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  • 1
    Electronic Resource
    Electronic Resource
    Comparison of acid reduction in antiulcer operations (1997)
    Springer
    Surgical endoscopy and other interventional techniques 11 (1997), S. 123 -125 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Acid reduction — Antiulcer operations — Peptic ulcer disease
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Three acid-reducing operations have recently been described for the laparoscopic treatment of peptic ulcer disease. These consist of a posterior truncal vagotomy combined with either (1) an anterior seromyotomy (SERO), (2) an anterior highly selective vagotomy (AHSV), or (3) a linear stapled lesser curvature excision (STAP). The purpose of this study was to investigate the physiologic effects of these procedures in terms of basal and maximal acid outputs. Methods: Fifty New Zealand rabbits were prospectively randomized into five open laparotomy groups (n= 10): a control group without vagal manipulation (CON), a bilateral truncal vagotomy with pyloromyotomy group (VP), a SERO group, an AHSV group, and a STAP group. All animals underwent placement of a gastrostomy tube for subsequent gastric secretory analysis. On postoperative day 6, basal acid outputs (BAO) and maximal acid outputs (MAO) following IV pentagastrin stimulation (30 μg/kg/h) were measured. Results were compared statistically using the ANOVA method. Results: Pentagastrin stimulation was associated with a significant increase in MAO in the CON group (p 〈 0.05 vs BAO); however, this response was effectively blunted in all the experimental groups. There were no differences in BAO or MAO between any of the vagotomized groups (SERO, HSV, STAP, VP). Conclusions: We conclude that the three acid-reducing procedures modified for laparoscopy are equally efficacious in reducing gastric acid secretion and that they compare favorably with VP. To our knowledge, this is the first report comparing basal and stimulated gastric acid secretion between these new acid-reducing techniques.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649900312
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  • 2
    Electronic Resource
    Electronic Resource
    Transthoracic induction of a hiatal hernia in domestic swine (1998)
    Springer
    Surgical endoscopy and other interventional techniques 12 (1998), S. 1061-1063 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Gastroesophageal reflux — Pig — Laparoscopic Nissen fundoplication — Hiatal hernia — Animal model
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: With the common performance of laparoscopic Nissen fundoplication for gastroesophageal reflux disease, there is renewed interest in the pathophysiology and potential histologic consequences of hiatal hernias. However, in vivo model exists that both reliably reproduces the hiatal hernia and is amenable to subsequent laparoscopic repair. Methods: A transthoracic approach was used to induce a hiatal hernia surgically in female James pigs (50–160 kg; n= 5). Results: Hiatal hernias were successfully induced in all pigs and verified with barium swallow, endoscopy, and/or laparoscopy. Laparoscopic reduction and Nissen fundoplication were subsequently completed on each animal on postoperative day 30. One postoperative death occurred on postoperative day 4 after thoracotomy. Conclusions: We describe the induction of a hiatal hernia via a transthoracic approach in domestic swine. The hiatal hernia is amenable to subsequent laparoscopic repair, enabling surgeons to acquire the technical skills required to correct this defect in the laboratory. To our knowledge, this is the first report of a reproducible model of a transthoracically induced hiatal hernia that allows subsequent laparoscopic repair. We suggest that in addition to refinement of surgical skills, our model may provide new information to researchers regarding the potential indications for antireflux procedures, as well as the natural history and appropriate management of hiatal hernias.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649900781
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  • 3
    Electronic Resource
    Electronic Resource
    Endoscopic axillary exploration and sentinel lymphadenectomy (1999)
    Springer
    Surgical endoscopy and other interventional techniques 13 (1999), S. 43-47 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Breast cancer — Sentinel nodes — Endoscopy — Axilla
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Minimally invasive approaches have changed the practice of surgery in several specialties. The purpose of this study was to develop a reproducible endoscopic technique for the evaluation of the axilla in breast cancer patients. Methods: A total of 23 patients with biopsy-proven breast carcinoma were enrolled. Patients were positioned in the supine position with the ipsilateral arm abducted at 90°. A 1-cm skin incision was made at the superior aspect of the axilla. Dissection was carried bluntly to the lateral border of the pectoralis major. A balloon distention device was inserted into the tract and distended under endoscopic vision to create a working space. Insufflation was initiated up to a pressure of 8 mmHg. A 30° laparoscope was introduced for visualization of axillary contents. One or two additional 5-mm cannulas were placed as needed under direct visualization. Manipulation of axillary contents was performed, and in 19 patients a sentinel node identification technique was applied. Results: In all patients, using insufflation and minimal instrument dissection, the axillary vein, long thoracic, and thoracodorsal nerves were found in their usual anatomical locations. Utilizing blunt and sharp dissection, the axilla was thoroughly inspected, and individual lymph nodes were easily identified and extracted. In 11 of 19 patients, a sentinel node or blue dye was identified using isosulfan blue. There was a procedure concordance of 84%, and there were no complications. Conclusions: We describe a novel endoscopic technique for the evaluation of the axilla in breast cancer patients. This technique allows (a) creation of a minimally invasive working space within the axilla, (b) recognition of key axillary anatomic landmarks, and (c) instrument manipulation within the axilla to identify and extract lymph nodes, and apply the sentinel node technique. This is the first report of a minimally invasive approach to axillary exploration to employ sentinel lymph node mapping.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649900895
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  • 4
    Electronic Resource
    Electronic Resource
    Intraperitoneal immunity and pneumoperitoneum (1999)
    Springer
    Surgical endoscopy and other interventional techniques 13 (1999), S. 1135-1138 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Laparoscopy — Pneumoperitoneum —Listeria monocytogenes— Helium — Intraperitoneal immunity
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Carbon dioxide (CO2) pneumoperitoneum has been implicated as a possible factor in depressed intraperitoneal immunity. Using in vitro functional assays, CO2 has been shown to decrease the function of peritoneal macrophages harvested from insufflated mice. However, an effective in vivo assessment is lacking. Listeria monocytogenes (LM), an intracellular pathogen, has served as a well-established in vivo model to study cell-mediated immune responses in mice. This study examines the immune competence of mice based on their ability to clear intraperitoneally administered LM following CO2 vs helium (He) insufflation. Methods: Eighty-five mice (C57Bl/6, males, 4–6 weeks old) were divided between the following four treatment groups: CO2 insufflation, He insufflation, abdominal laparotomy (Lap), and control (anesthesia only). Immediately postoperatively, each group was inoculated percutaneously and intraperitoneally with a sublethal dose (.015 × 106 org) of virulent LM (EGD strain). Half of the animals were killed on postoperative day 3 and half on day 5. Spleens and livers (sites of bacterial predilection) were harvested, homogenized, and plated on TSB agar. The amount of bacteria (1 × 106 LM/spleen and liver) from each group was then compared. Statistical significance was set at p≤ 0.05. Results: Control animals had nominal bacteria on day 3 (0.016 × 106 LM/spleen and liver), and the bacterial burden remained low at day 5 (0.038 × 106 LM/spleen and liver) postchallenge. On day 3, the bacterial burden was significantly higher in the CO2 group (5.46 × 106 LM/spleen and liver) as compared to He (0.093 × 106 LM/spleen and liver) and controls. The Lap group (3.44 × 106 LM/spleen and liver) had significantly more bacteria than the controls. There were no significant differences between any of the groups on day 5. Conclusions: In this animal model, CO2 pneumoperitoneum impaired cell-mediated intraperitoneal immunity significantly more than He pneumoperitoneum and controls on day 3. Also on day 3, laparotomy caused impairment of intraperitoneal immunity when compared to controls. Finally, intraperitoneal immunosuppression resolved by day 5.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649901189
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  • 5
    Electronic Resource
    Electronic Resource
    Conversion factors for laparoscopic splenectomy for immune thrombocytopenic purpura (1999)
    Springer
    Surgical endoscopy and other interventional techniques 13 (1999), S. 789-791 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Conversion — Immune thrombocytopenic purpura — Laparoscopy — Splenectomy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Since 1994, 27 patients at our institution have undergone laparoscopic splenectomy for immune thrombocytopenic purpura (ITP). Laparoscopic splenectomy was completed in 22 of these patients. We sought to identify factors that precluded successful laparoscopic splenectomy in the remaining 5 patients. Methods: Retrospective review of 27 patients with ITP undergoing laparoscopic splenectomy was performed at Duke University Medical Center from August, 1994 to September, 1997. Results: Laparoscopic splenectomy was performed in 16 women and 11 men with a mean age of 47.2 years. Five (18%) of these procedures were converted to open splenectomy. There was no significant difference in age, ASA score, gender, weight, height, or splenic size between the converted and laparoscopic groups. However, preoperative and postoperative platelet counts were significantly higher in the laparoscopic group than in the converted group (p 〈 0.001). Operative times also were significantly longer for the laparoscopic group than for the converted group (p 〈 0.001). Adherent adjacent structures, associated comorbidities, and technical errors prohibited laparoscopic completion in five patients. Technical errors with subsequent bleeding required conversion in two patients. A thickened greater omentum blanketing the splenic capsule and a densely adherent pancreatic tail extending well into the splenic hilum prevented laparoscopic completion in two patients. Increased peak airway pressures greater than 60 mmHg after pneumoperitoneum necessitated conversion in the remaining patient, who had a previous history of pulmonary insufficiency. Regardless of surgical approach, all patients achieved a therapeutic response after splenectomy. Splenectomies completed laparoscopically resulted in a significantly shorter length of hospital stay (p 〈 0.01). Conclusions: Densely adherent adjacent structures, technical errors, and cardiopulmonary instability may preclude successful completion of laparoscopic splenectomies. Thorough preoperative evaluation with an emphasis on the cardiopulmonary system may elicit a cohort of individuals with ITP who are unlikely to undergo laparoscopic splenectomy successfully. This cohort also may include individuals with preoperative platelet counts less than 35,000 mm−3.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649901100
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    Paper (German National Licenses)
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