A Paradigm Shift in Ventral Hernia Repair. Laparoscopic Component Separation During Laparoscopic Ventral Hernia Repair.
Component separation is an important technique in the repair of ventral hernias because it allows restoration of the normal anatomic relationship of the rectus muscles while maintaining a tension-free repair. Our group has previously reported on fully laparoscopic component separation as an important tool in the repair of ventral hernias. This technique allows for protection… Continue Reading
A Randomized Controlled Trial of Laparoscopic Nissen Fundoplication (LNF) versus Proton Pump Inhibitors for Treatment of Patients with Chronic Gastro-Esophageal Reflux Disease (GERD)
Objective: In patients with GERD who were stable and symptomatically controlled on long-term medical therapy we performed an RCT to compare ongoing optimized medical therapy with LNF.Methods: 201 patients were eligible for randomization, 104 gave informed consent (age mean 42.9, sd11; male 55 female 49) and 2 withdrew from the study immediately after randomization. Patients… Continue Reading
A realistic and a virtual reality laparoscopic incisional hernia repair simulator offer complementary training with acceptable workload
Background: National basic laparoscopic skills curricula have been developed and are being incorporated into training programs. Additional procedural based simulator curricula are needed. Our aim was to compare two laparoscopic ventral hernia simulators.Methods: Novices (n=7) were enrolled in an IRB approved protocol. They trained to proficiency on the 9 basic laparoscopic tasks of the Lap… Continue Reading
A retrospective analysis of the incidental gallbladder cancer and a review of the laparoscopic cholecystectomy.
BACKGROUND/PURPOSE: With the increasingly widespread acceptance of laparoscopic cholecystectomy (LC), the number of cases of incidental gallbladder cancer (IC) has increased. However, the surgical procedure for advanced cancer is still difficult to improve a prognosis. Otherwise, preoperative detecting early gallbladder cancer may be difficult in symptomatic patients with such as cholelithiasis. The present study aims… Continue Reading
Introduction:As a foundation for transgastric NOTES, we aimed to develop an easy and fast method to create and close a gastrotomy without the use of endoluminal suturing devices.Methods:Four pigs, mean weight 36 kg, were used for this survival study. Pigs were anesthetized and received preoperative IV antibiotics. The stomach was endoscopically irrigated with saline, followed… Continue Reading
Objective: Contrast esophagram (CE) is commonly performed following anti-reflux operations for gastroesophageal reflux disease (GERD). However, utilization of this procedure is not uniform, and guidelines on its interpretation and clinical relevance are lacking. We hypothesized that a standardized scoring system for interpretation of CE would improve its clinical relevance, particularly when compared to clinical outcomes.… Continue Reading
Introduction: Morbid obesity is a major health concern for the United States affecting over 15 million people. Despite its associated comorbidities, less than 1% of patients seek surgical intervention. The need for less costly, minimally invasive procedures that reduce complication rates and result in faster recovery would be a valuable adjunct in the treatment of… Continue Reading
Accuracy and Role of Surgeon-performed Intraoperative Ultrasound in Minimally Invasive Open Parathyroidectomy
Objective: Assessment of the accuracy and the role of surgeon-performed ultrasound in comparison to expert radiology-performed ultrasound, sestamibi scanning and histologic findings.Patients and Methods: From January 2006 to December 2007 we prospectively evaluated forty two consecutive patients undergoing parathyroidectomy for primary hyperparathyroidism. One surgeon who was unaware of the preoperative imaging studies did all ultrasound… Continue Reading
Background: Minimally invasive surgery is rapidly evolving with the promise of new endolumenal and translumenal surgical procedures performed with few or no external incisions. We describe our early human experience with a flexible platform technology that provides stable access and visualization, force transmission, two-handed tissue manipulation and durable tissue approximation. The EndoSurgical Operating System (EOS),… Continue Reading
With increased regularity of diagnostic colonoscopies, it has been suggested that rectal carcinoids are being detected earlier with decreasing need for radical therapy. The purpose of our study was to evaluate our experience with rectal carcinoids, in particular, to identify trends towards earlier detection and minimally invasive treatment options.Rectal carcinoid patients identified from a pathology… Continue Reading
Introduction: Large endoscopic submucosal dissection (ESD) of superficial esophageal cancers often requires subsequent of balloon dilation operations to prevent post-operative esophageal constriction. We therefore have previously developed a novel method to transplant oral mucosal epithelial cell sheets using cell sheet engineering to promote wound healing after ESD (Gut, 1704-1720, 2006). Although we have demonstrated the… Continue Reading
Background: Gastric carcinoid tumors are rare and little is known about the long term prognosis of these tumors, since no staging system currently exists. The aim of this study was to create a predictive staging system to accurately estimate prognosis. Methods: A retrospective review of 15,983 carcinoid patients from the SEER database identified 1,543 patients… Continue Reading
Background: Currently, surgeons may implant three different types of bands within the LapBand system. However, there is little data to guide the selection process. This study aims to determine the relationship between a patient’s body mass index (BMI), height, and weight and the anatomical measurements of the gastric cardia in morbidly obese patients undergoing LapBand… Continue Reading
Anti-reflux Surgery Is Not Totally Effective Against Esophageal Adenocarcinoma, Despite the Regression or Disappearance of Barrett’s Esophagus in Most Cases – A Study of 80 Barret’s Patients.
BACKGROUND: Barrett’s Esophagus (BE) is a complication of gastroesophageal reflux disease (GERD) and can be a pre-malignant condition. laparascopic anti-reflux surgeries (LARS) significantly correct physiological and anatomical abnormalities in patients with GERD; nevertheless, there is no consensus about its effectiveness in preventing malignant transformation in patients with BE. The impact of LARS on those suffering… Continue Reading
Application of virtual imaging to support diagnosis, operative procedures and education in laparoscopic surgery
Introduction: We introduce our integrated circumstances of virtual imaging to support diagnosis, operative procedures and education, including a new computer aided diagnosis system (CADS) to detect metastatic lymph nodes (LNs) in laparoscopic surgery. Methods: The effects of virtual colonography using only air instead of contrast medium, 3D-CT, and filmless PASC, were investigated. The accuracy of… Continue Reading