SAGES » Abstracts http://www.sages.org Society of American Gastrointestinal and Endoscopic Surgeons Fri, 24 Oct 2014 19:53:15 +0000 en-US hourly 1 http://wordpress.org/?v=4.0 A rare case of Hepatic Flexure Diverticulitis after pelvic laparoscopy and review of literature for management.http://www.sages.org/meetings/annual-meeting/abstracts-archive/a-rare-case-of-hepatic-flexure-diverticulitis-after-pelvic-laparoscopy-and-review-of-literature-for-management/ http://www.sages.org/meetings/annual-meeting/abstracts-archive/a-rare-case-of-hepatic-flexure-diverticulitis-after-pelvic-laparoscopy-and-review-of-literature-for-management/#respond Thu, 21 Aug 2014 07:04:20 +0000 http://www.sages.org/meetings/annual-meeting/abstracts-archive/a-rare-case-of-hepatic-flexure-diverticulitis-after-pelvic-laparoscopy-and-review-of-literature-for-management/ Aniket K Sakharpe, MD, MPH, Jakub Wilhelm, MD, Nida Mumtaz, BS, Abdul Badr, MD, Robert Bloch, MD, FACS, Leopoldo Baccaro, MD, George Ibrahim, MD. Drexel University and Easton Hospital. Diverticulosis commonly affects the geriatric patients, 10-15% of whom ultimately develop diverticulitis. Diverticulitis has many known complications, such as the formation of phlegmon, fistulas, bowel obstruction, […]

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Aniket K Sakharpe, MD, MPH, Jakub Wilhelm, MD, Nida Mumtaz, BS, Abdul Badr, MD, Robert Bloch, MD, FACS, Leopoldo Baccaro, MD, George Ibrahim, MD. Drexel University and Easton Hospital.

Diverticulosis commonly affects the geriatric patients, 10-15% of whom ultimately develop diverticulitis. Diverticulitis has many known complications, such as the formation of phlegmon, fistulas, bowel obstruction, bleeding, perforation and colonic abscess. Diverticulitis in the western world most commonly affects the sigmoid colon and presents as “left-sided appendicitis” in that location. A perforated sigmoid diverticulum is often recognized preoperatively. Diverticulosis involving the transverse colon, however, is a rare finding and a perforated diverticulum of thehepatic flexure is seldom considered in the differential diagnosis of acute abdomen. Right sided diverticulitis lacks the more specific signs and symptoms of sigmoid diverticulitis and is therefore a more difficult diagnosis based on clinical exam alone .We present a rare case of perforated hepatic flexure diverticulitis in a 57-year-old female who presented with free air in the abdomen after pelvic laproscopy.

The patient presented with a 5 day history of acute non-radiating right upper quadrant pain, which worsened with motion. A diagnostic laparoscopy done 5 days before for an ovarian cyst that was abandoned due to multiple intrabdominal adhesions in the pelvic area. Patient was tachycardic and febrile, the abdomen was soft, distended with rebound tenderness in the right upper quadrant. Laboratory studies revealed elevated white blood cell count of 15,000/ mL with 53% bands. We expected some iatrogenic injury to the lower colon but to our surprise noncontrast CT of the abdomen and pelvis revealed interloop bowel abscess with a lot of free air and thickening of the proximal transverse colon. On exploratory laparotomy patient was found to have a diverticular abscess due to perforated diverticula in the hepatic flexure and short segment of the proximal transverse colon. A partial transverse colectomy with end colostomy and distal mucus fistula was performed. The postoperative course was complicated by an intrabdominal abscess treated conservatively. The patient had reversal of the colostomy with colo-colonic anastomosis.

Diverticulitis frequently involves the sigmoid colon in Western populations and the right-sided colon in Asian populations.Extensive literature search indicates that 80% of patients with diverticulosis had diverticula in the descending and sigmoid colon, 10% in the transverse colon, 4% in the ascending and 2% in the cecum.Transverse colon diverticulitis can be managed with both medical and surgical interventions.

In conclusion transverse colon diverticulitis is a rare cause of acute abdomen and needs to be included in the differential diagnosis of our aging population

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Reducing Stray Energy Burns During Laparoscopic Surgeryhttp://www.sages.org/meetings/annual-meeting/abstracts-archive/reducing-stray-energy-burns-during-laparoscopic-surgery/ http://www.sages.org/meetings/annual-meeting/abstracts-archive/reducing-stray-energy-burns-during-laparoscopic-surgery/#respond Thu, 21 Aug 2014 06:57:43 +0000 http://www.sages.org/meetings/annual-meeting/abstracts-archive/reducing-stray-energy-burns-during-laparoscopic-surgery/ Jeffrey L Eakin. Pioneer Valley Hospital and Jordan Valley Medical Center. Coupling of energy through the outer insulation of conventional monopolar laparoscopic instruments has been a problem since the inception of minimally invasive surgery (MIS).  This stray energy may be coupled through a hole in the instrument’s outer insulation or through intact insulation by capacitive […]

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Jeffrey L Eakin. Pioneer Valley Hospital and Jordan Valley Medical Center.

Coupling of energy through the outer insulation of conventional monopolar laparoscopic instruments has been a problem since the inception of minimally invasive surgery (MIS).  This stray energy may be coupled through a hole in the instrument’s outer insulation or through intact insulation by capacitive coupling, both of which can burn a patient intraoperatively.  These stray energy burns can be catastrophic for patients.  Additionally these patient burns cost hospitals a substantial amount of money through CMS penalties, readmissions, and medico-legal expenses.  Encision’s new AEM EndoShield™ Protection System completely eliminates the risk of stray energy burns to patients during laparoscopy, improving patient outcomes and adding value to hospitals. 

 

The AEM EndoShield provides the electrical connection between an Electrosurgical Generator (ESU) and a MIS AEM instrument.  It actively monitors the AEM instrument’s protective shield throughout a procedure, eliminating the risk of capacitive coupling to the patient by draining the energy away from the patient to the AEM monitor. If an insulation failure occurs, the AEM EndoShield system actively drains the electrosurgical energy away from the patient through this protective shield.  In addition the AEM EndoShield immediately shuts down the instrument power, similar to a circuit breaker (GFCI) in the electrical wiring of a house.  The AEM EndoShield can be used with any compatible ESU, in any mode, at very high power settings (up  to 80 W).  This allows physicians complete flexibility to use an ESU’s full capability, generating the tissue effect they need, while guaranteeing the elimination of stray energy burns to patients. 

 

The AEM EndoShield has been shown to completely eliminate stray energy burns to patients, from capacitive coupling and insulation failure.  It has passed an independent review for 3rd edition electrical safety testing (IEC 60601-1) and the 510k application for the device was submitted December 31st, 2013.  By eliminating stray energy burns to patients, the AEM EndoShield helps physicians improve patient outcomes and avoid readmissions.  It also adds value to hospitals by helping avoid CMS HAC reduction penalties, the direct cost of a readmissions, and medico-legal expenses. 

 

The EndoShield is anticipated to be available in late spring 2014.  It will initially be launched with a compatibility list that includes the most popular ESUs on the US market.  The design of the EndoShield is universal and will allow compatibility with next generation ESUs as well.  As new ESUs come out, the EndoShield compatibility list will be expanded through extensive verification and validation testing.  This will allow the AEM EndoShield to be implemented in any physician’s OR, providing them with the Encision hold harmless guarantee to eliminate stray energy burns.  With the changing face of healthcare, the EndoShield will help physicians and hospitals stay ahead of the curve by improving patient outcomes while also saving money. 

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A Novel Fully Endoscopic, Endoluminal Gastric Bypass for the Treatment of Morbid Obesityhttp://www.sages.org/meetings/annual-meeting/abstracts-archive/a-novel-fully-endoscopic-endoluminal-gastric-bypass-for-the-treatment-of-morbid-obesity/ http://www.sages.org/meetings/annual-meeting/abstracts-archive/a-novel-fully-endoscopic-endoluminal-gastric-bypass-for-the-treatment-of-morbid-obesity/#respond Thu, 21 Aug 2014 06:57:43 +0000 http://www.sages.org/meetings/annual-meeting/abstracts-archive/a-novel-fully-endoscopic-endoluminal-gastric-bypass-for-the-treatment-of-morbid-obesity/ Bryan J Sandler, MD, Roberto Rumbaut, MD, C. Daniel Smith, MD, Gustavo Torres, MD, Luis Morales, MD, Lizelly Gonzalez, MD, Monica Garza, MD, Ryan C Broderick, MD, Cristina R Harnsberger, MD, Hans F Fuchs, MD, Moneer Almadani, MD, Garth R Jacobsen, MD, Santiago Horgan, MD. University of California, San Diego. OBJECTIVE: As an alternative to […]

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Bryan J Sandler, MD, Roberto Rumbaut, MD, C. Daniel Smith, MD, Gustavo Torres, MD, Luis Morales, MD, Lizelly Gonzalez, MD, Monica Garza, MD, Ryan C Broderick, MD, Cristina R Harnsberger, MD, Hans F Fuchs, MD, Moneer Almadani, MD, Garth R Jacobsen, MD, Santiago Horgan, MD. University of California, San Diego.

OBJECTIVE: As an alternative to traditional bariatric surgery, our goal was to create an entirely endoscopic method for the successful treatment of morbid obesity. We’ve developed a fully endoscopic, endoluminal gastric bypass surgery using an endoscopically placed prosthetic sleeve. The objective of this study is to evaluate the safety and feasibility of this technology.

 

DESCRIPTION: The endoscopic gastric bypass device consists of a 2-step procedure, the first of which is the fully endoscopic placement of a proximal polyester cuff that is sutured, using a novel endoluminal suturing platform (figures 1 and 2).  The second step is the attachment of a 100cm polyurethane sleeve that passes through the stomach, duodenum and into the proximal jejunum, which acts as a non-absorptive bypass.

 

Following placement of the endoscopic gastric bypass device 2cm above the GE junction. The patient is admitted overnight for observation and a barium swallow study is performed prior to discharge.

 

A liquid diet is maintained for two weeks then transitioned to soft diet while the cuff integrates into the esophagus. A second endoscopic procedure is then performed under anesthesia for attachment of the 100cm sleeve onto the cuff. The sleeve is unfolded and natural peristalsis assists distal placement of the device in the jejunum.

An IRB approved case series was performed at a single-center.  Inclusion criteria were standard bariatric patient, eligible for surgery.  Patients were excluded if prior anti-reflux surgery had been attempted. Endpoints included success of device placement, complications, and post-operative symptoms.

 

Figure 1: Endoscopic Suturing Device

Figure 2: Endoscopic Suturing Device

 

RESULTS: The first three patients were female, ages 31, 35 and 39 years old, and had body mass indices of 35.6, 36, and 36.6 kg/m2, respectively.  Proximal cuff placement was performed with zero complications.  Patients were tolerating a liquid diet and transitioned to soft mechanical and one and two weeks follow-up.  The 3 patients then underwent the second step of the procedure at 4-6 weeks.  This was completed endoscopically, under anesthesia, and the 3 patients were discharged home the same day.  Patients denied any adverse symptoms including dysphagia, odynophagia, nausea, or vomiting during follow-up.

 

CONCLUSIONS/FUTURE DIRECTIONS: Our study demonstrated the safety and feasibility of this endoluminal, endoscopic gastric bypass device.  Future directions include a pivotal, multicenter trial in the United States.

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A Novel Biodegradable Clip-based Fastening Device for Robotic Minimally Invasive Surgery (MIS): Next Generation Concept for Anastomosis Beyond Suturing and Stapling Tools.http://www.sages.org/meetings/annual-meeting/abstracts-archive/a-novel-biodegradable-clip-based-fastening-device-for-robotic-minimally-invasive-surgery-mis-next-generation-concept-for-anastomosis-beyond-suturing-and-stapling-tools/ http://www.sages.org/meetings/annual-meeting/abstracts-archive/a-novel-biodegradable-clip-based-fastening-device-for-robotic-minimally-invasive-surgery-mis-next-generation-concept-for-anastomosis-beyond-suturing-and-stapling-tools/#respond Thu, 21 Aug 2014 06:57:43 +0000 http://www.sages.org/meetings/annual-meeting/abstracts-archive/a-novel-biodegradable-clip-based-fastening-device-for-robotic-minimally-invasive-surgery-mis-next-generation-concept-for-anastomosis-beyond-suturing-and-stapling-tools/ J Opfermann, MS, A Krieger, PhD, PCW Kim, MD, PhD. Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, Washington, D.C.. Objective: The task of suturing for anastomosis requires complex coordination of surgical tools and suture management in minimal operative space. The lack of maneuverability and ergonomic design of MIS tools create challenges […]

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J Opfermann, MS, A Krieger, PhD, PCW Kim, MD, PhD. Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, Washington, D.C..

Objective: The task of suturing for anastomosis requires complex coordination of surgical tools and suture management in minimal operative space. The lack of maneuverability and ergonomic design of MIS tools create challenges resulting in longer procedure times, steeper learning curves, surgical fatigue, and higher rates of complication.  Robotic MIS tools increase dexterity and eliminate surgical tremor, but anastomosis is still performed with two tools requiring multiple ports and coordination.  We introduce the design and use of a novel, robotically controlled, laparoscopic clipping tool to better mimic human dexterity while performing MIS anastomosis (See Figure 1).  Our objective is to perform a more efficient and effective anastomosis with respect to leak rate, tensile strength, and bursting pressure.        

Description: The cable-driven laparoscopic clipping tool interfaces with a five axes motor stage, and mounts to a LWR (KUKA) robotic manipulator.  The first two axes drive ±90° articulation joints for improved dexterity within the end effector.  The third axis actuates a forcep to grasp and maneuver tissue, while the fourth axis advances a circular needle through target tissue.  Injection molded bio-absorbable Poly(Lactide-co-Glycolide) (PLGA) clips attach to the needle with a loop. A fifth axis shears the clip from the needle once a clasp is tightened around the clip.  EPOS2 controllers (Maxon Motors) orient DC Brush Motors through CAN communication for precise control.  A quick connect interface facilitates sterilization and easy detachment from the draped robotic positioning system.  Clip and clasp cartridges allow application of eight clips during anastomosis.

Results: Our team developed a prototype clipping tool capable of securing two layers of synthetic tissue (SynDaverTM Labs).  Figure 2 illustrates the clinical work flow to apply a clip and clasp for side to side anastomosis.  Synthetic tissue is first targeted then grasped between the forcep (2a).  Once secure, the needle is advanced beyond the tissue, and the forcep opened (2b).  After repositioning the end effector, a second tissue can be grasped, and the needle with clip advanced through both tissues.  When the clip’s T-shaped foot engages the second tissue (2c), the needle advance and forcep axis synchronize to pull grasped tissue to the top of the clipping tool (2d).  Finally, a clasp is applied to the clip securing the tissues (2e), while simultaneously shearing the clip from the needle.  Using the first prototype tool, we have successfully clipped and clasped two layers of synthetic tissue using a manual technique.

Conclusions:  Herein, we introduce a novel robotic laparoscopic clipping tool with smaller footprint and increased dexterity that simplifies complex two-handed suturing motion.  Initial experience with the clipping tool demonstrated a device capable of applying biodegradable clips and clasps to perform surgical anastomosis.  Presently, work to teleoperate the tool is underway with plans to complete a comparison study between hand suturing, robotically assisted suturing, and clip applied anastomosis.

                        
Figure 1: A novel clipping tool to perform anastomosis during robotic MIS.

                 
          (a)                   (b)                  (c)                   (d)                   (e)
Figure 2: Applying a clip and clasp to two layers of synthetic tissue with the prototype clipping tool.

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A Novel Patient Positioning Device for Improving Comfort and Safety During Endoscopic GI Procedureshttp://www.sages.org/meetings/annual-meeting/abstracts-archive/a-novel-patient-positioning-device-for-improving-comfort-and-safety-during-endoscopic-gi-procedures/ http://www.sages.org/meetings/annual-meeting/abstracts-archive/a-novel-patient-positioning-device-for-improving-comfort-and-safety-during-endoscopic-gi-procedures/#respond Thu, 21 Aug 2014 06:57:43 +0000 http://www.sages.org/meetings/annual-meeting/abstracts-archive/a-novel-patient-positioning-device-for-improving-comfort-and-safety-during-endoscopic-gi-procedures/ Thomas E Szymczak, PT. Vortek Surgical. INTRODUCTION Achieving and maintaining the desired position during endoscopic GI procedures including colonoscopy, EGD, ERCP, TIF, and similar procedures is a critical first step in performing a successful, complication-free procedure. Given the variety of patient types that may present for a procedure, a number of factors can present unique […]

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Thomas E Szymczak, PT. Vortek Surgical.

INTRODUCTION

Achieving and maintaining the desired position during endoscopic GI procedures including colonoscopy, EGD, ERCP, TIF, and similar procedures is a critical first step in performing a successful, complication-free procedure.

Given the variety of patient types that may present for a procedure, a number of factors can present unique positioning challenges, including:

  • History of neck, back, or shoulder pain
  • Shoulder injury or contracture (adhesive capsulitis or compression injury)
  • Obesity
  • History of sleep apnea
  • Structural airway abnormality
  • Many others

Even after establishing a desired position, dramatic or subtle changes can readily occur upon administration of sedation or anesthesia. A seemingly routine procedural course can be disrupted by airway compromise resulting from a change in head position that results in desaturation or other airway alignment restriction.  Inadequate positioning also presents other patient safety concerns that can include procedure-related shoulder compression, risk of pressure points, risk of corneal abrasion, risks if inadvertent or unanticipated rolling or falls, and exacerbation of pain any cervical or low back positional pain that can be felt for days or weeks post-procedure.  In the case of endoscopy patients, who often require repositioning during the procedure, the pillows or wedges commonly employed in positioning must all be moved and adjusted prior to resuming the procedure.   

 

DESCRIPTION

Historically, positioning tools available for use during endoscopic procedures have been limited, and usually consist of a combination of multiple pillows and wedges to seek the desired patient position.  These can be cumbersome to manage, especially during repositioning, and the multitude of components required can block or limit visibility and access to the patient during the procedure.

The EPS-30 Endoscopy Positioning Systems (Vortek Surgical, Indianapolis, IN) are specificially designed to meet the needs (and eliminate the challenges) of achieving a consistent and desired position for both upper and lower endoscopic GI procedures.  The versatile EPS-30 positioners are ergonomically designed to provide the necessary and consistent support in lateral, prone, and supine positions.  The  patented EPS-30 Positioners are comprised of a molded foam base and feature a durable latex-free vinyl coating for ease of cleaning and disinfection between uses.  The EPS-30 Positioners are configured to  maintain the relative elevation necessary for reducing risk of reflux or aspiration while under sedation.  They incorporate a number of components including:

  • Head Support with bolsters to maintain head and cervical alignment 
  • Arm/Shoulder recess to eliminate pressure and compression in sidelying
  • Front and rear bolsters to provide support and eliminate risks of inadvertent rolling
  • Chest Support to assist in maintaining support and elevation, and maintaining support of the left lower quadrant, often reducing the need for external counterpressure during scope advancement
  • Recovery Head Supportfor maintained cervical position and promotion of airway alignment in supine
  • Radiology compatible for use in ERCP and TIF
  • Durable, and latex-free coating for ease of cleaning and disinfection between patients

 

CONCLUSION:

The EPS-30 Endoscopy Positioners provide a comfortable, safe, and consistent positioning platform for the multiple positioning needs of GI endoscopy.

 

 

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Development of a low-cost, high-resolution, open-source laparoscopic tracking platformhttp://www.sages.org/meetings/annual-meeting/abstracts-archive/development-of-a-low-cost-high-resolution-open-source-laparoscopic-tracking-platform/ http://www.sages.org/meetings/annual-meeting/abstracts-archive/development-of-a-low-cost-high-resolution-open-source-laparoscopic-tracking-platform/#respond Thu, 21 Aug 2014 06:57:43 +0000 http://www.sages.org/meetings/annual-meeting/abstracts-archive/development-of-a-low-cost-high-resolution-open-source-laparoscopic-tracking-platform/ Brian Carrillo, Ahmed Nasr, Maeve O Trudeau, Ted Gerstle, Georges Azzie. Hospital for Sick Children, Children’s Hospital of Eastern Ontario, University of Toronto. Introduction: Our objective was to create a low-cost, high-fidelity laparoscopic tool tracking system that would be incorporated into our previously developed Pediatric Laparoscopic Surgery (PLS) simulator. In an effort to encourage dissemination […]

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Brian Carrillo, Ahmed Nasr, Maeve O Trudeau, Ted Gerstle, Georges Azzie. Hospital for Sick Children, Children’s Hospital of Eastern Ontario, University of Toronto.

Introduction: Our objective was to create a low-cost, high-fidelity laparoscopic tool tracking system that would be incorporated into our previously developed Pediatric Laparoscopic Surgery (PLS) simulator. In an effort to encourage dissemination of the simulator and this system, costs were kept as low as possible. In this vein, off-the-shelf components were used whenever possible, and the tracking system was designed to function with standard pediatric Minimal Access Surgery (MAS) instruments (Ø 3mm). In order to achieve the high fidelity required, the demand on the system was an ability to measure a movement of 0.1mm in any direction, and a rotation of 1.0°. Fidelity of the visuals was also sought, requiring high definition video with little to no lag. Additional requirements were that the system be: 1) unobtrusive to the trainee (no noticeable strain/friction on the instruments); and 2) small enough not to limit the range of motion in the workspace.

Methods: Our system makes use of off-the-shelf electronics that are extensively used in consumer grade electronic devices; this ensures that they are rigorously tested, very robust, incredibly small and quite inexpensive. Our device makes use of an optical sensor commonly found in computer mice to detect two of the motion analysis parameters (roll and surge).  It also employs an accelerometer that is commonly found in cellular phones to detect the other two motion analysis parameters (pitch and yaw). We combined these two sensors onto a small printed circuit board and mounted it to a custom 3D printed MIS port. The sensors are then connected to a low-cost, open-source microprocessor which combines the data from each of the ports and passes it off to a standard laptop.

Results: Our system is able to detect surge motions as small as 0.012mm, roll motions of 0.48° (Ø 3mm) and 0.29° (Ø 5mm), and pitch and yaw motions of 0.1°. This equates to roughly 0.35mm in any direction when the tool is fully inserted into the port.  Resolution improves as the tool is retracted from the port.

Conclusion: We successfully designed, constructed and tested a low-cost, high-resolution laparoscopic tool tracking system. We have subsequently used the device in several studies on motion analysis, the results of which have been presented in several journal articles and conference presentations (additional results have been accepted to be presented at SAGES 2014). Part of the mission of our institution is “Engaging in knowledge translation and sharing our expertise globally”; as such, we will be publishing a paper with all the technical details of the system, and will release both the hardware and software components as open source. We hope that this will both improve the system and keep costs as low as possible for use in developing markets/countries.

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Laparoscopic Simulatorhttp://www.sages.org/meetings/annual-meeting/abstracts-archive/laparoscopic-simulator/ http://www.sages.org/meetings/annual-meeting/abstracts-archive/laparoscopic-simulator/#respond Thu, 21 Aug 2014 06:57:43 +0000 http://www.sages.org/meetings/annual-meeting/abstracts-archive/laparoscopic-simulator/ JJ Pierce, Kara Boatwright, Trevor Cowan, Lance Jones, Seth Munger, Zach Romney, Terri Bateman, Brady Woolford. Brigham Young University. The need exists for a fixture that can simulate real intra-abdominal conditions during the early stages of benchmarking, developing, and testing of new innovative products and procedures for laparoscopy. Therefore, a senior engineering team at Brigham […]

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JJ Pierce, Kara Boatwright, Trevor Cowan, Lance Jones, Seth Munger, Zach Romney, Terri Bateman, Brady Woolford. Brigham Young University.

The need exists for a fixture that can simulate real intra-abdominal conditions during the early stages of benchmarking, developing, and testing of new innovative products and procedures for laparoscopy. Therefore, a senior engineering team at Brigham Young University is developing a laparoscopic simulator which replicates the conditions found within the human abdomen during laparoscopy. The simulator allows for insufflation of a cavity, heating, and tissue placement for manipulation. The simulator comprises an elastic membrane clamped between a frame and a plate. CO2 gas is insufflated through a trocar inserted through the elastic membrane. Trocar placement in the membrane may mimic typical placement during surgery. CO2 gas collects in a cavity between the elastic membrane and the plate to create a working space. The elastic membrane expands through the frame into a desired volume. The simulator is designed such that it can be used to simulate abdominal conditions for bariatric, normal, and pediatric patients. A recess is located on the plate where various tissues can be placed for cauterization, resection, or manipulation. Heating elements assist in replicating the temperatures encountered within the human abdomen. Instrumentation measures the temperature, humidity, and pressure conditions found within the cavity. Customized software is used to record and analyze the data that is measured. Extensive research has been conducted towards selecting an ideal elastic membrane for the abdominal simulator which will replicate the expansion of the abdomen experienced during laparoscopic surgery. The elastic properties of the membrane are critical to the performance of the laparoscopic simulator because it governs how the membrane expands when insufflated. Preliminary research discovered an average pressure versus deflection curve for an insufflated human abdomen which the simulator has been designed to replicate.  An initial simulator prototype was created to assess the pressure versus deflection curves of different elastic membranes. The abdominal deflection as a function of intra-abdominal pressure for the human studies compares very favorable to the results achieved from  the initial laparoscopoic simulator.

However, at pressures greater than approximately 5 mmHg the human abdomen no longer expands rapidly but instead pressurizes, due to reaching an elastic limit. Therefore, the abdominal deflection as a function of intra-abdominal pressure for the elastic membranes becomes increasingly disparate from that of the human studies at pressures higher than 5 mmHg. Additional testing of other elastic membranes at higher pressures is being performed to improve the comparison between the elastic membrane and the human abdomen. The results of these tests will be presented. A fixture that can simulate intra-abdominal conditions has been developed. Additional research is being conducted to optimize the environment within the simulator. The laparoscopic simulator provides the means for accelerated innovation by offering a unique, convenient test fixture that replicates laparoscopic conditions. 

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Early results of using Integrated Bipolar and Ultrasonic Energy Devices in Laparoscopic Donor Nephrectomyhttp://www.sages.org/meetings/annual-meeting/abstracts-archive/early-results-of-using-integrated-bipolar-and-ultrasonic-energy-devices-in-laparoscopic-donor-nephrectomy/ http://www.sages.org/meetings/annual-meeting/abstracts-archive/early-results-of-using-integrated-bipolar-and-ultrasonic-energy-devices-in-laparoscopic-donor-nephrectomy/#respond Thu, 21 Aug 2014 06:57:43 +0000 http://www.sages.org/meetings/annual-meeting/abstracts-archive/early-results-of-using-integrated-bipolar-and-ultrasonic-energy-devices-in-laparoscopic-donor-nephrectomy/ Erica Sutton, MD, Kelsey Lewis, BS, Michael Hughes, Jr., MD, Patrick Bone, BS. Hiram C. Polk, Jr. Department of Surgery, University of Louisville School of Medicine, Louisville, KY; Olympus America, Incorporated, Center Valley, PA. Objective of the Technology The Thunderbeat™ platform is designed to integrate the benefits of ultrasonic energy and bipolar technology into a single multi-functional […]

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Erica Sutton, MD, Kelsey Lewis, BS, Michael Hughes, Jr., MD, Patrick Bone, BS. Hiram C. Polk, Jr. Department of Surgery, University of Louisville School of Medicine, Louisville, KY; Olympus America, Incorporated, Center Valley, PA.

Objective of the Technology

The Thunderbeat™ platform is designed to integrate the benefits of ultrasonic energy and bipolar technology into a single multi-functional instrument.  We describe the improvements in OR time, instrument use and exchanges we have observed during our early use of Thunderbeat™ for laparoscopic donor nephrectomy (LDN).

 

Description of the technology and method of use or application

The Thunderbeat™ uses a center-pivot jaw to distribute closing pressures evenly across tissues independent of tissue thickness or type.  This allows the instrument to rapidly cut tissue with ultrasonic energy and to seal vessels 4-7mm in size as seen with bipolar energy.  We replaced our standard ultrasonic energy device with Thunderbeat™ for five consecutive cases of LDN (Group B).  We then compared our experience with Thunderbeat™ to the three LDN cases immediately prior (Group A).

 

Preliminary result

We observed a significant decrease in the overall operative time between groups A (mean 280 ± 58 min) and B (mean 178 ± 21 min), (p=0.01).  Fewer instrument exchanges contributed in part to the time savings.  We do not have complete recordings of the cases in Group A; however, anecdotally we observed fewer instrument exchanges in Group B (mean = 39 exchanges per case).  As our familiarity with the technology improved, we used fewer clips in the operation until finally the only clips used were on the distal ureter delivered via a reusable clip applier.  Thus, we have been able to eliminate the disposable clip applier, use of the hook cautery, and a 12mm port (in favor of a 5 mm port) that previously accommodated a 10mm disposable clip applier.  Our initial experience suggests the adrenal vein, lumbrical veins and gonadal vein can all be safely sealed and divided using Thunderbeat™.  Not having clips on the adrenal vein or lumbricals allowed us to divide the renal vein more proximally without interference of the clips to the stapler.

 

Conclusion/future direction

Thunderbeat™ has improved our operative efficiency for LDN by providing rapid tissue dissection and reliable vessel sealing of vessels 4-7mm.  Future investigation should randomize cases to standard ultrasonic energy devices versus Thunderbeat™ and prospectively measure operative data, instrument exchanges, smoke interference, renal vein length, and equipment costs.

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The Enhanced Utility of Laparoscopy in Traumahttp://www.sages.org/meetings/annual-meeting/abstracts-archive/the-enhanced-utility-of-laparoscopy-in-trauma/ http://www.sages.org/meetings/annual-meeting/abstracts-archive/the-enhanced-utility-of-laparoscopy-in-trauma/#respond Thu, 21 Aug 2014 06:57:43 +0000 http://www.sages.org/meetings/annual-meeting/abstracts-archive/the-enhanced-utility-of-laparoscopy-in-trauma/ Srinivas H Reddy, MD, Melvin E Stone, MD, Jacquelyn Shaw, BS, Sheldon Teperman, MD, Harry M Delany, MD. Jacobi Medical Center – Albert Einstein College of Medicine. Background:  The role of laparoscopy in trauma has long been a subject of debate. One of the earliest published reports of using this modality was for confirmation of […]

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Srinivas H Reddy, MD, Melvin E Stone, MD, Jacquelyn Shaw, BS, Sheldon Teperman, MD, Harry M Delany, MD. Jacobi Medical Center – Albert Einstein College of Medicine.

Background: 

The role of laparoscopy in trauma has long been a subject of debate. One of the earliest published reports of using this modality was for confirmation of peritoneal violation in abdominal trauma by Nino Carnevale back in 1977 from our institution, Jacobi Medical Center – Albert Einstein College of Medicine. With the evolving specialized training in advanced laparoscopy and the constantly improving instruments, scopes and monitors, has the role of laparoscopy changed in our management the trauma patient? The aim of this study was to review and evaluate outcomes of minimally invasive surgery in patients with trauma admitted to our hospital. We are also attempting to more clearly define updated criteria for laparoscopic intervention in patients with blunt or penetrating injury to abdominal viscera.

Methods:

This is a retrospective review of prospectively collected data of injured hemodynamically stable patients who underwent minimally invasive surgery for blunt or penetrating torso trauma in a level I trauma center in New York City from 2006 to 2011.  Data was collected from an updated trauma registry, operative logs and electronic medical records. Variables obtained included patient demographics, mechanism of injury, injury severity score (ISS), location of injury, operative procedures and findings, blood loss, complications, length of stay, postoperative outcomes.

Results:

Of the 359 patients needing emergent abdominal exploration for trauma, 56 (16%) underwent laparoscopic exploration. Diagnostic laparoscopy was initiated primarily in stab wound injuries (77%), but was also employed for gunshot wounds (16%) and blunt trauma (7%). Injury Severity Score (ISS) was significantly less for procedures initiated with diagnostic laparoscopy compared to exploratory laparotomy (ISS=8 vs. 13, p=0.001). Laparoscopy was useful in avoiding open laparotomies in 45% of patients when no significant injury was found, leading to a significant difference in negative exploration rates compared to open procedures (21% vs. 54%, p=0.0004). On the basis of laparoscopic findings, 43% of patients underwent conversion to exploratory laparotomy; 79% of these patients required repair of significant injuries. Therapeutic laparoscopy was performed in 12% of patients: diaphragm repair (n=1), gastric repair (n=2), colon repair (n=1), appendectomy (n=1), cholecystectomy (n=1) and coagulation of liver laceration (n=1). Outcomes were improved when laparoscopy was utilized: repeat operations declined by 10%, length of stay decreased up to four-fold (p=0.038), discharge dispositions requiring services fell by 16%, and mortality rates declined by 6.3%.

Conclusion:

Trauma laparoscopy is a safe and effective method for evaluation of the hemodynamically stable patient with suspected abdominal visceral injury and can reduce the number of negative and nontherapeutic trauma laparotomies as well as postoperative hospital days, and discharge care requirements. Laparoscopy was also helpful in diagnosing diaphragmatic and bowel injuries that were not seen on CT scan. Criteria for the selective use of laparoscopy in trauma need to be better defined and should include lower ISS and stab wound mechanism of injury. Moreover, in the current era where surgeons undergo more training in minimally invasive surgery than ever before, with significantly more laparoscopic operative experience, and the technologically improved equipment readily available, laparoscopy can be a very useful diagnostic, as well as a therapeutic modality in treating appropriately selected trauma patients.

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A Novel Tool for Meeting Infection Control Recommendations and Reducing Risks of Environmental Cross Transmission during Endoscopic GI Procedures: The ENDODRAPE Endoscopy Containment Systemshttp://www.sages.org/meetings/annual-meeting/abstracts-archive/a-novel-tool-for-meeting-infection-control-recommendations-and-reducing-risks-of-environmental-cross-transmission-during-endoscopic-gi-procedures-the-endodrape-endoscopy-containment-systems/ http://www.sages.org/meetings/annual-meeting/abstracts-archive/a-novel-tool-for-meeting-infection-control-recommendations-and-reducing-risks-of-environmental-cross-transmission-during-endoscopic-gi-procedures-the-endodrape-endoscopy-containment-systems/#respond Thu, 21 Aug 2014 06:57:43 +0000 http://www.sages.org/meetings/annual-meeting/abstracts-archive/a-novel-tool-for-meeting-infection-control-recommendations-and-reducing-risks-of-environmental-cross-transmission-during-endoscopic-gi-procedures-the-endodrape-endoscopy-containment-systems/ Thomas E Szymczak, PT, Safety, Consultant, President, Thomas J Small, MD, General, Surgeon, Medical, Director. Vortek Surgical, Indianapolis, IN. INTRODUCTION Encountering GI bacteria, bloodborne pathogens, and OPIM is predictable and preventable during endoscopic GI procedures.  As many of the most infectious, environmentally-transmitted bacteria originate from the GI tract, effective management is of critical importance.  However, […]

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Thomas E Szymczak, PT, Safety, Consultant, President, Thomas J Small, MD, General, Surgeon, Medical, Director. Vortek Surgical, Indianapolis, IN.

INTRODUCTION

Encountering GI bacteria, bloodborne pathogens, and OPIM is predictable and preventable during endoscopic GI procedures.  As many of the most infectious, environmentally-transmitted bacteria originate from the GI tract, effective management is of critical importance.  However, implementation of processes employed to contain such pathogens and prevent dissemination into post-procedural care environments has not been described or standardized. 

Currently available guidelines suggest the links between an endoscopy and an infection are often inadequately implemented aseptic and hygienic techniques (ASGE).  Though these procedures are often performed as a diagnostic tool for C. difficile or similar infectious bacteria, colonization or carrier status is often unknown prior to most procedures.  The manipulation of a flexible endoscope and use of any biopsy forceps or snares employed present significant and ongoing opportunity for contamination of the procedure gurney, exposed linens, and patient via contact with the scope and gloved hands.

DESCRIPTION

Endoscopic GI procedures, though not aseptic, are by performed in an environment of care where enteric contact isolation precautions apply.  Adequate preventative measures to improve the hygiene during these procedures should include implementation of the recommended protective barriers to prevent cross-contamination of exposed surfaces on the gurneys, rails, and linens.  In the alternative, interim disinfection of gurneys, changing of linens, and cleaning of exposed patient surfaces should be performed prior to moving a patient and gurney into PACU/recovery.  Interim cleaning and decontamination is a time-intensive process, requiring avoidable movement of a sedated patient and results in delays in procedure room turn times.

The ENDODRAPE® Endoscopy Containment Systems (Vortek Surgical) provide a simple solution to efficiently and effectively managing these risks and containing pathogens and OPIM during endoscopic GI procedures.  The ENDODRAPE® systems are comprised of a comprehensive, fluid resistant barrier that is quickly deployed prior to the start of a procedure.  This barrier establishes a “Zone of Protection” (similar to the aseptic fields implemented in sterile surgical environments), shielding the patient, linens, and gurney surfaces from contamination during the procedure.  This disposable barrier prevents bacteria and secretions from contacting the underlying surfaces, allowing for confidence of containment and ease of cleanup upon removal after completion of the procedure.

The Patented ENDODRAPE® systems, specifically designed for use in GI endoscopy, incorporate a number of procedure enhancing components, including: a modifiable scope guard to protect expensive endoscopes from damage and limit the common need for “wrestling” the scope during advancement and withdrawal; Integrated pockets for containing snares and biopsy forceps; Readily accessible gauze sponges in its integrated gauze pocket; and an optional reinforced accessory pad to facilitate patient repositioning.

After completion, the ENDODRAPE® is quickly removed and disposed of along with any contamination, disposable supplies and accessories.  The implementation of the ENDODRAPE® establishes a functional protective barrier in an integrated self-contained system that promotes procedural process flow and equipment protection. 

CONCLUSION:

The ENDODRAPE® Endoscopy Containment Systems provide a simple to implement and use, cost effective solution to balancing the needed advancement in infection control processes and efficiency requirements of GI endoscopy.

 

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