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1.
Surg Endosc ; 26(10): 2961-8, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22580874

RESUMO

BACKGROUND: Within the next few years, the medical industry will launch increasingly affordable three-dimensional (3D) vision systems for the operating room (OR). This study aimed to evaluate the effect of two-dimensional (2D) and 3D visualization on surgical skills and task performance. METHODS: In this study, 34 individuals with varying laparoscopic experience (18 inexperienced individuals) performed three tasks to test spatial relationships, grasping and positioning, dexterity, precision, and hand-eye and hand-hand coordination. Each task was performed in 3D using binocular vision for open performance, the Viking 3Di Vision System for laparoscopic performance, and the DaVinci robotic system. The same tasks were repeated in 2D using an eye patch for monocular vision, conventional laparoscopy, and the DaVinci robotic system. RESULTS: Loss of 3D vision significantly increased the perceived difficulty of a task and the time required to perform it, independently of the approach (P < 0.0001-0.02). Simple tasks took 25 % to 30 % longer to complete and more complex tasks took 75 % longer with 2D than with 3D vision. Only the difficult task was performed faster with the robot than with laparoscopy (P = 0.005). In every case, 3D robotic performance was superior to conventional laparoscopy (2D) (P < 0.001-0.015). CONCLUSIONS: The more complex the task, the more 3D vision accelerates task completion compared with 2D vision. The gain in task performance is independent of the surgical method.


Assuntos
Imageamento Tridimensional/instrumentação , Laparoscopia/instrumentação , Robótica/instrumentação , Cirurgia Assistida por Computador/instrumentação , Análise e Desempenho de Tarefas , Adulto , Aminofilina , Análise de Variância , Percepção de Profundidade , Feminino , Humanos , Imageamento Tridimensional/métodos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Robótica/métodos , Estudos de Tempo e Movimento , Adulto Jovem
2.
Br J Surg ; 98(8): 1056-62, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21560121

RESUMO

BACKGROUND: The aim of this meta-analysis was to provide a pooled analysis of individual trials comparing clinical outcome following laparoscopic Nissen fundoplication with or without division of the short gastric vessels (SGVs). METHODS: Primary outcome measures were the requirement for reoperation, and the presence of postoperative gastro-oesophageal reflux and postoperative dysphagia. Secondary outcome measures were duration of operation, length of hospital stay, postoperative complications (within 30 days of surgery), postoperative gas bloat syndrome, lower oesophageal sphincter resting pressure and DeMeester score. Pooled odds ratios were calculated for categorical outcomes, and weighted mean differences for secondary continuous outcomes, using random-effects models for meta-analysis. RESULTS: Five randomized trials were included in the analysis. There was no statistically significant effect on the requirement for reoperation, or presence of postoperative dysphagia or reflux. SGV division was associated with a longer duration of operation and a reduced postoperative lower oesophageal sphincter pressure. There was no statistically significant difference in length of hospital stay, postoperative complications, postoperative gas bloat syndrome or DeMeester score. CONCLUSION: This meta-analysis has demonstrated that clinical outcome following laparoscopic Nissen fundoplication appears to be similar regardless of whether the short gastric vessels are divided. However, it is not possible to exclude many potentially important clinical differences and further studies are needed.


Assuntos
Fundoplicatura/métodos , Refluxo Gastroesofágico/cirurgia , Laparoscopia/métodos , Complicações Pós-Operatórias/etiologia , Estômago/irrigação sanguínea , Transtornos de Deglutição/etiologia , Humanos , Tempo de Internação , Pressão , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Reoperação , Resultado do Tratamento
3.
Int J Med Robot ; 6(2): 125-31, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20506440

RESUMO

The aim of this meta-analysis was to compare clinical outcome following laparoscopic and robotic Nissen fundoplication. A systematic literature search of Medline, Embase and Cochrane Library databases was performed. Primary outcome measures were the requirement for re-operation, postoperative mortality and postoperative dysphagia. Secondary outcome measures were operative time, length of hospital stay, operative complications and cost. Six randomized trials, of 226 patients, were included in this meta-analysis. There was no significant difference in requirement for re-operation or in postoperative dysphagia. There was a significantly reduced total operative time in the laparoscopic group (weighted mean difference = 4.154; 95% CI = 1.932-6.375; p = 0.0002). There was no significant difference between robotic and laparoscopic groups for hospital stay or operative complications. Clinical results from robotic Nissen fundoplication were comparable to the standard laparoscopic approach, but there was associated increased operative time and procedure cost.


Assuntos
Fundoplicatura/métodos , Refluxo Gastroesofágico/cirurgia , Laparoscopia/métodos , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/cirurgia , Fundoplicatura/efeitos adversos , Refluxo Gastroesofágico/complicações , Humanos , Laparoscopia/efeitos adversos , Resultado do Tratamento
4.
Endoscopy ; 40(11): 918-24, 2008 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-19009484

RESUMO

BACKGROUND AND STUDY AIMS: The advantages of a hybrid natural orifice transluminal endoscopic surgery approach to Roux-en-Y gastric bypass (hNOTES-RYGBP) might include: easier access to the peritoneal cavity, reduced number of ports and related complications, improved cosmesis, and others. However, currently available conventional endoscopic and laparoscopic instruments might be unsuitable for complex surgical procedures using transluminal access. The aim of this study was to investigate the feasibility and limitations of a NOTES RYGBP. METHODS: hNOTES-RYGBP was performed in human cadavers. Pouch creation was achieved by needle-knife dissection using a transvaginal, flexible scope. Articulating linear staplers were placed transumbilically to transect the stomach. Measurements of the small bowel were accomplished intraluminally or with flexible and rigid graspers. New methods were tested to create the gastro-jejunal anastomosis. A linear laparoscopic stapler was used to form the jejuno-jejunal anastomosis. RESULTS: Stapler manipulation and anvil docking, bowel manipulation and measurement, and tissue dissection presented the main obstacles for hNOTES-RYGBP. Conventional instruments were too short for some transvaginal manipulations. The time to complete the procedure was 6 - 9 hours. It was feasible to perform a complete hNOTES-RYGBP in four out of seven cadavers. Two cadavers were unsuitable due to anatomical abnormalities or advanced decay. One procedure was terminated before completion because of time constraints. Combinations of flexible and rigid visualization and manipulation were helpful, especially for dissection and gastric pouch creation. CONCLUSIONS: Several factors made hNOTES-RYGBP very challenging and time-consuming. A lack of proper instrumentation resulting in insufficient tissue traction, countertraction, and instrument manipulation complicated several steps during the procedure. A combination of flexible with rigid endoscopic techniques offers specific advantages for components of this type of surgery. Changes in instrument design are required to improve more complex endosurgical procedures.


Assuntos
Endoscopia/métodos , Obesidade Mórbida/cirurgia , Cadáver , Estudos de Viabilidade , Feminino , Derivação Gástrica , Humanos , Masculino
5.
Endoscopy ; 40(7): 581-3, 2008 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-18609452

RESUMO

BACKGROUND AND STUDY AIMS: Decreased scarring is an advantage of minimally invasive surgery. The new experimental technique of natural orifice transluminal surgery (NOTES) aims at totally scarless surgery. We examined the general attitudes of patients and unaffected persons towards scarless surgery. METHODS AND PARTICIPANTS: We used a 7-item questionnaire in structured interviews with hospital visitors, following detailed standardized explanation of terms used and of possible complications, to groups of 10 participants, during an "open ward" day. A visual analog scale (VAS) from 1 (none) to 10 (very much) was used for all but one item. Questions concerned the importance of cosmetic results in abdominal surgery, satisfaction regarding existing scars, hypothetical acceptance of increased risk as a trade-off for the absence of scars, and other issues. Data were analyzed for participants overall, and for three age groups and both sexes. RESULTS: 292 participants (male : female 1 : 1; mean age 43 years) completed the questionnaire. Cosmetic issues were rated as important (median 8), but acceptance of existing scars was also high in those affected (median 8, n=68). Approval of scarless surgery decreased with a presumed risk increase (from score 9 down to score 5), and overall an increase in risk of 10 % was judged to be acceptable as a trade-off for total absence of scarring. Younger people tended to be less satisfied with scars, but were also less inclined than older people to accept higher surgical risk in this hypothetical context. CONCLUSIONS: People generally seem to favor scarless abdominal surgery, even with some increase in risk.


Assuntos
Abdome/cirurgia , Endoscopia/métodos , Estética , Adolescente , Adulto , Idoso , Atitude Frente a Saúde , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Medição da Dor , Opinião Pública , Inquéritos e Questionários
6.
Br J Surg ; 95(6): 793-8, 2008 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-18418858

RESUMO

BACKGROUND: Patients taking immunosuppressants after transplantation may require intestinal surgery. Mycophenolate mofetil (MMF) has been found to impair the healing of colonic anastomoses in rats. This study examined whether insulin-like growth factor (IGF) I prevents MMF impairment of anastomotic healing. METHODS: Sixty-three rats were divided into three groups (MMF, MMF/IGF and control). Animals underwent a sigmoid colon anastomosis with a 6/0 suture, and were killed on days 2, 4 and 6 after surgery. Investigations included bursting pressure measurement, morphometric analysis, and assessment of mucosal proliferation by 5-bromo-2'-deoxyuridine and Ki67 immunohistochemistry of the anastomoses. RESULTS: The leak rate was three of 21, one of 20 and two of 20 in the MMF, MMF/IGF-I and control groups respectively. Anastomotic bursting pressures were significantly lower in the MMF group than in the control group on days 2 and 4, but there was no significant difference by day 6. Values in the MMF/IGF-I and control groups were similar. Colonic crypt depth was significantly reduced in MMF-treated animals on days 2 and 4, but this impairment was attenuated by IGF-I on day 4. Similarly, IGF-I reduced the negative impact of MMF on mucosal proliferation on days 2 and 6. CONCLUSION: Exogenous IGF-I improves some aspects of MMF-impaired anastomotic healing.


Assuntos
Imunossupressores/efeitos adversos , Fator de Crescimento Insulin-Like I/farmacologia , Ácido Micofenólico/análogos & derivados , Cicatrização/efeitos dos fármacos , Anastomose Cirúrgica , Animais , Antimetabólitos , Bromodesoxiuridina , Proliferação de Células , Colo Sigmoide/citologia , Colo Sigmoide/fisiologia , Colo Sigmoide/cirurgia , Imuno-Histoquímica , Mucosa Intestinal/citologia , Antígeno Ki-67/metabolismo , Masculino , Ácido Micofenólico/efeitos adversos , Pressão , Ratos , Ratos Sprague-Dawley , Deiscência da Ferida Operatória/patologia , Deiscência da Ferida Operatória/fisiopatologia , Cicatrização/fisiologia
7.
Swiss Surg ; 9(3): 105-13, 2003.
Artigo em Alemão | MEDLINE | ID: mdl-12815830

RESUMO

Anastomotic leakage after visceral surgery is one of the most important and feared complication. According to the literature the rate of clinically apparent anastomotic leakage ranges from 3.4% to as high as 12% and at least one third of the mortality after colorectal surgery is attributed to leaks at the anastomotic site. Within this context, knowledge of factors influencing anastomotic healing appears even more important. Beside surgical-technical (suture technique, suture material) and surgical-tactical factors (primary anastomosis vs. discontinuity resection or formation of protective diverting stomas) knowledge of the various endogenous (diabetes, sepsis, infection, malnutrition) and exogenous factors (steroids, radiation, preoperative bowel preparation) influencing anastomotic healing is essential. Recently, it has been demonstrated that Mycophenolate mofetil, an immunosuppressive drug that is currently used in transplantation and in chronic inflammatory diseases significantly impairs mechanical stability of the healing anastomosis. In contrary, local application of keratinocyte growth factor (KGF) as well as insulin-like growth factor-I (IGF-I) have been shown to accelerate and improve anastomotic healing and mechanical stability in an animal model. Studies that will identify further factors and drugs influencing anastomotic healing are of great importance since the use of such drugs could have enormous clinical implications. The traditional use of temporary diverting stomas following operations such as coloanal anastomosis or ileopouch anastomosis as well as Hartmann's discontinuity resection could be eliminated even in immunocompromised or other high risk patients.


Assuntos
Anastomose Cirúrgica/métodos , Gastroenteropatias/cirurgia , Neoplasias Gastrointestinais/cirurgia , Deiscência da Ferida Operatória/etiologia , Cicatrização/fisiologia , Animais , Sistema Digestório/fisiopatologia , Gastroenteropatias/fisiopatologia , Neoplasias Gastrointestinais/fisiopatologia , Humanos , Fatores de Risco , Deiscência da Ferida Operatória/fisiopatologia , Técnicas de Sutura
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