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Surgical Endoscopy 04/2012; 15(2):224-224. · 4.01 Impact Factor
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ABSTRACT: Although laparoscopic surgery has become widespread during the past decade, no systematic study of the training needs exists. To obtain guidance for planning, we analyzed the national resident operative experience during the past 8 years.
The laparoscopic experiences of all surgical residents graduating between 1994 and 2001 were subjected to regression analysis. The laparoscopic volume of each trainee and change in ratio of laparoscopic/open operation over time were used to estimate the growth of individual laparoscopic operations in training programs.
Laparoscopic surgery constituted only 5.7% of a trainee's total surgical experience in 1994, but comprised 13% by 2001. A resident completing training in 1994 performed 53 laparoscopic operations, of which 79% (42) were cholecystectomies. By 2001, a graduate performed 126 laparoscopic operations, of which 68% (86) were cholecystectomies. During the interim, most laparoscopic operations exhibited growth. Trainee experience in some newer operations has also increased steadily but at a much slower rate.
This descriptive statistical survey of training experience yields a comprehensive picture of the laparoscopic capability of the young surgeon. The growth potential of some newer operations has also been measured. Using these data, guidelines can be drawn as to which operation programs should focus resources on training residents. Since competence depends on exposure, residency training alone may not provide sufficient depth to allow recent graduates to perform the newer operations independently.
Surgical Endoscopy 12/2003; 17(11):1792-5. · 4.01 Impact Factor
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ABSTRACT: After more than a decade of growth for laparoscopic cholecystectomy and decline in open cholecystectomy, the impact on the training of resident's in other open biliary operations can be analyzed quantitatively.
The national operative statistics for residents' operations from 1988 to 2001 (data in the public domain) were analyzed by regression analysis to establish trends and to calculate the rate of change. For laparoscopic biliary operations, the changes in laparoscopic and open operations over time and the number of operations per trainee each year were used to measure the growth of a laparoscopic operation and to predict future trends. A survey of attitude, management algorithm, and self-confidence for coping with unexpected events in laparoscopic cholecystectomy also was conducted for senior residents and recent graduates.
In 2001, open cholecystectomy decreased to 28%, open common duct exploration to 27%, sphincteroplasty to 20%, of 1988 (baseline year) levels. Cholecystostomy and choledochoenteric bypass decreased to 70% and 75%, respectively. The decline began before the era of laparoscopic cholecystectomy, but accelerated after its introduction. Many of the recent graduates surveyed in one program indicated a preference for a nonsurgical, mainly endoscopic, approach for all bile duct conditions, but also for the assistance of senior surgeons in the operative management of unexpected events.
The popularity of noninvasive therapy in biliary surgery significantly reduced the resident's exposure to open biliary surgery, adversely affecting their confidence in the management of unexpected events encountered during laparoscopic operations. Supplemental and remedial education measures must be instituted in training programs.
Surgical Endoscopy 03/2003; 17(2):338-40; discussion 341. · 4.01 Impact Factor
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ABSTRACT: Background: After more than a decade of growth for laparoscopic cholecystectomy and decline in open cholecystectomy, the impact on the training of resident's in other open biliary operations can be analyzed quantitatively. Methods: The national operative statistics for residents' operations from 1988 to 2001 (data in the public domain) were analyzed by regression analysis to establish trends and to calculate the rate of change. For laparoscopic biliary operations, the changes in laparoscopic and open operations over time and the number of operations per trainee each year were used to measure the growth of a laparoscopic operation and to predict future trends. A survey of attitude, management algorithm, and self-confidence for coping with unexpected events in laparoscopic cholecystectomy also was conducted for senior residents and recent graduates. Results: In 2001, open cholecystectomy decreased to 28%, open common duct exploration to 27%, sphincteroplasty to 20%, of 1988 (baseline year) levels. Cholecystostomy and choledochoenteric bypass decreased to 70% and 75%, respectively. The decline began before the era of laparoscopic cholecystectomy, but accelerated after its introduction. Many of the recent graduates surveyed in one program indicated a preference for a nonsurgical, mainly endoscopic, approach for all bile duct conditions, but also for the assistance of senior surgeons in the operative management of unexpected events. Conclusion: The popularity of noninvasive therapy in biliary surgery significantly reduced the resident's exposure to open biliary surgery, adversely affecting their confidence in the management of unexpected events encountered during laparoscopic operations. Supplemental and remedial education measures must be instituted in training programs.
Surgical Endoscopy 01/2003; 17(2):338-340. · 4.01 Impact Factor
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ABSTRACT: Although the feasibility of laparoscopic incisional herniorrhaphy has been demonstrated, its advantages over the open technique are still unproven.
Fourteen consecutive laparoscopic incisional hernia repairs were compared with 14 matched controls of the open repair done by the same surgeon at the same institution. The controls were selected by a medical record technician not connected with the study. The cases were selected to match diagnoses, ASA status, and body weight as closely as possible. The outcome data for operating time, blood loss, hospitalization, resumption of oral intake, and postoperative complications were analyzed for statistically significant differences.
There was no statistical difference between the two groups in the parameters of blood loss, hospital days, or days to oral intake. The laparoscopic operation took 40% longer. Similar complications were seen in both groups. No mortality or early recurrences occurred in either group.
Laparoscopic incisional hernia repair of at least moderate complexity had no demonstrable advantage over the open repair in the present study.
Surgical Endoscopy 03/2000; 14(2):117-9. · 4.01 Impact Factor
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ABSTRACT: Despite advances in laparoscopic surgery, management of unsuspected choledocholithiasis diagnosed at laparoscopic cholecystectomy is controversial. We propose a simple maneuver of laparoscopic trans-cystic duct stenting of the papilla during cholecystectomy, followed by elective stent-guided sphincterotomy, as an expedient option.
We studied retrospectively 16 patients with choledocholithiasis first diagnosed in the course of laparoscopic cholecystectomy, treated with laparoscopic stenting of the papilla via the cystic duct using a short Cotton-Leung stent before completion of cholecystectomy. Elective stent-guided, needle-knife sphincterotomy and stone clearance was performed 2 to 3 weeks postoperatively.
Of 16 patients attempted, the procedure failed in one due to an impacted stone that prevented passage of the guidewire. Stenting time was 13 +/- 5 minutes (n = 15). Two stented patients had no stones at endoscopic retrograde cholangiography. Thirteen patients had successful elective stent-guided sphincterotomy with stone clearance without complications.
Laparoscopic biliary stenting combined with stent-guided sphincterotomy is a simple, safe, and cost-effective option for the management of uncomplicated choledocholithiasis.
Gastrointestinal Endoscopy 08/1998; 48(1):71-4. · 4.88 Impact Factor
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ABSTRACT: Laparoscopic surgery of selected acute abdominal conditions has been shown to be highly effective. Therefore, we investigated the diagnostic accuracy and therapeutic efficacy of routine laparoscopic surgery for the acute abdomen.
After appropriate investigations, patients with acute abdomen, with or without a specific diagnosis, were offered the options of either laparoscopic or open surgery. Postoperatively, we analyzed the outcome measures of diagnostic accuracy, complications, and operating time of laparoscopy. The hospital stays for our patients were compared to case-matched controls.
The accuracy of laparoscopic diagnosis is the same as laparotomy. The 62% of our patients who were managed totally laparoscopically required shorter hospitalization than the case-matched controls treated by open operation. Morbidity was not increased by laparoscopy in patients who required conversion to open operation. The additional cost of laparoscopy appeared modest.
Routine laparoscopy for the acute abdomen is safe and accurate. Patients eligible for laparoscopic treatment also require less hospitalization time.
Surgical Endoscopy 03/1998; 12(3):219-22. · 4.01 Impact Factor
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ABSTRACT: Much of the information of a second-look laparotomy can be obtained by a second-look laparoscopy. We describe the strategy and technique of installing laparoscopy ports at the end of the primary laparotomy for visceral ischemia to facilitate a second-look laparoscopy in the ensuing 72 hours. The advantages and limitations are illustrated by three cases. The primary advantage appears to be that when second-look laparoscopy can be accomplished at a minimal cost, much of the inhibition to use it is removed. However, more experience is necessary before the procedure can be used to replace laparotomy.
The American surgeon 09/1997; 63(8):732-4. · 1.28 Impact Factor
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ABSTRACT: Patients may have abnormal anatomic relationships between the stomach and adjacent organs, particularly when there is a history of abdominal surgery and adhesion formation. Routine placement of a percutaneous endoscopic gastrostomy tube can then be unsafe and result in inadvertent colon perforation, small bowel enterotomy, or injury to other structures. Described herein is a 94-year-old malnourished male in whom the colon lay directly anterior to the greater curvature of the stomach. A new technique was devised--laparoscopically-directed PEG placement--which proved to be a safer alternative approach in this patient.
Journal of laparoendoscopic surgery 09/1993; 3(4):411-4.
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ABSTRACT: Endoscopic jejunostomy placed via a gastrostomy does not protect against aspiration, and surgical jejunostomy is still preferred for patients with gastroesophageal reflux. We describe a rapid percutaneous suture technique which enables laparoscopic jejunostomy to be done under low-pressure pneumoperitoneum, using local anesthesia with sedation. Eight patients underwent this procedure without morbidity and mortality, and all tubes functioned well. No patient died of aspiration at follow-up of over 6 months.
Digestive Surgery. 08/1970; 12(4):247-249.
