Endoscopic RSS : Gourt

News and notices

News and notices Content Type Journal ArticleCategory News and noticesDOI 10.1007/s00464-009-0731-9 Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Upper gastrointestinal investigations before gastric banding

Abstract Background Long-term complications after laparoscopic gastric banding (LAGB) are frequent, leading to reoperations for a substantial number of patients. It is not known whether esophageal motility or the lower esophageal sphincter (LES) play a role in the development of complications. The results of preoperative upper gastrointestinal (GI) testing were compared with outcome after LAGB. Methods Before LAGB, 68 bariatric patients had esophageal manometry, endoscopy, and pH monitoring. For 61 of these patients (90% follow-up rate), the differences in weight loss, complications, and reoperation rate were retrospectively compared. Results Of these patients, 8.2% had a nonspecific motility disorder of the esophagus, 44.3% had an incompetent sphincter shown by manometry, and 17.5% had acid reflux shown by pH monitoring. Endoscopic evaluation showed esophagitis in 10.3% and hiatal hernia in 33.8% of the patients. Abnormal pH monitoring and endoscopic findings were not predictive for the long-term outcome or complications. The presence of an incompetent LES led to reoperation for a greater number of patients (44.4 vs. 14.7%; p = 0.01), especially if the band was placed using the pars flaccida technique. Conclusions Endoscopy and pH monitoring do not predict outcome for gastric banding and therefore have no relevance in the selection of patients for gastric banding. Patients with an incompetent LES shown by manometry had a higher reoperation rate. If this finding can be confirmed, patients with LES incompetence may need another intervention. Content Type Journal ArticleDOI 10.1007/s00464-009-0720-zAuthors Marco Bueter, University of Würzburg Department of Surgery Würzburg GermanyAndreas Thalheimer, University of Würzburg Department of Surgery Würzburg GermanyCarel W. le Roux, Hammersmith Hospital, Imperial College London Department of Metabolic Medicine Du Cane Road London W12 0NN UKAlexander Wierlemann, University of Würzburg Department of Surgery Würzburg GermanyFlorian Seyfried, University of Würzburg Department of Surgery Würzburg GermanyMartin Fein, University of Würzburg Department of Surgery Würzburg Germany Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Ergonomics of disposable handles for minimally invasive surgery

Abstract Background The ergonomic deficiencies of currently available minimally invasive surgery (MIS) instrument handles have been addressed in many studies. In this study, a new ergonomic pistol handle concept, realized as a prototype, and two disposable ring handles were investigated according to ergonomic properties set by new European standards. Methods In this study, 25 volunteers performed four practical tasks to evaluate the ergonomics of the handles used in standard operating procedures (e.g., measuring a suture and cutting to length, precise maneuvering and targeting, and dissection of a gallbladder). Moreover, 20 participants underwent electromyography (EMG) tests to measure the muscle strain they experienced while carrying out the basic functions (grasp, rotate, and maneuver) in the x, y, and z axes. The data measured included the number of errors, the time required for task completion, perception of pressure areas, and EMG data. The values for usability in the test were effectiveness, efficiency, and user satisfaction. Surveys relating to the subjective rating were completed after each task for each of the three handles tested. Results Each handle except the new prototype caused pressure areas and pain. Extreme differences in muscle strain could not be observed for any of the three handles. Experienced surgeons worked more quickly with the prototype when measuring and cutting a suture (~20%) and during precise maneuvering and targeting (~20%). On the other hand, they completed the dissection task faster with the handle manufactured by Ethicon. Fewer errors were made with the prototype in dissection of the gallbladder. In contrast to the handles available on the market, the prototype was always rated as positive by the volunteers in the subjective surveys. Conclusions None of the handles could fulfil all of the requirements with top scores. Each handle had its advantages and disadvantages. In contrast to the ring handles, the volunteers could fulfil most of the tasks more efficiently using the prototype handle without any remarkable pressure areas, cramps, or pain. Content Type Journal ArticleDOI 10.1007/s00464-009-0714-xAuthors D. Büchel, University Hospital of Tübingen Experimental OR and Ergonomics Ernst-Simon-Strasse 16 72072 Tübingen GermanyR. Mårvik, St. Olavs Hospital, Trondheim, Norwegian University of Science and Technology (NTNU) National Center for Advanced Laparoscopic Surgery Trondheim NorwayB. Hallabrin, University Hospital of Tübingen Experimental OR and Ergonomics Ernst-Simon-Strasse 16 72072 Tübingen GermanyU. Matern, University Hospital of Tübingen Experimental OR and Ergonomics Ernst-Simon-Strasse 16 72072 Tübingen Germany Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Long-term effects of laparoscopic sleeve gastrectomy, gastric bypass, and adjustable gastric banding on type 2 diabetes

Abstract Background This study aimed to compare the efficacy of laparoscopic sleeve gastrectomy (SG) with that of laparoscopic gastric bypass (GBP) and laparoscopic adjustable gastric banding (AGB) for glucose homeostasis in morbidly obese subjects with type 2 diabetes mellitus (T2DM) at a 3-year follow-up assessment and to elucidate the role of weight loss in the T2DM resolution after SG. Methods For this study, 60 morbidly obese T2DM patients (44 females and 16 males) who underwent AGB (24 patients), GBP (16 patients), or SG (20 patients) between 1996 and 2008 were retrospectively analyzed. Age, sex, body mass index (BMI), estimated weight loss (EWL), fasting glycemia, HbA1c, euglycemic hyperinsulinemic clamp, discontinuation of diabetes treatment, and time until interruption of therapy were evaluated. Results In the study, 54 patients received oral hypoglycemic agents for at least 12 months before surgery, and 6 patients received insulin. The mean follow-up period was 36 months. The resolution rate was 60.8% for the AGB patients, 81.2% for the GBP patients, and 80.9% for the SG patients. The postoperative time until interruption of therapy was 12.6 months for the AGB patients, 3.2 months for the GBP patients, and 3.3 months for the SG patients. The hyperinsulinemic euglycemic clamp test was performed 12 months after surgery for the cured patients. Insulin resistance was restored to normal values in all the patients. The greatest improvement from preoperative values occurred in the SG group. For the not-cured GBP and SG patients, an improvement of 120 mg/dl in fasting plasma glucose was observed 3 months after the surgery, suggesting an enhancement in insulin sensitivity, which determines better medical control. The resolution rate remained constant at the 36-month follow-up evaluation in both the GBP and SG groups. Conclusions All three bariatric procedures are effective in treating diabetes, with a 3-year follow-up evaluation showing an effect that lasts. The AGB procedure was the least effective. The antidiabetic effect was similarly precocious after GBP and SG compared with AGB. This difference may indicate that a hormonal mechanism may be involved, independent of weight loss. Content Type Journal ArticleDOI 10.1007/s00464-009-0715-9Authors F. Abbatini, University “La Sapienza” Department of Surgical-Medical Digestive Diseases, Policlinico “Umberto I” Viale del Policlinico 00161 Rome ItalyM. Rizzello, University “La Sapienza” Department of Surgical-Medical Digestive Diseases, Policlinico “Umberto I” Viale del Policlinico 00161 Rome ItalyG. Casella, University “La Sapienza” Department of Surgical-Medical Digestive Diseases, Policlinico “Umberto I” Viale del Policlinico 00161 Rome ItalyG. Alessandri, University “La Sapienza” Department of Surgical-Medical Digestive Diseases, Policlinico “Umberto I” Viale del Policlinico 00161 Rome ItalyD. Capoccia, University “La Sapienza” Department of Clinical Sciences, Policlinico “Umberto I” Rome ItalyF. Leonetti, University “La Sapienza” Department of Clinical Sciences, Policlinico “Umberto I” Rome ItalyN. Basso, University “La Sapienza” Department of Surgical-Medical Digestive Diseases, Policlinico “Umberto I” Viale del Policlinico 00161 Rome Italy Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Ten years of Swedish experience with intraductal electrohydraulic lithotripsy and laser lithotripsy for the treatment of difficult bile duct stones: an effective and safe option for octogenarians

Abstract Background Endoscopic procedures using electrohydraulic lithotripsy (EHL) or intraductal laser lithotripsy (ILL) are the methods of choice for managing difficult common bile duct (CBD) stones. This retrospective study examined 10 years of Swedish experience using a mother-baby endoscopic system to assist in the fragmentation of CBD stones by EHL and ILL. Methods Between 1995 and 2006, 44 patients with a median age of 80 years underwent EHL or ILL at two Swedish centers after conventional endoscopic fragmentation of CBD stones had failed. Long-term follow-up assessment was conducted for 9 to 126 months (median, 53 months). Results Final stone clearance after EHL or ILL treatment with or without additional conventional endoscopic retrograde cholangiopancreatography (ERCP) was achieved for 34 (77%) of 44 patients. The results for 10 patients (23%) were defined as failures. Complete or partial stone fragmentation and definitive duct clearance were achieved in one session for 23 patients (52%). A second EHL or ILL attempt made in five cases of primary failure led to definitive stone clearance in three cases. Two patients experienced perioperative complications (stone basket impaction). Mild post-ERCP pancreatitis occurred for one patient and cholangitis for two patients. During long-term follow-up evaluation, recurrent CBD stones were found in one patient. Content Type Journal ArticleDOI 10.1007/s00464-009-0716-8Authors Fredrik Swahn, Karolinska University Hospital Huddinge Department of Surgery Stockholm SwedenGunnar Edlund, Östersund Hospital Department of Surgery Östersunds sjukhus 831 83 Östersund SwedenLars Enochsson, Karolinska University Hospital Huddinge Department of Surgery Stockholm SwedenConny Svensson, Östersund Hospital Department of Surgery Östersunds sjukhus 831 83 Östersund SwedenBo Lindberg, Intervention and Technology (CLINTEC), Karolinska Institutet Department of Clinical Science Stockholm SwedenUrban Arnelo, Karolinska University Hospital Huddinge Department of Surgery Stockholm Sweden Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Short-term outcomes of laparoscopic total mesorectal excision following neoadjuvant chemoradiotherapy

Abstract Objective To investigate the feasibility of laparoscopic total mesorectal excision (TME) in mid and lower rectal cancers following neoadjuvant chemoradiation (nCRT). Background The laparoscopic approach for colon cancer has been widely accepted. A few studies have shown that there are advantages of laparoscopic over open TME surgery for rectal cancer. However, the role of laparoscopy has not been clearly defined specifically in cases following nCRT. Methods All patients with rectal cancer who underwent nCRT were identified; no operations for rectal carcinoma were performed laparoscopically between 1997 and 2005. The laparoscopic cases were matched to open cases based on gender, procedure, age, and body mass index (BMI). The medical records were reviewed and short-term outcome was compared between these two groups. Statistical analysis was performed using SPSS© 15 software. Results Between 2002 and 2008, 64 patients were identified, including 32 patients who underwent laparoscopic surgery and 32 who had a laparotomy. There was no difference between the two groups based on gender, procedure, age, BMI or American Society of Anesthesiologists (ASA) classification. The procedures performed within each group included 8 abdominoperineal resections and 24 anterior resections, which included 20 colonic J-pouch-anal anastomoses and 4 straight coloanal anastomoses. In the laparoscopic group, 12 patients underwent totally laparoscopic operations, 12 were either laparoscopic-assisted or hand-assisted procedures, and 8 were converted to laparotomy. The reasons for conversion included bleeding, splenic injury, and difficult anatomy. There were no differences in comorbidities, tumor location, tumor size, tumor stage or radiation dose between the two groups. Operative time was longer in the laparoscopic group (267 ± 76 versus 205 ± 49 min, p < 0.001). Operative blood loss, complication rate, and mortality rate were all similar between the two groups. However, the laparoscopic group benefited from shorter length of stay (6.1 ± 2.4 versus 7.6 ± 2.3 days, p = 0.012), earlier first bowel movement (1.9 ± 1 versus 3.3 ± 2.4 days, p = 0.006), and shorter time to regular diet (3.9 ± 2.1 versus 5.8 ± 2.5 days, p = 0.003). There was no difference in lymph node harvest (both positive node harvest and total lymph node harvest), distal margin or radial margin. Conclusions In our experience, laparoscopic TME for mid and lower rectal cancer is feasible and safe. Patients benefit from the short-term advantages of laparoscopy, including shorter length of hospital stay, time to tolerating a regular diet, and time to first bowel movement or stoma function. Although there were no short-term differences in oncologic parameters, the long-term oncologic outcome requires further investigation. Content Type Journal ArticleDOI 10.1007/s00464-009-0702-1Authors P. Denoya, Cleveland Clinic Blvd Department of Colorectal Surgery 2950 Weston Fl 33331 USAH. Wang, Cleveland Clinic Blvd Department of Colorectal Surgery 2950 Weston Fl 33331 USAD. Sands, Cleveland Clinic Blvd Department of Colorectal Surgery 2950 Weston Fl 33331 USAJ. Nogueras, Cleveland Clinic Blvd Department of Colorectal Surgery 2950 Weston Fl 33331 USAE. Weiss, Cleveland Clinic Blvd Department of Colorectal Surgery 2950 Weston Fl 33331 USASteven D. Wexner, Cleveland Clinic Blvd Department of Colorectal Surgery 2950 Weston Fl 33331 USA Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Mixed reality for robotic treatment of a splenic artery aneurysm

Abstract Background Techniques of mixed reality can successfully be used in preoperative planning of laparoscopic and robotic procedures and to guide surgical dissection and enhance its accuracy. Methods A computer-generated three-dimensional (3D) model of the vascular anatomy of the spleen was obtained from the computed tomography (CT) dataset of a patient with a 3-cm splenic artery aneurysm. Using an environmental infrared localizer and a stereoscopic helmet, the surgeon can see the patient’s anatomy in transparency (augmented or mixed reality). This arrangement simplifies correct positioning of trocars and locates surgical dissection directly on top of the aneurysm. In this way the surgeon limits unnecessary dissection, leaving intact the blood supply from the short gastric vessels and other collaterals. Based on preoperative planning, we were able to anticipate that the vascular exclusion of the aneurysm would result in partial splenic ischemia. To re-establish the flow to the spleen, end-to-end robotic anastomosis of the splenic artery with the Da Vinci surgical system was then performed. Finally, the aneurysm was fenestrated to exclude arterial refilling. Results The postoperative course was uneventful. A control CT scan 4 weeks after surgery showed a well-perfused and homogeneous splenic parenchyma. The final 3D model showed the fenestrated calcified aneurysm and patency of the re-anastomosed splenic artery. Conclusions The described technique of robotic vascular exclusion of a splenic artery aneurysm, followed by re-anastomosis of the vessel, clearly demonstrates how this technology can reduce the invasiveness of the procedure, obviating an otherwise necessary splenectomy. Also, the use of intraoperative mixed-reality technology proved very useful in this case and is expected to play an increasing role in the operating room of the future. Content Type Journal ArticleCategory VideoDOI 10.1007/s00464-009-0703-0Authors Andrea Pietrabissa, Università di Pisa Sezione di Chirurgia Mininvasiva, Divisione di Chirurgia I Universitaria, Dipartimento di Oncologia, dei Trapianti e Delle Nuove Tecnologie in Medicina Ospedale di Cisanello, via Paradisa 2 56124 Pisa ItalyLuca Morelli, Università di Pisa Sezione di Chirurgia Mininvasiva, Divisione di Chirurgia I Universitaria, Dipartimento di Oncologia, dei Trapianti e Delle Nuove Tecnologie in Medicina Ospedale di Cisanello, via Paradisa 2 56124 Pisa ItalyMauro Ferrari, Università di Pisa Divisione di Chirurgia Vascolare, Dipartimento di Oncologia, dei Trapianti e Delle Nuove Tecnologie in Medicina Pisa ItalyAndrea Peri, Università di Pisa Sezione di Chirurgia Mininvasiva, Divisione di Chirurgia I Universitaria, Dipartimento di Oncologia, dei Trapianti e Delle Nuove Tecnologie in Medicina Ospedale di Cisanello, via Paradisa 2 56124 Pisa ItalyVincenzo Ferrari, Università di Pisa Center for Computer Assisted Surgery ENDOCAS Pisa ItalyAndrea Moglia, Università di Pisa Center for Computer Assisted Surgery ENDOCAS Pisa ItalyLuigi Pugliese, Università di Pisa Sezione di Chirurgia Mininvasiva, Divisione di Chirurgia I Universitaria, Dipartimento di Oncologia, dei Trapianti e Delle Nuove Tecnologie in Medicina Ospedale di Cisanello, via Paradisa 2 56124 Pisa ItalyFabio Guarracino, Azienda Ospedaliero-Universitaria Pisana Divisione di Anestesiologia Pisana ItalyFranco Mosca, Università di Pisa Sezione di Chirurgia Mininvasiva, Divisione di Chirurgia I Universitaria, Dipartimento di Oncologia, dei Trapianti e Delle Nuove Tecnologie in Medicina Ospedale di Cisanello, via Paradisa 2 56124 Pisa Italy Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Favorable outcomes with laparoscopic surgery for rectal cancer

Favorable outcomes with laparoscopic surgery for rectal cancer Content Type Journal ArticleCategory LetterDOI 10.1007/s00464-009-0713-yAuthors T. Liakakos, University of Athens 3rd Surgical Department Athens GreeceK. Kopanakis, University of Athens 3rd Surgical Department Athens GreeceD. Schizas, University of Athens 3rd Surgical Department Athens Greece Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

The esophageal hiatus: what is the normal size?

Abstract Background A hiatal hernia is defined as the protrusion of intra-abdominal organs through a dilated esophageal hiatus. The esophageal hiatus and its function have been described extensively, but an exact anatomical determination of its normal size is lacking. It seems important to define the normal size, as crural closure is an important part of surgical treatment of gastroesophageal reflux disease (GERD) and hiatal or paraesophageal hernias. The aim of this study was to determine normal values for the size of the esophageal hiatus. Methods In a prospective study 50 consecutive cadaver autopsies were performed between February and May 2008. The subjects had died from several diseases not related to GERD. Size of the esophageal hiatus was measured after opening the abdominal cavity before extirpation of any organs. Distance of the cardia and gastroesophageal junction and position of the angle of His were further measured. A formula was used to calculate the hiatal surface area (HSA). Results were analyzed regarding subject height, weight, body mass index (BMI), and chest circumference. Results In all 50 cadavers (24 male/26 female) the autopsy was performed and all measurements were obtained. Mean age was 74 years (40–90 years), mean height was 1.68 m (1.39–1.83 m), mean weight was 71 kg (40–120 kg), and mean body mass index (BMI) was 25 kg/m2 (14–40 kg/m2). Mean chest circumference was 101 cm (75–178 range). Mean HSA was 5.84 cm2 (3.62–9.56 cm2). In all cadavers the gastroesophageal junction was intraabdominal, the mean distance to the angle of His was 3.6 cm (2.7–4.6 cm), the mean length of the right and left crura was similar at 3.6 cm (2.7–4.6 cm), and the opening segment had a mean length of 2.4 cm (1.7–4.0 cm). Conclusion The mean HSA was determined in these normal subjects to be 5.84 cm2. It was directly proportional to chest circumference and independent of height, weight, BMI, and gender. Content Type Journal ArticleDOI 10.1007/s00464-009-0711-0Authors A. Shamiyeh, AKH Linz, Academic Teaching Hospital Ludwig Boltzmann Institute for Operative Laparoscopy, II. Surgical Department Krankenhausstrasse 9 4020 Linz AustriaK. Szabo, AKH Linz, Academic Teaching Hospital Ludwig Boltzmann Institute for Operative Laparoscopy, II. Surgical Department Krankenhausstrasse 9 4020 Linz AustriaF. A. Granderath, Neuwerk Hospital Department of General and Visceral Surgery Mönchengladbach GermanyG. Syré, Academic Teaching Hospital AKH Linz Department of Pathology Linz AustriaW. Wayand, AKH Linz, Academic Teaching Hospital Ludwig Boltzmann Institute for Operative Laparoscopy, II. Surgical Department Krankenhausstrasse 9 4020 Linz AustriaJ. Zehetner, AKH Linz, Academic Teaching Hospital Ludwig Boltzmann Institute for Operative Laparoscopy, II. Surgical Department Krankenhausstrasse 9 4020 Linz Austria Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Appropriateness of splenectomy for advanced cancer located in the upper third of the stomach

Appropriateness of splenectomy for advanced cancer located in the upper third of the stomach Content Type Journal ArticleCategory LetterDOI 10.1007/s00464-009-0710-1Authors Shinichi Sakuramoto, Kitasato University School of Medicine Department of Surgery 2-1-1 Asamizodai Sagamihara, Kanagawa 228-8520 JapanKeishi Yamashita, Kitasato University School of Medicine Department of Surgery 2-1-1 Asamizodai Sagamihara, Kanagawa 228-8520 JapanMasahiko Watanabe, Kitasato University School of Medicine Department of Surgery 2-1-1 Asamizodai Sagamihara, Kanagawa 228-8520 Japan Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

News and Notices

News and Notices Content Type Journal ArticleCategory News and noticesDOI 10.1007/s00464-009-0709-7 Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

The frontal cortex is activated during learning of endoscopic procedures (Ohuchida et al., Surgical Endoscopy, January 2009)

The frontal cortex is activated during learning of endoscopic procedures (Ohuchida et al., Surgical Endoscopy, January 2009) Content Type Journal ArticleCategory LetterDOI 10.1007/s00464-009-0704-zAuthors Daniel R. Leff, Imperial College London Division of Surgery, Oncology, Reproductive Biology and Anaesthetics, Department of Biosurgery and Surgical Technology 10th Floor, QEQM Building, St Mary’s Hospital, Praed Street London W2 1NY UKDavid R. C. James, Imperial College London Division of Surgery, Oncology, Reproductive Biology and Anaesthetics, Department of Biosurgery and Surgical Technology 10th Floor, QEQM Building, St Mary’s Hospital, Praed Street London W2 1NY UKFelipe Orihuela-Espina, Imperial College London Division of Surgery, Oncology, Reproductive Biology and Anaesthetics, Department of Biosurgery and Surgical Technology 10th Floor, QEQM Building, St Mary’s Hospital, Praed Street London W2 1NY UKGuang-Zhong Yang, Imperial College of Science, Technology, and Medicine Royal Society/Wolfson MIC Laboratory, 305/306 Huxley Building, Department of Computing, 180 Queens Gate London SW7 2BZ UKAra W. Darzi, Imperial College London Division of Surgery, Oncology, Reproductive Biology and Anaesthetics, Department of Biosurgery and Surgical Technology 10th Floor, QEQM Building, St Mary’s Hospital, Praed Street London W2 1NY UK Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Esophageal dilation after gastric banding: to test or not to test before surgery?

Esophageal dilation after gastric banding: to test or not to test before surgery? Content Type Journal ArticleCategory LetterDOI 10.1007/s00464-009-0706-xAuthors François Mion, Hospices Civils de Lyon Digestive Physiology Pavillon H, Hôpital E. Herriot 69437 Lyon Cedex 03 FranceSabine Roman, Hospices Civils de Lyon Digestive Physiology Pavillon H, Hôpital E. Herriot 69437 Lyon Cedex 03 FranceValérie Lindecker, Haute Autorité de Santé St. Denis France Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Re: Surg Endosc (2009) 23:1142–1145, DOI:10.1007/s00464-009-0382-x (published online 5 March 2009). Erica P. Podolsky, Steven J. Rottman, Paul G. Curcillo II. Single Port Access (SPA™) gastrostomy tube in patients unable to receive percutaneous endoscopic gastrostomy placement

Re: Surg Endosc (2009) 23:1142–1145, DOI:10.1007/s00464-009-0382-x (published online 5 March 2009). Erica P. Podolsky, Steven J. Rottman, Paul G. Curcillo II. Single Port Access (SPA™) gastrostomy tube in patients unable to receive percutaneous endoscopic gastrostomy placement Content Type Journal ArticleCategory LetterDOI 10.1007/s00464-009-0705-yAuthors Philip Cheng Hin Ng, University Hospital Lewisham London SE13 6LH UK Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Treatment of primary spontaneous pneumothorax by videothoracoscopic talc pleurodesis under local anesthesia: a review of 133 procedures

Abstract Aim To review our experience of treatment of primary spontaneous pneumothorax by videothoracoscopic talc pleurodesis. Methods From 2000 to 2008, 124 consecutive patients with primary spontaneous pneumothorax were operated; 105 were men (84.7%) and 19 were women (15.3%) with a mean age of 26.6 years (range 17–46 years). Results No mortality was recorded. Staging according to Vanderschueren’s classification was as follows: stage I, 61 patients (45.9%); stage II, 39 patients (29.3%); stage III, 31 patients (23.3%); stage IV, two patients (1.5%). The overall rate of complications was 9% (12/133), corresponding to prolonged air leak in 9(6.7%) patients and hemothorax in 3(2.2%) patients. Four patients (3%) had recurrence requiring reoperation. There were no episodes of acute respiratory failure, pneumonia or subcutaneous emphysema following talc pleurodesis. Conclusions Thoracoscopic pleural talc pleurodesis as a treatment for recurrent pneumothorax is easy, safe, and rapid, and causes minimal morbidity and mortality. Content Type Journal ArticleDOI 10.1007/s00464-009-0707-9Authors R. Ramos-Izquierdo, Hospital Universitari de Bellvitge, School of Medicine, University of Barcelona Department of Thoracic Surgery and Unit of Human Anatomy and Embryology, Servei de Cirurgia Toràcica Feixa Llarga s/n 08907 L’Hospitalet de Llobregat SpainJ. Moya, Hospital Universitari de Bellvitge Department of Thoracic Surgery L’Hospitalet de Llobregat SpainI. Macia, Hospital Universitari de Bellvitge Department of Thoracic Surgery L’Hospitalet de Llobregat SpainF. Rivas, Hospital Universitari de Bellvitge Department of Thoracic Surgery L’Hospitalet de Llobregat SpainA. Ureña, Hospital Universitari de Bellvitge Department of Thoracic Surgery L’Hospitalet de Llobregat SpainG. Rosado, Hospital Universitari de Bellvitge Department of Thoracic Surgery L’Hospitalet de Llobregat SpainI. Escobar, Hospital Universitari de Bellvitge Department of Thoracic Surgery L’Hospitalet de Llobregat SpainJ. Saumench, Hospital Universitari de Bellvitge Department of Thoracic Surgery L’Hospitalet de Llobregat SpainA. Cabrera, Hospital Universitari de Bellvitge Department of Anesthesiology L’Hospitalet de Llobregat SpainM. A. Delgado, Hospital Universitari de Bellvitge Department of Anesthesiology L’Hospitalet de Llobregat SpainR. Villalonga, Hospital Universitari de Bellvitge Department of Anesthesiology L’Hospitalet de Llobregat Spain Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Clinical outcomes for perforations during endoscopic submucosal dissection in patients with gastric lesions

Abstract Background The endoscopic submucosal dissection (ESD) technique has been gaining popularity, with continued advances in this treatment approach. However, ESD still is associated with potential complications such as severe bleeding and perforation. Methods This study was performed to compare the clinical outcomes for macro- and microperforations with ESD procedures and to determine the short-term prognosis after ESD. A macroperforation was defined as a gross perforation that occurred during an ESD procedure, and a microperforation was defined by free air observed on simple radiography after the procedure. Immediate closure of macroperforations was performed using endoclips. From July 2003 through May 2008, 1,711 patients underwent ESD for gastric lesions such as dysplasia, early cancer, and subepithelial lesions. Results Among 39 perforation cases (2.3%), macroperforations occurred for 26 patients (67%) and microperforations for 13 patients (33%). All the patients except one who underwent emergency surgery because of severe bleeding and perforation during ESD were managed successfully by intravenous antibiotics and no oral intake. The clinical prognosis and endoscopic characteristics of the patients with macroperforations did not differ from those of the patients with microperforations. Conclusions Perforations associated with ESD could be managed safely and successfully by nonsurgical methods. The clinical prognoses for macro- and microperforations were favorable and comparable. Content Type Journal ArticleDOI 10.1007/s00464-009-0693-yAuthors Seong Woo Jeon, Kyungpook National University School of Medicine Department of Internal Medicine Daegu South KoreaMin Kyu Jung, Kyungpook National University School of Medicine Department of Internal Medicine Daegu South KoreaSung Kook Kim, Kyungpook National University School of Medicine Department of Internal Medicine Daegu South KoreaKwang Bum Cho, Keimyung University College of Medicine Department of Internal Medicine Daegu South KoreaKyung Sik Park, Keimyung University College of Medicine Department of Internal Medicine Daegu South KoreaChang Keun Park, Fatima Hospital Department of Internal Medicine Daegu South KoreaJoong Goo Kwon, Daegu Catholic University School of Medicine Department of Internal Medicine Daegu South KoreaJin Tae Jung, Daegu Catholic University School of Medicine Department of Internal Medicine Daegu South KoreaEun Young Kim, Daegu Catholic University School of Medicine Department of Internal Medicine Daegu South KoreaTae Nyeun Kim, Youngnam University School of Medicine Department of Internal Medicine Daegu South KoreaByung Ik Jang, Youngnam University School of Medicine Department of Internal Medicine Daegu South KoreaChang Hun Yang, Dongguk University School of Medicine Department of Internal Medicine 707, Seokjang-dong Gyeongju Gyeongsangbuk-do 780-714 South Korea Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Long-term outcome of laparoscopic Nissen and laparoscopic Toupet fundoplication for gastroesophageal reflux disease: a prospective, randomized trial

Abstract Background A prospective, randomized trial was performed to evaluate the long-term outcome and patient satisfaction of laparoscopic complete 360° fundoplication compared with partial posterior 270° fundoplication. Partial fundoplication is purported to have fewer side effects with a higher failure rate in controlling gastroesophageal reflux disease (GERD), while complete fundoplication is thought to result in more dysphagia and gas-related symptoms. Methods Patients were randomized to either laparoscopic Nissen (LN) or laparoscopic Toupet (LT) fundoplication. Esophageal manometry, 24-h pH studies, a detailed questionnaire, and a visual analog symptom (VAS) score were completed before and after surgery. A final global outcome questionnaire was performed. Failure was defined as recurrent GERD requiring revision surgery, maintenance proton pump inhibitor (PPI) therapy, or surgery for postoperative dysphagia. Results One hundred patients were randomized to LN (50) or LT (50). There were no differences between LN and LT with respect to postoperative symptoms and physiological variables except a higher wrap pressure in the LN group (15.2 vs. 12.0 mmHg). Dysmotility improved in 8/14 (57%) and 6/11 (54%) patients in the LN group and the LT group, respectively, after surgery. There was no correlation between dysmotility and dysphagia both pre- and post surgery in the two groups. Recurrent symptoms of GERD occurred in 8/47 (17.0%) and 8/48 (16.6%) in the LN group and the LT group, respectively. Outcome of patients with dysmotility was similar to those with normal motility in both groups. At final follow-up (59.76 ± 24.23 months), in the LN group, 33/37 (89.1%) would recommend surgery to others, 32/37 (86.4%) would have repeat surgery, and 34/37 (91.8%) felt they were better off than before surgery. The corresponding numbers for the LT group (follow-up = 55.18 ± 25.97 months) were 35/36 (97.2%), 30/36 (83.3%), and 33/36 (91.6%). Conclusion LN and LT are equally effective in restoring the lower esophageal sphincter function and provide similar long-term control of GERD with no difference in dysphagia. Esophageal dysmotility had no influence on the outcome of either operation. Content Type Journal ArticleDOI 10.1007/s00464-009-0700-3Authors John M. Shaw, University of Cape Town Department of Surgery, J45 OMB, Health Sciences Faculty Anzio Road, Observatory 7925 Cape Town South AfricaPhilippus C. Bornman, University of Cape Town Department of Surgery, J45 OMB, Health Sciences Faculty Anzio Road, Observatory 7925 Cape Town South AfricaMarie D. Callanan, Groote Schuur Hospital Surgical Gastroenterology Unit Observatory 7925 Cape Town South AfricaIan J. Beckingham, Nottingham University Hospitals NHS Trust Nottingham NG7 2UH UKDavid C. Metz, University of Pennsylvania School of Medicine Division of Gastroenterology Philadelphia PA 92103 USA Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Do absorption and realistic distraction influence performance of component task surgical procedure?

Abstract Background Surgeons perform complex tasks while exposed to multiple distracting sources that may increase stress in the operating room (e.g., music, conversation, and unadapted use of sophisticated technologies). This study aimed to examine whether such realistic social and technological distracting conditions may influence surgical performance. Methods Twelve medical interns performed a laparoscopic cholecystectomy task with the Xitact LC 3.0 virtual reality simulator under distracting conditions (exposure to music, conversation, and nonoptimal handling of the laparoscope) versus nondistracting conditions (control condition) as part of a 2 x 2 within-subject experimental design. Results Under distracting conditions, the medical interns showed a significant decline in task performance (overall task score, task errors, and operating time) and significantly increased levels of irritation toward both the assistant handling the laparoscope in a nonoptimal way and the sources of social distraction. Furthermore, individual differences in cognitive style (i.e., cognitive absorption and need for cognition) significantly influenced the levels of irritation experienced by the medical interns. Conclusion The results suggest careful evaluation of the social and technological sources of distraction in the operation room to reduce irritation for the surgeon and provision of proper preclinical laparoscope navigation training to increase security for the patient. Content Type Journal ArticleDOI 10.1007/s00464-009-0689-7Authors Jon R. Pluyter, Tilburg University Department of Information Systems and Management Warandelaan 2 5037 AB Tilburg The NetherlandsSonja N. Buzink, Catharina Hospital Eindhoven Department of Surgery Michelangelolaan 2 P.O. Box 1350 5602 ZA Eindhoven The NetherlandsAnne-F. Rutkowski, Tilburg University Department of Information Systems and Management Warandelaan 2 5037 AB Tilburg The NetherlandsJack J. Jakimowicz, Catharina Hospital Eindhoven Department of Surgery Michelangelolaan 2 P.O. Box 1350 5602 ZA Eindhoven The Netherlands Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

SAGES guideline for laparoscopic appendectomy

SAGES guideline for laparoscopic appendectomy Content Type Journal ArticleCategory GuidelinesDOI 10.1007/s00464-009-0632-yAuthors James R. Korndorffer, Tulane University School of Medicine Department of Surgery New Orleans LA USAErika Fellinger, Cambridge Health Alliance Department of Surgery Cambridge MA USAWilliam Reed, Winthrop University Hospital Department of Surgery Mineola NY USA Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794

Reply to 464-009-531: Re: ‘New horizons in colorectal cancer surgery’ ((2009)23:1–3)

Reply to 464-009-531: Re: ‘New horizons in colorectal cancer surgery’ ((2009)23:1–3) Content Type Journal ArticleCategory Letter--ReplyDOI 10.1007/s00464-009-0530-3Authors M. H. G. M. van der Pas, VU University Medical Center Department of Surgery Amsterdam The NetherlandsW. J. H. J. Meijerink, VU University Medical Center Department of Surgery Amsterdam The Netherlands Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794