Peracikan regimen dikerjakan oleh orang yang berbeda dengan operator dan penilai. Tingkat nyeri statis, dinamis dan nyeri rujuk dinilai pada jamke-1, 6 dan 24 pascaoperasi. Waktu meminta analgetik tambahan pertama (petidin) juga dicatat. Data regimen yang diterima baru dibuka setelah pengumpulan data selesai. Hasil : Secara statistik terdapat perbedaan bermakna pada proporsi nyeri statis jam pertama antara kelompok R dan N. Kelompok R cenderung memiliki nilai VAS lebih rendah (p=0.05;OR=0.453). Tidak terdapat perbedaan bermakna pada keseluruhan jenis nyeri yang dinilai dalam tiap-tiap waktu penilaian. Median waktu meminta petidin juga tidak berbeda antara kedua kelompok. Simpulan: Instilasi ropivakain 0.375% intraperitonium tidak lebih efektif sebagai ajuvan terapi nyeri pascalaparoskopi kolesistektomi dibandingkan tanpa ajuvan.

---

ABSTRACTBackground: Laparoscopy cholecystectomy has been the preferred procedure for symptomatic cholelithiasis. Although less minimal, abdominal and shoulder pain are still reported. The pain rises after operation and persists for 3 days. The aim of this study was to determine the effect of intraperitoneal ropivacaine 0.375% as adjuvant in postlaparoscopy cholecystectomy pain therapy.Method: This was a randomized, double blinded, clinical control trial that held in central operating theater Ciptomangunkusumo hospital during November 2014 until April 2015. Subjects divided into two groups. The ropivacaine (R) group (n=35) got 40 mL ropivacain 0.375% and the control (N) group (n=33) got NaCl 0.9% in same volume. Regiment was prepared by different personel from the operator and evaluator. Pain at rest, cough and shoulder pain were recorded in VAS at 1st, 6th and 24th hours postoperative. Time to get the first petidine dose was also recorded.Result: Ropivacaine had higher proportion of mild pain at rest (VAS<4) at 1st hour (p=0.050; OR=0.453). There were no statistically significant difference for other pain proportions in any time measured. Median time to get first petidine dose did not differ between the two groups.Conclusion: Intraperitoneal instillation of ropivacaine 0.375% as adjuvant in postlaparoscopy cholecystectomy pain therapy is not more effective than without adjuvant.;Background: Laparoscopy cholecystectomy has been the preferred procedure for symptomatic cholelithiasis. Although less minimal, abdominal and shoulder pain are still reported. The pain rises after operation and persists for 3 days. The aim of this study was to determine the effect of intraperitoneal ropivacaine 0.375% as adjuvant in postlaparoscopy cholecystectomy pain therapy.Method: This was a randomized, double blinded, clinical control trial that held in central operating theater Ciptomangunkusumo hospital during November 2014 until April 2015. Subjects divided into two groups. The ropivacaine (R) group (n=35) got 40 mL ropivacain 0.375% and the control (N) group (n=33) got NaCl 0.9% in same volume. Regiment was prepared by different personel from the operator and evaluator. Pain at rest, cough and shoulder pain were recorded in VAS at 1st, 6th and 24th hours postoperative. Time to get the first petidine dose was also recorded.Result: Ropivacaine had higher proportion of mild pain at rest (VAS<4) at 1st hour (p=0.050; OR=0.453). There were no statistically significant difference for other pain proportions in any time measured. Median time to get first petidine dose did not differ between the two groups.Conclusion: Intraperitoneal instillation of ropivacaine 0.375% as adjuvant in postlaparoscopy cholecystectomy pain therapy is not more effective than without adjuvant., Background: Laparoscopy cholecystectomy has been the preferred procedure for symptomatic cholelithiasis. Although less minimal, abdominal and shoulder pain are still reported. The pain rises after operation and persists for 3 days. The aim of this study was to determine the effect of intraperitoneal ropivacaine 0.375% as adjuvant in postlaparoscopy cholecystectomy pain therapy.Method: This was a randomized, double blinded, clinical control trial that held in central operating theater Ciptomangunkusumo hospital during November 2014 until April 2015. Subjects divided into two groups. The ropivacaine (R) group (n=35) got 40 mL ropivacain 0.375% and the control (N) group (n=33) got NaCl 0.9% in same volume. Regiment was prepared by different personel from the operator and evaluator. Pain at rest, cough and shoulder pain were recorded in VAS at 1st, 6th and 24th hours postoperative. Time to get the first petidine dose was also recorded.Result: Ropivacaine had higher proportion of mild pain at rest (VAS<4) at 1st hour (p=0.050; OR=0.453). There were no statistically significant difference for other pain proportions in any time measured. Median time to get first petidine dose did not differ between the two groups.Conclusion: Intraperitoneal instillation of ropivacaine 0.375% as adjuvant in postlaparoscopy cholecystectomy pain therapy is not more effective than without adjuvant.]"

"Latar Belakang : Penatalaksanaan kolesistektomi laparoskopik telah menjadi baku emas untuk penanganan kolesistolitiasis simptomatik di RS Dr. Cipto Mangunkusumo (RSCM), sedangkan sampai saat ini belum ada sistem penilaian kantung empedu intraoperatif yang diterapkan saat operasi. Penilaian kantong empedu intraoperatif yang sesuai dapat menggambarkan tingkat kesulitan kolesistektomi laparaskopik secara objektif dan akan berpengaruh terhadap pemilihan teknik kolesistektomi laparaskopik yang tepat untuk mencegah terjadinya trauma bilier. Penelitian ini bertujuan mengevaluasi nilai G10 dan mencari hubungan dengan teknik operasi pada pasien yang sudah dilakukan kolesistektomi laparaskopik di RSCM.Metode : Dilakukan penelitian retrospektif pada subjek yang telah dilakukan kolesistektomi laparaskopik pada Januari 2019 sampai Desember 2019 di institusi kami. Kami mengumpulkan karakteristik subjek berdasarkan catatan medis rumah sakit. Kami menentukan nilai G10 dan teknik operasi berdasarkan dokumentasi gambar intraoperatif dan laporan bedah. Data nilai G10 dan klasifikasi teknik operasi dilakukan uji non parametrik Mann-Whitney untuk melihat perbedaannya. Dilakukan uji statistik Kendalls Tau untuk menilai hubungan antara nilai G10 dengan prosedur bailout. Dilakukan uji ROC untuk melihat sensitifitas dan spesifisitas nilai G10 terhadap prosedur bailout, kemudian ditentukan nilai cut-off nya.Hasil : 99 subjek Indonesia, usia rata-rata 49,80+13,421 tahun, menjalani kolesistektomi laparaskopik di Rumah Sakit Umum Dr.Cipto Mangunkusumo selama satu tahun. Sebagian besar diagnosis adalah kolesistolitiasis tanpa kolesistitis (68 subjek, 68,8%) dan kolesistitis kronis (23 subjek, 23,2%). Pembedahan elektif dilakuan pada 91 subjek (91,9%). Median nilai G10 adalah 2 (rentang 1-8). CVS dilakukan pada 81 subjek (81,8%), sedangkan 18 subjek dikelola dengan prosedur bailout (18,2%), terdiri dari 14 subjek dilakukan FF (14,2%), 2 subjek SC (2,0%) dan 2 subjek konversi operasi terbuka (2,0%). Nilai median G10 berbeda pada subjek yang menjalani CVS (1, rentang 1-6), FF (3, rentang 2-6), SC (5, rentang 5-5) dan konversi terbuka (6,5, rentang 5-8). Ada perbedaan median nilai G10 (<0,001) antara kelompok yang dilakukan CVS (1, rentang 1-6) dengan kelompok yang dilakukan prosedur bailout (4, rentang 2-8). Terdapat hubungan antara nilai G10 dengan prosedur bailout (<0,001, +0,478). Akurasi nilai G10 untuk memprediksi prosedur bailout dinilai dengan menggunakan kurva receiver operating characteristic (ROC) (<0,001, AUC 0,865) dan didapatkan cut-off point yang optimal untuk melakukan prosedur bailout adalah 2,5 (x², p=0,000019).Kesimpulan : Studi ini menunjukkan bahwa G10 adalah sistem penilaian kandung empedu intraoperatif yang objektif dan dapat diterapkan saat melakukan kolesistektomi laparaskopik. Nilai G10 berhubungan dengan prosedur bailout. Nilai 2,5 adalah cut-off point yang optimal untuk melakukan prosedur bailout saat kolesistektomi laparaskopik.

---

Introduction. Laparoscopic cholecystectomy has become a gold standard for symptomatic cholecystolithiasis management at Dr. Cipto Mangunkusumo Hospital (RSCM), while there is no intraoperative gallbladder assessment system applied during laparoscopic cholecystectomy. An appropriate intraoperative gallbladder assessment system can describe objectively the degree of difficulty in laparascopic cholecystectomy and fascilitate appropriate surgical decision-making to prevent biliary injury. This study aims to validate the intraoperative G10 scoring system and look for relationships with laparoscopic cholecystectomy techniques already performed at RSCM.

Method. A cross sectional study was established to the subjects had performed laparascopic cholecystectomy between Januari 2019 and December 2019. We collected characteristic of subjects based on medical records. We assessed the G10 scoring system and operation technique based on the documentation of intraoperatif images and surgical reports.

Results. Ninety-nine indonesian subjects, mean age 49.80+13.421 yrs, underwent laparascopic cholecystectomy at RSCM for a year. Most diagnosis were symptomatic cholecystolithiasis (67.7%) and chronic cholecystitis (23.2 %). Most of surgery was elective (91.9%). The median G10 score was 2 (range 1-8). CVS was feasible in 81.8%, whereas 18.2% cases were managed by bailout procedure. Of those, 14.2 % cases underwent FF, 2% SC and 2% open surgery conversion. The median G10 score differs among subjects undergoing CVS (median 1, range 1-6), FF (median 3, range 2-6), SC (median 5, range 5-5) and open conversion (median 6.5, range 5-8). There was a difference in the G10 score (<0.001) between the groups that performed CVS (median 1, range 1-6) and the groups that performed bailout procedures (median 4, ranges 2-8). There is a relationship between the G10 score and the bailout procedure (<0.001,+0.487). The accuracy of the G10 score to predict the bailout was assessed using a ROC curve (<0.001, AUC 0.865) and the optimal cut-off point to perform a bailout procedure was 2.5 (x², p=0.000019).

Conclusion. The G10 is an objective and applicable intraoperative gallbladder assessment system when performing laparoscopic cholecystectomy. The G10 score has a relationship with the bailout procedure during laparascopic cholecystectomy. G10 score 2.5 is the optimal cut-off point for a bailout procedure when performing laparoscopic cholecystectomy."

"ABSTRAKNama : Muhammad ZakiProgram Studi : Magister Ilmu KeperawatanJudul : Pengaruh Mobilisasi Dini dan Konsumsi Air Mineral Dua Jam Post Laparoskopik Kolesistektomi Terhadap Penurunan Skala Nyeri Bahu Pasien. Pembedahan laparoskopik kolesistektomi dapat menimbulkan pneumoperitonium yang akan menimbulkan efek nyeri pada bahu pasien yang secara nyata banyak muncul pada jam ke enam setelah pembedahan selesai. Penelitian ini bertujuan mengetahui pengaruh mobilisasi dini dan konsumsi air mineral saat diberikan dua jam post laparoskopik kolesistektomi terhadap penurunan skala nyeri bahu pasien. Desain penelitian ini menggunakan quasy experimental pre ndash; post with control group, metode pengumpulan sampel dilakukan secara purposive sampling. Sampel penelitian terdiri atas 18 orang tiap kelompok intervensi dan kelompok kontrol. Uji statistik menggunakan friedman test dan uji wilcoxon didapatkan hasil pengukuran skala nyeri bahu dengan menggunakan Numeric Rating Scale NRS pada jam ke 2, 6 dan jam ke 24 post laparoskopik kolesistektomi menunjukkan secara statistik dan klinis signifikan dalam menurunkan skala nyeri bahu pasien pada kedua kelompok. Sehingga dapat disimpulkan bahwa terdapat perbedaan signifikan pada kelompok kontrol dibandingkan kelompok intervensi pada pengaruh perubahan skala nyeri bahu responden setelah diberi tindakan mobilisasi dini dan konsumsi air mineral dengan p value= 0, 0001; ?

---

ABSTRACTName Muhammad ZakiStudy Program Master of Nursing ScienceTitle The effectiveness of early mobilization and mineral water Consumption two hours post laparoscopic cholecystectomy on decreasing shoulder pain. Laparoscopic Cholecystectomy is at risk for pneumoperitoneum that lead patients to feel pain on the shoulder after six hours post surgery. This study aimed to determine the effectiveness of early mobilization and consumption of mineral water two hours post laparoscopic cholecystectomy on decreasing the scale of shoulder pain. This queasy experimental study conducted pre post testing that involved 18 intervention groups and control groups. All subjects were chosen based on purposive sampling method. Data were analyzed by using test Friedman and Wilcoxon. The statistical test using Friedman test and Wilcoxon test showed the measurement of shoulder pain scale by using Numeric Rating Scale NRS at 2, 6 and 24 hours post laparoscopic cholecystectomy showed statistically and clinically significant in decreasing patient shoulder pain scale in both groups. So it can be concluded that there are significant differences in the control group compared to the intervention group on the effect of the change of shoulder pain scale after giving the action of early mobilization and mineral water consumption with p value 0, 0001 "

"Latar Belakang. Pembelajaran laparoskopik kolesistektomi umumnya hanya menekankan pada aspek keterampilan teknis dan belum memanfaatkan keterampilan nonteknis laparoskopik kolesistektomi dengan optimal, sehingga rentan terpajan risiko melakukan laparoskopik kolesistektomi yang mengalami cedera duktus biliaris. Penguasaan keterampilan nonteknis sangat penting bagi seorang dokter bedah, namun bukti-bukti studi yang menguatkan peran itu masih terbatas, terlebih di Indonesia. Studi ini bertujuan menganalisis peran pembelajaran keterampilan nonteknis kognitif dan merumuskan modul pembelajarannya. Metode. Dilakukan penelitian mixed method dengan pendekatan kualitatif dengan survei perilaku dokter bedah dalam melakukan laparoskopik kolesistektomi, dilanjutkan dengan analisis video operasi menggunakan sistem penilaian video Objective Structured Assessment of Technical Skills (vOSATS) dan Critical View of Safety (CVS) score. Hasil analisis kedua data tersebut menjadi bahan untuk wawancara mendalam yang menggali lebih lanjut fenomena yang mendasari perilaku dalam laparoskopik kolesistektomi. Selanjutnya data tersebut digunakan untuk menyusun modul pembelajaran melalui consensus Delphi, berdasarkan kebutuhan pembelajaran yang telah dieksplorasi. Pendekatan kuantitatif dirancang untuk mengevaluasi hasil pembelajaran dalam studi kuasi eksperimental yang membandingkan keterampilan nonteknis kognitif pada kelompok modul dan kelompok regular.Hasil dan Pembahasan. Hasil penelitian tahap kualitatif menemukan perilaku laparoskopik kolesistektomi responden penelitian yang belum baik, ditunjukkan oleh proporsi cedera duktus biliaris selama karir yang dilaporkan 62,79%, pencapaian CVS yang tidak sempurna, penggunaan alat bantu yang tidak optimal, dan kecenderungan untuk terlambat melakukan konversi. Pembelajaran keterampilan nonteknis kognitif dalam laparoskopik kolesistektomi juga belum terstruktur dan mendalam. Konsensus Delphi menyusun modul pembelajaran keterampilan nonteknis kognitif dalam bentuk kuliah didaktik dan diskusi berbasis kasus, dengan instrumen evaluasi keterampilan nonteknis kognitif laparoskopik kolesistektomi yang sahih dan andal, dalam bentuk pilihan ganda dan concordance test. Tahap kuantitatif menunjukkan rerata skor pilihan ganda, skor concordance test dan skor total yang lebih tinggi dibandingkan dengan kelompok regular (p < 0,001; Uji Mann-Whitney).Kesimpulan. Penelitian ini telah berhasil menyusun modul pembelajaran dan instrument evaluasi keterampilan nonteknis kognitif yang dapat mengajarkan dan menilai keterampilan nonteknis kognitif dengan baik.

---

Background. The current focus of laparoscopic cholecystectomy training primarily emphasizes technical skills and does not fully utilize the non-technical laparoscopic cholecystectomy skills to their best potential. This leaves a vulnerability to the risk of bile duct injuries during laparoscopic cholecystectomy. Mastery of non-technical skills is crucial for a surgeon, yet there is limited evidence from studies supporting this role, especially in Indonesia. The purpose of this study is to analyze the role of cognitive non-technical skills learning and formulate its learning modules. Method. A mixed method research was conducted using a qualitative approach to survey the behavior of surgeons performing laparoscopic cholecystectomy, followed by an analysis of operation videos using the Objective Structured Assessment of Technical Skills (vOSATS) and Critical View of Safety (CVS) score. The analysis of both data sets serves as material for an in-depth interview that further explores the underlying phenomena of behavior in laparoscopic cholecystectomy. Subsequently, the data is utilized to construct a learning module through the Delphi consensus, based on the explored learning needs. The quantitative approach is designed to evaluate learning outcomes in quasi- experimental studies comparing cognitive non-technical skills between the module group and the normal group.

Results and Discussion. The findings of the qualitative research phase revealed suboptimal laparoscopic cholecystectomy behavior among the study respondents, as indicated by a reported 62.79% proportion of bile duct injuries during their careers, imperfect achievement of CVS, suboptimal use of assistive tools, and a tendency to delay conversion. The teaching of non-technical cognitive skills in laparoscopic cholecystectomy is also lacking structure and depth. The Delphi consensus developed a module for teaching cognitive non-technical skills in the form of didactic lectures and case-based discussions. The module includes a valid and reliable evaluation instrument for cognitive non-technical skills in laparoscopic cholecystectomy, in the form of multiple-choice and concordance tests. The quantitative stage demonstrates that the mean scores of multiple-choice questions, concordance test scores, and overall scores are higher compared to the regular group (p < 0.001; Mann-Whitney test).

Conclusion. This study has successfully developed a learning module and an evaluation instrument for cognitive non-technical skills that can effectively teach and assess cognitive non-technical skills."

"Pendahuluan dan tujuan: Obstruksi pada persimpangan ureteropelvic dapat ditangani dengan pembedahan atau laparoskopi. Laparoskopi pieloplasti (LP) menunjukkan hasil yang lebih baik dari pada pembedahan. Penelitian ini bertujuan untuk melaporkan pengalaman pertama dari laparoskopi pieloplasti sebagai penanganan pada UPJO. Bahan dan metode: Pengumpulan data retrospektif dilakukan di Rumah Sakit Adam Malik, Medan dari tahun 2017 hingga 2019. Pasien didiagnosa dengan UPJO melalui renogram atau CT Scan dan gejala yang muncul ditawarkan untuk dilakukan LP sebagai pilihan terapi. Surat persetujuan didapatkan setelah adanya penjelasan terkait resiko, alternative dan ilmu baru dari Teknik laparoskopi. Status selama operasi, yakni lama operasi, kehilangan darah, serta segala luaran yang negative, dilakukan pencatatan. Hasil: didapatkan total 10 pasien yang dilakukan LP dengan usia rerata adalah 6.10 (+ 3.64) tahun; pria dan wanita didapatkan sebanyak delapan (80%) dan dua (20%). Rata-rata waktu operasi adalah 291,00(+22,828) menit, sedangkan jumlah kehilangan darah selama operasi adalah 56.00 (+18,97)ml, dan lama perawatan adalah 5,7(+0,95) hari. Rerata waktu yang dibutuhkan untuk melakuakn aktifitas kembali adalah 7,30(+0,95) hari. Tiak ditemuan komplikasi setelah operasi pada seluruh pasien. Kami melakukan evalausi dengan USG dan menemukan adanya hidronefrosis ringan pada enam pasien (60%) dan sedang pada empat pasien (40%). Kesimpulan: Dari pengalaman pertama melakukan LP, Teknik ini ditemukan berpotensi sebagai terapi pilihan untuk pieloplasti pada kasus UPJO. Kami menemukan hasil yang sebanding dengan penelitian lain dalam hal waktu operasi dan jumlah kehilangan darah selama operasi yang lebih baik. LP dapat digunakan sebagai opsi lini pertama pada penanganan UPJO.

---

Introduction and objectives: Ureteropelvic junction obstruction (UPJO) can be treated with surgery or laparoscopy. Laparoscopic pyeloplasty (LP) has been shown to provide better results than surgery. This study aims to report our first experience of laparoscopy pyeloplasty as the management of UPJO. Materials and methods: Retrospective data collection were done in Adam Malik General Hospital, Medan from 2017 to 2019. Patients with UPJO diagnosed by renogram or CT scan and symptoms were offered LP as the treatment option. Informed consent was obtained after explanation about risks, alternatives, and novelty of the laparoscopic technique. Intraoperative status, including duration of operation, blood loss, and all negative outcome, was documented.

Results: A total of 10 patients underwent LP with the average of age was 6.10 (± 3.64) years old; male and female patients were eight (80%) and two (20%). The mean of operation time was 291.00 (±22.828) minutes, while intraoperative blood loss was 56.00 (±18.97) mL, and the length of stay was 5.70 (±0.95) days. The average time to perform daily activities was 7.30 (±0.95) days. No postoperative complication was found in all of our patients. We performed an USG evaluation and revealed mild hydronephrosis in six patients (60%) and moderate hydronephrosis in four patients (40%). Conclusion: From our first experience in performing LP, this technique was found to be a potential treatment option in pyeloplasty for UPJO. We found the comparable result to other studies in term of operative times and a better intraoperative blood loss. LP could be used as the first line option for management of UPJO."