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SURGICAL TECHNOLOGY INTERNATIONAL V.
$175.00
STI V contains 54 articles with color illustrations.
Universal Medical Press, Inc.
San Francisco, 1996, ISBN: 0-9643425-4-5
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Minimal Access Surgery
Laparoscopic R/Evolution: Impetus to a New Understanding of Surgery
Grzegorz S. Litynski, Institute for History of Medicine, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt/Main, Germany; Zoltan Szabo, Ph.D., F.I.C.S., M.O.E.T. Institute, San Francisco, CA, Fetal Treatment Center, Division of Pediatric Surgery, University of California School of Medicine, San Francisco, CA
The history of the development of the fine art of physical examination is a record of the physician's efforts to pry ever deeper and deeper into the inner recesses of his patients (H. V.Findlay, 1937).The Iaparoscopic revolution or evolution caught the surgical field by surprise. Just a few years earlier, the term "endoscopic surgery" was not part of the vocabulary of most surgeons. As with all breakthroughs, the incorporation of laparoscopy into surgery posed its own set of challenges, including: (1) the growing significance of economic factors, (2) increasing pressure from industry, (3) a shift from the hospital to out-patient settings, (4) a different approach to surgical training, (5) changes in the surgeon-patient relationship, and (6) a range of ethical issues.
Laparoscopic Intraoperative Ultrasonography
Duncan Turner, M.D., M.B., B.S., F.A.C.O.G., Santa Barbara, CA
Ultrasonography has been an integral part of gynecology and general surgery in recent years. New technology has allowed this modality to be extended to include intraoperative assessment through a laparoscopic approach. This allows more accurate imaging with higher resolution than previously attainable. Combining the ultrasonic and visual images on the monitor screen simultaneously (picture in a picture) allows a further dimension of information which can modify surgical direction. The equipment used by the author is described and clinical experience discussed. Further clinical applications are considered and the practicality of the methodology assessed.
Economic Considerations in Laparoscopic Surgery: Disposable Versus Reusable Instrumentation
Raghu S. Savalgi, M.B.B.S., L.R.C.P., M.R.C.S., F.R.C.S., Ph.D.(Surg.), Yale University School of Medicine, New Haven, CT
The subject of the economic considerations involved in using disposable versus reusable instrumentation has become a controversial issue.The economic evaluations performed purely by economists may not appeal to the surgeon and may not be applicable in different parts of the world. The quality of disposable instruments and their convenience in laparoscopic surgery is not at issue; the controversy, instead, centers on the question of the cost-effectiveness of disposable equipment. High-quality instruments enable safe, suecessful operations. Some instruments are not available in reusable form and the quality of some reusable instruments (e-g-, laparoscopic scissors) is sometimes questionable, particularly as they are periodically in need of servicing or repair. For a routine cholecystectomy, clips can be mounted on a reusable applier to ligate the cystic duct and artery. This can save considerable cost. However, disposable clips and their appliers should be available in the operating room (OR) in case of emergencies such as uncontrolled bleeding.
Initial Experience of 3-D Video Endoscopy in General Surgery
Andreas Fountoulakis, M.D., Northwick Park and St. Mark's Hospital, London, U.K.; Alan Lomax, M.D., F.R.C.S.C., Dawson Creek District Hospital, Dawson Creek, B.C., Canada; Stephen Chadwick, M.S., F.R.C.S., Northwick Park Hospital, Harrow, London, U.K.
The worldwide explosion of Iaparoscopic surgery within general surgery began in the late 1980sand early 1990s.From its inception, surgeons have expected the image on the video monitor to resemble closely the image obtained in similar open surgery.The monitor image, however, is presented in two dimensions height and width. Orientation of the surgeon to the anatomy is more difficult and requires a sound knowledge of anatomy, the relationships of organs to each other, and an understanding of the individual patient's unique structures. Adding a third dimension, depth, to imitate natural vision in open surgery may provide surgeons with the confidence to perform more advanced procedures. In addition, trainee surgeons, without the experience of open surgery which their senior colleagues have gained, may more rapidly appreciate orientation of the anatomy and learn the surgical task more quickly.
Entry Technique for Laparoscopy
Osvaldo Contarini, M.D., F.A.C.S., F.I.C.S., Ashok Roychoudhury, M.D., Memorial Medical Center, Baptist Medical Center, Jacksonville, FL
The present trend in laparoscopic surgery is to make use of the Veress needle as an instrument for palpation of the abdominal cavity to secure "safe" blind introduction of the first trocar. The oxymoron is witness to the many mishaps experienced by the most daring surgeons who approach blindly each and every abdomen, irrespective of previous surgery. The "bayonet technique" heralded by the gynecological school oflaparoscopy has never been accepted by us, due to its inherent characteristic risk of injuries to the pelvic or retroperitoneal organs. Whenever the patient has had previous abdomino-pelvic surgery, the open laparoscopy technique is preferred with the Hasson's trocar either at the navel or at any other location, as deemed appropriate by the site of old incisions. Experience and laparoscopic findings have led us to enforce the principle that open laparoscopy should be instituted if any scar, even from previous Iaparoscopy, is present over the anterior abdominal wall. A variation in the technique for introduction of the Veress needle and safe execution of the pneumoperitoneum was devised to be used when the peritoneal cavity has not been violated surgically.
An Ambulatory Bilirubin Monitoring Device for Duodenogastroesophageal Reflux
Michael F. Vaezi, M.D., Ph.D., University of Alabama at Birmingham, Birmingham, AL; Joel E. Richter, M.D., F.A.C.P., F.A.C.G., The Cleveland Clinic Foundation, Cleveland, OH
Reflux of duodenal contents into the stomach is a normal physiological event occurring most commonly at night but also in the fasting and postprandial daytime periods. Previously, the terms "bile reflux" and "alkaline reflux" have been used to describe this process. However, duodenal contents contain more than just "bile" and studies have shown that the term "alkaline reflux" is a misnomer since pH > 7 does not correlate with reflux of duodenal contents. Therefore, duodenogastroesophageal reflux (DGER) may be a more appropriate term to describe the pathological regurgitation of duodenal contents through the pylorus into the stomach with subsequent reflux into the esophagus.
Clinical Application of Three-Dimensional (3-D) Vision Systems and Virtual Reality Helmets in Video-Assisted Surgery
Emanuele Lezoche, M.D., F.A.C.S., Alessandro M. Paganini, M.D., Ph.D., F.A.C.S., University of Ancona, Ancona, Italy; Davide Lomanto, M.D., Ph.D., University of Rome "La Sapienza," Rome, Italy; Francesco Carlei, M.D., University of L'Aquila, L'Aquila, Italy
Thoraco-Iaparoscopic surgery presents a series of technical difficulties linked mainly to the necessity of acquiring proper motor coordination and spatial reconstruction of an operative field that is seen from a distance on a two-dimensional video monitor, in the absence of any direct tactile feedback. In an effort to improve the motor coordination of the operating surgeon and of the surgical team, many apparatuses have recently become available on the market that allow the reproduction of a 3-D image on a video monitor. Such apparatuses have technical characteristics that are substantially diverse in technology and provide significantly different end results.
Laparoscopic Removal of Posterior Gastric Wall Polyp through Gastrotomy Using Hand Suturing and Mechanical Abdominal Wall Retractor
Gergely Csáky, M.D., Ph.D., Chief Department of Surgery County Hospital, Miskolc, Hungary
Gastrofiberscopy is suitable not only for diagnostics, but for the therapy of benign gastric polyp and early gastric cancer as well. Surgery is necessary if endoluminal ultrasonography cannot exclude the extension of early gastric cancer to the submucosa or if, because of a recurrent or giant polyp, gastrofiberscopic polypectomy is unsuccessful.
Laparoscopic Adjustable Silicone Gastric Banding (LASGB) for the Treatment of Morbid Obesity
Alessandro M. Paganini, M.D., Ph.D., F.A.C.S., Mario Guerrieri, M.D., Francesco Feliciotti, M.D., Emanuele Lezoche, M.D., F.A.C.S., Ospedale Umberto I, University of Ancona, Ancona, Italy
Morbid obesity is a serious disease that is responsible for several co-morbid conditions. Increased risks of hypertension, adult onset diabetes mellitus, dyslipidemia, pulmonary disease (Pickwickian syndrome), musculo-skeletal disorders, gallbladder disease, deep vein thrombosis, venous stasis ulcers, and increased prevalence of certain types of cancers (uterine, breast, colon carcinoma) have been reported, together with severe psychological and social disability. Nonsurgical treatment options including various combinations oflow-calorie or very-low-calorie diets, behavior modification, exercise, and drug therapy may achieve acceptable transient weight reduction but fail to maintain reduced body weight in most patients.
Visually Guided Trocar Entry: Experience with the Optical Trocar
Steven G. Kaali, M.D., F.A.C.O.G., David H. Barad, M.D., F.A.C.O.G., Irwin R. Merkatz, M.D., Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
Morbid obesity is a serious disease that is responsible for several co-morbid conditions. Increased risks of hypertension, adult onset diabetes mellitus, dyslipidemia, pulmonary disease (Pickwickian syndrome), musculo-skeletal disorders, gallbladder disease, deep vein thrombosis, venous stasis ulcers, and increased prevalence of certain types of cancers (uterine, breast, colon carcinoma) have been reported, together with severe psychological and social disability. Nonsurgical treatment options including various combinations oflow-calorie or very-low-calorie diets, behavior modification, exercise, and drug therapy may achieve acceptable transient weight reduction but fail to maintain reduced body weight in most patients.
Laparoscopic Gastrotomy in Intragastric Surgery for Early Gastric Cancer: A New Technique
Shuichi Ohashi, M.D., Yosuke Yoden, M.D., Hiroki Kanno, M.D., Kazuhide Tei, M.D., Akinori Akashi, M.D., Manzurul Haque, M.D., Takarazuka City Hospital, Kohama, Takarazuka, Hyogo, Japan
Laparoscopic surgery has been widely applied not only in cholecystectomy but also in gastrointestinal operations. In previous reports the authors proposed their original operative technique, laparoscopic intragastric surgery (LIGS), in which all trocars and surgical instruments are inserted directly into the gastric lumen to perform the resection of mucosal or submucosal lesions of the stomach. The purpose of this article is to introduce laparoscopic gastrotomy as a new technique for removing early gastric cancer by LIGS.
Technique of Transanal Endoscopic Microsurgery (TEM)
Mario Guierrieri, M.D., Alessandro M. Paganini, M.D., Ph.D., F.A.C.S., Francesco Feliciotti, M.D., Emanuele Lezoche, M.D., F.A.C.S., Ospedale Umberto I, University of Ancona, Ancona, Italy
Early stages of rectal cancer, well and moderately differentiated, have a low rate of regional spread and therefore may be treated by conservative therapy. Transanal Endoscopic Microsurgery (TEM) was Introduced into clinical practice by G. Buess in 1983.This technique allows for the local treatment of benign lesions and the early stages of rectal cancer through a modified rectoscope, yielding good exposure of the operative field with-three-dimensional vision; mucosectomy and full thickness excision procedures can be performed. TEM benefits are the same as other minimally invasive techniques: less pain, reduced morbidity, faster recovery time, and an absence of skin scars. In the present paper, the authors report the technique and the results of the experience of 89 TEM procedures for the treatment of rectal tumors.
Laparoscopic Removal of a Mesenteric Cyst Together with the Calculous Gallbladder: A Case Report
Istvan Gal, M.D., Ph.D., Laszlo Mecseky, M.D., Istvan Kovaks, M.D., Bugat Pal Hospital, Gyöngyös, Hungary
The incidence of mesenteric cysts is relatively uncommon. Sprague examined its frequency and noted that five large hospitals located in the Los Angeles area averaged one documented case of mesenteric cyst per 100,000 hospital admissions. The most common location appears to be the mesentery of the small bowel, especially that of the ileum. Cysts of the mesentery of the large bowel are somewhat less frequent, accounting for approximately 38% of the total incidence. Those involving the large bowel most commonly involve the mesentery of the sigmoid colon.
Jaundice Secondary to Spilled Gallstone During Laparoscopic Cholecystectomy
Venkatachala I. Sreenivas, M.D., Hospital of St. Raphael, Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT; Phaniraj Iyengar, M.D., Suresh T. Bhagia, M.D., Hospital of St. Raphael, New Haven, CT; Viswanadham Pothula, M.D., Hospital of St. Raphael, New Haven, CT
Advantages of laparoscopic cholecystectomy (LC) in terms of shorter hospital stay, less pain, and dimnished disability are well documented. Less well documented are the long-term comptications of this procedure. We report a patient who developed obstructive jaundice 8 months following LC from a spilled gallstone. In our review of the literature using MEDLINE from January 1990 to June 1995, we did not find this complication reported.