Effectiveness of a reusable low-cost balloon trocar dissection device in the creation of preperitoneal space during endoscopic surgery. An experimental study in swine

PURPOSE: To evaluate a new, low-cost, reusable balloon trocar device for dissection of the preperitoneal space during endoscopic surgery.METHODS:Twenty swine (weight: 15-37 kg) were randomized to two groups, according to whether the preperitoneal space was created with a new balloon device manufactured by Bhio-Supply (group B) or with the commercially available OMSPDB 1000(r) balloon device manufactured by Covidien (group C). Quality and size of the created preperitoneal space, identification of anatomic structures, balloon dissection time, total procedure time, balloon resistance and internal pressure after insufflation with 300 mL of ambient air, balloon-related complications, and procedure cost were assessed.RESULTS:No significant differences in dissection time, total procedure time, or size of the created preperitoneal space were found between the groups. Balloons in group B had a significantly higher internal pressure compared to balloons in group C. None of the balloons ruptured during the experiment. Three animals in group C had balloon-related peritoneal lacerations. Despite a higher individual device cost, group B had a lower procedure cost over the entire experiment.CONCLUSION:The new balloon device is not inferior to the commercially available device in terms of the safety and effectiveness for creating a preperitoneal space in swine.

Review of Pure Endoscopic Full-Thickness Resection of the Upper Gastrointestinal Tract

Natural-orifice transluminal endoscopic surgery (NOTES) using flexible endoscopy has attracted attention as a minimally invasive surgical method that does not cause an operative wound on the body surface. However, minimizing the number of devices involved in endoscopic, compared to laparoscopic, surgeries has remained a challenge, causing endoscopic surgeries to gradually be phased out of use. If a flexible endoscopic full-thickness suturing device and a counter-traction device were developed to expand the surgical field for gastrointestinal-tract collapse, then endoscopic full-thickness resection using NOTES, which is seen as an extension of endoscopic submucosal dissection for full-thickness excision of tumors involving the gastrointestinal-tract wall, might become an extremely minimally invasive surgical method that could be used to resect only full-thickness lesions approached by the shortest distance via the mouth. It is expected that gastroenterological endoscopists will use this surgery if device development is advanced. This extremely minimally invasive surgery would have an immeasurable impact with regard to mitigating the burden on patients and reducing healthcare costs. Development of a new surgical method using a multipurpose flexible endoscope is therefore considered a socially urgent issue.

Cost Comparison between Surgical Treatments and Endoscopic Submucosal Dissection in Patients with Early Gastric Cancer in Korea

BACKGROUND/AIMS: This study was conducted to evaluate whether medical costs can be reduced using endoscopic submucosal dissection (ESD) instead of conventional surgeries in patients with early gastric cancer (EGC). METHODS: Patients who underwent open gastrectomy (OG), laparoscopy-assisted gastrectomy (LAG), and ESD for EGC were recruited from three medical institutions in 2009. For macro-costing, the medical costs for each patient were derived from the expenses incurred during the patient's hospital stay and 1-year follow-up. The overall costs in micro-costing were determined by multiplying the unit cost with the resources used during the patients' hospitalization. RESULTS: A total of 194 patients were included in this study. The hospital stay for ESD was 5 to 8 days and was significantly shorter than the 12-day hospital stay for OG or the 11- to 17-day stay for LAG. Using macro-costing, the average medical costs for ESD during the hospital stay ranged from 2.1 to 3.4 million Korean Won (KRW) per patient, and the medical costs for conventional surgeries were estimated to be between 5.1 million and 8.2 million KRW. There were no significant differences in the 1-year follow-up costs between ESD and conventional surgeries. CONCLUSIONS: ESD patients had lower medical costs than those patients who had conventional surgeries for EGC with conservative indications.

Cost Comparison between Surgical Treatments and Endoscopic Submucosal Dissection in Patients with Early Gastric Cancer in Korea

BACKGROUND/AIMS: This study was conducted to evaluate whether medical costs can be reduced using endoscopic submucosal dissection (ESD) instead of conventional surgeries in patients with early gastric cancer (EGC). METHODS: Patients who underwent open gastrectomy (OG), laparoscopy-assisted gastrectomy (LAG), and ESD for EGC were recruited from three medical institutions in 2009. For macro-costing, the medical costs for each patient were derived from the expenses incurred during the patient's hospital stay and 1-year follow-up. The overall costs in micro-costing were determined by multiplying the unit cost with the resources used during the patients' hospitalization. RESULTS: A total of 194 patients were included in this study. The hospital stay for ESD was 5 to 8 days and was significantly shorter than the 12-day hospital stay for OG or the 11- to 17-day stay for LAG. Using macro-costing, the average medical costs for ESD during the hospital stay ranged from 2.1 to 3.4 million Korean Won (KRW) per patient, and the medical costs for conventional surgeries were estimated to be between 5.1 million and 8.2 million KRW. There were no significant differences in the 1-year follow-up costs between ESD and conventional surgeries. CONCLUSIONS: ESD patients had lower medical costs than those patients who had conventional surgeries for EGC with conservative indications.

Alternativas ao uso de animais como recurso didático / Alternatives for the use of animals as a didactic resource / Alternativas al uso de animales como recurso didáctico

A utilização de animais como recurso didático no ensino superior tem sido muito discutida. Tal fato se deve em função de muitos alunos e professores consideram que essas práticas vão contra seus pressupostos éticos e morais, além dos problemas de ordem psicológica que estas podem ocasionar. O debate acerca desse assunto tem aumentado muito nas últimas décadas, enquanto grupos de proteção aos animais têm tentado e conseguido com sucesso convencer muitas universidades pelo mundo a abolirem a utilização de animais de laboratório com fins didáticos, ou restringirem o seu uso ao mínimo necessário. Porém, para que animais deixem de ser utilizados para essa finalidade, torna-se necessária uma busca por recursos alternativos que propiciem aprendizado eficiente e satisfatório. Estes existem e incluem cadáveres e tecidos animais obtidos de fontes éticas; vídeos que podem ser gravados em situações reais; modelos, manequins e simuladores; multimídia; trabalho clínico com pacientes animais; auto-experimentação; laboratórios in vitro; estudos de campo e aprendizado baseado em casos. Vários estudos comprovam a eficácia do aprendizado proporcionado por tais métodos. Com relação ao custo de implantação, embora este possa ser maior no início, acaba por torná-los economicamente viáveis, por reduzir custos com a manutenção de animais em biotérios, anestésicos e outros medicamentos. Assim, é possível concluir que a utilização de métodos alternativos ao uso nocivo de animais é ética, eficaz e economicamente viável.

The use of animals as a didactic resource by universities has been very controversial. Such controversy comes from many students and professors who consider that these practices are against their ethical and moral principles, as well as the problems of psychological order they may cause. The debate over this subject has been increasing over the past few decades, while groups of animal protection have tried and successfully managed to convince many universities worldwide to abolish the use of laboratory animals with educational purpose, or restrict their use to the minimum necessary. However, in order to stop using animals for this purpose, a search for alternative materials which provide efficient and satisfactory learning becomes necessary. Such alternatives already exist and include bodies and animal tissues obtained from ethical sources; videos which can be obtained in real situations; models, mannequins and simulators; multimedia simulation; clinical work with animals; self experimentation; in vitro laboratories; field studies and learning based in cases. Several studies prove the efficacy of the learning provided by alternative methods. Besides, the implementation cost, although higher in the beginning ends up making the alternatives economically feasible since they reduce the costs with maintenance of animals, anesthetics, and other remedies. Thus, it is possible to conclude that the use of alternative methods to the harmful use of animals is ethical, efficient and economically feasible.

Mucho se ha discutido sobre la utilización de animales como recurso didáctico en la educación superior. Esto ocurre en función de muchos estudiantes y profesores que consideran que estas prácticas van contra sus principios éticos y morales además de los problemas psicológicos que éstos pueden causar. La discusión referente a este tema ha aumentado mucho en las últimas décadas, mientras que los grupos de protección a los animales han intentado y han obtenido con éxito convencer a muchas universidades en el mundo que supriman el uso de animales de laboratorio con la finalidad didáctica, o restrinjan su uso al mínimo necesario. Sin embargo, de modo que los animales dejen de ser utilizados para este propósito es necesaria una búsqueda de materiales alternativos que tornen el aprender eficiente y satisfactorio. Éstos existen e incluyen los cadáveres y los tejidos animales obtenidos de fuentes éticas; películas y videos que se pueden registrar situaciones verdaderas; modelos, maniquíes y simuladores; multimedias; trabajo clínico con los pacientes animales; auto-experimentación; laboratorios in vitro; estudios del campo y aprender basados en casos. Algunos estudios prueban la eficacia del aprender proporcionado por estos métodos. Por otra parte, el coste de la implantación, aunque grande al principio se vuelve económicamente viable por reducir gastos con el mantenimiento de animales en bioterios, anestésicos y otras medicinas. Así, es posible concluir que el uso de métodos alternativos al uso dañoso de animales es ético, eficiente y económicamente viable.