-
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this study was to evaluate the effects of carbon dioxide (CO2) pneumoperitoneum and wound closure technique on port site tumor implantation.
A standard quantity of rat mammary adenocarcinoma (SMT2A)was allowed to grow in a flank incision in Wistar-Furth rats (n = 90) for 14 days. Thereafter, 1-cm incisions were made in each animal in three quadrants. There were six control animals. The experimental animals were divided into a 60-min CO2 pneumoperitoneum group (n = 42) and a no pneumoperitoneum (n = 42) group. The flank tumor was lacerated transabdominally in the experimental groups. The three wound sites were randomized to closure of (a) skin; (b) skin and fascia; and (c) skin, fascia, and peritoneum. The abdominal wounds were harvested en bloc on postoperative day 7.
Histologic comparison of the port sites in the pneumoperitoneum and no-pneumoperitoneum groups did not demonstrate a statistically significant difference in tumor implantation for any of the closure methods. Evaluation of the closure techniques showed no statistical difference between the pneumoperitoneum group and the no-pneumoperitoneum group in the incidence of port site tumor implantation. Within the no-pneumoperitoneum group, there was a significant increase (p = 0.03) in tumor implantation with skin closure alone vs all three layers. Additionally, when we compared all groups by closure technique, the rate of tumor implantation was found to be significantly higher (p = 0.01) for skin closure alone vs closure of all three layers.
This study suggests that closure technique may influence the rate of port site tumor implantation. The use of a CO2 pneumoperitoneum did not alter the incidence of port site tumor implantation at 7 days postoperatively.
Surgical Endoscopy 04/2005; 19(3):441-7. · 4.01 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this study was to evaluate the feasibility of using 2-mm laparoscopic instruments in the treatment of appendicitis and to identify risk factors that may limit their use. Minilaparoscopic appendectomy was performed through a 2-mm port in the umbilicus for a videoendoscope, a 2-mm working port in the right upper quadrant, and a 5/12-mm suprapubic port for an endoscopic stapler. Minilaparoscopic appendectomy was attempted in 26 consecutive patients with appendicitis. Thirty-two consecutive patients undergoing conventional laparoscopic appendectomy with 5- and 10-mm instruments and videoendoscopes before the availability of 2-mm instrumentation were analyzed for comparison. Statistical comparisons were made by the Student t test and Fisher exact test. Differences were considered statistically significant at a P value less than 0.05. There were no conversions to an open appendectomy in the minilaparoscopic appendectomy or conventional laparoscopic appendectomy group. The mean operative time was 69.5 minutes for the minilaparoscopic appendectomy group and 85.5 minutes for the conventional laparoscopic appendectomy group (P = 0.02). The mean postoperative length of stay was 1.7 days for the minilaparoscopic appendectomy group and 2.5 days for the conventional laparoscopic appendectomy group (P = 0.08). There was no significant difference in the complication rates (P = 0.31). Minilaparoscopic appendectomy was completed in 13 (50.0%) patients. Independent risk factors (P = 0.05) for conversion to 5- or 10-mm ports were a retrocecal appendix and increasing patient age. There were no differences in the mean postoperative length of stay (P = 0.12) or complication rate (P = 0.39) between the two groups, but mean operative time was longer (P = 0.05) in the converted group. Perioperative outcomes for minilaparoscopic appendectomy are comparable to those of conventional laparoscopic appendectomy. The use of 2-mm instrumentation in the management of appendicitis is limited in patients with retrocecal appendicitis. Increasing patient age and a history of abdominal surgery may influence the need to convert 2-mm ports to 5- or 10-mm ports.
Surgical laparoscopy, endoscopy & percutaneous techniques 01/2002; 11(6):351-5. · 1.23 Impact Factor
-
American Journal of Emergency Medicine 11/2001; 19(6):522-3. · 1.98 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Advancements in laparoscopic surgery are often dictated by the limitations of technical instrumentation. Energy sources other than electrosurgery have become popular with the promise of quick and effective vascular control. With their success surgeons have begun using these on structures other than blood vessels with little or no data establishing their efficacy or safety. This study evaluates alternative energy sources in sealing ductal structures for possible use in liver or gallbladder surgery. After elective cholecystectomy cystic ducts (n = 45) were resealed ex vivo with surgical clips (n = 14), ultrasonic coagulating shears (n = 16), or electrothermal bipolar vessel sealer (n = 15), and bursting pressures were measured. Nineteen additional human cystic ducts were randomized to seal by ultrasonic coagulating shears (n = 9) or electrothermal bipolar vessel sealer (n = 10) and fixed in 10 per cent buffered formalin for histologic evaluation of thermal spread (mm). After this nine adult pigs were randomized to laparoscopic ligation and transection of the common bile duct using surgical clips (n = 3), ultrasonic coagulating shears (n = 3), or electrothermal bipolar vessel sealer (n = 3). The animals underwent necropsy for assessment of seal integrity on the sixth postoperative day. In the ex vivo study the mean cystic duct bursting pressure was 621 mm Hg with surgical clips and 482 mm Hg with the electrothermal bipolar vessel sealer (P = 0.39). The mean cystic duct bursting pressure after ultrasonic coagulating shears was 278 mm Hg, which was statistically less than surgical clips (P = 0.007) and electrothermal bipolar vessel sealer (P = 0.02). The mean thermal spread was 3.5 mm for ultrasonic coagulating shears and 13.4 mm for electrothermal bipolar vessel sealer (P = 0.0002). All animals undergoing ligation and transection of the common bile duct with ultrasonic coagulating shears and electrothermal bipolar vessel sealer developed bile peritonitis by postoperative day 6 as a result of seal leak. All animals undergoing surgical clip ligation and transection of the common bile duct maintained seal integrity. The mean common bile duct pressure above the surgical clip was 12 mm Hg (range 10-14). In conclusion the acute ex vivo study demonstrated a significant difference in the cystic duct bursting pressure between surgical clips and ultrasonic coagulating shears and between electrothermal bipolar vessel sealer and ultrasonic coagulating shears. The ultrasonic coagulating shears and electrothermal bipolar vessel sealer failed to maintain seal integrity in the in vivo animal study. Given the failure of the ultrasonic coagulating shears and electrothermal bipolar vessel sealer in the animal model these energy sources should not be used for transection of the cystic duct or major hepatic ducts during hepatobiliary surgery.
The American surgeon 10/2001; 67(9):901-6. · 1.28 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this clinical study is to evaluate the feasibility of using 2-mm laparoscopic instruments to perform an appendectomy in patients with clinically suspected acute appendicitis and compare the outcome of this mini-laparoscopic or "needlescopic" approach to the conventional laparoscopic appendectomy.
Two groups of patients undergoing appendectomy over 24 months were studied. In the first group, needlescopic appendectomy was performed in 15 patients by surgeons specializing in advanced laparoscopy. These patients were compared with the second or control group that included 21 consecutive patients who underwent laparoscopic appendectomy. We compared the patients' demographic data, operative findings, complications, postoperative pain medicine requirements, length of hospital stay, and recovery variables. Differences were considered statistically significant at a p-value < 0.05.
Patient demographics, history of previous abdominal surgery, and operative findings were similar in both groups. There was no conversion to open appendectomy in either group. No postoperative morbidity or mortality occurred in either group. The needlescopic group had a significantly shorter mean operative time (p = 0.02), reduced postoperative narcotics requirements (p = 0.05), shorter hospital stay (p = 0.04), and quicker return to work (p = 0.03) when compared with the laparoscopic group.
We conclude that the needlescopic technique is a safe and effective approach to appendectomy. When performed by experienced laparoscopic surgeons, the needlescopic technique results in significantly shorter postoperative convalescence and a prompt recovery.
BMC Surgery 01/2001; 1:4. · 1.33 Impact Factor
