Science.gov

Sample records for advanced laparoscopic skills

  1. Using simulation to improve the cognitive and psychomotor skills of novice students in advanced laparoscopic surgery: a meta-analysis.

    PubMed

    Al-Kadi, Azzam S; Donnon, Tyrone

    2013-01-01

    Advances in simulation technologies have enhanced the ability to introduce the teaching and learning of laparoscopic surgical skills to novice students. In this meta-analysis, a total of 18 randomized controlled studies were identified that specifically looked at training novices in comparison with a control group as it pertains to knowledge retention, time to completion and suturing and knotting skills. The combined random-effect sizes (ESs) showed that novice students who trained on laparoscopic simulators have considerably developed better laparoscopic suturing and knot tying skills (d = 1.96, p < 0.01), conducted fewer errors (d = 2.13, p < 0.01), retained more knowledge (d = 1.57, p < 0.01) than their respective control groups, and were significantly faster on time to completion (d = 1.98, p < 0.01). As illustrated in corresponding Forest plots, the majority of the primary study outcomes included in this meta-analysis show statistically significant support (p < 0.05) for the use of laparoscopic simulators for novice student training on both knowledge and advanced surgical skill development (28 of 35 outcomes, 80%). The findings of this meta-analysis support strongly the use of simulators for teaching laparoscopic surgery skills to novice students in surgical residency programs.

  2. [In vitro development of laparoscopic skills].

    PubMed

    Gödri, Veronika; Haidegger, Tamás; Saftics, György; Sándor, József; Wéber, György

    2012-08-01

    Minimally invasive surgery is a popular alternative to open surgical procedures. Laparoscopic surgeries require highly skilled surgeons with solid theoretical background and significant amount of practice. Pelvitrainers or simulators provide a good opportunity for practicing and developing laparoscopic skills. Laparoscopic training of medical students of the Semmelweis University is performed at the Institute of Experimental Surgery and Surgical Techniques on Apollo pelvitrainers. The trainer, the performed exercises and the time limits have to be validated by several measurements. Statistical evaluation of the results provides a possibility for the numerical evaluation of surgical skills as well as validating the usability of the pelvitrainer. In our study we tested the peg transfer exercise in pelvitrainers on four groups with different surgical background and level of expertise, complete novices (50 persons), medical students (326 persons), surgical residents (15), and experienced surgeons (4), respectively. A time limit of 240 s was defined for novices and 100 s for professionals. During the evaluation of the results the average time and the number of errors were calculated. The mean completion time of amateurs was 365.7 ± 130 s (mean ± standard deviation), with 2.57 errors. The performance of medical students was characterized by 159.3 ± 61.1 s average time with 1.21 errors, the completion time of residents was 257.9 ± 75.7 s with 1.13 error points, and 117.2 ± 29.1 s for the surgeons. These data show significant differences between the group, except between the results of medical students and surgeons. We plan to extend this study with the inclusion of more, experienced surgeons. PMID:22940390

  3. [In vitro development of laparoscopic skills].

    PubMed

    Gödri, Veronika; Haidegger, Tamás; Saftics, György; Sándor, József; Wéber, György

    2012-08-01

    Minimally invasive surgery is a popular alternative to open surgical procedures. Laparoscopic surgeries require highly skilled surgeons with solid theoretical background and significant amount of practice. Pelvitrainers or simulators provide a good opportunity for practicing and developing laparoscopic skills. Laparoscopic training of medical students of the Semmelweis University is performed at the Institute of Experimental Surgery and Surgical Techniques on Apollo pelvitrainers. The trainer, the performed exercises and the time limits have to be validated by several measurements. Statistical evaluation of the results provides a possibility for the numerical evaluation of surgical skills as well as validating the usability of the pelvitrainer. In our study we tested the peg transfer exercise in pelvitrainers on four groups with different surgical background and level of expertise, complete novices (50 persons), medical students (326 persons), surgical residents (15), and experienced surgeons (4), respectively. A time limit of 240 s was defined for novices and 100 s for professionals. During the evaluation of the results the average time and the number of errors were calculated. The mean completion time of amateurs was 365.7 ± 130 s (mean ± standard deviation), with 2.57 errors. The performance of medical students was characterized by 159.3 ± 61.1 s average time with 1.21 errors, the completion time of residents was 257.9 ± 75.7 s with 1.13 error points, and 117.2 ± 29.1 s for the surgeons. These data show significant differences between the group, except between the results of medical students and surgeons. We plan to extend this study with the inclusion of more, experienced surgeons.

  4. Training Simulator for Developing Laparoscopic Skills

    PubMed Central

    Aruna Kumari, Nakka V.; Eekhout, Juancho

    2001-01-01

    Objective: To measure, using objective pre- and post-training assessments, the degree of improvement in laparoscopic skills following training with a new laparoscopy training simulator (LTS 2000). Methods: This study utilized the LTS 2000 training simulator. The simulator was used in conjunction with a laparoscope joined to a camera, light source, and monitor or with a camcorder. Eleven exercises were planned with tasks designed to develop visual-motor-processing capabilities for referencing the 2-dimensional image of an object on a video screen, and to teach and allow practice of delicate manipulations, circular motions, oviductal cannulation, formation of Roeder loops, and simple suturing and knot-tying. The skill level of individual trainees was assessed before and after training with objective means. Each exercise was assigned a point value of 100 with a maximum score of 1100. Some exercises were scored in number of tasks per 1 minute, others in number of minutes per 1 task. A score of 100 was given for completing a target number of tasks in 1 minute and 0 for not completing any. A score of 100 was given for completing the assigned task in a target amount of time and 0 for not completing it in 3 times that amount. Scores between 100 and 0 were set linearly as a function of those values. Results: Of the 11 participating physicians, none scored above the 65th percentile of the maximum achievable score before training; 8 scored above the 73rd percentile after training. The average pretest score was 304.9 points (SD 190.8) range 43.2 to 705.7; posttest score was 834.2 points (SD 141.2) range 547.3 to 1021.7. The average number of hours spent in practice was 5.9 (range 2 to 23). A positive correlation existed between hours of practice and posttest score improvement. Conclusion: Sustained training with the new simulator resulted in significant improvement in laparoscopic skills in all tested physicians, regardless of prior level of experience. PMID:11548833

  5. Advanced Training in Laparoscopic Abdominal Surgery (Atlas): A Systematic Review

    PubMed Central

    Beyer-Berjot, Laura; Palter, Vanessa; Grantcharov, Teodor; Aggarwal, Rajesh

    2014-01-01

    Background Simulation has widely spread this last decade, especially in laparoscopic surgery, and training out of the operating room (OR) has proven its positive impact on basic skills during real laparoscopic procedures. However, few articles dealing with advanced training in laparoscopic abdominal surgery (ATLAS) have been published so far. Such training may reduce learning curves in the OR for junior surgeons with limited access to complex laparoscopic procedures as a primary operator. Methods Two reviewers, using MEDLINE, EMBASE, and The Cochrane Library, conducted a systematic research with combinations of the following keywords: (teaching OR education OR computer simulation) AND laparoscopy AND (gastric OR stomach OR colorectal OR colon OR rectum OR small bowel OR liver OR spleen OR pancreas OR advanced surgery OR advanced procedure OR complex procedure). Additional studies were searched in the reference lists of all included articles. Results Fifty-four original studies were retrieved. Their level of evidence was low: most of the studies were case series, one fifth purely descriptive, and there were 8 randomized trials. Porcine models and video trainers, as well as gastric and colorectal procedures were mainly assessed. The retrieved studies showed some encouraging trends in terms of trainees' satisfaction, improvement after training (but mainly on the training tool itself). Some tools have been proven to be construct-valid. Conclusions Higher quality studies are required to appraise ATLAS educational value. PMID:24947643

  6. Advances in laparoscopic urologic surgery techniques

    PubMed Central

    Abdul-Muhsin, Haidar M.; Humphreys, Mitchell R.

    2016-01-01

    The last two decades witnessed the inception and exponential implementation of key technological advancements in laparoscopic urology. While some of these technologies thrived and became part of daily practice, others are still hindered by major challenges. This review was conducted through a comprehensive literature search in order to highlight some of the most promising technologies in laparoscopic visualization, augmented reality, and insufflation. Additionally, this review will provide an update regarding the current status of single-site and natural orifice surgery in urology. PMID:27134743

  7. Advances in laparoscopic urologic surgery techniques.

    PubMed

    Abdul-Muhsin, Haidar M; Humphreys, Mitchell R

    2016-01-01

    The last two decades witnessed the inception and exponential implementation of key technological advancements in laparoscopic urology. While some of these technologies thrived and became part of daily practice, others are still hindered by major challenges. This review was conducted through a comprehensive literature search in order to highlight some of the most promising technologies in laparoscopic visualization, augmented reality, and insufflation. Additionally, this review will provide an update regarding the current status of single-site and natural orifice surgery in urology. PMID:27134743

  8. Objective classification of residents based on their psychomotor laparoscopic skills

    PubMed Central

    Klein, Stefan; de Winter, Joost C. F.; Jansen, Frank-Willem; Dankelman, Jenny

    2009-01-01

    Background From the clinical point of view, it is important to recognize residents’ level of expertise with regard to basic psychomotor skills. For that reason, surgeons and surgical organizations (e.g., Acreditation Council for Graduate Medical Education, ACGME) are calling for assessment tools that credential residents as technically competent. Currently, no method is universally accepted or recommended for classifying residents as “experienced,” “intermediates,” or “novices” according to their technical abilities. This study introduces a classification method for recognizing residents’ level of experience in laparoscopic surgery based on psychomotor laparoscopic skills alone. Methods For this study, 10 experienced residents (>100 laparoscopic procedures performed), 10 intermediates (10–100 procedures performed), and 11 novices (no experience) performed four tasks in a box trainer. The movements of the laparoscopic instruments were recorded with the TrEndo tracking system and analyzed using six motion analysis parameters (MAPs). The MAPs of all participants were submitted to principal component analysis (PCA), a data reduction technique. The scores of the first principal components were used to perform linear discriminant analysis (LDA), a classification method. Performance of the LDA was examined using a leave-one-out cross-validation. Results Of 31 participants, 23 were classified correctly with the proposed method, with 7 categorized as experienced, 7 as intermediates, and 9 as novices. Conclusions The proposed method provides a means to classify residents objectively as experienced, intermediate, or novice surgeons according to their basic laparoscopic skills. Due to the simplicity and generalizability of the introduced classification method, it is easy to implement in existing trainers. PMID:19915915

  9. Training and assessment of laparoscopic skills using a haptic simulator.

    PubMed

    Rolfsson, Göran; Nordgren, Anna; Bindzau, Stefan; Hagström, J-P; McLaughlin, John; Thurfjell, Lennart

    2002-01-01

    Surgical simulation is a promising technique for training of laparoscopic surgery. Computer based simulation provides not only a cost effective alternative to traditional training but also a way to assess the surgeons performance. In this paper, we present a haptic simulator that allows for training and assessment of basic laparoscopic skills. The skills trained are modeled around a cholecystectomy procedure and include bi-manual dissection, clips setting, catheter insertion and cutting. The system uses accurate anatomic models of the organs involved in the procedure. This combined with effective methods for soft tissue deformation and haptic feedback, giving the surgeon a precise feeling of the interaction between organs and surgical instruments, provides a realistic training environment. The system has been designed with procedural training in mind and by putting together the individual tasks it will be possible to train on performing a complete cholecystectomy procedure. PMID:15458123

  10. Laparoscopic ureteral reimplantation: a simplified dome advancement technique.

    PubMed

    Lima, Guilherme C; Rais-Bahrami, Soroush; Link, Richard E; Kavoussi, Louis R

    2005-12-01

    Laparoscopic Boari flap reimplantation has been used to treat long distal ureteral strictures. This technique requires extensive bladder mobilization and complex intracorporeal suturing. This demonstrates a novel laparoscopic bladder dome advancement approach for ureteral reimplantation. This technique obviates the need for bladder pedicle dissection and simplifies the required suturing.

  11. Methods and tools for objective assessment of psychomotor skills in laparoscopic surgery.

    PubMed

    Oropesa, Ignacio; Sánchez-González, Patricia; Lamata, Pablo; Chmarra, Magdalena K; Pagador, José B; Sánchez-Margallo, Juan A; Sánchez-Margallo, Francisco M; Gómez, Enrique J

    2011-11-01

    Training and assessment paradigms for laparoscopic surgical skills are evolving from traditional mentor-trainee tutorship towards structured, more objective and safer programs. Accreditation of surgeons requires reaching a consensus on metrics and tasks used to assess surgeons' psychomotor skills. Ongoing development of tracking systems and software solutions has allowed for the expansion of novel training and assessment means in laparoscopy. The current challenge is to adapt and include these systems within training programs, and to exploit their possibilities for evaluation purposes. This paper describes the state of the art in research on measuring and assessing psychomotor laparoscopic skills. It gives an overview on tracking systems as well as on metrics and advanced statistical and machine learning techniques employed for evaluation purposes. The later ones have a potential to be used as an aid in deciding on the surgical competence level, which is an important aspect when accreditation of the surgeons in particular, and patient safety in general, are considered. The prospective of these methods and tools make them complementary means for surgical assessment of motor skills, especially in the early stages of training. Successful examples such as the Fundamentals of Laparoscopic Surgery should help drive a paradigm change to structured curricula based on objective parameters. These may improve the accreditation of new surgeons, as well as optimize their already overloaded training schedules.

  12. Single incision laparoscopic surgery – is it time for laboratory skills training?

    PubMed Central

    Łaski, Dariusz; Makarewicz, Wojciech; Bobowicz, Maciej; Kobiela, Jarosław; Nateghi, Behzad; Proczko, Monika; Madejewska, Ilona; Gruca, Zbigniew; Śledzinski, Zbigniew

    2013-01-01

    Introduction With the introduction of new surgical equipment, there is always the need for new, more advanced training. The authors try to answer whether the use of the newest generation tools has an impact on achieving better results in single incision laparoscopic surgery (SILS) technique during the exercises in the surgical skills laboratory. Material and methods There were 51 participants in the study: 44 ‘novices’ and 7 ‘experts’. All subjects performed the ‘advanced grasping’ exercise according to the FLS programme manual using four types of laparoscopic approach including two SILS ports and SILS-dedicated instruments. The outcome measures involved task completion time and the number of errors. Results Tasks using straight laparoscopic instruments set together with classic three-port access as well as SILS access ports were finished significantly faster when compared with SILS-dedicated instruments (p < 0.05). There were no significant differences in performance times between the two setups with straight instruments (p < 0.05) and both setups with SILS-dedicated instruments, irrespective of the use of curved or dynamic articulated tools. Students with no previous laparoscopic experience had significantly worse task completion times in all tasks in comparison to students with laparoscopic laboratory training and the ‘experts’ group. Conclusions The use of the straight instruments in the SILS technique remain similar to its performance in full triangulation. SILS-dedicated instruments paradoxically increase the task completion time irrespective of possessed skills. The study showed the necessity of a SILS-dedicated tools training programme. PMID:24130635

  13. Surgical skills for laparoscopic resection of the bursa omentalis and lymph node scavenging with radical gastrectomy

    PubMed Central

    ZOU, LIAO-NAN; HE, YAO-BIN; LI, HONG-MING; DIAO, DE-CHANG; MO, DE-LONG; WANG, WEI; WAN, JIN

    2015-01-01

    The aim of the present study was to inquire into the feasibility, surgical skills required and short-term effect of a laparoscopic resection of the bursa omentalis and lymph node scavenging with radical gastrectomy. In this study, the clinical data of 18 patients who received a laparoscopic resection of the bursa omentalis with radical gastrectomy in the Department of Gastrointestinal Surgery, Guangdong Province Hospital of Traditional Chinese Medicine (Guangzhou, Guangdong, China) during the period between January 2012 and January 2014. A retrospective analysis was performed and the surgical duration, bursa omentalis resection time, amount of bleeding during the surgery, post-operative complications associated with the surgery, length of hospital stay, number of lymph nodes scavenged and short-term follow-up results were assessed. The results indicated that all of these 18 patients successfully received a resection of the bursa omentalis and no one required conversion to open surgery. The mean surgical duration was 289.3±30.3 min, the bursa omentalis resection time was 46.1±18.6 min and the amount of bleeding was recorded as 35.5±6.5 ml in these patients. No patients suffered from post-operative complications, such as pancreatic fistulae, anastomotic fistulae, intestinal obstructions or succumbing to the surgery, and no patients succumbed within a 6-month follow-up period. In conclusion, for advanced gastric carcinoma, laparoscopic resection of the bursa omentalis and lymph node scavenging with radical gastrectomy is feasible. In addition to meeting the requirement that the operator should be skilled and experienced in open bursa omentalis resection, and have well-knit basic skills in using a laparoscope, attention must also be paid to the construction of the surgical team. PMID:26170983

  14. Spatial Visualization Ability and Laparoscopic Skills in Novice Learners: Evaluating Stereoscopic versus Monoscopic Visualizations

    ERIC Educational Resources Information Center

    Roach, Victoria A.; Mistry, Manisha R.; Wilson, Timothy D.

    2014-01-01

    Elevated spatial visualization ability (Vz) is thought to influence surgical skill acquisition and performance. Current research suggests that stereo visualization technology and its association with skill performance may confer perceptual advantages. This is of particular interest in laparoscopic skill training, where stereo visualization may…

  15. Laparoscopic Suturing Skills Acquisition: A Comparison Between Laparoscopy-Exposed and Laparoscopy-Naive Surgeons

    PubMed Central

    Tamang, Tseten; Misra, Mahesh C.; Prakash, Pradeep; Rajan, Karthik; Bhattacharjee, Hemanga K.; Kumar, Subodh; Goswami, Amit

    2012-01-01

    Background: Laparoscopic suturing is a difficult skill to master but can be acquired with extensive training outside the operating room. This study was done with the primary aim of assessing whether prior exposure to laparoscopic surgery helped trainees in acquiring laparoscopic suturing skills more quickly than trainees with no prior exposure to laparoscopic surgery. Materials and Methods: Twenty laparoscopy-exposed and 20 laparoscopy-naïve surgeons performed 5 laparoscopic gastrojejunostomies each on a phantom porcine model. The performance was evaluated for operation time, overall anastomotic score (calculated by adding scores of anastomotic leak, size of the anastomosis, suture placement, and mucosal approximation), and the level of difficulty. The performance at the beginning of training (baseline) was compared to the performance at the end of training. Results: All participants showed statistically significant improvement in operation time, overall anastomotic score, and difficulty level. Laparoscopy-exposed surgeons had a significantly better operation time than laparoscopy-naïve surgeons at the beginning of training; however, the difference became insignificant by the end of training. The difference in overall anastomotic score was not significant between laparoscopy-exposed and naïve-surgeons. Laparoscopy-exposed surgeons showed significant improvements in anastomotic leak rate and size of the anastomosis, whereas laparoscopy naïve surgeons showed improvements in all the parameters, although these were not significant statistically. Conclusion: Training improves the laparoscopic suturing skills of laparoscopy-exposed as well as laparoscopy-naïve surgeons. Prior experience in laparoscopic surgery does not seem to influence the acquisition of laparoscopic suturing skills as laparoscopic-naïve surgeons manage to catch up with the skills of the laparoscopy-exposed surgeons. PMID:23484575

  16. Optimal training design for procedural motor skills: a review and application to laparoscopic surgery.

    PubMed

    Spruit, Edward N; Band, Guido P H; Hamming, Jaap F; Ridderinkhof, K Richard

    2014-11-01

    This literature review covers the choices to consider in training complex procedural, perceptual and motor skills. In particular, we focus on laparoscopic surgery. An overview is provided of important training factors modulating the acquisition, durability, transfer, and efficiency of trained skills. We summarize empirical studies and their theoretical background on the topic of training complex cognitive and motor skills that are pertinent to proficiency in laparoscopic surgery. The overview pertains to surgical simulation training for laparoscopy, but also to training in other demanding procedural and dexterous tasks, such as aviation, managing complex systems and sports. Evidence-based recommendations are provided for facilitating efficiency in laparoscopic motor skill training such as session spacing, adaptive training, task variability, part-task training, mental imagery and deliberate practice.

  17. Development of a Sustainable Simulator and Simulation Program for Laparoscopic Skills Training in Haiti.

    PubMed

    Damas, Emile; Norcéide, Chesnel; Zephyr, Yvel; Williams, Kerry-Lynn; Renouf, Tia; Dubrowski, Adam

    2016-01-01

    Laparoscopic surgery has been shown to have many favorable effects on surgical outcomes and postoperative recovery times. However, the cost of currently available training programs, such as the Fundamentals of Laparoscopic Surgery (FLS), limits their adoption in developing countries. To address this cost constraint, educators at the Justinian University Hospital (JUH) in Northern Haiti used local materials to build their own laparoscopic skills box trainer. This trainer is used to teach all surgical and OB/GYN residents in their laparoscopic skills program. The progressive curriculum consists of seven modules, three of which are for all trainees and four of which are specifically for surgery and OB/GYN (2). The seven modules are arranged in the order of difficulty; they start with basic maneuvers and progress to complex skills. This report describes both the preparation of the seven models and evaluation of the skills that are learned. This approach may facilitate global access to feasible, progressive, and sustainable laparoscopic training. PMID:27433411

  18. Development of a Sustainable Simulator and Simulation Program for Laparoscopic Skills Training in Haiti

    PubMed Central

    Damas, Emile; Norcéide, Chesnel; Zephyr, Yvel; Williams, Kerry-Lynn; Renouf, Tia

    2016-01-01

    Laparoscopic surgery has been shown to have many favorable effects on surgical outcomes and postoperative recovery times. However, the cost of currently available training programs, such as the Fundamentals of Laparoscopic Surgery (FLS), limits their adoption in developing countries. To address this cost constraint, educators at the Justinian University Hospital (JUH) in Northern Haiti used local materials to build their own laparoscopic skills box trainer. This trainer is used to teach all surgical and OB/GYN residents in their laparoscopic skills program. The progressive curriculum consists of seven modules, three of which are for all trainees and four of which are specifically for surgery and OB/GYN (2). The seven modules are arranged in the order of difficulty; they start with basic maneuvers and progress to complex skills. This report describes both the preparation of the seven models and evaluation of the skills that are learned. This approach may facilitate global access to feasible, progressive, and sustainable laparoscopic training. PMID:27433411

  19. Palliative laparoscopic hepatico- and gastrojejunostomy for advanced pancreatic cancer.

    PubMed

    Gentileschi, Paolo; Kini, Subhash; Gagner, Michel

    2002-01-01

    Only 10% to 20% of pancreatic tumors are resectable at the time of diagnosis. Patients with advanced disease have a median survival of 4.9 months. Palliation is often required for biliary or duodenal obstruction, or both, and for pain. Optimal palliation should guarantee the shortest possible hospital stay and as long a survival as possible with a good quality of life. In recent years, treatment options for palliation of biliary and duodenal obstruction due to pancreatic cancer have broadened. Endoscopic and percutaneous biliary stenting have been shown to be successful tools for safe palliation of high-risk patients. Nevertheless, fit patients with unresectable pancreatic cancer benefit from surgery, which allows long-lasting biliary and gastric drainage. While laparoscopic cholecystojejunostomy and gastroenterostomy in patients with advanced pancreatic cancer have been widely reported, laparoscopic hepatico-jejunostomy has been rarely described. In this article, we describe our technique of laparoscopic hepatico-jejunostomy and gastrojejunostomy. We also discuss current evidence on the indications for these procedures in patients with unresectable pancreatic cancer.

  20. Training basic laparoscopic skills using a custom-made video game.

    PubMed

    Goris, Jetse; Jalink, Maarten B; Ten Cate Hoedemaker, Henk O

    2014-09-01

    Video games are accepted and used for a wide variety of applications. In the medical world, research on the positive effects of playing games on basic laparoscopic skills is rapidly increasing. Although these benefits have been proven several times, no institution actually uses video games for surgical training. This Short Communication describes some of the theoretical backgrounds, development and underlying educational foundations of a specifically designed video game and custom-made hardware that takes advantage of the positive effects of games on basic laparoscopic skills. PMID:24408736

  1. Training basic laparoscopic skills using a custom-made video game.

    PubMed

    Goris, Jetse; Jalink, Maarten B; Ten Cate Hoedemaker, Henk O

    2014-09-01

    Video games are accepted and used for a wide variety of applications. In the medical world, research on the positive effects of playing games on basic laparoscopic skills is rapidly increasing. Although these benefits have been proven several times, no institution actually uses video games for surgical training. This Short Communication describes some of the theoretical backgrounds, development and underlying educational foundations of a specifically designed video game and custom-made hardware that takes advantage of the positive effects of games on basic laparoscopic skills.

  2. Development of virtual environments for training skills and reducing errors in laparoscopic surgery

    NASA Astrophysics Data System (ADS)

    Tendick, Frank; Downes, Michael S.; Cavusoglu, Murat C.; Gantert, Walter A.; Way, Lawrence W.

    1998-06-01

    In every surgical procedure there are key steps and skills that, if performed incorrectly, can lead to complications. In conjunction with efforts, based on task and error analysis, in the Videoscopic Training Center at UCSF to identify these key elements in laparoscopic surgical procedures, the authors are developing virtual environments and modeling methods to train the elements. Laparoscopic surgery is particularly demanding of the surgeon's spatial skills, requiring the ability to create 3D mental models and plans while viewing a 2D image. For example, operating a laparoscope with the objective lens angled from the scope axis is a skill that some surgeons have difficulty mastering, even after using the instrument in many procedures. Virtual environments are a promising medium for teaching spatial skills. A kinematically accurate model of an angled laparoscope in an environment of simple targets is being tested in courses for novice and experienced surgeons. Errors in surgery are often due to a misinterpretation of local anatomy compounded with inadequate procedural knowledge. Methods to avoid bile duct injuries in cholecystectomy are being integrated into a deformable environment consisting of the liver, gallbladder, and biliary tree. Novel deformable tissue modeling algorithms based on finite element methods will be used to improve the response of the anatomical models.

  3. Spatial visualization ability and laparoscopic skills in novice learners: evaluating stereoscopic versus monoscopic visualizations.

    PubMed

    Roach, Victoria A; Mistry, Manisha R; Wilson, Timothy D

    2014-01-01

    Elevated spatial visualization ability (Vz) is thought to influence surgical skill acquisition and performance. Current research suggests that stereo visualization technology and its association with skill performance may confer perceptual advantages. This is of particular interest in laparoscopic skill training, where stereo visualization may confer learning advantages to novices of variant Vz. This study explored laparoscopic skill performance scores in novices with variable spatial ability utilizing stereoscopic and traditional monoscopic visualization paradigms. Utilizing the McGill Inanimate System for Teaching and Evaluating Laparoscopic Skills (MISTELS) scoring protocol it was hypothesized that individuals with high spatial visualization ability (HVz) would achieve higher overall and individual MISTELS task scores as compared to low spatial visualization ability (LVz) counterparts. Further, we also hypothesized that a difference would exist between HVz and LVz individual scores based on the viewing modality employed. No significant difference was observed between HVz and LVz individuals for MISTELS tasks scores, overall or individually under both viewing modalities, despite higher average MISTELS scores for HVz individuals. The lack of difference between scores obtained under the stereo modality suggested that the additional depth that is conferred by the stereoscopic visualization may act to enhance performance for individuals with LVz, potentially equilibrating their performance with their HVz peers. Further experimentation is required to better ascertain the effects of stereo visualization in individuals of high and low Vz, though it appears stereoscopic visualizations could serve as a prosthetic to enhance skill performance.

  4. Play to Become a Surgeon: Impact of Nintendo WII Training on Laparoscopic Skills

    PubMed Central

    Giannotti, Domenico; Patrizi, Gregorio; Di Rocco, Giorgio; Vestri, Anna Rita; Semproni, Camilla Proietti; Fiengo, Leslie; Pontone, Stefano; Palazzini, Giorgio; Redler, Adriano

    2013-01-01

    Background Video-games have become an integral part of the new multimedia culture. Several studies assessed video-gaming enhancement of spatial attention and eye-hand coordination. Considering the technical difficulty of laparoscopic procedures, legal issues and time limitations, the validation of appropriate training even outside of the operating rooms is ongoing. We investigated the influence of a four-week structured Nintendo® Wii™ training on laparoscopic skills by analyzing performance metrics with a validated simulator (Lap Mentor™, Simbionix™). Methodology/Principal Findings We performed a prospective randomized study on 42 post-graduate I–II year residents in General, Vascular and Endoscopic Surgery. All participants were tested on a validated laparoscopic simulator and then randomized to group 1 (Controls, no training with the Nintendo® Wii™), and group 2 (training with the Nintendo® Wii™) with 21 subjects in each group, according to a computer-generated list. After four weeks, all residents underwent a testing session on the laparoscopic simulator of the same tasks as in the first session. All 42 subjects in both groups improved significantly from session 1 to session 2. Compared to controls, the Wii group showed a significant improvement in performance (p<0.05) for 13 of the 16 considered performance metrics. Conclusions/Significance The Nintendo® Wii™ might be helpful, inexpensive and entertaining part of the training of young laparoscopists, in addition to a standard surgical education based on simulators and the operating room. PMID:23460845

  5. Laparoscopic common bile duct exploration.

    PubMed

    Vecchio, Rosario; MacFadyen, Bruce V

    2002-04-01

    In recent years, laparoscopic common bile duct exploration has become the procedure of choice in the management of choledocholithiasis in several laparoscopic centers. The increasing interest for this laparoscopic approach is due to the development of instrumentation and technique, allowing the procedure to be performed safely, and it is also the result of the revised role of endoscopic retrograde cholangiopancreatography, which has been questioned because of its cost, risk of complications and effectiveness. Many surgeons, however, are still not familiar with this technique. In this article we discuss the technique and results of laparoscopic common bile duct exploration. Both the laparoscopic transcystic approach and choledochotomy are discussed, together with the results given in the literature. When one considers the costs, morbidity, mortality and the time required before the patient can return to work, it would appear that laparoscopic cholecystectomy with common bile duct exploration is more favorable than open surgery or laparoscopic cholecystectomy with preoperative or postoperative endoscopic sphincterotomy. However, the technique requires advanced laparoscopic skills, including suturing, knot tying, the use of a choledochoscope, guidewire, dilators and balloon stone extractor. Although laparoscopic common bile duct exploration appears to be the most cost-effective method to treat common bile duct stones, it should be emphasized that this procedure is very challenging, and it should be performed by well-trained laparoscopic surgeons with experience in biliary surgery. PMID:11981684

  6. Canada's Crisis in Advanced Skills

    ERIC Educational Resources Information Center

    Association of Canadian Community Colleges, 2008

    2008-01-01

    The key to economic and social development lies in the knowledge and skill base of human capital. This report, presented to the House of Commons Standing Committee on Finance, calls for vigorous action on the part of the Government of Canada, in concert with the provinces and territories, to protect the Canadian economy from a skills shortage…

  7. [Animal models in urological laparoscopic training].

    PubMed

    Usón Gargallo, J; Sánchez Margallo, F M; Díaz-Güemes Martín-Portugués, I; Loscertales Martín de Agar, B; Soria Gálvez, F; Pascual Sánchez-Gijón, S

    2006-05-01

    We present the experience of the Minimally Invasive Surgery Centre (MISC) in the development of a modular training model in laparoscopic surgery. The experience analysis includes the description of the training objectives, the learning process of simple and advance laparoscopic urologic techniques, as well as some current and future considerations before applying the laparoscopic techniques. This learning program pretends to optimize the knowledge of the surgeon and the clinical practice of these surgical techniques. The phases of the learning process have been classified in four levels, which include different modules and models and whose application will depend on the experience and surgical skills. This pyramidal training system permits the student to advance step by step through each level depending on her surgical skills. We have presented our experience in twelve courses about laparoscopic urology and four courses of laparoscopic radical prostatectomy, in which more than 300 urologists have assisted. Furthermore, some Spanish Urology Units have been developing special experimental training programs on laparoscopic radical prostatectomy, partial nephrectomy or laparoscopic dismembered pyeloplasty with Anderson-Hynes technique. It has been previously described that laparoscopic modular learning constitutes a very useful concept to avoid problems related to an incomplete and incorrect learning process. Also it seems clear that the laparoscopic training reduces the learning curve in laparoscopic urologic techniques.

  8. Validation of virtual reality to teach and assess psychomotor skills in laparoscopic surgery: results from randomised controlled studies using the MIST VR laparoscopic simulator.

    PubMed

    Taffinder, N; Sutton, C; Fishwick, R J; McManus, I C; Darzi, A

    1998-01-01

    Objective assessment of surgical technique is currently impossible. A virtual reality simulator for laparoscopic surgery (MIST VR) models the movements needed to perform minimally invasive surgery and can generate a score for various aspects of psychomotor skill. Two studies were performed using the simulator: first to assess surgeons of different surgical experience to validate the scoring system; second to assess in a randomised controlled way, the effect of a standard laparoscopic surgery training course. Experienced surgeons (> 100 laparoscopic cholecystectomies) were significantly more efficient, made less correctional submovements and completed the virtual reality tasks faster than trainee surgeons or non-surgeons. The training course caused an improvement in efficiency and a reduction in errors, without a significant increase in speed when compared with the control group. The MIST VR simulator can objectively assess a number of desirable qualities in laparoscopic surgery, and can distinguish between experienced and novice surgeons. We have also quantified the beneficial effect of a structured training course on psychomotor skill acquisition.

  9. Teaching Advanced SQL Skills: Text Bulk Loading

    ERIC Educational Resources Information Center

    Olsen, David; Hauser, Karina

    2007-01-01

    Studies show that advanced database skills are important for students to be prepared for today's highly competitive job market. A common task for database administrators is to insert a large amount of data into a database. This paper illustrates how an up-to-date, advanced database topic, namely bulk insert, can be incorporated into a database…

  10. The robotic-assisted laparoscopic pyeloplasty: gateway to advanced reconstruction.

    PubMed

    Tasian, Gregory E; Casale, Pasquale

    2015-02-01

    Robotic pyeloplasty is now commonly performed for children with ureteropelvic junction obstruction. Because surgical robotics is a tool that facilitates pyeloplasty and other reconstructive urologic operations, the indications for robotic-assisted laparoscopic pyeloplasty are the same as those for an open pyeloplasty but offer distinct advantages with respect to visualization, range of motion, and ease of laparoscopic suturing. In this review, the authors discuss the operative approach for robotic pyeloplasty in children and the extensions of the basic techniques to challenging clinical scenarios. PMID:25455175

  11. [Objective surgery -- advanced robotic devices and simulators used for surgical skill assessment].

    PubMed

    Suhánszki, Norbert; Haidegger, Tamás

    2014-12-01

    Robotic assistance became a leading trend in minimally invasive surgery, which is based on the global success of laparoscopic surgery. Manual laparoscopy requires advanced skills and capabilities, which is acquired through tedious learning procedure, while da Vinci type surgical systems offer intuitive control and advanced ergonomics. Nevertheless, in either case, the key issue is to be able to assess objectively the surgeons' skills and capabilities. Robotic devices offer radically new way to collect data during surgical procedures, opening the space for new ways of skill parameterization. This may be revolutionary in MIS training, given the new and objective surgical curriculum and examination methods. The article reviews currently developed skill assessment techniques for robotic surgery and simulators, thoroughly inspecting their validation procedure and utility. In the coming years, these methods will become the mainstream of Western surgical education.

  12. ANALYSIS OF STANDARD MULTI-PORT VS. SINGLE SITE ACCESS FOR LAPAROSCOPIC SKILLS TRAINING

    PubMed Central

    Cox, Daniel R; Zeng, Wenjing; Frisella, Margaret M; Brunt, L. Michael

    2015-01-01

    Introduction Single site access (SSA) laparoscopy is more challenging to perform than multi-port(MP) laparoscopy. We examined MP versus SSA skills training on laparoscopic performance in surgically naive individuals. Methods Forty end-of-1st year medical students were randomized into two groups. Both were trained on 4 basic laparoscopic drills (peg, rope, bean drop, pattern cutting) using a standard MP setup (Group 1) or SSA approach (Group 2). Time to proficiency and number of repetitions (reps) were recorded. Each group then crossed over to the alternate approach where the sequence was repeated. Data are mean ± SD and statistical analysis was with two-tailed, unpaired t-test. Results Total times to proficiency for the SSA and MP approaches was not significantly different between groups (Group 1 M-P 234.0 ± 114.9 min vs Group 2 SSA 216.4 ± 106.5 min, p=0.67). The MP-trained group took less time to reach proficiency on the standard MP setup than the SSA group on the SSA approach (119.1 ± 69.7 min vs 178.0 ± 93.4 min, p=0.058) with significantly fewer repetitions (77.6 ± 42.6 vs. 118.8 ± 54.3, p=0.027). The SSA-trained group took significantly less time to reach proficiency on the MP setup than the standard MP-trained group (38.4 ± 29.4 min vs. 119.1 ± 69.7 min; p=0.0013) requiring only a mean of 26.9 total repetitions. When the standard MP group crossed over to the SSA setup, they took significantly less time to reach proficiency with the SSA approach than the SSA-trained group (114.8 ± 50.5 min vs. 178.0 ± 93.4 min, p=0.026) but with more total repetitions than with the M-P approach (86.2 ± 35.2 vs 77.6 ± 42.6, p= NS). Conclusions Laparoscopic single site access skills training results in longer times and more repetitions to achieve proficiency than multi-port training, but the skills acquired transfer well to the multi-port approach. PMID:20872019

  13. Are short-term focused training courses on a phantom model using porcine gall bladder useful for trainees in acquiring basic laparoscopic skills?

    PubMed

    Bansal, Virinder Kumar; Panwar, Rajesh; Misra, Mahesh C; Bhattacharjee, Hemanga K; Jindal, Vikas; Loli, Athiko; Goswami, Amit; Krishna, Asuri; Tamang, Tseten

    2012-04-01

    The best training method in laparoscopic surgery has not been defined. We evaluated the efficacy of laparoscopic skills acquisition in a short-term focused program. Two hundred fifty-six participants undergoing training on a phantom model were divided into 2 groups. Group 1 had no exposure and group 2 had performed a few laparoscopic surgeries. Acquisition of laparoscopic skills was assessed by operation time and the modified Global Operative Assessment of Laparoscopic Skills (GOALS) scale. A questionnaire was sent to the participants after 3 to 6 months for assessment of impact of training. There was a statistically significant improvement in the assessed parameters and in the mean score of all 5 domains of GOALS. The participants in group 2 performed better than those in group 1 in the first case. The difference between both the groups disappeared after the training. Participants who responded to the questionnaire felt that training helped them in improving their performance in the operation theater. PMID:22487631

  14. Are short-term focused training courses on a phantom model using porcine gall bladder useful for trainees in acquiring basic laparoscopic skills?

    PubMed

    Bansal, Virinder Kumar; Panwar, Rajesh; Misra, Mahesh C; Bhattacharjee, Hemanga K; Jindal, Vikas; Loli, Athiko; Goswami, Amit; Krishna, Asuri; Tamang, Tseten

    2012-04-01

    The best training method in laparoscopic surgery has not been defined. We evaluated the efficacy of laparoscopic skills acquisition in a short-term focused program. Two hundred fifty-six participants undergoing training on a phantom model were divided into 2 groups. Group 1 had no exposure and group 2 had performed a few laparoscopic surgeries. Acquisition of laparoscopic skills was assessed by operation time and the modified Global Operative Assessment of Laparoscopic Skills (GOALS) scale. A questionnaire was sent to the participants after 3 to 6 months for assessment of impact of training. There was a statistically significant improvement in the assessed parameters and in the mean score of all 5 domains of GOALS. The participants in group 2 performed better than those in group 1 in the first case. The difference between both the groups disappeared after the training. Participants who responded to the questionnaire felt that training helped them in improving their performance in the operation theater.

  15. Construction and validation of a low-cost surgical trainer based on iPhone technology for training laparoscopic skills.

    PubMed

    Pérez Escamirosa, Fernando; Ordorica Flores, Ricardo; Minor Martínez, Arturo

    2015-04-01

    In this article, we describe the construction and validation of a laparoscopic trainer using an iPhone 5 and a plastic document holder case. The abdominal cavity was simulated with a clear plastic document holder case. On 1 side of the case, 2 holes for entry of laparoscopic instruments were drilled. We added a window to place the camera of the iPhone, which works as our camera of the trainer. Twenty residents carried out 4 tasks using the iPhone Trainer and a physical laparoscopic trainer. The time of all tasks were analyzed with a simple paired t test. The construction of the trainer took 1 hour, with a cost of skills anywhere and at their own pace.

  16. Strategies of laparoscopic spleen-preserving splenic hilar lymph node dissection for advanced proximal gastric cancer

    PubMed Central

    Chen, Qi-Yue; Huang, Chang-Ming; Zheng, Chao-Hui; Li, Ping; Xie, Jian-Wei; Wang, Jia-Bin; Lin, Jian-Xian; Lu, Jun; Cao, Long-Long; Lin, Mi; Tu, Ru-Hong; Hong, Zhi-Liang

    2016-01-01

    For advanced proximal gastric cancer (GC), splenic hilar (No. 10) lymph nodes (LN) are crucial links in lymphatic drainage. According to the 14th edition of the Japanese GC treatment guidelines, a D2 lymphadenectomy is the standard surgery for advanced GC, and No. 10 LN should be dissected for advanced proximal GC. In recent years, the preservation of organ function and the use of minimally invasive technology are being accepted by an increasing number of clinicians. Laparoscopic spleen-preserving splenic hilar LN dissection has become more accepted and is gradually being used in operations. However, because of the complexity of splenic hilar anatomy, mastering the strategies for laparoscopic spleen-preserving splenic hilar LN dissection is critical for successfully completing the operation. PMID:27358672

  17. Laparoscopic surgical skills training: an investigation of the potential of using surgeons' visual search behaviour as a performance indicator

    NASA Astrophysics Data System (ADS)

    Chen, Yan; Dong, Leng; Gale, Alastair G.; Rees, Benjamin; Maxwell-Armstrong, Charles

    2014-03-01

    Laparoscopic surgery is a difficult perceptual-motor task and effective and efficient training in the technique is important. Viewing previously recorded laparoscopic operations is a possible available training technique for surgeons to increase their knowledge of such minimal access surgery (MAS). It is not well known whether this is a useful technique, how effective it is or what effect it has on the surgeon watching the recorded video. As part of an on-going series of studies into laparoscopic surgery, an experiment was conducted to examine whether surgical skill level has an effect on the visual search behaviour of individuals of different surgical experience when they examine such imagery. Medically naive observers, medical students, junior surgeons and experienced surgeons viewed a laparoscopic recording of a recent operation. Initial examination of the recorded eye movement data indicated commonalities between all observers, largely irrespective of surgical experience. This, it is argued, is due to visual search in this situation largely being driven by the dynamic nature of the images. The data were then examined in terms of surgical steps and also in terms of interventions when differences were found related to surgical experience. Consequently, it is argued that monitoring the eye movements of trainee surgeons whilst they watch pre-recorded operations is a potential useful adjunct to existing training regimes.

  18. Robotic-assisted laparoscopic surgery: recent advances in urology.

    PubMed

    Autorino, Riccardo; Zargar, Homayoun; Kaouk, Jihad H

    2014-10-01

    The aim of the present review is to summarize recent developments in the field of urologic robotic surgery. A nonsystematic literature review was performed to retrieve publications related to robotic surgery in urology and evidence-based critical analysis was conducted by focusing on the literature of the past 5 years. The use of the da Vinci Surgical System, a robotic surgical system, has been implemented for the entire spectrum of extirpative and reconstructive laparoscopic kidney procedures. The robotic approach can be applied for a range of adrenal indications as well as for ureteral diseases, including benign and malignant conditions affecting the proximal, mid, and distal ureter. Current evidence suggests that robotic prostatectomy is associated with less blood loss compared with the open surgery. Besides prostate cancer, robotics has been used for simple prostatectomy in patients with symptomatic benign prostatic hyperplasia. Recent studies suggest that minimally invasive radical cystectomy provides encouraging oncologic outcomes mirroring those reported for open surgery. In recent years, the evolution of robotic surgery has enabled urologic surgeons to perform urinary diversions intracorporeally. Robotic vasectomy reversal and several other robotic andrological applications are being explored. In summary, robotic-assisted surgery is an emerging and safe technology for most urologic operations. The acceptance of robotic prostatectomy during the past decade has paved the way for urologists to explore the entire spectrum of extirpative and reconstructive urologic procedures. Cost remains a significant issue that could be solved by wider dissemination of the technology.

  19. The Role of Robotic Surgery for Rectal Cancer: Overcoming Technical Challenges in Laparoscopic Surgery by Advanced Techniques.

    PubMed

    Park, Seungwan; Kim, Nam Kyu

    2015-07-01

    The conventional laparoscopic approach to rectal surgery has several limitations, and therefore many colorectal surgeons have great expectations for the robotic surgical system as an alternative modality in overcoming challenges of laparoscopic surgery and thus enhancing oncologic and functional outcomes. This review explores the possibility of robotic surgery as an alternative approach in laparoscopic surgery for rectal cancer. The da Vinci® Surgical System was developed specifically to compensate for the technical limitations of laparoscopic instruments in rectal surgery. The robotic rectal surgery is associated with comparable or better oncologic and pathologic outcomes, as well as low morbidity and mortality. The robotic surgery is generally easier to learn than laparoscopic surgery, improving the probability of autonomic nerve preservation and genitourinary function recovery. Furthermore, in very complex procedures such as intersphincteric dissections and transabdominal transections of the levator muscle, the robotic approach is associated with increased performance and safety compared to laparoscopic surgery. The robotic surgery for rectal cancer is an advanced technique that may resolve the issues associated with laparoscopic surgery. However, high cost of robotic surgery must be addressed before it can become the new standard treatment.

  20. Association of gender and specialty interest with video-gaming, three-dimensional spatial analysis, and entry-level laparoscopic skills in third-year veterinary students.

    PubMed

    Bragg, Heather R; Towle Millard, Heather A; Millard, Ralph P; Constable, Peter D; Freeman, Lyn J

    2016-06-15

    OBJECTIVE To determine whether gender or interest in pursuing specialty certification in internal medicine or surgery was associated with video-gaming, 3-D spatial analysis, or entry-level laparoscopic skills in third-year veterinary students. DESIGN Cross-sectional study. SAMPLE A convenience sample of 68 (42 female and 26 male) third-year veterinary students. PROCEDURES Participants completed a survey asking about their interest in pursuing specialty certification in internal medicine or surgery. Subsequently, participants' entry-level laparoscopic skills were assessed with 3 procedures performed in box trainers, their video-gaming skills were tested with 3 video games, and their 3-D spatial analysis skills were evaluated with the Purdue University Visualization of Rotations Spatial Test. Scores were assigned for laparoscopic, video-gaming, and 3-D spatial analysis skills. RESULTS Significantly more female than male students were interested in pursuing specialty certification in internal medicine (23/42 vs 7/26), and significantly more male than female students were interested in pursuing specialty certification in surgery (19/26 vs 19/42). Males had significantly higher video-gaming skills scores than did females, but spatial analysis and laparoscopic skills scores did not differ between males and females. Students interested in pursuing specialty certification in surgery had higher video-gaming and spatial analysis skills scores than did students interested in pursuing specialty certification in internal medicine, but laparoscopic skills scores did not differ between these 2 groups. CONCLUSIONS AND CLINICAL RELEVANCE For this group of students, neither gender nor interest in specialty certification in internal medicine versus surgery was associated with entry-level laparoscopy skills. PMID:27270065

  1. Laparoscopic ovarian transposition prior to pelvic irradiation in a young female patient with advanced rectal cancer.

    PubMed

    Kihara, Kyoichi; Yamamoto, Seiichiro; Ohshiro, Taihei; Fujita, Shin

    2015-12-01

    In the report, we describe the first case of laparoscopic ovarian transposition prior to pelvic radio-chemo therapy in a young female patient with advanced rectal cancer in Japan. A 14-year-old female visited a hospital because of consistent diarrhea and melena. Colonoscopy examination showed a bulky tumor of the rectum, which was diagnosed as moderately to poorly differentiated adenocarcinoma. The diagnosis was cT3N2aM1a (due to lymph node in pelvic side wall), cStage IVA. In an attempt to improve local control and sphincter preservation, neoadjuvant concurrent radio-chemo therapy was planned. Considering that pelvic irradiation particularly in young female might cause ovarian failure, laparoscopic ovarian transposition was carried out prior to pelvic irradiation. Sequentially the patient underwent low anterior resection of the rectum and lymphadenectomy including pelvic side wall. The menstruation was maintained with delay for 6 months after adjuvant chemotherapy. There is no evidence of cancer recurrence at 3 years after the surgery.In premenopausal patients with rectal cancer undergoing pelvic irradiation, laparoscopic ovarian transposition is one of the choices to prevent ovarian failure. PMID:26943437

  2. COMPARISON OF LAPAROSCOPIC SKILLS PERFORMANCE USING SINGLE-SITE ACCESS (SSA) DEVICES VS. AN INDEPENDENT-PORT SSA APPROACH

    PubMed Central

    Schill, Matthew R.; Varela, J. Esteban; Frisella, Margaret M.; Brunt, L. Michael

    2015-01-01

    Background We compared performance of validated laparoscopic tasks on four commercially available single site access (SSA) access devices (AD) versus an independent port (IP) SSA set-up. Methods A prospective, randomized comparison of laparoscopic skills performance on four AD (GelPOINT™, SILS™ Port, SSL Access System™, TriPort™) and one IP SSA set-up was conducted. Eighteen medical students (2nd–4th year), four surgical residents, and five attending surgeons were trained to proficiency in multi-port laparoscopy using four laparoscopic drills (peg transfer, bean drop, pattern cutting, extracorporeal suturing) in a laparoscopic trainer box. Drills were then performed in random order on each IP-SSA and AD-SSA set-up using straight laparoscopic instruments. Repetitions were timed and errors recorded. Data are mean ± SD, and statistical analysis was by two-way ANOVA with Tukey HSD post-hoc tests. Results Attending surgeons had significantly faster total task times than residents or students (p< 0.001), but the difference between residents and students was NS. Pair-wise comparisons revealed significantly faster total task times for the IP-SSA set-up compared to all four AD-SSA’s within the student group only (p<0.05). Total task times for residents and attending surgeons showed a similar profile, but the differences were NS. When data for the three groups was combined, the total task time was less for the IP-SSA set-up than for each of the four AD-SSA set-ups (p < 0.001). Similarly,, the IP-SSA set-up was significantly faster than 3 of 4 AD-SSA set-ups for peg transfer, 3 of 4 for pattern cutting, and 2 of 4 for suturing. No significant differences in error rates between IP-SSA and AD-SSA set-ups were detected. Conclusions When compared to an IP-SSA laparoscopic set-up, single site access devices are associated with longer task performance times in a trainer box model, independent of level of training. Task performance was similar across different SSA

  3. Skills Required for Nursing Career Advancement: A Qualitative Study

    PubMed Central

    Sheikhi, Mohammad Reza; Fallahi-Khoshnab, Masoud; Mohammadi, Farahnaz; Oskouie, Fatemeh

    2016-01-01

    Background Nurses require certain skills for progression in their field. Identifying these skills can provide the context for nursing career advancement. Objectives This study aimed to identify the skills needed for nurses’ career advancement. Materials and Methods A qualitative approach using content analysis was adopted to study a purposive sample of eighteen nurses working in teaching hospitals affiliated with the Qazvin, Shahid Beheshti, and Iran Universities of Medical Sciences. The data were collected through semi-structured interviews, and analyzed using conventional content analysis. Results The three themes extracted from the data included interpersonal capabilities, competency for career success, and personal capacities. The results showed that acquiring a variety of skills is essential for career advancement. Conclusions The findings showed that personal, interpersonal, and functional skills can facilitate nurses’ career advancement. The effects of these skills on career advancement depend on a variety of conditions that require further studies. PMID:27556054

  4. Assessment of laparoscopic psychomotor skills in interns using the MIST Virtual Reality Simulator: a prerequisite for those considering surgical training?

    PubMed

    Cope, Daron H; Fenton-Lee, Douglas

    2008-04-01

    Selection for surgical training in Australia is currently based on assessment of a structured curriculum vitae, referral reports from selected clinicians and an interview. The formal assessment of laparoscopic psychomotor skill and ability to attain skills is not currently a prerequisite for selection. The aim of this study was to assess the innate psychomotor skills of interns and also to compare interns with an interest in pursuing a surgical career to interns with those with no interest in pursuing a surgical career. Twenty-two interns were given the opportunity to carry out tasks on the Minimal Invasive Surgical Trainer, Virtual Reality (Mentice, Gothenburg, Sweden) Simulator. The candidates were required to complete six tasks, repeated six times each. Scores for each task were calculated objectively by the simulator software. Demographic data were similar between the two groups. Although some candidates who were interested in pursuing a surgical career performed poorly on the simulator, there was no significant difference when comparing the two groups. The Minimal Invasive Surgical Trainer, Virtual Reality (Mentice) Simulator provides an objective and comparable assessment of laparoscopic psychomotor skills. We can conclude that interns have varying inherent ability as judged by the simulator and this does not seem to have an influence on their career selection. There was no significant difference in the scores between the two groups. Interns with and without inherent abilities have aspirations to pursue surgical careers and their aptitude does not seem to influence this decision. Surgical colleges could use psychomotor ability assessments to recruit candidates to pursue a career in surgery. Trainees needing closer monitoring and additional training could be identified early and guided to achieve competency.

  5. Laparoscopic Excision of Large Intra-Abdominal Cysts in Children: Needle Hitch Technique

    PubMed Central

    Antao, Brice; Tan, Jeffrey; Quinn, Feargal

    2015-01-01

    Laparoscopic surgery has both diagnostic and therapeutic advantages in the management of intra-abdominal cysts in children. Large cysts in small children pose technical challenges during laparoscopic surgery, requiring multiple incisions and advanced laparoscopic skills. This paper describes a novel laparoscopic technique using minimal manipulation for both aspiration and excision of the cyst. This simple, safe, and effective approach was used to achieve traction and facilitate excision of a large intra-abdominal cyst in a neonate and a young child. PMID:26798349

  6. A Case for Advanced Skills and Employability in Higher Education.

    ERIC Educational Resources Information Center

    Holmes, Alison; Miller, Stuart

    2000-01-01

    Case Studies to Advance Skills and Employability is a project designed to introduce a vocational dimension into academic curriculum. Key employability skills are developed as students work on real-life case situations in such areas as public sculpture, waste management, human organizations, and environmental issues. (SK)

  7. Employer-Led Organizations and Skill Supply Chains: Linking Worker Advancement with the Skill Needs of Employers. Issue Brief.

    ERIC Educational Resources Information Center

    Mills, Jack; Prince, Heath

    Skill supply chains apply a chain strategy to human resources to make the labor market more efficient. They link the multiple skill levels in a given labor market within a network of recruitment pathways for employers and advancement pathways for workers. Skill supply chains are based on employers' actual skill needs and on the principle that…

  8. Training Advanced Writing Skills: The Case for Deliberate Practice

    ERIC Educational Resources Information Center

    Kellogg, Ronald T.; Whiteford, Alison P.

    2009-01-01

    The development of advanced writing skills has been neglected in schools of the United States, with even some college graduates lacking the level of ability required in the workplace (National Commission on Writing, 2003, 2004). The core problem, we argue, is an insufficient degree of appropriate task practice distributed throughout the secondary…

  9. Colleges and Institutes: Advanced Skills for the Health Sector

    ERIC Educational Resources Information Center

    Association of Canadian Community Colleges, 2010

    2010-01-01

    This report provides the recommendations made by the Association of Canadian Community Colleges (ACCC) to the House of Commons Standing Committee on Health based from its examination on the health and human resources issues in Canada. Colleges are the advanced skills educators of choice. Aligned with the needs of employers, and operating on the…

  10. Advanced Academic Skills in the Low-Level ESL Class.

    ERIC Educational Resources Information Center

    Pearson, Christine R.

    1981-01-01

    Suggests and gives examples of how a few advanced skills and concepts are related to successful reading and writing and can be introduced in low-level ESL classes. Examples include generality-specificity distinction, relevance-irrelevance distinction, underlining and making notes, paraphrasing, and summarizing. This conceptually integrated…

  11. Are Skills the Answer? The Political Economy of Skill Creation in Advanced Industrial Countries.

    ERIC Educational Resources Information Center

    Crouch, Colin; Finegold, David; Sako, Mari

    This book analyzes vocational education and training (VET) systems in seven advanced industrial countries (AICs) to determine institutional arrangements for skills creation most promising in attaining the learning society. The AICs are France, Germany, Italy, Japan, United Kingdom, United States, and Sweden. Chapter 1 discusses special problems of…

  12. Clinical skills assessment of procedural and advanced communication skills: performance expectations of residency program directors

    PubMed Central

    Langenau, Erik E.; Zhang, Xiuyuan; Roberts, William L.; DeChamplain, Andre F.; Boulet, John R.

    2012-01-01

    Background High stakes medical licensing programs are planning to augment and adapt current examinations to be relevant for a two-decision point model for licensure: entry into supervised practice and entry into unsupervised practice. Therefore, identifying which skills should be assessed at each decision point is critical for informing examination development, and gathering input from residency program directors is important. Methods Using data from previously developed surveys and expert panels, a web-delivered survey was distributed to 3,443 residency program directors. For each of the 28 procedural and 18 advanced communication skills, program directors were asked which clinical skills should be assessed, by whom, when, and how. Descriptive statistics were collected, and Intraclass Correlations (ICC) were conducted to determine consistency across different specialties. Results Among 347 respondents, program directors reported that all advanced communication and some procedural tasks are important to assess. The following procedures were considered ‘important’ or ‘extremely important’ to assess: sterile technique (93.8%), advanced cardiovascular life support (ACLS) (91.1%), basic life support (BLS) (90.0%), interpretation of electrocardiogram (89.4%) and blood gas (88.7%). Program directors reported that most clinical skills should be assessed at the end of the first year of residency (or later) and not before graduation from medical school. A minority were considered important to assess prior to the start of residency training: demonstration of respectfulness (64%), sterile technique (67.2%), BLS (68.9%), ACLS (65.9%) and phlebotomy (63.5%). Discussion Results from this study support that assessing procedural skills such as cardiac resuscitation, sterile technique, and phlebotomy would be amenable to assessment at the end of medical school, but most procedural and advanced communications skills would be amenable to assessment at the end of the first

  13. Total Laparoscopic Hysterectomy Utilizing a Robotic Surgical System

    PubMed Central

    Nelson, Keith H.; Daucher, James A.

    2005-01-01

    Objectives: To describe the use of a robotic surgical system for total laparoscopic hysterectomy. Methods: We report a series of laparoscopic hysterectomies performed using the da Vinci Robotic Surgical System. Participants were women eligible for hysterectomy by standard laparoscopy. Operative times and complications are reported. Results: We completed 10 total laparoscopic hysterectomies between November 2001 and December 2002 with the use of the da Vinci Robotic Surgical System. Operative results were similar to those of standard laparoscopic hysterectomy. Operative time varied from 2 hours 28 minutes to 4 hours 37 minutes. Blood loss varied from 25 mL to 350 mL. Uterine weights varied from 49 g to 227 g. A cystotomy occurred in a patient with a history of a prior cystotomy unrelated to the robotic system. Conclusion: Total laparoscopic hysterectomy is a complex surgical procedure requiring advanced laparoscopic skills. Tasks like lysis of adhesions, suturing, and knot tying were enhanced with the robotic surgical system, thus providing unique advantages over existing standard laparoscopy. Total laparoscopic hysterectomy can be performed using robotic surgical systems. PMID:15791963

  14. Initial experience of laparoscopic incisional hernia repair.

    PubMed

    Razman, J; Shaharin, S; Lukman, M R; Sukumar, N; Jasmi, A Y

    2006-06-01

    Laparoscopic repair of ventral and incisional hernia has become increasingly popular as compared to open repair. The procedure has the advantages of minimal access surgery, reduction of post operative pain and the recurrence rate. A prospective study of laparoscopic incisional hernia repair was performed in our center from August 2002 to April 2004. Eighteen cases (n: 18) were performed during the study period. Fifteen cases (n: 15) had open hernia repair previously. Sixteen patients (n: 16) had successful repair of the hernia with the laparoscopic approach and two cases were converted to open repair. The mean hernia defect size was 156cm2. There was no intraoperative or immediate postoperative complication. The mean operating time was 100 +/- 34 minutes (75 - 180 minutes). The postoperative pain was graded as mild to moderate according to visual analogue score. The mean day of discharge after surgery was two days (1 - 3 days). During follow up, three patients (16.7%) developed seroma at the hernia sac which was resolved with conservative management after three weeks. One (5.6%) patient developed recurrence six months after surgery. In conclusion, laparoscopic repair of incisional hernia particularly recurrent hernia has been shown to be safe and effective in our centre. However, careful patient selection and acquiring the necessary advanced laparoscopic surgical skills coupled with the proper use of equipment are mandatory before embarking on this procedure.

  15. Laparoscopic liver resection: Current role and limitations.

    PubMed

    Mostaedi, Rouzbeh; Milosevic, Zoran; Han, Ho-Seong; Khatri, Vijay P

    2012-08-15

    Laparoscopic liver resection (LLR) for the treatment of benign and malignant liver lesions is often performed at specialized centers. Technological advances, such as laparoscopic ultrasonography and electrosurgical tools, have afforded surgeons simultaneous improvements in surgical technique. The utilization of minimally invasive techniques for liver resection has been reported to reduce operative time, decrease blood loss, and shorten length of hospital stay with equivalent postoperative mortality and morbidity rates compared to open liver resection (OLR). Non-anatomic liver resection and left lateral sectionectomy are now routinely performed laparoscopically at many institutions. Furthermore, major hepatic resections are performed by pure laparoscopy, hand-assisted technique, and the hybrid method. In addition, robotic surgery and single port surgery are revealing early promising results. The consensus recommendation for the treatment of benign liver disease and malignant lesions remains unchanged when considering a laparoscopic approach, except when comorbidities and anatomic limitations of the liver lesion preclude this technique. Disease free and survival rates after LLR for hepatocellular carcinoma and metastatic colon cancer correspond to OLR. Patient selection is a significant factor for these favorable outcomes. The limitations include LLR of superior and posterior liver lesions; however, adjustments in technique may now consider a laparoscopic approach as a viable option. As growing data continue to reveal the feasibility and efficacy of laparoscopic liver surgery, this skill is increasingly being adopted by hepatobiliary surgeons. Although the full scope of laparoscopic liver surgery remains infrequently used by many general surgeons, this technique will become a standard in the treatment of liver diseases as studies continue to show favorable outcomes.

  16. [Simulation of laparoscopic surgery--four years' experience at the Department of Surgery of the University Hospital Marburg].

    PubMed

    Hassan, Iyad; Osei-Agymang, Thomas; Radu, Daniela; Gerdes, Berthold; Rothmund, Matthias; Fernández, Emilio Domínguez

    2008-01-01

    It is well known that learning curves are longer for laparoscopic surgery compared to open surgery. Recently, virtual reality (VR) simulation was developed as alternative to conventional training. Such a new training system makes it possible to offer a wide range of repeatable surgical situations, and thus, enable assessments based on direct observation of performance. During the last four years we did several studies using a VR simulator (LapSim). After a constructive validity study - discrimination between novices and experienced laparoscopic surgeons, we were able to show that advanced residents benefit most from a three-day practical course for laparoscopic surgery, while - in a further investigation - we found contrary to training at the Pelvitrainer that novices in laparoscopic surgery have the most benefit from VR training. Minimally invasive surgery is significantly more sophisticated for the surgeon than open surgery. While Research on laparoscopic surgery has focused primarily on the development and assessment of technical skills, non technical skills such as visual-spatial perception and stress coping has received much less attention. We showed that spatial perception as well as stress coping positively correlates with virtual laparoscopic skills. A high degree of spatial perception led to faster adaption to a non-stereo environment and correlated with high level of laparoscopic skills. Furthermore, Ineffective stress-coping strategies correlate with poor virtual laparoscopic performance. VR simulation seems to be a promising tool to improve laparoscopic skills in a modern apprenticeship model. According to patient safety, the development of this instrument for surgery should be advanced professionally just as a flight simulators in aviation. PMID:18322767

  17. A Qualitative Assessment of Human Cadavers Embalmed by Thiel's Method Used in Laparoscopic Training for Renal Resection

    ERIC Educational Resources Information Center

    Rai, Bhavan Prasad; Tang, Benjie; Eisma, Roos; Soames, Roger W.; Wen, Haitao; Nabi, Ghulam

    2012-01-01

    Human cadaveric tissue is the fundamental substrate for basic anatomic and surgical skills training. A qualitative assessment of the use of human cadavers preserved by Thiel's method for a British Association of Urological Surgeons--approved, advanced laparoscopic renal resection skills training course is described in the present study. Four…

  18. [Recent advances of anastomosis techniques of esophagojejunostomy after laparoscopic totally gastrectomy in gastric tumor].

    PubMed

    Li, Xi; Ke, Chongwei

    2015-05-01

    The esophageal jejunum anastomosis of the digestive tract reconstruction techniques in laparoscopic total gastrectomy includes two categories: circular stapler anastomosis techniques and linear stapler anastomosis techniques. Circular stapler anastomosis techniques include manual anastomosis method, purse string instrument method, Hiki improved special anvil anastomosis technique, the transorally inserted anvil(OrVil(TM)) and reverse puncture device technique. Linear stapler anastomosis techniques include side to side anastomosis technique and Overlap side to side anastomosis technique. Esophageal jejunum anastomosis technique has a wide selection of different technologies with different strengths and the corresponding limitations. This article will introduce research progress of laparoscopic total gastrectomy esophagus jejunum anastomosis from both sides of the development of anastomosis technology and the selection of anastomosis technology.

  19. Inexpensive home-made laparoscopic trainer and camera.

    PubMed

    Pokorny, Morgan R; McLaren, Scott L

    2004-08-01

    Laparoscopic surgery is a well-established and important component of modern surgical practice across a range of surgical specialties. However, training in this modality is hampered by the nature of the equipment and its cost, and the difficulty of much of the surgery undertaken. Hence it can take some time for advanced and especially basic trainees to attain competency in laparoscopic techniques, and it remains difficult to practise or refine techniques. A solution to one half of this problem has been investigated by designing an inexpensive home-made laparoscopic camera and trainer system that can be assembled and used by one or more trainees either in a skills lab or at home. The components are readily available and the present system comprises a CMOS spy camera mounted on a rigid plastic tube that is used within a translucent plastic training box, obviating the need for an inbuilt light source. The costs were successfully constrained to under NZ$200. PMID:15315575

  20. Training and assessment of psychomotor skills for performing laparoscopic surgery using BEST-IRIS virtual reality training simulator.

    PubMed

    Makam, Ramesh; Rajan, C S; Brendon, Tulip; Shreedhar, V; Saleem, K; Shrivastava, Sangeeta; Sudarshan, R; Naidu, Prakash

    2004-01-01

    In this article, we present the results of a pilot study that examined the performance of people training on a Virtual Reality based BEST-IRIS Laparoscopic Surgery Training Simulator. The performance of experienced surgeons was examined and compared to the performance of residents. The purpose of this study is to validate the BEST-IRIS training simulator. It appeared to be a useful training and assessment tool.

  1. Advanced mathematical study and the development of conditional reasoning skills.

    PubMed

    Attridge, Nina; Inglis, Matthew

    2013-01-01

    Since the time of Plato, philosophers and educational policy-makers have assumed that the study of mathematics improves one's general 'thinking skills'. Today, this argument, known as the 'Theory of Formal Discipline' is used in policy debates to prioritize mathematics in school curricula. But there is no strong research evidence which justifies it. We tested the Theory of Formal Discipline by tracking the development of conditional reasoning behavior in students studying post-compulsory mathematics compared to post-compulsory English literature. In line with the Theory of Formal Discipline, the mathematics students did develop their conditional reasoning to a greater extent than the literature students, despite them having received no explicit tuition in conditional logic. However, this development appeared to be towards the so-called defective conditional understanding, rather than the logically normative material conditional understanding. We conclude by arguing that Plato may have been correct to claim that studying advanced mathematics is associated with the development of logical reasoning skills, but that the nature of this development may be more complex than previously thought.

  2. What's Working: Program Factors Influencing California Community College Basic Skills Mathematics Students' Advancement to Transfer Level

    ERIC Educational Resources Information Center

    Fiero, Diane M.

    2013-01-01

    Purpose: The purpose of this study was to determine which basic skills program factors were exhibited by successful basic skills programs that helped students advance to transfer-level mathematics. This study specifically examined California community college basic skills programs that assist students who place in mathematics courses 2 levels…

  3. Career Advancement through Bilingual Education Skills. Project CABES, 1987-1988.

    ERIC Educational Resources Information Center

    Berney, Tomi D.; Velazquez, Clara

    This report evaluates Project CABES (Career Advancement through Bilingual Education Skills) during its second year of extension of a federal funding cycle at New York's Seward Park High School. The major goal of Project CABES was to provide career advancement skills to 250 Hispanic 9th- through 12-grade students of limited English proficiency…

  4. Teaching Advanced Skills to Educationally Disadvantaged Students. Data Analysis Support Center (DASC) Task 4. Final Report.

    ERIC Educational Resources Information Center

    Means, Barbara, Ed.; Knapp, Michael S., Ed.

    This document comprises six papers that discuss teaching advanced skills to educationally disadvantaged students. An introductory paper, "Models for Teaching Advanced Skills to Educationally Disadvantaged Children" (B. Means and M. S. Knapp), synthesizes the themes that characterize the collection of papers as a whole, and discusses general issues…

  5. Robotic laparoscopic surgery: cost and training.

    PubMed

    Amodeo, A; Linares Quevedo, A; Joseph, J V; Belgrano, E; Patel, H R H

    2009-06-01

    The advantages of minimally invasive surgery are well accepted. Shorter hospital stays, decreased postoperative pain, rapid return to preoperative activity, decreased postoperative ileus, and preserved immune function are among the benefits of the laparoscopic approach. However, the instruments of laparoscopy afford surgeons limited precision and poor ergonomics, and their use is associated with a significant learning curve and the amount of time and energy necessary to develop and maintain such advanced laparoscopic skills is not insignificant. The robotic surgery allows all laparoscopists to perform advanced laparoscopic procedures with greater ease. The potential advantages of surgical robotic systems include making advanced laparoscopic surgical procedures accessible to surgeons who do not have advanced video endoscopic training and broadening the scope of surgical procedures that can be performed using the laparoscopic method. The wristed instruments, x10 magnifications, tremor filtering, scaling of movements and three-dimensional view allow the urologist to perform the intricate dissection and anastomosis with high precision. The robot is not, however, without significant disadvantages as compared with traditional laparoscopy. These include greater expense and consumption of operating room resources such as space and the availability of skilled technical staff, complete elimination of tactile feedback, and more limited options for trocar placement. The current cost of the da Vinci system is $ 1.2 million and annual maintenance is $ 138000. Many studies suggest that depreciation and maintenance costs can be minimised if the number of robotic cases is increased. The high cost of purchasing and maintaining the instruments of the robotic system is one of its many disadvantages. The availability of the robotic systems to only a limited number of centres reduces surgical training opportunities. Hospital administrators and surgeons must define the reasons for

  6. Robotic laparoscopic surgery: cost and training.

    PubMed

    Amodeo, A; Linares Quevedo, A; Joseph, J V; Belgrano, E; Patel, H R H

    2009-06-01

    The advantages of minimally invasive surgery are well accepted. Shorter hospital stays, decreased postoperative pain, rapid return to preoperative activity, decreased postoperative ileus, and preserved immune function are among the benefits of the laparoscopic approach. However, the instruments of laparoscopy afford surgeons limited precision and poor ergonomics, and their use is associated with a significant learning curve and the amount of time and energy necessary to develop and maintain such advanced laparoscopic skills is not insignificant. The robotic surgery allows all laparoscopists to perform advanced laparoscopic procedures with greater ease. The potential advantages of surgical robotic systems include making advanced laparoscopic surgical procedures accessible to surgeons who do not have advanced video endoscopic training and broadening the scope of surgical procedures that can be performed using the laparoscopic method. The wristed instruments, x10 magnifications, tremor filtering, scaling of movements and three-dimensional view allow the urologist to perform the intricate dissection and anastomosis with high precision. The robot is not, however, without significant disadvantages as compared with traditional laparoscopy. These include greater expense and consumption of operating room resources such as space and the availability of skilled technical staff, complete elimination of tactile feedback, and more limited options for trocar placement. The current cost of the da Vinci system is $ 1.2 million and annual maintenance is $ 138000. Many studies suggest that depreciation and maintenance costs can be minimised if the number of robotic cases is increased. The high cost of purchasing and maintaining the instruments of the robotic system is one of its many disadvantages. The availability of the robotic systems to only a limited number of centres reduces surgical training opportunities. Hospital administrators and surgeons must define the reasons for

  7. Simulation in laparoscopic surgery.

    PubMed

    León Ferrufino, Felipe; Varas Cohen, Julián; Buckel Schaffner, Erwin; Crovari Eulufi, Fernando; Pimentel Müller, Fernando; Martínez Castillo, Jorge; Jarufe Cassis, Nicolás; Boza Wilson, Camilo

    2015-01-01

    Nowadays surgical trainees are faced with a more reduced surgical practice, due to legal limitations and work hourly constraints. Also, currently surgeons are expected to dominate more complex techniques such as laparoscopy. Simulation emerges as a complementary learning tool in laparoscopic surgery, by training in a safe, controlled and standardized environment, without jeopardizing patient' safety. Simulation' objective is that the skills acquired should be transferred to the operating room, allowing reduction of learning curves. The use of simulation has increased worldwide, becoming an important tool in different surgical residency programs and laparoscopic training courses. For several countries, the approval of these training courses are a prerequisite for the acquisition of surgeon title certifications. This article reviews the most important aspects of simulation in laparoscopic surgery, including the most used simulators and training programs, as well as the learning methodologies and the different key ways to assess learning in simulation. PMID:25039039

  8. Simulation in laparoscopic surgery.

    PubMed

    León Ferrufino, Felipe; Varas Cohen, Julián; Buckel Schaffner, Erwin; Crovari Eulufi, Fernando; Pimentel Müller, Fernando; Martínez Castillo, Jorge; Jarufe Cassis, Nicolás; Boza Wilson, Camilo

    2015-01-01

    Nowadays surgical trainees are faced with a more reduced surgical practice, due to legal limitations and work hourly constraints. Also, currently surgeons are expected to dominate more complex techniques such as laparoscopy. Simulation emerges as a complementary learning tool in laparoscopic surgery, by training in a safe, controlled and standardized environment, without jeopardizing patient' safety. Simulation' objective is that the skills acquired should be transferred to the operating room, allowing reduction of learning curves. The use of simulation has increased worldwide, becoming an important tool in different surgical residency programs and laparoscopic training courses. For several countries, the approval of these training courses are a prerequisite for the acquisition of surgeon title certifications. This article reviews the most important aspects of simulation in laparoscopic surgery, including the most used simulators and training programs, as well as the learning methodologies and the different key ways to assess learning in simulation.

  9. Informative Top-k Retrieval for Advanced Skill Management

    NASA Astrophysics Data System (ADS)

    Colucci, Simona; di Noia, Tommaso; Ragone, Azzurra; Ruta, Michele; Straccia, Umberto; Tinelli, Eufemia

    The paper presents a knowledge-based framework for skills and talent management based on an advanced matchmaking between profiles of candidates and available job positions. Interestingly, informative content of top-k retrieval is enriched through semantic capabilities. The proposed approach allows to: (1) express a requested profile in terms of both hard constraints and soft ones; (2) provide a ranking function based also on qualitative attributes of a profile; (3) explain the resulting outcomes (given a job request, a motivation for the obtained score of each selected profile is provided). Top-k retrieval allows to select most promising candidates according to an ontology formalizing the domain knowledge. Such a knowledge is further exploited to provide a semantic-based explanation of missing or conflicting features in retrieved profiles. They also indicate additional profile characteristics emerging by the retrieval procedure for a further request refinement. A concrete case study followed by an exhaustive experimental campaign is reported to prove the approach effectiveness.

  10. Surgical Efficacy Among Laparoscopic Ultrasonic Dissectors: Are We Advancing Safely? A Review of Literature.

    PubMed

    Devassy, Rajesh; Gopalakrishnan, Sreelatha; De Wilde, Rudy Leon

    2015-10-01

    The specialty of laparoscopy has evolved with the advent of new technologies over the last few years. Energy-based devices and Ultrasonic dissectors are used with a lot of factors in play-including ergonomics and economics during surgery. Here an attempt is based to review the surgical efficacy and safety of these dissectors with importance to plume production and lateral thermal damage. The factors contributing to adversities to the dissectors are also to be noted. The strategy adopted was aimed at finding relevant studies from PubMed from 1995 to 2014. The basic principle of plume production and thermal damage are studied in this review. Factors contributing to the same that can lead to adversities during laparoscopic surgeries are identified. Summarizing key points that increase lateral thermal damage and plume production amongst different ultrasonic shears and suggesting a technique to identify the right balance between the existing dissectors was possible. The RF Device and USS are both useful and widely used and are more safer than monopolar devices. RF Device is considerably slower than USS, as it cannot achieve coagulation and cutting at the same time. Although USS definitely improvises dissection and has less thermal injury than RF Device, the clinical implications in balancing dissection efficacy with hemostasis need to be investigated further. The ideal haemostatic energy-based shear device would be one with excellent hemostatic results and visual acuity while allowing none or minimal thermal energy escape at the point of application. In our current setting, a combined use of both RF and USS device usage as applied in the particular situations has potential.

  11. Laparoscopic pyelolithotomy.

    PubMed

    Jordan, G H; McCammon, K A; Robey, E L

    1997-01-01

    Laparoscopic surgery has been applied to virtually every aspect of urinary tract disease. Presented is a case of laparoscopic-extended pyelolithotomy accomplished in a 16-month-old child with a large cystine stone that occupied the child's entire renal pelvis. Although not the first pyelolithotomy accomplished laparoscopically, we believe this to be the first extended laparoscopic pyelolithotomy and also believe this is the youngest patient in whom laparoscopic pyelolithotomy has been done. Extracorporeal shock wave lithotripsy and percutaneous and endoscopic stone techniques have drastically modified the management of urolithiasis. However, select cases in which these techniques may not be applicable (such as this toddler with bulky cystine lithiasis) may require open surgery. The laparoscopic approach represents an excellent, yet less-invasive option. PMID:9000203

  12. Advancing age progressively affects obstacle avoidance skills in the elderly.

    PubMed

    Weerdesteyn, Vivian; Nienhuis, Bart; Duysens, Jacques

    2005-01-01

    The ability to adequately avoid obstacles while walking is an important skill that allows safe locomotion over uneven terrain. The high proportion of falls in the elderly that is associated to tripping over obstacles potentially illustrates an age-related deterioration of this locomotor skill. Some studies have compared young and old adults, but very little is known about the changes occurring within different age groups of elderly. In the present study, obstacle avoidance performance was studied in 25 young (20-37 years) and 99 older adults (65-88 years). The participants walked on a treadmill at a speed of 3 km/h. An obstacle was dropped 30 times in front of the left foot at various phases in the step cycle. Success rates (successful avoidance) were calculated and related to the time available between obstacle appearance and the estimated instant of foot contact with the obstacle (available response times or ARTs ranging from 200 to more than 350 ms). In addition, latencies of avoidance reactions, the choice of avoidance strategies (long or short step strategy, LSS or SSS), and three spatial parameters related to obstacle avoidance (toe distance, foot clearance, and heel distance) were determined for each participant. Compared to the young, the older adults had lower success rates, especially at short ARTs. Furthermore, they had longer reaction times, more LSS reactions, smaller toe and heel distances, and larger foot clearances. Within the group of elderly, only the 65-69 year olds were not different from young adults with respect to success rate, despite marked changes in the other parameters measured. In particular, even this younger group of elderly showed a dramatic reduction in the amount of SSS trials compared to young adults. Overall, age was a significant predictor of success rates, reaction times, and toe distances. These parameters deteriorated with advancing age. Finally, avoidance success rates at short ARTs were considerably worse in elderly

  13. Visualization Skills: A Prerequisite to Advanced Solid Modeling

    ERIC Educational Resources Information Center

    Gow, George

    2007-01-01

    Many educators believe that solid modeling software has made teaching two- and three-dimensional visualization skills obsolete. They claim that the visual tools built into the solid modeling software serve as a replacement for the CAD operator's personal visualization skills. They also claim that because solid modeling software can produce…

  14. Open, laparoscopic and robotic radical prostatectomy: optimizing the surgical approach.

    PubMed

    Bivalacqua, Trinity J; Pierorazio, Phillip M; Su, Li-Ming

    2009-09-01

    As advances in the understanding of prostatic anatomy led to improvements in functional and oncologic outcomes after prostatectomy of the past few decades, advances in technology and surgical technique have made minimally-invasive prostate surgery a reality. Today patients diagnosed with clinically localized prostate cancer have more surgical treatment options than in the past including open, laparoscopic and robot-assisted laparoscopic radical prostatectomy. Advantages and disadvantages exist for each modality and lead to subtle differences in the technical execution of the procedure. Evidence from centers of excellence and from experienced surgeons demonstrates that both laparoscopic and robotic-assisted laparoscopic radical prostatectomy appear to be comparable to outcomes achieved with open radical retropubic prostatectomy series. Individual surgeon skill, experience and clinical judgment are likely the stronger predictors of outcome rather than the technique chosen. However, learning curves, oncologic outcomes and cost-efficacy remain important considerations in the dissemination of minimally-invasive prostate surgery. A greater appreciation of the periprostatic anatomy and further modification of surgical technique will result in continued improvement in functional outcomes and oncological control for patients undergoing radical prostatectomy, whether by open or minimally-invasive surgery. PMID:19286370

  15. Laparoscopic pancreatic surgery.

    PubMed

    Mori, Toshiyuki; Abe, Nobutsugu; Sugiyama, Masanori; Atomi, Yutaka

    2005-01-01

    In the past, in the pancreas, a minimally invasive technique was only used for diagnostic laparoscopy in evaluating periampullary malignancy. Recent advances in operative techniques and instrumentation have empowered surgeons to perform virtually all procedures in the pancreas, including the Whipple procedure. Some of these procedures represent the most sophisticated application of minimally invasive surgery, and their outcomes are reportedly better than those of conventional open approaches. In addition to the evaluation of resectability in periampullary malignancy, palliative procedures, including biliary bypasses and gastrojejunostomy, can be performed laparoscopically. Although it is reportedly feasible to perform a Whipple procedure laparescopically, no benefit of the laparoscopic approach over the conventional open approach has been documented. Laparoscopic distal pancreatectomy, with or without preserving the spleen, is technically easier than the Whipple procedure, and is more widely accepted. Indications for laparoscopic distal pancreatectomy include cystic neoplasms and islet-cell tumors located in the pancreatic body or tail. Complications of acute and chronic pancreatitis may be treated with the use of surgical laparoscopy. When infected necrotizing pancreatitis is identified, surgical intervention for drainage and debridement is required. According to the type and location of infected necrotizing pancreatitis, three laparoscopic operative approaches have been reported: infracolic debridement, retroperitoneal debridement, and laparoscopic transgastric pancreatic necrosectomy. When internal drainage is indicated for a pseudocyst, a minimally invasive technique is a promising option. Laparoscopic pseudocyst gastrostomy, cyst jejunostomy, or cyst duodenostomy can be performed, depending on the size and location of the pseudocyst. Especially when a pseudocyst is located in close contact with the posterior wall of the stomach, it is best drained by a

  16. Bilateral simultaneous single-port (LESS) laparoscopic nephrectomy (laparoendoscopic single site surgery)

    PubMed Central

    Page, Toby; Soomro, N. A.

    2010-01-01

    Minimal access surgery is rapidly expanding and currently single-port surgery is at the forefront of laparoscopy. Operating through a single port is technically demanding but through advances in camera design and instrument design, it is now gaining popularity. It offers minimal scar surgery as well as decreased postoperative pain and swift recovery. Here we present a case of bilateral simultaneous single-port laparoscopic nephrectomy (LESS) laparoendoscopic single site surgery in a 51-year-old man. Illustrating that LESS can be used by surgeons with laparoscopic skills outside of a few major international centers. PMID:21369399

  17. [Laparoscopic hysterectomy].

    PubMed

    Minelli, L; Franciolini, G; Franchini, M A; Mutolo, F; Momoli, G

    1990-12-01

    Our first laparoscopic hysterectomy is reported. Our report includes the following surgical actions: coagulation and dissection of the round ligament: opening of the front-large ligament; hydrodissection of the connective tissue between the two peritoneal pellicles of the large ligament; coagulation and dissection of the salpinx for tissues and uterine-ovarian vessels; dissection of the large back ligament as far as the uterines and sacrals; detachment of the bladder by means of forceps and hydrodissection; the same operations on the opposite side; visualisation of uterine vessels and dissection; dissection of uterines and sacrals; completion of the operation and removal of the ill part through the vaginal way. Laparoscopic hysterectomy or vaginal-laparoscopic hysterectomy could, in some cases, substitute abdominal hysterectomy or be less risky than vaginal operations. We point out the need for more complete laparoscopic instrumentation and more practical laparoscopic experience for surgeons and assistants.

  18. Laparoscopic surgery in weightlessness

    NASA Technical Reports Server (NTRS)

    Campbell, M. R.; Billica, R. D.; Jennings, R.; Johnston, S. 3rd

    1996-01-01

    BACKGROUND: Performing a surgical procedure in weightlessness has been shown not to be any more difficult than in a 1g environment if the requirements for the restraint of the patient, operator, and surgical hardware are observed. The feasibility of performing a laparoscopic surgical procedure in weightlessness, however, has been questionable. Concerns have included the impaired visualization from the lack of gravitational retraction of the bowel and from floating debris such as blood. METHODS: In this project, laparoscopic surgery was performed on a porcine animal model in the weightlessness of parabolic flight. RESULTS: Visualization was unaffected due to the tethering of the bowel by the elastic mesentery and the strong tendency for debris and blood to adhere to the abdominal wall due to surface tension forces. CONCLUSIONS: There are advantages to performing a laparoscopic instead of an open surgical procedure in a weightless environment. These will become important as the laparoscopic support hardware is miniaturized from its present form, as laparoscopic technology becomes more advanced, and as more surgically capable crew medical officers are present in future long-duration space-exploration missions.

  19. Virtual reality simulators and training in laparoscopic surgery.

    PubMed

    Yiannakopoulou, Eugenia; Nikiteas, Nikolaos; Perrea, Despina; Tsigris, Christos

    2015-01-01

    Virtual reality simulators provide basic skills training without supervision in a controlled environment, free of pressure of operating on patients. Skills obtained through virtual reality simulation training can be transferred on the operating room. However, relative evidence is limited with data available only for basic surgical skills and for laparoscopic cholecystectomy. No data exist on the effect of virtual reality simulation on performance on advanced surgical procedures. Evidence suggests that performance on virtual reality simulators reliably distinguishes experienced from novice surgeons Limited available data suggest that independent approach on virtual reality simulation training is not different from proctored approach. The effect of virtual reality simulators training on acquisition of basic surgical skills does not seem to be different from the effect the physical simulators. Limited data exist on the effect of virtual reality simulation training on the acquisition of visual spatial perception and stress coping skills. Undoubtedly, virtual reality simulation training provides an alternative means of improving performance in laparoscopic surgery. However, future research efforts should focus on the effect of virtual reality simulation on performance in the context of advanced surgical procedure, on standardization of training, on the possibility of synergistic effect of virtual reality simulation training combined with mental training, on personalized training.

  20. A comparative cohort study of totally laparoscopic and open aortobifemoral bypass for the treatment of advanced atherosclerosis

    PubMed Central

    Kazmi, Syed SH; Jørgensen, Jørgen Junkichi; Sundhagen, Jon Otto; Krog, Anne Helene; Flørenes, Tor L; Kollerøs, Dagfinn; Abdelnoor, Michael

    2015-01-01

    Background Totally laparoscopic aortobifemoral bypass (LABF) procedure has been shown to be feasible for the treatment of advanced aortoiliac occlusive disease (AIOD). This study compares the LABF with the open aortobifemoral bypass (OABF) operation. Methods In this prospective comparative cohort study, 50 consecutive patients with type D atherosclerotic lesions in the aortoiliac segment were treated with an LABF operation. The group was compared with 30 patients who were operated on with the OABF procedure for the same disease and time period. We had an explanatory strategy, and our research hypothesis was to compare the two surgical procedures based on a composite event (all-cause mortality, graft occlusion, and systemic morbidity). Stratification analysis was performed by using the Mantel–Haenszel method with the patient–time model. Cox multivariate regression method was used to adjust for confounding effect after considering the proportional hazard assumption. Cox proportional cause-specific hazard regression model was used for competing risk endpoint. Results There was a higher frequency of comorbidity in the OABF group. A significant reduction of composite event, 82% (hazard ratio 0.18; 95% CI 0.08–0.42, P=0.0001) was found in the LABF group when compared with OABF group, during a median follow-up time period of 4.12 years (range from 1 day to 9.32 years). In addition, less operative bleeding and shorter length of hospital stay were observed in the LABF group when compared with the OABF group. All components of the composite event showed the same positive effect in favor of LABF procedure. Conclusion LABF for the treatment of AIOD, Trans-Atlantic Inter-Society Consensus II type D lesions, seems to result in a less composite event when compared with the OABF procedure. To conclude, our results need to be replicated by a randomized clinical trial. PMID:26425098

  1. Preparing Students for Advanced Placement Spanish Literature: Content Sequencing of the Reading Skill.

    ERIC Educational Resources Information Center

    Stein, Roger D.

    1985-01-01

    Describes a reading-skill-building curriculum that prepares students to handle the reading in the Advanced Placement Spanish Literature course, a course that treats the works of Borges, Garcia Lorca, Matute, Neruda, and Unamuno. Suggests techniques and texts that aid in the teaching of these skills. (SED)

  2. Predictors of Grade-Level Advancement in a Job Opportunities and Basic Skills Program.

    ERIC Educational Resources Information Center

    Averitt, Sallie D.

    A study was conducted to determine: (1) if instruction correlated to the Tests of Adult Basic Education (TABE) resulted in improved basic skills for participants in the Job Opportunities and Basic Skills (JOBS) Program; and (2) to determine the impact of selected factors on grade-level advancement (pre- versus posttest TABE scores). A literature…

  3. Guidelines for Training in Advanced Gestalt Therapy Skills.

    ERIC Educational Resources Information Center

    Holiman, Marjorie; Engle, David

    1989-01-01

    Describes guidelines for gestalt training emphasizing observation of novice and expert therapists, opportunities to practice skills, and procedures to provide trainees with immediate feedback. Claims three methods of evaluation are useful to trainees: publicly monitoring progress; increasing specificity of feedback; and helping trainees to…

  4. Global Perspectives: Developing Media Literacy Skills to Advance Critical Thinking

    ERIC Educational Resources Information Center

    Radeloff, Cheryl L.; Bergman, Barbara J.

    2009-01-01

    Women's studies and feminist curricula have been lauded for the development and application of critical thinking skills for social and political change in its students (Fisher; Kellner and Share; Mayberry). Critical thinking can be defined as the ability to identify and challenge assumptions, to search for alternative ways of thinking, and to…

  5. A Suggested Syllabus for Advanced Writing Skills at English Language Teaching Departments

    ERIC Educational Resources Information Center

    Altay, Ismail Firat

    2010-01-01

    As is known, writing is an indispensable part of language education. As far as English Language Teaching Departments are concerned, writing courses, especially Advanced Writing Skills, are taken as a course of higher importance. However, forming a syllabus for Advanced Writing Course for English Language Teaching Departments is not an easy matter.…

  6. Learning and remembering strategies of novice and advanced jazz dancers for skill level appropriate dance routines.

    PubMed

    Poon, P P; Rodgers, W M

    2000-06-01

    This study examined the influence of the challenge level of to-be-learned stimulus on learning strategies in novice and advanced dancers. In Study 1, skill-level appropriate dance routines were developed for novice and advanced jazz dancers. In Study 2, 8 novice and 9 advanced female jazz dancers attempted to learn and remember the two routines in mixed model factorial design, with one between-participants factor: skill level (novice or advanced) and two within-participants factors: routine (easy or difficult) and performance (immediate or delayed). Participants were interviewed regarding the strategies used to learn and remember the routines. Results indicated that advanced performers used atypical learning strategies for insufficiently challenging stimuli, which may reflect characteristics of the stimuli rather than the performer. The qualitative data indicate a clear preference of novice and advanced performers for spatial compatibility of stimuli and response.

  7. Basic and advanced numerical performances relate to mathematical expertise but are fully mediated by visuospatial skills.

    PubMed

    Sella, Francesco; Sader, Elie; Lolliot, Simon; Cohen Kadosh, Roi

    2016-09-01

    Recent studies have highlighted the potential role of basic numerical processing in the acquisition of numerical and mathematical competences. However, it is debated whether high-level numerical skills and mathematics depends specifically on basic numerical representations. In this study mathematicians and nonmathematicians performed a basic number line task, which required mapping positive and negative numbers on a physical horizontal line, and has been shown to correlate with more advanced numerical abilities and mathematical achievement. We found that mathematicians were more accurate compared with nonmathematicians when mapping positive, but not negative numbers, which are considered numerical primitives and cultural artifacts, respectively. Moreover, performance on positive number mapping could predict whether one is a mathematician or not, and was mediated by more advanced mathematical skills. This finding might suggest a link between basic and advanced mathematical skills. However, when we included visuospatial skills, as measured by block design subtest, the mediation analysis revealed that the relation between the performance in the number line task and the group membership was explained by non-numerical visuospatial skills. These results demonstrate that relation between basic, even specific, numerical skills and advanced mathematical achievement can be artifactual and explained by visuospatial processing. (PsycINFO Database Record

  8. Basic and Advanced Numerical Performances Relate to Mathematical Expertise but Are Fully Mediated by Visuospatial Skills

    PubMed Central

    2016-01-01

    Recent studies have highlighted the potential role of basic numerical processing in the acquisition of numerical and mathematical competences. However, it is debated whether high-level numerical skills and mathematics depends specifically on basic numerical representations. In this study mathematicians and nonmathematicians performed a basic number line task, which required mapping positive and negative numbers on a physical horizontal line, and has been shown to correlate with more advanced numerical abilities and mathematical achievement. We found that mathematicians were more accurate compared with nonmathematicians when mapping positive, but not negative numbers, which are considered numerical primitives and cultural artifacts, respectively. Moreover, performance on positive number mapping could predict whether one is a mathematician or not, and was mediated by more advanced mathematical skills. This finding might suggest a link between basic and advanced mathematical skills. However, when we included visuospatial skills, as measured by block design subtest, the mediation analysis revealed that the relation between the performance in the number line task and the group membership was explained by non-numerical visuospatial skills. These results demonstrate that relation between basic, even specific, numerical skills and advanced mathematical achievement can be artifactual and explained by visuospatial processing. PMID:26913930

  9. Basic and advanced numerical performances relate to mathematical expertise but are fully mediated by visuospatial skills.

    PubMed

    Sella, Francesco; Sader, Elie; Lolliot, Simon; Cohen Kadosh, Roi

    2016-09-01

    Recent studies have highlighted the potential role of basic numerical processing in the acquisition of numerical and mathematical competences. However, it is debated whether high-level numerical skills and mathematics depends specifically on basic numerical representations. In this study mathematicians and nonmathematicians performed a basic number line task, which required mapping positive and negative numbers on a physical horizontal line, and has been shown to correlate with more advanced numerical abilities and mathematical achievement. We found that mathematicians were more accurate compared with nonmathematicians when mapping positive, but not negative numbers, which are considered numerical primitives and cultural artifacts, respectively. Moreover, performance on positive number mapping could predict whether one is a mathematician or not, and was mediated by more advanced mathematical skills. This finding might suggest a link between basic and advanced mathematical skills. However, when we included visuospatial skills, as measured by block design subtest, the mediation analysis revealed that the relation between the performance in the number line task and the group membership was explained by non-numerical visuospatial skills. These results demonstrate that relation between basic, even specific, numerical skills and advanced mathematical achievement can be artifactual and explained by visuospatial processing. (PsycINFO Database Record PMID:26913930

  10. The Essential Elements of a Robotic-Assisted Laparoscopic Hysterectomy.

    PubMed

    Simpson, Khara M; Advincula, Arnold P

    2016-09-01

    Robotic-assisted laparoscopic hysterectomies are being performed at higher rates since the da Vinci Surgical System (Intuitive Surgical, Inc, Sunnyvale, CA, USA) received US Food and Drug Administration approval in 2005 for gynecologic procedures. Despite the technological advancements over traditional laparoscopy, a discrepancy exists between what the literature states and what the benefits are as seen through the eyes of the end-user. There remains a significant learning curve in the adoption of safe and efficient robotic skills. The authors present important considerations when choosing to perform a robotic hysterectomy and a step-by-step technique. The literature on perioperative outcomes is also reviewed. PMID:27521880

  11. Laparoscopic hysterectomy.

    PubMed

    Sokol, Andrew I; Green, Isabel C

    2009-09-01

    The use of laparoscopy to perform all or part of hysterectomy has become widely accepted, with laparoscopic hysterectomy accounting for up to 15% of all hysterectomies performed in the United States. A recent Cochrane analysis has clearly shown that laparoscopic hysterectomy is associated with decreased length of stay and faster recovery time compared with laparotomy. There is no evidence to support a supracervical hysterectomy over a total hysterectomy in terms of frequency of pelvic support disorders or sexual function. This does not preclude the use of a supracervical hysterectomy in some clinical situations.

  12. [Hepatic and pancreatic laparoscopic surgery].

    PubMed

    Pardo, F; Rotellar, F; Valentí, V; Pastor, C; Poveda, I; Martí-Cruchaga, P; Zozaya, G

    2005-01-01

    The development of laparoscopic surgery also includes the more complex procedures of abdominal surgery such as those that affect the liver and the pancreas. From diagnostic laparoscopy, accompanied by laparoscopic echography, to major hepatic or pancreatic resections, the laparoscopic approach has spread and today encompasses practically all of the surgical procedures in hepatopancreatic pathology. Without forgetting that the aim of minimally invasive surgery is not a better aesthetic result but the reduction of postoperative complications, it is undeniable that the laparoscopic approach has brought great benefits for the patient in every type of surgery except, for the time being, in the case of big resections such as left or right hepatectomy or resections of segments VII and VIII. Pancreatic surgery has undergone a great development with laparoscopy, especially in the field of distal pancreatectomy due to cystic and neuroendocrine tumours where the approach of choice is laparoscopic. Laparoscopy similarly plays an important role, together with echolaparoscopy, in staging pancreatic tumours, prior to open surgery or for indicating suitable treatment. In coming years, it is to be hoped that it will continue to undergo an exponential development and, together with the advances in robotics, it will be possible to witness a greater impact of the laparoscopic approach on the field of hepatic and pancreatic surgery. PMID:16511579

  13. Evaluating New Approaches to Teaching of Sight-Reading Skills to Advanced Pianists

    ERIC Educational Resources Information Center

    Zhukov, Katie

    2014-01-01

    This paper evaluates three teaching approaches to improving sight-reading skills against a control in a large-scale study of advanced pianists. One hundred pianists in four equal groups participated in newly developed training programmes (accompanying, rhythm, musical style and control), with pre- and post-sight-reading tests analysed using…

  14. Delta's Key to the TOEFL iBT[R]: Advanced Skill Practice. Revised Edition

    ERIC Educational Resources Information Center

    Gallagher, Nancy

    2012-01-01

    Delta's Key to the TOEFL iBT: Advanced Skill Practice is a revised and updated edition of Delta's Key to the Next Generation TOEFL Test. Since the introduction of the TOEFL iBT in 2005, there have been significant changes to some of the test questions, particularly the integrated writing and integrated speaking tasks. The new 2011 edition of…

  15. Laparoscopic appendectomy

    NASA Astrophysics Data System (ADS)

    Richards, Kent F.; Christensen, Brent J.

    1991-07-01

    The accurate and timely diagnosis of acute appendicitis remains a difficult clinical dilemma. Misdiagnosis rates of up to 40% are not unusual. Laparoscopic appendectomy provides a definitive diagnosis and an excellent method for routine removal of the appendix with very low morbidity and patient discomfort.

  16. Teaching Advanced Leadership Skills in Community Service (ALSCS) to medical students.

    PubMed

    Goldstein, Adam O; Calleson, Diane; Bearman, Rachel; Steiner, Beat D; Frasier, Pamela Y; Slatt, Lisa

    2009-06-01

    Inadequate access to health care, lack of health insurance, and significant health disparities reflect crises in health care affecting all of society. Training U.S. physicians to possess not only clinical expertise but also sufficient leadership skills is essential to solve these problems and to effectively improve health care systems. Few models in the undergraduate medical curriculum exist for teaching students how to combine needed leadership competencies with actual service opportunities.The Advanced Leadership Skills in Community Service (ALSCS) selective developed in response to the shortage of leadership models and leadership training for medical students. The ALSCS selective is designed specifically to increase students' leadership skills, with an emphasis on community service. The selective integrates classroom-based learning, hands-on application of learned skills, and service learning. More than 60 medical students have participated in the selective since inception. Short-term outcomes demonstrate an increase in students' self-efficacy around multiple dimensions of leadership skills (e.g., fundraising, networking, motivating others). Students have also successfully completed more than a dozen leadership and community service projects. The selective offers an innovative model of a leadership-skills-based course that can have a positive impact on leadership skill development among medical school students and that can be incorporated into the medical school curriculum.

  17. Linking Complex Problem Solving and General Mental Ability to Career Advancement: Does a Transversal Skill Reveal Incremental Predictive Validity?

    ERIC Educational Resources Information Center

    Mainert, Jakob; Kretzschmar, André; Neubert, Jonas C.; Greiff, Samuel

    2015-01-01

    Transversal skills, such as complex problem solving (CPS) are viewed as central twenty-first-century skills. Recent empirical findings have already supported the importance of CPS for early academic advancement. We wanted to determine whether CPS could also contribute to the understanding of career advancement later in life. Towards this end, we…

  18. Development of a Training Model for Laparoscopic Common Bile Duct Exploration

    PubMed Central

    Rodríguez, Omaira; Benítez, Gustavo; Sánchez, Renata; De la Fuente, Liliana

    2010-01-01

    Background: Training and experience of the surgical team are fundamental for the safety and success of complex surgical procedures, such as laparoscopic common bile duct exploration. Methods: We describe an inert, simple, very low-cost, and readily available training model. Created using a “black box” and basic medical and surgical material, it allows training in the fundamental steps necessary for laparoscopic biliary tract surgery, namely, (1) intraoperative cholangiography, (2) transcystic exploration, and (3) laparoscopic choledochotomy, and t-tube insertion. Results: The proposed model has allowed for the development of the skills necessary for partaking in said procedures, contributing to its development and diminishing surgery time as the trainee advances down the learning curve. Further studies are directed towards objectively determining the impact of the model on skill acquisition. Conclusion: The described model is simple and readily available allowing for accurate reproduction of the main steps and maneuvers that take place during laparoscopic common bile duct exploration, with the purpose of reducing failure and complications. PMID:20529526

  19. The consequences of using advanced physical assessment skills in medical and surgical nursing: A hermeneutic pragmatic study

    PubMed Central

    Zambas, Shelaine I.; Smythe, Elizabeth A.; Koziol-Mclain, Jane

    2016-01-01

    Aims and objectives The aim of this study was to explore the consequences of the nurse's use of advanced assessment skills on medical and surgical wards. Background Appropriate, accurate, and timely assessment by nurses is the cornerstone of maintaining patient safety in hospitals. The inclusion of “advanced” physical assessment skills such as auscultation, palpation, and percussion is thought to better prepare nurses for complex patient presentations within a wide range of clinical situations. Design This qualitative study used a hermeneutic pragmatic approach. Method Unstructured interviews were conducted with five experienced medical and surgical nurses to obtain 13 detailed narratives of assessment practice. Narratives were analyzed using Van Manen's six-step approach to identify the consequences of the nurse's use of advanced assessment skills. Results The consequences of using advanced assessment skills include looking for more, challenging interpretations, and perseverance. The use of advanced assessment skills directs what the nurse looks for, what she sees, interpretation of the findings, and her response. It is the interpretation of what is seen, heard, or felt within the full context of the patient situation, which is the advanced skill. Conclusion Advanced assessment skill is the means to an accurate interpretation of the clinical situation and contributes to appropriate diagnosis and medical management in complex patient situations. Relevance to clinical practice The nurse's use of advanced assessment skills enables her to contribute to diagnostic reasoning within the acute medical and surgical setting. PMID:27607193

  20. [Laparoscopic skills training -- novel methods].

    PubMed

    Fábry, György; Haidegger, Tamás

    2013-05-12

    Bevezetés: A sebészeti műveletek gyakorlása mindig is fontos volt a mindennapi orvosi praxisban. Hagyományosan a beavatkozásokat állati vagy emberi preparátumokon gyakorolták, amelyek alkalmazása magas költségük mellett sok kényelmetlenséggel is jár, valamint etikai kérdéseket vet fel. A sebészeti fantomok megjelenése orvosolta ezeket a problémákat, sőt a beavatkozások könnyen ismételhetővé és mérhetővé váltak. A fantomokra épülő szimulátorok elterjedése lehetővé tette előbb a nyitott műtétek, majd napjainkra a laparoszkópos sebészet rutinszerű gyakorlását. Cél: A szerzők célja az Apollo laparoszkópos sebészeti tréner feladatainak fejlesztése során elért eredmények és azok validálásának bemutatása. Módszer: Öt új minimálisan invazív szimulációs feladatot fejlesztettek ki, a vonalvezető, lekötés, preparálás-lekötés, fonalvezető és a kamerakezelés nevű gyakorlatokat. Validálásukhoz 30 résztvevő adatait dolgozták fel, akik három csoportra tagozódtak. Az egészségügyben járatlan amatőrökre, orvostanhallgatókra és sebészetre specializálódott sebész szakorvosjelöltekre, rezidensekre. A feladatok szubjektív értékelését kérdőív segítségével, 20 elemű skálán (NASA Task Load Index) végezték, amelyben a hasznosságra, a mentális, fizikai és időbeli igénybevételre, a teljesítményre, az erőfeszítésre és a frusztráltságra vonatkozó kérdések szerepeltek. Emellett az egyes feladatoknál elemezték az elvégzéshez szükséges időeredményeket és az esetleges hibázások számát is. Meghatározták az egy napon belül végzett, 10 egymást követő mérés időeredményét, illetve a több napon át végzett követéses időeredményeket is, amelyekkel az egyének fejlődését értékelték. Eredmények: A résztvevők a feladatokat oktatás, önképzés céljaira megfelelőnek találták. Időeredményeikből kimutatható volt a különböző képzettségi szintek közötti eltérés, a követéses vizsgálatok pedig bizonyítható fejlődési lehetőséget mutattak ki az egyes feladatok tekintetében. Következtetés: A gyakorlatok alkalmasak a sebészeti képzésbe való bevezetésre, rutinszerű gyakorlásra, illetve a képzettségi szint felmérésére. Orv. Hetil., 2013, 154, 745–751.

  1. [Laparoscopic rectopexy].

    PubMed

    Herold, A; Bruch, H P

    1997-01-01

    Within 4 years 66 laparoscopic rectopexies were performed. The indications were: rectal prolapse, morphologic outlet-constipation and a combination of both. Using a modified suture rectopexy (according to Sudeck), we did not take any foreign material and resected the sigmoid in 35 patients. Conversion rate was 2%, complications that needed reoperation occurred in 9%. In the follow up period of 24.1 months in the mean (max. 50) no recurrent prolapse occurred. Incontinence was abolished or improved in 64%, outlet-constipation was improved in 85%. Especially in rectopexy the laparoscopic technique seems to be of benefit for the patient: quicker convalescence, less pain, small scars, a.o. But all these potential advantages have to be proven in prospective-if possible randomised-studies. PMID:9340966

  2. [Laparoscopic adrenalectomy].

    PubMed

    Horányi, J; Tihanyi, T; Darvas, K; Rácz, K; Fütö, L

    1998-07-12

    The authors performed three left and one right sided laparoscopic adrenalectomies between 3rd April and 8th August 1997. The indication of surgery was hormonally active cortical adenoma of about 2 cm size in three cases, a 6 cm large hormonally inactive tumour in one case respectively. For the operation on the left side three, on the right side four trocars with 11 mm diameter was used. The duration of the operations was between 115 and 220 min. The patients left one the second or third postoperative day, no complication was observed. The authors' opinion based on both literature data and their own experience is that laparoscopic approach to adrenalectomies is the method of choice today. PMID:9702083

  3. [Laparoscopic pyelolithotomy].

    PubMed

    Chiva Robles, Vicente; Escalera Almendros, Carlos; Pascual Mateo, Carlos; Rodríguez García, Nuria; García Tello, Ana; Berenguer Sánchez, Antonio

    2006-03-01

    The application of laparoscopy as a surgical technique in Urology has enabled to expand the therapeutic options for various pathologies. The treatment of urinary lithiasis localized in the renal pelvis is one of them. We report a laparoscopic pyelolithotomy, describing the operation step-by-step, from patient positioning and trochar insertion to drainage tube insertion and closure. The objective of this article is to show the technique, presenting it as an alternative option. PMID:16649523

  4. Laparoscopic salvage total pelvic exenteration: Is it possible post-chemo-radiotherapy?

    PubMed

    Patel, H; Joseph, J V; Amodeo, A; Kothari, K

    2009-10-01

    Indications for total pelvic exenteration in a male (removal of the bladder, prostate and rectum) and in a woman (removal bladder, uterus, vagina, ovaries and rectum) are rare. The advanced stage generally dictates that the patient has some form of chemotherapy or radiotherapy, or a combination of two to shrink/debulk the tumour. We report the first two cases of a salvage laparoscopic total pelvic exenteration in a male for rectal adenocarcinoma invading into the bladder and prostate, post-chemo-radiotherapy and in a woman for squamous cell carcinoma of cervix invading the bladder and rectum post-chemo-radiotherapy. Salvage surgery is often difficult and has been noted to have high morbidity. Applying a laparoscopic approach to this group may have advantages for the patient and the surgeon, i.e. less pain, early recovery and magnified views. As we have technically shown it to be possible, perhaps laparoscopic approaches should be discussed if the teams in these centres are of advanced laparoscopic surgeons working in multi-skilled groups.

  5. [Laparoscopic rectal resection technique].

    PubMed

    Anthuber, M; Kriening, B; Schrempf, M; Geißler, B; Märkl, B; Rüth, S

    2016-07-01

    The quality of radical oncological operations for patients with rectal cancer determines the rate of local recurrence and long-term survival. Neoadjuvant chemoradiotherapy for locally advanced tumors, a standardized surgical procedure for rectal tumors less than 12 cm from the anus with total mesorectal excision (TME) and preservation of the autonomous nerve system for sexual and bladder function have significantly improved the oncological results and quality of life of patients. The TME procedure for rectal resection has been performed laparoscopically in Germany for almost 20 years; however, no reliable data are available on the frequency of laparoscopic procedures in rectal cancer patients in Germany. The rate of minimally invasive procedures is estimated to be less than 20 %. A prerequisite for using the laparoscopic approach is implicit adherence to the described standards of open surgery. Available data from prospective randomized trials, systematic reviews and meta-analyses indicate that in the early postoperative phase the generally well-known positive effects of the minimally invasive approach to the benefit of patients can be realized without any long-term negative impact on the oncological results; however, the results of many of these studies are difficult to interpret because it could not be confirmed whether the hospitals and surgeons involved had successfully completed the learning curve. In this article we would like to present our technique, which we have developed over the past 17 years in more than 1000 patients. Based on our experiences the laparoscopic approach can be highly recommended as a suitable alternative to the open procedure. PMID:27277556

  6. [Laparoscopic choledochoduodenostomy].

    PubMed

    Baĭramov, N Iu; Zeĭnalov, N A; Pashadze, V A

    2013-01-01

    The article presents the results of laparoscopic choledoch-duodenostomy (CDS) applied to 23 patients with benign strictures of distal part of common bile duct (CBD). 21 patients had cholelithiasis in combination with the CBD stricture. The rest 2 patients had acalculous postcholecystectomy stricture. The laparoscopic CDS was executed by 5 trocars: 4 were placed in standard cholecystectomy positions and the 5th was placed by the right pararectal line at the umbilicus level and was used for traction of duodenum and continuous aspiration. 2 sm long side-to-side CDS was performed with interrupted sutures. The mean operative time was 128±36 (90-205) min. There was no conversion. The mean hospital stay was 4.5 (3-9) days. There was no mortality. 2 patients developed an anastomosis bile leakage: one received the relaparoscopy and T-draining of the CDS, in another patient the leakage seased spontaneously. 82.7% of patients showed excellent and good long term results. 3 patients reported bad outcome and very bad result was registered in 1 patient. In conclusion, the laparoscopic CDS gives good outcomes in experienced hands and could be considered as an alternative to endoscopic sphincterotomy in patients with distal CBD stenosis.

  7. Laparoscopic Ureterolithotomy

    PubMed Central

    Aras, Bekir; Ekşi, Mithat; Şener, Nevzat Can; Tugču, Volkan

    2016-01-01

    Background and Objective: The present study retrospectively analyzed the data of 213 patients who underwent laparoscopic ureterolithotomy. Methods: We retrospectively analyzed the data of 213 patients, in whom we performed conventional laparoscopic ureterolithotomy from April 2006 and January 2015 based on the diagnosis of an upper or middle ureteral stone. Patients with large ureteral stones (>15 mm) or a history of failed shock-wave lithotripsy or ureteroscopy were included in the study. Although the retroperitoneal approach was preferred for 170 patients, the transperitoneal approach was used in the remaining 43 patients. Results: The mean patient age was 39.3 ± 12.0 years (range, 18–73). The study population was composed of 78 (26.7%) female and 135 (63.3%) male patients. The mean stone size was 19.7 ± 2.5 mm. The mean operative time was 80.9 ± 10.9 minutes, and the mean blood loss was 63.3 ± 12.7 mL. Intraoperative insertion of a double-J catheter was performed in 76 patients. The overall stone-free rate was 99%. No major complication was observed in any patient. However, conversion to open surgery was necessary in 1 patient. Conclusion: With high success and low complication rates, laparoscopic ureterolithotomy is an effective and reliable method that ensures quick recovery and may be the first treatment option for patients with large, impacted ureteral stones, as well as for those with a history of failed primary treatment. PMID:27019576

  8. Enhancing presentation skills for the advanced practice nurse: strategies for success.

    PubMed

    Vollman, Kathleen M

    2005-01-01

    Professional speaking is a component of the professional practice role of the advanced practice nurse (APN). The skills to communicate effectively to one person or an audience of 100 provide the APN with the essential tools for implementing change, collaborating effectively, presenting information at professional meetings, or communicating the impact of clinical outcomes in the boardroom. Public speaking skills, a professional image, and improved communication can facilitate advancement along any career ladder. The greater your fear, the more self-confidence you will gain by stepping up to a challenge and conquering it. This article describes strategies for organizing and presenting your message in a clear and concise format. Techniques to manage the anxiety produced when attempting to articulate your thoughts is essential for effective communication. Skills for enhancing the delivery of your message through effective body language, professional image, voice modulation, and use of audiovisual aids are addressed. Creative techniques for fielding questions are key in promoting a dynamic closure and provide consistent reinforcement of the key message content. PMID:15714019

  9. Enhancing presentation skills for the advanced practice nurse: strategies for success.

    PubMed

    Vollman, Kathleen M

    2005-01-01

    Professional speaking is a component of the professional practice role of the advanced practice nurse (APN). The skills to communicate effectively to one person or an audience of 100 provide the APN with the essential tools for implementing change, collaborating effectively, presenting information at professional meetings, or communicating the impact of clinical outcomes in the boardroom. Public speaking skills, a professional image, and improved communication can facilitate advancement along any career ladder. The greater your fear, the more self-confidence you will gain by stepping up to a challenge and conquering it. This article describes strategies for organizing and presenting your message in a clear and concise format. Techniques to manage the anxiety produced when attempting to articulate your thoughts is essential for effective communication. Skills for enhancing the delivery of your message through effective body language, professional image, voice modulation, and use of audiovisual aids are addressed. Creative techniques for fielding questions are key in promoting a dynamic closure and provide consistent reinforcement of the key message content.

  10. Laparoscopic Inguinal Hernia Repair

    MedlinePlus

    ... Some hernia repairs are performed using a small telescope known as a laparoscope. If your surgeon has ... in the abdominal wall (muscle) using small incisions, telescopes and a patch (mesh). Laparoscopic repair offers a ...

  11. Surgical techniques: robot-assisted laparoscopic colposacropexy with the da Vinci(®) surgical system.

    PubMed

    Matthews, Catherine A

    2009-03-01

    Colposacropexy is the gold-standard operation for repair of apical vaginal support defects. While it is feasible to perform this operation using conventional laparoscopic techniques, a limited number of surgeons have mastered the advanced minimally invasive skills that are required. Introduction of the da Vinci(®) robotic system with instruments that have improved dexterity and precision and a camera system with three-dimensional imaging presents an opportunity for more surgeons treating women with pelvic organ prolapse to perform the procedure laparoscopically. This paper will outline a technique that is exactly modeled after the open procedure for completion of a robotic-assisted colposacropexy using the da Vinci(®) surgical system. PMID:27628451

  12. Laparoscopic and robot-assisted laparoscopic digestive surgery: Present and future directions.

    PubMed

    Rodríguez-Sanjuán, Juan C; Gómez-Ruiz, Marcos; Trugeda-Carrera, Soledad; Manuel-Palazuelos, Carlos; López-Useros, Antonio; Gómez-Fleitas, Manuel

    2016-02-14

    Laparoscopic surgery is applied today worldwide to most digestive procedures. In some of them, such as cholecystectomy, Nissen's fundoplication or obesity surgery, laparoscopy has become the standard in practice. In others, such as colon or gastric resection, the laparoscopic approach is frequently used and its usefulness is unquestionable. More complex procedures, such as esophageal, liver or pancreatic resections are, however, more infrequently performed, due to the high grade of skill necessary. As a result, there is less clinical evidence to support its implementation. In the recent years, robot-assisted laparoscopic surgery has been increasingly applied, again with little evidence for comparison with the conventional laparoscopic approach. This review will focus on the complex digestive procedures as well as those whose use in standard practice could be more controversial. Also novel robot-assisted procedures will be updated. PMID:26877605

  13. Laparoscopic and robot-assisted laparoscopic digestive surgery: Present and future directions

    PubMed Central

    Rodríguez-Sanjuán, Juan C; Gómez-Ruiz, Marcos; Trugeda-Carrera, Soledad; Manuel-Palazuelos, Carlos; López-Useros, Antonio; Gómez-Fleitas, Manuel

    2016-01-01

    Laparoscopic surgery is applied today worldwide to most digestive procedures. In some of them, such as cholecystectomy, Nissen’s fundoplication or obesity surgery, laparoscopy has become the standard in practice. In others, such as colon or gastric resection, the laparoscopic approach is frequently used and its usefulness is unquestionable. More complex procedures, such as esophageal, liver or pancreatic resections are, however, more infrequently performed, due to the high grade of skill necessary. As a result, there is less clinical evidence to support its implementation. In the recent years, robot-assisted laparoscopic surgery has been increasingly applied, again with little evidence for comparison with the conventional laparoscopic approach. This review will focus on the complex digestive procedures as well as those whose use in standard practice could be more controversial. Also novel robot-assisted procedures will be updated. PMID:26877605

  14. Laparoscopic and robot-assisted laparoscopic digestive surgery: Present and future directions.

    PubMed

    Rodríguez-Sanjuán, Juan C; Gómez-Ruiz, Marcos; Trugeda-Carrera, Soledad; Manuel-Palazuelos, Carlos; López-Useros, Antonio; Gómez-Fleitas, Manuel

    2016-02-14

    Laparoscopic surgery is applied today worldwide to most digestive procedures. In some of them, such as cholecystectomy, Nissen's fundoplication or obesity surgery, laparoscopy has become the standard in practice. In others, such as colon or gastric resection, the laparoscopic approach is frequently used and its usefulness is unquestionable. More complex procedures, such as esophageal, liver or pancreatic resections are, however, more infrequently performed, due to the high grade of skill necessary. As a result, there is less clinical evidence to support its implementation. In the recent years, robot-assisted laparoscopic surgery has been increasingly applied, again with little evidence for comparison with the conventional laparoscopic approach. This review will focus on the complex digestive procedures as well as those whose use in standard practice could be more controversial. Also novel robot-assisted procedures will be updated.

  15. Sectoral Skills Needs: The Role of Universities. Task Force on Labour Market Issues: Office for Partnerships for Advanced Skills.

    ERIC Educational Resources Information Center

    Council of Ontario Universities, Toronto.

    This report analyzes the role of the Task Force on Labour Market Issues of the Council of Ontario Universities in meeting industry skill needs, focusing particularly on three sectors: biotechnology, culture, and software/information technology. Also included are the findings of an earlier study on the skill needs and training requirements in the…

  16. Laparoscopic repair for vesicouterine fistulae

    PubMed Central

    Maioli, Rafael A.; Macedo, André R. S.; Garcia, André R. L.; de Almeida, Silvio H. M.; Rodrigues, Marco Aurélio Freitas

    2015-01-01

    advantages over open surgery in that it is associated with less pain, shorter length of hospital stay, better cosmesis, quicker recovery, and equal efficacy. Although cases of VUF are rarely noted, the laparoscopic skill obtained through other urological procedures suggest, that laparoscopic repair may be the procedure of choice for such cases (2). The reported operative time for the laparoscopic repair of VUF in the literature varies between 140 and 220 min (3). However, laparoscopic techniques should be considered as a mode of abdominal access and should not influence the method of surgical repair. Surgical success should depend on the adherence to good technique rather than the approach. Hence, this method appears to be a viable alternative for surgeons experienced with laparoscopic suturing techniques. Conclusion: Laparoscopic repair appears to be a viable alternative for surgeons experienced with laparoscopic suturing techniques. PMID:26689504

  17. Learning Curve of the Application of Huang Three-Step Maneuver in a Laparoscopic Spleen-Preserving Splenic Hilar Lymphadenectomy for Advanced Gastric Cancer.

    PubMed

    Huang, Ze-Ning; Huang, Chang-Ming; Zheng, Chao-Hui; Li, Ping; Xie, Jian-Wei; Wang, Jia-Bin; Lin, Jian-Xian; Lu, Jun; Chen, Qi-Yue; Cao, Long-Long; Lin, Mi; Tu, Ru-Hong

    2016-03-01

    To investigate the learning curve of the application of Huang 3-step maneuver, which was summarized and proposed by our center for the treatment of advanced upper gastric cancer. From April 2012 to March 2013, 130 consecutive patients who underwent a laparoscopic spleen-preserving splenic hilar lymphadenectomy (LSPL) by a single surgeon who performed Huang 3-step maneuver were retrospectively analyzed. The learning curve was analyzed based on the moving average (MA) method and the cumulative sum method (CUSUM). Surgical outcomes, short-term outcomes, and follow-up results before and after learning curve were contrastively analyzed. A stepwise multivariate logistic regression was used for a multivariable analysis to determine the factors that affect the operative time using Huang 3-step maneuver. Based on the CUSUM, the learning curve for Huang 3-step maneuver was divided into phase 1 (cases 1-40) and phase 2 (cases 41-130). The dissection time (DT) (P < 0.001), blood loss (BL) (P < 0.001), and number of vessels injured in phase 2 were significantly less than those in phase 1. There were no significant differences in the clinicopathological characteristics, short-term outcomes, or major postoperative complications between the learning curve phases. Univariate and multivariate analyses revealed that body mass index (BMI), short gastric vessels (SGVs), splenic hilar artery (SpA) type, and learning curve phase were significantly associated with DT. In the entire group, 124 patients were followed for a median time of 23.0 months (range, 3-30 months). There was no significant difference in the survival curve between phases. AUGC patients with a BMI less than 25 kg/m², a small number of SGVs, and a concentrated type of SpA are ideal candidates for surgeons who are in phase 1 of the learning curve.

  18. Learning Curve of the Application of Huang Three-Step Maneuver in a Laparoscopic Spleen-Preserving Splenic Hilar Lymphadenectomy for Advanced Gastric Cancer

    PubMed Central

    Huang, Ze-Ning; Huang, Chang-Ming; Zheng, Chao-Hui; Li, Ping; Xie, Jian-Wei; Wang, Jia-Bin; Lin, Jian-Xian; Lu, Jun; Chen, Qi-Yue; Cao, Long-long; Lin, Mi; Tu, Ru-Hong

    2016-01-01

    Abstract To investigate the learning curve of the application of Huang 3-step maneuver, which was summarized and proposed by our center for the treatment of advanced upper gastric cancer. From April 2012 to March 2013, 130 consecutive patients who underwent a laparoscopic spleen-preserving splenic hilar lymphadenectomy (LSPL) by a single surgeon who performed Huang 3-step maneuver were retrospectively analyzed. The learning curve was analyzed based on the moving average (MA) method and the cumulative sum method (CUSUM). Surgical outcomes, short-term outcomes, and follow-up results before and after learning curve were contrastively analyzed. A stepwise multivariate logistic regression was used for a multivariable analysis to determine the factors that affect the operative time using Huang 3-step maneuver. Based on the CUSUM, the learning curve for Huang 3-step maneuver was divided into phase 1 (cases 1–40) and phase 2 (cases 41–130). The dissection time (DT) (P < 0.001), blood loss (BL) (P < 0.001), and number of vessels injured in phase 2 were significantly less than those in phase 1. There were no significant differences in the clinicopathological characteristics, short-term outcomes, or major postoperative complications between the learning curve phases. Univariate and multivariate analyses revealed that body mass index (BMI), short gastric vessels (SGVs), splenic hilar artery (SpA) type, and learning curve phase were significantly associated with DT. In the entire group, 124 patients were followed for a median time of 23.0 months (range, 3–30 months). There was no significant difference in the survival curve between phases. AUGC patients with a BMI less than 25 kg/m2, a small number of SGVs, and a concentrated type of SpA are ideal candidates for surgeons who are in phase 1 of the learning curve. PMID:27043698

  19. Presacral schwannoma: laparoscopic resection, a viable option

    PubMed Central

    Jatal, Sudhir; Pai, Vishwas D.; Rakhi, Bharat

    2016-01-01

    Schwannomas are benign nerve sheath tumours arising from Schwann cells. Presacral schwannomas are rare with only case report and short case series being reported in literature. Complete surgical resection is the treatment of choice for these rare tumours. Approach to surgical resection depends on the type of the tumour. Type 3 tumours have conventionally been treated with open intra or extra peritoneal approach. With improvement in the laparoscopic surgical skills, more and more complex surgical procedures have been attempted via this approach. We are presenting a case of presacral schwannoma in an overweight lady treated by laparoscopic resection. PMID:27275489

  20. Laparoscopic Gynecology Procedures: Avoid the Risk

    PubMed Central

    1996-01-01

    Laparoscopic approaches to gynecological surgery have been developed by an elite group of highly skilled surgeons. As these procedures become more prevalent in the general gynecological approach to disease and the general gynecologist's approach to treatment, the complication rate for these procedures is likely to increase. In an effort to assist in avoiding these complications, guidelines for the performance of laparoscopic gynecological procedures need to be established. This article presents approaches to the most common gynecological procedures that can assist in the prevention of complications. PMID:18493397

  1. Anesthetic implications of laparoscopic surgery.

    PubMed Central

    Cunningham, A. J.

    1998-01-01

    multimodal analgesic regimen involving skin infiltration with local anesthesia. NSAIDs to attenuate peripheral pain and opioids for central pain may reduce postoperative discomfort and expedite patient recovery/discharge. There is no conclusive evidence to demonstrate clinically significant effects of nitrous oxide on surgical conditions during laparoscopic cholecystectomy or on the incidence of postoperative emesis. Laparoscopic cholecystectomy has proven to be a major advance in the treatment of patients with symptomatic gallbladder disease. PMID:10604786

  2. Laparoscopic adrenalectomy: An update

    PubMed Central

    Al-Zahrani, Hassan Mesfer

    2012-01-01

    Objective To review the current role and outcome of laparoscopic adrenalectomy (LA) in the management of adrenal tumours. Methods A Medline search using the keywords (adrenalectomy, laparoscopy, adrenal masses/tumours) was done for reports published between 1990 and 2011. Key articles were used to find more relevant references on the evaluation and laparoscopic management of adrenal masses. Results The hormonal evaluation is not standardised, but initial screening tests are recommended and followed with confirmatory ones when positive, equivocal or the clinical presentation suggest adrenal hyperfunction. The imaging studies had, and continued to, advance, especially computed tomography (CT), magnetic resonance imaging and positron-emission tomography/CT. These advances have increased the accuracy of the diagnosis of adrenal masses, with a reported high sensitivity and specificity of 95–100%. The introduction of laparoscopy has resulted in more adrenal lesions being removed, especially incidental lesions smaller than the 5–6 cm that was previously the indication for surgical excision. The technique has developed and larger lesions of >6 cm are now considered for LA in the proper setting. The transperitoneal and retroperitoneal approaches are currently widely practised, with minor differences in the outcome. The reported outcome, although mostly retrospective, is excellent and with fewer complications. The role of LA for adrenal malignancy should be considered cautiously. Preoperative imaging signs of invasion into surrounding structures should be considered a contraindication for LA. Conclusion LA is the standard procedure for most adrenal lesions of appropriate size and no signs of surrounding tissue invasion, giving an excellent outcome. PMID:26558005

  3. Laparoscopic resection of splenic flexure tumors.

    PubMed

    Carlini, Massimo; Spoletini, Domenico; Castaldi, Fabio; Giovannini, Cristiano; Passaro, Umberto

    2016-03-01

    In this paper a single institution experience in laparoscopic treatment of splenic flexure tumors (SFT) is reported. Low incidence of these tumors and complexity of the procedure make the laparoscopic resection not diffuse and not well standardized. Since 2004, in a specific database, we prospectively record clinicopathological features and outcome of all patients submitted to laparoscopic colorectal resection. From January 2004 to October 2015, out of 567 cases of minimally invasive colorectal procedures, we performed 20 laparoscopic resection of SFT, 11 with extracorporeal anastomosis and 9 totally laparoscopic. Twelve patients had an advanced disease. Conversion rate was null. The mean operative time was 105' (range 70'-135'). Comparing extracorporeal and intracorporeal anastomoses, we did not find any significant difference in mean duration of surgery. Mean distal margin was 9.4 ± 3.1 cm (mean ± DS), mean proximal margin 8.9 ± 2.7 cm. The mean number of harvested lymph nodes was 17.8 ± 5.6. Evaluating surgical short-term and oncological mid-term outcomes, laparoscopic resection of splenic flexure for tumors, even if challenging, resulted technically feasible and oncologically safe and it seems to be advisable.

  4. Laparoscopic resection of splenic flexure tumors.

    PubMed

    Carlini, Massimo; Spoletini, Domenico; Castaldi, Fabio; Giovannini, Cristiano; Passaro, Umberto

    2016-03-01

    In this paper a single institution experience in laparoscopic treatment of splenic flexure tumors (SFT) is reported. Low incidence of these tumors and complexity of the procedure make the laparoscopic resection not diffuse and not well standardized. Since 2004, in a specific database, we prospectively record clinicopathological features and outcome of all patients submitted to laparoscopic colorectal resection. From January 2004 to October 2015, out of 567 cases of minimally invasive colorectal procedures, we performed 20 laparoscopic resection of SFT, 11 with extracorporeal anastomosis and 9 totally laparoscopic. Twelve patients had an advanced disease. Conversion rate was null. The mean operative time was 105' (range 70'-135'). Comparing extracorporeal and intracorporeal anastomoses, we did not find any significant difference in mean duration of surgery. Mean distal margin was 9.4 ± 3.1 cm (mean ± DS), mean proximal margin 8.9 ± 2.7 cm. The mean number of harvested lymph nodes was 17.8 ± 5.6. Evaluating surgical short-term and oncological mid-term outcomes, laparoscopic resection of splenic flexure for tumors, even if challenging, resulted technically feasible and oncologically safe and it seems to be advisable. PMID:27040272

  5. Update on laparoscopic, robotic, and minimally invasive vaginal surgery for pelvic floor repair.

    PubMed

    Ross, J W; Preston, M R

    2009-06-01

    Advanced laparoscopic surgery marked the beginning of minimally invasive pelvic surgery. This technique lead to the development of laparoscopic hysterectomy, colposuspension, paravaginal repair, uterosacral suspension, and sacrocolpopexy without an abdominal incision. With laparoscopy there is a significant decrease in postoperative pain, shorter length of hospital stay, and a faster return to normal activities. These advantages made laparoscopy very appealing to patients. Advanced laparoscopy requires a special set of surgical skills and in the early phase of development training was not readily available. Advanced laparoscopy was developed by practicing physicians, instead of coming down through the more usual academic channels. The need for special training did hinder widespread acceptance. Nonetheless by physician to physician training and society training courses it has continued to grow and now has been incorporated in most medical school curriculums. In the last few years there has been new interest in laparoscopy because of the development of robotic assistance. The 3D vision and 720 degree articulating arms with robotics have made suture intensive procedures much easier. Laparosco-pic robotic-assisted sacrocolpopexy is in the reach of most surgeons. This field is so new that there is very little data to evaluate at this time. There are short comings with laparoscopy and even with robotic-assisted procedures it is not the cure all for pelvic floor surgery. Laparoscopic procedures are long and many patients requiring pelvic floor surgery have medical conditions preventing long anesthesia. Minimally invasive vaginal surgery has developed from the concept of tissue replacement by synthetic mesh. Initially sheets of synthetic mesh were tailored by physicians to repair the anterior and posterior vaginal compartment. The use of mesh by general surgeons for hernia repair has served as a model for urogynecology. There have been rapid improvements in biomaterials

  6. Use of classroom "clickers" to promote acquisition of advanced reasoning skills.

    PubMed

    DeBourgh, Gregory A

    2008-03-01

    Use of classroom response systems (a.k.a. "clickers" or "audience polling systems") are growing in popularity among faculty in colleges and universities. When used by faculty in a strategic instructional design, clickers can raise the level of participation and the effectiveness of interaction, promote engagement of students in active learning, foster communication to clarify misunderstanding and incorrect thinking, and provide a method to instructionally embed assessment as a learning activity rather than reliance on the traditional approach of summative assessment for assigning grades. This article describes the use of clicker technology in a baccalaureate nursing program to promote acquisition and application of advanced reasoning skills. Methods are suggested for embedding formative assessment and the tactical use of questioning as feedback and a powerful learning tool. Operational aspects of clickers technology are summarized and students' perceptions and satisfaction with use of this teaching and learning technology are described.

  7. Journal Clubs During Advanced Pharmacy Practice Experiences to Teach Literature-Evaluation Skills

    PubMed Central

    Gim, Suzanna; Nogid, Anna; Shah, Bupendra

    2012-01-01

    Objective. To determine pharmacy students’ attitudes and academic performance related to journal club during 2 advanced pharmacy practice experiences (APPEs). Design. Fourth-year pharmacy students were required to complete 3 journal club assignments during drug information and internal medicine APPEs. Assessment. A majority (91.3%) of the 105 students who responded to a 21-item survey instrument indicated that journal club assignments during the drug-information APPE were valuable to their understanding of research design and statistics. Students who completed the drug-information APPE before the internal medicine APPE scored higher on their understanding of the strengths and weaknesses and the clinical relevance of studies and had a higher learning slope (p = 0.01) than did students who completed the internal medicine APPE first. Conclusion. Incorporating journal clubs into APPEs is an effective means of teaching literature-evaluation skills to pharmacy students. PMID:22761529

  8. Right person, right skills, right job: the contribution of objective structured clinical examinations in advancing staff nurse experts.

    PubMed

    Mitchell, Marion; Strube, Petra; Vaux, Amanda; West, Nicky; Auditore, Anthony

    2013-10-01

    Recruitment processes need to discriminate among candidates to ensure that the right person with the right skills is selected for advancement opportunities. An innovative recruitment process using an objective structured clinical examination grounded in best practice guidelines resulted in improved recruitment practices for senior nursing clinical expert roles. Candidates' skills, knowledge, and attitudes in the areas of patient focus, clinical expertise, teamwork, and leadership were assessed using a clinical simulation. Candidates achieving advancement were assessed at 6 months to validate the efficacy of the process.

  9. Concomitant laparoscopic urological procedures: Does it contribute to morbidity?

    PubMed Central

    Maurya, Kamlesh; Sivanandam, S E; Sukumar, Sudhir; Bhat, Sanjay; Kumar, Ginil; Nair, Balagopal

    2009-01-01

    AIM: With advancement in minimal access surgery two laparoscopic procedures can be combined together shortening the total hospital stay, decreasing morbidity and overall reduced cost. Combining two laparoscopic procedures in a single session has been reported in general surgery. Very few articles are available in literature with regard to combined urological laparoscopic surgeries. This article retrospectively analyses the outcomes of multiple laparoscopic procedures performed in a single stage at our centre. MATERIALS AND METHODS: Patients undergoing simultaneous procedures from May 2003 to Jan 2009 were included in the study. Patients were categorised into three groups according to the primary urological organ involved, for better comparison with the control group. Diseases involving the adrenals gland were grouped in (group 1), kidney (group 2) and renal collecting system/ureter (group 3). All patients had one urological procedure for either of the above-mentioned organs combined with another surgical procedure. Similarly three control groups were chosen according to the primary urological organ involved (group 1c- unilateral laparoscopic adrenalectomy, group 2c- unilateral laparoscopic radical nephrectomy and group 3c- unilateral laparoscopic ureterolithotomy) for comparative study. The operative details, hospital stay and complications were analysed. RESULTS: Thirty-two patients underwent 64 laparoscopic procedures under single anaesthesia. The most common procedure in this series was laparoscopic adrenalectomy (n=34) followed by laparoscopic nephrectomy (n=13). Group 1 patients had a prolonged operative time (P = 0.012) and hospital stay (P = 0.025) when compared with group 1c. However, blood loss was comparable in both the groups. Patients in groups 2 and 3 had comparable operative times, blood loss and recovery period with respect to their controls. Intraoperatively, the end tidal carbon dioxide levels were within permissible limits. All procedures were

  10. Assessment of a manipulator device for NOTES with basic surgical skill tests: a bench study.

    PubMed

    Yasuda, Kazuhiro; Kitano, Seigo; Ikeda, Keiichi; Sumiyama, Kazuki; Tajiri, Hisao

    2014-10-01

    Advanced complex surgery performed with the natural orifice translumenal endoscopic surgery technique requires use of a multitasking platform. The aim of this study is to evaluate the basic functionality of a prototype multitasking platform "EndoSAMURAI" with the use of a biosimulation model and ex vivo porcine stomach. We compared the performance of basic surgical skill tasks between the EndoSAMURAI and standard laparoscopic instrumentation. Basic surgical tasks include cutting, dissection, and suturing and knot tying. Main outcome measurements were the time to complete each task and leak pressure to evaluate the quality of the suturing and knot tying. Although it took longer to perform all basic surgical tasks with the EndoSAMURAI than with laparoscopic instrumentation, all tasks could be performed precisely and with an accuracy comparable to that of the laparoscopic technique. Leak pressures of the gastric closure site between both techniques were also comparable.

  11. Laparoscopic anterior pelvic exenteration for locoregionally advanced rectal cancer directly invading the urinary bladder: A case report of low anterior resection with en bloc cystectomy for sphincter preservation

    PubMed Central

    Nakashima, Shinya; Hamada, Takeomi; Nishida, Takahiro; Maehara, Naoki; Ikeda, Takuto; Tsukino, Hiromasa; Mukai, Shoichiro; Kamoto, Toshiyuki; Kondo, Kazuhiro

    2015-01-01

    Abstract Laparoscopic multi‐visceral resection in patients with T4 colorectal cancer remains controversial. A 73‐year‐old man was admitted to the hospital for rectosigmoid cancer directly invading the urinary bladder trigone without distant metastasis. We successfully performed complete resection by laparoscopic anterior pelvic exenteration while preserving the anus. After laparoscopic mobilization of the rectum, urinary bladder, and prostate, the urethra and urethral catheter were dissected to reveal the lower rectum. By pulling the urethral catheter toward the head, the prostate was excised retrogradely from the lower rectum anterior wall. The lower rectum was resected and anastomosed by the double stapling technique with a safe distal margin from the tumor. Pathological findings of the resected specimen indicated no residual tumor in the surgical margin. There was no evidence of recurrence 34 months after surgery. En bloc, R0, laparoscopic anterior pelvic exenteration for T4 rectal cancer is feasible. However, further studies with long‐term follow‐up are required to resolve oncological outcomes. PMID:26303734

  12. Laparoscopic anterior pelvic exenteration for locoregionally advanced rectal cancer directly invading the urinary bladder: A case report of low anterior resection with en bloc cystectomy for sphincter preservation.

    PubMed

    Ishizaki, Hidenobu; Nakashima, Shinya; Hamada, Takeomi; Nishida, Takahiro; Maehara, Naoki; Ikeda, Takuto; Tsukino, Hiromasa; Mukai, Shoichiro; Kamoto, Toshiyuki; Kondo, Kazuhiro

    2015-08-01

    Laparoscopic multi-visceral resection in patients with T4 colorectal cancer remains controversial. A 73-year-old man was admitted to the hospital for rectosigmoid cancer directly invading the urinary bladder trigone without distant metastasis. We successfully performed complete resection by laparoscopic anterior pelvic exenteration while preserving the anus. After laparoscopic mobilization of the rectum, urinary bladder, and prostate, the urethra and urethral catheter were dissected to reveal the lower rectum. By pulling the urethral catheter toward the head, the prostate was excised retrogradely from the lower rectum anterior wall. The lower rectum was resected and anastomosed by the double stapling technique with a safe distal margin from the tumor. Pathological findings of the resected specimen indicated no residual tumor in the surgical margin. There was no evidence of recurrence 34 months after surgery. En bloc, R0, laparoscopic anterior pelvic exenteration for T4 rectal cancer is feasible. However, further studies with long-term follow-up are required to resolve oncological outcomes.

  13. Effect of laparoscopic abdominal surgery on splanchnic circulation: Historical developments

    PubMed Central

    Hatipoglu, Sinan; Akbulut, Sami; Hatipoglu, Filiz; Abdullayev, Ruslan

    2014-01-01

    With the developments in medical technology and increased surgical experience, advanced laparoscopic surgical procedures are performed successfully. Laparoscopic abdominal surgery is one of the best examples of advanced laparoscopic surgery (LS). Today, laparoscopic abdominal surgery in general surgery clinics is the basis of all abdominal surgical interventions. Laparoscopic abdominal surgery is associated with systemic and splanchnic hemodynamic alterations. Inadequate splanchnic perfusion in critically ill patients is associated with increased morbidity and mortality. The underlying pathophysiological mechanisms are still not well understood. With experience and with an increase in the number and diversity of the resulting data, the pathophysiology of laparoscopic abdominal surgery is now better understood. The normal physiology and pathophysiology of local and systemic effects of laparoscopic abdominal surgery is extremely important for safe and effective LS. Future research projects should focus on the interplay between the physiological regulatory mechanisms in the splanchnic circulation (SC), organs, and diseases. In this review, we discuss the effects of laparoscopic abdominal surgery on the SC. PMID:25561784

  14. Visual search behaviour during laparoscopic cadaveric procedures

    NASA Astrophysics Data System (ADS)

    Dong, Leng; Chen, Yan; Gale, Alastair G.; Rees, Benjamin; Maxwell-Armstrong, Charles

    2014-03-01

    Laparoscopic surgery provides a very complex example of medical image interpretation. The task entails: visually examining a display that portrays the laparoscopic procedure from a varying viewpoint; eye-hand coordination; complex 3D interpretation of the 2D display imagery; efficient and safe usage of appropriate surgical tools, as well as other factors. Training in laparoscopic surgery typically entails practice using surgical simulators. Another approach is to use cadavers. Viewing previously recorded laparoscopic operations is also a viable additional approach and to examine this a study was undertaken to determine what differences exist between where surgeons look during actual operations and where they look when simply viewing the same pre-recorded operations. It was hypothesised that there would be differences related to the different experimental conditions; however the relative nature of such differences was unknown. The visual search behaviour of two experienced surgeons was recorded as they performed three types of laparoscopic operations on a cadaver. The operations were also digitally recorded. Subsequently they viewed the recording of their operations, again whilst their eye movements were monitored. Differences were found in various eye movement parameters when the two surgeons performed the operations and where they looked when they simply watched the recordings of the operations. It is argued that this reflects the different perceptual motor skills pertinent to the different situations. The relevance of this for surgical training is explored.

  15. [The training concept of laparoscopic surgery in post-graduate education of doctors].

    PubMed

    Dzemeshkevich, S L; Skipenko, O G; Svistunov, A A; Kossovich, M A; Shubina, L B; Gribkov, D M; Vasil'ev, M V

    2013-01-01

    The active use of virtual devices and laparoscopic boxes for the control of the achieved skills level are the general idea of the suggested concept of the laparoscopic surgical training. The in vivo training make sense only after finishing the "virtual" course. The complete realization of these new concept of laparoscopic surgery training is possible only in frames of the endoscopic surgery department of the mighty hospital center. The organization of such center promise to rise the level of doctors' training.

  16. Thinking about Reading about Thinking about Reading about Thinking. Advanced Skills in Chapter 1. [Workshop. Leader's Guide.

    ERIC Educational Resources Information Center

    Advanced Technology, Inc., Indianapolis, IN.

    Designed to assist technical assistance center staff members and other inservice providers, this workshop leader's guide contains step-by-step procedures for preparing, organizing, and presenting a one-hour workshop on advanced skills for teachers, administrators, and others associated with Chapter 1 programs. Sections of the guide include: (1) an…

  17. Asilomar Leadership Skills Seminar: The Career Preparation, Advancement, and Enhancement of Women in California Community College Leadership

    ERIC Educational Resources Information Center

    Castillo-Garrison, Estella M.

    2012-01-01

    This mixed-methods research study examined the effects on the career preparation, advancement, and enhancement of women from California community college leadership who participated in the Asilomar Leadership Skills Seminar (Asilomar) from 2005-2011. Data were collected during the 2011-2012 academic year and were gathered from the results of 67…

  18. Advance Directives and Communication Skills of Prehospital Physicians Involved in the Care of Cardiovascular Patients.

    PubMed

    Gigon, Fabienne; Merlani, Paolo; Ricou, Bara

    2015-12-01

    Advance directives (AD) were developed to respect patient autonomy. However, very few patients have AD, even in cases when major cardiovascular surgery is to follow. To understand the reasons behind the low prevalence of AD and to help decision making when patients are incompetent, it is necessary to focus on the impact of prehospital practitioners, who may contribute to an increase in AD by discussing them with patients. The purpose of this study was to investigate self-rated communication skills and the attitudes of physicians potentially involved in the care of cardiovascular patients toward AD.Self-administered questionnaires were sent to general practitioners, cardiologists, internists, and intensivists, including the Quality of Communication Score, divided into a General Communication score (QOCgen 6 items) and an End-of-life Communication score (QOCeol 7 items), as well as questions regarding opinions and practices in terms of AD.One hundred sixty-four responses were received. QOCgen (mean (±SD)): 9.0/10 (1.0); QOCeol: 7.2/10 (1.7). General practitioners most frequently start discussions about AD (74/149 [47%]) and are more prone to designate their own specialty (30/49 [61%], P < 0.0001). Overall, only 57/159 (36%) physicians designated their own specialty; 130/158 (82%) physicians ask potential cardiovascular patients if they have AD and 61/118 (52%) physicians who care for cardiovascular patients talk about AD with some of them.The characteristics of physicians who do not talk about AD with patients were those who did not personally have AD and those who work in private practices.One hundred thirty-three (83%) physicians rated the systematic mention of patients' AD in the correspondence between physicians as good, while 114 (71%) at the patients' first registration in the private practice.Prehospital physicians rated their communication skills as good, whereas end-of-life communication was rated much lower. Only half of those surveyed speak about AD

  19. Laparoscopic colon surgery: past, present and future.

    PubMed

    Martel, Guillaume; Boushey, Robin P

    2006-08-01

    curve associated with laparoscopic colon surgery. Good evidence exists supporting the use of second-generation, sleeveless, hand-assist devices in this context. Similarly, new hemostatic devices such as the ultrasonic scalpel and the electrothermal bipolar vessel sealer may be particularly helpful for extensive colonic mobilizations, in which several vascular pedicles must be taken. The precise role of these hemostatic technologies has yet to be established, particularly in comparison with stapling devices and significantly cheaper laparoscopic clips. Finally, recent advances in camera systems are promising to improve the ease with which difficult colonic dissections can be performed.

  20. Electromagnetically navigated laparoscopic ultrasound.

    PubMed

    Wilheim, Dirk; Feussner, Hubertus; Schneider, Armin; Harms, Jens

    2003-01-01

    A three-dimensional (3D) representation of laparoscopic ultrasound examinations could be helpful in diagnostic and therapeutic laparoscopy, but has not yet been realised with flexible laparoscopic ultrasound probes. Therefore, an electromagnetic navigation system was integrated into the tip of a conventional laparoscopic ultrasound probe. Navigated 3D laparoscopic ultrasound was compared with the imaging data of 3D navigated transcutaneous ultrasound and 3D computed tomography (CT) scan. The 3D CT scan served as the "gold standard". Clinical applicability in standardized operating room (OR) settings, imaging quality, diagnostic potential, and accuracy in volumetric assessment of various well-defined hepatic lesions were analyzed. Navigated 3D laparoscopic ultrasound facilitates exact definition of tumor location and margins. As compared with the "gold standard" of the 3D CT scans, 3D laparoscopic ultrasound has a tendency to underestimate the volume of the region of interest (ROI) (Delta3.1%). A comparison of 3D laparoscopy and transcutaneous 3D ultrasonography demonstrated clearly that the former is more accurate for volumetric assessment of the ROI and facilitates a more detailed display of the lesions. 3D laparoscopic ultrasound imaging with a navigated probe is technically feasible. The technique facilitates detailed ultrasound evaluation of laparoscopic procedures that involve visual, in-depth, and volumetric perception of complex liver pathologies. Navigated 3D laparoscopic ultrasound may have the potential to promote the practical role of laparoscopic ultrasonography, and become a valuable tool for local ablative therapy. In this article, our clinical experiences with a certified prototype of a 3D laparoscopic ultrasound probe, as well as its in vitro and in vivo evaluation, is reported.

  1. Minireview on laparoscopic hepatobiliary and pancreatic surgery

    PubMed Central

    Tan-Tam, Clara; Chung, Stephen W

    2014-01-01

    The first laparoscopic cholecystectomy was performed in the mid-1980s. Since then, laparoscopic surgery has continued to gain prominence in numerous fields, and has, in some fields, replaced open surgery as the preferred operative technique. The role of laparoscopy in staging cancer is controversial, with regards to gallbladder carcinoma, pancreatic carcinoma, hepatocellular carcinoma and liver metastasis from colorectal carcinoma, laparoscopy in conjunction with intraoperative ultrasound has prevented nontherapeutic operations, and facilitated therapeutic operations. Laparoscopic cholecystectomy is the preferred option in the management of gallbladder disease. Meta-analyses comparing laparoscopic to open distal pancreatectomy show that laparoscopic pancreatectomy is safe and efficacious in the management of benign and malignant disease, and have better patient outcomes. A pancreaticoduodenectomy is a more complex operation and the laparoscopic technique is not feasible for this operation at this time. Robotic assisted pancreaticoduodenectomy has been tried with limited success at this time, but with continuing advancement in this field, this operation would eventually be feasible. Liver resection remains to be the best management for hepatocellular carcinoma, cholangiocarcinoma and colorectal liver metastases. Systematic reviews and meta-analyses have shown that laparoscopic liver resections result in patients with equal or less blood loss and shorter hospital stays, as compared to open surgery. With improving equipment and technique, and the incorporation of robotic surgery, minimally invasive liver resection operative times will improve and be more efficacious. With the incorporation of robotic surgery into hepatobiliary surgery, donor hepatectomies have also been completed with success. The management of benign and malignant disease with minimally invasive hepatobiliary and pancreatic surgery is safe and efficacious. PMID:24634709

  2. Integrating interprofessional collaboration skills into the advanced practice registered nurse socialization process.

    PubMed

    Farrell, Kathleen; Payne, Camille; Heye, Mary

    2015-01-01

    The emergence of interprofessional collaboration and practice as a means to provide patient-centered care and to decrease the current fragmentation of health care services in the 21st century provides a clear and unique opportunity for the advanced practice registered nurse (APRN) to assume a key role. For APRNs and other health care providers, to participate effectively as team members requires an interprofessional mindset. Development of interprofessional skills and knowledge for the APRN has been hindered by a silo approach to APRN role socialization. The Institute of Medicine Report (IOM; 2010) states that current health care systems should focus on team collaboration to deliver accessible, high-quality, patient-centered health care that addresses wellness and prevention of illness and adverse events, management of chronic illness, and increased capacity of all providers on the team. The purpose of this article is to demonstrate the need to incorporate interprofessional education (IPE) into the socialization models used in advanced practice nursing programs. IPE requires moving beyond profession-specific educational efforts to engage students of different health care professions in interactive learning. Being able to work effectively as member of a clinical team while a student is a fundamental part of that learning (Interprofessional Education Collaborative Expert Panel, 2011). The objective of IPE curriculum models in graduate nursing programs is to educate APRNs in the development of an interprofessional mindset. Interprofessional collaboration and coordination are needed to achieve seamless transitions for patients between providers, specialties, and health care settings (IOM, 2010). Achieving the vision requires the continuous development of interprofessional competencies by APRNs as part of the learning process, so that upon entering the workforce, APRNs are ready to practice effective teamwork and team-based care. Socialization of the professional APRN

  3. Technical Report of Successful Deployment of Tandem Visual Tracking During Live Laparoscopic Cholecystectomy Between Novice and Expert Surgeon

    PubMed Central

    Baronia, Benedicto C

    2016-01-01

    With the recent advances in eye tracking technology, it is now possible to track surgeons’ eye movements while engaged in a surgical task or when surgical residents practice their surgical skills. Several studies have compared eye movements of surgical experts and novices and developed techniques to assess surgical skill on the basis of eye movement utilizing simulators and live surgery. None have evaluated simultaneous visual tracking between an expert and a novice during live surgery. Here, we describe a successful simultaneous deployment of visual tracking of an expert and a novice during live laparoscopic cholecystectomy. One expert surgeon and one chief surgical resident at an accredited surgical program in Lubbock, TX, USA performed a live laparoscopic cholecystectomy while simultaneously wearing the visual tracking devices. Their visual attitudes and movements were monitored via video recordings. The recordings were then analyzed for correlation between the expert and the novice. The visual attitudes and movements correlated approximately 85% between an expert surgeon and a chief surgical resident. The surgery was carried out uneventfully, and the data was abstracted with ease. We conclude that simultaneous deployment of visual tracking during live laparoscopic surgery is a possibility. More studies and subjects are needed to verify the success of our results and obtain data analysis. PMID:27774359

  4. Single incision laparoscopic myomectomy.

    PubMed

    Ramesh, B; Vidyashankar, Madhuri; Bharathi, Bv

    2011-01-01

    Single port laparoscopic surgery (SPLS), also called SILS is the natural extension of multi-incisional laparoscopic surgery, in the quest for reduction of traumatic insult and residual scarring to the patient. Today with the evolution of newer instruments, bidirectional self-retaining sutures, and surgical experience we are able to perform many surgeries in gynecology.

  5. Single Incision Laparoscopic Myomectomy

    PubMed Central

    Ramesh, B; Vidyashankar, Madhuri; Bharathi, BV

    2011-01-01

    Single port laparoscopic surgery (SPLS), also called SILS is the natural extension of multi-incisional laparoscopic surgery, in the quest for reduction of traumatic insult and residual scarring to the patient. Today with the evolution of newer instruments, bidirectional self-retaining sutures, and surgical experience we are able to perform many surgeries in gynecology. PMID:22442539

  6. [Complications of laparoscopic cholecystectomy].

    PubMed

    Kyzer, S; Ramadan, E; Chaimoff, C

    1992-04-15

    92% of our first 60 laparoscopic cholecystectomies were successful. Postoperative complications included fever in 10 cases (17%), urinary retention in 5 (8%), intraabdominal abscess in 2 (3%), biliary leakage in 1 (2%) and unexplained abdominal pain in 10 (17%). Although laparoscopic cholecystectomy has obvious advantages, it also has major as well as minor complications. PMID:1398315

  7. The Blue DRAGON--a system for monitoring the kinematics and the dynamics of endoscopic tools in minimally invasive surgery for objective laparoscopic skill assessment.

    PubMed

    Rosen, Jacob; Brown, Jeffrey D; Barreca, Marco; Chang, Lily; Hannaford, Blake; Sinanan, Mika

    2002-01-01

    Minimally invasive surgeiy (MIS) involves a multi-dimensional series of tasks requiring a synthesis between visual information and the kinematics and dynamics of the surgical tools. Analysis of these sources of information is a key step in mastering MIS surgery but may also be used to define objective criteria for characterizing surgical performance. The BIueDRAGON is a new system for acquiring the kinematics and the dynamics of two endoscopic tools along with the visual view of the surgical scene. It includes two four-bar mechanisms equipped with position and force torque sensors for measuring the positions and the orientations (P/O) of two endoscopic tools along with the forces and torques applied by the surgeons hands. The methodology of decomposing the surgical task is based on a fully connected, finite-states (28 states) Markov model where each states corresponded to a fundamental tool/tissue interaction based on the tool kinematics and associated with unique F/T signatures. The experimental protocol included seven MIS tasks performed on an animal model (pig) by 30 surgeons at different levels of their residency training. Preliminary analysis of these data showed that major differences between residents at different skill levels were: (i) the types of tool/tissue interactions being used, (ii) the transitions between tool/tissue interactions being applied by each hand, (iii) time spent while perfonning each tool/tissue interaction, (iv) the overall completion time, and (v) the variable F/T magnitudes being applied by the subjects through the endoscopic tools. Systems like surgical robots or virtual reality simulators that inherently measure the kinematics and the dynamics of the surgical tool may benefit from inclusion of the proposed methodology for analysis of efficacy and objective evaluation of surgical skills during training. PMID:15458124

  8. Laparoscopic surgery: A qualified systematic review

    PubMed Central

    Buia, Alexander; Stockhausen, Florian; Hanisch, Ernst

    2015-01-01

    AIM: To review current applications of the laparoscopic surgery while highlighting the standard procedures across different fields. METHODS: A comprehensive search was undertaken using the PubMed Advanced Search Builder. A total of 321 articles were found in this search. The following criteria had to be met for the publication to be selected: Review article, randomized controlled trials, or meta-analyses discussing the subject of laparoscopic surgery. In addition, publications were hand-searched in the Cochrane database and the high-impact journals. A total of 82 of the findings were included according to matching the inclusion criteria. Overall, 403 full-text articles were reviewed. Of these, 218 were excluded due to not matching the inclusion criteria. RESULTS: A total of 185 relevant articles were identified matching the search criteria for an overview of the current literature on the laparoscopic surgery. Articles covered the period from the first laparoscopic application through its tremendous advancement over the last several years. Overall, the biggest advantage of the procedure has been minimizing trauma to the abdominal wall compared with open surgery. In the case of cholecystectomy, fundoplication, and adrenalectomy, the procedure has become the gold standard without being proven as a superior technique over the open surgery in randomized controlled trials. Faster recovery, reduced hospital stay, and a quicker return to normal activities are the most evident advantages of the laparoscopic surgery. Positive outcomes, efficiency, a lower rate of wound infections, and reduction in the perioperative morbidity of minimally invasive procedures have been shown in most indications. CONCLUSION: Improvements in surgical training and developments in instruments, imaging, and surgical techniques have greatly increased safety and feasibility of the laparoscopic surgical procedures. PMID:26713285

  9. Self-perceived competence among medical residents in skills needed to care for patients with advanced dementia versus metastatic cancer.

    PubMed

    Manu, Erika; Marks, Adam; Berkman, Cathy S; Mullan, Patricia; Montagnini, Marcos; Vitale, Caroline A

    2012-06-01

    To examine medical residents' perceived competence in caring for patients with dementia we conducted an online survey of all 120 second, third and fourth-year residents in Internal Medicine, Medicine/Pediatrics, and Family Medicine at University of Michigan. A structured survey elicited residents' training, experience, confidence, and perceived career needs for skills in estimating prognosis, symptom management, and communication in caring for patients with dementia, compared to patients with metastatic cancer. Among the 61 (51 %) respondents, a majority report lower confidence in assessing prognosis and eliciting treatment wishes in patients with dementia (vs. metastatic cancer), and in performing skills integral to the care of patients with dementia, including the ability to assess caregiver needs, decisional capacity, advise on place of care, and manage agitation, despite viewing these skills as important to their future careers. These findings support the need for enhanced education on optimal care of patients with advanced dementia.

  10. Self-perceived competence among medical residents in skills needed to care for patients with advanced dementia versus metastatic cancer.

    PubMed

    Manu, Erika; Marks, Adam; Berkman, Cathy S; Mullan, Patricia; Montagnini, Marcos; Vitale, Caroline A

    2012-06-01

    To examine medical residents' perceived competence in caring for patients with dementia we conducted an online survey of all 120 second, third and fourth-year residents in Internal Medicine, Medicine/Pediatrics, and Family Medicine at University of Michigan. A structured survey elicited residents' training, experience, confidence, and perceived career needs for skills in estimating prognosis, symptom management, and communication in caring for patients with dementia, compared to patients with metastatic cancer. Among the 61 (51 %) respondents, a majority report lower confidence in assessing prognosis and eliciting treatment wishes in patients with dementia (vs. metastatic cancer), and in performing skills integral to the care of patients with dementia, including the ability to assess caregiver needs, decisional capacity, advise on place of care, and manage agitation, despite viewing these skills as important to their future careers. These findings support the need for enhanced education on optimal care of patients with advanced dementia. PMID:22477667

  11. Predictors of aggressive tendencies in girls' basketball: an examination of beginning and advanced participants in a summer skills camp.

    PubMed

    Stephens, D E

    2001-09-01

    This study was designed to extend previous research on aggressive tendencies and moral atmosphere in two ways: (a) to include participants of two skill levels in a summer youth basketball skill camp and (b) to examine the influence of the coach on participants' aggressive tendencies. The participants were 136 youth from either a beginning (n = 89) or an advanced sport camp (n = 47). Results indicated that primary predictors of aggressive tendencies for both skill levels included participants' perception of their teammates' behavior in the same situation and their willingness to injure others if their coach requested. These findings are consistent with previous research establishing team norm as a significant predictor for self-described aggressive tendencies in a sport situation. PMID:11561390

  12. Predictors of aggressive tendencies in girls' basketball: an examination of beginning and advanced participants in a summer skills camp.

    PubMed

    Stephens, D E

    2001-09-01

    This study was designed to extend previous research on aggressive tendencies and moral atmosphere in two ways: (a) to include participants of two skill levels in a summer youth basketball skill camp and (b) to examine the influence of the coach on participants' aggressive tendencies. The participants were 136 youth from either a beginning (n = 89) or an advanced sport camp (n = 47). Results indicated that primary predictors of aggressive tendencies for both skill levels included participants' perception of their teammates' behavior in the same situation and their willingness to injure others if their coach requested. These findings are consistent with previous research establishing team norm as a significant predictor for self-described aggressive tendencies in a sport situation.

  13. Randomized Controlled Trials: A Systematic Review of Laparoscopic Surgery and Simulation-Based Training

    PubMed Central

    Vanderbilt, Allison A.; Grover, Amelia C.; Pastis, Nicholas J.; Feldman, Moshe; Granados, Deborah Diaz; Murithi, Lydia K.; Mainous, Arch G.

    2015-01-01

    Introduction: This systematic review was conducted to analyze the impact and describe simulation-based training and the acquisition of laparoscopic surgery skills during medical school and residency programs. Methods: This systematic review focused on the published literature that used randomized controlled trials to examine the effectiveness of simulation-based training to develop laparoscopic surgery skills. Searching PubMed from the inception of the databases to May 1, 2014 and specific hand journal searches identified the studies. This current review of the literature addresses the question of whether laparoscopic simulation translates the acquisition of surgical skills to the operating room (OR). Results: This systematic review of simulation-based training and laparoscopic surgery found that specific skills could be translatable to the OR. Twenty-one studies reported learning outcomes measured in five behavioral categories: economy of movement (8 studies); suturing (3 studies); performance time (13 studies); error rates (7 studies), and global rating (7 studies). Conclusion: Simulation-based training can lead to demonstrable benefits of surgical skills in the OR environment. This review suggests that simulation-based training is an effective way to teach laparoscopic surgery skills, increase translation of laparoscopic surgery skills to the OR, and increase patient safety; however, more research should be conducted to determine if and how simulation can become apart of surgical curriculum. PMID:25716408

  14. Laparoscopic Nissen fundoplication.

    PubMed Central

    Jamieson, G G; Watson, D I; Britten-Jones, R; Mitchell, P C; Anvari, M

    1994-01-01

    OBJECTIVE: The authors laparoscopic approach for a Nissen fundoplication is presented. SUMMARY BACKGROUND DATA: The technique has been undertaken in 155 patients over 29 months, with 137 patients having been observed for more than 3 months. METHODS: Three hundred sixty degree fundoplication was undertaken using three or four sutures to secure the wrap. Short gastric vessels were not divided, and the anterior wall of the stomach was used to construct the wrap around the esophagus with a large bougie in position. RESULTS: The operation was not completed laparoscopically in 19 patients because a satisfactory wrap could not be achieved. Ten patients undergoing laparoscopic fundoplication underwent a subsequent operation related to the laparoscopic procedure within 6 months, and there was one postoperative death. Seven other patients were readmitted to the hospital several days subsequent to their discharge, four because of pulmonary emboli. Of 137 patients who have been observed for more than 3 months, 133 patients are well and currently are free from reflux symptoms. CONCLUSIONS: In uncomplicated cases, laparoscopic fundoplication has similar advantages to laparoscopic cholecystectomy. In spite of the fact that it has not yet achieved the overall usefulness of open fundoplication, it seems likely that laparoscopic fundoplication will be used increasingly in the treatment of patients with gastroesophageal reflux disease. Images Figure 7. Figure 8. PMID:8053735

  15. The pitfalls of laparoscopic surgery: challenges for robotics and telerobotic surgery.

    PubMed

    Ballantyne, Garth H

    2002-02-01

    After its debut in 1988, laparoscopic cholecystectomy rapidly became the standard of care for cholelithiasis, yet very few surgeons use minimally invasive techniques for other abdominal operations. Why do most surgeons continue to perform traditional open gastrointestinal operations? We believe that the answer to this question lies in the fact that advanced laparoscopic operations are difficult to learn, perform, and master. A number of inherent pitfalls of laparoscopy hinder the performance of these operations even after the surgeon has accumulated years of experience. These pitfalls include an unstable video camera platform, limited motion (degrees of freedom) of straight laparoscopic instruments, two-dimensional imaging, and poor ergonomics for the surgeon. Inexperienced or bored laparoscopic camera-holders move the camera frequently and rotate it away from the horizon. The long, straight laparoscopic instruments are limited in their motion by the fixation enforced by the abdominal wall trocars. Similarly, the standard two-dimensional video imaging used in most laparoscopic operations impedes the surgeon's depth perception, compounding the limitations of laparoscopic instruments. In addition, surgeons are forced to assume ergonomically awkward stances in performing many laparoscopic operations. These four factors hinder a surgeon's efforts to learn and to perform advanced laparoscopic operations, significantly lengthening the learning curve. The articles presented in this issue suggest that robotics and telerobotics offer solutions to these nagging pitfalls of laparoscopic surgery.

  16. Learning curve in laparoscopic liver surgery: a fellow’s perspective

    PubMed Central

    Lee, Ser Yee; Chan, Chung Yip; Tan, Siong San

    2015-01-01

    The learning curve for laparoscopic liver surgery is infrequently addressed in current literature. In this paper, we explored the challenges faced in embarking on laparoscopic liver surgery in a unit that did predominantly open liver surgery. In setting up our laparoscopic liver surgery program, we adopted skills and practices learnt during fellowships at various high volume centers in North America and Australia, with modifications to suit our local patients’ disease patterns. We started with simple minor resections in anterolateral segments to build confidence, which allowed us to train the surgical and nursing team before progressing to more difficult resections. Inter institutional collaboration and exchange of skills also enabled the synergistic development of techniques for safe progression to more complex surgeries. Multimedia resources and international guidelines for laparoscopic liver surgery are increasingly accessible, which further guide the practice of this emerging field, as evidence continues to validate the laparoscopic approach in well selected cases. PMID:26734626

  17. Increase in Counselling Communication Skills after Basic and Advanced Microskills Training

    ERIC Educational Resources Information Center

    Kuntze, Jeroen; van der Molen, Henk T.; Born, Marise P.

    2009-01-01

    Background: Mastering counselling communication skills is one of the requirements that lead to the diploma of a registered European psychologist. The microcounseling method proves to be effective in training these skills. Aim: Research into the effectiveness of the microcounseling method often reports overall effect sizes only. The aim of this…

  18. Total laparoscopic hysterectomy via suture and ligation technique

    PubMed Central

    Kang, Hye Won; Lee, Ji Won; Kim, Ho Yeon; Kim, Bo Wook

    2016-01-01

    Objective The term 'total laparoscopic hysterectomy (TLH) with classical suture method' refers to a surgical procedure performed using only sutures and ligations with intracorporeal or extracorporeal ties, without using any laser or electronic cauterization devices during laparoscopic surgery as in total abdominal hysterectomy. However, the method is not as widely used as electric coagulation equipment for TLH because further advances in technology and surgical technique are required and operative time can take longer. In the current study, we evaluated the benefits of the classical suture method for TLH. Methods This study retrospectively reviewed patients who received TLH using the classical suture method from August 2005 to April 2014. The patients' baseline characteristics were analyzed, including age, parity, cause of operation, medical and surgical history. Surgical outcomes analyzed included the weight of the uterus, operative time, complications, changes in hemoglobin level, blood transfusion requirements, and postoperative hospital stay. Results Of 746 patients who underwent TLH with the classical suture method, mean operation time was 96.9 minutes. Mean average decline in hemoglobin was 1.6 g/dL and transfusion rate was 6.2%. Urinary tract injuries were reported in 8 patients. Urinary tract injuries comprised 6 cases of bladder injury and 3 cases of ureter injury. There were no cases of vaginal stump infection, hematoma, bowel injury or abdominal wound complication. All cases involving complications occurred before 2010. Conclusion The classical suture method for TLH presents tolerable levels of complications and blood loss. Advanced surgical skill is expected to decrease operation time and complications. PMID:26866034

  19. Using Computer-Assisted Argumentation Mapping to develop effective argumentation skills in high school advanced placement physics

    NASA Astrophysics Data System (ADS)

    Heglund, Brian

    Educators recognize the importance of reasoning ability for development of critical thinking skills, conceptual change, metacognition, and participation in 21st century society. There is a recognized need for students to improve their skills of argumentation, however, argumentation is not explicitly taught outside logic and philosophy---subjects that are not part of the K-12 curriculum. One potential way of supporting the development of argumentation skills in the K-12 context is through incorporating Computer-Assisted Argument Mapping to evaluate arguments. This quasi-experimental study tested the effects of such argument mapping software and was informed by the following two research questions: 1. To what extent does the collaborative use of Computer-Assisted Argumentation Mapping to evaluate competing theories influence the critical thinking skill of argument evaluation, metacognitive awareness, and conceptual knowledge acquisition in high school Advanced Placement physics, compared to the more traditional method of text tables that does not employ Computer-Assisted Argumentation Mapping? 2. What are the student perceptions of the pros and cons of argument evaluation in the high school Advanced Placement physics environment? This study examined changes in critical thinking skills, including argumentation evaluation skills, as well as metacognitive awareness and conceptual knowledge, in two groups: a treatment group using Computer-Assisted Argumentation Mapping to evaluate physics arguments, and a comparison group using text tables to evaluate physics arguments. Quantitative and qualitative methods for collecting and analyzing data were used to answer the research questions. Quantitative data indicated no significant difference between the experimental groups, and qualitative data suggested students perceived pros and cons of argument evaluation in the high school Advanced Placement physics environment, such as self-reported sense of improvement in argument

  20. Laparoscopic gastric banding - discharge

    MedlinePlus

    ... laparoscopic gastric banding - discharge; Obesity gastric banding discharge; Weight loss - gastric banding discharge ... as your body gets used to your weight loss and your weight becomes stable. Weight loss may be slower after ...

  1. Laparoscopic Ventral Hernia Repair

    MedlinePlus

    ... the likelihood of a hernia including persistent coughing, difficulty with bowel movements or urination, or frequent need for straining. What are the Advantages of Laparoscopic Ventral Hernia Repair? Keep reading... Page 1 of 2 1 2 » Brought to ...

  2. Laparoscopic Adrenal Gland Removal

    MedlinePlus

    ... adrenal tumors that appear malignant. What are the Advantages of Laparoscopic Adrenal Gland Removal? In the past, ... of procedure and the patients overall condition. Common advantages are: Less postoperative pain Shorter hospital stay Quicker ...

  3. Laparoscopic Spine Surgery

    MedlinePlus

    ... to pressure on the nerve. Are There Other Advantages to the Anterior Approach? Inter-vertebral disc height ( ... require removal of any bone. What are the Advantages of the Laparoscopic (Minimally Invasive) Approach? Keep reading... ...

  4. Laparoscopic Colon Resection

    MedlinePlus

    ... inches to complete the procedure. What are the Advantages of Laparoscopic Colon Resection? Results may vary depending ... type of procedure and patient’s overall condition. Common advantages are: Less postoperative pain May shorten hospital stay ...

  5. Laparoscopic gastric banding

    MedlinePlus

    ... adjustable gastric banding; Bariatric surgery - laparoscopic gastric banding; Obesity - gastric banding; Weight loss - gastric banding ... gastric banding is not a "quick fix" for obesity. It will greatly change your lifestyle. You must ...

  6. Laparoscopic adrenalectomy: Surgical techniques

    PubMed Central

    Mellon, Matthew J.; Sethi, Amanjot; Sundaram, Chandru P.

    2008-01-01

    Since its first description in 1992, laparoscopic adrenalectomy has become the gold standard for the surgical treatment of most adrenal conditions. The benefits of a minimally invasive approach to adrenal resection such as decreased hospital stay, shorter recovery time and improved patient satisfaction are widely accepted. However, as this procedure becomes more widespread, critical steps of the operation must be maintained to ensure expected outcomes and success. This article reviews the surgical techniques for the laparoscopic adrenalectomy. PMID:19468527

  7. Laparoscopic retroperitoneal renal cystectomy.

    PubMed

    Munch, L C; Gill, I S; McRoberts, J W

    1994-01-01

    Laparoscopic manipulation of retroperitoneal organs is usually performed by the transperitoneal approach primarily because of the ease of access by way of the pneumoperitoneum. However, difficulty in adequately accessing structures that are surrounded by bowel, liver, spleen or postoperative adhesions makes this approach suboptimal in certain cases. We describe the use of the retroperitoneal laparoscopic approach to the upper pole of a kidney for marsupialization of a symptomatic, recurrent, complex renal cyst. An algorithm for current management of symptomatic renal cysts is discussed.

  8. Retroperitoneal laparoscopic pyelolithotomy.

    PubMed

    Gaur, D D; Agarwal, D K; Purohit, K C; Darshane, A S

    1994-04-01

    Retroperitoneal laparoscopic pyelolithotomy was successful in 5 of 8 patients using the recently described balloon technique of retroperitoneal laparoscopy. All patients were considered for this new minimally invasive procedure only on economic grounds. However, with improved technique and instrumentation, the retroperitoneal laparoscopic approach could become a practical alternative for the management of patients with medium sized pelvic stones not amenable to extracorporeal shock wave lithotripsy nor ideally suitable for percutaneous nephrolithotomy, or when both of these facilities are not available. PMID:8126827

  9. Laparoscopic Total Mesorectum Excision

    PubMed Central

    Quilici, F.A.; Cordeiro, F.; Reis, J.A.; Kagohara, O.; Simões Neto, J.

    2002-01-01

    The main controversy of colon-rectal laparoscopic surgery comes from its use as a cancer treatment. Two points deserve special attention: the incidence of portsite tumor implantation and the possibility of performing radical cancer surgery, such as total mesorectum excision. Once these points are addressed, the laparoscopic approach will be used routinely to treat rectal cancer. To clarify these points, 32 patients with cancer of the lower rectum participated in a special protocol that included preoperative radiotherapy and laparoscopic total mesorectum excision. All data were recorded. At the same time, all data recorded from the experience of a multicenter laparoscopic group (Brazilian Colorectal Laparoscopic Surgeons – 130 patients with tumor of the lower rectum) were analyzed and compared with the data provided by our patients. Analysis of the results suggests that a laparoscopic approach allows the same effective resection as that of conventional surgery and that preoperative irradiation does not influence the incidence of intraoperative complications. The extent of lymph nodal excision is similar to that obtained with open surgery, with an average of 12.3 lymph nodes dissected per specimen. The rate of local recurrence was 3.12%. No port site implantation of tumor was noted in this series of patients with cancer of the lower rectum. PMID:12113422

  10. [Sacrocolpopexy - pro laparoscopic].

    PubMed

    Hatzinger, M; Sohn, M

    2012-05-01

    Innovative techniques have a really magical attraction for physicians as well as for patients. The number of robotic-assisted procedures worldwide has almost tripled from 80,000 procedures in the year 2007 to 205,000 procedures in 2010. In the same time the total number of Da Vinci surgery systems sold climbed from 800 to 1,400. Advantages, such as three-dimensional visualization, a tremor-filter, an excellent instrument handling with 6 degrees of freedom and better ergonomics, together with aggressive marketing led to a veritable flood of new Da Vinci acquisitions in the whole world. Many just took the opportunity to introduce a new instrument to save a long learning curve and start immediately in the surgical master class.If Da Vinci sacrocolpopexy is compared with the conventional laparoscopic approach, robotic-assisted sacrocolpopexy shows a significantly longer duration of the procedure, a higher need for postoperative analgesics, much higher costs and an identical functional outcome without any advantage over the conventional laparoscopic approach. Although the use of robotic-assisted systems shows a significantly lower learning curve for laparoscopic beginners, it only shows minimal advantages for the experienced laparoscopic surgeon. Therefore it remains uncertain whether robotic-assisted surgery shows a significant advantage compared to the conventional laparoscopic surgery, especially with small reconstructive laparoscopic procedures such as sacrocolpopexy. PMID:22526178

  11. Laparoscopic repair of left lumbar hernia after laparoscopic left nephrectomy.

    PubMed

    Gagner, Michel; Milone, Luca; Gumbs, Andrew; Turner, Patricia

    2010-01-01

    Lumbar hernias, rarely seen in clinical practice, can be acquired after open or laparoscopic flank surgery. We describe a successful laparoscopic preperitoneal mesh repair of multiple trocar-site hernias after extraperitoneal nephrectomy. All the key steps including creating a peritoneal flap, reducing the hernia contents, and fixation of the mesh are described. A review of the literature on this infrequent operation is presented. Laparoscopic repair of lumbar hernias has all the advantages of laparoscopic ventral hernia repair.

  12. Digital Environment for Movement Control in Surgical Skill Training.

    PubMed

    Juanes, Juan A; Gómez, Juan J; Peguero, Pedro D; Ruisoto, Pablo

    2016-06-01

    Intelligent environments are increasingly becoming useful scenarios for handling computers. Technological devices are practical tools for learning and acquiring clinical skills as part of the medical training process. Within the framework of the advanced user interface, we present a technological application using Leap Motion, to enhance interaction with the user in the process of a laparoscopic surgical intervention and integrate the navigation through augmented reality images using manual gestures. Thus, we intend to achieve a more natural interaction with the objects that participate in a surgical intervention, which are augmented and related to the user's hand movements. PMID:27091754

  13. Digital Environment for Movement Control in Surgical Skill Training.

    PubMed

    Juanes, Juan A; Gómez, Juan J; Peguero, Pedro D; Ruisoto, Pablo

    2016-06-01

    Intelligent environments are increasingly becoming useful scenarios for handling computers. Technological devices are practical tools for learning and acquiring clinical skills as part of the medical training process. Within the framework of the advanced user interface, we present a technological application using Leap Motion, to enhance interaction with the user in the process of a laparoscopic surgical intervention and integrate the navigation through augmented reality images using manual gestures. Thus, we intend to achieve a more natural interaction with the objects that participate in a surgical intervention, which are augmented and related to the user's hand movements.

  14. [A technic for laparoscopic gastrostomy].

    PubMed

    Kala, Z; Vomela, J; Hanke, I

    1995-08-01

    The authors describe the technique of laparoscopic gastrostomy and laparoscopic assisted gastrostomy. It is an alternative method for patients, when PEG (percutaneous endoscopic gastronomy) or other more physiologic way of food administration is not possible to perform.

  15. C.I.S.H. Laparoscopic Hysterectomy: The Experience at the "Centro Materno Infantil"

    PubMed

    Decunto; Traverso; Gibelli; Harpe

    1994-08-01

    Laparoscopic hysterectomy has been established firmly as a surgical alternative to standard abdominal hysterectomy around the world. In Argentina, we had introduced operative laparoscopy at the Hospital Aleman in May 1993, with a major change from basic diagnostic laparoscopy to advanced operative laparoscopy. A total of 180 major laparoscopic cases have been performed from May 1993 to January 1994, including laparoscopic hysterectomies. Of our first five C.I.S.H. laparoscopic hysterectomies, all had excellent outcomes, with greatly diminished hospital stay and less usage of analgesics postoperatively. The average length of stay was 2.5 days. No major complications occurred.

  16. Laparoscopic Versus Open Appendectomy

    PubMed Central

    Guller, Ulrich; Hervey, Sheleika; Purves, Harriett; Muhlbaier, Lawrence H.; Peterson, Eric D.; Eubanks, Steve; Pietrobon, Ricardo

    2004-01-01

    Objective: To compare length of hospital stay, in-hospital complications, in-hospital mortality, and rate of routine discharge between laparoscopic and open appendectomy based on a representative, nationwide database. Summary Background Data: Numerous single-institutional randomized clinical trials have assessed the efficacy of laparoscopic and open appendectomy. The results, however, are conflicting, and a consensus concerning the relative advantages of each procedure has not yet been reached. Methods: Patients with primary ICD-9 procedure codes for laparoscopic and open appendectomy were selected from the 1997 Nationwide Inpatient Sample, a database that approximates 20% of all US community hospital discharges. Multiple linear and logistic regression analyses were used to assess the risk-adjusted endpoints. Results: Discharge abstracts of 43,757 patients were used for our analyses. 7618 patients (17.4%) underwent laparoscopic and 36,139 patients (82.6%) open appendectomy. Patients had an average age of 30.7 years and were predominantly white (58.1%) and male (58.6%). After adjusting for other covariates, laparoscopic appendectomy was associated with shorter median hospital stay (laparoscopic appendectomy: 2.06 days, open appendectomy: 2.88 days, P < 0.0001), lower rate of infections (odds ratio [OR] = 0.5 [0.38, 0.66], P < 0.0001), decreased gastrointestinal complications (OR = 0.8 [0.68, 0.96], P = 0.02), lower overall complications (OR = 0.84 [0.75, 0.94], P = 0.002), and higher rate of routine discharge (OR = 3.22 [2.47, 4.46], P < 0.0001). Conclusions: Laparoscopic appendectomy has significant advantages over open appendectomy with respect to length of hospital stay, rate of routine discharge, and postoperative in-hospital morbidity. PMID:14685099

  17. Laparoscopic Splenectomy Coupled with Laparoscopic Cholecystectomy

    PubMed Central

    Vecchio, Rosario; Marchese, Salvatore; La Corte, Francesco; Cacciola, Rossella Rosaria; Cacciola, Emma

    2014-01-01

    Background and Objectives: The aim of this study was to evaluate the results of laparoscopic surgery performed for coexisting spleen and gallbladder surgical diseases. Methods: Between May 2004 and October 2012, 12 patients underwent concomitant laparoscopic splenectomy and cholecystectomy. Indications for surgery included idiopathic thrombocytopenic purpura in 5 patients, hereditary spherocytosis in 4 patients, and thalassemia intermedia in 3 patients. Results: The mean operative time was 100 minutes (range, 80–160 minutes), and the blood loss ranged from 0 to 150 mL (mean, 50 mL). The mean longitudinal diameter of the spleen was 14 cm. One patient required conversion to open procedure. An accessory spleen was detected and removed in one case. The mean length of hospital stay was 5 days. No deaths or other major intraoperative and/or postoperative complications occurred. Conclusion: Provided that the technique is performed by an experienced surgical team, concomitant laparoscopic splenectomy and cholecystectomy is a safe and feasible procedure and may be considered for coexisting spleen and gallbladder diseases. PMID:24960489

  18. Laparoscopic removal of a gallbladder remnant in a patient with severe biliary pancreatitis

    PubMed Central

    Cawich, Shamir O; Mohammed, Fawwaz; Spence, Richard; Naraynsingh, Vijay

    2016-01-01

    Many surgeons opt to perform subtotal cholecystectomy to limit duct injuries in difficult cases. In these cases, however, there is a risk for the gallbladder remnant to become diseased. In these cases, a completion cholecystectomy is necessary. Although technically challenging, the laparoscopic approach to completion cholecystectomy is feasible and safe, when performed by surgeons with advanced laparoscopic experience. PMID:27656198

  19. Laparoscopic removal of a gallbladder remnant in a patient with severe biliary pancreatitis

    PubMed Central

    Cawich, Shamir O; Mohammed, Fawwaz; Spence, Richard; Naraynsingh, Vijay

    2016-01-01

    Many surgeons opt to perform subtotal cholecystectomy to limit duct injuries in difficult cases. In these cases, however, there is a risk for the gallbladder remnant to become diseased. In these cases, a completion cholecystectomy is necessary. Although technically challenging, the laparoscopic approach to completion cholecystectomy is feasible and safe, when performed by surgeons with advanced laparoscopic experience.

  20. Laparoscopic removal of a gallbladder remnant in a patient with severe biliary pancreatitis.

    PubMed

    Cawich, Shamir O; Mohammed, Fawwaz; Spence, Richard; Naraynsingh, Vijay

    2016-01-01

    Many surgeons opt to perform subtotal cholecystectomy to limit duct injuries in difficult cases. In these cases, however, there is a risk for the gallbladder remnant to become diseased. In these cases, a completion cholecystectomy is necessary.Although technically challenging, the laparoscopic approach to completion cholecystectomy is feasible and safe, when performed by surgeons with advanced laparoscopic experience. PMID:27656198

  1. Reliable assessment of laparoscopic performance in the operating room using videotape analysis.

    PubMed

    Chang, Lily; Hogle, Nancy J; Moore, Brianna B; Graham, Mark J; Sinanan, Mika N; Bailey, Robert; Fowler, Dennis L

    2007-06-01

    The Global Operative Assessment of Laparoscopic Skills (GOALS) is a valid assessment tool for objectively evaluating the technical performance of laparoscopic skills in surgery residents. We hypothesized that GOALS would reliably differentiate between an experienced (expert) and an inexperienced (novice) laparoscopic surgeon (construct validity) based on a blinded videotape review of a laparoscopic cholecystectomy procedure. Ten board-certified surgeons actively engaged in the practice and teaching of laparoscopy reviewed and evaluated the videotaped operative performance of one novice and one expert laparoscopic surgeon using GOALS. Each reviewer recorded a score for both the expert and the novice videotape reviews in each of the 5 domains in GOALS (depth perception, bimanual dexterity, efficiency, tissue handling, and overall competence). The scores for the expert and the novice were compared and statistically analyzed using single-factor analysis of variance (ANOVA). The expert scored significantly higher than the novice did in the domains of depth perception (p = .005), bimanual dexterity (p = .001), efficiency (p = .001), and overall competence ( p = .001). Interrater reliability for the reviewers of the novice tape was Cronbach alpha = .93 and the expert tape was Cronbach alpha = .87. There was no difference between the two for tissue handling. The Global Operative Assessment of Laparoscopic Skills is a valid, objective assessment tool for evaluating technical surgical performance when used to blindly evaluate an intraoperative videotape recording of a laparoscopic procedure.

  2. Librarian-lead tutorial for enhancement of pharmacy students' information-searching skills in advanced experiential rotations.

    PubMed

    Lapidus, Mariana; Kostka-Rokosz, Maria D; Dvorkin-Camiel, Lana

    2009-10-01

    Pharmacy schools across the United States expose students to literature searching and evaluation mostly during required didactic drug information courses. The majority of Doctor of Pharmacy (PharmD) students do not utilize library-available electronic resources on a regular basis, and their didactic experience alone is not sufficient to make them successful in their advanced experiential drug information (DI) rotations. This pilot study demonstrates an improvement of students' perceptions regarding information searching and evaluating abilities as the result of their participation in a small group tutorial with a reference librarian, thus indicating effectiveness of the tutorial in refreshing and enhancing database knowledge skills.

  3. Music Attenuates Excessive Visual Guidance of Skilled Reaching in Advanced but Not Mild Parkinson's Disease

    PubMed Central

    Sacrey, Lori-Ann R.; Clark, Callie A. M.; Whishaw, Ian Q.

    2009-01-01

    Parkinson's disease (PD) results in movement and sensory impairments that can be reduced by familiar music. At present, it is unclear whether the beneficial effects of music are limited to lessening the bradykinesia of whole body movement or whether beneficial effects also extend to skilled movements of PD subjects. This question was addressed in the present study in which control and PD subjects were given a skilled reaching task that was performed with and without accompanying preferred musical pieces. Eye movements and limb use were monitored with biomechanical measures and limb movements were additionally assessed using a previously described movement element scoring system. Preferred musical pieces did not lessen limb and hand movement impairments as assessed with either the biomechanical measures or movement element scoring. Nevertheless, the PD patients with more severe motor symptoms as assessed by Hoehn and Yahr (HY) scores displayed enhanced visual engagement of the target and this impairment was reduced during trials performed in association with accompanying preferred musical pieces. The results are discussed in relation to the idea that preferred musical pieces, although not generally beneficial in lessening skilled reaching impairments, may normalize the balance between visual and proprioceptive guidance of skilled reaching. PMID:19718260

  4. Basic and Advanced Numerical Performances Relate to Mathematical Expertise but Are Fully Mediated by Visuospatial Skills

    ERIC Educational Resources Information Center

    Sella, Francesco; Sader, Elie; Lolliot, Simon; Cohen Kadosh, Roi

    2016-01-01

    Recent studies have highlighted the potential role of basic numerical processing in the acquisition of numerical and mathematical competences. However, it is debated whether high-level numerical skills and mathematics depends specifically on basic numerical representations. In this study mathematicians and nonmathematicians performed a basic…

  5. Advancing the Language Skills of Young Latino Children. New Journalism on Latino Children

    ERIC Educational Resources Information Center

    Bridges, Margaret; Anguiano, Rebecca; Fuller, Bruce

    2010-01-01

    More than 20% of U.S. children entering kindergarten today are of Latino heritage. And Latino children--growing-up in highly diverse communities--enter school with weaker math and English preliteracy skills than their non-Latino peers. The growing percentage of Spanish-speaking children in today's classrooms raises questions for educators,…

  6. The Next Challenge: Advancement of Low-Skilled, Low-Wage Workers

    ERIC Educational Resources Information Center

    Rubin, Jerry

    2004-01-01

    With the series "Advancement for Low-Wage Workers," Jobs for the Future seeks to elevate discussion of this critical issue within and outside the workforce field. These occasional papers address public policy and on-the-ground practice. "The Next Challenge," the series introduction, argues for placing not just employment, but also advancement at…

  7. Laparoscopic versus conventional appendectomy.

    PubMed Central

    Vallina, V L; Velasco, J M; McCulloch, C S

    1993-01-01

    OBJECTIVE: The goal of this study was to prospectively define the impact of laparoscopy on the management of patients with a presumed diagnosis of appendicitis. SUMMARY BACKGROUND DATA: While the role of laparoscopy in the management of cholelithiasis is well established, its impact on the management of acute appendicitis needs to be objectively defined and compared to that of conventional management. Several authors have predicted that laparoscopic appendectomy will become the preferred treatment for appendicitis. METHODS: Two groups of consecutive patients with similar clinical characteristics of acute appendicitis were compared. Data on the laparoscopic group were compiled prospectively on standardized forms; data on the conventional group were collected retrospectively. Operative time, hospital stay, analgesia, cost, and return to normal activities were noted. RESULTS: Seventeen consecutive patients who underwent appendectomy were compared to 18 consecutive patients who underwent laparoscopy (16 of these 18 had laparoscopic appendectomy). There was no significant difference between the two groups in terms of clinical characteristics and appendiceal histopathology. The mean operative times were 61 +/- 4.1 minutes and 46 +/- 2.9 minutes for the laparoscopy and conventional groups, respectively (p < 0.01). Hospital stay was significantly shorter in the laparoscopic appendectomy group, with 81% of patients being discharged on their first postoperative day (p < 0.001). The laparoscopic appendectomy patients required significantly less narcotic analgesia (p < 0.02). Return to normal activity was not significantly different between the two groups. The average total cost of laparoscopic appendectomy was 30% greater than that of conventional appendectomy. CONCLUSIONS: Laparoscopy is a useful adjunct to the management of patients with a presumed clinical diagnosis of acute appendicitis. PMID:8239785

  8. [The advantages of implementing an e-learning platform for laparoscopic liver surgery].

    PubMed

    Furcea, L; Graur, F; Scurtu, L; Plitea, N; Pîslă, D; Vaida, C; Deteşan, O; Szilaghy, A; Neagoş, H; Mureşan, A; Vlad, L

    2011-01-01

    The rapid expansion of laparoscopic surgery has led to the development of training methods for acquiring technical skills. The importance and complexity of laparoscopic liver surgery are arguments for developing a new integrated system of teaching, learning and evaluation, based on modern educational principles, on flexibility allowing wide accessibility among surgeons. This paper presents the development of e-learning platform designed for training in laparoscopic liver surgery and pre-planning of the operation in a virtual environment. E-learning platform makes it possible to simulate laparoscopic liver surgery remotely via internet connection. The addressability of this e-learning platform is large, being represented by young surgeons who are mainly preoccupied by laparoscopic liver surgery, as well as experienced surgeons interested in obtaining a competence in the hepatic minimally invasive surgery. PMID:22308919

  9. The Effects of Using Concept Mapping for Improving Advanced Level Biology Students' Lower- and Higher-Order Cognitive Skills

    NASA Astrophysics Data System (ADS)

    Bramwell-Lalor, Sharon; Rainford, Marcia

    2014-03-01

    This paper reports on teachers' use of concept mapping as an alternative assessment strategy in advanced level biology classes and its effects on students' cognitive skills on selected biology concepts. Using a mixed methods approach, the study employed a pre-test/post-test quasi-experimental design involving 156 students and 8 teachers from intact classes. A researcher-constructed Biology Cognitive Skills Test was used to collect the quantitative data. Qualitative data were collected through interviews and students' personal documents. The data showed that the participants utilized concept mapping in various ways and they described positive experiences while being engaged in its use. The main challenge cited by teachers was the limited time available for more consistent use. The results showed that the use of concept mapping in advanced level biology can lead to learning gains that exceed those achieved in classes where mainly traditional methods are used. The students in the concept mapping experimental groups performed significantly better than their peers in the control group on both the lower-order (F(1) = 21.508; p < .001) and higher-order (F(1) = 42.842, p < .001) cognitive items of the biology test. A mean effect size of .56 was calculated representing the contribution of treatment to the students' performance on the test items.

  10. Communication Skills and Decision Making for Elderly Patients With Advanced Kidney Disease: A Guide for Nephrologists.

    PubMed

    Koncicki, Holly M; Schell, Jane O

    2016-04-01

    Elderly patients comprise the most rapidly growing population initiating dialysis therapy and may derive particular benefit from comprehensive assessment of geriatric syndromes, coexisting comorbid conditions, and overall prognosis. Palliative care is a philosophy that aims to improve quality of life and assist with treatment decision making for patients with serious illness such as kidney disease. Palliative skills for the nephrology provider can aid in the care of these patients. This review provides nephrology providers with 4 primary palliative care skills to guide treatment decision making: (1) use prognostic tools to identify patients who may benefit from conservative management, (2) disclose prognostic information to patients who may not do well with dialysis therapy, (3) incorporate patient goals and values to outline a treatment plan, and (4) prepare patients and families for transitions and end of life.

  11. Machine Tool Advanced Skills Technology (MAST). Common Ground: Toward a Standards-Based Training System for the U.S. Machine Tool and Metal Related Industries. Volume 1: Executive Summary, of a 15-Volume Set of Skills Standards and Curriculum Training Materials for the Precision Manufacturing Industry.

    ERIC Educational Resources Information Center

    Texas State Technical Coll., Waco.

    The Machine Tool Advanced Skills Technology (MAST) consortium was formed to address the shortage of skilled workers for the machine tools and metals-related industries. Featuring six of the nation's leading advanced technology centers, the MAST consortium developed, tested, and disseminated industry-specific skill standards and model curricula for…

  12. Single-Site Nissen Fundoplication Versus Laparoscopic Nissen Fundoplication

    PubMed Central

    Sharp, Nicole E.; Vassaur, John

    2014-01-01

    Background: Advances in minimally invasive surgery have led to the emergence of single-incision laparoscopic surgery (SILS). The purpose of this study is to assess the feasibility of SILS Nissen fundoplication and compare its outcomes with traditional laparoscopic Nissen fundoplication. Methods: This is a retrospective study of 33 patients who underwent Nissen fundoplication between January 2009 and September 2010. Results: There were 15 SILS and 18 traditional laparoscopic Nissen fundoplication procedures performed. The mean operative time was 129 and 182 minutes in the traditional laparoscopic and single-incision groups, respectively (P = .019). There were no conversions in the traditional laparoscopic group, whereas 6 of the 15 patients in the SILS group required conversion by insertion of 2 to 4 additional ports (P = .0004). At short-term follow-up, recurrence rates were similar between both groups. To date, there have been no reoperations. Conclusions: SILS Nissen fundoplication is both safe and feasible. Short-term outcomes are comparable with standard laparoscopic Nissen fundoplication. Challenges related to the single-incision Nissen fundoplication include overcoming the lengthy learning curve and decreasing the need for additional trocars. PMID:25392613

  13. A Surgical Virtual Reality Simulator Distinguishes Between Expert Gynecologic Laparoscopic Surgeons and Perinatologists

    PubMed Central

    von Dadelszen, Peter; Allaire, Catherine

    2011-01-01

    Background: Concern regarding the quality of surgical training in obstetrics and gynecology residency programs is focusing attention on competency based education. Because open surgical skills cannot necessarily be translated into laparoscopic skills and with minimally invasive surgery becoming standard in operative gynecology, the discrepancy in training between obstetrics and gynecology will widen. Training on surgical simulators with virtual reality may improve surgical skills. However, before incorporation into training programs for gynecology residents the validity of such instruments needs to first be established. We sought to prove the construct validity of a virtual reality laparoscopic simulator, the SurgicalSimTM, by showing its ability to distinguish between surgeons with different laparoscopic experience. Methods: Eleven gynecologic surgeons (experts) and 11 perinatologists (controls) completed 3 tasks on the simulator, and 10 performance parameters were compared. Results: The experts performed faster, more efficiently, and with fewer errors, proving the construct validity of the SurgicalSim. Conclusions: Laparoscopic virtual reality simulators can measure relevant surgical skills and so distinguish between subjects having different skill levels. Hence, these simulators could be integrated into gynecology resident endoscopic training and utilized for objective assessment. Second, the skills required for competency in obstetrics cannot necessarily be utilized for better performance in laparoscopic gynecology. PMID:21985726

  14. Beyond advance directives: importance of communication skills at the end of life.

    PubMed

    Tulsky, James A

    2005-07-20

    Patients and their families struggle with myriad choices concerning medical treatments that frequently precede death. Advance directives have been proposed as a tool to facilitate end-of-life decision making, yet frequently fail to achieve this goal. In the context of the case of a man with metastatic cancer for whom an advance directive was unable to prevent a traumatic death, I review the challenges in creating and implementing advance directives, discuss factors that can affect clear decision making; including trust, uncertainty, emotion, hope, and the presence of multiple medical providers; and offer practical suggestions for physicians. Advance care planning remains a useful tool for approaching conversations with patients about the end of life. However, such planning should occur within a framework that emphasizes responding to patient and family emotions and focuses more on goals for care and less on specific treatments.

  15. Laparoscopic Cholecystectomy in Situs Inversus Totalis

    PubMed Central

    S, Mahesh Shetty; BB, Sunil Kumar

    2014-01-01

    Situs inversus totalis is a rare condition where the organs in the body is placed in the opposite side. When such patient presents with the diseases of the intra abdominal organs the diagnosis is challenging and the operative procedure to be performed will be difficult. This may require the anticipation of variations in anatomy, ergonomic changes required during surgery and mastery over the operative skills in reversed anatomy. Cholelithiasis in situs inversus totalis is one such situation. Herein we report a case of situs inversus totalis who underwent successful laparoscopic cholecystectomy for symptomatic gallbladder calculi. PMID:25177601

  16. Structuralized box-trainer laparoscopic training significantly improves performance in complex virtual reality laparoscopic tasks

    PubMed Central

    Stefaniak, Tomasz J.; Makarewicz, Wojciech; Proczko, Monika; Gruca, Zbigniew; Śledziński, Zbigniew

    2011-01-01

    Introduction In the era of flowering minimally invasive surgical techniques there is a need for new methods of teaching surgery and supervision of progress in skills and expertise. Virtual and physical box-trainers seem especially fit for this purpose, and allow for improvement of proficiency required in laparoscopic surgery. Material and methods The study included 34 students who completed the authors‘ laparoscopic training on physical train-boxes. Progress was monitored by accomplishment of 3 exercises: moving pellets from one place to another, excising and clipping. Analysed parameters included time needed to complete the exercise and right and left hand movement tracks. Students were asked to do assigned tasks prior to, in the middle and after the training. Results The duration of the course was 28 h in total. Significant shortening of the time to perform each exercise and reduction of the left hand track were achieved. The right hand track was shortened only in exercise number 1. Conclusions Exercises in the laboratory setting should be regarded as an important element of the process of skills acquisition by a young surgeon. Virtual reality laparoscopic training seems to be a new, interesting educational tool, and at the same time allows for reliable control and assessment of progress. PMID:23255997

  17. Study Skills.

    ERIC Educational Resources Information Center

    Thomas, Anne

    1993-01-01

    Three developments lend support to the idea that schools must help teach study skills: (1) advances in cognitive psychology that suggest children are active learners; (2) society's concern for at-risk students; and (3) growing demands for improved student performance. There is evidence that systematic study skills instruction does improve academic…

  18. SINERGIA laparoscopic virtual reality simulator: didactic design and technical development.

    PubMed

    Lamata, Pablo; Gómez, Enrique J; Sánchez-Margallo, Francisco M; López, Oscar; Monserrat, Carlos; García, Verónica; Alberola, Carlos; Florido, Miguel Angel Rodríguez; Ruiz, Juan; Usón, Jesús

    2007-03-01

    VR laparoscopic simulators have demonstrated its validity in recent studies, and research should be directed towards a high training effectiveness and efficacy. In this direction, an insight into simulators' didactic design and technical development is provided, by describing the methodology followed in the building of the SINERGIA simulator. It departs from a clear analysis of training needs driven by a surgical training curriculum. Existing solutions and validation studies are an important reference for the definition of specifications, which are described with a suitable use of simulation technologies. Five new didactic exercises are proposed to train some of the basic laparoscopic skills. Simulator construction has required existing algorithms and the development of a particle-based biomechanical model, called PARSYS, and a collision handling solution based in a multi-point strategy. The resulting VR laparoscopic simulator includes new exercises and enhanced simulation technologies, and is finding a very good acceptance among surgeons.

  19. Gallbladder removal - laparoscopic

    MedlinePlus

    ... is pumped into your belly to expand the space. This gives the surgeon more room to see and work. The gallbladder is then removed using the laparoscope and other instruments. An x-ray called a cholangiogram may be done during ...

  20. Laparoscopic lumbar hernia repair.

    PubMed

    Madan, Atul K; Ternovits, Craig A; Speck, Karen E; Pritchard, F Elizabeth; Tichansky, David S

    2006-04-01

    Lumbar hernias are rare clinical entities that often pose a challenge for repair. Because of the surrounding anatomy, adequate surgical herniorraphy is often difficult. Minimally invasive surgery has become an option for these hernias. Herein, we describe two patients with lumbar hernias (one with a recurrent traumatic hernia and one with an incisional hernia). Both of these hernias were successfully repaired laparoscopically.

  1. Machine Tool Advanced Skills Technology (MAST). Common Ground: Toward a Standards-Based Training System for the U.S. Machine Tool and Metal Related Industries. Volume 11: Computer-Aided Manufacturing & Advanced CNC, of a 15-Volume Set of Skill Standards and Curriculum Training Materials for the Precision Manufacturing Industry.

    ERIC Educational Resources Information Center

    Texas State Technical Coll., Waco.

    This document is intended to help education and training institutions deliver the Machine Tool Advanced Skills Technology (MAST) curriculum to a variety of individuals and organizations. MAST consists of industry-specific skill standards and model curricula for 15 occupational specialty areas within the U.S. machine tool and metals-related…

  2. Mathematics Problem Solving: A More Advanced Skill for Chapter 1. Workshop Leader's Guide.

    ERIC Educational Resources Information Center

    Advanced Technology, Inc., Indianapolis, IN.

    This guide is designed to assist inservice providers in conducting successful workshops for teachers, administrators, and others associated with Chapter 1 mathematics programs. It contains step-by-step procedures for preparing, organizing, and presenting the workshop. Included in this guide are: (1) an advanced planner, which includes a detailed…

  3. Advanced Technological Education (ATE) Program: Building a Pipeline of Skilled Workers. Policy Brief

    ERIC Educational Resources Information Center

    American Youth Policy Forum, 2010

    2010-01-01

    In the Fall of 2008, the American Youth Policy Forum hosted a series of three Capitol Hill forums showcasing the Advanced Technological Education (ATE) program supported by the National Science Foundation (NSF). The goal of these forums was to educate national policymakers about the importance of: (1) improving the science and math competencies of…

  4. The Effects of Advance Organizers and Subtitles on EFL Learners' Listening Comprehension Skills

    ERIC Educational Resources Information Center

    Yang, Hui-Yu

    2014-01-01

    The present research reports the findings of three experiments which explore how subtitles and advance organizers affect EFL learners' listening comprehension of authentic videos. EFL learners are randomly assigned to one of two groups. The control group receives no treatment and the experimental group receives the experimental conditions of…

  5. Project T.E.A.M. (Technical Education Advancement Modules). Job Search Skills.

    ERIC Educational Resources Information Center

    Mason, Joan S.

    This module is one of a series developed by Project TEAM (Technical Education Advancement Modules), a cooperative demonstration program for high technology training for unemployed, underemployed, and existing industrial employees needing upgrading. This module is a 3-hour overview course intended to develop competencies in the following job search…

  6. Virtual reality training versus blended learning of laparoscopic cholecystectomy: a randomized controlled trial with laparoscopic novices.

    PubMed

    Nickel, Felix; Brzoska, Julia A; Gondan, Matthias; Rangnick, Henriette M; Chu, Jackson; Kenngott, Hannes G; Linke, Georg R; Kadmon, Martina; Fischer, Lars; Müller-Stich, Beat P

    2015-05-01

    This study compared virtual reality (VR) training with low cost-blended learning (BL) in a structured training program.Training of laparoscopic skills outside the operating room is mandatory to reduce operative times and risks.Laparoscopy-naïve medical students were randomized in 2 groups stratified for sex. The BL group (n = 42) used E-learning for laparoscopic cholecystectomy (LC) and practiced basic skills with box trainers. The VR group (n = 42) trained basic skills and LC on the LAP Mentor II (Simbionix, Cleveland, OH). Each group trained 3 × 4 hours followed by a knowledge test concerning LC. Blinded raters assessed the operative performance of cadaveric porcine LC using the Objective Structured Assessment of Technical Skills (OSATS). The LC was discontinued when it was not completed within 80 min. Students evaluated their training modality with questionnaires.The VR group completed the LC significantly faster and more often within 80 min than BL (45% v 21%, P = .02). The BL group scored higher than the VR group in the knowledge test (13.3 ± 1.3 vs 11.0 ± 1.7, P < 0.001). Both groups showed equal operative performance of LC in the OSATS score (49.4 ± 10.5 vs 49.7 ± 12.0, P = 0.90). Students generally liked training and felt well prepared for assisting in laparoscopic surgery. The efficiency of the training was judged higher by the VR group than by the BL group.VR and BL can both be applied for training the basics of LC. Multimodality training programs should be developed that combine the advantages of both approaches.

  7. Considerations for design of an e-learning program augmenting advanced geriatric nurse practitioner's clinical skills training.

    PubMed

    Rostad, Hanne M; Grov, Ellen Karine; Moen, Anne

    2014-01-01

    E-learning programs offer learners flexibility, more control over their learning experience, possibilities for repetition and allows for learning to be more individualized compared to traditional teaching methods. This paper presents considerations for an interdisciplinary project to design an e-learning program for graduate students enrolled in a master's program in Advanced Geriatric Nursing. The e-learning program offers new opportunities for learners to apply theoretical knowledge and develop their skills in the process of collaborative knowledge creation. A model based on the systematic development of instruction and learning and a pedagogical framework for e-learning has guided the design process. This paper explains how the e-learning program was created and how content was developed and implemented in an e-learning environment. PMID:24943556

  8. Teaching paediatric resuscitation skills in a developing country: introduction of the Advanced Paediatric Life Support course into Vietnam.

    PubMed

    Young, Simon; Hutchinson, Adrian; Nguyen, Van Tu; Le, Thanh Hai; Nguyen, Dich Van; Vo, Thi Kim Hue

    2008-06-01

    In 2001, a nationwide study revealed deficiencies in the emergency care of seriously ill and injured children in Vietnam. In response, a project was initiated to conduct the Advanced Paediatric Life Support course in Vietnam and ascertain whether this course would provide a practical and sustainable method of improving the knowledge and skills of medical and nursing staff in this area. After approval to use the course was secured and funding obtained, the project commenced in 2003. Key Vietnamese personnel travelled to Australia to complete the course, undertake instructor training and gain organizational experience. Teaching materials were translated, reviewed and modified to account for local diseases and clinical practices while maintaining the fundamental principles of the parent course. Commencing in March 2004, 10 courses were conducted by Australian and Vietnamese instructors, training 239 doctors and nurses from a wide variety of clinical backgrounds. Additionally, three instructor courses were conducted, training 52 new instructors. As the skill and confidence of the Vietnamese instructors grew, the number and responsibilities of the international faculty reduced. The infrastructure now exists for the course to operate in a sustainable fashion within Vietnam. We believe that this project demonstrates that the course can be successfully modified to provide teaching in paediatric emergency care in a developing country.

  9. Single-port laparoscopic surgery.

    PubMed

    Tsai, Anthony Y; Selzer, Don J

    2010-01-01

    Laparoscopic surgery performed through a single-incision is gaining popularity. The demand from the public for even less invasive procedures will motivate surgeons, industry, and academic centers to explore the possibilities and refine the technology. Although the idea seems quite attractive, there are several technological obstacles that are yet to be conquered by improved technology or additional training. The question of safety has yet to be answered and will require well-designed randomized control trials. Opponents to the approach argue that the size of the single incision (see Table 1) is frequently larger than all the standard laparoscopy incisions combined. On the other hand, proponents remember a similar argument from traditional open surgeons during the initial development of laparoscopy. That argument was quickly discredited when the immediate benefits oflaparoscopy were compared with patients undergoing surgery with small laparotomy incisions. During the development of a new technique, the learning curve exposes patients to risk and society to expense. LESS pioneers appear to have reached a level of comfort with technology and techniques that paves the way for scientific scrutiny. Perhaps, the surgical community will capitalize on this situation with randomized, controlled studies and sound evidence to support or refute the benefits of LESS. If we do not seize this opportunity, patient demand and industry's dual edge message of financial success versus fear of losing referrals will lead to a scenario similar to the development of laparoscopic cholecystectomy in the 1990s. Regardless of its future, the surgical community will still benefit from a renewed excitement as surgeons aim to continually reduce the amount of pain and trauma our patients must endure. In addition, technological advances on instrumentation will benefit the field of laparoscopy and improve patient care.

  10. Laparoscopic Cholecystectomy in Cirrhotic Patient

    PubMed Central

    Casaccia, Marco; Mazza, Davide; Toouli, James; Laura, Vanna; Fabiani, Pascal; Mouiel, Jean

    1996-01-01

    Cholecystectomy is associated with increased risk in patients with liver cirrhosis. Moreover, cirrhosis and portal hypertension have been considered relative or absolute contraindication to laparoscopic cholecystectomy. As experience with laparoscopic cholecystectomy increased, we decided to treat cirrhotic patients via this approach. Between January 1994 and April 1995, nine patients with a Child-Pugh's stage A cirrhosis underwent elective laparoscopic cholecystectomy with intraoperative cholangiography. There was no significant per- or post-operative bleeding and no blood transfusion was necessary. There was no mortality and very low morbidity. Median hospital stay was 3 days. This series suggests that wellcompensated cirrhosis can not be considered a contraindication to laparoscopic cholecystectomy. PMID:9184860

  11. Virtual reality in laparoscopic surgery.

    PubMed

    Uranüs, Selman; Yanik, Mustafa; Bretthauer, Georg

    2004-01-01

    Although the many advantages of laparoscopic surgery have made it an established technique, training in laparoscopic surgery posed problems not encountered in conventional surgical training. Virtual reality simulators open up new perspectives for training in laparoscopic surgery. Under realistic conditions in real time, trainees can tailor their sessions with the VR simulator to suit their needs and goals, and can repeat exercises as often as they wish. VR simulators reduce the number of experimental animals needed for training purposes and are suited to the pursuit of research in laparoscopic surgery. PMID:15747974

  12. Virtual reality in laparoscopic surgery.

    PubMed

    Uranüs, Selman; Yanik, Mustafa; Bretthauer, Georg

    2004-01-01

    Although the many advantages of laparoscopic surgery have made it an established technique, training in laparoscopic surgery posed problems not encountered in conventional surgical training. Virtual reality simulators open up new perspectives for training in laparoscopic surgery. Under realistic conditions in real time, trainees can tailor their sessions with the VR simulator to suit their needs and goals, and can repeat exercises as often as they wish. VR simulators reduce the number of experimental animals needed for training purposes and are suited to the pursuit of research in laparoscopic surgery.

  13. Appraisal of laparoscopic cholecystectomy.

    PubMed Central

    Graves, H A; Ballinger, J F; Anderson, W J

    1991-01-01

    This paper reports the experience of three general surgeons performing 304 laparoscopic cholecystectomies in three private hospitals between October 1989 and November 1990. Laparoscopic cholecystectomy boasts two major advantages over the conventional procedure: the remarkable reduction in postoperative pain and economic benefit, largely due to the patient's early return to work. Revealing a complication rate of 2% and no deaths, this study has shown that this procedure can offer patients these advantages with a medical risk no greater than that accompanying conventional cholecystectomy. Patient safety must be paramount, and it is the responsibility of the surgical community to ensure that all surgeons receive the highest quality training and that the technique is applied appropriately. Images Fig. 3. Fig. 4. Fig. 5. Fig. 6. Fig. 7. PMID:1828140

  14. Developing advanced clinical skills in the management of breathlessness: evaluation of an educational intervention.

    PubMed

    Froggatt, Katherine; Walford, Carole

    2005-09-01

    The dissemination of knowledge regarding care interventions is often supported through educational initiatives. However, the efficacy of education to make a difference to practice is not always demonstrated. An educational course has been developed and piloted that aimed to educate nurses about skills for the management of breathlessness. The course was developed with, and utilised the expertise of, researchers, practitioners and educators experienced in the management of breathlessness. Twelve clinical nurse specialists, from Scotland and South East England, working in oncology and palliative care, participated in the first course. A longitudinal evaluation was undertaken to consider the impact of the course upon the participants' practice and the care of people who are breathless. Interviews were conducted at two time points and a self-rated familiarity and confidence tool was completed by the participants at three time points. The participants rated themselves as improving their familiarity and confidence with the different aspects of the intervention. Attendance on the course also impacted upon the care of people who were breathless, improving their ability to self-manage their condition. Recommendations for future educational developments of this type are provided. PMID:16112528

  15. Laparoscopic assisted cholecystostomy.

    PubMed

    Grecu, F

    1999-01-01

    Laparoscopic assisted cholecystostomy (LAC) is a safe method for external biliary drainage in jaundiced patients with distal common bile duct obstruction. It consists of the retrieval of the fundus of the gallbladder through the trocar, thus through abdominal wall followed by suture to the skin. This technique could be an option for surgeons who manage a patients with jaundice by distal common bile duct obstruction.

  16. A structured strategy to combine education for advanced MIS training in surgical oncology training programs.

    PubMed

    Brar, S S; Wright, F; Okrainec, A; Smith, A J

    2011-09-01

    Changing realities in surgery and surgical technique have heightened the need for agile adaptation in training programs. Current guidelines reflect the growing acceptance and adoption of the use of minimally invasive surgery (MIS) in oncology. North American general surgery residents are often not adequately skilled in advanced laparoscopic surgery skills at the completion of their residency. Presently, advanced laparoscopic surgery training during surgical oncology fellowship training occurs on an ad-hoc basis in many surgical oncology programs. We present a rational and template for a structured training in advanced minimally invasive surgical techniques during surgical oncology fellowship training. The structure of the program seeks to incorporate evidence-based strategies in MIS training from a comprehensive review of the literature, while maintaining essential elements of rigorous surgical oncology training. Fellows in this stream will train and certify in the Fundamentals of Laparoscopic Surgery (FLS) course. Fellows will participate in the didactic oncology seminar series continuously throughout the 27 months training period. Fellows will complete one full year of dedicated MIS training, followed by 15 months of surgical oncology training. Minimal standards for case volume will be expected for MIS cases and training will be tailored to meet the career goals of the fellows. We propose that a formalized MIS-Surgical Oncology Fellowship will allow trainees to benefit from an effective training curriculum and furthermore, that will allow for graduates to lead in a cancer surgery milieu increasingly focused on minimally invasive approaches.

  17. The EndoHand: comparison with standard laparoscopic instrumentation.

    PubMed

    Jackman, S V; Jarzemski, P A; Listopadzki, S M; Lee, B R; Stoianovici, D; Demaree, R; Jarrett, T W; Kavoussi, L R

    1999-06-01

    Laparoscopic instrumentation is constantly being refined in an attempt to achieve the proficiency, flexibility, and tactile feedback that would be available if the human hand were small enough to be used in laparoscopic surgery. The EndoHand (DAUM GmbH, Schwerin, Germany) is a novel laparoscopic three-fingered hand developed as an advancement over standard laparoscopic tools. Grasping and manipulation ability, dexterity, and tactile feedback were compared with those of current laparoscopic instrumentation. Experiments included measurement of achievable angles of approach to a fixed point behind a 2-cm-tall obstruction, completion time and error rates during a pelvic trainer dexterity task, and tactile feedback using a device invented to simulate tissue resistance. Subjectively, the EndoHand was able to pick up a range of objects similar to those graspable by a Babcock clamp. More complex types of manipulation were possible with the EndoHand because of its wrist joint. The range of approach angles to the fixed point was 35 degrees to 90 degrees with the EndoHand and 70 degrees to 90 degrees with the straight instruments. The dexterity of the EndoHand was significantly less than that of the other two instruments, as measured by time (P = 0.0002) and errors (P = 0.02). Standard instruments were also more accurate in the tactile feedback trials (P = 0.02). The EndoHand is a prototype of a unique new generation of laparoscopic instruments. Although it falls short in both dexterity and tactile feedback, significant promise is shown in its ability to perform sophisticated manipulation of objects and its flexibility to work at a larger range of angles to the target tissue. The EndoHand may be most useful on the nondominant hand of the surgeon to assist with positioning and holding tissue in a specific orientation. Clinical trials will determine its eventual role in laparoscopic surgery.

  18. Design Skills Education for Students of Advanced Course in College of Technology in Cooperation with the Support Program for Contemporary Educational Needs

    NASA Astrophysics Data System (ADS)

    Fujita, Naoyuki; Sakabe, Toshiya; Koshiba, Takashi; Ishitobi, Manabu

    Since 2004, Nara National College of Technology has been conducting “The Super Science Teacher Delivery Lecture Project”, in which the staff of our college visit elementary or junior high schools to provide special classes on science, technology or other subjects. This project was adopted as part of the Support Program for Contemporary Educational Needs by the Ministry of Education, Culture, Sports, Science and Technology. To provide education on design skills for students in the advanced mechanical engineering course and advanced electronic and information engineering course of the faculty of advanced engineering of our college, Problem Based Learning (PBL) has been conducted with the cooperation of the Super Science Teacher Delivery Lecture Project. In the PBL, students developed the teaching materials and experiments for science and technology lessons of elementary or junior high school students. In addition, the design skills of the students were evaluated by the reports on design skills, the demonstration of the delivery lecture and the records of the their efforts. From the results of the student questionnaire on this PBL, it is clear that most of the students understood “what are the design skills?” and acquired design skills.

  19. Current trends in laparoscopic groin hernia repair: A review.

    PubMed

    Pahwa, Harvinder Singh; Kumar, Awanish; Agarwal, Prerit; Agarwal, Akshay Anand

    2015-09-16

    Hernia is a common problem of the modern world with its incidence more in developing countries. Inguinal hernia is the most common groin hernia repaired worldwide. With advancement in technology operative techniques of repair have also evolved. A PubMed and COCHRANE database search was accomplished in this regard to establish the current status of laparoscopic inguinal hernia repair in view of recent published literature. Published literature support that laparoscopic hernia repair is best suited for recurrent and bilateral inguinal hernia although it may be offered for primary inguinal hernia if expertise is available.

  20. Laparoscopic surgery complications: Postoperative peritonitis

    PubMed Central

    Drăghici, L; Drăghici, I; Ungureanu, A; Copăescu, C; Popescu, M; Dragomirescu, C

    2012-01-01

    Introduction: Complications within laparoscopic surgery, similar to classic surgery are inevitable and require immediate actions both to diminish intraoperative risks and to choose the appropriate therapeutic attitude. Peritonitis and hemorrhagic incidents are both part of the complications aspect of laparoscopic surgery. Fortunately, the incidence is limited, thus excluding the rejection of celioscopic methods. Patient’s risks and benefits are to be analyzed carefully prior recommending laparoscopic surgery. Materials and methods: This study presents a statistical analysis of peritonitis consecutive to laparoscopic surgery, experience of „Sf. Ioan” Emergency Hospital, Bucharest, and Department of Surgery (2000-2010). Results:There were 180 (0,96%) complicated situations requiring reinterventions, from a total of 18676 laparoscopic procedures. 106 cases (0,56%) represented different grades of postoperative peritonitis. Most frequently, there were consecutive laparoscopic appendicectomia and colecistectomia. During the last decade, few severe cases of peritonitis followed laparoscopic bariatric surgical procedures. Conclusions: This study reflects the possibility of unfavorable evolution of postoperative peritonitis comparing with hemorrhagic incidents within laparoscopic surgery. PMID:23049630

  1. Laparoscopic hernioplasty of hiatal hernia

    PubMed Central

    Yang, Xuefei; Hua, Rong; He, Kai; Shen, Qiwei

    2016-01-01

    Laparoscopic surgery is a good choice for surgical treatment of hiatal hernia because of its mini-invasive nature and intraperitoneal view and operating angle. This article will talk about the surgical procedures, technical details, precautions and complications about laparoscopic hernioplasty of hiatal hernia. PMID:27761447

  2. The Effects of Using Concept Mapping for Improving Advanced Level Biology Students' Lower- and Higher-Order Cognitive Skills

    ERIC Educational Resources Information Center

    Bramwell-Lalor, Sharon; Rainford, Marcia

    2014-01-01

    This paper reports on teachers' use of concept mapping as an alternative assessment strategy in advanced level biology classes and its effects on students' cognitive skills on selected biology concepts. Using a mixed methods approach, the study employed a pre-test/post-test quasi-experimental design involving 156 students and 8 teachers…

  3. Colleges and Institutes: Advanced Skills and Applied Research. Submission to the House of Commons Standing Committee on Finance Pre-Budget Consultations 2009

    ERIC Educational Resources Information Center

    Association of Canadian Community Colleges, 2009

    2009-01-01

    Integrated with the industrial and technical drivers of the economy, Canada's colleges, institutes, polytechnics and cegeps offer the advanced skills of faculty and staff to support the private sector's need for applied research, product and process innovation, commercialization and technology transfer. Federal investments in research over the…

  4. A laparoscopic simulator – maybe it is worth making it yourself

    PubMed Central

    Piotrowski, Piotr; Jędrzejczyk, Adam; Pawełczak, Dariusz; Pasieka, Zbigniew

    2014-01-01

    Introduction Laparoscopic trainers have gained recognition for improving laparoscopic surgery skills and preparing for operations on humans. Unfortunately, due to their high price, commercial simulators are hard to obtain, especially for young surgeons in small medical centers. The solution might be for them to construct a device by themselves. Aim To make a relatively cheap and easy to construct laparoscopic trainer for residents who wish to develop their skills at home. Material and methods Two laparoscopic simulators were designed and constructed: 1) a box model with an optical system based on two parallel mirrors, 2) a box model with an HD webcam, a light source consisting of LED diodes placed on a camera casing, and a modeling servo between the webcam and aluminum pipe to allow electronic adjustment of the optical axis. Results The two self-constructed simulators were found to be effective training devices, the total cost of parts for each not exceeding $100. Advice is also given for future constructors. Conclusions Home made trainers are accessible to any personal budget and can be constructed with a minimum of practical skill. They allow more frequent practice at home, outside the venue and hours of surgical departments. What is more, home made trainers have been shown to be comparable to commercial trainers in facilitating the acquisition of basic laparoscopic skills. PMID:25337161

  5. [Laparoscopic ultrasound in biliary diseases].

    PubMed

    Cociorvei, A; Calu, V

    2011-01-01

    Laparoscopic ultrasound is an intraoperative exploration of the abdominal viscera using ultrasounds. The aim of this work is to obviate this new method of exploration and to underline its advantages and limits. In this study were enroled 65 pacients with gallbladder stones, admitted in The Surgical Clinic, "Elias" Emergency Hospital, from October 2005 until December 2006. The measured parameters were CBD size and the presence of stones or sludge within CBD, and various methods were compared: abdominal ultrasound, laparoscopic ultrasound and laparoscopic cholangiography. The results allowed us to consider that laparoscopic ultrasound is a useful tool for the intraoperative diagnosis of choledocolithiasis. When compared to laparoscopic cholangiography, our study revealed the same specificity and positive predictive value, and a sensitivity of 0.93.

  6. Recent Advances in Improvement of Forecast Skill and Understanding Climate Processes Using AIRS Version-5 Products

    NASA Technical Reports Server (NTRS)

    Susskind, Joel; Molnar, Gyula; Iredell, Lena; Rosenberg, Robert

    2012-01-01

    AIRS/AMSU is the state of the art infrared and microwave atmospheric sounding system flying aboard EOS Aqua. These observations, covering the period September 2002 until the present, have been analyzed using the AIRS Science Team Version-5 retrieval algorithm. AIRS is a high spectral resolution infrared grating spectrometer with spect,ral coverage from 650 per centimeter extending to 2660 per centimeter, with low noise and a spectral resolving power of 2400. A brief overview of the AIRS Version-5 retrieval procedure will be presented, including the AIRS channels used in different steps in the retrieval process. Many researchers have used these products to make significant advances in both climate and weather applications. Recent significant results of these experiments will be presented, including results showing that 1) assimilation of AIRS Quality Controlled temperature profiles into a General Circulation Model (GCM) significantly improves the ability to predict storm tracks of intense precipitation events; and 2) anomaly time-series of Outgoing Longwave Radiation (OLR) computed using AIRS sounding products closely match those determined from the CERES instrument, and furthermore explain that the phenomenon that global and especially tropical mean OLR have been decreasing since September 2002 is a result of El Nino/La Nina oscillations during this period.

  7. Laparoscopic management of tumor in supernumerary ovary

    PubMed Central

    Prakash, Ved; Kant, Anita; Parashar, Abha; Rani, Uma

    2016-01-01

    Laparoscopic management of most of the adnexal masses has become feasible in the present era of advancing endoscopic techniques. A postmenopausal lady presented with lump in the abdomen, appeared to be a solid ovarian mass on ultrasound, and magnetic resonance imaging. On laparoscopy, both the ovaries were normal and the mass was not connected to uterus or adnexa. The mass was removed and histopathology confirmed it to be ovarian tissue thus confirming it to be a tumor in a supernumerary ovary. Examples of supernumerary ovary are among the rarest of gynecological abnormalities. PMID:27134478

  8. Skill-Mix and Policy Change in the Health Workforce: Nurses in Advanced Roles. OECD Health Working Papers, No. 17

    ERIC Educational Resources Information Center

    Buchan, James; Calman, Lynn

    2005-01-01

    An important potential contribution to the efficient use of the health workforce, is the possibility of "skill mix" changes. "Skill mix" is a relatively broad term which can refer to the mix of staff in the workforce or the demarcation of roles and activities among different categories of staff. Most of the policy attention on using skill-mix…

  9. Laparoscopic revolution in bariatric surgery

    PubMed Central

    Sundbom, Magnus

    2014-01-01

    The history of bariatric surgery is investigational. Dedicated surgeons have continuously sought for an ideal procedure to relieve morbidly obese patients from their burden of comorbid conditions, reduced life expectancy and low quality of life. The ideal procedure must have low complication risk, both in short- and long term, as well as minimal impact on daily life. The revolution of laparoscopic techniques in bariatric surgery is described in this summary. Advances in minimal invasive techniques have contributed to reduced operative time, length of stay, and complications. The development in bariatric surgery has been exceptional, resulting in a dramatic increase of the number of procedures performed world wide during the last decades. Although, a complex bariatric procedure can be performed with operative mortality no greater than cholecystectomy, specific procedure-related complications and other drawbacks must be taken into account. The evolution of laparoscopy will be the legacy of the 21st century and at present, day-care surgery and further reduction of the operative trauma is in focus. The impressive effects on comorbid conditions have prompted the adoption of minimal invasive bariatric procedures into the field of metabolic surgery. PMID:25386062

  10. Use of CO2 laser flexible waveguides during laparoscopic cholecystectomy

    NASA Astrophysics Data System (ADS)

    Lanzafame, Raymond J.

    1992-06-01

    Laparoscopic cholecystectomy has revolutionized the management of symptomatic cholelithiasis and cholecystitis. Although electrosurgery devices are used by a majority of surgeons, laser technology is a valued addition to the armamentarium of the skilled laser laparoscopist. A variety of fiberoptic capable wavelengths have been applied successfully during this procedure. Use of the CO2 laser for this purpose has lagged due to difficulties encountered with free-beam and rigid waveguide dissections via the laparoscope. Recent developments in flexible waveguide technology have the potential to expand the role of the CO2 laser for laparoscopic cholecystectomy and other procedures. Twelve laparoscopic cholecystectomies were performed using Luxar (Bothell, WA) flexible microwaveguides of various configurations. In each case, dissection of the gallbladder from the gallbladder bed was accomplished with acceptable speed and hemostasis. There were no complications. Shortcomings include coupling and positioning with an articulated arm and occasional clogging of some waveguide tips with debris. Modifications of this technology are suggested. Flexible waveguides make the CO2 laser a practical alternative for surgical laparoscopy.

  11. Robot-assisted surgical systems: a new era in laparoscopic surgery.

    PubMed

    Ruurda, J P; van Vroonhoven, Th J M V; Broeders, I A M J

    2002-07-01

    The introduction of laparoscopic surgery offers clear advantages to patients; to surgeons, it presents the challenge of learning new remote operating techniques quite different from traditional operating. Telemanipulation, introduced in the late 1990s, was a major advance in overcoming the reduced dexterity introduced by laparoscopic techniques. This paper reviews the development of robotic systems in surgery and their role in the operating room of the future.

  12. Visual enhancement of laparoscopic nephrectomies using the 3-CCD camera

    NASA Astrophysics Data System (ADS)

    Crane, Nicole J.; Kansal, Neil S.; Dhanani, Nadeem; Alemozaffar, Mehrdad; Kirk, Allan D.; Pinto, Peter A.; Elster, Eric A.; Huffman, Scott W.; Levin, Ira W.

    2006-02-01

    Many surgical techniques are currently shifting from the more conventional, open approach towards minimally invasive laparoscopic procedures. Laparoscopy results in smaller incisions, potentially leading to less postoperative pain and more rapid recoveries . One key disadvantage of laparoscopic surgery is the loss of three-dimensional assessment of organs and tissue perfusion. Advances in laparoscopic technology include high-definition monitors for improved visualization and upgraded single charge coupled device (CCD) detectors to 3-CCD cameras, to provide a larger, more sensitive color palette to increase the perception of detail. In this discussion, we further advance existing laparoscopic technology to create greater enhancement of images obtained during radical and partial nephrectomies in which the assessment of tissue perfusion is crucial but limited with current 3-CCD cameras. By separating the signals received by each CCD in the 3-CCD camera and by introducing a straight forward algorithm, rapid differentiation of renal vessels and perfusion is accomplished and could be performed real time. The newly acquired images are overlaid onto conventional images for reference and comparison. This affords the surgeon the ability to accurately detect changes in tissue oxygenation despite inherent limitations of the visible light image. Such additional capability should impact procedures in which visual assessment of organ vitality is critical.

  13. Association of stress management skills and perceived stress with physical and emotional well-being among advanced prostrate cancer survivors following androgen deprivation treatment.

    PubMed

    Penedo, Frank J; Benedict, Catherine; Zhou, Eric S; Rasheed, Mikal; Traeger, Lara; Kava, Bruce R; Soloway, Mark; Czaja, Sara; Antoni, Michael H

    2013-03-01

    Advanced prostate cancer (APC) is associated with disruptions that compromise health related quality of life (HRQOL). Treatment often includes androgendeprivation therapy (ADT), which results in a range of side effects (e.g., fatigue, urinary dysfunction) that further impact HRQOL. Despite these challenges, there are limited evaluations of the impact of stress and stress management skills on HRQOL among APC survivors on ADT. This study evaluated relationships among stress, stress management skills, and HRQOL, and it was hypothesized that better stress management skills would relate to greater physical and emotional well-being by mitigating perceived stress levels. Participants (N = 77) were 69.7 years old (SD = 9.8), 18.6 months post-treatment (SD = 17.5), and ethnically diverse (65 % Non-Hispanic White, 13 % Hispanic, 21 % African-American). Measures included the Measure of Current Status for stress management skills, the Perceived Stress Scale for perceived stress, and the Medical Outcomes Study-Short Form (MOS SF-36; physical functioning and emotional well-being subscales) for HRQOL. Direct effects and mediation models were evaluated to determine the relationships between perceived stress, stress management skills, and HRQOL domains, controlling for relevant covariates. Stress management skills and perceived stress were significantly associated with physical functioning (β = .24, p < .05 and β = -.43, p < .01, respectively) and emotional well-being (β = .35, p < .01 and β = -.64, p < .01, respectively). Regression analyses supported the hypothesis that reduced perceived stress mediated the relationship between stress management skills and both physical functioning and emotional well-being. These results demonstrate that one way stress management skills may impact HRQOL is by lessening ongoing perceptions of stress.

  14. Laparoscopic donor nephrectomy.

    PubMed

    Deger, S; Giessing, M; Roigas, J; Wille, A H; Lein, M; Schönberger, B; Loening, S A

    2005-01-01

    Laparoscopic live donor nephrectomy (LDN) has removed disincentives of potential donors and may bear the potential to increase kidney donation. Multiple modifications have been made to abbreviate the learning curve while at the same time guarantee the highest possible level of medical quality for donor and recipient. We reviewed the literature for the evolution of the different LDN techniques and their impact on donor, graft and operating surgeon, including the subtleties of different surgical accesses, vessel handling and organ extraction. We performed a literature search (PubMed, DIMDI, medline) to evaluate the development of the LDN techniques from 1995 to 2003. Today more than 200 centres worldwide perform LDN. Hand-assistance has led to a spread of LDN. Studies comparing open and hand-assisted LDN show a reduction of operating and warm ischaemia times for the hand-assisted LDN. Different surgical access sites (trans- or retroperitoneal), different vessel dissection approaches, donor organ delivery techniques, delivery sites and variations of hand-assistance techniques reflect the evolution of LDN. Proper techniques and their combination for the consecutive surgical steps minimize both warm ischaemia time and operating time while offering the donor a safe minimally invasive laparoscopic procedure. LDN has breathed new life into the moribund field of living kidney donation. Within a few years LDN could become the standard approach in living kidney donation. Surgeons working in this field must be trained thoroughly and well acquainted with the subtleties of the different LDN techniques and their respective advantages and disadvantages. PMID:16754618

  15. Experimental laparoscopic aortobifemoral bypass.

    PubMed

    Dion, Y M; Chin, A K; Thompson, T A

    1995-08-01

    The goal of the present study is to develop a technique for laparoscopic aortobifemoral bypass. Piglets weighing between 60 and 78 kg were anesthetized with halothane. The lateral retroperitoneal approach was preferred to the more familiar anterior transperitoneal approach and was successfully completed in 19 piglets. The piglets were placed in the right lateral decubitus position. The first port (2 cm) was inserted halfway between the tip of the 12th rib and the iliac crest. Four other trocars were placed in the retroperitoneum after balloon inflation had allowed creation of a space which permitted visualization of the aorta from the left renal artery down to the aorto-iliac junction. After evacuation of the retropneumoperitoneum, the cavity was maintained using an abdominal lift device and a retractor. Using this approach, we performed four aorto-bifemoral bypasses (end-to-end aortic anastomosis) after conventional intravenous heparinization (100 IU/kg) in less than 4 h. Blood loss did not exceed 250 ml and the hematocrit remained stable. Postmortem evaluation of the grafts revealed they were positioned as in a conventional bypass, their limbs having followed in the created retroperitoneal tunnels along the path of the native arteries. No mortality occurred before sacrifice of the animals. We believe that this first performed series of totally retroperitoneal laparoscopic aortobifemoral bypasses in the porcine model is useful in preparation for human application due to the anatomical similarities in the periaortic region.

  16. Laparoscopic endoscopic cooperative surgery.

    PubMed

    Hiki, Naoki; Nunobe, Souya; Matsuda, Tatsuo; Hirasawa, Toshiaki; Yamamoto, Yorimasa; Yamaguchi, Toshiharu

    2015-01-01

    Laparoscopic and endoscopic cooperative surgery (LECS) is a newly developed concept for tumor dissection of the gastrointestinal tract that was first investigated for local resection of gastric gastrointestinal stromal tumors (GIST). The first reported version of LECS for GIST has been named 'classical LECS' to distinguish it from other modified LECS procedures, such as inverted LECS, a combination of laparoscopic and endoscopic approaches to neoplasia with a non-exposure technique (CLEAN-NET), and non-exposed endoscopic wall-inversion surgery (NEWS). These modified LECS procedures were developed for dissection of malignant tumors which may seed tumor cells into the abdominal cavity. While these LECS-related procedures might prevent tumor seeding, their application is limited by several factors, such as tumor size, location and technical difficulty. Currently, classical LECS is a safe and useful procedure for gastric submucosal tumors without mucosal defects, independent of tumor location, such as proximity to the esophagogastric junction or pyloric ring. For future applications of LECS-related procedures for other malignant diseases with mucosal lesions such as GIST with mucosal defects and gastric cancer, some improvements in the techniques are needed.

  17. Outcomes and Use of Laparoscopic Versus Open Gastric Resection

    PubMed Central

    Kubasiak, John C.; Jacobson, Richard A.; Janssen, Imke; Myers, Jonathan A.; Millikan, Keith W.; Deziel, Daniel J.; Luu, Minh B.

    2015-01-01

    Background and Objectives: The advantages of laparoscopy over open surgery are well established. Laparoscopic resection for gastric cancer is safe and results in equivalent oncologic outcomes when compared with open resection. The purpose of this study was to assess the use of laparoscopy to treat gastric cancer and the associated outcomes. Methods: The American College of Surgeons National Surgical Quality Improvement Project (NSQIP) dataset was queried for patients with gastric cancer (ICD-9 Code 151.0–151.9) from January 2005 through December 2012. Logistic regression was used to evaluate the 30-day morbidity and mortality of open gastrectomy (CPT code 43620-2, 43631-4) versus that of the laparoscopic procedure on the stomach (CPT code 43650), while adjusting for preoperative risk factors. Results: A total of 4116 patients with gastric cancer were identified and divided by surgical approach into 2 groups: open gastrectomy (n = 3725; 90.5%) and laparoscopic procedure on the stomach (n = 391; 9.5%). After adjustment for preoperative risk factors, complications were significantly fewer in laparoscopic versus open gastric resection (odds ratio [OR] 0.61, 95% confidence interval [CI] = 0.45–0.82; P = .001). After adjusting for preoperative risk factors, there was no statistically significant difference in mortality with laparoscopic compared to open gastric resection (OR 0.74; 95% CI = 0.32–1.72; P = .481). Conclusions: Laparoscopy is underused in the treatment of gastric cancer. Given that laparoscopic gastric resection has a lower morbidity in comparison to open resection, steps should be made toward advancing the use of laparoscopy for gastric cancer. PMID:26941544

  18. A brief history of endoscopy, laparoscopy, and laparoscopic surgery.

    PubMed

    Spaner, S J; Warnock, G L

    1997-12-01

    The ideas that form the framework for laparoscopic surgery were initially reported over a century ago. However, the introduction of the technique into the field of general surgery has been a relatively recent development. Laparoscopic surgery owes much of its history to the development of endoscopic technique. Early physicians such as the Arabian, Albukasim (936-1013 A.D.), and later in 1805, the Frankfurt-born physician, Phillip Bozzini, were among the first to develop methods to examine body orifices. Throughout the mid 1800's, several scientists attempted to construct endoscope-like instruments. The first effective open-tube endoscope was developed in 1853 by Desormeaux. This instrument was used to examine the urethra and the bladder. In the late 1800's, other physicians including Kussmaul and Nitze refined the original endoscopic models and began utilizing their new tools in their medical practice. Laparoscopy or endoscopically examining the peritoneal cavity was first attempted in 1901 by George Kelling who called this examining procedure "Celioscopy". In the early 1930's, the first reports of laparoscopic interventions for nondiagnostic purposes were published. Initial procedures included lysis of abdominal adhesions and diagnostic biopsies of abdominal organs under direct visualization. Throughout the 1960's and 1970's, laparoscopy became a vital part of gynecological practice. Despite these technological advances, it was not until after 1986, following the development of a video computer chip that allowed the magnification and projection of images onto television screens, that the techniques of laparoscopic surgery truly became integrated into the discipline of general surgery. The first laparoscopic cholecystectomy performed on a human patient was done in 1987 by the French physician Mouret. The rapid acceptance of the technique of laparoscopic surgery by the general population is unparalleled in surgical history. It has changed the field of general

  19. Thermostasis during laparoscopic urologic surgery.

    PubMed

    Kaynan, Ayal M; Winfield, Howard N

    2002-09-01

    It has been postulated that gaseous insufflation of the abdominal cavity results in temperature elevation, particularly in children, and that the use of heating blankets should be avoided during laparoscopic surgery. On review of the last 102 laparoscopic genitourinary cases, we conclude that the use of nonheated, nonhumidified carbon dioxide for insufflation during laparoscopic surgery under a general anesthetic results in mild hypothermia. The use of warming devices in this setting is both safe and appropriate. Children have a rise in temperature relative to preoperative measurement, although they are explicitly capable of hypothermia. Neither the duration of the procedure, the surgical approach, nor conversion to open exploration had a significant impact on temperature regulation. Adrenalectomy results in more exaggerated temperature changes than do other laparoscopic procedures. PMID:12396438

  20. Modified laparoscopic ventral mesh rectopexy.

    PubMed

    Sileri, P; Capuano, I; Franceschilli, L; Giorgi, F; Gaspari, A L

    2014-06-01

    We present a modified laparoscopic ventral mesh rectopexy procedure using biological mesh and bilateral anterior mesh fixation. The rectopexy is anterior with a minimal posterior mobilization. The rectum is symmetrically suspended to the sacral promontory through a mesorectal window.

  1. Spleen removal - laparoscopic - adults - discharge

    MedlinePlus

    Recovering from laparoscopic spleen removal usually takes several weeks. You may have some of these symptoms as ... should go away over several days to a week. A sore throat from the breathing tube that ...

  2. [Laparoscopic surgery for esophageal achalasia].

    PubMed

    Ozawa, S; Ando, N; Ohgami, M; Kitagawa, Y; Kitajima, M

    2000-04-01

    Laparoscopic surgery for esophageal achalasia was first reported by Shimi et al. in 1991. Subsequently the procedure has been performed all over the world and laparoscopic Heller myotomy and Dor fundoplication (Heller and Dor operation) is now thought to be the operation of first choice. It is indicated for patients who are resistant to medical therapy (calcium blocker etc.) or have pneumatic dilatation and those with frequent aspiration at night. As Csendes et al. reported that surgical treatment was better than pneumatic dilatation and as laparoscopic surgery is less invasive, the indications for the laparoscopic Heller and Dor operation can include all achalasia patients except those who respond to medical therapy, do not accept surgery, or cannot tolerate surgery. We successfully performed the laparoscopic Heller and Dor operation on 22 patients, all of whom had an uneventful postoperative course. Manometric evaluation, endoscopic examination, and 24-hour pH monitoring showed good results. There are six important technical points: 1) flexible laparoscopy; 2) pneumoperitoneum; 3) gauze in the abdominal cavity to absorb blood; 4) laparosonic coagulating shears; 5) extracorporeal knot-tying technique; and 6) intracorporeal knot-tying technique. If an experienced surgeon is in charge, the laparoscopic Heller and Dor operation is an ideal, minimally invasive treatment for esophageal achalasia.

  3. Laparoscopic herniorrhaphy in children.

    PubMed

    Bertozzi, Mirko; Marchesini, Laura; Tesoro, Simonetta; Appignani, Antonino

    2015-01-01

    The authors report their experience in laparoscopic repair of inguinal hernias in children. From May 2010 to November 2013, 122 patients with inguinal hernia underwent laparoscopic herniorrhaphy (92 males and 30 females). Telescope used was 5 mm, while trocars for the operative instruments were 3 or 2 mm. After introducing the camera at the umbilical level and trocars in triangulation, a 4-0 nonabsorbable monofilament suture was inserted directly through the abdominal wall. The internal inguinal ring was then closed by N or double N suture. All operations were performed in one-day surgery setting. In the case of association of inguinal and umbilical hernia an original technique was performed for positioning and fixing the umbilical trocar and for the primary closure of the abdominal wall defect. The postoperative follow-up consisted of outpatient visits at 1 week and 1, 3, and 6 months. The mean age of patients was 38.5 months. Of all patients, 26 were also suffering from umbilical hernia (19 males and 7 females). A total of 160 herniorrhaphies were performed; 84 were unilateral (66 inguinal hernia, 18 inguinal hernia associated with umbilical hernia), 38 bilateral (30 inguinal hernia, 8 inguinal hernia associated with umbilical hernia). Nine of 122 patients (6 males and 3 females) were operated in emergency for incarcerated hernia. A pre-operative diagnosis of unilateral inguinal hernia was performed in 106 cases. Of these patients, laparoscopy revealed a controlateral open internal inguinal ring in 22 cases (20.7%). The mean operative time was 29.9±15.9 min for the monolateral herniorrhaphies, while in case of bilateral repair the mean operative time was 41.5±10.4 min. The mean operative time for the repair of unilateral inguinal hernia associated with umbilical hernia was 30.1±7.4 while for the correction of bilateral inguinal hernia associated with umbilical hernia 39.5±10.6 min. There were 3 recurrences (1.8%): 2 cases in unilateral repair and 1 case a

  4. Outpatient laparoscopic sterilization.

    PubMed

    Hamid Arshat; Yuliawiratman

    1981-03-01

    This is a report on a pilot study conducted in Malaysia of outpatient sterilization utilizing laparoscopic technique under local anesthesia and sedation. The preliminary report based on 305 patients is presented with emphasis on the advantages and possible weaknesses of such procedure. Sterilization is performed in the Family Planning Specialist Center, Maternity Hospital. Patients are motivated towards sterilization during the immediate postpartum period in the Maternity Hospital and are counseled regarding the actual procedure. The mean age of the 305 patients was 32.08 years; the mean gravidity was 4.92; and the mean parity was 4.57. The majority of the patients came from the lower social strata with low educational attainment and low income. 253 cases of sterilizations were performed by laparoscopic procedures and 43 cases by minilaparotomy. In 9 cases difficulty was encountered with laparoscopy and subsequently the minilaparotomy was used. The majority of cases seemed to tolerate the sedation and local anesthesia fairly well and without much complaint of pain. Only a very small number of patients complained of pain particularly at the time when the Fallope or Lay rings were applied to the fallopian tubes. The overall complication rate was 14 (4.9%) and of these mild wound sepsis accounted for 6 (1.96%). Most of the wound sepsis was very mild and healed very quickly on daily dressing. No cases of pelvic sepsis were reported. There were 3 cases of uterine perforation by the uterine elevator. There were 2 cases where the fallopian tubes were traumatized and some degree of bleeding occurred. The bleeding was easily controlled by applying another Fallope ring. 2 patients had vomiting during the laparoscopic procedure. There were 7 cases of failed sterilization. 6 of the cases were performed by a trainee registrar in obstetrics and gynecology. The last was performed by a specialist gynecologist. Most of the failures were due to wrong application of rings. The cost

  5. Study Skills.

    ERIC Educational Resources Information Center

    Gleason, Mary M.; And Others

    1988-01-01

    Study strategies used to assist mildly handicapped students become more actively engaged and successful in gaining and responding to information in content area classes are described. They include using advance organizers, summarizing/paraphrasing what is read, enhancing listening skills, and improving the organization, appearance, and accuracy of…

  6. Laparoscopic partial splenic resection.

    PubMed

    Uranüs, S; Pfeifer, J; Schauer, C; Kronberger, L; Rabl, H; Ranftl, G; Hauser, H; Bahadori, K

    1995-04-01

    Twenty domestic pigs with an average weight of 30 kg were subjected to laparoscopic partial splenic resection with the aim of determining the feasibility, reliability, and safety of this procedure. Unlike the human spleen, the pig spleen is perpendicular to the body's long axis, and it is long and slender. The parenchyma was severed through the middle third, where the organ is thickest. An 18-mm trocar with a 60-mm Endopath linear cutter was used for the resection. The tissue was removed with a 33-mm trocar. The operation was successfully concluded in all animals. No capsule tears occurred as a result of applying the stapler. Optimal hemostasis was achieved on the resected edges in all animals. Although these findings cannot be extended to human surgery without reservations, we suggest that diagnostic partial resection and minor cyst resections are ideal initial indications for this minimally invasive approach.

  7. [Laparoscopic interventions in urology].

    PubMed

    Janetschek, G

    1995-01-01

    From December 1991 to October 1993, 230 laparoscopic operations were performed for urological indications in 205 patients, including 48 children aged between 6 months and 14 years. The rate of intra-operative complications was 2.5%. Intra-operative bleeding (2 patients), cardiovascular insufficiency (1 patient) and pneumothorax (1 patient) necessitated conversion to laparotomy in 4 patients. In another patient intra-operative bleeding occurred, which was successfully managed conservatively by means of blood transfusion. The only serious postoperative complication was a hernia at the entry site of a trocar in a 6-months-old child. A broad spectrum of different operations was performed, including diagnostic and therapeutic laparoscopy for cryptorchism and intersex states, varicocele ligature, pediatric hydrocele (transection of an open processus vaginalis), nephrectomy, ureterectomy, heminephroureterectomy, marsupialization of renal cysts and a lymphocele, pelvic and retroperitoneal lymphadenectomy, adrenalectomy, ureteral re-implantation, pyeloplasty, lumbar sympathectomy and herniotomy. The overall results were very satisfactory.

  8. Laparoscopic Cholecystectomy in Cirrhotics

    PubMed Central

    2012-01-01

    Background and Objectives: Due to the concern of risk of intra- and postoperative complications and associated morbidity, cirrhosis of the liver is often considered a contraindication for laparoscopic cholecystectomy (LC). This article intends to review the literature and underline the various approaches to dealing with this technically challenging procedure. Methods: A Medline search of major articles in the English literature on LC in cirrhotic patients over a 16-y period from 1994 to 2011 was reviewed and the findings analyzed. A total of 1310 cases were identified. Results: Most the patients who underwent LC were in Child-Pugh class A, followed by Child-Pugh classes B and C, respectively. The overall conversion rate was 4.58%, and morbidity was 17% and mortality 0.45%. Among the patients who died, most were in Child-Pugh class C, with a small number in classes B and A. The cause of death included, postoperative bleeding, liver failure, sepsis, duodenal perforation, and myocardial infarction. A meta-analysis of 400 patients in the literature, comparing outcomes of patients undergoing LC with and without cirrhosis, revealed higher conversion rate, longer operative time, higher bleeding complications, and overall increased morbidity in patients with cirrhosis. Safe LC was facilitated by measures that included the use of ultrasonic shears and other hemostatic measures and using subtotal cholecystectomy in patients with difficult hilum and gallbladder bed. Conclusions: Laparoscopic cholecystectomy can be safely performed in cirrhotic patients, within Child-Pugh classes A and B, with acceptable morbidity and conversion rate. PMID:23318064

  9. Novel 3-D laparoscopic magnetic ultrasound image guidance for lesion targeting

    PubMed Central

    Sindram, David; McKillop, Iain H; Martinie, John B; Iannitti, David A

    2010-01-01

    Objectives: Accurate laparoscopic liver lesion targeting for biopsy or ablation depends on the ability to merge laparoscopic and ultrasound images with proprioceptive instrument positioning, a skill that can be acquired only through extensive experience. The aim of this study was to determine whether using magnetic positional tracking to provide three-dimensional, real-time guidance improves accuracy during laparoscopic needle placement. Methods: Magnetic sensors were embedded into a needle and laparoscopic ultrasound transducer. These sensors interrupted the magnetic fields produced by an electromagnetic field generator, allowing for real-time, 3-D guidance on a stereoscopic monitor. Targets measuring 5 mm were embedded 3–5 cm deep in agar and placed inside a laparoscopic trainer box. Two novices (a college student and an intern) and two experts (hepatopancreatobiliary surgeons) targeted the lesions out of the ultrasound plane using either traditional or 3-D guidance. Results: Each subject targeted 22 lesions, 11 with traditional and 11 with the novel guidance (n = 88). Hit rates of 32% (14/44) and 100% (44/44) were observed with the traditional approach and the 3-D magnetic guidance approach, respectively. The novices were essentially unable to hit the targets using the traditional approach, but did not miss using the novel system. The hit rate of experts improved from 59% (13/22) to 100% (22/22) (P < 0.0001). Conclusions: The novel magnetic 3-D laparoscopic ultrasound guidance results in perfect targeting of 5-mm lesions, even by surgical novices. PMID:21083797

  10. [A review of 445 cases of laparoscopic hysterectomy: benefits and outcome].

    PubMed

    Malzoni, M; Perniola, G; Hannuna, K; Iuele, T; Fruscella, M L; Basili, R; Ebano, V; Marziani, R

    2004-01-01

    Hysterectomy is a major procedure indicated for women with gynaecologic pathologies. After reporting the first laparoscopic hysterectomy (Reich 1989), this technique has recently been considered as a safe and efficient alternative to traditional abdominal hysterectomy in the management of benign uterine pathologies when vaginal route is contraindicated. The laparoscopic approach should not be held to compete with vaginal hysterectomy. From 1995 to 2001 in our institute, the proportion of laparoscopic hysterectomy has increased and laparotomic hysterectomy has decreased. Between January 1999 and January 2001 we carried out 445 total laparoscopic hysterectomies. There were 5 laparotomy conversions for large uterus. The average haemoglobin drop was 1,36 g/dl. Median operative time was 95 +/- 27 min. The mean in postoperative stay was 2.7 +/- 0.8 gg. The postoperative complications were minimal. Laparoscopic approach is less painful, is associated to less blood loss, shorter hospital stay, more rapid recovery and a better assumption by affected women. Some disadvantages are reported too, such as larger operating time, high rate of complication and experience required for performing laparoscopy including a learning curve. A training period is necessary to standardize the operating procedure, to put in place methods of avoiding complication and to reach a plateau of surgical skill. The purpose of this study was to show the role of total laparoscopic hysterectomy and how it can be performed safely with a minimal morbidity after a period of training in which we worked out shrewdness to get a standardized technique with the most effective outcome.

  11. Innovative Training Experience for Advancing Entry Level, Mid-Skilled and Professional Level URM Participation in the Geosciences Workforce

    NASA Astrophysics Data System (ADS)

    Okoro, M. H.; Johnson, A.

    2015-12-01

    The representation of URMs in the U.S. Geosciences workforce remains proportionally low compared to their representation in the general population (Bureau of Labor Sta.s.cs, 2014). Employment in this and related industries is projected to grow 32% by 2030 for minority workers (Gillula and Fullenbaum, 2014), corresponding to an additional 48,000 jobs expected to be filled by minorities (National Research Council, 2014). However, there is a shortage of employees with proper training in the hard sciences (Holeywell, 2014; Ganzglass, 2011), as well as craft skills (Hoover and Duncan, 2013), both important for middle skill employment. Industry recognizes the need for developing and retaining a diverse workforce, therefore we hightlight a program to serve as a potential vanguard initative for developing an innovative training experience for URM and underserved middle skilled workers with essential knowledge, experience and skills necessary to meet the demands of the Geosciences industry's growing need for a safe, productive and diverse workforce. Objectives are for participants to achieve the following: understanding of geosciences workforce trends and associated available opportunities; mastery of key environmental, health and safety topics; improvements in decision making skills and preparedness for responding to potential environmental, health and safety related situations; and engagement in one-on-one coaching sessions focused on resume writing, job interviewing and key "soft skills" (including conflict resolution, problem solving and critical observation, representing 3 major skills that entry- level workers typically lack.

  12. Laparoscopic Gastrectomy and Transvaginal Specimen Extraction in a Morbidly Obese Patient with Gastric Cancer

    PubMed Central

    Sumer, Fatih; Karagul, Servet

    2016-01-01

    Laparoscopic gastrectomy for cancer has some significant postoperative benefits over open surgery with similar oncologic outcomes. This procedure is more popular in the Far East countries where obesity is not a serious public health problem. In the Western countries, laparoscopic gastrectomy for cancer is not a common procedure, yet obesity is more common. Herein, we aimed to demonstrate the feasibility of laparoscopic gastrectomy for advanced gastric cancer in a morbidly obese patient. Additionally, we used natural orifice specimen extraction as an option to decrease wound-related complications, which are more prevalent in morbidly obese patients. In this case, we performed a fully laparoscopic subtotal gastrectomy with lymph node dissection and Roux-en-Y gastrojejunostomy with the specimen extracted through the vagina. To the best of our knowledge, this was the first report of a natural orifice surgery in a morbidly obese patient with gastric cancer. PMID:27104027

  13. Single port laparoscopic mesh rectopexy

    PubMed Central

    2016-01-01

    Introduction Traditionally, laparoscopic mesh rectopexy is performed with four ports, in an attempt to improve cosmetic results. Following laparoscopic mesh rectopexy there is a new operative technique called single-port laparoscopic mesh rectopexy. Aim To evaluate the single-port laparoscopic mesh rectopexy technique in control of rectal prolapse and the cosmesis and body image issues of this technique. Material and methods The study was conducted in El Fayoum University Hospital between July 2013 and November 2014 in elective surgery for symptomatic rectal prolapse with single-port laparoscopic mesh rectopexy on 10 patients. Results The study included 10 patients: 3 (30%) males and 7 (70%) females. Their ages ranged between 19 years and 60 years (mean: 40.3 ±6 years), and they all underwent laparoscopic mesh rectopexy. There were no conversions to open technique, nor injuries to the rectum or bowel, and there were no mortalities. Mean operative time was 120 min (range: 90–150 min), and mean hospital stay was 2 days (range: 1–3 days). Preoperatively, incontinence was seen in 5 (50%) patients and constipation in 4 (40%). Postoperatively, improvement in these symptoms was seen in 3 (60%) patients for incontinence and in 3 (75%) for constipation. Follow-up was done for 6 months and no recurrence was found with better cosmetic appearance for all patients. Conclusions Single-port laparoscopic mesh rectopexy is a safe procedure with good results as regards operative time, improvement in bowel function, morbidity, cost, and recurrence, and with better cosmetic appearance. PMID:27350840

  14. Virtual Reality Training Versus Blended Learning of Laparoscopic Cholecystectomy

    PubMed Central

    Nickel, Felix; Brzoska, Julia A.; Gondan, Matthias; Rangnick, Henriette M.; Chu, Jackson; Kenngott, Hannes G.; Linke, Georg R.; Kadmon, Martina; Fischer, Lars; Müller-Stich, Beat P.

    2015-01-01

    Abstract This study compared virtual reality (VR) training with low cost-blended learning (BL) in a structured training program. Training of laparoscopic skills outside the operating room is mandatory to reduce operative times and risks. Laparoscopy-naïve medical students were randomized in 2 groups stratified for sex. The BL group (n = 42) used E-learning for laparoscopic cholecystectomy (LC) and practiced basic skills with box trainers. The VR group (n = 42) trained basic skills and LC on the LAP Mentor II (Simbionix, Cleveland, OH). Each group trained 3 × 4 hours followed by a knowledge test concerning LC. Blinded raters assessed the operative performance of cadaveric porcine LC using the Objective Structured Assessment of Technical Skills (OSATS). The LC was discontinued when it was not completed within 80 min. Students evaluated their training modality with questionnaires. The VR group completed the LC significantly faster and more often within 80 min than BL (45% v 21%, P = .02). The BL group scored higher than the VR group in the knowledge test (13.3 ± 1.3 vs 11.0 ± 1.7, P < 0.001). Both groups showed equal operative performance of LC in the OSATS score (49.4 ± 10.5 vs 49.7 ± 12.0, P = 0.90). Students generally liked training and felt well prepared for assisting in laparoscopic surgery. The efficiency of the training was judged higher by the VR group than by the BL group. VR and BL can both be applied for training the basics of LC. Multimodality training programs should be developed that combine the advantages of both approaches. PMID:25997044

  15. Laparoscopic excision of infarcted accessory spleen.

    PubMed

    Yousef, Yasmin; Cameron, Brian H; Maizlin, Zeev V; Boutross-Tadross, Odette

    2010-04-01

    An accessory spleen is present in about 10-30% of the population and, usually, does not cause symptoms. We present a case report of an unusual presentation of accessory spleen infarction, with a literature review. A 12-year old male presented with acute left-upper quadrant pain that slowly resolved. An ultrasound and computed tomography scan showed a 3.5 x 2.5 x 2 cm solid mass abutting and displacing the splenic flexure of the colon, with surrounding inflammatory changes. This was interpreted as a colonic duplication cyst, and the boy was treated with antibiotics and underwent elective laparoscopic exploration. It was removed laparoscopically without complication and, on pathologic examination, proved to be consistent with an infarcted accessory spleen. Less than two dozen similar cases of accessory spleen infarction have been reported in the literature, most presenting with acute abdominal pain. Preoperative diagnoses included appendicitis, ovarian torsion, neoplasm, and, in our case, colonic duplication. The natural course of infarcted accessory spleen would be to atrophy, but, even with advanced imaging techniques, it may be impossible to diagnose infarcted accessory spleen with enough confidence to avoid surgery.

  16. Laparoscopic partial nephrectomy and wedge resection.

    PubMed

    Kozlowski, P M; Winfield, H N

    2000-12-01

    Partial nephrectomy is a more challenging operation than radical or simple nephrectomy, primarily because of the risk of complications such as bleeding. This problem is even more troublesome with minimally invasive approaches because of the dearth of effective hemostatic instruments and supplies. The location of the lesion determines whether a transperitoneal or a retroperitoneal route will be employed. Centrally located or anterior renal lesions generally are approached transperitoneally whereas peripheral lateral or posterior lesions are accessed by retroperitoneoscopy. The Harmonic Scalpel with slow cutting and high coagulation settings is useful for incising the renal capsule and parenchyma. The argon beam coagulator is helpful to stop any persistent bleeding. The few reported series of laparoscopic partial nephrectomy indicate considerably longer operative times than are needed for open surgery and hospitalization of upwards of 5 days, largely to monitor drainage and urine leakage. It is hoped that this advanced laparoscopic technique will become more user friendly with further developments in techniques and instrumentation to provide patients with the expected benefits of minimally invasive surgery.

  17. Laparoscopic and robot-assisted gastrectomy for gastric cancer: Current considerations.

    PubMed

    Caruso, Stefano; Patriti, Alberto; Roviello, Franco; De Franco, Lorenzo; Franceschini, Franco; Coratti, Andrea; Ceccarelli, Graziano

    2016-07-01

    Radical gastrectomy with an adequate lymphadenectomy is the main procedure which makes it possible to cure patients with resectable gastric cancer (GC). A number of randomized controlled trials and meta-analysis provide phase III evidence that laparoscopic gastrectomy is technically safe and that it yields better short-term outcomes than conventional open gastrectomy for early-stage GC. While laparoscopic gastrectomy has become standard therapy for early-stage GC, especially in Asian countries such as Japan and South Korea, the use of minimally invasive techniques is still controversial for the treatment of more advanced tumours, principally due to existing concerns about its oncological adequacy and capacity to carry out an adequately extended lymphadenectomy. Some intrinsic drawbacks of the conventional laparoscopic technique have prevented the worldwide spread of laparoscopic gastrectomy for cancer and, despite technological advances in recent year, it remains a technically challenging procedure. The introduction of robotic surgery over the last ten years has implied a notable mutation of certain minimally invasive procedures, making it possible to overcome some limitations of the traditional laparoscopic technique. Robot-assisted gastric resection with D2 lymph node dissection has been shown to be safe and feasible in prospective and retrospective studies. However, to date there are no high quality comparative studies investigating the advantages of a robotic approach to GC over traditional laparoscopic and open gastrectomy. On the basis of the literature review here presented, robot-assisted surgery seems to fulfill oncologic criteria for D2 dissection and has a comparable oncologic outcome to traditional laparoscopic and open procedure. Robot-assisted gastrectomy was associated with the trend toward a shorter hospital stay with a comparable morbidity of conventional laparoscopic and open gastrectomy, but randomized clinical trials and longer follow-ups are

  18. Laparoscopic and robot-assisted gastrectomy for gastric cancer: Current considerations

    PubMed Central

    Caruso, Stefano; Patriti, Alberto; Roviello, Franco; De Franco, Lorenzo; Franceschini, Franco; Coratti, Andrea; Ceccarelli, Graziano

    2016-01-01

    Radical gastrectomy with an adequate lymphadenectomy is the main procedure which makes it possible to cure patients with resectable gastric cancer (GC). A number of randomized controlled trials and meta-analysis provide phase III evidence that laparoscopic gastrectomy is technically safe and that it yields better short-term outcomes than conventional open gastrectomy for early-stage GC. While laparoscopic gastrectomy has become standard therapy for early-stage GC, especially in Asian countries such as Japan and South Korea, the use of minimally invasive techniques is still controversial for the treatment of more advanced tumours, principally due to existing concerns about its oncological adequacy and capacity to carry out an adequately extended lymphadenectomy. Some intrinsic drawbacks of the conventional laparoscopic technique have prevented the worldwide spread of laparoscopic gastrectomy for cancer and, despite technological advances in recent year, it remains a technically challenging procedure. The introduction of robotic surgery over the last ten years has implied a notable mutation of certain minimally invasive procedures, making it possible to overcome some limitations of the traditional laparoscopic technique. Robot-assisted gastric resection with D2 lymph node dissection has been shown to be safe and feasible in prospective and retrospective studies. However, to date there are no high quality comparative studies investigating the advantages of a robotic approach to GC over traditional laparoscopic and open gastrectomy. On the basis of the literature review here presented, robot-assisted surgery seems to fulfill oncologic criteria for D2 dissection and has a comparable oncologic outcome to traditional laparoscopic and open procedure. Robot-assisted gastrectomy was associated with the trend toward a shorter hospital stay with a comparable morbidity of conventional laparoscopic and open gastrectomy, but randomized clinical trials and longer follow-ups are

  19. Laparoscopic and robot-assisted gastrectomy for gastric cancer: Current considerations.

    PubMed

    Caruso, Stefano; Patriti, Alberto; Roviello, Franco; De Franco, Lorenzo; Franceschini, Franco; Coratti, Andrea; Ceccarelli, Graziano

    2016-07-01

    Radical gastrectomy with an adequate lymphadenectomy is the main procedure which makes it possible to cure patients with resectable gastric cancer (GC). A number of randomized controlled trials and meta-analysis provide phase III evidence that laparoscopic gastrectomy is technically safe and that it yields better short-term outcomes than conventional open gastrectomy for early-stage GC. While laparoscopic gastrectomy has become standard therapy for early-stage GC, especially in Asian countries such as Japan and South Korea, the use of minimally invasive techniques is still controversial for the treatment of more advanced tumours, principally due to existing concerns about its oncological adequacy and capacity to carry out an adequately extended lymphadenectomy. Some intrinsic drawbacks of the conventional laparoscopic technique have prevented the worldwide spread of laparoscopic gastrectomy for cancer and, despite technological advances in recent year, it remains a technically challenging procedure. The introduction of robotic surgery over the last ten years has implied a notable mutation of certain minimally invasive procedures, making it possible to overcome some limitations of the traditional laparoscopic technique. Robot-assisted gastric resection with D2 lymph node dissection has been shown to be safe and feasible in prospective and retrospective studies. However, to date there are no high quality comparative studies investigating the advantages of a robotic approach to GC over traditional laparoscopic and open gastrectomy. On the basis of the literature review here presented, robot-assisted surgery seems to fulfill oncologic criteria for D2 dissection and has a comparable oncologic outcome to traditional laparoscopic and open procedure. Robot-assisted gastrectomy was associated with the trend toward a shorter hospital stay with a comparable morbidity of conventional laparoscopic and open gastrectomy, but randomized clinical trials and longer follow-ups are

  20. [Laparoscopic surgery in day surgery].

    PubMed

    Micali, S; Bitelli, M; Torelli, F; Valitutti, M; Micali, F

    1998-06-01

    Since ten years laparoscopic techniques have been employed as alternatives of many established open procedures in gynecologic, abdominal and finally urologic surgery. Laparoscopic techniques show significant advantages compared to open surgery, such as less hospitalization, reduced need of analgesic drugs, quick return to daily activities and far a better cosmetic results. Laparoscopic surgery has been advocated for urologic, uro-gynecologic and andrologic diseases. Since 1983 one-day surgery was proposed for only a few gynecologic and abdominal procedures and only recently for laparoscopic renal biopsy and abdominal testis evaluation. In these preliminary experiences the conditions for a correct management of laparoscopic one-day surgery have been clearly pointed out: 1. correct surgical indication; 2. through knowledge of surgical technique; 3. duration of the procedure less than 90 minutes; 4. correct anesthesia. Technique of anesthesia must be adapted to the surgical procedure required, its duration and the physical features of the patient. General anesthesia is usually preferred for either longer and more complex procedures or when a higher abdominal insufflation pressure is needed. Spinal or local anesthesia are preferred for simpler procedures or when only one trocar is required. At date only few urologic procedures seem to be suitable to one-day laparoscopic surgery. 1) Varicocele: although laparoscopic varicocelectomy in one-day surgery has never been reported previously, it can be performed in a short time, only 3 trocars are needed and insufflation pressure can be maintained within 15 mm Hg. 2) Renal biopsy and marsupialization of renal cysts. These are usually managed percutaneously but in some particular indications procedures under direct vision should be preferable. Both are short-lasting and only superficial general anesthesia is required; as surgical access is retroperitoneal only two trocars are sufficient; at date only renal biopsies have

  1. Laparoscopic Single Site Adrenalectomy Using a Conventional Laparoscope and Instrumentation

    PubMed Central

    Colon, Modesto J; LeMasters, Patrick; Newell, Phillipa; Divino, Celia; Weber, Kaare J.

    2011-01-01

    Background and Objectives: We present a case of Laparoendoscopic Single Site Surgery (LESS) left adrenalectomy performed with a conventional laparoscope and instruments. Methods: A 45-year-old male was diagnosed with hyperaldosteronism. Computed tomography detected a left adrenal nodule. Bilateral adrenal vein sampling was consistent with a left-sided source for hyperaldosteronism. Results: Total operative time for LESS left adrenalectomy was 120 minutes. The surgery was performed with conventional instruments, a standard 5-mm laparoscope, and a SILS port, with no additional incisions or trocars needed. No complications occurred, and the patient reported an uneventful recovery. Conclusions: LESS adrenalectomy is a feasible procedure. Although articulating instruments and laparoscopes may offer advantages, LESS adrenalectomy can be done without these. PMID:21902983

  2. Laparoscopic approach in gastrointestinal emergencies.

    PubMed

    Jimenez Rodriguez, Rosa M; Segura-Sampedro, Juan José; Flores-Cortés, Mercedes; López-Bernal, Francisco; Martín, Cristobalina; Diaz, Verónica Pino; Ciuro, Felipe Pareja; Ruiz, Javier Padillo

    2016-03-01

    This review focuses on the laparoscopic approach to gastrointestinal emergencies and its more recent indications. Laparoscopic surgery has a specific place in elective procedures, but that does not apply in emergency situations. In specific emergencies, there is a huge range of indications and different techniques to apply, and not all of them are equally settle. We consider that the most controversial points in minimally invasive procedures are indications in emergency situations due to technical difficulties. Some pathologies, such as oesophageal emergencies, obstruction due to colon cancer, abdominal hernias or incarcerated postsurgical hernias, are nearly always resolved by conventional surgery, that is, an open approach due to limited intraabdominal cavity space or due to the vulnerability of the bowel. These technical problems have been solved in many diseases, such as for perforated peptic ulcer or acute appendectomy for which a laparoscopic approach has become a well-known and globally supported procedure. On the other hand, endoscopic procedures have acquired further indications, relegating surgical solutions to a second place; this happens in cholangitis or pancreatic abscess drainage. This endoluminal approach avoids the need for laparoscopic development in these diseases. Nevertheless, new instruments and new technologies could extend the laparoscopic approach to a broader array of potentials procedures. There remains, however, a long way to go. PMID:26973409

  3. Laparoscopic approach in gastrointestinal emergencies

    PubMed Central

    Jimenez Rodriguez, Rosa M; Segura-Sampedro, Juan José; Flores-Cortés, Mercedes; López-Bernal, Francisco; Martín, Cristobalina; Diaz, Verónica Pino; Ciuro, Felipe Pareja; Ruiz, Javier Padillo

    2016-01-01

    This review focuses on the laparoscopic approach to gastrointestinal emergencies and its more recent indications. Laparoscopic surgery has a specific place in elective procedures, but that does not apply in emergency situations. In specific emergencies, there is a huge range of indications and different techniques to apply, and not all of them are equally settle. We consider that the most controversial points in minimally invasive procedures are indications in emergency situations due to technical difficulties. Some pathologies, such as oesophageal emergencies, obstruction due to colon cancer, abdominal hernias or incarcerated postsurgical hernias, are nearly always resolved by conventional surgery, that is, an open approach due to limited intraabdominal cavity space or due to the vulnerability of the bowel. These technical problems have been solved in many diseases, such as for perforated peptic ulcer or acute appendectomy for which a laparoscopic approach has become a well-known and globally supported procedure. On the other hand, endoscopic procedures have acquired further indications, relegating surgical solutions to a second place; this happens in cholangitis or pancreatic abscess drainage. This endoluminal approach avoids the need for laparoscopic development in these diseases. Nevertheless, new instruments and new technologies could extend the laparoscopic approach to a broader array of potentials procedures. There remains, however, a long way to go. PMID:26973409

  4. Laparoscopic radical nephrectomy with inferior vena cava thrombectomy: highlight of key surgical steps

    PubMed Central

    Sim, A.; Todenhöfer, T.; Mischinger, J.; Fahmy, O.; Boettge, J.; Rausch, S.; Bier, S.; Aufderklamm, S.; Stenzl, A.; Gakis, G.; Schwentner, C.

    2016-01-01

    ABSTRACT Objective: Vascular involvement in the form of renal vein (RV) or inferior vena cava (IVC) thrombus can be seen in 4-10% of patients presented with RCC. In patients without presence of metastasis, surgical treatment in the form of radical nephrectomy remains the treatment of choice with 5-year survival rates of 45-70%. Open surgery is still the first treatment option of choice at the moment for RCC patients with IVC thrombus. Materials and Methods: In our study, we are reporting a case of patient with RCC and level I IVC thrombus treated with laparoscopy. Our patient is a 72 years old man with underlying co-morbidity of hypertension and chronic kidney disease (CKD) presented with right-sided RCC. The CT scan done showed a large right renal upper pole tumor measuring 8.4x5.2cm with level I IVC thrombus (Figure-1). There were no regional lymphadenopathy and the staging scans were negative. Results: The operative time was 124 minutes and blood loss was minimal. The patient was progressed to diet on POD 1 with bowel movement on POD 2. There was no significant change in the pre and post-operative glomerular filtration rate (GFR). The surgical drain was removed on POD2. The patient was discharged well on POD 5. There were no perioperative complications. The pathology was pT3bN0M0 Fuhrman grade II clear cell RCC. Conclusions: As a conclusion, laparoscopic radical nephrectomy and IVC thrombectomy is a complex and technically demanding surgery. With advancement of surgical skills as well as technology, more cases of minimally invasive laparoscopic radical nephrectomy and IVC thrombectomy can performed to improve the perioperative outcomes of carefully selected patients in a high volume center. PMID:27564306

  5. Comparison of a flexible-tip laparoscope with a rigid straight laparoscope for single-incision laparoscopic cholecystectomy.

    PubMed

    Matsui, Yoichi; Ryota, Hironori; Sakaguchi, Tatsuma; Nakatani, Kazuyoshi; Matsushima, Hideyuki; Yamaki, So; Hirooka, Satoshi; Yamamoto, Tomohisa; Kwon, A-Hon

    2014-12-01

    This study assessed whether a flexible-tip laparoscope improves operative outcomes including operative length while performing single-incision laparoscopic cholecystectomy (SILC) compared with the use of a conventional straight laparoscope. The flexible-tip laparoscope decreased the operative time compared with the straight laparoscope. Although SILC has potential benefits, surgeons experience problems for in-line viewing through a laparoscope and from contact of instruments with the laparoscope, resulting in longer operative times and the need for additional ports. The aim of this study was to determine whether a flexible-tip laparoscope improves operative outcomes, including operative length and the rate of insertion of additional ports, while performing SILC compared with the use of a conventional rigid straight laparoscope. We reviewed data on patients for whom we performed SILC at the Department of Surgery, Kansai Medical University, for the period from November 1, 2009, to February 28, 2013. The information was assessed with respect to patient characteristics, types of laparoscope used, operative data as well as postoperative outcomes. Operating time for SILC using the flexible-tip laparoscope was significantly shorter than with the straight laparoscope (81.5 ± 23.2 vs 94.4 ± 21.1 minutes) as a result of a better view of the operating field without contact with working instruments. Although a trend was shown toward a reduced rate of the need for extra ports in the flexible-tip laparoscope group, the difference did not reach statistical significance. Using the flexible-tip laparoscope solved the problem of in-line viewing and decreased the operative time for SILC.

  6. Machine Tool Advanced Skills Technology (MAST). Common Ground: Toward a Standards-Based Training System for the U.S. Machine Tool and Metal Related Industries. Volume 12: Instrumentation, of a 15-Volume Set of Skill Standards and Curriculum Training Materials for the Precision Manufacturing Industry.

    ERIC Educational Resources Information Center

    Texas State Technical Coll., Waco.

    This document is intended to help education and training institutions deliver the Machine Tool Advanced Skills Technology (MAST) curriculum to a variety of individuals and organizations. MAST consists of industry-specific skill standards and model curricula for 15 occupational specialty areas within the U.S. machine tool and metals-related…

  7. Machine Tool Advanced Skills Technology (MAST). Common Ground: Toward a Standards-Based Training System for the U.S. Machine Tool and Metal Related Industries. Volume 10: Computer-Aided Drafting & Design, of a 15-Volume Set of Skill Standards and Curriculum Training Materials for the Precision Manufacturing Industry.

    ERIC Educational Resources Information Center

    Texas State Technical Coll., Waco.

    This document is intended to help education and training institutions deliver the Machine Tool Advanced Skills Technology (MAST) curriculum to a variety of individuals and organizations. MAST consists of industry-specific skill standards and model curricula for 15 occupational specialty areas within the U.S. machine tool and metals-related…

  8. Machine Tool Advanced Skills Technology (MAST). Common Ground: Toward a Standards-Based Training System for the U.S. Machine Tool and Metal Related Industries. Volume 2: Career Development, General Education and Remediation, of a 15-Volume Set of Skill Standards and Curriculum Training Materials for the Precision Manufacturing Industry.

    ERIC Educational Resources Information Center

    Texas State Technical Coll., Waco.

    This document is intended to help education and training institutions deliver the Machine Tool Advanced Skills Technology (MAST) curriculum to a variety of individuals and organizations. MAST consists of industry-specific skill standards and model curricula for 15 occupational specialty areas within the U.S. machine tool and metals-related…

  9. Machine Tool Advanced Skills Technology (MAST). Common Ground: Toward a Standards-Based Training System for the U.S. Machine Tool and Metal Related Industries. Volume 5: Mold Making, of a 15-Volume Set of Skill Standards and Curriculum Training Materials for the Precision Manufacturing Industry.

    ERIC Educational Resources Information Center

    Texas State Technical Coll., Waco.

    This document is intended to help education and training institutions deliver the Machine Tool Advanced Skills Technology (MAST) curriculum to a variety of individuals and organizations. MAST consists of industry-specific skill standards and model curricula for 15 occupational speciality areas within the U.S. machine tool and metals-related…

  10. Machine Tool Advanced Skills Technology (MAST). Common Ground: Toward a Standards-Based Training System for the U.S. Machine Tool and Metal Related Industries. Volume 8: Sheet Metal & Composites, of a 15-Volume Set of Skill Standards and Curriculum Training Materials for the Precision Manufacturing Industry.

    ERIC Educational Resources Information Center

    Texas State Technical Coll., Waco.

    This document is intended to help education and training institutions deliver the Machine Tool Advanced Skills Technology (MAST) curriculum to a variety of individuals and organizations. MAST consists of industry-specific skill standards and model curricula for 15 occupational specialty areas within the U.S. machine tool and metals-related…

  11. Machine Tool Advanced Skills Technology (MAST). Common Ground: Toward a Standards-Based Training System for the U.S. Machine Tool and Metal Related Industries. Volume 4: Manufacturing Engineering Technology, of a 15-Volume Set of Skill Standards and Curriculum Training Materials for the Precision Manufacturing Industry.

    ERIC Educational Resources Information Center

    Texas State Technical Coll., Waco.

    This document is intended to help education and training institutions deliver the Machine Tool Advanced Skills Technology (MAST) curriculum to a variety of individuals and organizations. MAST consists of industry-specific skill standards and model curricula for 15 occupational specialty areas within the U.S. machine tool and metals-related…

  12. Machine Tool Advanced Skills Technology (MAST). Common Ground: Toward a Standards-Based Training System for the U.S. Machine Tool and Metal Related Industries. Volume 3: Machining, of a 15-Volume Set of Skill Standards and Curriculum Training Materials for the Precision Manufacturing Industry.

    ERIC Educational Resources Information Center

    Texas State Technical Coll., Waco.

    This document is intended to help education and training institutions deliver the Machine Tool Advanced Skills Technology (MAST) curriculum to a variety of individuals and organizations. MAST consists of industry-specific skill standards and model curricula for 15 occupational specialty areas within the U.S. machine tool and metals-related…

  13. Machine Tool Advanced Skills Technology (MAST). Common Ground: Toward a Standards-Based Training System for the U.S. Machine Tool and Metal Related Industries. Volume 9: Tool and Die, of a 15-Volume Set of Skill Standards and Curriculum Training Materials for the Precision Manufacturing Industry.

    ERIC Educational Resources Information Center

    Texas State Technical Coll., Waco.

    This document is intended to help education and training institutions deliver the Machine Tool Advanced Skills Technology (MAST) curriculum to a variety of individuals and organizations. MAST consists of industry-specific skill standards and model curricula for 15 occupational specialty areas within the U.S. machine tool and metals-related…

  14. Machine Tool Advanced Skills Technology (MAST). Common Ground: Toward a Standards-Based Training System for the U.S. Machine Tool and Metal Related Industries. Volume 7: Industrial Maintenance Technology, of a 15-Volume Set of Skill Standards and Curriculum Training Materials for the Precision Manufacturing Industry.

    ERIC Educational Resources Information Center

    Texas State Technical Coll., Waco.

    This document is intended to help education and training institutions deliver the Machine Tool Advanced Skills Technology (MAST) curriculum to a variety of individuals and organizations. MAST consists of industry-specific skill standards and model curricula for 15 occupational specialty areas within the U.S. machine tool and metals-related…

  15. Machine Tool Advanced Skills Technology (MAST). Common Ground: Toward a Standards-Based Training System for the U.S. Machine Tool and Metal Related Industries. Volume 14: Automated Equipment Technician (CIM), of a 15-Volume Set of Skill Standards and Curriculum Training Materials for the Precision Manufacturing Industry.

    ERIC Educational Resources Information Center

    Texas State Technical Coll., Waco.

    This document is intended to help education and training institutions deliver the Machine Tool Advanced Skills Technology (MAST) curriculum to a variety of individuals and organizations. MAST consists of industry-specific skill standards and model curricula for 15 occupational specialty areas within the U.S. machine tool and metals-related…

  16. Machine Tool Advanced Skills Technology (MAST). Common Ground: Toward a Standards-Based Training System for the U.S. Machine Tool and Metal Related Industries. Volume 13: Laser Machining, of a 15-Volume Set of Skill Standards and Curriculum Training Materials for the Precision Manufacturing Industry.

    ERIC Educational Resources Information Center

    Texas State Technical Coll., Waco.

    This document is intended to help education and training institutions deliver the Machine Tool Advanced Skills Technology (MAST) curriculum to a variety of individuals and organizations. MAST consists of industry-specific skill standards and model curricula for 15 occupational specialty areas within the U.S. machine tool and metals-related…

  17. Machine Tool Advanced Skills Technology (MAST). Common Ground: Toward a Standards-Based Training System for the U.S. Machine Tool and Metal Related Industries. Volume 6: Welding, of a 15-Volume Set of Skill Standards and Curriculum Training Materials for the Precision Manufacturing Industry.

    ERIC Educational Resources Information Center

    Texas State Technical Coll., Waco.

    This document is intended to help education and training institutions deliver the Machine Tool Advanced Skills Technology (MAST) curriculum to a variety of individuals and organizations. MAST consists of industry-specific skill standards and model curricula for 15 occupational specialty areas within the U.S. machine tool and metals-related…

  18. Laparoscopic cryptorchidectomy in standing bulls

    PubMed Central

    KANEKO, Yasuyuki; TORISU, Shidow; KITAHARA, Go; HIDAKA, Yuichi; SATOH, Hiroyuki; ASANUMA, Taketoshi; MIZUTANI, Shinya; OSAWA, Takeshi; NAGANOBU, Kiyokazu

    2015-01-01

    Laparoscopic cryptorchidectomy without insufflation was applied in 10 standing bulls aged 3 to 15 months. Nine bulls were preoperatively pointed out intra-abdominal testes by computed tomography. Preoperative fasting for a minimum of 24 hr provided laparoscopic visualization of intra-abdominal area from the kidney to the inguinal region. Surgical procedure was interrupted by intra-abdominal fat and testis size. It took 0.6 to 1.5 hr in 4 animals weighing 98 to 139 kg, 0.8 to 2.8 hr in 4 animals weighing 170 to 187 kg, and 3 and 4 hr in 2 animals weighing 244 and 300 kg to complete the cryptorchidectomy. In conclusion, standing gasless laparoscopic cryptorchidectomy seems to be most suitable for bulls weighing from 100 to 180 kg. PMID:25715955

  19. Laparoscopic telesurgical workstation

    NASA Astrophysics Data System (ADS)

    Cavusoglu, Murat C.; Cohn, Michael B.; Tendick, Frank; Sastry, S. Shankar

    1998-06-01

    Robotic telesurgery is a promising application of robotics to medicine, aiming to enhance the dexterity and sensation of minimally invasive surgery through millimeter-scale manipulators under control of the surgeon. With appropriate communication links, it would also be possible to perform remote surgery for care in rural areas where specialty care is unavailable, or to provide emergency care en route to a hospital. The UC Berkeley/Endorobotics/UCSF Telesurgical Workstation is a master-slave telerobotic system, with two 6 degree of freedom (DOF) robotic manipulators, designed for laparoscopic surgery. The slave robotic has a 2 DOF wrist inside the body to allow high dexterity manipulation in addition to the 4 DOF of motion possible through the entry port, which are actuated by an external gross motion platform. The kinematics and the controller of the system are designed to accommodate the force and movement requirements of complex tasks, including suturing and knot tying. The system has force feedback in 4 axes to improve the sensation of telesurgery. In this paper, the telesurgical system will be introduced with discussion of kinematic and control issues and presentation of in vitro test results.

  20. Laparoscopic reversal of Hartmann's procedure.

    PubMed

    Fiscon, Valentino; Portale, Giuseppe; Mazzeo, Antonio; Migliorini, Giovanni; Frigo, Flavio

    2014-12-01

    Reestablishing continuity after a Hartmann's procedure is considered a major surgical procedure with high morbidity/mortality. The aim of this study was to assess the short-/long-term outcome of laparoscopic restoration of bowel continuity after HP. A prospectively collected database of colorectal laparoscopic procedures (>800) performed between June 2005 and June 2013 was used to identify 20 consecutive patients who had undergone laparoscopic reversal of Hartmann's procedure (LHR). Median age was 65.4. Ten patients (50 %) had undergone surgery for perforated diverticulitis, 3 (15 %) for cancer, and 7 (35 %) for other reasons (volvulus, posttraumatic perforation, and sigmoid perforation from foreign body). Previous HP had been performed laparoscopically in only 3 patients. Median operative time was 162.5 min. All the procedures were completed laparoscopically. Intraoperative complication rate was nil. Post-operative mortality and morbidity were respectively 0 and 10 % (1 pneumonia, 1 bowel obstruction from post-anastomotic stenosis which required resection and redo of the anastomosis). Median time to first flatus was 3 days, to normal diet 5 days. Median hospital stay was 9 days without readmissions. We followed up the patients for a median of 44 months: when asked, all 20 (100 %) said they would undergo the operation (LHR) again; 3 (15 %) had been re-operated of laparoscopic mesh repair for incisional hernia. When performed by experienced surgeons, LHR is a feasible, safe, reproducible operation, which allows early return of bowel function, early discharge and fast return to work for the patient. It has a low morbidity rate.

  1. The Right Jobs: Identifying Career Advancement Opportunities for Low-Skilled Workers. A Guide for Public and Private Sector Workforce Development Practitioners. Advancement for Low-Wage Workers

    ERIC Educational Resources Information Center

    Goldberger, Susan; Lessell, Newell; Biswas, Radha Roy

    2005-01-01

    The Right Jobs provides workforce policymakers and directors of workforce development programs with a structured approach to: (1) Identifying the most promising employment opportunities within reach of low-skill workers; (2) Determining the postsecondary training and career preparation routes that will yield results for their clients; and (3)…

  2. Analysis and physics of laparoscopic intracorporeal square-knot tying.

    PubMed

    Medina, Marelyn

    2005-01-01

    Square knots are often used in open surgery to approximate tissue borders or tie off tubular structures like vessels or ducts. Three common methods are used for surgical square-knot tying: one-hand tying, two-hand tying, and the instrument-tying technique. Two types of suture placements are studied in both the open and laparoscopic surgical fields. The first called equal length has suture segment ends placed at equal distances from the tying site. The second called unequal length has one suture end further away from the tying site than the other. Laparoscopic intracorporeal square-knot tying maneuvers are analyzed herein. Mechanical analysis of square-knot tying movements reveals that regardless of location or method used in construction, all square knots consist of 2 half-knots. For study purposes, these sets of movements are identified in laparoscopy as maneuver A and maneuver B. Further breakout of these maneuvers reveals that they consist of 5 motions. This study reveals that 16 different ways exist to place a square knot by means of the laparoscopic intracorporeal technique. It is likely that difficulty mastering this essential skill is not just the result of poor instrumentation, improper port placement, or the limitations of a 2-dimensional video image. It may also be attributed to mixing up the different square-knot tying techniques during random practice exercises. This is possible if the surgeon is ignorant of the technical variations present in what most people consider a simple task.

  3. Laparoscopic Division of Median Arcuate Ligament for the Celiac Axis Compression Syndrome-Two Case Reports with Review of Literature.

    PubMed

    Ramakrishnan, Parthasarathy; Deuri, Biswajit; Keerthi, M S S; Naidu, Subrahmaneswara Babu; Subbaiah, Rajapandian; Raj, Praveen; Palanisamy, Senthilnathan; Chinnusamy, Palanivelu

    2016-04-01

    Median arcuate ligament (MAL) syndrome is an uncommon condition caused by the external compression of the celiac trunk by the median arcuate ligament. In the current era of technological advancement, this syndrome may be corrected through the laparoscopic approach. We report two patients who were diagnosed as MAL syndrome and underwent laparoscopic division of MAL fibers at our institute. Both the patients improved symptomatically following the procedure and were discharged on the fourth post-operative day. Also, they remained symptom free during subsequent follow-up period of 1 year and 8 months, respectively. Laparoscopic approach to correct the MAL syndrome is feasible and safe. It may be the preferred modality of treatment in view of its superior visualization and lack of morbidity. However, adequate experience in advanced laparoscopic surgery is required before attempting this procedure.

  4. Advancing the IS Curricula: The Identification of Important Communication Skills Needed by IS Staff during Systems Development

    ERIC Educational Resources Information Center

    Miller, Ruth A.; Luse, Donna W.

    2004-01-01

    Although research indicates communication is important among information systems (IS) staff, users, and managers to ensure successful development projects, the ineffective communication skills of IS staff are often cited as a possible cause of failed IS projects. To develop effective systems, communication between IS users and systems developers…

  5. Intake Interview Skills for Rehabilitation Counselors: A Typescript Manual. Advanced Facilitative Case Management Series, Training Package I.

    ERIC Educational Resources Information Center

    Rubin, Stanford E.; Farley, Roy C.

    This guide is the case study manual for the first in a series of instructor-assisted training modules for rehabilitation counselors, supervisors, and graduate students. This typescript manual for the first module focuses on basic intake interviewing skills consisting of: (1) systematic interview programming including attracting, planning and…

  6. Integrating Literacy and Workplace Skills for Worker Advancement. Worker Education Program Final Report, May 1, 1992 - March 31, 1994.

    ERIC Educational Resources Information Center

    Boyter-Escalona, Margaret

    Final evaluation of the Workplace Education Program, funded by the National Workplace Literacy Program to provide workplace literacy education programs to 425 members of Chicago (Illinois) area clothing and textile workers union members, is presented. The program's goal was to enhance workers' basic literacy skills for present job stabilization…

  7. Siegfried the Dragonslayer Meets the Web: Using Digital Media for Developing Historical Awareness and Advanced Language and Critical Thinking Skills

    ERIC Educational Resources Information Center

    Rasmussen, Ann Marie

    2011-01-01

    This article describes an undergraduate, German-language course that aimed to improve students' language skills, critical thinking, and declarative knowledge of German history and culture by studying multiple manifestations of the legend of Siegfried the Dragonslayer. The course used web-based e-learning tools to address two major learning…

  8. Laparoscopic Gastric Banding

    PubMed Central

    Suter, Michel; Giusti, Vittorio; Worreth, Marc; Héraief, Eric; Calmes, Jean-Marie

    2005-01-01

    Objective: The objective of this study was to evaluate the results of laparoscopic gastric banding using 2 different bands (the Lapband [Bioenterics, Carpinteria, CA] and the SAGB [Swedish Adjustable Gastric Band; Obtech Medical, 6310 Zug, Switzerland]) in terms of weight loss and correction of comorbidities, short-and long-term complications, and improvement of quality of life in morbidly obese patients Summary Background Data: During the past 10 years, gastric banding has become 1 of the most common bariatric procedures, at least in Europe and Australia. Weight loss can be excellent, but it is not sufficient in a significant proportion of patients, and a number of long-term complications can develop. We hypothesized that the type of band could be of importance in the outcome. Methods: One hundred eighty morbidly obese patients were randomly assigned to receive the Lapband or the SAGB. All the procedures were performed by the same surgeon. The primary end point was weight loss, and secondary end points were correction of comorbidities, early- and long-term complications, importance of food restriction, and improvement of quality of life. Results: Initial weight loss was faster in the Lapband group, but weight loss was eventually identical in the 2 groups. There was a trend toward more early band-related complications and more band infections with the SAGB, but the study had limited power in that respect. Correction of comorbidities, food restriction, long-term complications, and improvement of quality of life were identical. Only 55% to 60% of the patients achieved an excess weight loss of at least 50% in both groups. There was no difference in the incidence of long-term complications. Conclusions: Gastric banding can be performed safely with the Lapband or the SAGB with similar short- and midterm results with respect to weight loss and morbidity. Only 50% to 60% of the patients will achieve sufficient weight loss, and close to 10% at least will develop severe

  9. Annual repeat rates of laparoscopic surgery: a marker of practice variation.

    PubMed

    Jarrell, John

    2010-01-01

    Use of laparoscopy is an area of interest owing to a previous report of significant numbers of repeat laparoscopic surgery in some women in Alberta, Canada. It was hypothesized that analyzing individual-woman rates of annual repeat procedures documents potential overuse of laparoscopic surgery. Administrative data concerning yearly individual specific laparoscopy experiences were obtained from Alberta Health and Wellness for the years 1996 to 2007. Rates of repeat diagnostic and operative laparoscopic procedures were determined for each fiscal year and analyzed using statistical process control methods. The rate of reoperation for an individual woman for both procedures has "special causes" of variation. Rates of reoperation within the fiscal year varied significantly. The reasons could include operating room access, initial clinical enthusiasm for new surgery, changing surgical skills, and changing processes in decision making. The presence of such variation will require policy initiatives to address high rates of annual repeat procedures. PMID:20833984

  10. Enhancing Extemporaneous Speaking Skills in the Advanced Oral Communication Course and Team Testing Techniques in the Basic Course.

    ERIC Educational Resources Information Center

    Reppert, James E.

    In an advanced oral communication course, students make five major presentations. One of the foundations of extemporaneous speaking is the ability to outline relevant points and phrases in a coherent, orderly manner. Advanced students must be able to take any topic and dissect it quickly to determine the most succinct way to present it to an…

  11. Laparoscopic pyelolithotomy: optimizing surgical technique.

    PubMed

    Salvadó, José A; Guzmán, Sergio; Trucco, Cristian A; Parra, Claudio A

    2009-04-01

    The classic approach to renal stone disease includes shockwave lithotripsy, ureteroscopy or percutaneous nephrolithotripsy, and, in some cases, a combination of both. The usefulness of laparoscopy in this regard remains debated. In this report and video, we present our technique of laparoscopic pyelolithotomy assisted by flexible instrumentation to achieve maximal stone clearance in a selected group of patients.

  12. Laparoscopic paracolostomy hernia mesh repair.

    PubMed

    Virzí, Giuseppe; Giuseppe, Virzí; Scaravilli, Francesco; Francesco, Scaravilli; Ragazzi, Salvatore; Salvatore, Ragazzi; Piazza, Diego; Diego, Piazza

    2007-12-01

    Paracolostomy hernia is a common occurrence, representing a late complication of stoma surgery. Different surgical techniques have been proposed to repair the wall defect, but the lowest recurrence rates are associated with the use of mesh. We present the case report of a patient in which laparoscopic paracolostomy hernia mesh repair has been successfully performed. PMID:18097321

  13. Laparoscopic Resection of Adrenal Teratoma

    PubMed Central

    Vitagliano, Gonzalo; Villeta, Matias; Arellano, Leonardo; Santis, Oscar

    2006-01-01

    Background: Teratoma is a germ-cell tumor that commonly affects the gonads. Its components originate in the ectoderm, endoderm, and mesoderm. Extragonadal occurrence is rare. Teratomas confined to the adrenal gland are exceptional; only 3 cases have been reported in the English-language literature. We report 2 cases of mature teratomas of the adrenal gland that were laparoscopically excised. Methods: Two patients (ages 8 and 61 years) were diagnosed with adrenal teratoma at our institution. Radiological examination showed a solid 8-cm adrenal lesion in both cases. Hormonal assessment was normal. Both patients underwent laparoscopic transperitoneal adrenalectomy. Results: Surgical time was 120 minutes and 50 minutes, respectively. One patient was discharged on postoperative day 2, and the other remained hospitalized until day 10. The latter patient required percutaneous drainage of a retroperitoneal collection. Both tumors were identified as mature cystic teratomas. No evidence was present of recurring disease in either patient. Conclusions: Adrenal teratoma is rare. Laparoscopic transperitoneal adrenalectomy is a feasible, effective technique that enables excellent oncologic results. To our knowledge, this is the first report of laparoscopic adrenalectomy for pure adrenal teratoma. PMID:17575773

  14. Suprapubic approach for laparoscopic appendectomy

    PubMed Central

    Singh, Manish K.; Kumar, Mani K.; Mohan, Lalit

    2013-01-01

    Objective: To evaluate the results of laparoscopic appendectomy using two suprapubic port incisions placed below the pubic hair line. Design: Prospective hospital based descriptive study. Settings: Department of surgery of a tertiary care teaching hospital located in Rohtas district of Bihar. The study was carried out over a period of 11months during November 2011 to September 2012. Participants: Seventy five patients with a diagnosis of acute appendicitis. Materials and Methods: All patients underwent laparoscopic appendectomy with three ports (one 10-mm umbilical for telescope and two 5 mm suprapubic as working ports) were included. Operative time, conversion, complications, hospital stay and cosmetic results were analyzed. Results: Total number of patients was 75 which included 46 (61.33%) females and 29 (38.67%) males with Mean age (±Standard deviation {SD}) at the time of the diagnosis was 30.32 (±8.86) years. Mean operative time was 27.2 (±5.85) min. One (1.33%) patient required conversion to open appendectomy. No one patient developed wound infection or any other complication. Mean hospital stay was 22.34 (±12.18) h. Almost all patients satisfied with their cosmetic results. Conclusion: A laparoscopic approach using two supra pubic ports yields the better cosmetic results and also improves the surgeons working position during laparoscopic appendectomy. Although, this study had shown better cosmetic result and better working position of the surgeon, however it needs further comparative study and randomized controlled trial to confirm our findings. PMID:24082738

  15. Laparoscopic pyelolithotomy: optimizing surgical technique.

    PubMed

    Salvadó, José A; Guzmán, Sergio; Trucco, Cristian A; Parra, Claudio A

    2009-04-01

    The classic approach to renal stone disease includes shockwave lithotripsy, ureteroscopy or percutaneous nephrolithotripsy, and, in some cases, a combination of both. The usefulness of laparoscopy in this regard remains debated. In this report and video, we present our technique of laparoscopic pyelolithotomy assisted by flexible instrumentation to achieve maximal stone clearance in a selected group of patients. PMID:19358685

  16. Impact of advanced cardiac life support‐skilled paramedics on survival from out‐of‐hospital cardiac arrest in a statewide emergency medical service

    PubMed Central

    Woodall, John; McCarthy, Molly; Johnston, Trisha; Tippett, Vivienne

    2007-01-01

    Background Prehospital research has found little evidence in support of advanced cardiac life support (ACLS) for out‐of‐hospital cardiac arrest. However, these studies generally examine city‐based emergency medical services (EMS) systems. The training and experience of ACLS‐skilled paramedics differs internationally, and this may also contribute to negative findings. Additionally, the frequency of negative outcome in out‐of‐hospital cardiac arrest suggests that it is difficult to establish sufficient numbers to detect an effect. Purpose To examine the effect of ACLS on cardiac arrest in Queensland, Australia. Queensland has a population of 3.8 million and an area of over 1.7 million km2, and is served by a statewide EMS system, which deploys resources using a two‐tier model. Advanced treatments such as intubation and cardioactive drug administration are provided by extensively trained intensive care paramedics. Methods An observational, retrospective design was used to examine all cases of cardiac arrest attended by the Queensland Ambulance Service from January 2000 to December 2002. Logistic regression was used to examine the effect of the presence of an intensive care paramedic on survival to hospital discharge, adjusting for age, sex, initial rhythm, the presence of a witness and bystander cardiopulmonary resuscitation. Results The presence of an intensive care paramedic had a significant effect on survival (OR = 1.43, 95% CI = 1.02 to 1.99). Conclusions Highly trained ACLS‐skilled paramedics provide added survival benefit in EMS systems not optimised for early defibrillation. The reasons for this benefit are multifactorial, but may be the result of greater skill level and more informed use of the full range of prehospital interventions. PMID:17251628

  17. Laparoscopic colorectal surgery: Current status and implementation of the latest technological innovations

    PubMed Central

    Pascual, Marta; Salvans, Silvia; Pera, Miguel

    2016-01-01

    The introduction of laparoscopy is an example of surgical innovation with a rapid implementation in many areas of surgery. A large number of controlled studies and meta-analyses have shown that laparoscopic colorectal surgery is associated with the same benefits than other minimally invasive procedures, including lesser pain, earlier recovery of bowel transit and shorter hospital stay. On the other hand, despite initial concerns about oncological safety, well-designed prospective randomized multicentre trials have demonstrated that oncological outcomes of laparoscopy and open surgery are similar. Although the use of laparoscopy in colorectal surgery has increased in recent years, the percentages of patients treated with surgery using minimally invasive techniques are still reduced and there are also substantial differences among centres. It has been argued that the limiting factor for the use of laparoscopic procedures is the number of surgeons with adequate skills to perform a laparoscopic colectomy rather than the tumour of patients’ characteristics. In this regard, future efforts to increase the use of laparoscopic techniques in colorectal surgery will necessarily require more efforts in teaching surgeons. We here present a review of recent controversies of the use of laparoscopy in colorectal surgery, such as in rectal cancer operations, the possibility of reproducing complete mesocolon excision, and the benefits of intra-corporeal anastomosis after right hemicolectomy. We also describe the results of latest innovations such as single incision laparoscopic surgery, robotic surgery and natural orifice transluminal endoscopic surgery for colon and rectal diseases. PMID:26811618

  18. Training of basic laparoscopy skills on SimSurgery SEP.

    PubMed

    Buzink, Sonja N; Goossens, Richard H M; De Ridder, Huib; Jakimowicz, Jack J

    2010-01-01

    The aim of this study was to assess the performance curve for novices training in bimanual tissue manipulation and angled laparoscope navigation, and compare those performances with the performances of experienced laparoscopic surgeons. The Camera Navigation task with a 30 degrees angled laparoscope and the Place Arrow task of the new SimSurgery SEP virtual reality simulator were used. Fourteen medical trainees (no laparoscopy experience) performed four training sessions within one week, including 15 repetitions of each task in total. The experienced participants (>50 procedures & familiar with angled laparoscope) performed each task twice. The performance on both tasks by the novices improved significantly over the training sessions. The experienced participants performed both tasks significantly better than the novices in repetition 3. After repetition 15, the performances of the novices on both tasks were of the same level as the performances of the experienced participants. By training on SimSurgery SEP, medical trainees can extensively improve their skills in navigation with 30 degrees angled laparoscope and bimanual tissue manipulation. Further research should focus on the transfer of skills acquired on the simulator to the clinical setting. Knowledge on proficiency thresholds and training end-points for pre-clinical criterion-based training of different laparoscopic tasks also needs to be extended.

  19. Enhanced vision system for laparoscopic surgery.

    PubMed

    Tamadazte, Brahim; Fiard, Gaelle; Long, Jean-Alexandre; Cinquin, Philippe; Voros, Sandrine

    2013-01-01

    Laparoscopic surgery offers benefits to the patients but poses new challenges to the surgeons, including a limited field of view. In this paper, we present an innovative vision system that can be combined with a traditional laparoscope, and provides the surgeon with a global view of the abdominal cavity, bringing him or her closer to open surgery conditions. We present our first experiments performed on a testbench mimicking a laparoscopic setup: they demonstrate an important time gain in performing a complex task consisting bringing a thread into the field of view of the laparoscope.

  20. Immune Thrombocytopenic Purpura During Pregnancy: Laparoscopic Treatment

    PubMed Central

    Anglin, Beth V.; Rutherford, Cynthia; Ramus, Ronald; Lieser, Mark

    2001-01-01

    Background and Objectives: Laparoscopic surgical techniques in pregnancy have been accepted and pose minimal risks to the patient and fetus. We present the first reported case of a pregnant woman with immune thrombocytopenia purpura who underwent laparoscopic splenectomy during the second trimester. Methods and Results: The anesthesia, hematology, and obstetrics services closely followed the patient's preoperative and intraoperative courses. After receiving immunization, stress dose steroids, and prophylactic antibiotics, she underwent a successful laparoscopic splenectomy. After a short hospital stay, the patient was discharged home. Conclusion: Immune thrombocytopenia purpura can be an indication for splenectomy. As demonstrated in appendectomy, cholecystectomy, and our case presentation, laparoscopic splenectomy can be safely performed during pregnancy. PMID:11303997

  1. Laparoscopic renal surgery for benign disease.

    PubMed

    Liao, Joseph C; Breda, Alberto; Schulam, Peter G

    2007-01-01

    Fifteen years after the first report, laparoscopic nephrectomy has demonstrated proven efficacy and safety comparable with an open approach, with a significant advantage of a faster recovery. Wide dissemination of these surgical techniques and continued improvement in instrumentation has made laparoscopy the preferred approach for treating benign pathologic conditions of the kidney. In this review, the expanding indications of laparoscopic simple nephrectomy and the outcomes of the larger clinical series are examined. We discuss the technical aspects of both transperitoneal and retroperitoneal approaches. Finally, laparoscopic cyst decortication and some of the novel applications of laparoscopic renal surgery are highlighted.

  2. Laparoscopic ovariectomy in dogs: comparison between laparoendoscopic single-site and three-portal access

    PubMed Central

    Díaz-Güemes Martin-Portugués, Idoia; Fresno Bermejo, Laura; Sánchez-Margallo, Francisco Miguel

    2015-01-01

    This study was conducted to evaluate the feasibility and therapeutic safety of laparoendoscopic single-site ovariectomy (LESS-OVE) and 3-portal laparoscopic ovariectomy (Lap-OVE) in dogs. Ten female mixed breed dogs were included in the study. Dogs were divided into group 1 (LESS-OVE; n = 5) and group 2 (Lap-OVE; n = 5). All procedures were performed by laparoscopic-skilled surgeons, and the anesthetic protocol was the same for all patients. In both groups, the ovarian vascular pedicle and ligaments were transected using a bipolar vessel sealer/divider device. The mean total surgical time was slightly longer in LESS-OVE (36.6 ± 3.5 min) than Lap-OVE (32.0 ± 3.0 min); however, the differences were not significant. Perioperative complications were not reported in any group. Both laparoscopic techniques were shown to be equally feasible and safe for patients. However, surgeons found LESS-OVE to require more skill than Lap-OVE. Therefore, additional studies should be conducted to evaluate this novel approach in clinical veterinary practice, and a proper laparoscopic training program for veterinary surgeons should be developed. PMID:26119164

  3. Continuing the cultural competency journey through exploration of knowledge, attitudes, and skills with advanced practice psychiatric nursing students: an exemplar.

    PubMed

    Hoke, Mary M; Robbins, Leslie K

    2011-06-01

    Numerous training and education programs have evolved to address culturally competent health care delivery. This article describes an exemplar educational approach used to teach cultural competency to beginning graduate psychiatric mental health nursing students. Using interactive strategies delivered within the 4 phases of the curriculum, the approach has been shown to facilitate students' ongoing journey to cultural competence. Building on baccalaureate nursing competencies, the course addresses attitudes, knowledge, skills, and cultural humility to strengthen cultural self-assessment, cross-cultural clinical practice expertise, and the use of culturally appropriate research for graduate students.

  4. Evaluation of a laparoscopic training program with or without robotic assistance.

    PubMed

    Letouzey, V; Huberlant, S; Faillie, J L; Prudhomme, M; Mares, P; de Tayrac, R

    2014-10-01

    The aim of the present study was to evaluate the value of a box trainer simulator in laparoscopy training. A further aim was to determine if robotic-assisted approaches further improved the young residents' skills in laparoscopic surgery. The study was a prospective randomized study. Twelve residents in obstetrics & gynecology completed four laparoscopy-related procedures of varying complexity using a box trainer simulator. Participants were randomized into two groups; robotic-assisted laparoscopy (LRA) and traditional laparoscopy (TL). All subjects were assessed with a time and technical score, which are quantitative and qualitative approaches (respectively). All residents completed the training and a satisfaction questionnaire, which confirmed that the training was well regarded. Regardless of the workshop type, there was a clear time and technical improvement for the difficult tasks. The improvement of time score was most apparent for simple tasks in LRA and for more complex tasks in TL. After training, we did not find a significant difference for the technical score between Novices and Experts in TL and LRA. These findings suggest that training in laparoscopy surgery is useful, reproducible and well accepted by both novice and more advanced trainees. Furthermore, gynecological endoscopy center consider including robotic-assisted approaches in their surgical training program.

  5. Virtual reality thread simulation for laparoscopic suturing training.

    PubMed

    Figueras Sola, Pablo J; Rodriguez Bescós, Samuel; Lamata, Pablo; Pagador, J Blas; Sánchez-Margallo, Francisco M; Gómez, Enrique J

    2006-01-01

    The level of realism in virtual reality trainers might not be proportional to its didactic value. As an example, three exercises to train suturing skills are proposed in this article. They use a discrete thread model with a simple but good enough behaviour, and constitute a training means for three laparoscopic skills: (1) Accurate grasping, which trains grasping a precise point in the thread. (2) Coordinated Pulling, which trains tightening the thread co-ordinately and in different space orientations; and (3) Knotting, which allow the surgeon to practice this manoeuvre. These three exercises, found interesting among experts in surgical training, are now being validated in MIS workshops at the Minimally Invasive Surgery Centre of Cáceres (Spain).

  6. Laparoscopic calyceal diverticulectomy: video review of techniques and outcomes.

    PubMed

    Gonzalez, Ricardo Dario; Whiting, Bryant; Canales, Benjamin K

    2011-10-01

    Calyceal diverticula are cystic dilations within renal parenchyma prone to urinary stasis, stone formation, and recurrent infection. Using ICD-9 code 55.39 and CPT code 50549, we identified five women and two men (mean age 42 years) who underwent laparoscopic calyceal diverticulectomy at our center from August 2007 to July 2010. Patient videos that highlight basic and advanced laparoscopic techniques (retroperitoneal approach and partial nephrectomy) were selected from an Institutional Review Board-approved video library. Because few published case series exist in the literature, we include equipment used and outcomes for all patients. Posterior diverticula (4/7) were ablated by balloon-assisted retroperitoneal approach. One patient required concomitant partial nephrectomy for a solid renal mass, and laparoscopic ultrasound probe was required for diverticular identification in two patients. No complications were noted with reasonable mean blood loss (40 mL), operating times (160 minutes), and hospital stay (2 days). All diverticula were resolved at 3-month follow-up computed tomography imaging.

  7. Laparoscopic Colorectal Training Gap in Colorectal and Surgical Residents

    PubMed Central

    Soliman, Mark; Williamson, Paul; Ferrara, Andrea

    2016-01-01

    Background and Objectives: Laparoscopic colorectal surgery is an established safe procedure with demonstrated benefits. Proficiency in this specialty correlates with the volume of cases. We examined training in this surgical field for both general surgery and colon and rectal surgery residents to determine whether the number of cases needed for proficiency is being realized. Methods: We examined the Accreditation Council for Graduate Medical Education (ACGME) and American Board of Colorectal Surgeons (ABCRS) operative statistics for graduating general surgery and colon and rectal surgery residents. Results: Although the number of advanced laparoscopy cases had increased for general surgery residents, there was still a significant gap in case volume between the average number of laparoscopic colorectal operations performed by graduating general surgery residents (21.6) and those performed by graduating colon and rectal surgery residents (81.9) in 2014. Conclusion: There is a gap between general surgery and colon and rectal surgery residency training for laparoscopic colorectal surgery. General surgery residents are not meeting the volume of cases necessary for proficiency in colorectal surgery. This deficit represents a structural difference in training. PMID:27493468

  8. Combined Endoscopic and Laparoscopic Surgery

    PubMed Central

    Garrett, Kelly A.; Lee, Sang W.

    2015-01-01

    Benign colon polyps are best treated endoscopically. Colon polyps that are not amenable for endoscopic removals either because they are too large or situated in anatomically difficult locations can pose a clinical dilemma. Traditionally the most common recommendation for these patients has been to offer a colon resection. Although the laparoscopic approach has improved short-term outcomes, morbidities associated with bowel resection are still significant. We may be over treating majority of these patients because of the remote possibility that these polyps may be harboring a cancer. A combined approach using both laparoscopy and colonoscopy (combined endoscopic and laparoscopic surgery) has been described as an alternative to bowel resection in select patients with polyps that cannot be removed endoscopically. Polyp removal using this combined approach may be an effective alternative in select patients. PMID:26491405

  9. Laparoscopic treatment of mesenteric cysts.

    PubMed

    Asoglu, O; Igci, A; Karanlik, H; Parlak, M; Kecer, M; Ozmen, V; Muslumanoglu, M

    2003-05-01

    Mesenteric cysts are rare intraabdominal tumors. We review the diagnosis, laparoscopic management, patient's outcome and follow-up of evaluation for three cases of mesenteric cyst that presented to Istanbul University, Istanbul Medical School, Department of Surgery, from 1999 to 2002. All of the patients presented with nonspecific abdominal symptoms such as constipation, abdominal discomfort, and anorexia. Preoperative evaluation for differentiating mesenteric cyst from malignancy is made by abdominal ultrasound and computed tomography. The procedure was completed laparoscopically using three trocars in three patients. In one patient retroperitoneal resection was performed. There were no intraoperative or postoperative complications. The follow-up periods ranged from 6 to 36 months, and there were no recurrences. Currently, the surgical treatment of mesenteric cyst should be performed by laparoscopy, which offers significant advantages in terms of reduced morbidity and hospital stay. For appropriate cases in which cyst arises from mesenterium of colon, the retroperitoneal approach should be applied.

  10. Assessing Advanced High School and Undergraduate Students' Thinking Skills: The Chemistry--From the Nanoscale to Microelectronics Module

    ERIC Educational Resources Information Center

    Dori, Yehudit Judy; Dangur, Vered; Avargil, Shirly; Peskin, Uri

    2014-01-01

    Chemistry students in Israel have two options for studying chemistry: basic or honors (advanced placement). For instruction in high school honors chemistry courses, we developed a module focusing on abstract topics in quantum mechanics: Chemistry--From the Nanoscale to Microelectronics. The module adopts a visual-conceptual approach, which…

  11. Laparoscopic Management of Mobile Cecum

    PubMed Central

    Soares, Cleber; Catena, Fausto; Di Saverio, Salomone; Sartelli, Massimo; Gomes, Camila Couto; Gomes, Felipe Couto

    2016-01-01

    Background and Objectives: The mobile cecum is an embryologic abnormality and has been associated with functional colon disease (chronic constipation and irritable bowel syndrome). However, unlike functional disease, the primary treatment is operative, using laparoscopic cecopexy. We compare the epidemiology and pathophysiology of mobile cecum syndrome and functional colon disease and propose diagnostic and treatment guidelines. Method: This study was a case–control series of 15 patients who underwent laparoscopic cecopexy. Age, gender, recurrent abdominal pain, and constipation based on Rome III criteria were assessed. Ileocecal–appendiceal unit displacement was graded as follows: I (cecum retroperitoneal or with little mobility); II (wide mobility, crossing the midline); and III (maximum mobility, reaching the left abdomen). Patients with Grades II and III underwent laparoscopic cecopexy. The clinical outcomes were evaluated according to modified Visick's criteria, and postoperative complications were assessed according to the Clavien-Dindo classification. Results: The mean age was 31.86 ± 12.02 years, and 13 patients (86.7%) were women. Symptoms of constipation and abdominal pain were present in 14 (93.3%) and 11 (73.3%), respectively. Computed tomography was performed in 8 (53.3%) patients. The mean operative time was 41 ± 6.66 min. There were no postoperative infections. One (7.8%) patient was classified as Clavien Dindo IIIb and all patients were classified as Visick 1 or 2. Conclusion: Many patients with clinical and epidemiological features of functional colon disease in common in fact have an anatomic anomaly, for which the treatment of choice is laparoscopic cecopexy. New protocols should be developed to support this recommendation. PMID:27807396

  12. Laparoscopic cholecystectomy in biliary pancreatitis.

    PubMed

    Graham, L D; Burrus, R G; Burns, R P; Chandler, K E; Barker, D E

    1994-01-01

    Laparoscopic cholecystectomy has emerged as the treatment of choice for uncomplicated cholelithiasis. Despite early concerns, many surgeons have applied this new technique to more complicated biliary tract disease states, including biliary pancreatitis. To evaluate the safety of laparoscopic cholecystectomy in this setting, we retrospectively reviewed 29 patients with clinical and laboratory evidence of biliary pancreatitis who underwent this procedure between March 1990 and December 1992. The severity of pancreatitis was determined by Ranson's criteria. Two patients had a Ranson's score of 6, one of 5, one of 4, five scored 3, nine scored 2, nine also scored 1, and two patients scored 0. The mean serum amylase level on admission was 1,610 (range 148 to 7680). All patients underwent laparoscopic cholecystectomy during the same hospital admission for biliary pancreatitis, with the mean time of operation being 5.5 days from admission. Operative time averaged 123 minutes (range 60-220 minutes). Intraoperative cholangiography was obtained in 76 per cent of patients. Three patients had choledocholithiasis on intraoperative cholangiography and were treated with choledochoscopy, laparoscopic common bile duct exploration, and saline flushing of the duct. The mean length of hospital stay was 11 days (range 5-32 days). There were seven postoperative complications requiring prolonged hospitalization with all but one treated non-operatively. One patient with a preoperative Ranson score of 6 developed necrotizing pancreatitis and subsequently required operative pancreatic debridement and drainage. There were no deaths in this series and no postoperative wound infections. The average recovery period for return to work was 2 weeks. These statistics compare favorably with literature reports for open cholecystectomy in biliary pancreatitis.(ABSTRACT TRUNCATED AT 250 WORDS)

  13. [Laparoscopic partial nephrectomy: technique and outcomes].

    PubMed

    Colombo, J R; Gill, I S

    2006-05-01

    The indication of laparoscopic partial nephrectomy (LPN) has evolved considerably, and the technique is approaching established status at our institution. Over the past 5 years, the senior author has performed more than 450 laparoscopic partial nephrectomies at the Cleveland Clinic. Herein we present our current technique, review contemporary data and oncological outcomes of LPN.

  14. Cicatrical cecal volvulus following laparoscopic cholecystectomy.

    PubMed

    Morris, Michael W; Barker, Andrea K; Harrison, James M; Anderson, Andrew J; Vanderlan, Wesley B

    2013-01-01

    Laparoscopic cholecystectomy is the procedure of choice for the treatment of symptomatic biliary disease. There is currently no agreement on the management of spilled gallstones, which commonly occurs during laparoscopic cholecystectomy and may produce significant morbidity. We present a case of spilled gallstones causing cicatrical cecal volvulus and also provide a review of pertinent literature. PMID:23925032

  15. Improving Library Research Skills.

    ERIC Educational Resources Information Center

    Holley, Catherine W.

    This report describes a program to advance library research skills in two sixth grade science classes. The problem was assessed through a survey, questionnaire, and worksheet, and by direct observation. Analysis of probable cause data revealed that students displayed a lack of research skills related to library research. Some of the causes were…

  16. Laparoscopic Diagnosis and Treatment in Gynecologic Emergencies

    PubMed Central

    Cantele, Héctor; Leyba, José Luis; Navarrete, Manuel; Llopla, Salvador Navarrete

    2003-01-01

    Objective: To present an analysis of our experience with 22 consecutive cases of acute abdominal gynecologic emergencies managed with a laparoscopic approach. Methods: From March 1997 to October 1998, 22 patients with a diagnosis of acute abdominal gynecologic emergencies underwent laparoscopic intervention. A transvaginal ultrasound was performed on all patients preoperatively to supplement the diagnostic workup. Surgical time, complications, and length of hospital stay were evaluated, and the laparoscopic diagnosis was compared with the preoperative diagnosis. Results: The laparoscopic diagnosis was different from the preoperative diagnosis in 31.8% of patients. Of the 22 patients, laparoscopic therapeutic procedures were performed in 18 (81.8%), all satisfactorily, and with no need for conversion to open surgery. No morbidity or mortality occurred. Conclusion: Laparoscopy is a safe and effective method for diagnosing and treating gynecologic emergencies. PMID:14558712

  17. Intraoperative laparoscopic complications for urological cancer procedures

    PubMed Central

    Montes, Sergio Fernández-Pello; Rodríguez, Ivan Gonzalez; Ugarteburu, Rodrigo Gil; Villamil, Luis Rodríguez; Mendez, Begoña Diaz; Gil, Patricio Suarez; Madera, Javier Mosquera

    2015-01-01

    AIM: To structure the rate of intraoperative complications that requires an intraoperative or perioperative resolution. METHODS: We perform a literature review of Medline database. The research was focused on intraoperative laparoscopic procedures inside the field of urological oncology. General rate of perioperative complications in laparoscopic urologic surgery is described to be around 12.4%. Most of the manuscripts published do not make differences between pure intraoperative, intraoperative with postoperative consequences and postoperative complications. RESULTS: We expose a narrative statement of complications, possible solutions and possible preventions for most frequent retroperitoneal and pelvic laparoscopic surgery. We expose the results with the following order: retroperitoneal laparoscopic surgery (radical nephrectomy, partial nephrectomy, nephroureterectomy and adrenalectomy) and pelvic laparoscopic surgery (radical prostatectomy and radical cystectomy). CONCLUSION: Intraoperative complications vary from different series. More scheduled reports should be done in order to better understand the real rates of complications. PMID:25984519

  18. Single-Incision Laparoscopic Cholecystectomy: our experience and review of literature

    PubMed Central

    ZANGHÌ, G.; LEANZA, V.; VECCHIO, R.; MALAGUARNERA, M.; ROMANO, G.; RINZIVILLO, N.M.A.; CATANIA, V.; BASILE, F.

    2015-01-01

    Aim After the revolution in the surgery of gallbladder stones represented by the laparoscopic cholecystectomy, we tried a new technique that further maximize the aesthetic results and that at the same time is of easy learning for young surgeons. Patients and methods From January 2011 to December 2012 we performed at our department 320 cholecystectomy: 27 in laparotomy and 293 in laparoscopy. Of these, 88 underwent to Single Incision Laparoscopic Surgery (SILS), namely the Single Incision Laparoscopic Cholecystectomy (SILC), in recruited patients aged between 19–65 years; 56 patients were females and 32 were males. Results The laparoscopic cholecystectomy with the SILS methodology is a safe technique. Respect to multi-port Laparoscopic Cholecystectomy (LC), we have cosmetic advances. The pain is less in extra-umbilical sites, and the major umbilical pain can be prevented by local anaesthesia. The times are slightly longer, especially at the beginning of training, but after a few of operations it is reduced to about one hour. We didn’t found any other difference in vantage and advantage between the two technics, only a case of postoperative umbilical hernia in SILS. Conclusion We found the SILS a safe and effective technique for the cholecystectomy. PMID:26888698

  19. Laparoscopic Transcystic Common Bile Duct Exploration: Advantages over Laparoscopic Choledochotomy

    PubMed Central

    Wang, Kai; Yuan, Rongfa; Xiong, Xiaoli; Wu, Linquan

    2016-01-01

    Purpose The ideal treatment for choledocholithiasis should be simple, readily available, reliable, minimally invasive and cost-effective for patients. We performed this study to compare the benefits and drawbacks of different laparoscopic approaches (transcystic and choledochotomy) for removal of common bile duct stones. Methods A systematic search was implemented for relevant literature using Cochrane, PubMed, Ovid Medline, EMBASE and Wanfang databases. Both the fixed-effects and random-effects models were used to calculate the odds ratio (OR) or the mean difference (MD) with 95% confidence interval (CI) for this study. Results The meta-analysis included 18 trials involving 2,782 patients. There were no statistically significant differences between laparoscopic choledochotomy for common bile duct exploration (LCCBDE) (n = 1,222) and laparoscopic transcystic common bile duct exploration (LTCBDE) (n = 1,560) regarding stone clearance (OR 0.73, 95% CI 0.50–1.07; P = 0.11), conversion to other procedures (OR 0.62, 95% CI 0.21–1.79; P = 0.38), total morbidity (OR 1.65, 95% CI 0.92–2.96; P = 0.09), operative time (MD 12.34, 95% CI −0.10–24.78; P = 0.05), and blood loss (MD 1.95, 95% CI −9.56–13.46; P = 0.74). However, the LTCBDE group showed significantly better results for biliary morbidity (OR 4.25, 95% CI 2.30–7.85; P<0.001), hospital stay (MD 2.52, 95% CI 1.29–3.75; P<0.001), and hospital expenses (MD 0.30, 95% CI 0.23–0.37; P<0.001) than the LCCBDE group. Conclusions LTCBDE is safer than LCCBDE, and is the ideal treatment for common bile duct stones. PMID:27668730

  20. [LAPAROSCOPIC MYOMECTOMY WITH UTERINE ARTERY CLIPPING VERSUS CONVENTIONAL LAPAROSCOPIC MYOMECTOMY].

    PubMed

    Blagovest, Bechev; Magunska, Nadya; Kovachev, Emil; Ivanov, Stefan

    2015-01-01

    Uterine leiomyomas are one of the most common benign smooth muscle tumors in women, with a prevalence of 20 to 40% in women over the age of 35 years. Fifty percent of them may necessitate treatment, because of bleeding, pelvic pain and infertility. Laparoscopic myomectomy is one of the treatment options. The major concern of myomectomy either by open procedure or by laparoscopy is the bleeding encountered during the operation. One of the methods to reduce the intraoperative blood loss and to prevent excessive bleeding is the clipping of both uterine arteries and aa. ovaricae. PMID:26817264

  1. CURRENT STATUS OF RESIDENCY TRAINING IN LAPAROSCOPIC SURGERY IN BRAZIL: A CRITICAL REVIEW

    PubMed Central

    NÁCUL, Miguel Prestes; CAVAZZOLA, Leandro Totti; de MELO, Marco Cezário

    2015-01-01

    Introduction The surgeon's formation process has changed in recent decades. The increase in medical schools, new specialties and modern technologies induce an overhaul of medical education. Medical residency in surgery has established itself as a key step in the formation of the surgeon, and represents the ideal and natural way for teaching laparoscopy. However, the introduction of laparoscopic surgery in the medical residency programs in surgical specialties is insufficient, creating the need for additional training after its termination. Objective To review the surgical teaching ways used in services that published their results. Methods Survey of relevant publications in books, internet and databases in PubMed, Lilacs and Scielo through july 2014 using the headings: laparoscopy; simulation; education, medical; learning; internship and residency. Results The training method for medical residency in surgery focused on surgical procedures in patients under supervision, has proven successful in the era of open surgery. However, conceptually turns as a process of experimentation in humans. Psychomotor learning must not be developed directly to the patient. Training in laparoscopic surgery requires the acquisition of psychomotor skills through training conducted initially with surgical simulation. Platforms based teaching problem solving as the Fundamentals of Laparoscopic Surgery, developed by the American Society of Gastrointestinal Endoscopic Surgery and the Laparoscopic Surgical Skills proposed by the European Society of Endoscopic Surgery has been widely used both for education and for the accreditation of surgeons worldwide. Conclusion The establishment of a more appropriate pedagogical process for teaching laparoscopic surgery in the medical residency programs is mandatory in order to give a solid surgical education and to determine a structured and safe professional activity. PMID:25861077

  2. Readmission Following Laparoscopic Sleeve Gastrectomy

    PubMed Central

    Maselli, Amy; Lindborg, Ryan; Kabata, Krystyna; Tortolani, Anthony; Gorecki, Piotr

    2016-01-01

    Background and Objectives: Prior studies have established a 1.7–4.33% readmission rate for laparoscopic sleeve gastrectomy (LSG), a rate that falls within the reported range for other bariatric procedures. The current report describes the incidence of 30-day readmission after primary LSG procedures performed at a single bariatric center of excellence (COE) and examines factors that may be associated with readmission. Methods: Data on 343 consecutive LSG operations performed from February 2010 to May 2014 by a single surgeon (PG) were analyzed. Patients readmitted within 30 d were compared to the remaining patients by using Student's t test for continuous variables and the χ2 test for categorical variables. Results: All LSGs were completed laparoscopically with no conversions to open procedures. There were no reoperations, leaks, perioperative hemorrhages, or mortalities. Twelve patients (3.5%) were readmitted; 1 was readmitted twice. There were no identified risk factors for readmission, including patient demographics, comorbidities, and perioperative factors. Notably, 7 (7%) readmissions occurred in the initial 100 patients and 5 (2%) in the remaining 243 patients (P = .04). Clinical pathways were modified after the initial 100 patients; routine contrast esophagograms were no longer performed, and a 1-day routine postoperative stay was adopted. Operative time also decreased from 94.2 ± 23.8 to 78.2 ± 20.0 min (P < .001). Conclusions: Readmission rates after LSG remain in a range similar to those described for other laparoscopic bariatric procedures. Larger prospective studies are needed to identify patterns of complications and readmissions in patients undergoing LSG that may differ from other bariatric procedures. PMID:27667914

  3. Laparoscopic-assisted ovariectomy of tigers (Panthera tigris) with the use of the LigaSure device.

    PubMed

    Steeil, James C; Sura, Patricia A; Ramsay, Edward C; Reilly, Sabrina; Seddighi, Reza; Whittemore, Jacqueline

    2012-09-01

    Laparoscopic ovariectomy was performed in seven tigers with the use of a vessel-sealing device and a three-port technique. A comparison group of seven tigers that underwent traditional ovariohysterectomy was assembled with the use of a medical records search. Mean operative times for laparoscopic ovariectomy were compared to standard ovariohysterectomy, and mean combined laparoscopic incision length compared to standard ovariohysterectomy incision lengths. Significance was set at P < or = 0.05. Mean surgical time for laparoscopic ovariectomy (82 min, range 71-126 min) was significantly shorter than standard ovariohysterectomy surgical time (129 min, range 80-165 min, P = 0.007). Mean combined laparoscopic incision length (8.07 cm, range 3.80-9.50 cm) was significantly shorter than the mean incision length for standard ovariohysterectomy (13.57 cm, range 12.00-20.00 cm, P = 0.009). There were no clinically important complications observed in either group. Laparoscopic ovariectomy has a significantly shorter surgical time and combined incision length compared to standard ovariohysterectomy in tigers, and appears to be a safe and rapid sterilization method for tigers. Equipment cost and the necessity for advanced training may limit its use in some institutions. Further prospective evaluation is warranted to determine whether it is associated with decreased morbidity, mortality, or cost.

  4. Laparoscopic Supracervical Hysterectomy versus Laparoscopic-Assisted Vaginal Hysterectomy

    PubMed Central

    Waters, Heidi C.; Pan, Katy; Subramanian, Dhinagar; Sedgley, Robert C.; Raff, Gregory J.

    2011-01-01

    Objectives: To compare the incidence of perioperative complications and postoperative healthcare utilization and costs in laparoscopic supracervical hysterectomy (LSH) versus laparoscopic-assisted vaginal hysterectomy (LAVH) patients. Methods: Women ≥18 years with LSH or LAVH were extracted using a large national commercial claims database from 1/1/2007 through 9/30/2008. Outcome was perioperative complications and gynecologic-related postoperative resource use and costs. Multivariate analysis was performed to compare postsurgical outcomes between the cohorts. Results: The final sample consisted of 6,198 LSH patients and 14,181 LAVH patients. LSH patients were significantly more likely to have dysfunctional uterine bleeding and leiomyomas and less likely to have endometriosis and prolapse as the primary diagnosis, and also significantly more likely to have a uterus that weighed >250 grams than LAVH patients. Compared with LAVH patients, LSH patients had significantly lower overall infection rates (7.4% versus 6.2%, P=.002) and lower total gynecologic-related postoperative costs ($252 versus $385, P<.001, within 30 days of follow-up and $350 versus $569, P<.001, within 180 days of follow-up). Significant cost differences remained following multivariate adjustment for patient characteristics. Conclusions: LSH patients demonstrated fewer perioperative complications and lower GYN-related postoperative costs compared to LAVH patients. PMID:22643499

  5. Laparoscopic and robotic adrenal surgery: transperitoneal approach

    PubMed Central

    Okoh, Alexis K.

    2015-01-01

    Recent advances in technology and the need to decrease surgical morbidity have led a rapid progress in laparoscopic adrenalectomy (LA) over the past decade. Robotics is attractive to the surgeon owing to the 3-dimensional image quality, articulating instruments, and stable surgical platform. The safety and efficacy of robotic adrenalectomy (RA) have been demonstrated by several reports. In addition, RA has been shown to provide similar outcomes compared to LA. Development of adrenal surgery has involved the description of several surgical approaches including the anterior transperitoneal, lateral transperitoneal (LT) and posterior retroperitoneal (PR). Among these, the most frequently preferred technique is LT adrenalectomy, primarily due to the surgeon’s familiarity of the operative field, wider working space and visibility. The LT technique is suitable for the resection of larger, unilateral tumors and in scenarios where conversion to an open transperitoneal approach is warranted, it offers a lesser burden. Also, the larger view of the entire abdominal cavity and excellent exposure of both adrenal glands and surrounding structures provided by the LT technique render it safe and feasible in pediatric and pregnant individuals. PMID:26425457

  6. SIMPLIFIED LAPAROSCOPIC CHOLECYSTECTOMY WITH TWO INCISIONS

    PubMed Central

    ABAID, Rafael Antoniazzi; CECCONELLO, Ivan; ZILBERSTEIN, Bruno

    2014-01-01

    Background Laparoscopic cholecystectomy has traditionally been performed with four incisions to insert four trocars, in a simple, efficient and safe way. Aim To describe a simplified technique of laparoscopic cholecystectomy with two incisions, using basic conventional instrumental. Technique In one incision in the umbilicus are applied two trocars and in epigastrium one more. The use of two trocars on the same incision, working in "x" does not hinder the procedure and does not require special instruments. Conclusion Simplified laparoscopic cholecystectomy with two incisions is feasible and easy to perform, allowing to operate with ergonomy and safety, with good cosmetic result. PMID:25004296

  7. Laparoscopic resection of giant mesenteric cyst.

    PubMed

    Polat, C; Ozaçmak, I D; Yücel, T; Ozmen, V

    2000-12-01

    Benign cystic tumors are rare intra-abdominal lesions that may be retroperitoneal, mesenteric, or omental. Most of them cause nonspecific symptoms, but rarely, they cause serious complications such as volvulus, rupture, or bowel obstruction. The diagnosis of these tumors can be made by abdominal ultrasonography or CT. Their only treatment is surgical excision, which can be done by either laparotomy or laparoscopic surgery. In last decade, laparoscopic surgical approaches have replaced open procedures in many surgical abdominal diseases. In this paper, a patient with laparoscopically excised mesenteric cyst is presented along with a literature review.

  8. Intraoperative Loss of a Surgical Needle: A Laparoscopic Dilemma

    PubMed Central

    Clarke, Robert; Schofield, Andrew

    2015-01-01

    Background: Increasing awareness around patient safety and efforts to reduce medical errors has become a priority in the modern health care system. Losing needles during laparoscopic procedures is an uncommon occurrence; however, it poses a significant dilemma for the operating surgeon because retrieval can be a major challenge even for highly skilled and experienced operators. Objective: The objective of this paper was to review the current literature and highlight this potentially serious issue and suggest a method of dealing with this uncommon occurrence. Methods: A comprehensive literature search was conducted using several Internet search engines including PubMed, Google Scholar, and ScienceDirect. Conclusions: The risks associated with retained small foreign bodies remains unknown, and there are few reports and little consensus on how surgeons should manage retained needles or other small foreign bodies during laparoscopic surgery. We propose an algorithm that may be implemented as a standard operating procedure in surgical theatres when a surgeon is faced with such a dilemma. PMID:25901106

  9. Laparoscopic total gastrectomy for Ménétrier's disease.

    PubMed

    Sanchez, Caroline; Brody, Fred; Pucci, Edward; Bashir, Showkat

    2007-02-01

    Most patients with Ménétrier's disease are treated nonoperatively with nutritional support, antacids, and pain medications. Surgical intervention is rarely required. We report the case of a 41-year-old male with HIV and hepatitis B who presented with weight loss, abdominal pain, nausea, and vomiting. A computed tomography scan of the abdomen showed diffuse gastric thickening without lymphadenopathy and an upper endoscopy revealed chronic gastritis and enlarged gastric folds without evidence of Helicobacter pylori. Multiple endoscopic biopsies showed chronic inflammation without malignancy. A laparoscopic assisted full thickness biopsy revealed foveolar hyperplasia consistent with Ménétrier's disease. Postoperatively, the patient's symptoms continued to worsen and were complicated by lower gastrointestinal bleeding secondary to gastric erosions. The patient did not experience any hematemesis, only melena. A laparoscopic total gastrectomy with a Roux-en-Y esophagojejunostomy was performed. The patient was discharged home on postoperative day 7 tolerating a postgastrectomy diet. His hematocrit stabilized and he remained asymptomatic at 16-month follow-up. Ménétrier's disease is a rare gastrointestinal entity that can be treated safely with minimally invasive skills. We report this case in detail and discuss Ménétrier's disease.

  10. Xanthogranulomatous cholecystitis in laparoscopic surgery.

    PubMed

    Guzmán-Valdivia, Gilberto

    2005-04-01

    Xanthogranulomatous cholecystitis (XGC) is one presentation of cholecystitis and can be a cause of difficulty in cholecystectomy. We reviewed the clinical files of 12,426 patients who had undergone cholecystectomy. In this group, there were 182 cases of XGC, and 41 of these patients had undergone laparoscopic surgery. Patients with XGC represented 1.46% of the cholecystectomies that were performed. Of the 41 patients who underwent laparoscopic surgery, 27 were men (66%) and 14 were women (34%) (average age, 52 years). A total of 36 patients (88%) presented with a chronic condition. XGC was found to be associated with lithiasis in 85%, with jaundice in 22%, and with cancer in 2.4% (one patient). A total of 33 patients (80%) required conversion to open surgery, because of technical difficulties; of these patients, 64% underwent partial cholecystectomy. We conclude that XGC creates difficulty at laparoscopy and therefore any preoperative suspicion of XGC should cause the clinician to consider open cholecystectomy. PMID:15797229

  11. Complications of Laparoscopic Gynecologic Surgery

    PubMed Central

    Fuentes, Mariña Naveiro; Naveiro Rilo, José Cesáreo; Paredes, Aida González; Aguilar Romero, María Teresa; Parra, Jorge Fernández

    2014-01-01

    Background and Objectives: To analyze the frequency of complications during laparoscopic gynecologic surgery and identify associated risk factors. Methods: A descriptive observational study was performed between January 2000 and December 2012 and included all gynecologic laparoscopies performed at our center. Variables were recorded for patient characteristics, indication for surgery, length of hospital stay (in days), major and minor complications, and conversions to laparotomy. To identify risk factors and variables associated with complications, crude and adjusted odds ratios were calculated with unconditional logistic regression. Results: Of all 2888 laparoscopies included, most were procedures of moderate difficulty (adnexal surgery) (54.2%). The overall frequency of major complications was 1.93%, and that of minor complications was 4.29%. The level of technical difficulty and existence of prior abdominal surgery were associated with a higher risk of major complications and conversions to laparotomy. Conclusion: Laparoscopic gynecologic surgery is associated with a low frequency of complications but is a procedure that is not without risk. Greater technical difficulty and prior surgery were factors associated with a higher frequency of complications. PMID:25392659

  12. Techniques of Fluorescence Cholangiography During Laparoscopic Cholecystectomy for Better Delineation of the Bile Duct Anatomy

    PubMed Central

    Kono, Yoshiharu; Ishizawa, Takeaki; Tani, Keigo; Harada, Nobuhiro; Kaneko, Junichi; Saiura, Akio; Bandai, Yasutsugu; Kokudo, Norihiro

    2015-01-01

    Abstract To evaluate the clinical and technical factors affecting the ability of fluorescence cholangiography (FC) using indocyanine green (ICG) to delineate the bile duct anatomy during laparoscopic cholecystectomy (LC). Application of FC during LC began after laparoscopic fluorescence imaging systems became commercially available. In 108 patients undergoing LC, FC was performed by preoperative intravenous injection of ICG (2.5 mg) during dissection of Calot's triangle, and clinical factors affecting the ability of FC to delineate the extrahepatic bile ducts were evaluated. Equipment-related factors associated with bile duct detectability were also assessed among 5 laparoscopic systems and 1 open fluorescence imaging system in ex vivo studies. FC delineated the confluence between the cystic duct and common hepatic duct (CyD–CHD) before and after dissection of Calot's triangle in 80 patients (74%) and 99 patients (92%), respectively. The interval between ICG injection and FC before dissection of Calot's triangle was significantly longer in the 80 patients in whom the CyD–CHD confluence was detected by fluorescence imaging before dissection (median, 90 min; range, 15–165 min) than in the remaining 28 patients in whom the confluence was undetectable (median, 47 min; range, 21–205 min; P < 0.01). The signal contrast on the fluorescence images of the bile duct samples was significantly different among the laparoscopic imaging systems and tended to decrease more steeply than those of the open imaging system as the target-laparoscope distance increased and porcine tissues covering the samples became thicker. FC is a simple navigation tool for obtaining a biliary roadmap to reach the “critical view of safety” during LC. Key factors for better bile duct identification by FC are administration of ICG as far in advance as possible before surgery, sufficient extension of connective tissues around the bile ducts, and placement of the tip of

  13. Laparoscopic extirpation of giant adrenal ganglioneuroma

    PubMed Central

    Abraham, George P; Siddaiah, Avinash T; Das, Krishanu; Krishnamohan, Ramaswami; George, Datson P; Abraham, Jisha J; Chandramathy, Sreerenjini K

    2014-01-01

    Laparoscopic adrenalectomy is the standard of care for management of adrenal neoplasms. However, large sized adrenal lesions are considered as relative contraindication for laparoscopic extirpation. We report laparoscopic excision of giant ganglioneuroma of adrenal gland in a 33-year-old female patient. Patient was presented with left loin pain of 2 months duration. Computed tomography (CT) scan was suggestive of non-enhancing left suprarenal mass measuring 17 × 10 cm. Preoperative endocrine evaluation ruled out functional adrenal tumor. Patient underwent transperitoneal excision of suprarenal mass. The lesion could be completely extirpated laparoscopically. Duration of surgery was 250 minutes. Estimated blood loss was 230 milliliters. Specimen was extracted through pfannenstiel incision. No significant intraoperative or postoperative happenings were recorded. Microscopic features were suggestive of ganglioneuroma of adrenal gland. PMID:24501511

  14. Laparoscopic Anti-Reflux (GERD) Surgery

    MedlinePlus

    ... Opportunities Sponsorship Opportunities Login Laparoscopic Anti-Reflux (GERD) Surgery Patient Information from SAGES Print PDF Find a SAGES Surgeon Surgery for “Heartburn” If you suffer from moderate to ...

  15. Total laparoscopic reversal of Hartmann's procedure.

    PubMed

    Masoni, Luigi; Mari, Francesco Saverio; Nigri, Giuseppe; Favi, Francesco; Pindozzi, Fioralba; Dall'Oglio, Anna; Pancaldi, Alessandra; Brescia, Antonio

    2013-01-01

    Hartmann's procedure is still performed in those cases in which colorectal anastomosis might be unsafe. Reversal of Hartmann's procedure (HR) is considered a major surgical procedure with a high morbidity (55 to 60%) and mortality rate (0 to 4%). To decrease these rates, laparoscopic Hartmann's reversal procedure was successfully experienced. We report our totally laparoscopic Hartmann's reversal technique. Between 2004 and 2010 we performed 27 HRs with a totally laparoscopic approach. The efficacy and safety of this technique were demonstrated evaluating the operative data, postoperative complications, and the outcome of the patients. There were no open conversions or major intraoperative complications. Anastomotic leaking occurred in one patient requiring an ileostomy; one patient needed a blood transfusion and one had a nosocomial pneumonia. The mean postoperative hospitalization was 5.7 days. Laparoscopic HR is a feasible and safe procedure and can be considered a valid alternative to open HR.

  16. A retroperitoneal bronchogenic cyst: laparoscopic treatment.

    PubMed

    Ishizuka, O; Misawa, K; Nakazawa, M; Nishizawa, O

    2004-01-01

    Subdiaphragmatic bronchogenic cysts are rare, and those located retroperitoneally are exceptional. We describe a retroperitoneal cyst presenting as an asymptomatic adrenal mass which was treated with laparoscopic surgery with three trocars.

  17. Laparoscopic rectosigmoid resection for acute sigmoid diverticulitis.

    PubMed

    Zdichavsky, Marty; Königsrainer, Alfred; Granderath, Frank A

    2009-04-01

    Laparoscopic sigmoid colectomy has been widely accepted as elective approach but is, however, still discussed controversially for acute cases. Patients receiving a laparoscopic early single-stage procedure benefit from an early postoperative convalescence with a minimum of disability. As more surgeons gain expertise in minimally invasive surgery of the rectosigmoid, this video highlights the main steps of a rectosigmoid resection for acute complicated diverticulitis. PMID:18795376

  18. Laparoscopic pyloromyotomy and pyloroplasty in dogs.

    PubMed

    Holak, P; Matyjasik, H; Jałyński, M; Adamiak, Z; Jaskólska, M

    2016-01-01

    This article describes clinical experiments involving laparoscopic pyloromyotomy and pyloroplasty in six dogs diagnosed with hypertrophy of the pyloric sphincter. Laparoscopic pyloromyotomy was performed in three dogs, and pyloroplasty was carried out in the remaining three animals. The patients were operated on based on the authors' previous experiences with experimental pyloromyotomy and pyloroplasty in pigs. Pyloromyotomy and pyloroplasty resulted in full recovery and complete subsidence of symptoms in all patients. PMID:27096790

  19. Telesurgical laparoscopic cholecystectomy between two countries.

    PubMed

    Cheah, W K; Lee, B; Lenzi, J E; Goh, P M

    2000-11-01

    Telesurgery is a form of operative videoconferencing in which a remotely located surgeon observes a procedure through a camera and provides visual and auditory feedback to the operative site. With the use of more robotic devices in laparoscopic surgery, various forms of telesurgery have been tried. We describe the first two international telesurgical, telementored, robot-assisted laparoscopic cholecystectomies performed in the world, between the Johns Hopkins Institute, Baltimore, Maryland, USA, and the National University Hospital, Singapore. PMID:11285531

  20. Laparoscopic splenectomy in patients with hematologic diseases.

    PubMed Central

    Flowers, J L; Lefor, A T; Steers, J; Heyman, M; Graham, S M; Imbembo, A L

    1996-01-01

    OBJECTIVE. The authors review their initial experience with laparoscopic splenectomy in patients with hematologic diseases. Efficacy, morbidity, and mortality of the technique are presented, and other patient recovery parameters are discussed. SUMMARY BACKGROUND DATA. Laparoscopic splenectomy is performed infrequently and data regarding its safety and efficacy are scarce. Factors such as a high level of technical difficulty, the potential for sudden, severe hemorrhage, and slow accrual of operative experience due to a relatively limited number of procedures are responsible. The potential patient benefits from the development of a minimally invasive form of splenectomy are significant. METHODS. Clinical follow-up, a prospective longitudinal database, and review of medical records were analyzed for all patients referred for elective splenectomy for hematologic disease from March 1992 to March 1995. RESULTS. Laparoscopic splenectomy was attempted in 43 patients and successfully completed in 35 (81%). Therapeutic platelet response to splenectomy occurred in 82% of patients with immune thrombocytopenic purpura and hematocrit level increased in 60% of patients with autoimmune hemolytic anemia undergoing successful laparoscopic splenectomy. The morbidity rate was 11.6% (5 of 43 patients), and the mortality rate was 4.7% (2 of 43 patients). Return of gastrointestinal function occurred in patients 23.1 hours after laparoscopic splenectomy and 76 hours after conversion to open splenectomy (p < 0.05). Mean length of stay was 2.7 days after laparoscopic splenectomy and 6.8 days after conversion to open splenectomy (p < 0.05). CONCLUSION. Laparoscopic splenectomy may be performed with efficacy, morbidity, and mortality rates comparable to those of open splenectomy for hematologic diseases, and it appears to retain other patient benefits of laparoscopic surgery. Images Figure 2. Figure 3. Figure 4. Figure 5. Figure 6. PMID:8678613

  1. Open or Laparoscopic Treatment: Differences and Outcomes.

    PubMed

    Oliveira, Enio C; Bafutto, Mauro; Almeida, Jose R

    2016-10-01

    Surgical treatment of diverticulitis is still characterized by high morbidity and mortality. Surgical approach evolved from the early 20th century with 3-stage laparotomy to colon resection with primary anastomosis. In the last 2 decades, laparoscopic colectomy has been applied to elective and emergency setting of diverticular disease. Recently, laparoscopic lavage and drainage has been used to treat purulent peritonitis. All those modalities of treatment have been discussed and pointed pros and cons. PMID:27622372

  2. Laparoscopic Habib™ 4X: a bipolar radiofrequency device for bloodless laparoscopic liver resection

    PubMed Central

    Pai, M.; Navarra, G.; Ayav, A.; Sommerville, C.; Khorsandi, S. K.; Damrah, O.; Jiao, L. R.

    2008-01-01

    Background. In recent years the progress of laparoscopic procedures and the development of new and dedicated technologies have made laproscopic hepatic surgery feasible and safe. In spite of this laparoscopic liver resection remains a surgical procedure of great challenge because of the risk of massive bleeding during liver transection and the complicated biliary and vascular anatomy in the liver. A new laparoscopic device is reported here to assist liver resection laparoscopically. Methods. The laparoscopic Habib™ 4X is a bipolar radiofrequency device consisting of a 2x2 array of needles arranged in a rectangle. It is introduced perpendicularly into the liver, along the intended transection line. It produces coagulative necrosis of the liver parenchyma sealing biliary radicals and blood vessels and enables bloodless transection of the liver parenchyma. Results. Twenty-four Laparoscopic liver resections were performed with LH4X out of a total of 28 attempted resections over 12 months. Pringle manoeuvre was not used in any of the patients. None of the patients required intraoperative transfusion of red cells or blood products. Conclusion. Laparoscopic liver resection can be safely performed with laparoscopic Habib™ 4X with a significantly low risk of intraoperative bleeding or postoperative complications. PMID:18773100

  3. Transcystic Approach to Laparoscopic Common Bile Duct Exploration

    PubMed Central

    Fei, Zhewei; Huang, Xia; Wang, Xiaojun

    2014-01-01

    Background and Objectives: One-stage laparoscopic management for common bile duct stones in patients with gallbladder stones has gained wide acceptance. We developed a novel technique using a transcystic approach for common bile duct exploration as an alternative to the existing procedures. Methods: From April 2010 to June 2012, 9 consecutive patients diagnosed with cholelithiasis and common bile duct stones were enrolled in this study. The main inclusion criteria included no upper abdominal surgical history and the presence of a stone measuring <5 mm. After the gallbladder was dissected free from the liver connections in a retrograde fashion, the fundus of the gallbladder was extracted via the port incision in the right epigastrium. The choledochoscope was inserted into the gallbladder through the small opening in the fundus of the gallbladder extracorporeally and was advanced toward the common bile duct via the cystic duct under the guidance of both laparoscopic imaging and endoscopic imaging. After stones were retrieved under direct choledochoscopic vision, a drainage tube was placed in the subhepatic space. Results: Of 9 patients, 7 had successful transcystic common bile duct stone clearance. A narrow cystic duct and the unfavorable anatomy of the junction of the cystic duct and common bile duct resulted in losing access to the common bile duct. No bile leakage, hemobilia, or pancreatitis occurred. Wound infection occurred in 2 patients. Transient epigastric colic pain occurred in 2 patients and was relieved by use of anisodamine. A transient increase in the amylase level was observed in 3 patients. Short-term follow-up did not show any recurrence of common bile duct stones. Conclusion: Our novel transcystic approach to laparoscopic common bile duct exploration is feasible and efficient. PMID:25516702

  4. Laparoscopic management of cholecystocolic fistula

    PubMed Central

    CONDE, Lauro Massaud; TAVARES, Pedro Monnerat; QUINTES, Jorge Luiz Delduque; CHERMONT, Ronny Queiroz; PEREZ, Mario Castro Alvarez

    2014-01-01

    Introduction Cholecystocolic fistula is a rare complication of gallbladder disease. Its clinical presentation is variable and nonspecific, and the diagnosis is made, mostly, incidentally during intraoperative maneuver. Cholecystectomy with closure of the fistula is considered the treatment of choice for the condition, with an increasingly reproducible tendency to the use of laparoscopy. Aim To describe the laparoscopic approach for cholecystocolic fistula and ratify its feasibility even with the unavailability of more specific instruments. Technique After dissection of the communication and section of the gallbladder fundus, the fistula is externalized by an appropriate trocar and sutured manually. Colonic segment is reintroduced into the cavity and cholecystectomy is performed avoiding the conversion procedure to open surgery. Conclusion Laparoscopy for resolution of cholecystocolic fistula isn't only feasible, but also offers a shorter stay at hospital and a milder postoperative period when compared to laparotomy. PMID:25626940

  5. Laparoscopic treatment of genitourinary fistulae.

    PubMed

    Garza Cortés, Roberto; Clavijo, Rafael; Sotelo, Rene

    2012-09-01

    We present the laparoscopic management of genitourinary fistulae, mainly five types of fistulae, vesicovaginal, ureterovaginal, vesicouterine, rectourethral and rectovesical fistula. Vesicovaginal fistula (VVF) is mostly secondary to urogynecologic procedures in developed countries, abdominal hysterectomy being the main cause of this condition; they represent 84.9% of the genitourinary fistulae (1).Management has been described for this type of fistula, where low success rate (7-12%) has been reported. Ureterovaginal fistulas may occur following pelvic surgery, particularly gynecological procedures, or as a result of vaginal foreign bodies or stone fragments after shock wave lithotripsy, patients typically present with global and persistent urine leakage through the vagina, this causes patient discomfort, distress, and typically protection is used to stay dry, the initial management is often conservative but typically fails. Vesicouterine fistula is a rare condition that only occurs in 1 to 4% of genitourinary fistulas, the primary cause is low segment cesareansection, and clinically presents in three different forms, which will be described. Treatment of this type of fistulae has been conservative,with hormone therapy and surgery, depending on the presenting symptoms. Recto-urinary (rectovesical and rectourethral) fistulae (RUF) are uncommon and can be difficult to manage clinically. Although they may develop in patients with inflammatory bowel disease and perirectal abscesses, rectourethral fistula frequently result as an iatrogenic complication of extirpative or ablative prostate procedures. Rectovesical fistula usually develops following radical prostatectomy, and occurs along the vesicourethral anastomotic line or along the suture line of a posterior "racquet-handle" closure of the bladder. Conservative management consisting of urinary diversion, broad-spectrum antibiotics and parenteral nutrition is often initially attempted but these measures often fail

  6. Cardiopulmonary function and laparoscopic cholecystectomy.

    PubMed

    Wahba, R W; Béïque, F; Kleiman, S J

    1995-01-01

    This review analyzes the literature dealing with cardiopulmonary function during and pulmonary function following laparoscopic cholecystectomy in order to describe the patterns of changes in these functions and the mechanisms involved as well as to identify areas of concern and lacunae in our knowledge. Information was obtained from a Medline literature search and the annual meeting supplements of Anesthesiology, Anesth Analg, Br J Anaesth, and Can J Anaesth. The principal findings were that changes in cardiovascular function due to the insufflation are characterized by an immediate decrease in cardiac index and an increase in mean arterial blood pressure and systemic vascular resistance. In the next few minutes there is partial restoration of cardiac index and resistance but blood pressure and heart rate do not change. The pattern is the result of the interaction between increased abdominal pressure, neurohumoral responses and absorbed CO2. Pulmonary function changes are characterized by reduced compliance without large alterations in PaO2, but tissue oxygenation can be adversely affected due to reduced O2 delivery. A major difficulty in maintaining normocarbia is due to the abdominal distention reducing pulmonary compliance and to CO2 absorption. End tidal CO2 tension is not a reliable index of PaCO2, particularly in ASA III-IV patients. The pattern of lung function following LC is characterized by a transient reduction in lung volumes and capacities with a restrictive breathing pattern and the loss of the abdominal contribution to breathing. Atelectasis also occurs. These changes are qualitatively similar to but of a lesser magnitude than those following "open" abdominal operations. It is concluded that the changes in cardiopulmonary function during laparoscopic upper abdominal surgery lead us to suggest judicious invasive monitoring and careful interpretation in ASA III-IV patients. Lung function following extensive procedures in sick patients has not been

  7. Effects of Hand Dominance and Postural Selection on Muscle Activities of Virtual Laparoscopic Surgical Training Tasks.

    PubMed

    Huang, Chun-Kai; Boman, Ashley; White, Anthony; Oleynikov, Dmitry; Siu, Ka-Chun

    2016-01-01

    This study investigated how the ergonomic factors, such as hand dominance and postural selection, influenced on surgical performance regarding the changes of muscle activity. Twenty novices performed two virtual laparoscopic surgical training tasks and five target muscle activities were measured. Compared with using dominant hand, surgical skills performance using non-dominant hand increased muscle activities. Muscle fatigue is more likely induced in standing position than sitting position during practice. This study suggests an emerging need to focus on hand dominance during laparoscopic surgical training to address the impact of hand discrepancy on bimanual coordination. It is also important to pay attention on postural selection during training to reduce muscle fatigue, which possibly leads to injuries. PMID:27046567

  8. Total Laparoscopic Modified Duhamel Operation in Combination With Transanal Endoscopic Microsurgery

    PubMed Central

    Han, Yi; Lin, Mou-Bin; Zhang, Ya-Jie

    2014-01-01

    Introduction: Laparoscopic-assisted colonic resection has been well described for multiple surgical indications and typically requires an abdominal incision for specimen removal that is associated with most of the postoperative pain. We report the total laparoscopic modified Duhamel operation for megacolon in combination with transanal endoscopic microsurgery for transanal specimen retrieval and anastomosis to avoid the additional abdominal extraction incision. Case Description: Two cases are presented: case 1 was a 15-year-old boy who presented with intermittent abdominal distention, pain, and constipation for 3 years' duration and was diagnosed with Hirschsprung disease, and case 2 was a 60-year-old man who presented with repeated attacks of incomplete intestinal obstruction for 2 years' duration and was diagnosed with adult megacolon. They were treated by the total laparoscopic modified Duhamel operation without an abdominal extraction incision in combination with transanal endoscopic microsurgery. The operations were successfully accomplished without conversion to open surgery. The patients tolerated the procedure well, complained of minimal postoperative pain, and did not require narcotics beyond the day of the operation. No surgical complications occurred. Discharge from the hospital occurred on the ninth postoperative day in case 1 and the 13th postoperative day in case 2. Discussion: The total laparoscopic modified Duhamel operation in combination with transanal endoscopic microsurgery is a feasible and minimally invasive technique for idiopathic megacolon and adult megacolon. This advanced surgical technique was developed by combining laparoscopy with the concept of natural orifice transluminal endoscopic surgery. PMID:24680156

  9. Interprofessional Obstetric Ultrasound Education: Successful Development of Online Learning Modules; Case-Based Seminars; and Skills Labs for Registered and Advanced Practice Nurses, Midwives, Physicians, and Trainees.

    PubMed

    Shaw-Battista, Jenna; Young-Lin, Nichole; Bearman, Sage; Dau, Kim; Vargas, Juan

    2015-01-01

    Ultrasound is an important aid in the clinical diagnosis and management of normal and complicated pregnancy and childbirth. The technology is widely applied to maternity care in the United States, where comprehensive standard ultrasound examinations are routine. Targeted scans are common and used for an increasing number of clinical indications due to emerging research and a greater availability of equipment with better image resolution at lower cost. These factors contribute to an increased demand for obstetric ultrasound education among students and providers of maternity care, despite a paucity of data to inform education program design and evaluation. To meet this demand, from 2012 to 2015 the University of California, San Francisco nurse-midwifery education program developed and implemented an interprofessional obstetric ultrasound course focused on clinical applications commonly managed by maternity care providers from different professions and disciplines. The course included matriculating students in nursing and medicine, as well as licensed practitioners such as registered and advanced practice nurses, midwives, and physicians and residents in obstetrics and gynecology and family medicine. After completing 10 online modules with a pre- and posttest of knowledge and interprofessional competencies related to teamwork and communication, trainees attended a case-based seminar and hands-on skills practicum with pregnant volunteers. The course aimed to establish a foundation for further supervised clinical training prior to independent practice of obstetric ultrasound. Course development was informed by professional guidelines and clinical and education research literature. This article describes the foundations, with a review of the challenges and solutions encountered in obstetric ultrasound education development and implementation. Our experience will inform educators who wish to facilitate obstetric ultrasound competency development among new and experienced

  10. Interprofessional Obstetric Ultrasound Education: Successful Development of Online Learning Modules; Case-Based Seminars; and Skills Labs for Registered and Advanced Practice Nurses, Midwives, Physicians, and Trainees.

    PubMed

    Shaw-Battista, Jenna; Young-Lin, Nichole; Bearman, Sage; Dau, Kim; Vargas, Juan

    2015-01-01

    Ultrasound is an important aid in the clinical diagnosis and management of normal and complicated pregnancy and childbirth. The technology is widely applied to maternity care in the United States, where comprehensive standard ultrasound examinations are routine. Targeted scans are common and used for an increasing number of clinical indications due to emerging research and a greater availability of equipment with better image resolution at lower cost. These factors contribute to an increased demand for obstetric ultrasound education among students and providers of maternity care, despite a paucity of data to inform education program design and evaluation. To meet this demand, from 2012 to 2015 the University of California, San Francisco nurse-midwifery education program developed and implemented an interprofessional obstetric ultrasound course focused on clinical applications commonly managed by maternity care providers from different professions and disciplines. The course included matriculating students in nursing and medicine, as well as licensed practitioners such as registered and advanced practice nurses, midwives, and physicians and residents in obstetrics and gynecology and family medicine. After completing 10 online modules with a pre- and posttest of knowledge and interprofessional competencies related to teamwork and communication, trainees attended a case-based seminar and hands-on skills practicum with pregnant volunteers. The course aimed to establish a foundation for further supervised clinical training prior to independent practice of obstetric ultrasound. Course development was informed by professional guidelines and clinical and education research literature. This article describes the foundations, with a review of the challenges and solutions encountered in obstetric ultrasound education development and implementation. Our experience will inform educators who wish to facilitate obstetric ultrasound competency development among new and experienced

  11. Laparoscopic sacrocolpopexy versus transvaginal mesh for recurrent pelvic organ prolapse.

    PubMed

    Iglesia, Cheryl B; Hale, Douglass S; Lucente, Vincent R

    2013-03-01

    Both expert surgeons agree with the following: (1) Surgical mesh, whether placed laparoscopically or transvaginally, is indicated for pelvic floor reconstruction in cases involving recurrent advanced pelvic organ prolapse. (2) Procedural expertise and experience gained from performing a high volume of cases is fundamentally necessary. Knowledge of outcomes and complications from an individual surgeon's audit of cases is also needed when discussing the risks and benefits of procedures and alternatives. Yet controversy still exists on how best to teach new surgical techniques and optimal ways to efficiently track outcomes, including subjective and objective cure of prolapse as well as perioperative complications. A mesh registry will be useful in providing data needed for surgeons. Cost factors are also a consideration since laparoscopic and especially robotic surgical mesh procedures are generally more costly than transvaginal mesh kits when operative time, extra instrumentation and length of stay are included. Long-term outcomes, particularly for transvaginal mesh procedures, are lacking. In conclusion, all surgery poses risks; however, patients should be made aware of the pros and cons of various routes of surgery as well as the potential risks and benefits of using mesh. Surgeons should provide patients with honest information about their own experience implanting mesh and also their experience dealing with mesh-related complications.

  12. Conversion of laparoscopic to open cholecystectomy in the current era of laparoscopic surgery.

    PubMed

    Le, Viet H; Smith, Dane E; Johnson, Brent L

    2012-12-01

    Laparoscopic cholecystectomy is the gold standard treatment for benign gallbladder pathologies. In certain circumstances, the procedure must be converted to open to safely complete the operation. This study aims to evaluate the reasons for conversion of this operation in the current era of laparoscopic surgery. A retrospective review of medical records was undertaken to identify all laparoscopic converted to open cholecystectomy performed at a single center over a 2-year period. Reasons for conversion, surgeon's preoperative indications, and specimen pathologic results were documented. A review of published data from the previous two decades was also conducted for comparison of contemporary versus historical reasons for intraoperative conversion. Between May 2008 and April 2010, 3371 laparoscopic cholecystectomies were performed at Greenville Hospital System University Medical Center. Eighty-six patients (2.6%) required conversion to open cholecystectomy during the study period. A diagnosis of acute cholecystitis (58.8%) was more common among converted cases. Inflammation (35%), adhesions (28%), and anatomic difficulty (22%) were the three most common intraoperative findings leading to conversion. In the years since laparoscopic cholecystectomy was introduced, there has been a noted improvement in the quality of laparoscopic equipment affording a near wholesale shift toward the laparoscopic approach in the surgical management of this condition. However, inflammation, adhesions, and anatomic difficulty continue to challenge the use and safety of this approach in a small number of patients. The willingness and ability of surgeons to convert to open cholecystectomy continues to be important to the safety of this operation.

  13. Conversion of laparoscopic to open cholecystectomy in the current era of laparoscopic surgery.

    PubMed

    Le, Viet H; Smith, Dane E; Johnson, Brent L

    2012-12-01

    Laparoscopic cholecystectomy is the gold standard treatment for benign gallbladder pathologies. In certain circumstances, the procedure must be converted to open to safely complete the operation. This study aims to evaluate the reasons for conversion of this operation in the current era of laparoscopic surgery. A retrospective review of medical records was undertaken to identify all laparoscopic converted to open cholecystectomy performed at a single center over a 2-year period. Reasons for conversion, surgeon's preoperative indications, and specimen pathologic results were documented. A review of published data from the previous two decades was also conducted for comparison of contemporary versus historical reasons for intraoperative conversion. Between May 2008 and April 2010, 3371 laparoscopic cholecystectomies were performed at Greenville Hospital System University Medical Center. Eighty-six patients (2.6%) required conversion to open cholecystectomy during the study period. A diagnosis of acute cholecystitis (58.8%) was more common among converted cases. Inflammation (35%), adhesions (28%), and anatomic difficulty (22%) were the three most common intraoperative findings leading to conversion. In the years since laparoscopic cholecystectomy was introduced, there has been a noted improvement in the quality of laparoscopic equipment affording a near wholesale shift toward the laparoscopic approach in the surgical management of this condition. However, inflammation, adhesions, and anatomic difficulty continue to challenge the use and safety of this approach in a small number of patients. The willingness and ability of surgeons to convert to open cholecystectomy continues to be important to the safety of this operation. PMID:23265130

  14. Image acquisition in laparoscopic and endoscopic surgery

    NASA Astrophysics Data System (ADS)

    Gill, Brijesh S.; Georgeson, Keith E.; Hardin, William D., Jr.

    1995-04-01

    Laparoscopic and endoscopic surgery rely uniquely on high quality display of acquired images, but a multitude of problems plague the researcher who attempts to reproduce such images for educational purposes. Some of these are intrinsic limitations of current laparoscopic/endoscopic visualization systems, while others are artifacts solely of the process used to acquire and reproduce such images. Whatever the genesis of these problems, a glance at current literature will reveal the extent to which endoscopy suffers from an inability to reproduce what the surgeon sees during a procedure. The major intrinsic limitation to the acquisition of high-quality still images from laparoscopic procedures lies in the inability to couple directly a camera to the laparoscope. While many systems have this capability, this is useful mostly for otolaryngologists, who do not maintain a sterile field around their scopes. For procedures in which a sterile field must be maintained, one trial method has been to use a beam splitter to send light both to the still camera and the digital video camera. This is no solution, however, since this results in low quality still images as well as a degradation of the image that the surgeon must use to operate, something no surgeon tolerates lightly. Researchers thus must currently rely on other methods for producing images from a laparoscopic procedure. Most manufacturers provide an optional slide or print maker that provides a hardcopy output from the processed composite video signal. The results achieved from such devices are marginal, to say the least. This leaves only one avenue for possible image production, the videotape record of an endoscopic or laparoscopic operation. Video frame grabbing is at least a problem to which industry has applied considerable time and effort to solving. Our own experience with computerized enhancement of videotape frames has been very promising. Computer enhancement allows the researcher to correct several of the

  15. Changes in cerebral hemodynamics during laparoscopic cholecystectomy.

    PubMed

    De Cosmo, G; Iannace, E; Primieri, P; Valente, M R; Proietti, R; Matteis, M; Silvestrini, M

    1999-10-01

    Laparoscopic surgery requires a series of procedures, including intraperitoneal CO2 insufflation, which can cause cardiovascular and hemogasanalytic modifications, potentially able to impair cerebral perfusion. The aim of this study was to evaluate changes in cerebral blood flow velocity during laparoscopic cholecystectomy. Eighteen patients undergoing laparoscopic cholecystectomy were studied. Middle cerebral artery blood flow velocity was monitored using transcranial Doppler ultrasonography. Electrical bioimpedance was employed to measure cardiac output, stroke volume and to calculate derived parameters. End-tidal CO2, mean arterial blood pressure, end expiratory anesthetic concentration and O2 saturation were monitored non-invasively. Cerebral artery blood flow velocity increased significantly after CO2 insufflation (p < 0.05) and remained stable. The highest values were reached after CO2 desufflation. A significant reduction in stroke volume and cardiac output (p < 0.05) associated with increased vascular systemic resistances (p < 0.001) was observed soon after CO2 insufflation. The decrease in cardiac output and the increase in vascular systemic resistances remained significant throughout abdominal insufflation. Heart rate and mean arterial pressure remained substantially unchanged with the exception of a significant decrease (p < 0.001) before CO2 insufflation. There was no significant change in end-tidal CO2 during abdominal insufflation. These findings suggest that the cerebrovascular system can undergo adaptive changes during all phases of laparoscopic surgery. However, the extent of cardio- and cerebrovascular variation indicates the need for careful preliminary evaluation of cerebral hemodynamics in patients with vascular disorders before laparoscopic surgery. PMID:10555187

  16. Laparoscopic use of laser and monopolar electrocautery

    NASA Astrophysics Data System (ADS)

    Hunter, John G.

    1991-07-01

    Most general surgeons are familiar with monopolar electrocautery, but few are equally comfortable with laser dissection and coagulation. At courses across the country, surgeons are being introduced to laparoscopy and laser use in one and two day courses, and are certified from that day forward as laser laparoscopists. Some surgeons are told that laser and electrosurgery may be equally acceptable techniques for performance of laparoscopic surgery, but that a surgeon may double his patient volume by advertising 'laser laparoscopic cholecystectomy.' The sale of certain lasers has skyrocketed on the basis of such hype. The only surprise is that laparoscopic cholecystectomy complications occurring in this country seem to be more closely related to the laparoscopic access and visualization than to the choice of laser of electrocautery as the preferred instrument for thermal dissection. The purpose of this article is to: 1) Discuss the physics and tissue effects of electrosurgery and laser; 2) compare the design and safety of electrosurgical and laser delivery systems; and 3) present available data comparing laser and electrocautery application in laparoscopic cholecystectomy.

  17. Laparoscopic adrenalectomy: A single center experience

    PubMed Central

    Kumar, Suresh; Bera, Moley K; Vijay, Mukesh K; Dutt, Arindam; Tiwari, Punit; Kundu, Anup K

    2010-01-01

    AIMS: To evaluate the efficacy and safety of laparoscopic adrenalectomy in benign adrenal disorders. METHODS AND MATERIAL: Since July 2007, twenty patients have undergone laparoscopic adrenalectomy for various benign adrenal disorders at our institution. Every patient underwent contrast enhanced CT-abdomen. Serum corticosteroid levels were conducted in all, and urinary metanephrines, normetanephrines and VMA levels were performed in suspected pheochromocytoma. All the patients underwent laparoscopic adrenalectomy via the transperitoneal approach. RESULTS: The patients were in the age range of 18-57 years, eleven males and nine females, seven right, eleven left, two bilateral. The mean operative time was 150 minutes (120-180), mean hospital stay four days (3-5), mean intraoperative blood loss 150 ml and mean post-operative analgesic need was for 36 (24-72) hours. One out of twenty-two laparoscopic operations had to be converted into open adrenalectomy due to intra-operative complications. CONCLUSIONS: Laparoscopic adrenalectomy is a safe, effective and useful procedure without any major post-operative complication and is the gold standard for all benign adrenal disorders. PMID:21120066

  18. Laparoscopic excision of an infected "egg-shelled" retroperitoneal pseudocyst.

    PubMed

    Palanivelu, Chinnusamy; Rangarajan, Muthukumaran; Senthilkumar, Rangaswamy; Madhankumar, Madhupalayam Velusamy; Annapoorni, Shankar

    2008-12-01

    Primary retroperitoneal pseudocysts are rare entities. Though laparoscopic approach has been described in their treatment, open surgical excision is still the mainstay of treatment for these lesions. We present a case of infected retroperitoneal pseudocyst and its successful laparoscopic excision. The patient was an 80-year old female. Contrast enhanced CT scan of the abdomen and ultrasonography confirmed a large retroperitoneal cyst. Laparoscopic resection was accomplished after puncturing and decompressing the cyst. There were no complications or conversion. The operating time was 176 minutes. The patient was discharged 3 days after surgery. Histopathology revealed a pseudocyst. Retroperitoneal pseudocysts can be resected laparoscopically with careful and meticulous laparoscopic dissection, utilizing the advantages of laparoscopy.

  19. Laparoscopic Resection of an Adrenal Schwannoma

    PubMed Central

    Konstantinos, Toutouzas G.; Panagiotis, Kekis B.; Nikolaos, Michalopoulos V.; Ioannis, Flessas; Andreas, Manouras; Geogrios, Zografos

    2012-01-01

    Background and Objectives: Schwannomas are tumors originating from Schwann cells of the peripheral nerve sheath (neurilemma) of the neuroectoderm. Rarely, schwannomas can arise from the retroperitoneum and adrenal medulla. We describe a case of a 71-y-old woman who presented with an incidentally discovered adrenal tumor. Methods: Ultrasound and computed tomography scans revealed a lesion with solid and cystic areas originating from the left adrenal gland. The patient underwent complete laparoscopic resection of the tumor and the left adrenal gland. Results: Histopathological examination and immunohistochemical staining of the excised specimen revealed a benign schwannoma measuring 5.5×5×3.7 cm. To our knowledge, few other cases of laparoscopic resection of adrenal schwannomas have been reported. Conclusion: Because preoperative diagnosis of adrenal tumors is inconclusive, complete laparoscopic excision allows for definitive diagnosis with histological evaluation and represents the treatment of choice. PMID:23484583

  20. [Anterograde laparoscopic cholecystectomy: when and why].

    PubMed

    Miscusi, G; Masoni, L; de Anna, L; Brescia, A; Gasparrini, M; Taglienti, D; Micheletti, A; Marsano, N; Montori, A

    1993-01-01

    Today largely diffused is the concept that laparoscopic cholecystectomy (LC) represents the treatment of choice for symptomatic gallstones. Nonetheless some questions have been raised on the real safety of this new method in terms of procedure-related complications. On the basis of our experience with traditional open cholecystectomy, we have recently performed a prograde LC in those cases with difficulties in identifying the anatomical structures of the so called Calot's triangle. This alternative route can be easily performed laparoscopically and has been useful in reducing the time of the intervention in the most difficult setting and to increase the safety of the procedure. The technical details and the results are compared with those of the laparoscopic retrograde route.

  1. Ovarian vein thrombosis following total laparoscopic hysterectomy.

    PubMed

    Tanaka, Yusuke; Kato, Hiroyasu; Hosoi, Ayako; Isobe, Masanori; Koyama, Shinsuke; Shiki, Yasuhiko

    2012-11-01

    Ovarian vein thrombosis usually occurs in pregnant patients, especially during the postpartum period. However, it is a rare complication following laparoscopic surgery in gynecology. The risk of a thromboembolic event is not well defined, and evidence-based guidelines regarding deep vein thrombosis prophylaxis in gynecological laparoscopic surgery are still lacking. Herein we report a rare case of ovarian vein thrombosis following total laparoscopic hysterectomy in a 35-year-old woman who developed a fever of unknown origin on postoperative day 3. A complete fever work-up was done. Her urine, vaginal stump and blood culture were all negative, and her white blood cell count was normal. CT revealed left ovarian vein thrombosis. The patient responded well to anticoagulation in conjunction with antibiotic therapy.

  2. Single-port laparoscopic appendectomy during pregnancy.

    PubMed

    Koh, A Ra; Lee, Jung Hun; Choi, Joong Sub; Eom, Jeong Min; Hong, Jin Hwa

    2012-04-01

    As a result of the increased demand for minimally invasive surgery, single-port laparoscopic surgery performed via a single incision was introduced and has been performed in various fields. Herein, we report our initial experience with single-port laparoscopic appendectomy (SP-LA) using Gelport access for the treatment of acute appendicitis in 2 pregnant women. SP-LA using Gelport access was performed successfully in these pregnant women without prolongation of operation time, and there was no need for ancillary trocar insertions or conversion to conventional laparoscopy. One woman spontaneously delivered at 39 weeks' gestation approximately 20 weeks after the surgery and the other has maintained a healthy pregnancy. SP-LA can be considered a minimally invasive alternative to conventional laparoscopic appendectomy in pregnant women (Supplemental Digital Content 1, http://links.lww.com/SLE/A55).

  3. Laparoscopic Versus Open Gastrectomy for Gastric Adenocarcinoma in the West: A Case–Control Study

    PubMed Central

    Kelly, Kaitlyn J.; Selby, Luke; Chou, Joanne F.; Dukleska, Katerina; Capanu, Marinela; Coit, Daniel G.; Brennan, Murray F.; Strong, Vivian E.

    2016-01-01

    Introduction Data on laparoscopic gastrectomy in patients with gastric cancer in the Western hemisphere are lacking. This study aimed to compare outcomes following laparoscopic versus open gastrectomy for gastric adenocarcinoma at a Western center. Methods Eighty-seven consecutive patients who underwent laparoscopic gastrectomy from November 2005 to April 2013 were compared with 87 patients undergoing open resection during the same time period. Patients were matched for age, stage, body mass index, and procedure (distal subtotal vs. total gastrectomy). Endpoints were short- and long-term perioperative outcomes. Results Overall, 65 patients (37 %) had locally advanced disease, and 40 (23 %) had proximal tumors. The laparoscopic approach was associated with longer operative time (median 240 vs.165 min; p < 0.01), less blood loss (100 vs.150 mL; p < 0.01), higher rate of microscopic margin positivity (9 vs.1 %; p = 0.04), decreased duration of narcotic and epidural use (2 vs. 4 days, p = 0.04, and 3 vs. 4 days, p = 0.02, respectively), decreased minor complications in the early (27 vs. 16 %) and late (17 vs. 7 %) postoperative periods (p < 0.01), decreased length of stay (5 vs. 7 days; p = 0.01), and increased likelihood of receiving adjuvant therapy (82 vs. 51 %; p < 0.01). There was no difference in the number of lymph nodes retrieved (median 20 in both groups), major morbidity, or 30-day mortality. Conclusions Laparoscopic gastrectomy for gastric adenocarcinoma is safe and effective for select patients in the West. PMID:25631063

  4. Laparoscopic radical prostatectomy training for residents: Hospital Universitario La Paz model

    PubMed Central

    Gregorio, Sergio Alonso y; Molina, Susana Sánchez; Gómez, Angel Tabernero; Ledo, Jesús Cisneros; Sebastián, Jesús Díez; Barthel, Jesús Javier de la Peña

    2014-01-01

    Introduction In the last decade, we have seen the advance of laparoscopic surgery in urology. All laparoscopic procedures in our department are performed by staff members and are assisted by a single resident, ensuring resident training in laparoscopic surgery. The aim of this study is to evaluate the results of the Hospital La Paz training program for residents in the field of laparoscopic surgery. Material and methods We have done a retrospective review of LRP performed by the residents in our department. We also evaluated different variables. Descriptive statistical analysis was done and the results were compared with the descriptive analysis of the initial series of our department. Results We reviewed 82 patients, with an average age of 61.6 years. Most cases were pT1c at diagnosis. Average surgical time was 288 minutes, with a transfusion rate of 9.7% and a intra and postoperative complication rates of 1.2% and 7.3%. The mean hospital stay was 3.3 days. Histological results of this series are: 76.8% of pT2 and 23.2% of pT3. The biochemical relapse rate is 15.8%. Global surgical margin rate is 20.7%. The global continence rate is 52.4%. Conclusions The outcomes of LRP performed by residents are similar to the ones reported in the initial series of our department. The fact that 84.6% of the residents formed in this period actually belong to different laparoscopic units supports the success of La Paz Hospital training model. PMID:25247081

  5. An evidence-based laparoscopic simulation curriculum shortens the clinical learning curve and reduces surgical adverse events

    PubMed Central

    De Win, Gunter; Van Bruwaene, Siska; Kulkarni, Jyotsna; Van Calster, Ben; Aggarwal, Rajesh; Allen, Christopher; Lissens, Ann; De Ridder, Dirk; Miserez, Marc

    2016-01-01

    Background Surgical simulation is becoming increasingly important in surgical education. However, the method of simulation to be incorporated into a surgical curriculum is unclear. We compared the effectiveness of a proficiency-based preclinical simulation training in laparoscopy with conventional surgical training and conventional surgical training interspersed with standard simulation sessions. Materials and methods In this prospective single-blinded trial, 30 final-year medical students were randomized into three groups, which differed in the way they were exposed to laparoscopic simulation training. The control group received only clinical training during residency, whereas the interval group received clinical training in combination with simulation training. The Center for Surgical Technologies Preclinical Training Program (CST PTP) group received a proficiency-based preclinical simulation course during the final year of medical school but was not exposed to any extra simulation training during surgical residency. After 6 months of surgical residency, the influence on the learning curve while performing five consecutive human laparoscopic cholecystectomies was evaluated with motion tracking, time, Global Operative Assessment of Laparoscopic Skills, and number of adverse events (perforation of gall bladder, bleeding, and damage to liver tissue). Results The odds of adverse events were 4.5 (95% confidence interval 1.3–15.3) and 3.9 (95% confidence interval 1.5–9.7) times lower for the CST PTP group compared with the control and interval groups. For raw time, corrected time, movements, path length, and Global Operative Assessment of Laparoscopic Skills, the CST PTP trainees nearly always started at a better level and were never outperformed by the other trainees. Conclusion Proficiency-based preclinical training has a positive impact on the learning curve of a laparoscopic cholecystectomy and diminishes adverse events. PMID:27512343

  6. Thinking Skills.

    ERIC Educational Resources Information Center

    Suhor, Charles

    One of a series dealing with current issues affecting language arts instruction, this paper focuses on thinking skills. The paper begins by raising two issues: whether thinking skills should be taught as part of each subject area, as a separate skill, or both, and whether English and language arts teachers have a special role in the teaching of…

  7. Library Skills.

    ERIC Educational Resources Information Center

    Paul, Karin; Kuhlthau, Carol C.; Branch, Jennifer L.; Solowan, Diane Galloway; Case, Roland; Abilock, Debbie; Eisenberg, Michael B.; Koechlin, Carol; Zwaan, Sandi; Hughes, Sandra; Low, Ann; Litch, Margaret; Lowry, Cindy; Irvine, Linda; Stimson, Margaret; Schlarb, Irene; Wilson, Janet; Warriner, Emily; Parsons, Les; Luongo-Orlando, Katherine; Hamilton, Donald

    2003-01-01

    Includes 19 articles that address issues related to library skills and Canadian school libraries. Topics include information literacy; inquiry learning; critical thinking and electronic research; collaborative inquiry; information skills and the Big 6 approach to problem solving; student use of online databases; library skills; Internet accuracy;…

  8. Retroperitoneal laparoscopic bilateral lumbar sympathectomy.

    PubMed

    Segers, B; Himpens, J; Barroy, J P

    2007-06-01

    The first retroperitoneal lumbar sympathectomy was performed in 1924 by Julio Diez. The classic procedure for sympathectomy is open surgery. We report a unilateral laparoscopic retroperitoneal approach to perform bilateral lumbar sympathectomy. This approach was performed for a 43-year-old man with distal arterial occlusive disease and no indication for direct revascularization. His predominant symptoms were intermittent claudication at 100 metres and cold legs. The patient was placed in a left lateral decubitus position. The optical system was placed first in an intra-abdominal position to check that the trocars were well positioned in the retroperitoneal space. The dissection of retroperitoneum was performed by CO2 insufflation. The inferior vena cava was reclined and the right sympathetic chain was individualized. Two ganglia (L3-L4) were removed by bipolar electro-coagulation. The aorta was isolated on a vessel loop and careful anterior traction allowed a retro-aortic pre-vertebral approach between the lumbar vessels. The left sympathetic chain was dissected. Two ganglia (L3-L4) were removed by bipolar electro-coagulation. PMID:17685269

  9. Lost Stones During Laparoscopic Cholecystectomy

    PubMed Central

    Arozamena, C.; Gutierrez, L.; Bracco, J.; Mon, A.; Almeyra, R. Sanchez; Secchi, M.

    1998-01-01

    Background: Gallbladder perforation, with loss of calculi in the abdomen is frequent during laparoscopic cholecystectomy. Recent publications report complications in port sites or in the abdominal cavity. A study of 3686 laparsocopic cholecystectomies performed by 6 surgeons was undertaken. In 627 patients, perforation of the gallbladder occurred and in 254 stones were spilled into the abdominal cavity. In 214 they were retrieved and in 40 left in the abdomen. Twelve patients developed complications. Percutaneous drainage was successful in 2 with serous collections. Two patients with abdominal abscesses were reoperated, stones retrieved and the abdomen drained. One patient developed an intestinal obstruction due to a stone in the ileum. One patient who had a cholecystectomy in another hospital developed a paraumbilical tumor. At reoperation a stone was retrieved. In another six patients, stones were found in port sites. Stones lost into the abdomen should be removed because of their potential morbidity, especially if they are large or if infection is present in the gallbladder at the time of initial surgery. There is no indication for routine conversion to open surgery when stone spillage occurs, although patients should be informed to avoid legal consequence, and to hasten early diagnosis of later complications. PMID:9893240

  10. Retroperitoneal laparoscopic bilateral lumbar sympathectomy.

    PubMed

    Segers, B; Himpens, J; Barroy, J P

    2007-06-01

    The first retroperitoneal lumbar sympathectomy was performed in 1924 by Julio Diez. The classic procedure for sympathectomy is open surgery. We report a unilateral laparoscopic retroperitoneal approach to perform bilateral lumbar sympathectomy. This approach was performed for a 43-year-old man with distal arterial occlusive disease and no indication for direct revascularization. His predominant symptoms were intermittent claudication at 100 metres and cold legs. The patient was placed in a left lateral decubitus position. The optical system was placed first in an intra-abdominal position to check that the trocars were well positioned in the retroperitoneal space. The dissection of retroperitoneum was performed by CO2 insufflation. The inferior vena cava was reclined and the right sympathetic chain was individualized. Two ganglia (L3-L4) were removed by bipolar electro-coagulation. The aorta was isolated on a vessel loop and careful anterior traction allowed a retro-aortic pre-vertebral approach between the lumbar vessels. The left sympathetic chain was dissected. Two ganglia (L3-L4) were removed by bipolar electro-coagulation.

  11. Objective psychomotor skills assessment of experienced, junior, and novice laparoscopists with virtual reality.

    PubMed

    Gallagher, A G; Richie, K; McClure, N; McGuigan, J

    2001-11-01

    Objective assessment of psychomotor skills in surgery is now a priority; however, this assessment is difficult to achieve because of measurement difficulties associated with the reliability and validity of assessing surgical skills in vivo and in the laboratory. In this study virtual reality (VR) was used to overcome these problems in the objective psychomotor assessment of senior, junior, and novice laparoscopists. Twelve experienced laparoscopic surgeons (performed >50 Minimal Access Surgery (MAS) procedures), 12 inexperienced laparoscopic surgeons (<10 MAS procedures), and 12 laparoscopic novices (no MAS procedures) participated in the study. Each subject completed all six tasks of the Minimally Invasive Surgical Trainer; Virtual Reality (MIST VR). In comparison to the other groups, experienced laparoscopic surgeons performed the tasks significantly (p < 0.01) faster, had a lower error rate, were more economic in their movement of surgical instruments and in the use of diathermy. As a group they also showed greater consistency in their performance. MIST VR distinguished between the three groups of laparoscopists. VR provides a useful objective assessment tool for evaluating psychomotor skills for laparoscopic surgery.

  12. Comparison of Laparoscopic, Hand-Assisted, and Open Surgical Nephroureterectomy

    PubMed Central

    Maeda, Toshihiro; Tanaka, Toshiaki; Fukuta, Fumimasa; Kobayashi, Ko; Nishiyama, Naotaka; Takahashi, Satoshi; Masumori, Naoya

    2014-01-01

    Background and Objectives: The aim of this study was to compare oncologic outcomes after laparoscopic nephroureterectomy, hand-assisted laparoscopic nephroureterectomy, and open nephroureterectomy for upper urinary tract urothelial cancer. Methods: Between April 1995 and August 2010, 189 patients underwent laparoscopic nephroureterectomy, hand-assisted laparoscopic nephroureterectomy, or open nephroureterectomy for upper urinary tract urothelial cancer. Of these patients, 110 with no previous or concurrent bladder cancer or any metastatic disease were included in this study. Cancer-specific survival, recurrence-free survival, and intravesical recurrence-free survival rates were analyzed by the Kaplan-Meier method and compared with the log-rank test. The median follow-up period for the cohort was 70 months (range, 6–192 months). Results: The 3 groups were well matched for tumor stage, grade, and the presence of lymphovascular invasion and concomitant carcinoma in situ. The estimated 5-year cancer-specific survival rates were 81.1%, 65.6%, and 65.2% for laparoscopic nephroureterectomy, hand-assisted laparoscopic nephroureterectomy, and open nephroureterectomy, respectively (P = .4179). The estimated 5-year recurrence-free survival rates were 33.8%, 10.0%, and 41.2% for laparoscopic nephroureterectomy, hand-assisted laparoscopic nephroureterectomy, and open nephroureterectomy, respectively (P = .0245). The estimated 5-year intravesical recurrence-free survival rates were 64.8%, 10.0%, and 76.2% for laparoscopic nephroureterectomy, hand-assisted laparoscopic nephroureterectomy, and open nephroureterectomy, respectively (P < .0001). Conclusion: Although there was no significant difference in cancer-specific survival rate among the laparoscopic nephroureterectomy, hand-assisted laparoscopic nephroureterectomy, and open nephroureterectomy groups, hand-assisted laparoscopic nephroureterectomy may be inferior to laparoscopic nephroureterectomy or open nephroureterectomy

  13. Laparoscopic repair of abdominal incisional hernia

    PubMed Central

    Yang, Xue-Fei

    2016-01-01

    Abdominal incisional hernia is a common complication after open abdominal operations. Laparoscopic procedures have obvious mini-invasive advantages for surgical treatment of abdominal incisional hernia, especially to cases with big hernia defect. Laparoscopic repair of incisional hernia has routine mode but the actual operations will be various according to the condition of every hernia. Key points of these operations include design of the position of trocars, closure of defects and fixation of meshes. The details of these issues and experiences of perioperative evaluation and treatment will be talked about in this article. PMID:27761446

  14. Transanal polypectomy using single incision laparoscopic instruments

    PubMed Central

    Dardamanis, Dimitrios; Theodorou, Dimitrios; Theodoropoulos, George; Larentzakis, Andreas; Natoudi, Maria; Doulami, Georgia; Zoumpouli, Christina; Markogiannakis, Haridimos; Katsaragakis, Stylianos; Zografos, George C

    2011-01-01

    Transanal excision of rectal polyps with laparoscopic instrumentation and a single incision laparoscopic port is a novel technique that uses technology originally developed for abdominal procedures from the natural orifice of the rectum. Transanal endoscopic microsurgery (TEM) is a well established surgical approach for certain benign or early malignant lesions of the rectum, under specific indications. Our technique is a hybrid technique of transanal surgery, a reasonable method for polyp resection without the need of the sophisticated and expensive instrumentation of TEM which can be applied whenever endoscopic or conventional transanal surgical removal is not feasible. PMID:21528096

  15. Transanal polypectomy using single incision laparoscopic instruments.

    PubMed

    Dardamanis, Dimitrios; Theodorou, Dimitrios; Theodoropoulos, George; Larentzakis, Andreas; Natoudi, Maria; Doulami, Georgia; Zoumpouli, Christina; Markogiannakis, Haridimos; Katsaragakis, Stylianos; Zografos, George C

    2011-04-27

    Transanal excision of rectal polyps with laparoscopic instrumentation and a single incision laparoscopic port is a novel technique that uses technology originally developed for abdominal procedures from the natural orifice of the rectum. Transanal endoscopic microsurgery (TEM) is a well established surgical approach for certain benign or early malignant lesions of the rectum, under specific indications. Our technique is a hybrid technique of transanal surgery, a reasonable method for polyp resection without the need of the sophisticated and expensive instrumentation of TEM which can be applied whenever endoscopic or conventional transanal surgical removal is not feasible.

  16. Laparoscopic Fertility Sparing Management of Cervical Cancer

    PubMed Central

    Facchini, Chiara; Rapacchia, Giuseppina; Montanari, Giulia; Casadio, Paolo; Pilu, Gianluigi; Seracchioli, Renato

    2014-01-01

    Fertility can be preserved after conservative cervical surgery. We report on a 29-year-old woman who was obese, para 0, and diagnosed with cervical insufficiency at the first trimester of current pregnancy due to a previous trachelectomy. She underwent laparoscopic transabdominal cervical cerclage (LTCC) for cervical cancer. The surgery was successful and she was discharged two days later. The patient underwent a caesarean section at 38 weeks of gestation. Laparoscopic surgery is a minimally invasive approach associated with less pain and faster recovery, feasible even in obese women. PMID:24696772

  17. Current Trends in Laparoscopic Ventral Hernia Repair

    PubMed Central

    Patapis, Paul; Zavras, Nick; Tzanetis, Panagiotis; Machairas, Anastasios

    2015-01-01

    Background and Objectives: The purpose of this study was to analyze the surgical technique, postoperative complications, and possible recurrence after laparoscopic ventral hernia repair (LVHR) in comparison with open ventral hernia repair (OVHR), based on the international literature. Database: A Medline search of the current English literature was performed using the terms laparoscopic ventral hernia repair and incisional hernia repair. Conclusions: LVHR is a safe alternative to the open method, with the main advantages being minimal postoperative pain, shorter recovery, and decreased wound and mesh infections. Incidental enterotomy can be avoided by using a meticulous technique and sharp dissection to avoid thermal injury. PMID:26273186

  18. Laparoscopic excision of intra-abdominal paragonimiasis.

    PubMed

    Kim, Jun-Young; Kang, Chang-Moo; Choi, Gi-Hong; Yang, Woo-Ick; Sim, Seo-Bo; Kwon, Ji-Eun; Kim, Kyung-Sik; Choi, Jin-Sub; Lee, Woo-Jung; Kim, Byong-Ro

    2007-12-01

    Lung fluke, Paragonimus westermani of Paragonimus species usually are accompanied by a persistent cough, hemoptysis, and chest pain. Extrapulmonary paragonimiasis caused by ectopic parasites in aberrant locations such as the abdominal wall, abdominal organs, and brain has been reported and the most commonly involved extrapulmonary organ is the brain. We present a case of 56-year-old male patient with intra-abdominal paragonimiasis who underwent laparoscopic excision of abdominal granuloma caused by parasite infection. An intra-abdominal mass associated with eosinophilia might be related to parasite infection. A laparoscopic approach is the most appropriate treatment modality in such benign abdominal pathology.

  19. Laparoscopic rectocele repair using polyglactin mesh.

    PubMed

    Lyons, T L; Winer, W K

    1997-05-01

    We assessed the efficacy of laparoscopic treatment of rectocele defect using a polyglactin mesh graft. From May 1, 1995, through September 30, 1995, we prospectively evaluated 20 women (age 38-74 yrs) undergoing pelvic floor reconstruction for symptomatic pelvic floor prolapse, with or without hysterectomy. Morbidity of the procedure was extremely low compared with standard transvaginal and transrectal approaches. Patients were followed at 3-month intervals for 1 year. Sixteen had resolution of symptoms. Laparoscopic application of polyglactin mesh for the repair of the rectocele defect is a viable option, although long-term follow-up is necessary. PMID:9154790

  20. Laparoscopic excision of a mesenteric cyst.

    PubMed

    Mackenzie, D J; Shapiro, S J; Gordon, L A; Ress, R

    1993-06-01

    Benign abdominal cystic tumors are rare. They include retroperitoneal, mesenteric, and omental cysts. Most of these lesions present with vague abdominal pain and nausea. Less commonly they will present with bowel obstruction due to external compression. The diagnosis of these tumors is by abdominal ultrasound or computed tomography. Surgical enucleation is the treatment of choice. Laparoscopic surgical techniques are replacing or complimenting open abdominal surgical procedures. As the indications for these techniques increase, newer applications will arise. Presented here is a case of laparoscopic excision of a mesenteric cyst.

  1. [Retroperitoneal bronchogenic cyst treated by laparoscopic surgery].

    PubMed

    Rud, O; May, M; Brookman-Amissah, S; Moersler, J; Greiner, A; Gilfrich, C

    2010-03-01

    The diagnosis of primary retroperitoneal cystic tumors is very infrequent in surgical pathology. We report the case of a 51-year-old woman presenting with an incidental left-sided retroperitoneal mass (32 x 24 mm in diameter) suspected of being an adrenal tumor. Intraoperatively the tumor was identified as a cystic lesion filled with mucous secretion and laparoscopically completely resected. The diagnosis was histopathologically confirmed as a bronchogenic cyst. In this article the laparoscopic removal of such a rare benign congenital aberration resulting from an abnormal budding of the tracheobronchial tree is presented.

  2. Laparoscopic partial nephrectomy in a horseshoe kidney.

    PubMed

    Molina, Wilson R; Gill, Inderbir S

    2003-12-01

    A 68-year-old man with an incidentally found 2-cm complex enhancing cystic right renal mass in the right moiety of a horseshoe kidney was treated with a three-port retroperitoneal laparoscopic approach. The tumor was completely excised with cold Endoshears, and Surgicel bolsters were tightly buttressed into the resection bed with 0 Vicryl sutures. The warm ischemia time was 31 minutes. To our knowledge, this is the initial case of retroperitoneal laparoscopic partial nephrectomy in a horseshoe kidney. Three-dimensional CT with volume rendering in a video format provides the necessary information about the number, location, and extrarenal anatomy of the renal artery and vein.

  3. Risk factors for pulmonary complications following laparoscopic gastrectomy

    PubMed Central

    Ntutumu, Redondo; Liu, Hao; Zhen, Li; Hu, Yan-Feng; Mou, Ting-Yu; Lin, Tian; I, Balde A.; Yu, Jiang; Li, Guo-Xin

    2016-01-01

    Abstract The risk factors associated with postoperative pulmonary complications (PPCs) following laparoscopic gastrectomy have not been well studied. We sought to identify the risk factors for PPCs following gastric cancer surgery. A retrospective analysis was performed on all gastric cancer patients in a prospective database who underwent a laparoscopic gastrectomy from 2004 to 2014. The potential risk factors for PPCs were evaluated. PPCs occurred in 6.8% (83/1205) of patients and included pneumonia in 56 (67.5%) patients, pleural effusion in 26 (31.3%) patients, and pulmonary embolism in 1 (1.2%) patient. The multivariate analysis identified the following significant risk factors for PPCs: advanced age (odds ratio [OR] = 1.043, 95% confidence interval [CI] = 1.021%, 1.066%), chronic obstructive pulmonary disease (COPD) (OR = 17.788, 95% CI = 2.618%, 120.838%), total gastrectomy (OR = 2.781, 95% CI = 1.726%, 4.480%), time to first diet (OR = 1.175, 95% CI = 1.060%, 1.302%), and postoperative hospital stay (OR = 1.015, 95% CI = 1.002%, 1.028%). The risk factors for pneumonia included advanced age (OR = 1.036, 95% CI = 1.010%, 1.063%), total gastrectomy (OR = 3.420, 95% CI = 1.960%, 5.969%), and time to first diet (OR = 1.207, 95% CI = 1.703%, 1.358%). Only pancreatectomy was a risk factor for pleural effusion (OR = 9.082, 95% CI = 2.412%, 34.206%). The frequency of PPCs in patients with gastric cancer who underwent laparoscopic surgery was relatively high. Patients with cardiac and pulmonary comorbidities and those who undergo total gastrectomy and combined resection should be considered at high risk. PMID:27512884

  4. State Skill Standards: Photography

    ERIC Educational Resources Information Center

    Howell, Frederick; Reed, Loretta; Jensen, Capra; Robison, Gary; Taylor, Susan; Pavesich, Christine

    2007-01-01

    The Department of Education has undertaken an ambitious effort to develop statewide skill standards for all content areas in career and technical education. The standards in this document are for photography programs and are designed to clearly state what the student should know and be able to do upon completion of an advanced high-school program.…

  5. State Skill Standards: Welding

    ERIC Educational Resources Information Center

    Pointer, Mike; Naylor, Randy; Warden, John; Senek, Gene; Shirley, Charles; Lefcourt, Lew; Munson, Justin; Johnson, Art

    2005-01-01

    The Department of Education has undertaken an ambitious effort to develop statewide occupational skill standards. The standards in this document are for welding programs and are designed to clearly state what the student should know and be able to do upon completion of an advanced high-school program. The writing team determined that any statewide…

  6. State Skill Standards: Metalworking

    ERIC Educational Resources Information Center

    Pointer, Mike; Naylor, Randy; Warden, John; Senek, Gene; Shirley, Charles; Lefcourt, Lew; Munson, Justin; Johnson, Art

    2005-01-01

    The Department of Education has undertaken an ambitious effort to develop statewide occupational skill standards. The standards in this document are for metalworking programs and are designed to clearly state what the student should know and be able to do upon completion of an advanced high-school program. The writing team determined that any…

  7. Analysis of a Standardized Technique for Laparoscopic Cuff Closure following 1924 Total Laparoscopic Hysterectomies

    PubMed Central

    Peters, Alfred; Sten, Margaret S.

    2016-01-01

    Objective. To review the vaginal cuff complications from a large series of total laparoscopic hysterectomies in which the laparoscopic culdotomy closure was highly standardized. Methods. Retrospective cohort study (Canadian Task Force Classification II-3) of consecutive total and radical laparoscopic hysterectomy patients with all culdotomy closures performed laparoscopically was conducted using three guidelines: placement of all sutures 5 mm deep from the vaginal edge with a 5 mm interval, incorporation of the uterosacral ligaments with the pubocervical fascia at each angle, and, whenever possible, suturing the bladder peritoneum over the vaginal cuff edge utilizing two suture types of comparable tensile strength. Four outcomes are reviewed: dehiscence, bleeding, infection, and adhesions. Results. Of 1924 patients undergoing total laparoscopic hysterectomy, 44 patients (2.29%) experienced a vaginal cuff complication, with 19 (0.99%) requiring reoperation. Five patients (0.26%) had dehiscence after sexual penetration on days 30–83, with 3 requiring reoperation. Thirteen patients (0.68%) developed bleeding, with 9 (0.47%) requiring reoperation. Twenty-three (1.20%) patients developed infections, with 4 (0.21%) requiring reoperation. Three patients (0.16%) developed obstructive small bowel adhesions to the cuff requiring laparoscopic lysis. Conclusion. A running 5 mm deep × 5 mm apart culdotomy closure that incorporates the uterosacral ligaments with the pubocervical fascia, with reperitonealization when possible, appears to be associated with few postoperative vaginal cuff complications. PMID:27579179

  8. Analysis of a Standardized Technique for Laparoscopic Cuff Closure following 1924 Total Laparoscopic Hysterectomies.

    PubMed

    O'Hanlan, Katherine A; Emeney, Pamela L; Peters, Alfred; Sten, Margaret S; McCutcheon, Stacey P; Struck, Danielle M; Hoang, Joseph K

    2016-01-01

    Objective. To review the vaginal cuff complications from a large series of total laparoscopic hysterectomies in which the laparoscopic culdotomy closure was highly standardized. Methods. Retrospective cohort study (Canadian Task Force Classification II-3) of consecutive total and radical laparoscopic hysterectomy patients with all culdotomy closures performed laparoscopically was conducted using three guidelines: placement of all sutures 5 mm deep from the vaginal edge with a 5 mm interval, incorporation of the uterosacral ligaments with the pubocervical fascia at each angle, and, whenever possible, suturing the bladder peritoneum over the vaginal cuff edge utilizing two suture types of comparable tensile strength. Four outcomes are reviewed: dehiscence, bleeding, infection, and adhesions. Results. Of 1924 patients undergoing total laparoscopic hysterectomy, 44 patients (2.29%) experienced a vaginal cuff complication, with 19 (0.99%) requiring reoperation. Five patients (0.26%) had dehiscence after sexual penetration on days 30-83, with 3 requiring reoperation. Thirteen patients (0.68%) developed bleeding, with 9 (0.47%) requiring reoperation. Twenty-three (1.20%) patients developed infections, with 4 (0.21%) requiring reoperation. Three patients (0.16%) developed obstructive small bowel adhesions to the cuff requiring laparoscopic lysis. Conclusion. A running 5 mm deep × 5 mm apart culdotomy closure that incorporates the uterosacral ligaments with the pubocervical fascia, with reperitonealization when possible, appears to be associated with few postoperative vaginal cuff complications. PMID:27579179

  9. Quality training in laparoscopic colorectal surgery: does it improve clinical outcome?

    PubMed

    Pitiakoudis, M; Michailidis, L; Zezos, P; Kouklakis, G; Simopoulos, C

    2011-10-01

    Laparoscopic colorectal surgery (LCRS) is a safe, effective and cost-efficient option for the treatment of various benign and malignant conditions. However, its implementation to surgical practice is still limited. That is mainly due to its association with a steep learning curve. We performed a review of the literature to determine whether quality training in LCRS can reduce that learning curve and lead to better clinical outcomes. We concluded that a structured training program with pre-clinical phase focused on basic skill acquisition and a clinical phase focused on mentoring from experts can shorten the learning curve and improve clinical outcomes. PMID:21887564

  10. Are you good enough for your patients? The European certification model in laparoscopic surgery

    PubMed Central

    Campo, R.; Molinas, C.R.; De Wilde, R.L.; Brolmann, H.; Brucker, S.; Mencaglia, L.; Odonovan, P.; Wallwiener, D.; Wattiez, A.

    2012-01-01

    Quality control, training and education in gynaecological surgery are challenged and urgent measures are emerging. The implementation of a structured and validated program for training and quality control seems the most urgent measurement to be taken. The European Academy of Gynaecological Surgery has made a first attempt to do so. Through a practical and theoretical tests system, the skills of an individual surgeon is measured and the conditions to enter the different level of expertise are clearly defined. This certification system based on the best possible level of scientific evidence provides a first practical tool, universally implementable for a decent quality control and structured training program in Gynaecological laparoscopic surgery. PMID:24753896

  11. Are you good enough for your patients? The European certification model in laparoscopic surgery.

    PubMed

    Campo, R; Molinas, C R; De Wilde, R L; Brolmann, H; Brucker, S; Mencaglia, L; Odonovan, P; Wallwiener, D; Wattiez, A

    2012-01-01

    Quality control, training and education in gynaecological surgery are challenged and urgent measures are emerging. The implementation of a structured and validated program for training and quality control seems the most urgent measurement to be taken. The European Academy of Gynaecological Surgery has made a first attempt to do so. Through a practical and theoretical tests system, the skills of an individual surgeon is measured and the conditions to enter the different level of expertise are clearly defined. This certification system based on the best possible level of scientific evidence provides a first practical tool, universally implementable for a decent quality control and structured training program in Gynaecological laparoscopic surgery.

  12. The European Academy laparoscopic “Suturing Training and Testing’’ (SUTT) significantly improves surgeons’ performance

    PubMed Central

    Sleiman, Z.; Tanos, V.; Van Belle, Y.; Carvalho, J.L.; Campo, R.

    2015-01-01

    The efficiency of suturing training and testing (SUTT) model by laparoscopy was evaluated, measuring the suturingskill acquisition of trainee gynecologists at the beginning and at the end of a teaching course. During a workshop organized by the European Academy of Gynecological Surgery (EAGS), 25 participants with three different experience levels in laparoscopy (minor, intermediate and major) performed the 4 exercises of the SUTT model (Ex 1: both hands stitching and continuous suturing, Ex 2: right hand stitching and intracorporeal knotting, Ex 3: left hand stitching and intracorporeal knotting, Ex 4: dominant hand stitching, tissue approximation and intracorporeal knotting). The time needed to perform the exercises is recorded for each trainee and group and statistical analysis used to note the differences. Overall, all trainees achieved significant improvement in suturing time (p < 0.005) as measured before and after completion of the training. Similar significantly improved suturing time differences (p < 0.005) were noted among the groups of trainees with different laparoscopic experience. In conclusion a short well-guided training course, using the SUTT model, improves significantly surgeon’s laparoscopic suturing ability, independently of the level of experience in laparoscopic surgery. Key words: Endoscopy, laparoscopic suturing, psychomotor skills, surgery, teaching, training suturing model. PMID:26977264

  13. Laparoscopic radical prostatectomy and resection of rectum performed together: first experience

    PubMed Central

    Orhalmi, Julius; Kosina, Josef; Balik, Michal; Pacovsky, Jaroslav

    2015-01-01

    Introduction Laparoscopy is an increasingly used approach in the surgical treatment of rectal cancer and prostate cancer. The anatomical proximity of the two organs is the main reason to consider performing both procedures simultaneously. Aim To present our first experience of laparoscopic rectal resection and radical prostatectomy, performed simultaneously, in 3 patients. Material and methods The first patient was diagnosed with locally advanced rectal cancer and tumor infiltration of the prostate and seminal vesicles. The other 2 patients were diagnosed with tumor duplicity. The surgery of the first patient started with laparoscopic prostatectomy except division of the prostate from the rectal wall. The next step was resection of the rectum, extralevator amputation of the rectum and vesicourethral anastomosis. In the other patients, resection of the rectum, followed by radical prostatectomy, was performed. Results The median follow-up was 12 months. The median operation time was 4 h 40 min, with blood loss of 300 ml. The operations and postoperative course were without incident in the case of 2 patients. However, 1 patient had stercoral peritonitis and a vesicorectal fistula in the early postoperative stage. Sigmoidostomy and postponed ureteroileal conduit were carried out. All patients were in oncologic remission. Conclusions Combined laparoscopic rectal resection and radical prostatectomy is a viable option for selected patients with locally advanced rectal cancer or tumor duplication. The procedures were completed without complications in 2 out of 3 patients. PMID:26649093

  14. Leiomyoma of the seminal vesicles: laparoscopic excision.

    PubMed

    Casado Varela, Javier; Hermida Gutiérrez, Juan Francisco; Castillón Vela, Ignacio T; León Rueda, Maria Eugenia; Ortega Medina, Luis; Moreno Sierra, Jesús

    2014-01-01

    Leiomyoma of the seminal vesicles is an extremely rare type of benign tumor of the genitourinary system and can cause lower urinary tract symptoms. Despite their low incidence, these tumors can be identified with transrectal ultrasound of the seminal vesicles during prostate examination. The removal of these tumors is facilitated by a laparoscopic approach.

  15. Single-Incision Laparoscopic Total Colectomy

    PubMed Central

    Ojo, Oluwatosin J.; Carne, David; Guyton, Daniel

    2012-01-01

    Background and Objectives: To present our experience with a single-incision laparoscopic total colectomy, along with a literature review of all published cases on single-incision laparoscopic total colectomy. Methods: A total of 22 cases were published between 2010 and 2011, with our patient being case 23. These procedures were performed in the United States and United Kingdom. Surgical procedures included total colectomy with end ileostomy, proctocolectomy with ileorectal anastomosis, and total proctocolectomy with ileopouch-anal anastomosis. Intraoperative and postoperative data are analyzed. Results: Twenty-two of the 23 cases were performed for benign cases including Crohns, ulcerative colitis, and familial adenomatous polyposis. One case was performed for adenocarcinoma of the cecum. The mean age was 35.3 years (range, 13 to 64), the mean body mass index was 20.1 (range, 19 to 25), mean operative time was 175.9 minutes (range, 139 to 216), mean blood loss was 95.3mL (range, 59 to 200), mean incision length was 2.61cm (range, 2 to 3). Average follow-up was 4.6 months with 2 reported complications. Conclusions: Single-incision laparoscopic total colectomy is feasible and safe in the hands of an experienced surgeon. It has been performed for both benign and malignant cases. It is comparable to the conventional multi-port laparoscopic total colectomy. PMID:22906326

  16. LAPAROSCOPIC RESECTION OF GASTROINTESTINAL STROMAL TUMORS (GIST)

    PubMed Central

    LOUREIRO, Marcelo de Paula; de ALMEIDA, Rômulo Augusto Andrade; CLAUS, Christiano Marlo Paggi; BONIN, Eduardo Aimoré; CURY-FILHO,, Antônio Moris; DIMBARRE, Daniellson; da COSTA, Marco Aurélio Raeder; VITAL, Marcílio Lisboa

    2016-01-01

    Background Gastrointestinal mesenchymal or stromal tumors (GIST) are lesions originated on digestive tract walls, which are treated by surgical resection. Several laparoscopic techniques, from gastrectomies to segmental resections, have been used successfully. Aim Describe a single center experience on laparoscopic GIST resection. Method Charts of 15 operated patients were retrospectively reviewed. Thirteen had gastric lesions, of which ten were sub epithelial, ranging from 2-8 cm; and three were pure exofitic growing lesions. The remaining two patients had small bowel lesions. Surgical laparoscopic treatment consisted of two distal gastrectomies, 11 wedge gastric resections and two segmental enterectomies. Mechanical suture was used in the majority of patients except on six, which underwent resection and closure using manual absorbable sutures. There were no conversions to open technique. Results Mean operative time was 1h 29 min±92 (40-420 min). Average lenght of hospital stay was three days (2-6 days). There were no leaks, postoperative bleeding or need for reintervention. Mean postoperative follow-up was 38±17 months (6-60 months). Three patients underwent adjuvant Imatinib treatment, one for recurrence five months postoperatively and two for tumors with moderate risk for recurrence . Conclusion Laparoscopic GIST resection, not only for small lesions but also for tumors above 5 cm, is safe and acceptable technique. PMID:27120729

  17. Carbon dioxide embolism during laparoscopic sleeve gastrectomy

    PubMed Central

    Zikry, Amir Abu; DeSousa, Kalindi; Alanezi, Khaled H

    2011-01-01

    Bariatric restrictive and malabsorptive operations are being carried out in most countries laparoscopically. Carbon dioxide or gas embolism has never been reported in obese patients undergoing bariatric surgery. We report a case of carbon dioxide embolism during laparoscopic sleeve gastrectomy (LSG) in a young super obese female patient. Early diagnosis and successful management of this complication are discussed. An 18-year-old super obese female patient with enlarged fatty liver underwent LSG under general anesthesia. During initial intra-peritoneal insufflation with CO2 at high flows through upper left quadrant of the abdomen, she had precipitous fall of end-tidal CO2 and SaO2 % accompanied with tachycardia. Early suspicion led to stoppage of further insufflation. Clinical parameters were stabilized after almost 30 min, while the blood gas analysis was restored to normal levels after 1 h. The area of gas entrainment on the damaged liver was recognized by the surgeon and sealed and the surgery was successfully carried out uneventfully. Like any other laparoscopic surgery, carbon dioxide embolism can occur during bariatric laparoscopic surgery also. Caution should be exercised when Veress needle is inserted through upper left quadrant of the abdomen in patients with enlarged liver. A high degree of suspicion and prompt collaboration between the surgeon and anesthetist can lead to complete recovery from this potentially fatal complication. PMID:21772696

  18. Laparoscopic Total Extraperitoneal Hernia Repair Outcomes

    PubMed Central

    Bresnahan, Erin R.

    2016-01-01

    Background and Objectives: Laparoscopic inguinal hernia repair has become increasingly popular as an alternative to open surgery. The purpose of this study was to evaluate the safety and effectiveness of the laparoscopic total extraperitoneal procedure with the use of staple fixation and polypropylene mesh. Methods: A retrospective chart review examined outcomes of 1240 laparoscopic hernia operations in 783 patients, focusing on intraoperative and early postoperative complications, pain, and time until return to work and normal physical activities. Results: There were no intraoperative complications in this series; 106 patients experienced early postoperative complications across 8 evaluated categories: urinary retention (4.1%), seroma (3.0%), testicular/hemiscrotal swelling (1.9%), testicular atrophy (0%), hydrocele (0.6%), mesh infection (0.1%), and neurological symptoms (transient, 1.0%; persistent, 0.2%). Patients used an average of 5.6 Percocet pills after the procedure, and mean times until return to work and normal activities, including their routine exercise regimen, were 3.0 and 3.8 days, respectively. Conclusion: Complication rates and convalescence times were considered equivalent or superior to those found in other studies assessing both laparoscopic and open techniques. The usage of multiple Endostaples did not result in increased neurologic complications in the early postoperative period when compared with findings in the literature. In the hands of an experienced surgeon, total extraperitoneal repair is a safe, effective alternative to open inguinal hernia repair. PMID:27493471

  19. Understanding perceptual boundaries in laparoscopic surgery.

    PubMed

    Lamata, Pablo; Gomez, Enrique J; Hernández, Félix Lamata; Oltra Pastor, Alfonso; Sanchez-Margallo, Francisco Miquel; Del Pozo Guerrero, Francisco

    2008-03-01

    Human perceptual capabilities related to the laparoscopic interaction paradigm are not well known. Its study is important for the design of virtual reality simulators, and for the specification of augmented reality applications that overcome current limitations and provide a supersensing to the surgeon. As part of this work, this article addresses the study of laparoscopic pulling forces. Two definitions are proposed to focalize the problem: the perceptual fidelity boundary, limit of human perceptual capabilities, and the Utile fidelity boundary, that encapsulates the perceived aspects actually used by surgeons to guide an operation. The study is then aimed to define the perceptual fidelity boundary of laparoscopic pulling forces. This is approached with an experimental design in which surgeons assess the resistance against pulling of four different tissues, which are characterized with both in vivo interaction forces and ex vivo tissue biomechanical properties. A logarithmic law of tissue consistency perception is found comparing subjective valorizations with objective parameters. A model of this perception is developed identifying what the main parameters are: the grade of fixation of the organ, the tissue stiffness, the amount of tissue bitten, and the organ mass being pulled. These results are a clear requirement analysis for the force feedback algorithm of a virtual reality laparoscopic simulator. Finally, some discussion is raised about the suitability of augmented reality applications around this surgical gesture.

  20. Laparoscopic surgery and the systemic immune response.

    PubMed Central

    Vittimberga, F J; Foley, D P; Meyers, W C; Callery, M P

    1998-01-01

    OBJECTIVE: The authors review studies relating to the immune responses evoked by laparoscopic surgery. SUMMARY BACKGROUND DATA: Laparoscopic surgery has gained rapid acceptance based on clinical grounds. Patients benefit from faster recovery, decreased pain, and quicker return to normal activities. Only more recently have attempts been made to identify the metabolic and immune responses that may underlie this clinical success. The immune responses to laparoscopy are now being evaluated in relation to the present knowledge of immune responses to traditional laparotomy and surgery in general. METHODS: A review of the published literature of the immune and metabolic responses to laparoscopy was performed. Laparoscopic surgery is compared with the traditional laparotomy on the basis of local and systemic immune responses and patterns of tumor growth. The impact of pneumoperitoneum and insufflation gases on the immune response is also reviewed. CONCLUSIONS: The systemic immune responses for surgery in general may not apply to laparoscopic surgery. The body's response to laparoscopy is one of lesser immune activation as opposed to immunosuppression. PMID:9527054

  1. [Laparoscopic diagnosis of acute mesenteric lymphadenitis].

    PubMed

    Perminova, G I; Sirotinskiĭ, V V; Sokolov, A A

    1989-01-01

    In 14 patients with non-specific mesadenitis, the diagnosis was established at emergency laparoscopy, performed for suspected acute appendicitis. Laparoscopic semiotics of the disease is described. Conservative treatment with additional local administration of drugs was successful. The mean duration of the in-hospital treatment of the patients was 4.6 days.

  2. Laparoscopic Hernia Repair and Bladder Injury

    PubMed Central

    Bhoyrul, Sunil; Mulvihill, Sean J.

    2001-01-01

    Background: Bladder injury is a complication of laparoscopic surgery with a reported incidence in the general surgery literature of 0.5% and in the gynecology literature of 2%. We describe how to recognize and treat the injury and how to avoid the problem. Case Reports: We report two cases of bladder injury repaired with a General Surgical Interventions (GSI) trocar and a balloon device used for laparoscopic extraperitoneal inguinal hernia repair. One patient had a prior appendectomy; the other had a prior midline incision from a suprapubic prostatectomy. We repaired the bladder injury, and the patients made a good recovery. Conclusion: When using the obturator and balloon device, it is important to stay anterior to the preperitoneal space and bladder. Prior lower abdominal surgery can be considered a relative contraindication to extraperitoneal laparoscopic hernia repair. Signs of gas in the Foley bag or hematuria should alert the surgeon to a bladder injury. A one- or two-layer repair of the bladder injury can be performed either laparoscopically or openly and is recommended for a visible injury. Mesh repair of the hernia can be completed provided no evidence exists of urinary tract infection. A Foley catheter is placed until healing occurs. PMID:11394432

  3. Hepatocyte Isolation After Laparoscopic Liver Resection.

    PubMed

    Horner, Rosa; Kluge, Martin; Gassner, Joseph; Nösser, Maximilian; Major, Rebeka Dalma; Reutzel-Selke, Anja; Leder, Annekatrin K; Struecker, Benjamin; Morgul, Mehmet H; Pratschke, Johann; Sauer, Igor M; Raschzok, Nathanael

    2016-09-01

    Liver tissue obtained from partial hepatectomy is a common source for isolation of primary human hepatocytes. Until now, liver resections were most commonly performed by conventional open surgery. Although the laparoscopic approach is currently emerging in liver surgery, data on the outcome of hepatocyte isolation from laparoscopically resected liver tissue are not available. A total of 22 hepatocyte isolations were performed using the two-step collagenase perfusion technique from October 2015 to March 2016. Liver tissue was obtained from n = 15 open liver resections (OLRs) and n = 7 laparoscopic liver resections (LLRs). Isolation parameters (cell yield, viability, and Percoll survival) were assessed and hepatocyte function (plating efficiency, urea, albumin, and aspartate aminotransferase) was measured over a culture period of 6 days (OLR: n = 13; LLR: n = 3). Total cell yield (OLR: 36.81 ± 6.77 × 10(6) cells/g vs. LLR 16.84 ± 10.66 × 10(6) cells/g, p = 0.0318) as well as viable yield (OLR 31.70 ± 6.05 × 10(6) cells/g vs. LLR 14.70 ± 9.89 × 10(6) cells/g, p = 0.0260) was significantly higher in the OLR group. Subgroup analysis revealed that the worse outcome of isolation of laparoscopically resected liver tissue was associated with right-lateral LLRs, whereas hepatocyte isolation from left-lateral LLRs was as effective as from open surgery. Hepatocyte function did not differ between hepatocytes from openly resected versus left-lateral laparoscopically resected liver tissue. We here present the first data on hepatocyte isolation from laparoscopic liver surgery. Although the overall outcome is worse compared with open surgery, our data suggest that liver tissue from laparoscopic resection of the left lobe is an excellent source for primary human hepatocytes. PMID:27481660

  4. Large-Vessel Sealing in Laparoscopic Colectomy with an Ultrasonic Device

    PubMed Central

    Plasencia, Gustavo; Van der Speeten, Kurt; Hinoul, Piet; Batiller, Jonathan; Severin, Kimberley S.; Schwiers, Michael L.; Rockall, Tim

    2016-01-01

    Background and Objective: The Harmonic ACE+7 Shears with Advanced Hemostasis Mode (Ethicon, Somerville, NJ, USA) is an ultrasonic device designed to transect and seal vessels up to 7 mm in diameter. The device applies an algorithm that optimizes ultrasonic energy delivery combined with a longer sealing cycle. The purpose of this study was to assess the initial clinical experience with the Harmonic device by evaluating large-vessel sealing during laparoscopic colectomy in consecutive cases. Methods: This prospective, multicenter, observational series involved 40 adult patients who were to undergo elective laparoscopic colectomy where dissection and transection of the inferior mesenteric artery was indicated. The primary study endpoint was first-pass hemostasis, defined as a single activation of the Advanced Hemostasis Mode to transect and seal the inferior mesenteric artery. The use of any additional energy device or hemostatic product to establish or maintain hemostasis was noted. Patients were observed after surgery for ∼4 weeks for adverse events that were considered to be related to the study procedure or study device. Descriptive statistical analyses were performed for study endpoints. Results: Forty patients underwent the laparoscopic colectomy procedure. First-pass hemostasis of the inferior mesenteric artery was achieved and maintained in all 40 patients, with no required additional hemostatic measures. Exposure of the vessel was reported as skeletonized in 22 of 40 (55%) patients. Mean transection time was 21.9 ± 7.4 s. One adverse event (postoperative anemia) was considered possibly related to the study device. Conclusion: In this initial clinical consecutive series, the device demonstrated successful transection and sealing of the large mesenteric vessels during laparoscopic colorectal surgery. PMID:27186065

  5. Laparoscopic antireflux surgery--technique and results.

    PubMed

    Fingerhut, A; Etienne, J C; Millat, B; Comandella, M G

    1997-09-01

    Although gastroesophageal reflux disease (GERD) can be effectively treated by proton-pump inhibitors, surgery is still the only means of definitive cure of the disease. After introduction of laparoscopic surgery, there has been a clear trend to surgical repair of the incompetent cardia. The indications for surgical treatment are: endoscopically proven esophagitis, persistent or recurrent complaints under medical treatment, esophageal stricture and/or pH-metrically proven acid reflux as well as reflux-induced coughing (chronic aspiration). Although the laparoscopic antireflux operations is a technically demanding procedure, it can be performed with similar results as compared to conventional surgery. The operative technique is reported in detail. From January 1992 to March 1997, 146 consecutive patients with GERD have been operated on laparoscopically. The overall conversion rate was 8.2% (n = 12). 133 patients were operated on according to the Nissen procedure including hiatoplasty. The Toupet operation was performed in only one case. 84 men and 42 women had a mean age of 49 years (20-76). The median duration of symptoms was 48 months (1-600). Except five patients all had medical treatment for at least 2 years. Twice pneumatic balloon dilatation of an esophageal stricture was necessary preoperatively. The median operation time was 210 minutes (70-660). Conversion to open surgery because of intraoperative complications was necessary in 6 patients. Postoperative complications occurred in 14 patients, all of them being successfully treated conservatively. No patient died. 121 patients (90.3%) had follow up examinations for at least 6 months. Retreatment was necessary in 5 cases: 1x slipped Nissen (laparoscopic repair), 1x intrathoracic hernia (conventional reoperation), 2x dysphagia > 4 months postoperatively (endoscopic balloon dilatation) and 1x recurrent ulcer (conventional operation). With a correct indication, laparoscopic Nissen repair for GERD is a suitable

  6. Surgical treatment: Myomectomy and hysterectomy; Endoscopy: A major advancement.

    PubMed

    Thubert, Thibault; Foulot, Hervé; Vinchant, Marie; Santulli, Pietro; Marzouk, Paul; Borghese, Bruno; Chapron, Charles

    2016-07-01

    Uterine fibroids affect 25% of women worldwide. Symptomatic women can be treated by either medical or surgical treatment. Development of endoscopic surgery has widely changed the management of myoma. Currently, although laparoscopic or laparoscopic robot-assisted myomectomies or hysterectomies are common, there has been no consensual guideline concerning the surgical techniques, operative route, and usefulness of preoperative treatment. Hysteroscopy management is a major advancement avoiding invasive surgery. This study deals with a literature review concerning surgical management of fibroids. PMID:27400649

  7. The Fundamentals of Laparoscopic Surgery and LapVR evaluation metrics may not correlate with operative performance in a novice cohort

    PubMed Central

    Steigerwald, Sarah N.; Park, Jason; Hardy, Krista M.; Gillman, Lawrence; Vergis, Ashley S.

    2015-01-01

    Background Considerable resources have been invested in both low- and high-fidelity simulators in surgical training. The purpose of this study was to investigate if the Fundamentals of Laparoscopic Surgery (FLS, low-fidelity box trainer) and LapVR (high-fidelity virtual reality) training systems correlate with operative performance on the Global Operative Assessment of Laparoscopic Skills (GOALS) global rating scale using a porcine cholecystectomy model in a novice surgical group with minimal laparoscopic experience. Methods Fourteen postgraduate year 1 surgical residents with minimal laparoscopic experience performed tasks from the FLS program and the LapVR simulator as well as a live porcine laparoscopic cholecystectomy. Performance was evaluated using standardized FLS metrics, automatic computer evaluations, and a validated global rating scale. Results Overall, FLS score did not show an association with GOALS global rating scale score on the porcine cholecystectomy. None of the five LapVR task scores were significantly associated with GOALS score on the porcine cholecystectomy. Conclusions Neither the low-fidelity box trainer or the high-fidelity virtual simulator demonstrated significant correlation with GOALS operative scores. These findings offer caution against the use of these modalities for brief assessments of novice surgical trainees, especially for predictive or selection purposes. PMID:26641071

  8. Laparoscopic gastrectomy for gastric cancer in China: an overview.

    PubMed

    Lan, Huanrong; Zhu, Naibiao; Lan, Yuefu; Jin, Ketao; Teng, Lisong

    2015-01-01

    Since its introduction in China in 2000, laparoscopic gastrectomy has shown classical advantages of minimally invasive surgery over open counterpart. Like all the pioneers of the technique, Chinese gastrointestinal surgeons claim that laparoscopic gastrectomy led to faster recovery, shorter hospital stay and more rapid return to daily activities respect to open gastrectomy while offering the same functional and oncological results. There has been booming interest in laparoscopic gastrectomy since 2006 in China. The last decade has witnessed national growth in the application of laparoscopic gastrectomy and yielded a significant amount of scientific data to support its clinical merits and advantages. However, few prospective randomized controlled trials have investigated the benefits of laparoscopic gastrectomy in China. In this article, we make an overview of the current data and state of the art of laparoscopic gastrectomy for gastric cancer in China. PMID:25911902

  9. Critical Learning Skills for Business Students

    ERIC Educational Resources Information Center

    Jance, Marsha; Morgan, Anita

    2013-01-01

    A survey addressing critical skills for business students was developed and disseminated. Sixteen critical skills (such as critical thinking and time management) were identified as skills that need to be acquired in order for business students to be successful in their advanced courses and careers. The survey was disseminated and taken by several…

  10. Virtual Reality Simulator Developed Welding Technology Skills

    ERIC Educational Resources Information Center

    Yunus, Faizal Amin Nur; Baser, Jamil Abd; Masran, Saiful Hadi; Razali, Nizamuddin; Rahim, Bekri

    2011-01-01

    The purpose of this study was to identify the suitability of VR welding simulator application towards CBT in developing welding skills upon new trainees at the Centre of Instructor and Advanced Skills Training (CIAST) Shah Alam Selangor and National Youth Skills Institute (IKBN) Pagoh Johor. The significance of the study was to create a…

  11. Laparoscopic resection of rectal cancer in the elderly

    PubMed Central

    Peters, Walter R.

    2016-01-01

    Recent published trials have failed to demonstrate that laparoscopic resection is not inferior to open resection of rectal cancer in terms of pathologic outcomes. However, there have been numerous studies showing the benefit of laparoscopic resection in terms of short-term complications and quality of life. Fewer complications and shorter hospital stays improve the chance of maintaining functional status, which is very important for the elderly population. Thus, laparoscopic resection of rectal cancer remains a viable option for the elderly.

  12. Mesh erosion after laparoscopic posterior rectopexy: A rare complication.

    PubMed

    Mathew, Mittu J; Parmar, Amit K; Reddy, Prasanna K

    2014-01-01

    Laparoscopic posterior mesh rectopexy (LPMR) is now an accepted surgical treatment for complete rectal prolapse. It is associated with complications such as partial mucosal prolapse, fecal impaction, constipation, and rarely recurrence. Erosion of the mesh into the rectum after LPMR is very rare. We report herein the case of 40-year-old man who presented with mesh erosion into the rectum and managed successfully by the laparoscopic excision of mesh. This is probably the first such case managed by the laparoscopic approach.

  13. Laparoscopic removal of a benign pelvic retroperitoneal dermoid cyst.

    PubMed

    Sharpe, L A; Van Oppen, D J

    1995-02-01

    Retroperitoneal tumors are rare, often malignant, and difficult to diagnose. Surgical removal is associated with significant morbidity and mortality. We believe this to be the first report of laparoscopic removal of a benign pelvic retroperitoneal dermoid cyst from the right pararectal and presacral areas. Iatrogenic enterocele was prevented by laparoscopic suturing and knot tying to perform a modified McCall culdoplasty. The excellent outcome of this case suggests that laparoscopic management should be considered for carefully selected benign retroperitoneal tumors.

  14. Superior mesenteric vein thrombosis after laparoscopic sleeve gastrectomy.

    PubMed

    Pineda, Lucas; Sarhan, Mohammad; Ahmed, Leaque

    2013-08-01

    Laparoscopic procedures for morbid obesity are becoming standard of care which, in experienced hands, has a very low mortality and morbidity. Superior mesenteric vein thrombosis has been reported in the literature after different bariatric and nonbariatric laparoscopic procedures. Laparoscopic sleeve gastrectomy is a relatively new procedure in the treatment of morbid obesity; its complications being well-known including staple line leak, bleeding, and stricture among others. We present a case of superior mesenteric vein thrombosis after laparoscopic sleeve gastrectomy successfully managed conservatively with therapeutic anticoagulation, and propose a different hypothesis for the development of such a complication.

  15. Laparoscopic Peptic Ulcer Perforation Closure: the Preferred Choice.

    PubMed

    Shah, Franal H; Mehta, Sudhir G; Gandhi, Mona D; Saraj

    2015-12-01

    Peptic ulcer perforation is a common life-threatening emergency needing immediate intervention. Laparoscopic closure of perforation is now widely practiced over conventional open closure. This study aimed to compare laparoscopic peptic ulcer perforation closure with conventional open closure in terms of operative time, postoperative analgesia, complications, hospital stay, and return to routine activities. This unicentric, nonblinded, prospective, randomized study was carried out in 50 patients with peptic ulcer perforation who were randomly allocated to undergo either laparoscopic closure or open closure surgery with 25 patients in each group. The mean operative time (60 vs 90 min) was less in the laparoscopic group (p < 0.05). Postoperative analgesia requirements (1 vs 6 days) were also less in laparoscopic patients (p < 0.05). Complications (nil vs 6; p < 0.05) and hospital stay (3 vs 8 days) were less in laparoscopic patients (p < 0.05). Patients return to normal activities (5 vs 10 days; p < 0.05) earlier in laparoscopic perforation closure than in open closure. Our study has shown better outcomes and lesser morbidities with laparoscopic approach in terms of shorter operative time, shorter hospital stay, less analgesic requirements, and less wound infections. Patients also return to routine activities earlier with the laparoscopic approach. It is a safe alternative to open surgery and should be a preferred choice when there are no contraindications to laparoscopy.

  16. Laparoscopic excision of retroperitoneal tumors: technique and review of the laparoscopic experience.

    PubMed

    Cadeddu, M O; Mamazza, J; Schlachta, C M; Seshadri, P A; Poulin, E C

    2001-04-01

    A technique for laparoscopic excision of benign retroperitoneal tumors, including a teratoma and two cystic lesions, is described. Laparoscopic resection of a 12-cm retroperitoneal teratoma was accomplished with the patient in the left lateral decubitus position. Medial mobilization of the ascending colon and the duodenum was required for access to the lesion. Resections of two cystic lesions (measuring 20 cm and 12 cm) were performed with the patients in the lithotomy position. The colon required medial mobilization in both cases to gain access to the cysts. Once the cysts were dissected from surrounding structures, they were punctured, and the aspirated fluid was sent for cytologic analysis. There were no complications or conversions. Mean operating time was 122 minutes (range, 80-190). Patients were discharged 1 day after surgery, requiring only nonsteroidal anti-inflammatory medications for analgesia. Retroperitoneal tumors can be resected laparoscopically with careful preoperative investigation and meticulous laparoscopic technique. A major advantage of laparoscopic resections is that the patient recovers rapidly with minimal morbidity.

  17. Solo surgeon single-port laparoscopic surgery with a homemade laparoscope-anchored instrument system in benign gynecologic diseases.

    PubMed

    Yang, Yun Seok; Kim, Seung Hyun; Jin, Chan Hee; Oh, Kwoan Young; Hur, Myung Haeng; Kim, Soo Young; Yim, Hyun Soon

    2014-01-01

    The objective of this study was to present the initial operative experience of solo surgeon single-port laparoscopic surgery (SPLS) in the laparoscopic treatment of benign gynecologic diseases and to investigate its feasibility and surgical outcomes. Using a novel homemade laparoscope-anchored instrument system that consisted of a laparoscopic instrument attached to a laparoscope and a glove-wound retractor umbilical port, we performed solo surgeon SPLS in 13 patients between March 2011 and June 2012. Intraoperative complications and postoperative surgical outcomes were determined. The primary operative procedures performed were unilateral salpingo-oophorectomy (n = 5), unilateral salpingectomy (n = 2), adhesiolysis (n = 1), and laparoscopically assisted vaginal hysterectomy (n = 5). Additional surgical procedures included additional adhesiolysis (n = 4) and ovarian drilling (n = 1).The primary indications for surgery were benign ovarian tumors (n = 5), ectopic pregnancy (n = 2), pelvic adhesion (infertility) (n = 1), and benign uterine tumors (n = 5). Solo surgeon SPLS was successfully accomplished in all procedures without a laparoscopic assistant. There were no intraoperative or postoperative complications. Our laparoscope-anchored instrument system obviates the need for an additional laparoscopic assistant and enables SPLS to be performed by a solo surgeon. The findings show that with our system, solo surgeon SPLS is a feasible and safe alternative technique for the treatment of benign gynecologic diseases in properly selected patients.

  18. Strategies to optimize the performance of Robotic-assisted ­laparoscopic hysterectomy

    PubMed Central

    Lambrou, N.; Diaz, R.E.; Hinoul, P.; Parris, D.; Shoemaker, K.; Yoo, A.; Schwiers, M.

    2014-01-01

    A hybrid technique of robot-assisted, laparoscopic hysterectomy using the ENSEAL® Tissue Sealing Device is described in a retrospective, consecutive, observational case series. Over a 45 month period, 590 robot-assisted total laparoscopic hysterectomies +/- oophorectomy for benign and malignant indications were performed by a single surgeon with a bedside assistant at a tertiary healthcare center. Patient demographics, indications for surgery, comorbidities, primary and secondary surgical procedures, total operative and surgical time, estimated blood loss (EBL), length of stay (LOS), complications, transfusions and subsequent readmissions were analyzed. The overall complication rate was 5.9% with 35 patients experiencing 69 complications. Mean (SD) surgery time, operating room (OR) time, EBL, and LOS for the entire cohort were 75.5 (39.42) minutes, 123.8 (41.15) minutes, 83.1 (71.29) millilitres, and 1.2 (0.93) days, respectively. Mean surgery time in the first year (2009) was 91.6 minutes, which declined significantly each year by 18.0, 19.0, and 24.3 minutes, respectively. EBL and LOS did not vary ­significantly across the entire series. Using the cumulative sum method, an optimization curve for surgery time was evaluated, with three distinct optimization phases observed. In summary, the use of an advanced laparoscopic tissue-sealing device by a bedside surgical assistant provided an improved operative efficiency and reliable vessel sealing during robotic hysterectomy. PMID:25374656

  19. Telerobotic laparoscopic repair of incisional ventral hernias using intraperitoneal prosthetic mesh.

    PubMed

    Ballantyne, Garth H; Hourmont, Katherine; Wasielewski, Annette

    2003-01-01

    Laparoscopic ventral hernia repair shortens the length of hospital stay and achieves low rates of hernia recurrence. The inherent difficulties of performing advanced laparoscopy operations, however, have limited the adoption of this technique by many surgeons. We hypothesized that the virtual operative field and hand-like instruments of a telerobotic surgical system could overcome these limitations. We present herein the first 2 reported cases of telerobotic laparoscopic ventral hernia repair with mesh. The operations were accomplished with the da Vinci telerobotic surgical system. The hernia defects were repaired with dual-sided, expanded polytetrafluoroethylene (ePTFE) mesh. The mesh was secured in place with 8 sutures that were passed through the abdominal wall, and 5-mm surgical tacks were placed around the circumference of the mesh. The 2 operations were accomplished with total operative times of 120 and 135 minutes and total operating room times of 166 and 180 minutes, respectively. The patients were discharged home on postoperative days 1 and 4. The surgeon sat in an ergonomically comfortable position at a computer console that was remote from the patient. Immersion of the surgeon within the 3-dimensional virtual operative field expedited each stage of these procedures. The articulation of the wristed telerobotic instruments greatly facilitated reaching the anterior abdominal cavity near the abdominal wall. This report indicates that telerobotic laparoscopic ventral hernia repair is feasible and suggests that telepresence technology facilitates this procedure. PMID:12722992

  20. Telerobotic Laparoscopic Repair of Incisional Ventral Hernias Using Intraperitoneal Prosthetic Mesh

    PubMed Central

    Hourmont, Katherine; Wasielewski, Annette

    2003-01-01

    Laparoscopic ventral hernia repair shortens the length of hospital stay and achieves low rates of hernia recurrence. The inherent difficulties of performing advanced laparoscopy operations, however, have limited the adoption of this technique by many surgeons. We hypothesized that the virtual operative field and hand-like instruments of a telerobotic surgical system could overcome these limitations. We present herein the first 2 reported cases of telerobotic laparoscopic ventral hernia repair with mesh. The operations were accomplished with the da Vinci telerobotic surgical system. The hernia defects were repaired with dual-sided, expanded polytetrafluoroethylene (ePTFE) mesh. The mesh was secured in place with 8 sutures that were passed through the abdominal wall, and 5-mm surgical tacks were placed around the circumference of the mesh. The 2 operations were accomplished with total operative times of 120 and 135 minutes and total operating room times of 166 and 180 minutes, respectively. The patients were discharged home on postoperative days 1 and 4. The surgeon sat in an ergonomically comfortable position at a computer console that was remote from the patient. Immersion of the surgeon within the 3-dimensional virtual operative field expedited each stage of these procedures. The articulation of the wristed telerobotic instruments greatly facilitated reaching the anterior abdominal cavity near the abdominal wall. This report indicates that telerobotic laparoscopic ventral hernia repair is feasible and suggests that telepresence technology facilitates this procedure. PMID:12722992

  1. The feasibility of single port laparoscopic cholecystectomy: a pilot study of 20 cases

    PubMed Central

    Rao, Prashanth P.; Bhagwat, Sonali M.; Rane, Abhay

    2008-01-01

    Introduction. Laparoscopic cholecystectomy has become the gold standard for symptomatic cholelithiasis 1. Traditionally done through four ports, three and two port surgeries have been described. We present a novel technique of single port cholecystectomy using the R-PortR (Advanced Surgical Concepts). Materials and methods. The R-PortR is a Tri-port that allows the ingress of three 5 mm instruments through a single port. Twenty patients with symptomatic cholelithiasis were subjected to single port cholecystectomy using the R-PortR through the umbilicus. Two patients also had choledocholithiasis. Modified instruments with angulated shafts were used for the surgery. A telescope with a coaxial light cable was also used. Whenever necessary, an extra needle for retraction or an additional 5 mm port was used. Results. Single port laparoscopic was accomplished in 17 of the 20 patients. In one patient an additional port was used for the cholecystectomy and in two others it was used for the common bile duct exploration but not for the dissection of Calot's triangle. Of the 17 patients, seven needed a single needle to retract the fundus of the gall bladder. Conclusions. Single port laparoscopic cholecystectomy is feasible and safe using the R-Port. The level of difficulty is higher and a needle for retraction or an additional port may be used whenever the visualization of Calot's triangle is unsatisfactory. Further studies and the development of better instrumentation are necessary before this can be recommended as a standard procedure. PMID:18982149

  2. Chylous ascites secondary to laparoscopic donor nephrectomy.

    PubMed

    Shafizadeh, Stephen F; Daily, Patrick P; Baliga, Prabhakar; Rogers, Jeffrey; Baillie, G Mark; Rajagopolan, P R; Chavin, Kenneth D

    2002-08-01

    Live donor renal transplantation offers many significant advantages over cadaveric donor transplantation. Yet living donation continues to be underused, accounting for less than 30% of all donor renal transplants. In an attempt to remove the disincentives to live donation, Ratner et al. developed laparoscopic donor nephrectomy (LDN). LDN is gaining acceptance in the transplant community. The overriding concern must always be the safety and welfare of the donor. To this end, potential complications of LDN must be identified and discussed. We present a patient who developed the complication of chylous ascites from LDN. To improve the laparoscopic technique further, a discussion of its successes and complications needs to be encouraged. To this end, we present chylous ascites as a potential complication after LDN. We also offer suggestions to minimize the likelihood of this complication. PMID:12137847

  3. [Laparoscopic pyelolithotomy in a horseshoe kidney].

    PubMed

    Sasaki, Yumiko; Kohjimoto, Yasuo; Nishizawa, Satoshi; Kikkawa, Kazuro; Nampo, Yoshihito; Matsumura, Nagahide; Inagaki, Takeshi; Hara, Isao

    2012-02-01

    A 66-year-old woman had a 22 mm right kidney stone accompanied with a horseshoe kidney. The size of this stone had been increasing gradually from 7 mm to 22 mm during the past 5 years. Although apparent pelviuretic junction stenosis could not be identified by intravenous urography, external pelvis was dilated in both kidneys. Complete excretion of fragmented stones by extracorporeal shockwave lithotripsy seemed to be difficult because impaired urinary passage from the renal pelvis to the ureter was suspected. Percutaneous nephrolithotomy was also difficult due to malrotation of the pelvic-caliceal system and possible interposition of bowel loops between kidney and abdominal wall. Therefore, we chose laparoscopic pyelolithotomy. This procedure made it possible to remove the stone completely with minimum invasiveness. We assume that laparoscopic pyelolithotomy is a safe and effective approach for renal pelvic stone in case of horseshoe kidney.

  4. Laparoscopic cholecystectomy for traumatic gallbladder perforation

    PubMed Central

    Hamilton, C; Carmichael, SP; Bernard, AC

    2012-01-01

    In trauma, laparoscopic surgery is commonly utilized as a diagnostic rather than therapeutic measure (1). Its use is often negated because of exigency or limitations in visibility due to haemorrhage. In the present case, a 35-year-old male was involved in a motor vehicle collision and arrived haemodynamically stable with abdominal pain. Abdominal CT revealed liver laceration and active contrast extravasation near the gallbladder fossa. Although angiography with embolization would normally be used, exploratory laparoscopy was performed because of concern for gallbladder injury. The gallbladder was found to be perforated and nearly completely avulsed from the fossa. Laparoscopic cholecystectomy was performed and the patient recovered uneventfully. Gallbladder perforation after trauma is typically an incidental finding during operation for haemorrhagic shock or other indication. Early diagnosis and swift surgical intervention are required, usually via laparotomy. However, when diagnosed preoperatively in the stable trauma victim, gallbladder perforation can be treated successfully with laparoscopy. PMID:24960682

  5. Laparoscopic Management of Adhesive Small Bowel Obstruction

    PubMed Central

    Konjic, Ferid; Idrizovic, Enes; Hasukic, Ismar; Jahic, Alen

    2016-01-01

    Introduction: Adhesions are the reason for bowel obstruction in 80% of the cases. In well selected patients the adhesive ileus laparoscopic treatment has multiple advantages which include the shorter hospitalization period, earlier food taking, and less postoperative morbidity rate. Case report: Here we have a patient in the age of 35 hospitalized at the clinic due to occlusive symptoms. Two years before an opened appendectomy had been performed on him. He underwent the treatment of exploration laparoscopy and laparoscopic adhesiolysis. Dilated small bowel loops connected with the anterior abdominal wall in the ileocecal region by adhesions were found intraoperatively and then resected harmonically with scalpel. One strangulation around which a small bowel loop was wrapped around was found and dissected. Postoperative course was normal. PMID:27041815

  6. Successful laparoscopic transabdominal cerclage in uterus didelphys.

    PubMed

    Ades, Alex; Hong, Phoebe

    2015-11-17

    The incidence of uterus didelphys is around 3/10,000 women. It is a class III Müllerian duct anomaly resulting from a complete non-fusion of the paired Müllerian ducts between the 12th and 16th weeks of gestation. Although the prevalence of cervical insufficiency in women with uterus didelphys is unknown, the incidence of cervical insufficiency in women with Müllerian anomalies has been reported as high as 30%. We present a case of successful pregnancy outcome following a laparoscopic transabdominal cerclage in a woman with uterus didelphys and cervical insufficiency. The case demonstrates that laparoscopic transabdominal cerclage can be performed successfully in women with uterus didelphys and a satisfactory obstetric outcome can be achieved.

  7. Gastrobronchial fistula following laparoscopic sleeve gastrectomy

    PubMed Central

    Abraham, Albin; Virdi, Ravi Paul Singh; Rajan, Dhyan; Singh, Jaspreet; Mustacchia, Paul; Iqbal, Javed; Rizvon, Kaleem

    2012-01-01

    Acquired fistulas between the tracheobronchial tree and the gastrointestinal tract are rare but serious complications of laparoscopic sleeve gastrectomies with significant morbidity and mortality. With the rising popularity and widespread acceptance of bariatric surgery techniques, the occurrence of gastrobronchial fistulas is being increasingly recognised. We present the case of a 26-year-old woman who underwent laparoscopic sleeve gastrectomy for morbid obesity and presented later with a history of chronic productive cough. Upper gastrointestinal series showed the presence of a communicating fistula between the stomach and the lung, with extravasation of contrast into the lung. The aim of this paper is to highlight the importance of considering the diagnosis of a gastrobronchial fistula in cases of persistent respiratory infections in the postoperative period following bariatric surgery and to review its incidence, clinical manifestations and treatment. PMID:22977059

  8. Traumatic Gallbladder Rupture Treated by Laparoscopic Cholecystectomy.

    PubMed

    Egawa, Noriyuki; Ueda, Junji; Hiraki, Masatsugu; Ide, Takao; Inoue, Satoshi; Sakamoto, Yuichiro; Noshiro, Hirokazu

    2016-01-01

    Gallbladder rupture due to blunt abdominal injury is rare. There are few reports of traumatic gallbladder injury, and it is commonly associated with other concomitant visceral injuries. Therefore, it is difficult to diagnose traumatic gallbladder rupture preoperatively when it is caused by blunt abdominal injury. We report a patient who underwent laparoscopic cholecystectomy after an exact preoperative diagnosis of traumatic gallbladder rupture. A 43-year-old man was admitted to our hospital due to blunt abdominal trauma. The day after admission, abdominal pain and ascites increased and a muscular defense sign appeared. Percutaneous drainage of the ascites was performed, and the aspirated fluid was bloody and almost pure bile. He was diagnosed with gallbladder rupture by the cholangiography using the endoscopic retrograde cholangiopancreatography technique. Laparoscopic cholecystectomy was performed safely, and he promptly recovered. If accumulated fluids contain bile, endoscopic cholangiography is useful not only to diagnose gallbladder injury but also to determine the therapeutic strategy. PMID:27462188

  9. Single port laparoscopic liver surgery: A minireview

    PubMed Central

    Karabicak, Ilhan; Karabulut, Kagan

    2016-01-01

    Nowadays, the trend is to perform surgeries with “scarless” incisions. In light of this, the single-port laparoscopic surgery (SPLS) technique is rapidly becoming widespread due to its lack of invasiveness and its cosmetic advantages, as the only entry point is usually hidden in the umbilicus. The interest in “scarless” liver resections did not grow as rapidly as the interest in other scarless surgeries. Hepatopancreatobiliary surgeons are reluctant to operate a malignant lesion through a narrow incision with limited exposure. There are concerns over adverse oncological outcomes for single-port laparoscopic liver resections (SPL-LR) for hepatocellular carcinoma or metastatic colorectal cancer. In addition, getting familiar with using the operating instruments through a narrow incision with limited exposure is very challenging. In this article, we reviewed the published literature to describe history, indications, contraindications, ideal patients for new beginners, technical difficulty, advantages, disadvantages, oncological concern and the future of SPL-LR. PMID:27358670

  10. Laparoscopic sleeve gastrectomy for morbid obesity

    PubMed Central

    Iannelli, Antonio; Dainese, Raffaella; Piche, Thierry; Facchiano, Enrico; Gugenheim, Jean

    2008-01-01

    The incidence of obesity is steadily rising, and it has been estimated that 40% of the US population will be obese by the year 2025 if the current trend continues. In recent years there has been renewed interest in the surgical treatment of morbid obesity in concomitance with the epidemic of obesity. Bariatric surgery proved effective in providing weight loss of large magnitude, correction of comorbidities and excellent short-term and long-term outcomes, decreasing overall mortality and providing a marked survival advantage. The Laparoscopic Sleeve Gastrectomy (LSG) has increased in popularity and is currently very “trendy” among laparoscopic surgeons involved in bariatric surgery. As LSG proved to be effective in achieving considerable weight loss in the short-term, it has been proposed by some as a sole bariatric procedure. This editorial focuses on the particular advantages of LSG in the treatment of morbid obesity. PMID:18240338

  11. Traumatic Gallbladder Rupture Treated by Laparoscopic Cholecystectomy

    PubMed Central

    Egawa, Noriyuki; Ueda, Junji; Hiraki, Masatsugu; Ide, Takao; Inoue, Satoshi; Sakamoto, Yuichiro; Noshiro, Hirokazu

    2016-01-01

    Abstract Gallbladder rupture due to blunt abdominal injury is rare. There are few reports of traumatic gallbladder injury, and it is commonly associated with other concomitant visceral injuries. Therefore, it is difficult to diagnose traumatic gallbladder rupture preoperatively when it is caused by blunt abdominal injury. We report a patient who underwent laparoscopic cholecystectomy after an exact preoperative diagnosis of traumatic gallbladder rupture. A 43-year-old man was admitted to our hospital due to blunt abdominal trauma. The day after admission, abdominal pain and ascites increased and a muscular defense sign appeared. Percutaneous drainage of the ascites was performed, and the aspirated fluid was bloody and almost pure bile. He was diagnosed with gallbladder rupture by the cholangiography using the endoscopic retrograde cholangiopancreatography technique. Laparoscopic cholecystectomy was performed safely, and he promptly recovered. If accumulated fluids contain bile, endoscopic cholangiography is useful not only to diagnose gallbladder injury but also to determine the therapeutic strategy. PMID:27462188

  12. Laparoscopic cholecystectomy using 2-mm instruments.

    PubMed

    Uranüs, S; Peng, Z; Kronberger, L; Pfeifer, J; Salehi, B

    1998-10-01

    Today, laparoscopic cholecystectomy is the method of choice for treatment of symptomatic gallbladder disorders. It minimizes effects of the operation that are independent of the gallbladder, such as trauma to the abdominal wall and other soft tissue. The surgical wounds were even smaller when 2-mm trocars were used. Laparoscopic cholecystectomy using 2-mm instruments was performed in a consecutive series of 14 patients with symptomatic gallstones. The procedure was completed in 12 cases, with conversion to open surgery in two cases. Intraoperative cholangiography was always performed. The postoperative course was always uneventful. The cosmetic effect was highly satisfactory. The procedure using 2-mm instruments could be indicated in selected patients with uncomplicated gallstone disease. PMID:9820716

  13. Laparoscopic cholecystectomy using 2-mm instruments.

    PubMed

    Uranüs, S; Peng, Z; Kronberger, L; Pfeifer, J; Salehi, B

    1998-10-01

    Today, laparoscopic cholecystectomy is the method of choice for treatment of symptomatic gallbladder disorders. It minimizes effects of the operation that are independent of the gallbladder, such as trauma to the abdominal wall and other soft tissue. The surgical wounds were even smaller when 2-mm trocars were used. Laparoscopic cholecystectomy using 2-mm instruments was performed in a consecutive series of 14 patients with symptomatic gallstones. The procedure was completed in 12 cases, with conversion to open surgery in two cases. Intraoperative cholangiography was always performed. The postoperative course was always uneventful. The cosmetic effect was highly satisfactory. The procedure using 2-mm instruments could be indicated in selected patients with uncomplicated gallstone disease.

  14. Haptic rendering for VR laparoscopic surgery simulation.

    PubMed

    McColl, Ryan; Brown, Ian; Seligman, Cory; Lim, Fabian; Alsaraira, Amer

    2006-03-01

    This project concerns the application of haptic feedback to a VR laparoscopic surgery simulator. Haptic attributes such as mass, friction, elasticity, roughness and viscosity are individually modeled, validated and applied to the existing visual simulation created by researchers at Monash University. Haptic feedback is an essential element in an immersive and realistic virtual reality laparoscopic training simulator. The haptic system must display stable, continuous and realistic multi-dimensional force feedback, and its inclusion should enhance the simulators training capability. Stability is a recurring concern throughout haptic history, and will be tackled with the implementation of a stable control algorithm and a passive environment model. Haptic force feedback modeling, systems implementation and validation studies form the principal areas of new work associated with this project. PMID:16623225

  15. Laparoscopic pyelolithotomy in a horseshoe kidney

    PubMed Central

    Ölçücüoğlu, Erkan; Çamtosun, Ahmet; Biçer, Sait; Bayraktar, Ahmet Murat

    2014-01-01

    The horseshoe kidney is the most frequent renal anomaly, with a prevalence of 0.25% and a male to female ratio of 2:1. In this article we aimed to report a 50-year-old man who had left kidney stones accompanied with a horseshoe kidney. In this case percutaneous nephrolithotomy was deemed to be a risky procedure due to malrotation of the pelviocalyceal system and possible interposition of bowel loops between kidney and the abdominal wall. Therefore, we preferred laparoscopic pyelolithotomy. At the end of the procedure, the patient was stone-free. We observed no complication. The patient was discharged after 72 hours. We assume that laparoscopic pyelolithotomy is a safe and effective approach for renal pelvic stone in case of horseshoe kidney. PMID:26328185

  16. Laparoscopic pyelolithotomy in a horseshoe kidney.

    PubMed

    Ölçücüoğlu, Erkan; Çamtosun, Ahmet; Biçer, Sait; Bayraktar, Ahmet Murat

    2014-12-01

    The horseshoe kidney is the most frequent renal anomaly, with a prevalence of 0.25% and a male to female ratio of 2:1. In this article we aimed to report a 50-year-old man who had left kidney stones accompanied with a horseshoe kidney. In this case percutaneous nephrolithotomy was deemed to be a risky procedure due to malrotation of the pelviocalyceal system and possible interposition of bowel loops between kidney and the abdominal wall. Therefore, we preferred laparoscopic pyelolithotomy. At the end of the procedure, the patient was stone-free. We observed no complication. The patient was discharged after 72 hours. We assume that laparoscopic pyelolithotomy is a safe and effective approach for renal pelvic stone in case of horseshoe kidney. PMID:26328185

  17. [Laparoscopic pyelolithotomy in a horseshoe kidney].

    PubMed

    Sasaki, Yumiko; Kohjimoto, Yasuo; Nishizawa, Satoshi; Kikkawa, Kazuro; Nampo, Yoshihito; Matsumura, Nagahide; Inagaki, Takeshi; Hara, Isao

    2012-02-01

    A 66-year-old woman had a 22 mm right kidney stone accompanied with a horseshoe kidney. The size of this stone had been increasing gradually from 7 mm to 22 mm during the past 5 years. Although apparent pelviuretic junction stenosis could not be identified by intravenous urography, external pelvis was dilated in both kidneys. Complete excretion of fragmented stones by extracorporeal shockwave lithotripsy seemed to be difficult because impaired urinary passage from the renal pelvis to the ureter was suspected. Percutaneous nephrolithotomy was also difficult due to malrotation of the pelvic-caliceal system and possible interposition of bowel loops between kidney and abdominal wall. Therefore, we chose laparoscopic pyelolithotomy. This procedure made it possible to remove the stone completely with minimum invasiveness. We assume that laparoscopic pyelolithotomy is a safe and effective approach for renal pelvic stone in case of horseshoe kidney. PMID:22450835

  18. Cooperative laparoscopic endoscopic and hybrid laparoscopic surgery for upper gastrointestinal tumors: Current status

    PubMed Central

    Ntourakis, Dimitrios; Mavrogenis, Georgios

    2015-01-01

    AIM: To investigate the cooperative laparoscopic and endoscopic techniques used for the resection of upper gastrointestinal tumors. METHODS: A systematic research of the literature was performed in PubMed for English and French language articles about laparoscopic and endoscopic cooperative, combined, hybrid and rendezvous techniques. Only original studies using these techniques for the resection of early gastric cancer, benign tumors and gastrointestinal stromal tumors of the stomach and the duodenum were included. By excluding case series of less than 10 patients, 25 studies were identified. The study design, number of cases, tumor pathology size and location, the operative technique name, the endoscopy team and surgical team role, operative time, type of closure of visceral wall defect, blood loss, complications and length of hospital stay of these studies were evaluated. Additionally all cooperative techniques found were classified and are presented in a systematic approach. RESULTS: The studies identified were case series and retrospective cohort studies. A total of 706 patients were operated on with a cooperative technique. The tumors resected were only gastrointestinal stromal tumors (GIST) in 4 studies, GIST and various benign submucosal tumors in 22 studies, early gastric cancer (pT1a and pT1b) in 6 studies and early duodenal cancer in 1 study. There was important heterogeneity between the studies. The operative techniques identified were: laparoscopic assisted endoscopic resection, endoscopic assisted wedge resection, endoscopic assisted transgastric and intragastric surgery, laparoscopic endoscopic cooperative surgery (LECS), laparoscopic assisted endoscopic full thickness resection (LAEFR), clean non exposure technique and non-exposed endoscopic wall-inversion surgery (NEWS). Each technique is illustrated with the roles of the endoscopic and laparoscopic teams; the indications, characteristics and short term results are described. CONCLUSION: Along with

  19. [Complications and reoperations following laparoscopic antireflux surgery].

    PubMed

    Horváth, Örs Péter; Varga, Gábor; Biró, Zsanett; Papp, András; Bognár, Laura; Vereczkei, András

    2016-09-01

    Laparoscopic antireflux surgery is an effective treatment for patients with gastro-esophageal reflux disease, when it is refractory to conservative management. In experienced centers the procedure is safe, although complications may develop either during surgery or in the early or late postoperative period, which may necessitate revisional surgery. Between 1998 and 2015 a total of 407 patients underwent laparoscopic antireflux surgery at the Department of Surgery, University of Pécs. This interval was divided into two periods. In the first one, between 1998 and 2006, we operated on 241 patients who were all enrolled in a prospective study. All the diagnostic examinations were carried out at our institution. In the second period 166 patients were treated with minimal invasive surgery and the data were analyzed retrospectively. The 407 patients comprised 161 men and 246 women with a median age of 53,1 years. Hiatoplasty was reinforced with teres ligament in 27 cases, a prosthetic mesh was used in 28 cases and fascia lata in a four cases, when hiatal closures were not considered reliable. In 16 cases (4%) the operation was converted to open procedure, and our mortality rate was 0,5%. Revisional surgery was performed laparoscopically in 39 patients, and thoraco-laparotomy was done in six cases (12%). 5 additional reoperations were performed in patients, who had their primary antireflux surgery in another institution. Our 4% conversion, 12% reoperation and 0,5% mortality rates correspond to the figures published in the literature. In conclusion, this study confirms that laparoscopic antireflux surgery is a safe procedure with very good clinical outcomes. Late complications, such as recurrent reflux disease and reherniation, as well as revisional surgery occured almost exclusively after surgical treatment of the large hiatal hernias. PMID:27644924

  20. Laparoscopic Surgical Techniques for Endometriosis and Adenomyosis

    PubMed Central

    Wood, C.; Maher, P.; Woods, R.

    2000-01-01

    The details of surgical techniques for laparoscopic removal of endometriosis and adenomyosis are described briefly in textbooks and gynaecological journal articles. We have described a wide variety of techniques for the various procedures required in the treatment of endometriosis and adenomyosis, excluding hysterectomy. The principles are based upon those used in removal of primary cancer lesions. The limitations of thermal ablation are discussed, and evidence of improved results after excision of lesions have been submitted for publication. PMID:18493534

  1. Durability of laparoscopic repair of paraesophageal hernia.

    PubMed Central

    Edye, M B; Canin-Endres, J; Gattorno, F; Salky, B A

    1998-01-01

    OBJECTIVES: To define a method of primary repair that would minimize hernia recurrence and to report medium-term follow-up of patients who underwent laparoscopic repair of paraesophageal hernia to verify durability of the repair and to assess the effect of inclusion of an antireflux procedure. SUMMARY BACKGROUND DATA: Primary paraesophageal hernia repair was completed laparoscopically in 55 patients. There were five recurrences within 6 months when the sac was not excised (20%). After institution of a technique of total sac excision in 30 subsequent repairs, no early recurrences were observed. METHODS: Inclusion of an antireflux procedure, incidence of subsequent hernia recurrence, dysphagia, and gastroesophageal reflux symptoms were recorded in clinical follow-up of patients who underwent a laparoscopic procedure. RESULTS: Mean length of follow-up was 29 months. Forty-nine patients were available for follow-up, and one patient had died of lung cancer. Mean age at surgery was 68 years. The surgical morbidity rate in elderly patients was no greater than in younger patients. Eleven patients (22%) had symptoms of mild to moderate reflux, and 15 were taking acid-reduction medication for a variety of dyspeptic complaints. All but 2 of these 15 had undergone 360 degrees fundoplication at initial repair. Two patients (4%) had late recurrent hernia, each small, demonstrated by esophagram or endoscopy. CONCLUSIONS: Laparoscopic repair in the medium term appeared durable. The incidence of postsurgical reflux symptoms was unrelated to inclusion of an antireflux procedure. In the absence of motility data, partial fundoplication was preferred, although dysphagia after floppy 360 degrees wrap was rare. With the low morbidity rate of this procedure, correction of symptomatic paraesophageal hernia appears indicated in patients regardless of age. Images Figure 1. PMID:9790342

  2. Laparoscopic liver resection: Experience based guidelines

    PubMed Central

    Coelho, Fabricio Ferreira; Kruger, Jaime Arthur Pirola; Fonseca, Gilton Marques; Araújo, Raphael Leonardo Cunha; Jeismann, Vagner Birk; Perini, Marcos Vinícius; Lupinacci, Renato Micelli; Cecconello, Ivan; Herman, Paulo

    2016-01-01

    Laparoscopic liver resection (LLR) has been progressively developed along the past two decades. Despite initial skepticism, improved operative results made laparoscopic approach incorporated to surgical practice and operations increased in frequency and complexity. Evidence supporting LLR comes from case-series, comparative studies and meta-analysis. Despite lack of level 1 evidence, the body of literature is stronger and existing data confirms the safety, feasibility and benefits of laparoscopic approach when compared to open resection. Indications for LLR do not differ from those for open surgery. They include benign and malignant (both primary and metastatic) tumors and living donor liver harvesting. Currently, resection of lesions located on anterolateral segments and left lateral sectionectomy are performed systematically by laparoscopy in hepatobiliary specialized centers. Resection of lesions located on posterosuperior segments (1, 4a, 7, 8) and major liver resections were shown to be feasible but remain technically demanding procedures, which should be reserved to experienced surgeons. Hand-assisted and laparoscopy-assisted procedures appeared to increase the indications of minimally invasive liver surgery and are useful strategies applied to difficult and major resections. LLR proved to be safe for malignant lesions and offers some short-term advantages over open resection. Oncological results including resection margin status and long-term survival were not inferior to open resection. At present, surgical community expects high quality studies to base the already perceived better outcomes achieved by laparoscopy in major centers’ practice. Continuous surgical training, as well as new technologies should augment the application of laparoscopic liver surgery. Future applicability of new technologies such as robot assistance and image-guided surgery is still under investigation. PMID:26843910

  3. Chylous cyst formation following laparoscopic fundoplication.

    PubMed

    Wykypiel, Heinz F; Margreiter, Raimund

    2007-01-01

    Formation of an abdominal chylous cyst is a rare event, predominantly occurring after spinal, vascular or urologic retroperitoneal surgery. As far as we know, the presented case is the first report in the literature of chylous cyst formation after laparoscopic fundoplication. A 57-year-old man with a history of a conservatively treated spinal compression fracture (T11/12) underwent laparoscopic fundoplication in 1996 for recurrent heartburn with insufficient response to treatment with PPI. His reflux symptoms disappeared but over the following years he developed intermittent abdominal pain in the right upper quadrant. Gastroscopy in 2002 revealed a slight compression of the distal esophagus. CT scan revealed a cystic formation next to the distal esophagus which was initially interpreted to be part of the fundoplicate itself. Aggravation of symptoms and weight loss was noted in 2006. A further CT scan revealed a 7 cm cyst along the fundoplicate and the lesser curvature of the stomach. The cyst was subsequently drained laparoscopically. Cholesterol (351 mg/d), LDL-cholesterol (263 mg/dl), triglycerides (334 mg/dl) and chylomicrons led to the diagnosis chylous cyst and the patient was put on a medium-chain triglyceride diet. After 12 weeks the discharge stopped and the drain was removed. The patient remained symptom-free for seven months but then presented again with the same complaints. This time an even larger cyst was diagnosed, extending from the lesser curvature of the stomach through the esophageal hiatus up to the right atrium. A Roux-en-Y chylous cystojejunostomy was then performed and has solved the problem up to the present. A chylous cyst may develop after laparoscopic fundoplication. If simple drainage fails, a cystojejunostomy can solve this problem.

  4. Laparoscopic liver resection: Experience based guidelines.

    PubMed

    Coelho, Fabricio Ferreira; Kruger, Jaime Arthur Pirola; Fonseca, Gilton Marques; Araújo, Raphael Leonardo Cunha; Jeismann, Vagner Birk; Perini, Marcos Vinícius; Lupinacci, Renato Micelli; Cecconello, Ivan; Herman, Paulo

    2016-01-27

    Laparoscopic liver resection (LLR) has been progressively developed along the past two decades. Despite initial skepticism, improved operative results made laparoscopic approach incorporated to surgical practice and operations increased in frequency and complexity. Evidence supporting LLR comes from case-series, comparative studies and meta-analysis. Despite lack of level 1 evidence, the body of literature is stronger and existing data confirms the safety, feasibility and benefits of laparoscopic approach when compared to open resection. Indications for LLR do not differ from those for open surgery. They include benign and malignant (both primary and metastatic) tumors and living donor liver harvesting. Currently, resection of lesions located on anterolateral segments and left lateral sectionectomy are performed systematically by laparoscopy in hepatobiliary specialized centers. Resection of lesions located on posterosuperior segments (1, 4a, 7, 8) and major liver resections were shown to be feasible but remain technically demanding procedures, which should be reserved to experienced surgeons. Hand-assisted and laparoscopy-assisted procedures appeared to increase the indications of minimally invasive liver surgery and are useful strategies applied to difficult and major resections. LLR proved to be safe for malignant lesions and offers some short-term advantages over open resection. Oncological results including resection margin status and long-term survival were not inferior to open resection. At present, surgical community expects high quality studies to base the already perceived better outcomes achieved by laparoscopy in major centers' practice. Continuous surgical training, as well as new technologies should augment the application of laparoscopic liver surgery. Future applicability of new technologies such as robot assistance and image-guided surgery is still under investigation.

  5. Application of Competency-Based Education in Laparoscopic Training

    PubMed Central

    Xue, Dongbo; Bo, Hong; Zhao, Song; Meng, Xianzhi

    2015-01-01

    Background and Objectives: To induce competency-based education/developing a curriculum in the training of postgraduate students in laparoscopic surgery. Methods: This study selected postgraduate students before the implementation of competency-based education (n = 16) or after the implementation of competency-based education (n = 17). On the basis of the 5 competencies of patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, and professionalism, the research team created a developing a curriculum chart and specific improvement measures that were implemented in the competency-based education group. Results: On the basis of the developing a curriculum chart, the assessment of the 5 comprehensive competencies using the 360° assessment method indicated that the competency-based education group's competencies were significantly improved compared with those of the traditional group (P < .05). The improvement in the comprehensive assessment was also significant compared with the traditional group (P < .05). Conclusion: The implementation of competency-based education/developing a curriculum teaching helps to improve the comprehensive competencies of postgraduate students and enables them to become qualified clinicians equipped to meet society's needs. PMID:25901105

  6. Acupuncture for postoperative pain in laparoscopic surgery: a systematic review protocol

    PubMed Central

    Lee, Seunghoon; Park, Jimin; Kim, Jihye; Kang, Jung Won; Choi, Do-Young; Park, Sun Jin; Nam, Dongwoo; Lee, Jae-Dong

    2014-01-01

    Introduction This review aims to evaluate the effectiveness and safety of acupuncture for patients with postoperative pain after laparoscopic surgery. Methods and analysis We will search the following databases from their inception to October 2014: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Allied and Complementary Medicine Database (AMED), three Chinese databases (China National Knowledge Infrastructure (CNKI), the Chongqing VIP Chinese Science and Technology Periodical Database (VIP) and the Wanfang database), one Japanese database (Japan Science and Technology Information Aggregator, Electronic (J-STAGE)) and eight Korean databases (Korean Association of Medical Journal Edition, Korean Medical Database, Korean Studies Information Service System, National Discovery for Science Leaders, Database Periodical Information Academic, Korean National Assembly Digital Library, Oriental Medicine Advanced Searching Integrated System and Korean Traditional Knowledge Portal). All randomised controlled trials of acupuncture for postoperative pain after laparoscopic surgery will be considered for inclusion. The risk of bias and reporting quality will be assessed using the Cochrane risk of bias tool, the Consolidated Standards of Reporting Trials (CONSORT) and the revised STandards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA). The risk ratio for dichotomous data and mean difference or standard mean difference for continuous data will be calculated with 95% CIs. Dissemination The results of this review will be disseminated through peer-reviewed publication or conference presentation. Our findings will summarise the current evidence of acupuncture to treat postoperative pain after laparoscopic surgery, and may provide important guidance for acupuncture usage after laparoscopic surgery for clinicians and patients. Trial registration number

  7. Use of a clinical pathway in laparoscopic gastrectomy for gastric cancer

    PubMed Central

    Kim, Hee Sung; Kim, Sun Oak; Kim, Byung Sik

    2015-01-01

    AIM: To evaluate the implementation of a clinical pathway and identify clinical factors affecting the clinical pathway for laparoscopic gastrectomy. METHODS: A standardized clinical pathway for gastric cancer (GC) patients was developed in 2001 by the GC surgery team at the Asan Medical Center. We reviewed the collected data of 4800 consecutive patients treated using the clinical pathway following laparoscopic gastrectomy with lymph node dissection for GC involving intracorporeal and extracorporeal anastomosis. The patients were treated between August 2004 and October 2013 in a single institution. To evaluate the rate of completion and risk factors affecting dropout from the clinical pathway, we used a multivariate logistic regression analysis. RESULTS: The overall completion rate of the clinical pathway for laparoscopic gastrectomy was 84.1% (n = 4038). In the comparison between groups of intracorporeal anastomosis and extracorporeal anastomosis patients, the completion rates were 83.88% (n = 1740) and 84.36% (n = 2071), respectively, showing no statistically significant difference. The main reasons for dropping out were postoperative complications (n = 463, 9.7%) and the need for patient observation (n = 299, 6.2%). Among the discharged patients treated using the clinical pathway, the number of patients who were readmitted within 30 d due to postoperative complications was 54 (1.1%). In a multivariate analysis, the intraoperative events (OR = 2.558) were the most predictable risk factors for dropping out of the clinical pathway. Additionally, being male (OR = 1.459), advanced age (OR = 1.727), total gastrectomy (OR = 2.444), combined operation (OR = 1.731), and ASA score (OR = 1.889) were significant risk factors affecting the dropout rate from the clinical pathway. CONCLUSION: Laparoscopic gastrectomy appears to be a good indication for the application of a clinical pathway. For successful application, patients with risk factors should be managed carefully. PMID

  8. Laparoscopic surgery for endometrial cancer: a review.

    PubMed

    Hauspy, Jan; Jiménez, Waldo; Rosen, Barry; Gotlieb, Walter H; Fung-Kee-Fung, Michael; Plante, Marie

    2010-06-01

    Uterine cancer is the fourth most common cancer in Canadian women, with an estimated 4200 new cases and 790 disease-related deaths in 2008. We investigated the domains that are important for further implementation of minimally invasive surgery for the management of endometrial cancer by performing a literature review to assess the available data on overall and disease-free survival in laparoscopic versus open surgery. We also investigated the influence of patient- related factors, surgical factors, quality of life, and cost implications. Among the 23 articles reviewed, five were randomized controlled trials (RCTs), four were prospective reviews, and 14 were retrospective reviews. The RCTs showed no difference in overall and disease-free survival for patients with endometrial cancer who had undergone laparoscopic hysterectomy compared with open surgery. Morbid obesity is a limiting factor for the feasibility of complete laparoscopic staging. Laparoscopy seems to decrease complications and decrease blood loss. It also shortens hospital stay, with improved short-term quality of life and cosmesis, while yielding similar lymph node counts. Overall, laparoscopy is cost-effective, because the increased operation cost of laparoscopy is offset by the shorter hospital stay and faster return to work. On the basis of currently available data, patients with endometrial cancer should be offered minimally invasive surgery as part of their treatment for endometrial cancer whenever possible.

  9. Laparoscopic surgery for pancreatic insulinomas: an update.

    PubMed

    Aggeli, Chrysanthi; Nixon, Alexander M; Karoumpalis, Ioannis; Kaltsas, Gregory; Zografos, George N

    2016-04-01

    Insulinomas are the most common functioning neuroendocrine tumors of the pancreas, occurring in almost 1-4 per 1 million persons each year. In contrast to other pancreatic neuroendocrine tumors, they are usually benign and solitary at the time of diagnosis. Due to their benign nature, surgical excision is the treatment of choice, with excellent long-term results. The introduction of minimally invasive techniques in the surgical treatment of insulinoma has been gaining popularity due to shorter length of hospital stay and better cosmetic results, with serious complications being comparable to those of open surgery. Preoperative localization is of paramount importance in the determination of the appropriate surgical approach. Many invasive and non-invasive methods exist for localization of an insulinoma. A combination of these modalities is usually adequate to preoperatively localize the vast majority of tumors. Laparoscopic ultrasound is mandatory to localize these tumors intraoperatively. Despite extensive experience in highly specialized centers producing encouraging results, no randomized trials have been realized to conclusively validate these case series, this partly due to the rarity of insulinoma in the population. In this article we present the current state of laparoscopic management of insulinoma delineating still unanswered issues and we underscore some of the technical details of the most common laparoscopic procedures employed.

  10. Laparoscopic Management of Superior Mesenteric Artery Syndrome

    PubMed Central

    Fenoglio, Michael E.

    2003-01-01

    Objectives: The differential diagnosis of intestinal obstruction includes mechanical obstruction, obstruction secondary to systemic disease, and idiopathic intestinal pseudo-obstruction. The causes of these are extensive; however, the majority of cases involve a mechanical cause. Superior mesenteric artery syndrome (SMAS) is a rare and controversial form of mechanical obstruction with just over 300 well-defined cases described in the literature. The diagnosis is often difficult to establish, even after surgery. In addition, this syndrome sometimes may be managed conservatively, leaving a definitive diagnosis unproven. We describe herein 2 patients with SMAS successfully treated with laparoscopic duodenojejunostomy. Methods: Two cases of SMAS occurred in young men ages 23 and 34. The workup included a consultation with a gastroenterologist, an upper gastrointestinal (GI) endoscopy, upper GI series with small bowel follow-through, computed tomography scan, ultrasound of the abdomen, and abdominal aortogram. This diagnosis was established after consultation with the surgeon and the gastroenterologist in each case. Results: Laparoscopic duodenojejunostomy was performed in each case, and both patients have had complete resolution of their preoperative symptoms. Conclusions: A laparoscopic approach to the management of superior mesenteric artery syndrome is a reasonable and successful way of treating these patients. PMID:12856847

  11. Dropped gallstones during laparoscopic cholecystectomy: the consequences.

    PubMed

    Tumer, Ali Riza; Yüksek, Yunus Nadi; Yasti, Ahmet Cinar; Gözalan, Ugur; Kama, Nuri Aydin

    2005-04-01

    During laparoscopic cholecystectomy, gallbladder perforation has been reported, leading to bile leak and spillage of gallstones into the peritoneum. Because the consequences can be dangerous, conversion to laparotomy as an instant management for gallstone spillage is one of the topics of current discussion in laparoscopic cholesystectomy. In this article, we discussed the option of not converting to laparotomy after intraperitoneal gallstone spillage as an acceptable approach to management or not.A prospectively maintained database of 1528 consecutive laparoscopic cholecystectomies performed during a 10-year period at the 4th Surgical Clinic of The Ankara Numune Education and Research Hospital was analyzed. Perforations resulting in gallstone spillage into the abdominal cavity were documented in 58 (3.8%) patients. Among those 58 patients seven (12%) experienced complications from retained stones. To maintain acceptable management of such patients, surgeons should inform each patient preoperatively that stones may be spilled. In the event of spillage, the patient should be informed postoperatively, and followed closely for complications. Follow-up should not waste time and money with unnecessary examinations, and it should avoid psychological trauma to the patient with a wrong diagnosis of cancer as a stone may mimic cancer radiologically. Thus the surgeon should not hesitate to record the events and inform the patient about the spillage of the stones and possible consequences. PMID:15770380

  12. Differences in Left and Right Laparoscopic Adrenalectomy

    PubMed Central

    Rieder, Jocelyn M.; Nisbet, Alan A.; Wuerstle, Melanie C.; Tran, Viet Q.; Kwon, Eric O.

    2010-01-01

    Background and Objectives: The classic belief is that right-sided laparoscopic adrenalectomy is technically more difficult to perform than left-sided. The purpose of this study was to determine whether objective outcomes are different for the right- versus left- sided operation. Methods: A retrospective review of 163 laparoscopic adrenalectomies was performed to compare outcomes. Variables extracted included age, demographics, body mass index (BMI), laterality, indication, operative time, estimated blood loss (EBL), gland size, complications, open conversion rates, and length of stay. Results: Of the adrenalectomies performed, 109 were on the left and 54 on the right. Age, BMI, and indication were similar for each group. The mean EBL on the left side was 113mL (range, 2 to 3000) and 84mL (range, 10 to 700) for the right (P=0.85). The mean operative time on the left side was 187 minutes (range, 62 to 475) and on the right was 156 minutes (range, 50 to 365) (P=0.02). There was no difference in complication or conversion rate. Conclusions: There was no difference in complication or conversion rates between each side, and we observed a trend toward lower blood loss for the right side. Although we report generally similar outcomes, the mean operative time for a right-sided laparoscopic adrenalectomy was significantly less (31 minutes) than the left side. PMID:21333190

  13. Core value of laparoscopic colorectal surgery

    PubMed Central

    Li, Xin-Xiang; Wang, Ren-Jie

    2015-01-01

    Since laparoscopy was first used in cholecystectomy in 1987, it has developed quickly and has been used in most fields of traditional surgery. People have now accepted its advantages like small incision, quick recovery, light pain, beauty and short hospital stays. In early times, there are still controversies about the application of laparoscopy in malignant tumor treatments, especially about the problems of oncology efficacy, incision implantation and operation security. However, these concerns have been fully eliminated by evidences on the basis of evidence-basis medicine. In recent years, new minimally invasive technologies are appearing continually, but they still have challenges and may increase the difficulties of radical dissection and the risks of potential complications, so they are confined to benign or early malignant tumors. The core value of the laparoscopic technique is to ensure the high quality of tumor’s radical resection and less complications. On the basis of this, it is allowed to pursue more minimally invasive techniques. Since the development of laparoscopic colorectal surgery is rapid and unceasing, we have reasons to believe that laparoscopic surgery will become gold standard for colorectal surgery in the near future. PMID:26676111

  14. Laparoscopic fundoplication for gastroesophageal reflux disease.

    PubMed

    Frazzoni, Marzio; Piccoli, Micaela; Conigliaro, Rita; Frazzoni, Leonardo; Melotti, Gianluigi

    2014-10-21

    Gastroesophageal reflux disease (GERD) is a condition that develops when the reflux of gastric contents into the esophagus leads to troublesome symptoms and/or complications. Heartburn is the cardinal symptom, often associated with regurgitation. In patients with endoscopy-negative heartburn refractory to proton pump inhibitor (PPI) therapy and when the diagnosis of GERD is in question, direct reflux testing by impedance-pH monitoring is warranted. Laparoscopic fundoplication is the standard surgical treatment for GERD. It is highly effective in curing GERD with a 80% success rate at 20-year follow-up. The Nissen fundoplication, consisting of a total (360°) wrap, is the most commonly performed antireflux operation. To reduce postoperative dysphagia and gas bloating, partial fundoplications are also used, including the posterior (Toupet) fundoplication, and the anterior (Dor) fundoplication. Currently, there is consensus to advise laparoscopic fundoplication in PPI-responsive GERD only for those patients who develop untoward side-effects or complications from PPI therapy. PPI resistance is the real challenge in GERD. There is consensus that carefully selected GERD patients refractory to PPI therapy are eligible for laparoscopic fundoplication, provided that objective evidence of reflux as the cause of ongoing symptoms has been obtained. For this purpose, impedance-pH monitoring is regarded as the diagnostic gold standard.

  15. Laparoscopic Proximal Gastrectomy With Gastric Tube Reconstruction

    PubMed Central

    Shiraishi, Norio; Toujigamori, Manabu; Shiroshita, Hidefumi; Etoh, Tsuyoshi; Inomata, Masafumi

    2016-01-01

    Background and Objectives: There is no standardized method of reconstruction in laparoscopic proximal gastrectomy (LPG). We present a novel technique of reconstruction with a long, narrow gastric tube in LPG for early gastric cancer (EGC). Methods: During the laparoscopic procedure, the upper part of the stomach is fully mobilized with perigastric and suprapancreatic lymphadenectomy, and then the abdominal esophagus is transected. After a minilaparotomy is created, the entire stomach is pulled outside. A long, narrow gastric tube (20 cm long, 3 cm wide) is created with a linear stapler. The proximal part of the gastric tube is formed into a cobra head shape for esophagogastric tube anastomosis, which is then performed with a 45-mm linear stapler under laparoscopic view. The end of the esophagus is fixed on the gastric tube to prevent postoperative esophageal reflux. Results: Thirteen patients with early proximal gastric cancer underwent the procedure. The mean operative time was 283 min, and median blood loss was 63 ml. There were no conversions to open surgery, and no intraoperative complications. Conclusion: This new technique of reconstruction after LPG is simple and feasible. The procedure has the potential of becoming a standard reconstruction technique after LPG for proximal EGC. PMID:27547027

  16. Laparoscopic ablation of symptomatic renal cysts.

    PubMed

    Rubenstein, S C; Hulbert, J C; Pharand, D; Schuessler, W W; Vancaillie, T G; Kavoussi, L R

    1993-10-01

    We report a laparoscopic approach to the drainage and ablation of symptomatic simple renal cysts. Ten patients with chronic pain, 6 of whom failed primary aspiration, underwent laparoscopic cyst ablation: 6 had solitary renal cysts, 3 had multiple cysts and 1 had a peripelvic cyst. The approach was transabdominal in 9 patients and extraperitoneal in 1. Intraoperatively, cyst fluid was obtained for cytological examination, and cyst walls were excised and sent for pathological examination. When possible, the remaining inner cyst walls were fulgurated to prevent recurrence. Mean total operating room time was 2 hours 27 minutes and blood loss was minimal. The sole complication was a postoperative retroperitoneal hematoma, which was managed conservatively. Malignancy was diagnosed in 2 patients, each of whom had a negative preoperative aspiration. These patients subsequently underwent radical nephrectomy. All remaining patients were asymptomatic at a mean followup of 10 months. Laparoscopic ablation of renal cysts is a safe and effective alternative to open surgery in patients who have failed conservative measures. Preoperative and intraoperative evaluation for malignancy should be performed.

  17. Core value of laparoscopic colorectal surgery.

    PubMed

    Li, Xin-Xiang; Wang, Ren-Jie

    2015-12-10

    Since laparoscopy was first used in cholecystectomy in 1987, it has developed quickly and has been used in most fields of traditional surgery. People have now accepted its advantages like small incision, quick recovery, light pain, beauty and short hospital stays. In early times, there are still controversies about the application of laparoscopy in malignant tumor treatments, especially about the problems of oncology efficacy, incision implantation and operation security. However, these concerns have been fully eliminated by evidences on the basis of evidence-basis medicine. In recent years, new minimally invasive technologies are appearing continually, but they still have challenges and may increase the difficulties of radical dissection and the risks of potential complications, so they are confined to benign or early malignant tumors. The core value of the laparoscopic technique is to ensure the high quality of tumor's radical resection and less complications. On the basis of this, it is allowed to pursue more minimally invasive techniques. Since the development of laparoscopic colorectal surgery is rapid and unceasing, we have reasons to believe that laparoscopic surgery will become gold standard for colorectal surgery in the near future. PMID:26676111

  18. Postoperative Ascites of Unknown Origin following Laparoscopic Appendicectomy: An Unusual Complication of Laparoscopic Surgery

    PubMed Central

    Feretis, M.; Boyd-Carson, H.; Karim, A.

    2014-01-01

    Postoperative ascites is a very rare complication of laparoscopic surgery. Significant iatrogenic injuries to the bowel, the urinary tract, and the lymphatic system should be excluded promptly to avoid devastating results for the patient. In some cases, in spite of investigating patients extensively, no definitive causative factor for the accumulation of fluid can be identified. In such cases, idiopathic allergic or inflammatory reaction of the peritoneum may be responsible for the development of ascites. We present a case of ascites of an unknown origin in a young female patient following a laparoscopic appendicectomy. PMID:24822146

  19. Laparoscopic removal of gastric band after laparoscopic gastric bypass and following placement of adjustable gastric band

    PubMed Central

    Lanaia, Andrea; Zizzo, Maurizio; Cartelli, Concetto M.; Fumagalli, Matteo; Bonilauri, Stefano

    2015-01-01

    Banded gastric bypass is a bariatric surgical intervention that has been regularly performed in many centers. According to some series, banded gastric bypass is safe and feasible. We describe the case of a 42-year-old woman undergoing laparoscopic gastric bypass in 2008. Subsequently, she underwent surgery in order to place adjustable gastric banding on previous bypass because of gastric pouch dilatation. Five months later, patient showed anorexia and signs of malnutrition. For this reason, she underwent laparoscopic removal of gastric banding. In our opinion, placing a device to restrict an already dilated gastric pouch must be avoided. PMID:26232597

  20. Cultivating strategic thinking skills.

    PubMed

    Shirey, Maria R

    2012-06-01

    This department highlights change management strategies that may be successful in strategically planning and executing organizational change initiatives. With the goal of presenting practical approaches helpful to nurse leaders advancing organizational change, content includes evidence-based projects, tools, and resources that mobilize and sustain organizational change initiatives. In this article, the author presents an overview of strategic leadership and offers approaches for cultivating strategic thinking skills.

  1. Retention of laryngoscopy skills in medical students: a randomised, cross-over study of the Macintosh, A.P. Advance(™) , C-MAC(®) and Airtraq(®) laryngoscopes.

    PubMed

    Hunter, I; Ramanathan, V; Balasubramanian, P; Evans, D A; Hardman, J G; McCahon, R A

    2016-10-01

    In addition to being effective and easy to learn how to use, the ideal laryngoscope should be associated with minimal reduction in skill performance during gaps in practice over time. We compared the time taken to intubate the trachea of a manikin by novice medical students immediately after training, and then after 1 month, with no intervening practice. We designed a two-period, four-group, randomised, cross-over trial to compare the Macintosh, Venner(™) A.P. Advance(™) with difficult airway blade, C-MAC(®) with D-Blade and Airtraq(®) with wireless video-viewer. A bougie was used to aid intubation with the Macintosh and the C-MAC. After training, there was no significant difference in median (IQR [range]) intubation time using the videolaryngoscopes compared with the Macintosh, which took 30 (26.5-35 [12-118])s. One month later, the intubation time was longer using the C-MAC (41 (29.5-52 [20-119])s; p = 0.002) and A.P. Advance (40 (28.5-57.5 [21-107])s; p = 0.0003)m compared with the Macintosh (27 (21-29 [16-90])s); there was no difference using the Airtraq (27 (20.5-32.5 [15-94])s; p = 0.258) compared with the Macintosh. While skill acquisition after a brief period of learning and practice was equal for each laryngoscope, performance levels differed after 1 month without practice. In particular, the consistency of performance using the C-MAC and A.P. Advance was worse compared with the Macintosh and the Airtraq. While the clinical significance of this is doubtful, we believe that reliable and consistent performance at laryngoscopy is desirable; for the devices that we tested, this requires regular practice.

  2. Retention of laryngoscopy skills in medical students: a randomised, cross-over study of the Macintosh, A.P. Advance(™) , C-MAC(®) and Airtraq(®) laryngoscopes.

    PubMed

    Hunter, I; Ramanathan, V; Balasubramanian, P; Evans, D A; Hardman, J G; McCahon, R A

    2016-10-01

    In addition to being effective and easy to learn how to use, the ideal laryngoscope should be associated with minimal reduction in skill performance during gaps in practice over time. We compared the time taken to intubate the trachea of a manikin by novice medical students immediately after training, and then after 1 month, with no intervening practice. We designed a two-period, four-group, randomised, cross-over trial to compare the Macintosh, Venner(™) A.P. Advance(™) with difficult airway blade, C-MAC(®) with D-Blade and Airtraq(®) with wireless video-viewer. A bougie was used to aid intubation with the Macintosh and the C-MAC. After training, there was no significant difference in median (IQR [range]) intubation time using the videolaryngoscopes compared with the Macintosh, which took 30 (26.5-35 [12-118])s. One month later, the intubation time was longer using the C-MAC (41 (29.5-52 [20-119])s; p = 0.002) and A.P. Advance (40 (28.5-57.5 [21-107])s; p = 0.0003)m compared with the Macintosh (27 (21-29 [16-90])s); there was no difference using the Airtraq (27 (20.5-32.5 [15-94])s; p = 0.258) compared with the Macintosh. While skill acquisition after a brief period of learning and practice was equal for each laryngoscope, performance levels differed after 1 month without practice. In particular, the consistency of performance using the C-MAC and A.P. Advance was worse compared with the Macintosh and the Airtraq. While the clinical significance of this is doubtful, we believe that reliable and consistent performance at laryngoscopy is desirable; for the devices that we tested, this requires regular practice. PMID:27530359

  3. Critical appraisal of laparoscopic vs open rectal cancer surgery

    PubMed Central

    Tan, Winson Jianhong; Chew, Min Hoe; Dharmawan, Angela Renayanti; Singh, Manraj; Acharyya, Sanchalika; Loi, Carol Tien Tau; Tang, Choong Leong

    2016-01-01

    AIM: To evaluate the long-term clinical and oncological outcomes of laparoscopic rectal resection (LRR) and the impact of conversion in patients with rectal cancer. METHODS: An analysis was performed on a prospective database of 633 consecutive patients with rectal cancer who underwent surgical resection. Patients were compared in three groups: Open surgery (OP), laparoscopic surgery, and converted laparoscopic surgery. Short-term outcomes, long-term outcomes, and survival analysis were compared. RESULTS: Among 633 patients studied, 200 patients had successful laparoscopic resections with a conversion rate of 11.1% (25 out of 225). Factors predictive of survival on univariate analysis include the laparoscopic approach (P = 0.016), together with factors such as age, ASA status, stage of disease, tumor grade, presence of perineural invasion and vascular emboli, circumferential resection margin < 2 mm, and postoperative adjuvant chemotherapy. The survival benefit of laparoscopic surgery was no longer significant on multivariate analysis (P = 0.148). Neither 5-year overall survival (70.5% vs 61.8%, P = 0.217) nor 5-year cancer free survival (64.3% vs 66.6%, P = 0.854) were significantly different between the laparoscopic group and the converted group. CONCLUSION: LRR has equivalent long-term oncologic outcomes when compared to OP. Laparoscopic conversion does not confer a worse prognosis. PMID:27358678

  4. Urethral injury in laparoscopic-assisted abdominoperineal resection

    PubMed Central

    Stitt, Laurel; Flores, Francisco Avila; Dhalla, Sonny S.

    2015-01-01

    We present a 71-year-old man who underwent laparoscopic-assisted abdominoperineal resection for recurrence of rectal cancer, which was complicated by a urethral injury. Traumatic urinary catheter insertion was ruled out as an alternative etiology. This case highlights the importance of recognizing urethral injury as a possible complication of laparoscopic-assisted abdominoperineal resection surgery. PMID:26834902

  5. [Surgical risks and their prevention in laparoscopic cholecystectomy].

    PubMed

    Sazhin, V P; Iudin, V A; Sazhin, I V; Nuzhdikhin, A V; Osipov, V V; Pod"iablonskaia, I A; Aĭvazian, S A

    2015-01-01

    It was analyzed the treatment results of 3739 patients with chronic and acute cholecystitis who underwent laparoscopic cholecystectomy. Three groups of predisposing factors were determined in 427 high risk patients. Laparoscopic cholecystectomy in view of these factors and enhancement of approach to dissect gall-bladder decreases the number of intraoperative complications. PMID:26271417

  6. Laparoscopic treatment of mucinous urachal adenocarcinoma with mucocele.

    PubMed

    Oberndoerfer, Marine; Bucher, Pascal; Caviezel, Alessandro; Platon, Alexandra; Ott, Vincent; Egger, Jean-François; Morel, Philippe

    2009-02-01

    We present a case of an asymptomatic 76-year-old woman treated laparoscopically for an urachal mucocele owing to a nonmetastatic urachal mucinous adenocarcinoma. Since laparoscopic en bloc resection of the urachus and partial cystectomy, the patient has been healthy and disease-free for 12 months. Modern surgical treatment of urachal adenocarcinoma is discussed in the light of this case.

  7. Laparoscopic lumbar hernia repair in a child with lumbocostovertebral syndrome.

    PubMed

    Jones, Sarah L; Thomas, Iona; Hamill, James

    2010-02-01

    Lumbocostovertebral syndrome is the association of a congenital lumbar hernia with rib and vertebral anomalies. We report the first case of a laparoscopic repair of a lumbar hernia in a child with lumbocostovertebral syndrome. Laparoscopic lumbar hernia repair appears to be safe and feasible in children.

  8. Recognition and Management of Urologic Injuries With Laparoscopic Hysterectomy.

    PubMed

    Dassel, Mark W; Adelman, Marisa R; Sharp, Howard T

    2015-12-01

    Injuries to the urinary tract during laparoscopic hysterectomy are quite rare, but are among the most serious injuries that occur during gynecologic surgery. Injury rates among subtypes of laparoscopic hysterectomy have been found to be similar. The most effective way to avoid urinary tract injury is knowledge of urinary tract anatomy and careful and thoughtful dissection.

  9. Retroperitoneal lymphocele formation after selective laparoscopic retroperitoneal lymph node sampling.

    PubMed

    Goh, M; Kantoff, P; Kavoussi, L R

    1994-06-01

    Laparoscopic retroperitoneal lymph node sampling is being evaluated at several institutions as a minimally invasive alternative to evaluate pathologically retroperitoneal lymph nodes in cases of clinical stage A testis tumor. We report on the development of a symptomatic lymphocele after selective laparoscopic retroperitoneal lymph node sampling.

  10. Laparoscopic Management of a Hydatid Cyst of the Adrenal Gland

    PubMed Central

    Nanjappa, Bhuvanesh; Gowda, Kiran Krishne

    2014-01-01

    Hydatid disease is endemic in parts of India, yet genitourinary involvement is rare. Laparoscopic management of such cases is uncommonly reported. We present a case of an adrenal hydatid and its management by laparoscopic aspiration, instillation of scolicidal solution, and partial excision of the cyst. PMID:25045450

  11. Laparoscopic vs mini-incision open appendectomy

    PubMed Central

    Çiftçi, Fatih

    2015-01-01

    AIM: To compare laparoscopic vs mini-incision open appendectomy in light of recent data at our centre. METHODS: The data of patients who underwent appendectomy between January 2011 and June 2013 were collected. The data included patients’ demographic data, procedure time, length of hospital stay, the need for pain medicine, postoperative visual analog scale of pain, and morbidities. Pregnant women and patients with previous lower abdominal surgery were excluded. Patients with surgery converted from laparoscopic appendectomy (LA) to mini-incision open appendectomy (MOA) were excluded. Patients were divided into two groups: LA and MOA done by the same surgeon. The patients were randomized into MOA and LA groups a computer-generated number. The diagnosis of acute appendicitis was made by the surgeon with physical examination, laboratory values, and radiological tests (abdominal ultrasound or computed tomography). All operations were performed with general anaesthesia. The postoperative vision analog scale score was recorded at postoperative hours 1, 6, 12, and 24. Patients were discharged when they tolerated normal food and passed gas and were followed up every week for three weeks as outpatients. RESULTS: Of the 243 patients, 121 (49.9%) underwent MOA, while 122 (50.1%) had laparoscopic appendectomy. There were no significant differences in operation time between the two groups (P = 0.844), whereas the visual analog scale of pain was significantly higher in the open appendectomy group at the 1st hour (P = 0.001), 6th hour (P = 0.001), and 12th hour (P = 0.027). The need for analgesic medication was significantly higher in the MOA group (P = 0.001). There were no differences between the two groups in terms of morbidity rate (P = 0.599). The rate of total complications was similar between the two groups (6.5% in LA vs 7.4% in OA, P = 0.599). All wound infections were treated non-surgically. Six out of seven patients with pelvic abscess were successfully treated with

  12. Postgraduate cadaver surgery: An educational course which aims at improving surgical skills

    PubMed Central

    Tjalma, W.A.A.; Degueldre, M.; Van Herendael, B.; D’Herde, K.; Weyers, S.

    2013-01-01

    Objective: To describe the postgraduate surgical skills training programme of the Flemish Society of Obstetrics and Gynaecology (VVOG*). Laparoscopic surgical techniques and indications have increased substantially during the past two decades. From surgeons it is expected that they keep up with all techniques and should be able to perform all relevant procedures. Learning new procedures in daily practice is hazardous and difficult to achieve. A training experience with cadaver surgery could improve the course and outcome of surgery on patients. We present the objective, structure, and outcome of the endoscopic postgraduate training course. Structure: The overall objective of the endoscopic postgraduate training course is to refresh anatomical knowledge and improve general gynaecological laparoscopic surgical skills. The VVOG endoscopic training programme is based on black box training, followed by pig surgery. New is the possibility to perform surgical procedures on specifically prepared human cadavers. The course consists of an anatomical teaching session followed by lectures with videotaped procedures on the anatomical exploration of the pelvis, laparoscopic hysterectomy and pelvic lymphadenectomy. During the hands-on session the participant performs the surgical procedures in a controlled, nonthreatening and interactive way under the guidance of an experienced trainer. Conclusions: All participants provided feedback on their experiences. The evaluation of the workshop revealed that this course is an opportunity to practise and improve clinical laparoscopic skills of gynaecological procedures and anatomy. Attending the course was regarded as of genuine additional value for surgical practice. PMID:24753929

  13. Evolution and advances in laparoscopic ventral and incisional hernia repair

    PubMed Central

    Vorst, Alan L; Kaoutzanis, Christodoulos; Carbonell, Alfredo M; Franz, Michael G

    2015-01-01

    Primary ventral hernias and ventral incisional hernias have been a challenge for surgeons throughout the ages. In the current era, incisional hernias have increased in prevalence due to the very high number of laparotomies performed in the 20th century. Even though minimally invasive surgery and hernia repair have evolved rapidly, general surgeons have yet to develop the ideal, standardized method that adequately decreases common postoperative complications, such as wound failure, hernia recurrence and pain. The evolution of laparoscopy and ventral hernia repair will be reviewed, from the rectoscopy of the 4th century to the advent of laparoscopy, from suture repair to the evolution of mesh reinforcement. The nuances of minimally invasive ventral and incisional hernia repair will be summarized, from preoperative considerations to variations in intraoperative practice. New techniques have become increasingly popular, such as primary defect closure, retrorectus mesh placement, and concomitant component separation. The advent of robotics has made some of these repairs more feasible, but only time and well-designed clinical studies will tell if this will be a durable modality for ventral and incisional hernia repair. PMID:26649152

  14. Simulation System for Training in Laparoscopic Surgery

    NASA Technical Reports Server (NTRS)

    Basdogan, Cagatay; Ho, Chih-Hao

    2003-01-01

    A computer-based simulation system creates a visual and haptic virtual environment for training a medical practitioner in laparoscopic surgery. Heretofore, it has been common practice to perform training in partial laparoscopic surgical procedures by use of a laparoscopic training box that encloses a pair of laparoscopic tools, objects to be manipulated by the tools, and an endoscopic video camera. However, the surgical procedures simulated by use of a training box are usually poor imitations of the actual ones. The present computer-based system improves training by presenting a more realistic simulated environment to the trainee. The system includes a computer monitor that displays a real-time image of the affected interior region of the patient, showing laparoscopic instruments interacting with organs and tissues, as would be viewed by use of an endoscopic video camera and displayed to a surgeon during a laparoscopic operation. The system also includes laparoscopic tools that the trainee manipulates while observing the image on the computer monitor (see figure). The instrumentation on the tools consists of (1) position and orientation sensors that provide input data for the simulation and (2) actuators that provide force feedback to simulate the contact forces between the tools and tissues. The simulation software includes components that model the geometries of surgical tools, components that model the geometries and physical behaviors of soft tissues, and components that detect collisions between them. Using the measured positions and orientations of the tools, the software detects whether they are in contact with tissues. In the event of contact, the deformations of the tissues and contact forces are computed by use of the geometric and physical models. The image on the computer screen shows tissues deformed accordingly, while the actuators apply the corresponding forces to the distal ends of the tools. For the purpose of demonstration, the system has been set

  15. Is laboratory training essential for beginners in learning laparoscopic adrenalectomy?

    PubMed

    Yang, Qing; Du, Jun; Zhao, Zhi-Hua; Chen, Xu-Sheng; Zhou, Lei; Yao, Xin

    2013-04-01

    The aim is to develop a staged clinical laparoscopic training program (without laboratory trainings) for beginners to perform laparoscopic adrenalectomy (LA) and to determine its safety and feasibility. Five beginners with no previous experience in adrenalectomy were randomly selected to receive the staged clinical laparoscopic training, including open retroperitoneal adrenalectomy or radical nephrectomy and mentor-initiated clinical laparoscopic training. The clinical data of the 15 LAs performed by each the trainees were collected and compared with the data from the initial 15 LAs of the mentor. All LAs were completed successfully, and no procedure required conversion to open surgery. The median operative time of the trainees was obviously less than the mentor's. The learning curve of the trainees was shorter compared with that of the mentor. The perioperative complication rate was similar between trainees and mentor. Beginners without laboratory trainings could perform LA safely and effectively after they participated in staged clinical laparoscopic training.

  16. Laparoscopic entry: a review of Canadian general surgical practice

    PubMed Central

    Compeau, Christopher; McLeod, Natalie T.; Ternamian, Artin

    2011-01-01

    Background Laparoscopic surgery has gained popularity over open conventional surgery as it offers benefits to both patients and health care practitioners. Although the overall risk of complications during laparoscopic surgery is recognized to be lower than during laparotomy, inadvertent serious complications still occur. Creation of the pneumoperitoneum and placement of laparoscopic ports remain a critical first step during endoscopic surgery. It is estimated that up to 50% of laparoscopic complications are entry-related, and most injury-related litigations are trocar-related. We sought to evaluate the current practice of laparoscopic entry among Canadian general surgeons. Methods We conducted a national survey to identify general surgeon preferences for laparoscopic entry. Specifically, we sought to survey surgeons using the membership database from the Canadian Association of General Surgeons (CAGS) with regards to entry methods, access instruments, port insertion sites and patient safety profiles. Laparoscopic cholecystectomy was used as a representative general surgical procedure. Results The survey was completed by 248 of 1000 (24.8%) registered members of CAGS. Respondents included both community and academic surgeons, with and without formal laparoscopic fellowship training. The demographic profile of respondents was consistent nationally. A substantial proportion of general surgeons (> 80%) prefer the open primary entry technique, use the Hasson trocar and cannula and favour the periumbilical port site, irrespective of patient weight or history of peritoneal adhesions. One-third of surgeons surveyed use Veress needle insufflation in their surgical practices. More than 50% of respondents witnessed complications related to primary laparoscopic trocar insertion. Conclusion General surgeons in Canada use the open primary entry technique, with the Hasson trocar and cannula applied periumbilically to establish a pneumoperitoneum for laparoscopic surgery. This

  17. Efficacy of laparoscopic transversus abdominis plane block for elective laparoscopic cholecystectomy in elderly patients

    PubMed Central

    Tihan, Deniz; Totoz, Tolga; Tokocin, Merve; Ercan, Gulcin; Calikoglu, Tugba Koc; Vartanoglu, Talar; Celebi, Fatih; Dandin, Ozgur; Kafa, Ilker Mustafa

    2016-01-01

    Transversus abdominis plane (TAP) block technique seems to offer one of the most efficient methods for a local pain control. Our aim is to demonstrate the effectiveness and safety of TAP block for post-operative pain control under laparoscopic vision in elderly patients during laparoscopic cholecystectomy. The patients aged more than 65 years old, who had cholecystectomy due to symptomatic cholelithiasis, were retrospectively evaluated. The patients that were operated under general anesthesia + laparoscopic TAP block and those who were operated only under only general anesthesia were compared according to their’ age and gender, comorbidities, American Society of Anesthesiologists scores, visual analog scale (VAS) for pain and length of stay in the hospital. Median (±interquartile range) values of post-operative 24th-hour-VAS for pain was found consecutively 2 (±1-3) in TAP block + group and 3 (±2-5) in TAP block - group. The median post-operative 24th-hour-VAS value in overall patients was three. Patients’ VAS values were higher in the TAP block – group with a statistically significant difference (p = 0.001). Furthermore, no statistically significant difference was found for other parameters in two groups. The laparoscopic-guided TAP block can easily be performed and has potential for lower visceral injury risk and shorter operational time. Efficacy, safety and other advantages (analgesic requirements, etc.) make it an ideal abdominal field block in elderly patients. PMID:26773187

  18. Job-Linked Literacy: Innovative Strategies at Work. Part III. Moving Ahead: Basic Skills for Career Advancement. A Work in America Policy Study.

    ERIC Educational Resources Information Center

    Rosow, Jerome M.; Zager, Robert

    This volume, Interim Report No. 3 in a 3-year study, considers literacy programs designed to qualify employees for promotions or professional advancement. It adopts a multidimensional definition of moving ahead, one that extends to monetary rewards, career development, and employment security. The volume is divided into two parts: report and case…

  19. Hand-assisted laparoscopic living-donor nephrectomy as an alternative to traditional laparoscopic living-donor nephrectomy.

    PubMed

    Buell, Joseph F; Hanaway, Michael J; Potter, Steven R; Cronin, David C; Yoshida, Atsushi; Munda, Rino; Alexander, J Wesley; Newell, Kenneth A; Bruce, David S; Woodle, E Steve

    2002-11-01

    The benefits of laparoscopic living-donor nephrectomy (LDN) are well described, while similar data on hand-assisted laparoscopic living-donor nephrectomy (HALDN) are lacking. We compare hand-assisted laparoscopic living-donor nephrectomy with open donor nephrectomy. One hundred consecutive hand-assisted laparoscopic living-donor nephrectomy (10/98-8/01) donor/recipient pairs were compared to 50 open donor nephrectomy pairs (8/97-1/00). Mean donor weights were similar (179.6 +/- 40.8 vs. 167.4 +/- 30.3 lb; p = NS), while donor age was greater among hand-assisted laparoscopic living-donor nephrectomy (38.2 +/- 9.5 vs. 31.2 +/- 7.8 year; p < 0.01). Right nephrectomies was fewer in hand-assisted laparoscopic living-donor nephrectomy [17/100 (17%) vs. 22/50 (44%); p < 0.05]. Operative time for hand-assisted laparoscopic living-donor nephrectomy (3.9 +/- 0.7 vs. 2.9 +/- 0.5 h; p < 0.01) was longer; however, return to diet (6.9 +/- 2.8 vs. 25.6 +/- 6.1 h; p < 0.01), narcotics requirement (17.9 +/- 6.3 vs. 56.3 +/- 6.4h; p < 0.01) and length of stay (51.7 +/- 22.2 vs. 129.6 +/- 65.7 h; p < 0.01) were less than open donor nephrectomy. Costs were similar ($11072 vs. 10840). Graft function and 1-week Cr of 1.4 +/- 0.9 vs. 1.6 +/- 1.1 g/dL (p = NS) were similar. With the introduction of HALDN, our laparoscopic living-donor nephrectomy program has increased by 20%. Thus, similar to traditional laparoscopic donor nephrectomy, hand-assisted laparoscopic living-donor nephrectomy provides advantages over open donor nephrectomy without increasing costs. PMID:12482153

  20. [Traumatic Spigelian hernia. Elective extraperitoneal laparoscopic repair].

    PubMed

    Moreno-Egea, Alfredo; Campillo-Soto, Alvaro; Girela-Baena, Enrique; Torralba-Martínez, José Antonio; Corral de la Calle, Miquel; Aguayo-Albasini, José Luis

    2006-01-01

    Traumatic Spigelian hernia is rare. These hernias are usually treated in the same admission through open surgery. We present a case of Spigelian hernia in a high anatomical location following injury, with a cutaneous lesion and preperitoneal hematoma. Delayed parietal repair was performed through extraperitoneal laparoscopy. Elective laparoscopic repair in this case avoided surgery in an injured area, providing clear cosmetic advantages to the patient. We describe a modification to the classical approach to facilitate access to high-lying Spigelian defects. PMID:16426535

  1. [LAPAROSCOPIC TREATMENT OF INTRALIGAMENTAL LEIOMYOMA PER MAGNA].

    PubMed

    Bechev, B; Magunska, N; Kovachev, Emil; Ivanov, Stefan

    2016-01-01

    Uterine myoma is the most frequent benign tumor of female organs. Intraligamentary myomas in the broad ligament are rare. We present a case of 50 years old patient with 22 cm intraligamentary myoma with cystic degeneration, who is referred to the Gynecological Department of Ob/Gyn Hospital "Dr. Shterev" with complains of severe pain. This case is interesting for its rareness and diagnostic dilemma, because degenerative myomas can imitate malignant mass. Total laparoscopic hysterectomy with ablastic vaginal morcellation of the specimen in endobag was performed. The patient was discharged from the clinic next day. PMID:27514135

  2. Appendagitis following Diagnostic Laparoscopy and Laparoscopic Appendicectomy

    PubMed Central

    Kumar, R.; Bamford, R. F.; Kumar, D.

    2016-01-01

    Appendagitis is an uncommon clinical entity, often not recognised, and mistaken for more serious infective conditions. We describe a proven case of appendagitis which occurred after confirmed appendicitis. We postulate that this condition can coexist with appendicitis and indeed may be the result of coinflammation. This has several implications. Firstly, clinicians must retain an index of suspicion for this condition in a patient with localised abdominal pain which occurs after appendicitis. Secondly, it would be reasonable to suggest careful examination of colocated appendages in a patient with an otherwise normal-appearing appendix. Treatment might require laparoscopic resection, as performed in this case. PMID:27462475

  3. [LAPAROSCOPIC ANTERIOR UTERINE LIGAMENTOPEXY--OUR EXPERIENCE].

    PubMed

    Blagovest, Bechev; Magunska, Nadya; Kovachev, Emil; Ivanov, Stefan

    2015-01-01

    A great number operative techniques for correction of retroverted uterus are reported in the last years. The aim of these different methods is correction of the retroversion of the uterus, which is connected with pelvic congestion and symptomatic relief. We present a clinical case of 26 years old patient with one Caesarean section. The lady complains of chronic pelvic pain, dispareunia and dismenorrhea. The US exam shows an uterus in strong retroversion position. We restored the anatomic position of the uterus using laparoscopic anterior ligementopexy.

  4. Techniques of laparoscopic cholecystectomy: Nomenclature and selection.

    PubMed

    Haribhakti, Sanjiv P; Mistry, Jitendra H

    2015-01-01

    There are more than 50 different techniques of laparoscopic cholecystectomy (LC) available in literature mainly due to modifications by surgeons in aim to improve postoperative outcome and cosmesis. These modifications include reduction in port size and/or number than what is used in standard LC. There is no uniform nomenclature to describe these different techniques so that it is not possible to compare the outcomes of different techniques. We brief the advantages and disadvantages of each of these techniques and suggest the situation where particular technique would be useful. We also propose a nomenclature which is easy to remember and apply, so that any future comparison will be possible between the techniques.

  5. Glue granuloma following laparoscopic hernia repair.

    PubMed

    Ihedioha, U; Panteleimonitis, S; Mann, C; Finch, G J

    2014-05-01

    Minimal inflammation of tissues can occur following skin closure with a foreign material. This foreign body reaction can lead to granuloma formation. We report the case of a middle-aged man who, having undergone laparoscopic surgery and had the port site wounds closed with skin glue, was detected to have a non-healing wound. A crystal mass protruding from the incision site was confirmed histologically as a chronic granulomatous reaction to skin glue. A foreign body granulomatous reaction to skin glue has not been described in the literature. PMID:24700107

  6. Glue granuloma following laparoscopic hernia repair.

    PubMed

    Ihedioha, U; Panteleimonitis, S; Mann, C; Finch, G J

    2014-05-01

    Minimal inflammation of tissues can occur following skin closure with a foreign material. This foreign body reaction can lead to granuloma formation. We report the case of a middle-aged man who, having undergone laparoscopic surgery and had the port site wounds closed with skin glue, was detected to have a non-healing wound. A crystal mass protruding from the incision site was confirmed histologically as a chronic granulomatous reaction to skin glue. A foreign body granulomatous reaction to skin glue has not been described in the literature.

  7. Appendagitis following Diagnostic Laparoscopy and Laparoscopic Appendicectomy.

    PubMed

    Kumar, R; Bamford, R F; Kumar, D; Singh-Ranger, G

    2016-01-01

    Appendagitis is an uncommon clinical entity, often not recognised, and mistaken for more serious infective conditions. We describe a proven case of appendagitis which occurred after confirmed appendicitis. We postulate that this condition can coexist with appendicitis and indeed may be the result of coinflammation. This has several implications. Firstly, clinicians must retain an index of suspicion for this condition in a patient with localised abdominal pain which occurs after appendicitis. Secondly, it would be reasonable to suggest careful examination of colocated appendages in a patient with an otherwise normal-appearing appendix. Treatment might require laparoscopic resection, as performed in this case. PMID:27462475

  8. Laparoscopic resection of a giant mesenteric cyst.

    PubMed

    Saw, E C; Ramachandra, S

    1994-02-01

    Laparoscopic resection of a giant retroperitoneal, mesenteric cyst in a 38-year-old man who presented with abdominal distension and pedal edema is described. The diagnosis was made by abdominal computed tomography, which revealed a large cystic mass that was causing extrinsic compression of the inferior vena cava and the right ureter. The hospital course was uneventful, and the patient was discharged 2 days postoperatively. This new endoscopic approach offers a useful alternative to the traditional transabdominal excision of a mesenteric cyst and may have some theoretical advantages, including less postoperative pain and shorter convalescence.

  9. [Laparoscopic resection of a simple renal cyst].

    PubMed

    Lopatkin, N A; Fidarov, F B; Martov, A G

    1999-01-01

    Laparoscopic dissection of common renal cysts was made in 27 patients who complained of low back pains and hypertension. The diagnosis and indications for operation rested on ultrasonic investigation and dynamic nephroscintigraphy. All the surgical interventions were performed under endotracheal anesthesia after creation of pneumoperitoneum with the use of three trochars. The procedure comprised maximal dissection of the free cystic wall, electrocoagulation of the residual part's margins and retroperitoneal drainage. Postoperative period was uneventful in 92.6% of the cases. Control examination 3 and 6 months after the operation indicated good results: pain relief, stabilization of arterial pressure and improvement of renal function.

  10. [Laparoscopic approach excision of mesenteric cysts].

    PubMed

    Bosco, L; Clerico, G; Galetto, P V; Jon, G

    1997-11-01

    The authors reports a case of a young woman suffering from mesenteric cyst. The incidence of these lesions is 1 to 100,000 admissions in adult patients and 1 to 20,000 admissions in pediatric age. These cysts, with retroperitoneal and omental cysts, have a similar etiopathogenesis as lymphatic ectopic tissue. In the majority of cases these cysts are asymptomatic and often the diagnosis is intraoperative. In this case the cyst was removed successfully with laparoscopic approach. This mini-invasive method allows a complete and radical excision of the cyst and reduces postoperative hospital stay and morbidity.

  11. Transperitoneal laparoscopic adrenalectomy: experience in 100 patients.

    PubMed

    Terachi, T; Matsuda, T; Terai, A; Ogawa, O; Kakehi, Y; Kawakita, M; Shichiri, Y; Mikami, O; Takeuchi, H; Okada, Y; Yoshida, O

    1997-10-01

    Between July 1992 and October 1996, 100 transperitoneal laparoscopic adrenalectomies were performed on 99 patients at our hospital and affiliated hospitals. The clinical diagnoses were primary aldosteronism (41 patients), Cushing's syndrome (15), pre-Cushing's syndrome (6), pheochromocytoma (7; 8 adrenal glands), adrenal cancer (2), nonfunctioning adenoma (22), myelolipoma (3), and complicated adrenal cyst (3). Ninety-seven glands were removed laparoscopically. The mean operative time was 240 +/- 76 (SD) minutes and the mean blood loss 68 +/- 80 mL for the series. The mean blood was 77 +/- 113 mL when the three operations that were converted to open surgery are included. The mean times for the return to a normal diet and unassisted ambulation were 1.3 +/- 0.6 and 1.4 +/- 0.8 days, respectively. The mean duration of the use of analgesics was 1.5 +/- 1.3 days, including the day of surgery. In contrast, in the latest 10 open adrenalectomies done at Kyoto University Hospital, the mean operative time was 186 +/- 53 minutes and the mean blood loss 220 +/- 170 mL. The mean times for return to a normal diet and for unassisted ambulation and the mean duration of the use of analgesics were 1.9 +/- 0.3, 2.9 +/- 1.1, and 2.9 +/- 1.7 days, respectively. Thirty-six operations, excluding one converted to open surgery, performed at Kyoto University Hospital were selected to look at the learning curve for transperitoneal laparoscopic adrenalectomy and evaluated for operative time and blood loss. The mean operative time and mean blood loss in the first 10 procedures performed at Kyoto University Hospital were 256 +/- 63 minutes and 89 +/- 57 mL; however, these values were reduced to 177 +/- 39 minutes and 48 +/- 32 mL in the next 10 procedures at the same hospital. Laparoscopic adrenalectomy via the transperitoneal anterior approach can be equivalent to open adrenalectomy in efficiency with a shorter convalescence.

  12. Laparoscopic Pringle maneuver: how we do it?

    PubMed Central

    Lhuaire, Martin; Memeo, Riccardo; Pessaux, Patrick; Kianmanesh, Reza; Sommacale, Daniele

    2016-01-01

    Laparoscopic liver resection (LLR) is technically possible with new devices which allow a relatively bloodless liver parenchymal transection. Despite, the main concern remains intraoperative hemorrhage. Currently, perioperative excessive blood loss during LLR is difficult to control with necessity of laparotomy conversion. Moreover, major blood loss requires transfusion and increases postoperative morbidity and mortality. When in-flow is limited by the hepatic pedicle clamping, it reduces intraoperative blood loss. The Pringle maneuver, first described in 1908, is the simplest method of inflow occlusion and currently can be achieved during LLR. The purpose of this note was to describe two different modalities of Pringle maneuver used by two different teams during LLR. PMID:27500146

  13. Skills Center.

    ERIC Educational Resources Information Center

    Canter, Patricia; And Others

    The services of the Living Skills Center for the Visually Handicapped, a habilitative service for blind young adults, are described. It is explained that the Center houses its participants in their own apartments in a large complex and has served over 70 young people in 4 years. The evaluation section describes such assessment instruments as an…

  14. Leadership Skills

    ERIC Educational Resources Information Center

    Parish, Thomas S.

    2006-01-01

    While this may not be a "complete list" of what leadership skills one needs to effectively lead in any/every situation, it should provide a great overview of many of the things s/he needs to do, at least initially.

  15. Sharing Skills.

    ERIC Educational Resources Information Center

    Mealy, Virginia; And Others

    1987-01-01

    Three articles describe methods for teaching library skills. The first presents a song used to teach students the Dewey Decimal system; the second describes a reading program incorporating Halloween and foreign countries; and the third includes short poems designed to teach students to care for library books properly. (CLB)

  16. Laparoscopically assisted ventriculoperitoneal shunt placement: a prospective randomized controlled trial.

    PubMed

    Schucht, Philippe; Banz, Vanessa; Trochsler, Markus; Iff, Samuel; Krähenbühl, Anna Katharina; Reinert, Michael; Beck, Jürgen; Raabe, Andreas; Candinas, Daniel; Kuhlen, Dominique; Mariani, Luigi

    2015-05-01

    OBJECT In ventriculoperitoneal (VP) shunt surgery, laparoscopic assistance can be used for placement of the peritoneal catheter. Until now, the efficacy of laparoscopic shunt placement has been investigated only in retrospective and nonrandomized prospective studies, which have reported decreased distal shunt dysfunction rates in patients undergoing laparascopic placement compared with mini-laparotomy cohorts. In this randomized controlled trial the authors compared rates of shunt failure in patients who underwent laparoscopic surgery for peritoneal catheter placement with rates in patients who underwent traditional mini-laparotomy. METHODS One hundred twenty patients scheduled for VP shunt surgery were randomized to laparoscopic surgery or mini-laparotomy for insertion of the peritoneal catheter. The primary endpoint was the rate of overall shunt complication or failure within the first 12 months after surgery. Secondary endpoints were distal shunt failure, overall complication/ failure, duration of surgery and hospitalization, and morbidity. RESULTS The overall shunt complication/failure rate was 15% (9 of 60 cases) in the laparoscopic group and 18.3% (11 of 60 cases) in the mini-laparotomy group (p = 0.404). Patients in the laparoscopic group had no distal shunt failures; in contrast, 5 (8%) of 60 patients in the mini-laparotomy group experienced distal shunt failure (p = 0.029). Intraoperative complications occurred in 2 patients (both in the laparoscopic group), and abdominal pain led to catheter removal in 1 patient per group. Infections occurred in 1 patient in the laparoscopic group and 3 in the mini-laparotomy group. The mean durations of surgery and hospitalization were similar in the 2 groups. CONCLUSIONS While overall shunt failure rates were similar in the 2 groups, the use of laparoscopic shunt placement significantly reduced the rate of distal shunt failure compared with mini-laparotomy.

  17. Idiopathic omental infarction, diagnosed and managed laparoscopically: a case report.

    PubMed

    Abdulaziz, Ahmed; El Zalabany, Tamer; Al Sayed, Abdul Rahim; Al Ansari, Ahmed

    2013-01-01

    Idiopathic omental infarction is a rare cause of acute abdomen in adults, and the clinical finding can mimic acute appendicitis. Although idiopathic omental infarction is uncommon, the incidence of its detection has become more frequent as a result of advances in radiological technologies. We reported on a 21-year-old man who presented with sudden onset of intermittent right lower quadrant abdominal pain for seven days. The pain became more localized at the right iliac fossa (RIF) at day 2 before admission. A physical examination revealed a fever (38.2°C), severe RIF tenderness, mass-like fullness, and positive rebound tenderness. A CT of the abdomen showed inflammatory changes and increased fat density mass in the right upper quadrant measuring 5 × 4 cm representing focal panniculitis. However, the appendix was visualized normally and the findings were not in favor of acute appendicitis. Diagnosis was carried on laparoscopically. Serosanguinous free fluid was found in all abdominal quadrants. A 6 × 4 cm gangrenous omental mass was noted. The omental mass was excised and an appendectomy was performed. In summary, omental infarction should be considered as a deferential diagnosis for acute right-sided abdominal pain, especially if the clinical finding does not correspond to appendicitis.

  18. [Laparoscopic surgery of the colorectum: analysis of results of the National Registry of the Italian Society of Endoscopic Surgery and New Technologies (S.I.C.E.)].

    PubMed

    Silecchia, G; Perrotta, N; Basso, N

    2001-01-01

    The aim of this paper was to review the data from the Italian Registry of Laparoscopic Colo-Rectal Surgery sponsored by SICE. The Italian Registry was set up in January 1993 by the merging of two Registries existing since November 1991. Thirty-five centres, up to March 2001, had participated in the Registry, with 2,793 patients recorded (F = 1,409, M = 1,384), 1878 for malignancy and 915 for benign diseases. The median age was 63.7 years. The conversion rate was 10.8%. Mortality was 0.6% (18 cases) and major abdominal complications occurred in 11.1% of patients. The reoperation rate was 5.1%. After a median follow-up of 59 months, 16 patients (0.9%) presented abdominal wall metastases. Relapses occurred in 18.5% of patients after curative resections for rectal cancer, and in 12.7% after curative resections for colon cancer. Laparoscopic colo-rectal surgery has gained widespread acceptance. The reproducibility and safety of all the major laparoscopic colo-rectal procedures has been demonstrated. Nevertheless, the lack of long-term results of randomised trials in terms of oncological efficacy and the technical difficulties of the procedures suggests that laparoscopic colo-rectal surgery should be performed only in referral centres by skilled surgeons.

  19. Laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy.

    PubMed

    Kayaalp, Cüneyt; Soyer, Vural; Ersan, Veysel; Aydın, Cemalettin; Karagül, Servet

    2016-01-01

    Congenital choledochal cysts are rare in adults. Due to the risk of developing cholangiocarcinoma, the current standard of care is complete excision of the cyst and reconstruction with hepaticojejunostomy. So far, more than 200 laparoscopic resections have been reported in adults, the majority being from Far Eastern countries over the last five years. Herein, the technique of laparoscopic type I choledochal cyst excision and hepaticojejunostomy is presented in a 37-year-old male with an accompanying video. The advantages of laparoscopic surgery are applicable for choledochal cyst excision as well. We believe that teamwork, expertise on intracorporeal suturing and hepatobiliary surgery are central issues for this operation.

  20. Laparoscopic Management of Hilar Cholangiocarcinoma: a Case Report.

    PubMed

    Puntambekar, Shailesh; Sharma, Vikrant; Kumar, Sanjay; Mitkare, Sainath; Joshi, Geetanjali; Parikh, Hirav

    2016-02-01

    The only option for cure of Klatskin's tumour is surgical excision. The radicality of the procedure is determined by the extent of the tumour and functional parameters of the patient. Complete laparoscopic resection of hilar cholangiocarcinoma with biliary reconstruction is a challenging procedure. The main aim is to achieve pathological negative margins, complete lymph node retrieval and enterobiliary bypass. We present a case report of a patient with hilar cholangiocarcinoma managed laparoscopically. The nodal yield was nine. On 6-month follow-up, the patient was symptom free. The main aim is to study the feasibility of performing this complex procedure completely laparoscopically. PMID:27186042