Wiley Nifong

East Carolina University, North Carolina, United States

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Publications (3)8.22 Total impact

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    ABSTRACT: Introduction: Since September 2002 we have performed 51 minimally invasive atrial fibrillation (AF) ablative operations with six-month follow-up available for the first 29 patients (57.9%). Both robotic (da VinciĀ®, Intuitive Surgical, Inc., Sunnyvale, CA) and videoscopic modalities were used. Microwave ablation was completed by either an endocardial or a combination of epicardial and endocardial approaches. Robotic precision may increase accuracy for lesion placement while the endocardial approach may improve electrical isolation.Methods: Robotic endocardial (RE) (n = 7; 24%), robotic combined (RC) (n = 8; 28%), videoscopic endocardial (VE) (n = 9; 31%) and videoscopic combined (VC) (n = 5; 17%) approaches were used. Endocardial lesions encircle the left atrial appendage and pulmonary veins with another lesion from the pulmonary veins to the mitral valve annulus. The combined approach isolates the pulmonary veins epicardially while the remainder of the lesions are placed endocardially.Results: At six months, absence of AF occurred in 100% and 86% of patients undergoing RE and RC, respectively. VE and VC yielded freedom from AF in 89% and 40%, respectively. Overall, sinus rhythm was achieved in 93% of robotic patients (n = 14) and 71% of videoscopic patients (n = 14). Freedom from AF was 94% (n = 16) in endocardial alone and 67% (n = 12) in combined.Conclusions: Rhythm at six-month follow-up of our first 29 patients trend toward improved results with the robotic endocardial approach. A prospective randomized study will further determine the most efficacious method to surgically treat atrial fibrillation.
    No preview · Article · Sep 2004 · Journal of the American College of Surgeons
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    ABSTRACT: The femoral region of rats is commonly used in biomedical research and surgical training throughout the world. This study reports on an easier and more efficient surgical approach, the Fanua-Wilgis (FW) technique, for dissecting and exposing the femoral artery in the rat model that differs from the traditional longitudinal technique. The traditional longitudinal techniques call for an incision perpendicular to the length of the inguinal field. The epigastric fat pad then is dissected and retracted laterally to avoid damage to the superficial epigastric vessels (Figure 1). The femoral neurovascular bundle is then exposed. The neurovascular bundle should be located between the vastus medialis muscle and adductor longus muscles on the surface of the pectineus. The FW technique involves marking the skin in the groin region in the shape of a"C"(Figure 2). The incision follows the mark, exposing the epigastric fat pad and the pyramidalis muscle (Figure 3). Dissection proceeds by retracting the skin and epigastric fat pad (Figure 4), thereby, exposing the femoral neuromuscular bundle (Figure 5). Wound closure for both techniques is done by individual simple sutures in the skin (Figure 6). Time to arterial exposure, bleeding, and complications for the two techniques were compared. The study was approved by the IACUC of MedStar Research Institute, and all animal care procedures followed the NRC guidelines. All operations were carried out with the animals under anesthesia with sodium pentobarbital (50 mg/kg body weight) given intraperitoneally. Forty rats were used. The FW technique was used in 20 rats (n=20) with an average of 3 min from the time of incision to femoral exposure. There were no complications noted. The amount of bleeding was measured on a scale of 1 to 3. Light bleeding (1) was noted in 30%of the rats, but stopped completely after 1 min of applied pressure. Moreover, the average amount of bleeding using the FW technique was 0.33 mL per animal. By comparison, on the 20 rats (n=20) where the longitudinal technique was used, it took an average of 9 min (n=20) from the time of incision to femoral exposure. Heavy bleeding (3) was noted in 25%of the animals, medium bleeding (2) in 20%, light bleeding (1) in 20%, and only 30%had no bleeding. Bleeding was controlled by the application of pressure. There was one complication-an animal expired, presumably due to blood loss. The average amount of bleeding using the longitudinal technique was 1.55 mL per animal. All animals were euthanized right after the surgery, so no postoperative analgeisa or observations were required.
    No preview · Article · Feb 2004 · Journal of Investigative Surgery
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    ABSTRACT: Application of the Vacuum-Assisted Closure device (VAC) to open sternal wounds has negative hemodynamic effects. We hypothesized that the interposition of a muscle flap attenuates these negative hemodynamic effects. After institutional approval, monitoring lines were placed in anesthetized, ventilated pigs. Through a median sternotomy, sonometric crystals were strategically positioned around the left ventricle. A rectus flap was rotated over the mediastinal wound, and the VAC was placed over the flap. After baseline measurements, a vacuum of 125 mmHg [Group (GP) 1, n = 5] or 50 mmHg (GP2, n = 6) was initiated. Hemodynamics were recorded every 15 min for 1.5 h, and 15 min after cessation of the vacuum therapy. GP3 (n = 6) underwent intermittent VAC cycling (on 5 min/off 2 min). Significance determined by t test. While non-flapped animals had significant detriment in both left ventricular filling volume and cardiac output, flapped animals had insignificant depression of both parameters. Application of muscle flaps to sternal wounds prior to VAC therapy significantly attenuates the negative hemodynamic effects seen when the VAC is used alone.
    No preview · Article · Jan 2004 · Journal of Surgical Research