Quentin Gaudissart

University of Padova, Padua, Veneto, Italy

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Publications (7)9.19 Total impact

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    Surgical Endoscopy 11/2007; 21(10):1875-82. · 3.43 Impact Factor
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    ABSTRACT: The purpose of this study was to evaluate the perceptual (2-dimensional [2D] vs. 3-dimensional [3D] view) and instrumental (classical vs. robotic) impacts of new robotic system on learning curves. Forty medical students without any surgical experience were randomized into 4 groups (classical laparoscopy with 3D-direct view or with 2D-indirect view, robotic system in 3D or in 2D) and repeated a laparoscopic task 6 times. After these 6 repetitions, they performed 2 trials with the same technique but in the other viewing condition (perceptive switch). Finally, subjects performed the last 3 trials with the technique they never used (technical switch). Subjects evaluated their performance answering a questionnaire (impressions of mastery, familiarity, satisfaction, self-confidence, and difficulty). Our study showed better performance and improvement in 3D view than in 2D view whatever the instrumental aspect. Participants reported less mastery, familiarity, and self-confidence and more difficulty in classical laparoscopy with 2D-indirect view than in the other conditions. Robotic surgery improves surgical performance and learning, particularly by 3D view advantage. However, perceptive and technical switches emphasize the need to adapt and pursue training also with traditional technology to prevent risks in conversion procedure.
    American journal of surgery 08/2007; 194(1):115-21. · 2.36 Impact Factor
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    ABSTRACT: OBJECTIVE: Our purpose was to describe the imaging findings of intragastric band erosion, an underreported complication after laparoscopic adjustable gastric banding for the treatment of morbid obesity. In this long-term complication, the gastric band fastened around the upper stomach to create a small proximal gastric pouch gradually erodes into the stomach wall and can extend into the gastric lumen. We present three cases of patients with band erosion in whom findings on an upper gastrointestinal series and CT established the diagnosis. CONCLUSION: Diagnosis of intragastric band erosion after gastric banding is usually made with endoscopy. However, the radiologic appearance of band erosion when visualized on an upper gastrointestinal series is pathognomonic and allows initial imaging diagnosis. In patients with extraluminal air or prosthesis infection, CT findings also are suggestive of this postoperative complication.
    American Journal of Roentgenology 02/2005; 184(1):109-12. · 2.90 Impact Factor
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    ABSTRACT: The laparoscopic application of an adjustable silicone gastric band (Lap-Band System, Bioenterics, Carpinteria, CA) (Fig. 1), based on a similar device introduced by Kuzmak in 1986, is gaining widespread acceptance as a gastric restrictive procedure in treatment of morbid obesity. The advantage of an operation that does not open the gastrointestinal tract and can be performed laparoscopically is obvious. This procedure, using the laparoscopic approach , has been performed in our institutions since 1992. The goals of this article are to describe both our standardized surgical technique that minimized the morbidity rate and its results.
    Surgical technology international 10/2002; 10:109-14.
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    ABSTRACT: Background: Laparoscopic surgery is beneficial to the patient but challenging for the surgeon. The visual axis is not the same as the operative axis. The surgeon must manipulate long, sharp instruments through a fixed opening under the control of a two-dimensional monitor and without the help of any tactile sensation. The body cavity is penetrated by cannulas, which cannot be interchanged, so that the surgeon is obliged to move around the patient in order to reach the best position for every step of the procedure. Methods: A computer interface in command of a mechanical system (robot) makes it possible: 1) To regain several lost degrees of freedom through intra-abdominal articulations; 2) to obtain better visual control of instrument manipulation thanks to three-dimensional vision; 3) to modulate amplitude of surgical motions by downscaling and stabilization; 4) to operate at distance from the patient. These possibilities lead to improved surgical performance. In addition, the surgeon operates in an ergonomically correct position. The robot (da Vinci™ System, Intuitive Surgical, Mountain View, CA, USA) consists of a console and a surgical cart, which supports three articulated robotic arms. The surgeon sits at the console where he or she manipulates joystick-like handles while observing the operating field through binoculars that provide a three-dimensional image. This computer is capable of modulating data by eliminating physiologic tremor and by downscaling the amplitude of motions by a factor of 5 or 3 to 1. Results: The first robot-assisted procedure in a human was performed in March 1997 by our team. Since then, we have used robot-assisted laparoscopic surgery for 147 procedures, including 39 anti-reflux operations. Our study demonstrates the feasibility of telesurgery on humans in a variety of procedures including robotic Nissen fundoplication, with no morbidity specifically related to the use of robotics, and with acceptable operative times. Conclusions: In its present embodiment, the system seems most efficient when involved in microsuturing within the abdomen or in very confined spaces. Improved ergonomic conditions and improved instrument mobility at the level of distal articulation seem beneficial in routine abdominal procedures. More research is necessary for further improvement in tool configuration and visualization. The robotic approach implies new operative strategies, including specific trocar placement.Zusammenfassung:Grundlagen: Während das laparoskopische Vorgehen für den Patienten Vorteile mit sich bringt, überwiegen für den Chirurgen gewisse Nachteile. Blickrichtung und operative Ausführung liegen auf verschiedenen räumlichen Ebenen. Der Chirurg führt lange, scharfe – durch Trokare fix positionierte – Instrumente. Dabei kontrolliert er seine Bewegungen lediglich über ein zweidimensionales Monitorbild und verfügt über kein taktiles Feedback. Da das Wechseln der Trokare nicht ganz unproblematisch ist, muß der Chirurg seine Position dem jeweiligen Akt anpassen. Methodik: Durch ein Computer-gesteuertes mechanisches System (Roboter) wird folgendes ermöglicht: 1) Wettmachen der Bewegungseinschränkung durch intraabdominelle Gelenke; 2) bessere visuelle Kontrolle der Manipulationen durch dreidimensionale Darstellung des Operationsfeldes; 3) die Amplituden der Bewegungen der Hand des Chirurgen können moduliert und stabilisiert werden; 4) es kann abseits vom Patienten operiert werden. Die Performance und die ergonomischen Bedingungen für den Chirurgen wurden verbessert. Der Roboter (da Vinci™ System, Intuitive Surgical, Mountain View, CA, USA) besteht aus einer Konsole und einem Wagen mit drei Roboterarmen. Der Chirurg sitzt an der Konsole, bewegt Joystick-ähnliche Handgriffe und schaut in ein dreidimensionales Operationsfeld. Durch den Computer können Zitterbewegungen eliminiert und die Bewegungsamplituden um den Faktor 5 bzw. 3 zu 1 moduliert werden. Ergebnisse: Weltweit der erste roboter-assistierte Eingriff am Menschen erfolgte durch unser Team 1997. Seitdem haben wir insgesamt 147 Eingriffe, darunter 39 Antirefluxoperationen mit dem Roboter durchgeführt. Unsere Studie zeigt, daß verschiedene Eingriffe am Menschen, darunter auch Nissenfundoplikationen, ohne Roboter-assoziierte Morbidität bei akzeptablen Operationszeiten machbar sind. Schlußfolgerungen: In der jetzigen Ausstattung bietet sich der Roboter für feines Nähen im Abdomen oder in engen Räumen an. Die verbesserten ergonomischen Bedingungen sowie die bessere Beweglichkeit der Instrumente sind für den Allgemeinchirurgen von Nutzen. Weitere Anstrengungen zur Verbesserung von Instrumentenkonfiguration und Visualisierung sind notwendig. Das Arbeiten mit dem Roboter verlangt spezielle operative Strategien und angepaßte Trokarplazierungen.
    European Surgery 09/2002; 34(3):161 - 165. · 0.15 Impact Factor
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    ABSTRACT: The introduction of laparoscopic adjustable silicone gastric banding (LASGB) has recently revolutionized gastric restrictive procedures in the treatment of morbid obesity. We analysed the short and long term results of this minimally invasive bariatric procedure. A total of 652 patients with a body mass of (median) 45 kg/m(2) were treated. There were only minor preoperative incidents. One patient died more than one month after the procedure. Early postoperative complications included 2 gastric perforations caused by a nasogastric tube and one early slipping of the band. Late complications occurred in 7% of the patients: 25 patients suffered a pouch dilation, 2 patients had gastric erosion by the band; 18 patients had port complications requiring reoperation. Loss of excess weight was 62% at 2 years. Laparoscopic adjustable gastric banding is a safe and effective treatment for morbid obesity. The most frequent complication is pouch dilation. Further study is warranted for the evaluation of long term results.
    Seminars in Laparoscopic Surgery 07/2002; 9(2):105-14.
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    ABSTRACT: The aim of this study was to evaluate the impact of 3D and 2D vision on performance of novice subjects using da Vinci robotic system. 224 nurses without any surgical experience were divided into two groups and executed a motor task with the robotic system in 2D for one group and with the robotic system in 3D for the other group. Time to perform the task was recorded. Our data showed significant better time performance in 3D view (24.67 +/- 11.2) than in 2D view (40.26 +/- 17.49, P < 0.001). Our findings emphasized the advantage of 3D vision over 2D view in performing surgical task, encouraging the development of efficient and less expensive 3D systems in order to improve the accuracy of surgical gesture, the resident training and the operating time.
    Acta chirurgica Belgica 106(6):662-4. · 0.36 Impact Factor