15TH SLS ANNUAL MEETING AND ENDO EXPO 2006
SEPTEMBER 6-9, 2006 • BOSTON MASSACHUSETTS
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SCIENTIFIC ABSTRACTS
Supplement to JSLS, Volume 10, Number 3
GENERAL SESSIONS
Best of Laparoscopy Updates
Multidisciplinary Plenary Sesssions
Future Technology Session
CONGRESS FEATURES
Sept 6, 2006 Eight intensive half and full-day Master’s Classes
Sept 7, 2006 SLS Special Evening Event: Dinner With Faculty at the John F. Kennedy Library and Museum, featuring Thomas Fogarty, MD, a driving force in medical device development
Sept 7–8, 2006 Over 200 cutting edge scientific presentations including Laparoscopy Updates
Sept 7, 2006 Three new Multidisciplinary Plenary Sessions directed by those at the zenith of minimally invasive surgery: Innovations in Surgery and Medicine: From the Bench to the Bedside; Informatics for the Laparoendoscopic Surgeon; Competency and Its Assessment Metrics
Sept 8, 2006 Watch the Masters perform surgery–LIVE–during two simultaneous telesurgeries
Sept 9, 2006 Be inspired by a vision of the future at the Breakfast and Future Technology Session directed by the brilliant Richard M. Satava, MD, featuring Kenneth Kamler, MD, presenting Medicine in the Extreme, Anthony Atala, MD, with the latest in Growing Organs, and David Hanson presenting Robots and Emotional Expression
ENDO EXPO 2006
Over 50 exhibitors will provide on-going presentations about not only the innovations of the year but also the latest ideas and technological developments to aid surgeons in the operating room
IMPORTANT DEADLINES
July 6, 2006 Registration deadline for $100 SLS member discount
August 7, 2006 Last day to receive discounted room rates at The Westin Copley Place
VISA INFORMATION
International attendees, please apply for your visa now.
If you need a written invitation, please visit www.SLS.org or email Conferences@SLS.org.
Additional visa information is available at www.unitedstatesvisas.gov.
SPECIAL EVENT
SLS EVENING WITH FACULTY AT THE JOHN F. KENNEDY LIBRARY & MUSEUM
Thursday, September 7, 2006
6:00pm–8:30pm
John F. Kennedy Library and Museum
Boston, Mass.
Special Guest Speaker:
Thomas J. Fogarty, MD, presents
Evolution and the Impact of Surgical Technology
Join the SLS faculty, the driving force in minimally invasive surgery, and special guest speaker Thomas J. Fogarty, MD, a driving force in the development of medical devices, for dinner and a lecture at the John F. Kennedy (another driving force) Library and Museum, overlooking Boston Harbor. Thomas J. Fogarty, MD, developed his first medical device, the balloon embolectomy catheter, almost 50 years ago. At the time, it was unheard of to operate within an artery, but Fogarty’s balloon catheter was designed for just that and opened the way for endovascular therapy. It also was the first “less-invasive” medical technique used, resulting in less trauma to patients. Since then, Fogarty has helped launch many start-up medical device companies, including CTS, which makes devices for minimally invasive surgery. Fogarty is Clinical Professor of Surgery and Director of Research at Stanford University School of Medicine in California. Being in California, he has been exposed to winemaking, which he found intriguing, and now has his own winery. Because of wine’s well-documented health benefits, wine should be considered not so much as an adult beverage but as a health food according to Fogarty. Join us for this festive evening and hear about the latest from Dr Fogarty and what’s in store for SLS.
SPECIAL EVENT
EXCEL AWARD PRESENTATION & LECTURE
Friday, September 8, 2006
12:45pm–1:45pm
Excel Award Recipient:
Richard M. Satava, MD, presents
The Impossible Futures of Surgery
Established in 1991, the Excel Award has been presented to 21 surgeons deemed by the SLS Advisory Board to have made outstanding contributions to laparoscopy, endoscopy, and minimally invasive surgery. These outstanding surgeons are from various specialties and of various nationalities.
The 2006 recipient of this prestigious award, Richard M. Satava, MD, FACS, has long been active in SLS and numerous other societies, is a past president and member of the SLS Board of Trustees, and is a regular presenter at the SLS annual meeting. Dr Satava is Professor of Surgery at the University of Washington Medical Center, Program Manager of Advanced Biomedical Technology at the Defense Advanced Research Projects Agency (DARPA), and Special Assistant in Advanced Surgical Technologies at the US Army Medical Research and Materiel Command in Ft. Detrick, Maryland. He served on the White House Office of Science and Technology Policy (OSTP) committee on Health, Food and Safety. Dr Satava’s brilliant career has included 23 years of military surgery during which he has been an active flight surgeon, an Army astronaut candidate, MASH surgeon for the Grenada Invasion, and a hospital commander during Desert Storm—all the while continuing clinical surgical practice.
Active in surgical education and research, Dr Satava has contributed to more than 200 publications in diverse areas of advanced surgical technology, including Surgery in the Space Environment, Video and 3-D imaging, Telepresence Surgery, Virtual Reality Surgical Simulation, and Objective Assessment of Surgical Competence and Training. He also sits on the editorial boards of numerous surgical and scientific journals, is a past president of SAGES, and is on the Board of Governors of the NBME.
While striving to practice the complete discipline of surgery, Dr Satava is aggressively pursuing the leading edge of advanced technologies to formulate the architecture for the next generation of Medicine.
SPECIAL EVENT: BREAKFAST AND FUTURE TECHNOLOGY SESSSION
BEYOND HUMAN LIMITATION: PERFORMANCE IN THE EXTREMES, ORGAN REGROWTH, AND EMOTIONAL ROBOTS
Saturday, September 9, 2006
7:30am–10:30am
Richard M. Satava, MD, Director
Keynote Speaker Kenneth Kamler, MD presents
Medicine in the Extreme: Adventures of an Explorer in Extreme Environments
Keynote speaker, Kenneth Kamler, has been on Mt. Everest twice at the request of NASA helping to test space-age remote medical monitoring equipment.
Anthony Atala, MD, presents
Regenerative Medicine: New Approaches in Healthcare for the 21st Century
David Hanson presents
Robots and Emotional Expression
The Future Technology Session offers a look at what science fiction has actually become fact. The keynote speaker, Kenneth Kamler, MD, will show his experience in the most extreme of environments, with truly unbelievable accomplishments in the most unlikely places—the Amazon jungle, miles under the sea and at the top of Mt. Everest. This will give a personal insight into his accomplishments, which he has documented in his award-winning book, Surviving the Extremes. He will be available for a book signing after the session.
Professor Anthony Atala will update us on the latest of human organs he has grown with tissue engineering and stem cells. His success in clinical trials has made the fiction of replacing synthetically grown organs a reality.
Professor David Hanson will take us to the world of robots where their facial expressions are indistinguishable from human emotion. The future of robots in which they look and react like humans is one step closer. David Hanson’s work earned him (and his Einstein robotic face) personal praise from President Bush and a place on the cover of a number of magazines and journals.
CONGRESS EDUCATIONAL METHODS AND OBJECTIVES
The 15th International Congress and Endo Expo 2006 employs a variety of educational formats including topical general sessions, the presentation of scientific papers, open forums, posters, and original videos offered in small specialty-specific breakout sessions, and informal gatherings of participants and expert faculty.
The increasing complexity of minimally invasive diagnostics and therapy requires a continuous educational process. The exchange of knowledge and expertise among the physicians taking part in this congress contributes to the continuation of excellence in minimally invasive surgery.
Upon completion of the congress, participants will be able to:
• Increase comprehension of the basic and fundamental principles of laparoscopic, endoscopic, and minimally invasive techniques, enhancing the participant’s understanding of these techniques;
• Understand the recent advances in laparoscopic, endoscopic and minimally invasive techniques;
• Determine the appropriate use of laparoscopic, endoscopic and minimally invasive equipment as part of a treatment plan in the care of patients;
• Comprehend the developing technologies that will be available in the future to enhance the standard of patient care; and
• Acquire educational information within the physician’s specialty, which will enhance their professional development and patient care.
MASTER’S CLASSES | WEDNESDAY, SEPTEMBER 6, 2006
#1 Master’s Class in the Prevention and Management of Laparoscopic and Endoscopic Surgical Complications
9:00am–12:00pm
Faculty
Raymond J. Lanzafame, MD, MBA, Director
Carl J. Levinson, MD, Co-Director
Lawrence C. Biskin, MD
Ceana Nezhat, MD
Howard N. Winfield, MD
Topics
• Introduction and a Disastrous Case
• Detailed Anatomy of Selected Anatomic Sites, Based on Attendee Preconference Questionnaire
• Case Videos and Discussion
• Selected Video Cases/Disasters and Faculty Selected Highlights
#2 Master’s Class in Laparoscopic Treatment of Adhesions for the General Surgeon, Gynecologist, and Urologist Including Abdominal and Pelvic Pain
1:00pm–4:30pm
Faculty
Harry Reich, MD, Director
Michael P. Diamond, MD, Co-Director
James E. Carter, MD, PhD
Nicola Di Lorenzo, MD, PhD
Douglas E. Ott, MD, MBA
Topics
• Introduction and SCAR Study
• Why is the Surgical Treatment of Patients With Chronic Abdominal Pain From Intraabdominal Adhesions so Controversial?
• What Causes Adhesions? Do Adhesions Cause Pain?
• Abdominal and Pelvic Pain
• The Role of Laparoscopic Adhesiolysis and Adhesion Reduction Adjuvants in Gynecology and Infertility
• What About Acute Bowel Obstruction?
• Laparoscopic Entry Techniques After Multiple Laparotomies
• How Laparoscopy Effects the Peritoneum: Its Effect on Adhesion Formation and Methods of Reduction
• Laparoscopic Adhesiolysis—Surgical Plan and Techniques
• Deep Cul-De-Sac Dissection for Adhesions Involving Fibrotic Endometriosis, Including a Simple Technique to Repair Rectal Enterotomies
• Intraoperative Treatment of Bowel Injuries at the Time of Laparoscopy—Recognition, Repair, Resect, Hand-Assist, Open
• What’s Coming Next in Adhesiolysis and Adhesion Reduction Adjuvants
#3 Master’s Class in Laparoscopy for Complex Problems with Emphasis in Pediatrics and Pregnancy
9:00am–4:30pm
Faculty
Gustavo Stringel, MD, Director
Robert K. Zurawin, MD, Co-Director
Craig Albanese, MD
Tommaso Falcone, MD
Raymond J. Lanzafame, MD, MBA
Topics
• Laparoscopy for Complex Problems in the Pediatric Patient, Including Access and Complications
• Advanced Laparoscopic Procedures in Newborns and Infants
• Laparoscopic Hernia Repair in Children, Including Inguinal Hernia, Umbilical Hernia, and Epigastric and Ventral Hernia
• Laparoscopy for Complex Problems in the Female Adolescent Patient
• Question and Answer with Pediatric Panel
• Laparoscopic Procedures in the Pregnant Patient. Physiological Considerations. Effect on the Mother and Fetus
• Laparoscopic General Surgery Procedures During Pregnancy, Including Laparoscopic Cholecystectomy, Appendectomy and Lysis of Adhesions
• Laparoscopy for Abdominal Tumors: in the Pediatric Patient; in Pediatric and Adolescent Gynecology; in Pregnancy
• The Role of Laparoscopy in Abdominal Pain: the Pediatric Surgeon; the Pediatric Gynecologist; the Pregnant Patient
#4 Master’s Class in Robotic Laparoscopic Surgery Jointly with the Minimaly Invasive Robotic Surgery Association
9:00am–4:30pm
Faculty
Garth Ballantyne, MD, Director and President of MIRA
Santiago Horgan, MD, Co-Director
William E. Kelley, Jr., MD, Co-Director
Arnold Byer, MD
Ara Darzi, MD
Tommaso Falcone, MD
Marc Katz, MD
Jacques Marescaux, MD
Joseph Petelin, MD
Richard M. Satava, MD
Ash Tewari, MD
Topics
• Remote Preserve Robots
• Augmented Reality Surgery
• Telerobotic Bariatric Surgery
• Telerobotic Colorectal Surgery
• Telerobotic Heller Myotomy & Esophagectomy
• MIRA Update
• Telerobotic Urology for Benign Disease
• Telerobotic Preperitoneal Radical Prostectomy
• Telerobotic Vascular Surgery
• Telerobotic Cardiac Surgery
• Telerobotic Gynecologic Surgery
• Remote Mobile Teleconferencing with a Robot Over the Internet
• The Future of Surgical Robotics
#5 Master’s Class in Gynecologic Endoscopic Surgery
9:00am–4:30pm
Faculty
Farr Nezhat, MD, Director
Ceana Nezhat, Co-Director
Jacques Dequesne, MD
Tommaso Falcone, MD
Harrith M. Hasson, MD
Wm. Leroy Heinrichs, MD, PhD
William E. Kelley, Jr., MD
Camran Nezhat, MD
Steven F. Palter, MD
Danny Seidman, MD
Robert Zurawin, MD
Topics
• Safe Abdominal Entry—Complications and Managements
• Laparoscopy and Infertility: Is There any Role?
• Laparoscopic Treatment of Endometriosis in Failed IVF
• Laparoscopy and Hysterectomy: LAVH, TLH, or Supracervical
• Role of Endoscopy in Pelvic Floor Repair
• Anatomical Principals in Laparoscopy: How to Minimize Complications
• New Horizons in Myoma Managements
• Laparoscopy and Gynecological Malignancy: Where We Are and Where We Are Going
• Role of Simulation in Advanced Operative Endoscopy
• Robotics: Past, Present and Future
• Open Laparoscopy: The Original Technique 29 years of Experience
• Evaluation and Management of Bowel Injuries
• My Experience in the Role of Laparoscopy in Japan
• Update in Hysteroscopy, Ablations and Sterilization Techniques
• Hands On Laboratory: New Instruments and Simulators
#6 Master’s Class in Laparoscopic General Surgery Jointly with the Society of American Gastrointestinal and Endoscopic Surgeons
9:00am–4:30pm
Faculty
Michael S. Kavic, MD, Director
W. Peter Geis, MD, Co-Director
William E. Kelley, Jr., MD, Co-Director
Morris E. Franklin, Jr., MD
Santiago Horgan, MD
Raymond J. Lanzafame, MD, MBA
Joseph B. Petelin, MD
Phillip P. Shadduck, MD
Topics
• NOTES: Pipedream or Reality
• Laparoscopic Hernia Repair—the Right Prosthetic
• Endoscopic Options for GERD
• Complex and Recurrent Hiatal Hernia Repair
• Laparoscopic Management Achalsia
• Robotic technology in the Laparoscopic Era
• Laparoscopic Adrenalectomy
• Laparoscopic Splenectomy
• Bariatrics—Laparoscopic Banding/Bypass
• Laparoscopic Options Benign Colon Disease
• Laparoscopic Options Malignant Colon Disease
#8 Master’s Class on How to Assess Competency in Laparocopic Surgery, Includes Hands-On Laboratory
9:00am–4:30pm
Faculty
Harrith M. Hasson, MD, Director
Richard M. Satava, MD, Co-Director
Ara Darzi, MD
Wm. Leroy Heinrichs, MD, PhD
Tadashi Matsuda, MD
Laboratory Faculty
Randy Haluck, MD
Dennis Klassen, MD
Charles H. Koh, MD
Mark L. Smith, MD, PhD
Maria Terry, MD
Topics
• Assessing Cognitive and Technical Skills in Laparoscopic Surgery
• Technical Surgical Proficiency: Basic Laparoscopic Skills
• Virtual Reality Training in Laparoscopic Surgery
• Assessing Laparoscopic Surgical Performance by Reviewing Unedited Video Tapes—The Japanese Experience
• Presentation of Simulators
• Group Discussion With Q&A
• Hands On Practice by Participants
• Summarization
MULTIDISCIPLINARY PLENARY SESSIONS | THURSDAY, SEPTEMBER 7, 2006
INNOVATIONS IN SURGERY AND MEDICINE: FROM THE BENCH TO THE BEDSIDE
Thursday, September 7, 2006
8:30am–10:00am
Physician innovators and researchers have made the world a better place. However these experts by nature lack the experience and the know how to bring an idea to reality. During this session, an international, renowned panel will address how to bring an idea to reality for the benefit of patients. To bring an idea to fruition involves research, patent protection, and business dimensions. This session will guide participants one step closer to bringing their dream of innovation to reality for the benefit of mankind.
FACULTY AND PRESENTATIONS
Camran Nezhat, MD, Director
Richard M. Satava, MD, Co-Director
Thomas J. Fogarty, MD: How to Start and Bring Your Idea of Surgical Instrument to Reality
Leslie Bottorff, Venture Capitalist: Venture Side of Starting a Company and What to Look for in an Idea
Chris Mitchell, Attorney: How to Start a Company Around Your Idea
INFORMATICS FOR THE LAPAROENDOSCOPIC SURGEON
Thursday, September 7, 2006
10:30am–11:30am
Informatics is primarily concerned with the structure, creation, management, storage, retrieval, dissemination, and transfer of information. This session will provide physicians with introductory knowledge on biomedical informatics with the focus on the current status of telemedicine, electronic medical records, and Internet resources, including medical search engines. Principles of designing a medical database for EMR will be elaborated on, and how to integrate this information into handheld devices will be discussed.
FACULTY AND PRESENTATIONS
Gustavo Stringel, MD, Director: General Informatic Session—Electronic Medical Records, CPOE, HIPAA Compliance, and Evidence Based Medicine
Alex Gandsas, MD, Co-Director:
Your Computer, the Internet and Your PDA (PalmPilot), Searching the Web and Finding Information
Paul Alan Wetter, MD: Introduction—SLS Websites
COMPETENCY AND ITS ASSESSMENT METRICS
Thursday, September 7, 2006
11:30am–12:45pm
Competency and the objective assessment of competency have been mandated by the Accreditation Council on Graduate Medical Education (ACGME) and the American Board of Medical Specialties (ABMS). The Residency Review Committee (RRC) has indicated that all training programs are required to have skills training with the focus of objectively assessing skills competence. This session will review the current approaches to competency and assessment in addition to giving guidance as to the correct definitions and metrics that can be used. There is already a next generation of skills training and methods that are being considered, including criterion-based training and intelligent tutoring, which will be introduced.
FACULTY AND PRESENTATIONS
Richard M. Satava, MD, Director: Competency, Proficiency and the Next Generation of Skills Training and Assessment Curricula Using Simulators
Harrith M. Hasson, MD, Co-Director: Technical Skill—a Component of Surgical Performance
Steve Dawson, MD: A Scientific Basis for Measuring Surgical Skills Using Laparoscopic Simulation
Wm. LeRoy Heinrichs, MD, PhD: Objective Measures of Surgical Competency
Neal Seymour, MD: Predictive Validity of Simulation Performance in Operative Performance
CONCURRENT SCIENTIFIC SESSIONS
LAPAROSCOPY UPDATES
Thurday, September 7, 2006
Presented by the SLS Special Interest Group Committees
Abdominal / Pelvic Pain / Adhesions, Maurice Chung, MD
Biliary Disease and Cholecystectomy, A. Elizabeth Martin, MD
Core Competencies, Gustavo Stringel
Endometriosis/Ovarian, Farr Nezhat, MD
Hernia, Lawrence Biskin, MD
Hysterectomy, Ceana Nezhat, MD
Office and Outpatient Laparoscopy, James F. Carter, MD
Pediatric Surgery, Harsh Grewal, MD
Pelvic Reconstructive Surgery / Stress Incontinence, Conrad Duncan, MD
Robotic Surgery, Ash Tewari, MD
Thoracic Surgery, Neil A. Christie, MD
Urology, Howard Winfield, MD
CONCURRENT SCIENTIFIC SESSIONS
Thursday, September 7, 2006 & Friday, September 8, 2006
Over 200 Scientific Papers, Open Forum Presentations, Videos, and Posters will be presented by SLS members and colleagues from around the world. Preliminary Listing.
GENERAL SURGERY
Role of Subfascial Endoscopic Perforator Surgery (SEPS) by Harmonic Scalpel in Managemant of Chronic Venous Insufficiency of Lower Limbs, Narayan Agarwal MD
Transabdominal Laparoscopic Inguinal Hernia Repair: the Tricks We Have Learned, Which We Want to Propose and Discuss, Ferdinando Agresta MD
Penetrating Abdominal Trauma With no Signs of Peritoneal Penetration, Would a Diagnostic Laparoscopy Avoid a Laparotomy, Syed I Ahmed MD
Gastric Banding Without Fixation Suture
Housam A L Trabulsi MD
Laparoscopic Fundoplication: the Beneficial Effects of Preservation of Short Gastric Vessels, Muhammad Z Aslam MD
Laparoscopic versus Open Nissen Fundoplication in Infants After Neonatal Laparotomy,
Katherine A Barsness MD
One Stage Laparoscopic Roux-en-Y Gastric Bypass Surgery is Safe and Effective in High-Risk Super Obese Patients, Eraj M Basseri MD
Laparoscopic Restorative Proctocolectomy: Is the Anastomosis Compromised?, Joel J Bauer MD
Hand-assisted Laparoscopic Surgery (HALS) in Colorectal Surgery. A Single Institution Experience, Anne-Marie Boller MD
Spleen-preserving Laparoscopic Distal Pancreatectomy, Natalino Bedin MD
Combined Surgical and Endoscopic Rescue of Severe Sepsis Post Bariatric Surgery,
Gianluca Bonanomi MD
Follow-up and Early Referral Are Mandatory in Order to Avoid Late Diagnosis of Adjustable Gastric Banding Complications, Gianluca Bonanomi MD
Seldinger Technique for Band-to-Band Revisional Surgery, Catherine A Boulay MD
Adenomyomatosis and Cholesterolosis of the Gallbladder: Laparotomy Conversion During VLS Cholecystectomy. Case Report, De Werra Carlo MD
Edometriosis of the Cecum Mimicking Acute Appendicitis: a Case Report, Adel Chokki MD
Patient Recall and Comprehension After Laparoscopic Appendectomy, Benjamin L Clapp MD
Minimal Access Thyroidectomy Using an Endoscopic Transaxillary Approach, Titus D Duncan MD
Endoscopic Transaxillary Near Total Thyroidectomy: a Feasibility Study, Titus D Duncan MD
Initial Experience With the Use of the ON-Q Pain Pump During Laparoscopic Ventral Hernia Repair, Roger Ernest DO
Blood Loss in Colonic Surgery. Comparison Between Laparoscopic and Open Techniques,
Greco Francesco MD
Wound Complication in Laparoscopic Roux-en-Y Gastric Bypass, Wesley P Francis MD
Laparoscopic Versus Open Appendectomy in Perforated Appendicitis, Yasuyuki Fukami MD
Laparoscopic Thoracic Duct Ligation, Mark D Gaon MD
Laparoscopic Splenectomy With Hand-Assisted Specimen Extraction in Massive Splenomegaly in Thalassemia Major, Nikolaos I Gatsoulis MD PhD
Videolaparoscopic Treatment of Paraesophageal Hernia, Roberta Gelmini MD
Laparoscopic Nissen With Mesh, George Kevin Gillian MD
Laparoscopic Excision of a Glucagonoma, Timothy E Goundrey MD
Bilateral Pulmonary Artery Thrombus After Laparoscopic Gastric Bypass: a Rare Occurrence,
Ajay Goyal MD
Laparoscopic Retrieval of a Large Retained Fecalith After Laparoscopic Appendectomy,
Bryan S Helsel MD
Mucocele of the Appendix, Fernando A Herrera MD
Laparoscopic Cholecystectomy With Combined Method, Ryuichi Hotta MD
Assessment of Surgical Trainees for Technical Errors Enacted by Using Instrument Differently: Observational Clinical Human Reliability Analysis (OCHRA), Mubashar Hussain Dr Med
Objective Assessment of Surgical Trainees for Their Technical Errors by Observational Clinical Human Reliability Analysis, Mubashar Hussain Dr Med
Small Bowel Obstruction After Laparascopic Roux-en-Y Gastric Bypass, Muhammad Jawad MD
The Impact of Laparoscopic Gastric Bypass Surgery on C-Reactive Protein Levels, Neel R Joshi MD
Conversion to Laparoscopy?, Daniel S Kim MD
Congenital Diaphragmatic Falciform Ligament Herniation: a Rare Case, Dan G Kolder MD
Randomized Clinical Trial of Three-Port vs Standard Four-Port Laparoscopic Cholecystectomy,
Manoj Kumar MD
Gangrenous Cholecystytis: Laparoscopic Treatment, Sebastiano Lacitignola MD
Polytetrafluoroethylene Patch Repair for Large Hiatal Hernia, Luis E. Laguna MD
Laparoscopic Colectomy for Bening and Malignant Diseases, Luis Enrique Laguna MD
The Impact of Routine Preoperative ERCP in Gallstone Pancreatitis, Jonathan A Laryea MD
Selective, Versus Routine, Upper GI Series Leads to Equal Morbidity and Reduced Hospital Stay in Laparoscopic Gastric Bypass Patients, Sophia D. Lee MD
Intracorporeal Stapled Billroth-I Gastroduodenostomy Using Hand-Access Device, Young-Joon Lee MD
Patient Satisfaction After Laparoscopic Cholecystectomy, Kiran M Lodha MD
Patients Paying for Bariatric Surgery Out of Pocket, Atul K Madan MD
Routine Histology of Gallbladder in Laparoscopic Era. Is There Any Justification?, Sajid Mahmud MD
Our Experience in TAPP Hernia Repair, Lombardi Marco MD
Long-term Results in Stapled Hemorrhoidectomy, Lombardi Marco MD
Laparoscopic Resection With Intraoperative Radiotherapy: a New Step in the Multimodal Treatment of Advanced Colorectal Cancer, Civello Ignazio Massimo Prof Dr Med
Is it Appropriate That Laparoscopy-assisted Gastrectomy With Extended Lymph Node Dissection is Performed in Advanced Gastric Cancer?, Young-Joon Moon MD
Laparoscopic Preperitoneal Inguinal Hernia Repair Using Preformed Polyester Mesh Without Fixation—4 Year Study, John E Morrison MD
Role of Diagnostic Laparoscopy in Penetrating Abdominal Stab Wounds, Albeir Mousa MD
Pathophysiology of Parietal and Visceral Peritoneum Tissue Acidosis During CO2 Pneumoperitoneum, Ospan A Mynbaev MD PhD
Pathophysiology of Peritoneal Tissue Acidosis During Laparoscopic Surgery, Ospan A Mynbaev MD PhD
Role and Value of the Predictive Factors of Common Biliary Duct Lithiasis in Preparation to the Laparoscopic Cholecystectomy. Retrospective Study, Vincenzo Neri MD
Significance of Laparoscopic Live Donor Nephrectomy: Lessons Learnd From 128 Cases,
Andreas Paul Prof Dr Med
A Synthetic Cyanoacrylate Tissue Sealant Impairs Tissue Integration of Macroporous Mesh in Experimental Hernia Repair, Alexander H Petter-Puchner MD
Equine Cross Linked Collagen Implants for Experimental Incisional Hernia Repair, Alexander H Petter-Puchner MD
Mesh Fixation With Fibrin Sealant in Transabdominal Preperitoneal Mesh Repair: Recurrence and Impact on Quality of Life Evaluated in a Prospective Manner, Alexander H Petter-Puchner MD
Videothoracoscopic Neurophrenicotomy, Igor Polianskyi Prof Dr Med
Laparoscopic Laddís Procedure in an Adult Male with Symptomatic Malrotation, Emil L Popa MD
A Pilot Study Evaluating a Novel Magnetic Gasless Laparoscopy Device in Porcine Laparoscopic Liver Resections, Adam Howard Power MD
Initial Experience With the Use of the ON-Q Pain Pump During Laparoscopic Inguinal Hernia Repair, Anuj Prashar DO
Chronic Pain After Laparoscopic Repair of Ventral and Incisional Hernia, Srdjan Rakic MD PhD
Laparoscopic Appendectomy in Patients With a Body Mass Index of 25 or Greater, Robert L Ricca MD
Transgastric Surgery: Current Indications and Future Implications, Kurt E Roberts MD
Laparoscopic-assisted, Transgastric Endoscopy: Current Indications and Future Implications,
Roberts E. Roberts MD
Difficulty of Laparoscopic Heller Myotomy Is Not Determined by Preoperative Therapy and Neither Difficulty of Myotomy nor Preoperative Therapy Determine Long-term Outcome,
Alexander Rosemurgy MD
K-ras Mutation as Prognostic Factor in Procedure of the Colorectal Cancer—Laparoscopic vs Laparotomic Approach, Lukas Sakra MD
Autologous Skin Grafting With Bioabsorbable Stent for Widespread Endoscopic Mucosal Resection of the Esophagus, Tadashi Sakurai MD
Assessing Decision Making in Laparoscopic Surgery, Sudip K Sarker MD PhD
Chronic Inguinal Pain After Laparoscopic Inguinal Hernia Repair: the Role of Tack and Mesh Removal, Jeffrey D Sedlack MD
A Ten Year Single Surgeon Experience With Laparoscopic Appendectomy, Jeffrey D Sedlack MD
Laparoscopic Approach in Acute Cholecystitis, Dragos Stojanovic MD PhD
Intussusception as a Complication Following Roux en Y Gastric Bypass, Renee E Thompson MD
Social History of Patients Undergoing Laparoscopic Bariatric Surgery, David S Tichansky MD
Major Bile Duct Injuries After Laparoscopic Choleystectomy: a Tertiary Center Experience,
Juergen Treckmann MD
Laparoscopic Treatment of Rectal Cancer: Tips, Tricks, and Limits, Paolo Ubiali MD
Trocar Port Site Incisional Hernias After Laparoscopic Surgery, Ali Uzunkoy Prof Dr Med
Hernia Recurrence in Right Subcostal Incisions After Laparoscopic Repair, Eelco Wassenaar MD
Laparoscopic Repair of Umbilical Hernia: One Hundred Fifty-four Consecutive Corrections,
Eelco Wassenaar MD
The Aesthetic Inguinal Herniorrhaphy: a Single Umbilical Incision Technique, James A Westervelt MD
GYNECOLOGY
Ruptured Non-Communicating Hemi-uterus Presenting With Acute Pelvic Pain, Mark Howard Amols MD
Biopsy of Sentinel Lymph Node Improves Staging of Early Cervical Cancer, Anne-Sophie Bats MD
Analyzing Tension Free Vaginal Tape-Obturator (TVT-O) Suburethral Sling Procedures With Integrated Definition (IDEF0) Modeling Language and Performance Audits of Intraoperative Video,
James Dean Bauer MD
Embryoscopy in Recurrent Pregnancy Loss, Howard J A Carp Prof Dr Med
Day Surgery Laparoscopic Subtotal Hysterectomy: a Multicentered Study With 250 Patients,
Stefanos Chandakas MD PhD
The Safety of Helica Thermal Coagulator in the Treatment of Endometriosis: a Series of 500 Patients, Stefanos Chandakas MD PhD
Pelvic Peritonitis After Laparoscopic Supra Cervical Hysterectomy, Leroy Charles MD
Reactionary Haemorrhage in Gynaecological Surgery, Mark Erian MD
Intraoperative Sentinel Node Detection Using Technetium-99m Sulfur Colloid Predicts Nodal Metastases in Patients With Early-Stage Cervical Cancer, Amanda Nickles Fader MD
Myolysis Revisited, Herbert A Goldfarb MD
Minimally Invasive Outpatient Treatment for Bowel (Fecal) Incontinence: a New Procedure for the Gynecologist, Stephen A Grochmal MD
The Identification of Bowel Incontinence in Gynecologic Practice: a Multicenter Investigation of a New Questionnaire, Stephen A Grochmal MD
Moving Forward With Breast Endoscopy: From Diagnostic to Interventional Ductoscopy,
Volker R Jacobs MD PhD
Laparoscopic Treatment of Infiltrated Endometriosis, Francesco La Grotta MD
Influence of Surgical Access on Outcome of Early Borderline Ovarian Tumors.,
Fabrice R Lecuru MD PhD
Diagnostic Hysteroscopy Findings During Follow-Up of Women With HNPCC, Fabrice R Lecuru MD PhD
Effect of Carbon Dioxide Pneumoperitoneum During Laparoscopic Surgery on Morphology of Peritoneum, Yan Liu MD
The Anatomic Relationship of the Umbilicus to Retroperitoneal Major Vessels, Yan Liu MD
Complications of Hysterectomy, Sadok Mohamed Dr Med
Ectopic Pregnancy, Sadok Mohamed Dr Med
Breast Cancer, Sadok Mohamed Dr Med
CISH Hysterectomy 15 Year Perspective, John E Morrison MD
A Comparative Study of Hysteroscopic Sterilization Performed In-office Versus a Hospital Operating Room, Mark Nichols MD
Usefulness of Minihysteroscopic Bipolar Coagulation for Bleeding Control After Removal of Transcervically Prolapsed Myoma on OPD Basis, Sung-Tack Oh MD PhD
The Usefulness of Minihysteroscopic Bipolar Coagulation of Bleeding Point, Sung-Tack Oh MD PhD
Second Look Laparoscopy for Severe Endometriosis: Does Reoperation Within One Year of Initial Surgery Improve Patients Pain?, Hilda Elena Rodriguez MD
Laparoscopic Hysterectomy with Retroperitoneal Dissection and Uterine Artery Occulsion,
Jay P Shah MD
Da Vinci Assisted Laparoscopic Sacrocolpopexy, Amir Shariati MD
Laparoscopic Tubal Anastomosis, Jonathan Y Song MD
Laparoscopic Approach to the Large Leiomyoma, Jonathan Y Song MD
Pregnant Woman With Dermoid Cyst Developing in an Accessory Ovary Located in the Left Infundibulopelvic Ligament, Hidenori Takashi MD
Primary Omental Ectopic Pregnancy. A Case Report, Hidenori Takashi MD
Laparoscopic Findings in Serious Surface Papillary Carcinoma—A Case Report, Takashi Yamada MD PhD
Laparoscopic Appendectomies Performed by Gynecologists in Women With Pelvic Pain,
Parveen S Vahora MD
Fertiloscopy: Review of a 1500 Cases Continuous Series, Antoine A Watrelot MD
Laparoscopic Resection of Retroperitoneal Cyst, Tomone Yano MD
UROLOGY
Techniques for Laparoscopic Localization of Intraluminal Ureteral Pathology, Ronney Abaza MD
Da Vinci-assisted vs Pure Laparoscopic Aortorenal Bypass in an Acute Porcine Model, Ronney Abaza MD
Robotic-assisted Pyeloplasty With Synchronous Removal of Renal Calculi in the Adult Patient: Technical Modifications, Fatih Atug MD
Robotic Pyeloplasty in Children, Fatih Atug MD
Transurethral Excision of the Distal Ureter and Retroperitoneoscopic Radical Nephroureterectomy With Three Ports in Modified Lithotomy Position, Yildirim Bayazit MD
Comparison of Healing After Cystotomy and Repair With Fibrin Glue and Sutured Closure in the Porcine Model, James F Borin MD
Robotic Partial Ureterectomy for Upper Ureteral Tumor: a Conservative Approach, Erik P Castle MD
Standardized Evaluation of Complications of Robotic Radical Prostatectomy, Erik P Castle MD
Positive Surgical Margins in Robotic Radical Prostatectomies: Impact of Learning Curve on Oncologic Outcomes, Erik P Castle MD
Laparoscopic En Bloc Resection of Locally Advanced Renal Cell Carcinoma and Overlying Right Colon: a Multidisciplinary Approach, Erik P Castle MD
Laparoscopic Nephrolithotomy: a Minimally Invasive Treatment Option, Erik P Castle MD
Robotic-assisted Radical Cystoprostatectomy With Extended Bilateral Pelvic Lymphadenectomy and Orthotopic Neobladder, Erik P Castle MD
Initial Experience With Robotic-assisted Radical Cystectomy in 17 Cases, Erik P Castle MD
High Power (80 W) Potassium-Titanyl-Phosphate (KTP) Laser Photoselective Vaporization Prostatectomy (PVP) for Symptomatic Benign Prostatic Hyperplasia (BPH), Daniel J Culkin MD
Laparoscopic-assisted Lysis of Fibrotic Capsule Around Penile Prosthesis Reservoir and Placement of Artificial Urinary Sphincter, Brian H Eisner MD
Incidence of Urothelial Carcinoma Recurrence Following Hand-assisted Laparoscopic Nephroureterectomy With Cystoscopic en Bloc Excision of the Distal Ureter and Bladder Cuff,
Arthur E Fetzer MD
Laparoscopic Donor Nephrectomy: a Review of the Last 220 Cases, Christopher Ip MD
Pediatric Laparoscopic Pyeloplasty, Po N Lam MD
Percutaneous Cystolithotomy of Large Urinary Diversion Calculi Using a Combination of Laparoscopic and Endourologic Techniques, Po N. Lam MD
Video of Complications During Laparoscopic Nephrectomy and Adrenalectomy, Michael C Lipke MD
Open Adrenalectomy: Has Laparoscopy Made It Obsolete?, Michael C Lipke MD
Laparoscopic Donor Nephrectomy in the Presence of a Circumaortic Renal Vein, Gregory G Lovallo MD
Conversion From Open to Robotic-assisted Radical Prostatectomy is Associated With a Reduction of Positive Surgical Margins Amongst Private Practice Based Urologists, Ralph R Madeb MD
Tips and Tricks to Facilitate Renal Parenchymal Suturing During Laparoscopic Partial Nephrectomy, Elspeth M McDougall MD
Laparosopic Adrenalectomy for Benign And Malignant Adrenal Lesions Using a Novel Vessel-Sealing System: a Combined Experience, Ravi Munver MD
The Learning Curve for Robotic-assisted Laparoscopic Radical Prostatectomy: a Multiinstitutional Experience of Laparoscopic and Oncologic Trained Urologists, Ravi Munver MD
Robotic Radical Prostatectomy: Histopathologic and Short Term Biochemical Recurrence Data at One Year, Vipul R Patel MD
Laparoscopic Inguinal Hernia Repair During Laparoscopic Radical Prostatectomy, David M Rodin MD
Asymptomatic Unilateral Urolithiasis in Living Donor Transplant Kidneys, Chandru P Sundaram MD
Complications in 253 Laparoscopic Donor Nephrectomies, Chandru P Sundaram MD
Laparoscopic Management of Renal Cell Carcinoma With Complete Renal Vein Tumor Thrombus,
Raju Thomas MD
The Large Adrenal Tumor: Laparoscopic Adrenalectomy Technique, Raju Thomas MD
Laparoscopic Donor Nephrectomy in the Setting of Multiple Vessels or Anomalous Vasculature,
Ilya A Volfson MD
Effect of Vascular Clamping on Partial Nephrectomies, Melissa M Walls MD
High Power (80 W) Potassium-Titanyl-Phosphate (KTP) Laser Photoselective Vaporization Prostatectomy (PVP) for Large Volume Benign Prostatic Hyperplasia (BPH), Carson Wong MD
High Power (80 W) Potassium-Titanyl-Phosphate (KTP) Laser Photoselective Vaporization Prostatectomy (PVP) for Refractory Urinary Retention Secondary to Benign Prostatic Hyperplasia (BPH), Carson Wong MD
MULTISPECIALTY
Intravesical Jump Start Therapy Using a Therapeutic Cocktail for the Treatment of Interstitial Cystitis, Jeffrey R Dell MD
Short-Term Impact of a Laparoscopic Mini-Residency Experience on Postgraduate Urologists Practice Patterns, Elspeth M McDougall MD
Construct Validity Testing of the Lapmentor™ Laparoscopic Surgical Simulator,
Elspeth M McDougall MD
Developing a Laparoscopic Skills Curriculum Using Virtual Reality Simulation, Kurt E Roberts MD
Minilaparoscopy-assisted Natural Orifice Surgery, Daniel A Tsin MD
Laparoscopic Pelvic Lymph Node Dissection and Radical Prostatectomy by a Transperitoneal or an Extraperitoneal Method: Impact of Different Types of Previous Inguinal Hernia Repair,
Ramakrishna Venkatesh MD
GENERAL INFORMATION
CONGRESS FEES
Registration Deadline: August 23, 2006
SLS physician members register online by July 6, 2006 and save $100
Congress $595
Also includes admission to exhibit hall, welcome reception, 1 ticket to breakfast with keynote speaker, and future technology session
Master’s Classes
1 half-day class $195
2 half-day classes $295
1 full-day class $295
SCHOLARSHIPS TO ANNUAL MEETING
Residents, Fellows-in-Training, Nurses, and Affiliated Medical Personnel are eligible for a $300 scholarship towards the full Congress Registration fee. Application deadline: May 5, 2006.
ACCREDITATION
The Society of Laparoendoscopic Surgeons (SLS) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
DESIGNATION
The SLS designates this educational activity for a maximum of 26 category 1 credits toward the AMA Physician’s Recognition Award(TM). Each physician should claim only those credits that he/she actually spent in the activity.
Half-Day Master’s Classes: 3 credits
Full-Day Master’s Classes: 6 credits
15th International Congress: 3 days: 20 credits
DESTINATION: BOSTON, MASSACHUSETTS
Boston is one of America’s oldest cities and is home to some of the world’s finest inpatient hospitals, many institutions of higher education, and numerous cultural and professional sports organizations. Tourism is one of Boston's and New England's largest industries, and as a result you will find that Boston is a city willing to accommodate and entertain you as few other cities can.
For more information on tours, sites, shopping, and everything Boston, visit http://boston.com/travel/boston/.
ACCOMMODATIONS AND TRAVEL
The Westin Copley Place
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EXHIBIT HALL EVENTS
WELCOME RECEPTION: Kick off the congress at an informal reception open to all registrants in the Exhibit Hall. Meet old and new friends, and get a preliminary look at the technical exhibits.
Old friends, Paul Alan Wetter and Liselotte Mettler,
meet new technology at Endo Expo 2005
SLS CYBER CAFE: While away, stay in touch. Check your E-mail, surf the Net, participate in an educational program, or go wireless at the SLS WiFi station. Educational programs will be scheduled throughout the day.
SLS INNOVATIONS OF THE YEAR: Come see what and how many innovative
devices have been developed over the past year. The SLS Innovations of
the Year will be recognized at the 15th International Congress and Endo
Expo 2006. It is not necessary for a company to exhibit or advertise to
be eligible for this recognition. SLS encourages all commercial
entities to enter their most innovative product for consideration.
Contact SLS for details: Tel 305.665.9959, Toll free 1.800.446.2659,
Fax 305.667.4123, Conferences@SLS.org
NEW PRODUCT PRESENTATIONS BY EXHIBITORS: SLS invites all exhibitors to
share information about new products, technology, and developments
during the New Product Presentation Session. Exhibitors who submit new
product information will be allowed a one-minute presentation during
the mid-day break, Friday, September 8, 2006. Note: each exhibitor will
be allowed to present only one product that must have been developed
within the past year. Contact SLS for details:
Tel 305.665.9959, Toll
free 1.800.446.2659, Fax 305.667.4123, Conferences@SLS.org
TOP GUN: It’s High Noon—Are You Ready for a Shoot Out? It doesn’t matter whether you’re right-handed or left-handed. In this shoot out, you use your nondominant hand. See who’s fastest on the draw—or stitch—in this entertaining, but challenging, training exercise in minimally invasive surgical procedures. Congratulations to last year’s winner, Roderick Brown, MD. See if you will take home the trophy this year and be named the “fastest draw” in SLS’ 2006 Top Gun Laparoscopy Shoot Out!
Top Gun host, James C. Rosser, Jr., and
the 2005 Top Gun winners
15TH SLS ANNUAL MEETING AND ENDO EXPO 2006 SCIENTIFIC ABSTRACTS
Supplement to
JSLS, JOURNAL OF THE SOCIETY OF LAPAROENDOSCOPIC SURGEONS
VOLUME 10, NUMBER 3
6101 General Surgery
Laparoscopic Fundoplication: the Beneficial Effects of Preservation of Short Gastric Vessels
M. Z. Aslam, MBBS, D. Garkuwa, FRCS, S. Johnson, MRCS, R. Rajagopal, FRCS, K. S. Wynne, FRCS
South Shields General Hospital
Introduction: In the operative treatment of gastroesophageal reflux disease, division or preservation of short gastric vessels has always remained a subject of controversy. This randomized study was performed to determine whether the preservation of short gastric vessels during laparoscopic fundoplication achieves an acceptably low incidence of postoperative complications while at the same time providing adequate control of reflux, and conferring long-term clinical benefit to the patient.
Methods: From January 2000 to January 2003, 73 patients (M: 36, F: 37; mean age, 44 years) with proven gastroesophageal reflux disease underwent laparoscopic fundoplication with preservation of short gastric vessels. Patients with esophageal motility disorder, with concurrent abdominal surgery or with a previous reflux surgery were excluded from the study. Clinical assessment was performed using a standardized clinical grading system to assess dysphagia, heartburn, bloating, and epigastric pain at 1, 6, and 12 months postoperatively.
Results: Average operating time was 45 minutes to 60 minutes, no open conversion was needed, and the average hospital stay was 36 hours. Postoperatively, the incidence of heartburn was 7% (5 patients) at 1 month and 1 year. The incidence of postoperative dysphagia and gas bloating was 27% (20) and 10% (7), respectively, at 1 month, which dropped down to 7% (5) and 1.4% (1), respectively, at 1 year. The overall patient satisfaction rate was 90% (65).
Conclusion: Preservation of short gastric vessels brings good results without an increase in dysphagia. The added benefits are reduced bloating, operating time, morbidity, and consequently hospital stay.
6102 Gynecology
Pathophysiology of Peritoneal Tissue Acidosis During Laparoscopic Surgery
O. A. Mynbaev, L. Dollé, S. Pismensky, C. A. Jacobi, B. Vanacker, M. Bracke
VUB, Belgium
Introduction: Parietal peritoneum (PP) acidosis during laparoscopy is a well-established phenomenon and a poorly understood mechanism. Our aim was to study the mechanism of PP acidosis during CO2 pneumoperitoneum.
Methods: “Because venous CO2 tension is considered representative of tissue PCO2.,” we monitored arterial and venous blood gas and acid-base and metabolite-lactate parameters during CO2 pneumoperitoneum in 10 anesthetized-ventilated rabbits (AVR) with increasing intraperitoneal pressure (IPP: 0, 5, 10, 15mm Hg) every 15 minutes. Blood flow was monitored in the abdominal aorta in 5 animals and in the inferior vena cava in another 5. Baseline parameters were obtained from 6 AVR.
Results: We found high pronounced PvCO2 and PaCO2 with corresponding decreased pH and increased lactate concentrations in both venous and arterial blood. Overall acid-base parameter changes were related to CO2 accumulation. Abdominal aorta and inferior vena cava blood flow were significantly affected.
Conclusions: The suggested mechanism of PP tissue acidosis during CO2 pneumoperitoneum is the considerably high mesothelial surface CO2 tension with subsequent CO2 saturation underlying PP tissue due to continuous CO2 insufflation. CO2 passes through PP and accumulates in venous and arterial blood due to increased tissue-to-venous and venous-to-arterial CO2 tension differences. PP acidosis severity directly depends on CO2 insufflation and its absorption, whereas the severity of blood gas and blood flow disturbances is related to the degree of IPP. Increased lactate concentrations and high tissue acidosis in hypoxic PP tissue can be the suitable microenvironment for rapid invasion and metastasis of transplanted cancer cells into the basal membrane after removing malignant tumors from the abdominal cavity via laparoscopy.
6103 Gynecology
Congenital Diaphragmatic Falciform Ligament Herniation: A Rare Case
D. G. Kolder, MD, W. S. Eubanks, MD
University of Missouri Hospitals and Clinics
The occurrence of diaphragmatic herniation involving only the falciform ligament is rare. In the era of minimally invasive surgery, herniation through the falciform ligament from multiple causes has been described. Several types of congenital and acquired hernias of the diaphragm have been well-defined. Anterior congenital hernias of the diaphragm (hernia of Morgagni) are rare and when detected, rarely contain liver or the falciform ligament. We present an unusual case of congenital herniation of the diaphragm containing the falciform ligament. The asymptomatic finding was discovered at laparoscopy, a finding not yet described in the literature.
6104 General Surgery
Randomized Clinical Trial of Three-Port Versus Standard Four-Port Laparoscopic Cholecystectomy
Manoj Kumar, MD, Akshay Pratap, MD, C. S. Agrawal, MD
B. P. Koirala Institute of Health Sciences, Dharan, Nepal
Introduction: Laparoscopic cholecystectomy (LC) for gallstone disease is widely accepted as a standard procedure performed using 4 trocars. The fourth (lateral) trocar is used to grasp the fundus of the gallbladder so as to expose Calot's triangle. It has been argued that the fourth trocar may not be necessary in most cases and that LC can be done safely with only 3 ports. The aim of this study was to investigate the technical feasibility, safety, and benefit of 3-port laparoscopic cholecystectomy versus standard 4-port laparoscopic cholecystectomy in our set up.
Methods: Between September 2004 and January 2005, 70 consecutive patients undergoing elective laparoscopic cholecystectomy for gallstone disease were randomized to be treated via either the 3-port or 4-port technique. Postoperative pain was assessed by using a 10-cm unscaled visual analogue score at the first, sixth, twelfth, and twenty-fourth hours after surgery.
Results: Demographic data were comparable in both groups. No difference was noted in the 2 groups regarding age, sex, weight, and ethnicity. In terms of outcome, no difference existed in success rate, quantity of oral analgesic (diclofenac sodium) requirement, or postoperative hospital stay. Overall pain score and patient satisfaction score were slightly better in the 3-port group. Patients in the 3-port group had shorter mean operative time (42.4 min vs. 64.3 min) than the 4-port group had.
Conclusion: The 3-port technique is as safe as the standard 4-port technique. The main advantages of the 3-port technique are that it causes less pain, is less expensive, and leaves fewer scars.
6106 General Surgery
Histology Examination of the Gallbladder in the Laparoscopic Era: Is it Justified?
Sajid Mahmud, MD, Il Alam, I. Alhamdani
Morriston Hospital, Swansea
Introduction: Gallbladder carcinoma (GBCa) is a rare malignancy that has a very poor prognosis. Laparoscopic cholecystectomy (LC) is the gold standard treatment for symptomatic gallstones. The aim of our study was to assess the incidence of GBCa and the possibility of reducing the routine histological examination of gallbladder specimens.
Method: Pathology laboratory data of gallbladder specimens over a 5-year period (June 2000 through July 2005) were analyzed retrospectively. The case notes were retrieved in all cases of malignancies.
Results: This study comprised 1452 specimen. Four (0.27%) cases of primary GBCa, 1 of primary B-cell lymphoma, 1 of secondary carcinoma, and 1 of intraepithelial neoplasia were detected. Operative notes revealed that a high index existed of suspicion of malignancy in all cases. Of the 4 primary GBCa, 3 were stage T2 and 1 was T4. Preoperative ultrasound suspected carcinoma in only 1 case but a thickened gallbladder wall was noted in all cases.
Conclusion: All cases of GBCa were suspected preoperatively or intraoperatively. Histological examination did not alter the management or outcome in any of the cases. We suggest that selectively sending specimens for histopathological examination would result in reduced demands on the histopathology department without compromising patient safety.
6107 General Surgery
Videothoracoscopic Neurophrenicotomy
Igor Polianskyi, Prof Dr Med, Yaroslav Dupeshko, MD, Vyacheslav Sakhatskyy, MD
Bukovinian State Medical Academy Chernivtsy
Introduction: Videolaparoscopic neurophrenicotomy is used to perform denervation of the diaphragm. The operation is indicated where denervation of the diaphragm is necessary to liquidate the residual cavity after pulmonectomy in cases of involuntary contractions of the diaphragm and in other cases. Morphological studies carried out on adult corpses revealed that phrenic nerves are situated on the surface of the pericardium and associated intimately with a. pericardiacophrenica and v. pericardiacophrenica. This structure reaches the diaphragm through the pericardiophrenicum positioning itself between the ligament’s leaves.
Methods: Based on the discovered patterns of topographic interrelations, we propose a small invasive neurophrenicotomy technique. With the patient in the supine position, the first trocar is inserted into the pleural cavity through the VII to VIII intercoastal spaces on the midauxiliary line. Through this port, a video camera is inserted. The lungs are collapsed by carbon dioxide insufflation. The second trocar is inserted through the IV intercoastal space on the anterior auxiliary line. The pericardiophrenicum ligament is mobilized between the pericardium and diaphragm by using the dissector. The ligament is cut between 2 applied clips. Relaxation of the diaphragm and the absence of its contraction after irritation of the phrenic nerve distal to the severance of the ligament can be used to prove adequate dissection of the phrenic nerve.
Results: The operation ended with pleural cavity drainage through one of the trocars.
Conclusion: The method proposed has been used in the clinical setting with favorable results.
6108 Urology
Conversion from Open to Robotic-Assisted Radical Prostatectomy Is Associated with a Reduction in Positive Surgical Margins Among Private Practice-Based Urologists
Ralph Madeb, Dragan Golijanin, Craig Nicholson, Joy Knopf, Kelly Picone, Frederick Tonetti, John R. Valvo, Louis Eichel
Center of Urology and University of Rochester School of Medicine, Rochester, New York
Introduction: Several recent studies have suggested that leaders in robotic surgery have decreased their own positive margin rates by switching from open to robot-assisted radical prostatectomy. Theoretically, this improvement is largely attributed to enhanced visualization of the deep pelvis and precision of dissection afforded by the instrumentation. To date, it has not been determined whether this phenomenon exists among nonfellowship-trained urologists in private practice. Herein, we describe the positive margin rates of 2 nonfellowship-trained private practice urologists who converted from open radical retropubic prostatectomy to robot-assisted laparoscopic radical prostatectomy.
Methods: The margin positivity data from 2 nonfellowship-trained, private practice urologists (surgeon 1 and surgeon 2) were reviewed retrospectively. The last 50 cases of open radical retropubic prostatectomy from each surgeon were compared with the first 50 and 43 robotic prostatectomy cases of surgeons 1 and 2, respectively. A positive surgical margin was defined as a tumor present at the inked margin of the prostate.
Results: A significant decrease occurred in the overall and pT2 positive margin rates for both surgeons. The overall positive margin rate and pT2 positive margin rate for surgeon 1 dropped from 44% to 20% and from 37% to 5.7%, respectively, after changing from open to robotic prostatectomy. For surgeon 2, the overall positive margin rate changed from 26% to 16% and the pT2 positive margin rate changed from 27.5% to 8% after converting.
Conclusion: Changing from open to robotic-assisted radical prostatectomy may improve the ability of urologists to obtain negative surgical margins. This phenomenon does seem to apply to nonfellowship-trained urologists in private practice and can be realized within the first 50 cases performed.
6109 General Surgery
Role of Subfascial Endoscopic Perforator Surgery (SEPS) by Harmonic Scalpel in the Management of Chronic Venous Insufficiency of the Lower Limbs
P. N. Agarwal, Ravi Kant, Sudhir K. Jain
Maulana Azad Medical College, University of New Delhi, New Delhi, India
Introduction: Thirty patients suffering from chronic venous insufficiency of the lower limbs were selected for this study. Disease in all patients was classified as class 3 through class 5 according to CEAPS classification. Ten patients had only skin changes, 8 had skin changes plus healed venous ulcers, and 12 had active venous ulcers.
Methods: Color Doppler was used in all patients to evaluate the venous system of both lower limbs to look for perforators and incompetence of the sapheno-femoral of sapheno-popliteal junction. All patients underwent subfascial endoscopic perforator surgery (SEPS) with the 2-port technique. A Harmonic scalpel was used to manage the perforators. SEPS was combined with flush ligation of sapheno-femoral junction and stripping of the long saphenous vein up to the knee joint. Patients were followed up in the surgical clinic on a monthly basis for 12 months. At 1-month follow-up, a repeat color Doppler study of the lower limb veins was performed to look for any residual perforators. In the follow-up, patients were monitored for healing of ulcers and reversal of skin changes. A note was also made of cosmetic outcome and return to activity.
Results: Ulcers have healed in all the patients, cosmetic results were good, and return to normal activity was early. No patient has experienced a recurrence. One patient developed wound infection and was managed with appropriate antibiotics. Early discharge of patients from the hospital was possible in all cases.
Conclusion: Our results are very encouraging. SEPS as a procedure of choice for the management of chronic venous disease of the lower limbs may have an appropriate role in the surgeon’s armamentarium.
6110 General Surgery
Combined Surgical and Endoscopic Rescue of Severe Sepsis After Bariatric Surgery
Gianluca Bonanomi, MD, Mario Traina, MD, Ilaria Tarantino, MD, Simona Di Caro, MD, Bruno Gridelli, MD
Minimally Invasive and Bariatric Surgery Program, Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
Introduction: Gastric fistula is a serious complication of vertical banded gastroplasty. Failure to control the leakage and development of sepsis can lead to prolonged hospitalization and mortality.
Methods: A 32-year-old morbidly obese male was transferred to our intensive care unit with a clinical picture of severe sepsis following open vertical banded gastroplasty that was performed at another institution. The patient underwent 2 surgical attempts at fistula closure that were unsuccessful. On admission, the patient was critically ill, mechanically ventilated through a tracheostomy, and the abdominal laparotomy was completely dehiscent.
Results: Emergent abdominal CT scan with gastrographin showed the presence of high output gastric fistula at the angle of His and diffuse peritoneal collection. The patient underwent combined surgical placement of peritoneal drains and intraoperative endoscopic injection of cyanoacrylate glue and placement of a self-expanding covered stent over the fistula. The patient recovered from sepsis and was discharged home in fair clinical condition. At 1-year follow-up, the patient was stable, and an upper endoscopy was negative for stenosis or ulceration.
Conclusion: Combined surgical and endoscopic management of high output leakage following vertical banded gastroplasty may be a successful option to rescue patients with life-threatening sepsis.
6112 General Surgery
Role of Diagnostic Laparoscopy in Penetrating Abdominal Stab Wounds
Albeir Mousa, MD
Brookdale University Hospital and Medical Center
Introduction: The role of diagnostic laparoscopy (DL) in abdominal stab wounds (ASW) is not well characterized. This study was to define the role of DL in minimizing the number of exploratory laparotomies (EL).
Methods: Our trauma registry and operative log were used to identify patients with penetrating stab wound injuries to the anterior abdominal wall, who underwent laparoscopy with or without laparotomy during the past 36 months. Patient demographics, operative findings, complications, and length of stay were reviewed. The number of laparoscopic explorations, and therapeutic, nontherapeutic, and negative laparotomies were analyzed.
Results: There were 66 DL performed for ASW. Among those, only 37 were converted to EL. Peritoneal violations (PV) were present in 41 patients, and 30 of 37 (81%) EL were therapeutic laparotomies (TL). By using DL, 25 (38%) EL were prevented. Four patients had peritoneal violations on DL but did not undergo exploratory laparotomy. Seven of the 37 (19%) patients who underwent initial EL had a nontherapeutic laparotomy (NTL). All patients who underwent only DL were discharged within 36 hours, while patients who had NTL were discharged within 72 hours. No mortality and morbidity occurred within the DL group. Mean follow-up was 13 months, and no associated complications were encountered during this time.
Conclusions: Laparoscopy has an important diagnostic role in stable patients with penetrating abdominal trauma. It minimizes the number of negative exploratory laparotomies performed. In carefully selected patients, therapeutic laparoscopy is practical, feasible, and offers all the advantages of minimally invasive surgery. Evidence of PV is a reasonable indicator to determine the need for exploratory laparotomy and reduce nontherapeutic laparotomy.
6113 Gynecology
Embryoscopy in Recurrent Pregnancy Loss
H. J. A. Carp, MB, BS, FRCOG
Department of Obstetrics & Gynecology; Sheba Medical Center, Tel Hashomer, Tel Aviv University, Israel
Recurrent miscarriage can be due to maternal or embryonic causes. Maternal causes have been widely researched, but the treatment of maternal causes has been confounded by abnormal embryos that have not been diagnosed. Fetal causes of pregnancy loss include structural anomalies that are incompatible with life and chromosomal aberrations. The diagnosis of both of these is problematic at present. Eighty-nine percent of recurrent miscarriages occur in the first trimester, when the embryo is too small to be diagnosed as normal or abnormal on ultrasound. Phillip and Kalousek have reported that 31% of missed abortions are "disorganized," ie, structurally abnormal on embryoscopy. Embryonic karyotyping is problematic due to the overgrowth of maternal tissue, infection of the preparation, and culture failure. Ferro et al have used embryoscopy to take a directed sample from the embryo, thereby avoiding contamination by maternal tissue. A pilot study on embryoscopy is being carried out at the Sheba Medical Center to accurately diagnose structural anomalies (disorganized embryos) and to take an accurate biopsy of embryonic tissue for karyotyping. After confirmation of a missed abortion by ultrasound, embryoscopy is performed with the patient under general anesthesia during dilatation and curettage. The embryo is visualized, the findings are recorded, and biopsies are taken from the embryo and placental villi for genetic analysis. The importance of accurate diagnosis in recurrent miscarriage cannot be overstressed. Until now, the various treatments for maternal causes of pregnancy loss (immunotherapy, thromboprophylaxis, hormone support, and others) and for fetal causes (PGD) have been assessed on an empirical basis. Embryoscopy allows these treatment modalities to be assessed rationally in an evidence-based approach when an accurate diagnosis of cause is available.
6114 General Surgery
Laparoscopic Retrieval of a Large Retained Fecalith after Laparoscopic Appendectomy
Bryan S. Helsel, MD, Christopher H. Moon, MD, Richard K. Inae, MD, Ian H. Freeman, MD
Department of Surgery, Tripler Army Medical Center, Tripler, Hawaii
Introduction: Retained fecaliths after an appendectomy is a rare event. Due to the associated high rate of abscess formation, most authorities recommend removal. Difficulty locating a lost fecalith may necessitate open conversion of a laparoscopic procedure.
Methods: We report the case of a 25-year-old male who underwent laparoscopic appendectomy for a gangrenous, perforated appendix. He was found to have a large fecalith, 12x10mm in size. During the procedure, it was lost. Despite a detailed and careful exploration, we were unable to find and extract the fecalith. Postoperatively, the patient developed an ileus. Radiographic studies were performed of adjacent tissue. On postoperative day 4, an exploratory laparoscopy was performed. Trocars were inserted to localize the fecalith, which included a 10-mm infraumbilical port, a 5-mm left lower quadrant port, and a 5-mm right lower quadrant port. This showed it to be in the pelvis with an associated thickened site. Using the radiographic studies as a guide, the fecalith was located and extracted with endograspers and an endocatch bag.
Results: The patient subsequently improved and was discharged 5 days later without further incident.
Conclusion: We conclude that laparoscopic retrieval following radiographic localization of a retained fecalith is a viable alternative to immediate open conversion.The views expressed in this abstract are those of the authors and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.
6115 General Surgery
Laparoscopic Versus Open Appendectomy in Perforated Appendicitis
Fukami Yasuyuki, MD, Hasegawa Hiroshi, MD, Sakamoto Eiji, MD,Komatsu Shunichiro, MD,
Hiromaysu Takashi, MD
Department of Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
Introduction: The purpose of this clinical study was to evaluate the efficacy of
laparoscopic appendectomy in patients with perforated appendicitis.
Methods: Between January 1999 and December 2004, 73 consecutive patients underwent appendectomy for perforated appendicitis. Thirty-nine underwent open appendectomy (OA) during the first 3 years (between January 1999 and December 2001), 34 underwent laparoscopic appendectomy (LA) during the last 3 years (between January 2002 and December 2004). Laparoscopic appendectomy was performed using a 3-trocar technique and the endoscopic stapler.
Results: No case needed to be converted to OA from LA. No statistically significant difference in the operative time in minutes was found between the LA (97.9±30.6) and OA (92.0±31.4). LA required less analgesic useÅ@(LA, 2.7 times; OA, 8.3 times; P<0.001), and oral intake was resumed earlier (LA, 2.6 days; OA, 5.1 days; P<0.05). Postoperative stay was shorter in LA (LA, 11.7 days; OA, 25.8 days; P<0.001). Postoperative wound infection was less frequent in LA (LA, 8.8%; OA, 43.6%; P=0.0022).
Conclusions: Laparoscopic appendectomy for perforated appendicitis has significant advantages over open appendectomy with respect to frequency of analgesic use, start of oral feeding, postoperative stay, and postoperative wound infection.
6115 General Surgery
Laparoscopic Versus Open Appendectomy in Perforated Appendicitis
Fukami Yasuyuki, MD, Hasegawa Hiroshi, MD, Sakamoto Eiji, MD,
Komatsu Shunichiro, MD, Hiromaysu Takashi, MD
Department of Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
Introduction: The purpose of this clinical study was to evaluate the efficacy of
laparoscopic appendectomy in patients with perforated appendicitis.
Methods: Between January 1999 and December 2004, 73 consecutive patients underwent appendectomy for perforated appendicitis. Thirty-nine underwent open appendectomy (OA) during the first 3 years (between January 1999 and December 2001), 34 underwent laparoscopic appendectomy (LA) during the last 3 years (between January 2002 and December 2004). Laparoscopic appendectomy was performed using a 3-trocar technique and the endoscopic stapler.
Results: No case needed to be converted to OA from LA. No statistically significant difference in the operative time in minutes was found between the LA (97.9±30.6) and OA (92.0±31.4). LA required less analgesic useÅ@(LA, 2.7 times; OA, 8.3 times; P<0.001), and oral intake was resumed earlier (LA, 2.6 days; OA, 5.1 days; P<0.05). Postoperative stay was shorter in LA (LA, 11.7 days; OA, 25.8 days; P<0.001). Postoperative wound infection was less frequent in LA (LA, 8.8%; OA, 43.6%; P=0.0022).
Conclusions: Laparoscopic appendectomy for perforated appendicitis has significant advantages over open appendectomy with respect to frequency of analgesic use, start of oral feeding, postoperative stay, and postoperative wound infection.
6116 Gynecology
Reactionary Hemorrhage in Gynecological Surgery
Mark Erian, FRCOG, FRANZCOG, Glenda McLaren, FRCOG, FRANZCOG
Royal Brisbane Women’s Hospital
Introduction: To assess the incidence of reactionary hemorrhage in contemporary gynecological surgery, vaginal hysterectomy, and laparoscopic hysterectomy. This is a retrospective audit in a major teaching tertiary referral center.
Methods: There were 424 vaginal and 211 laparoscopic hysterectomies performed. The number of patients returning to the operating theater within 24 hours following the initial surgery was recorded. Immediate resuscitation was achieved followed by exploration laparoscopy, laparotomy, or both of these. Complete homeostasis must be accomplished before closure of the wound(s).
Results: Each group included 3 patients. The incidence was 0.7% in the vaginal hysterectomy group and 1.42% in the laparoscopic hysterectomy group. No association was noted between the incidence of reactionary hemorrhage and the patient’s BMI, uterine size, or pathology, eg, fibroid, adenomyosis; however, 4 of the 6 patients (2 in each group) had extensive pelvic adhesions attached to the uterus. The mean duration of laparoscopic procedures was 52 minutes (range, 29 to 75). The mean duration of laparotomy procedures was 28 minutes (range, 25 to 80). On average, in-patient hospital stay was prolonged by 1.5 days following laparoscopic management and 3 days in the laparotomy group. The average estimated blood loss was 2.5 liters (range, 2 to 3), as per the combined assessment of the gynecological and anesthetic teams. Following blood transfusion, all patients were started on “double” oral iron tablets, and the hemoglobin level was more than 80g/L before discharge.
Conclusion: Despite meticulous surgical technique, one would expect a very small proportion of patients to suffer from reactionary hemorrhage in contemporary gynecological surgery. Timely intervention is vital.
6117 Gynecology
Minilaparoscopy Assisted Natural Orifice Surgery
Daniel A. Tsin, MD
The Mount Sinai School of Medicine
Introduction: Interest has revived in peritoneoscopy via natural orifice surgery. Several of the limitations of this type of surgery could be solved with the minilaparoscopy assisted natural orifice surgery (MANOS) approach. We are using MANOS in operative culdoscopy.
Methods: The technique of culdolaparoscopy entails the use of minilaparoscopy limited to 3-mm abdominal ports, together with a 12-mm or larger natural orifice site, in this case, a vaginal port. The entrance from the natural orifice site into the peritoneal cavity is visualized and aided with minilaparoscopy. These ports are multifunctional. The natural orifice and the abdominal sites are used for insufflations, visual purposes, and introduction of operative instruments. The natural orifice port is also used for specimen extraction. We have used this technique in appendectomies, cholecystectomies, myomectomies, oophorectomies, and salpingoophorectomies.
Results: We have used this procedure in 100 cases. In this series, we had only one case of postoperative fever after an ovarian cystectomy, which was diagnosed as drug-related fever.
6118 General Surgery
Role and Value of the Predictive Factors of Common Biliary Duct Lithiasis
in Preparation for Laparoscopic Cholecystectomy: Retrospective Study
Vincenzo Neri, MD, Antonio Ambrosi, MD, Tiziano Pio Valentino, MD
University of Foggia
Introduction: The aim of this study was to evaluate the clinical-instrumental predictive
factors of common biliary duct stones (CBDS). Their presence is an indication for endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy (ERCP/ES) before the laparoscopic cholecystectomy (LC).
Methods: From 1997 through 2005, 102 ERCP/ES were performed; 76 patients were examined from 1999 to 2005. Patients with acute biliary pancreatitis (48) were excluded because, in our opinion, in these cases, the ERCP/ES has a therapeutic role, regardless of the suspicion of CBDS. We present a retrospective study of 28 ERCP/ES before the LC with the suspicion of CBDS. The clinical, instrumental, and bio-humoral data were analyzed by univariate and multivariate statistical studies.
Results: The univariate analysis identified alkaline phosphatase (P<0.0001), gamma-gt
(P<0.0001), direct bilirubin (P<0.0001), and CBD dilatation on abdominal ultrasonography (USG) (P<0.0001) as predictors of CBDS. A multivariate analysis subsequently identified alkaline phosphatase (P<0.0001), gamma-gt (P<0.0001), and direct bilirubin (P<0.0001) as independent predictive factors of CBDS; on the contrary,dilatation of the CBD (P=0.0759) was not statistically significant.
Conclusion: The dilatation of the CBD, alone, is not statistically significant.
The concordance of cholestasis factors with the dilatation of the CBD is
statistically significant for the diagnosis of CBDS, and it indicates the need for ERCP/ES before LC; however, the ERCP/ES, as an invasive procedure, cannot be performed before LC, if only the dilatation of the CBD is present, and an increase in cholestasis factors is absent.
6119 General Surgery
Assessing Decision Making in Laparoscopic Surgery
Sudip K. Sarker, MD, PhD, Saif Rheman, Avril Chang
Academic Surgery, Royal Free Hospital, Imperial College London, UK
Introduction: Making correct decisions is pivotal in the delivery of safe, effective, surgical healthcare, as well as being an integral part of surgical competency and excellence. To date, no attempt has been made to assess how and why surgeons make decisions while operating. In the present study, we aimed to develop and validate an operative decision-making tool in laparoscopic surgery.
Methods: Three decision-making modules were developed on a desktop computer program for laparoscopic cholecystectomy: knowledge, technical skill, and dynamics. The modules were based on didactic knowledge, technical skill, and intraoperative dynamic decision making. The last 2 modules were based on answering questions watching recorded live operations. The questions were devised by 2 experienced surgeons with >14 years postgraduate surgical experience. Three groups with varying degrees of surgical experience were assessed: novice (medical students), intermediate (junior surgeons), and expert (senior surgeons). These groups were determined by the number of laparoscopic cholecystectomies performed and the number of years of operative surgical experience.
Results: Thirty-five subjects were assessed: 15 novices, 12 intermediates, and 8 experts. Mean time to perform the program was 32 minutes (range, 21 to 45). Construct validity between the individual groups using the Mann-Whitney test was significant, P<0.05.
Conclusions: Our computer-based decision-making assessment tool in laparoscopic surgery seems to have face, content, concurrent, and construct validities. Surgical decision making is a multifaceted process; by assessing how and why decisions are made effectively, focused surgical training may be achieved.
6120 General Surgery
Preoperative Upper Endoscopy is Useful Prior to Revisional Bariatric Surgery
Benjamin Clapp, MD, Sherman Yu, MD, Trey Sands, MD, Erik Wilson, MD,Terry Scarborough, MD
Introduction: We hypothesized that patients who have previously had bariatric surgery and are undergoing revision to laparoscopic Roux-en-y gastric bypass would have abnormal findings detected by upper endoscopy that could potentially influence patient management. The procedures being revised included vertical banded gastroplasties, laparoscopic adjustable gastric bands, nonadjustable gastric bands, and previous Roux-n-y gastric bypasses (open and laparoscopic).
Methods: We conducted a retrospective chart review of patients who previously had undergone one of the above mentioned bariatric surgeries. We preoperatively performed an upper endoscopy on all patients. The endoscopy reports were reviewed and the findings entered into a database.
Results: Eighty-five percent of 55 patients needing revisional bariatric surgery had an abnormal upper endoscopy. Eleven percent had a gastrogastric fistula. Gastritis and esophagitis were noted in 65% and 37%, respectively. Eleven percent of patients had band erosion, 2 from a nonadjustable band, and 5 from vertical banded gastroplasties. Sixty-five percent of our patients required medical treatment based on our findings.
Conclusions: Preoperative upper endoscopy provides valuable information prior to
revisional laparoscopic bariatric surgery. In addition to identifying patients that need preoperative medications, the preoperative upper endoscopy also provided valuable information regarding pouch size and anatomy. Preoperative upper endoscopy should be performed by the operating surgeon on every patient undergoing revisional bariatric surgery.
6121 Gynecology
Ectopic Pregnancy
M. Sadok, MD, F. Haiba, MD, H. Ouzaa, MD
Hopital Militaire d’Oran-service Maternité
Introduction: Ectopic pregnancy is the development of fertilized ovum outside the uterine cavity. The frequency of ectopic pregnancy compared with the frequency of intrauterine pregnancy has been estimated to be between 1% and 3%. But the incidence is on the rise. We sought to determine the number of ectopic pregnancies managed at the Military Hospital of Oran over a 6-year period.
Methods: From January 2000 to December 2005, a study was conducted of ectopic pregnancies at the Military Hospital of Oran. We reviewed and analyzed the incidence, presentation on admission, and history of patients with ectopic pregnancy. The investigation included a pregnancy test, culdocentesis, transvaginal ultrasound, and laparoscopy.
Results: The total number of deliveries during the study period was 5000. The incidence of ectopic pregnancy was 1 in 100 normal intrauterine pregnancies.The 50 patients who had an ectopic pregnancy were included in the study.
Conclusion: The incidence of ectopic pregnancy at the Military Hospital of Oran over a 6-year period was 1 in 100 normal intrauterine pregnancies.
6122 General Surgery
Patient Recall and Comprehension after Laparoscopic Appendectomy
Benjamin Clapp, MD, Melba Jarmillo, BS, Luis Macias, MD, Valeria Vigil, MD,
Marcia Plett, PA-C, Cuatemoc Gallardo, MD, Andrew Kassir, MD
Introduction: The purpose of this study was to determine patient recall and comprehension after laparoscopic appendectomy in an underserved population.
Laparoscopic surgery can lead to diagnostic uncertainty secondary to poor recall and variable port placement.
Methods: After IRB approval, we identified a cohort of patients who underwent laparoscopic appendectomy from 2000 to 2004 at a single institution. We then attempted to contact the patients to conduct a 16-question telephone survey, which determined whether the patient spoke English or Spanish as a primary language, ethnicity, educational level, and questions about recall of perioperative events and diagnoses. If we could not reach the patient, we tried to call back on 3 different occasions.
Results: Between 2000 and 2004, 186 patients underwent laparoscopic appendectomy. Of these, 65% were Hispanic. We found that only 17% of these patients returned for a postoperative visit. Only 19.3% could be contacted by phone. Forty-seven percent of the patients contacted by phone spoke Spanish exclusively. Overall, 89% of patients contacted knew what operation they had and gave their correct diagnosis.
Conclusions: The low percentage of patients available to follow-up makes this study statistically insignificant. However, we believe that fact in itself is important. In Southwestern states, we see a large migrant population. This highlights the need to communicate effectively with patients at the time of laparoscopic surgery to avoid in the future the diagnostic uncertainty associated with laparoscopic incisions.
6123 General Surgery
K-ras Mutation as a Prognostic Factor in Colorectal Cancer Procedures: Laparoscopic vs. Laparotomic Approach
L. Sákra, MD, M. Sácha, MD, M. Rajman, MD
Surgical Department, General Hospital Pardubice, Czech Republic
Introduction: Colorectal carcinoma is a serious problem in the Czech Republic, and its incidence is on the rise. According to some statistical analyses, the Czech Republic has the highest incidence of colorectal carcinoma of developed countries worldwide. Therefore, it is advisable to incorporate new modalities into examination and therapeutic algorithms that will lead to early diagnosis or to a change in the existing therapeutic procedures.
Method: The main objective of this project was to identify K-ras mutations in colorectal tumors, to detect tumor cells with the K-ras mutation in the peripheral blood, to detect the K-ras mutation in liver metastases, and to verify the hypothesis claiming that tumors with the K-ras mutation have a worse prognosis and often metastasize, mainly to the liver. The outcomes of laparotomic versus laparoscopic procedures were analyzed.
Results: This project has been ongoing since June 2004. Seventy-five patients have met the defined parameters and have been included in the study to date.
Conclusion: The laparoscopic approach was monitored by the detection of the spread of tumor cells with K-ras mutation in the blood. This approach gives the same results as the results with laparotomic procedures.
6125 Gynecology
Complications from Hysterectomy
M. Sadok, MD, F. Haiba, MD, H. Ouzaa, MD
Department of Gynecology-Obstetrics, Oran Hôpital Militaire
Introduction: Hysterectomy is one of the most common major gynecological surgical procedures performed. Our objective was to determine the operative and postoperative complications of this procedure.
Methods: This study was conducted in the gynecology and obstetric service of Oran University Hospital Center from January 2000 to December 2005. Indications, complications, and mortality associated with hysterectomy were assessed.
Results: The number of hysterectomies performed in 6 years at our unit was 300. Major indications for hysterectomies were dysfunctional uterine bleeding (60%) and fibroid uterus, (35%) followed by prolapse (5%). Complications developed in 10% of these. The frequency of complications was related to the indication for hysterectomy, age, parity, and history of associated serious illness. It was found that the frequency of complications in fibroid uterus was higher (8%) than that for dysfunctional uterine bleeding (DUB) (2%). No operative deaths occurred.
Conclusion: We have a fairly high frequency of complications associated with hysterectomy. To reduce these complications, proper selection, preoperative preparation, and less invasive alternative treatment for the commonest indications of hysterectomy (ie, fibroids and DUB), for example various methods of endometrial ablation or resections, can be used.
6127 Gynecology
Moving Forward with Breast Endoscopy: From Diagnostic to Interventional Ductoscopy
Volker R. Jacobs, MD, PhD, MBA, Uta Euler, MD, PhD, Susanne Grunwald, MD, PhD,
Ralf Ohlinger, MD, PhD, Thorsten Fischer, MD, PhD, Marion Kiechle, MD, PhD,Stefan Paepke, MD, PhD
Frauenklinik (OB/GYN), Technical University, Munich, Germany Ernst-Moritz-Arndt-University, Greifswald, Germany
Introduction: Endoscopy of the breast, called ductoscopy, can give additional direct visual information about intraductal breast lesions that cannot be seen with conventional visual diagnostics like sonography, mammography, MRI, or galactography. After development and increasing application of diagnostic ductoscopy in Germany, research interest is shifting to interventional ductoscopy. We describe the evolution of interventional techniques and the use of newly developed devices for interventional ductoscopy.
Methods: In cooperation with PolyDiagnost, Pfaffenhofen, and Storz, Tuttlingen, all German, a variety of different instruments and techniques were developed and evaluated for clinical application. These were the vision-guided ductal lavage, a technique for acquisition of nipple aspirate fluid (NAF), vision-guided brush cytology of suspicious lesions with a 0.38-mm brush, removal of intraductal lesions with a 0.38-mm Titanium basket, a 0.8-mm vision-guided biopsy forceps, alternative visualization of breast ducts with addition of auto fluorescent light as well as use of 0.40-mm thin metal wires through the working channel for marking of intraductal findings or controlled retrieval of breast duct target lesions.
Results: The use of all miniature instruments is simple, safe, and effective. In our series, we have had no intra- or postoperative complications so far. Due to reusability of most instruments after appropriate sterilization according to instrument handling protocols, the instrument costs can be reduced in contrast to costs of disposable instruments. Interventional ductoscopy enhances diagnostic ductoscopy to a comprehensive and independent technique. Until establishment as a new standard, interventional ductoscopy remains experimental and should be further evaluated in multicenter trials for operative safety and equivalence to existing diagnostic and operative standards.
Conclusions: Interventional ductoscopy follows the principle of least minimal invasiveness and opens a variety of new options. With these new technical options, interventional ductoscopy seems to advance to become a potential one-stop screening method as well as a substitute for conventional procedures like ductectomy.
6128 Gynecology
A Comparative Study of Hysteroscopic Sterilization Performed In-office Versus a Hospital Operating Room
Mark Nichols, MD, James Carter, MD, Donald Fylstra, MD, and the Essure® System U.S. Post-Approval Study Group
Introduction: We compared hysteroscopic female sterilization procedures performed in-office versus a hospital operating room (OR) among newly trained physicians.
Methods: Subjects were a subset of a cohort enrolled in an FDA-mandated postapproval study. Both demographic and procedural differences between the groups were examined. For variables that were not normally distributed, the Mann Whitney-U statistic was used to determine whether significant differences existed. Normally distributed variables were evaluated by an independent samples t test or chi-square test, as appropriate.
Results: Inclusion criteria were met by 320 women enrolled in the study. In an OR, 252 procedures were performed, and 68 were performed in-office. No significant difference existed with regard to scope-in and scope-out time, with an average of 17 minutes in the OR and 15 minutes in-office. No significant difference existed in bilateral placement rates between the settings with a success rate of 88% in the OR and 91% in-office. The incidence of minor adverse events was comparable, with 2% of cases involving a minor adverse event in the OR and 1% in-office. Receipt of NSAIDs before the procedure was significantly related to successful bilateral placement. Among cases with successful bilateral placement, only 18% failed to receive NSAIDs before the procedure, whereas 33% of unsuccessful bilateral placements involved no NSAIDs (P=0.03).
Conclusion: No clear advantage exists to performing hysteroscopic sterilization in a hospital operating room. Hysteroscopic sterilization can be performed safely and efficiently in an office setting.
6129 General Surgery
Chronic Inguinal Pain After Laparoscopic Inguinal Hernia Repair: The Role of Tack and Mesh Removal
Jeffrey D. Sedlack, MD, Jonathan A. Laryea, MD
Department of Surgery, Waterbury Hospital, Waterbury, CT
Introduction: Chronic inguinal pain occurs as a postoperative complication in up to 8% of hernia repairs. Inguinal pain after laparoscopic hernia repair will typically resolve with time and conservative management. The question arises as to the treatment of patients with significant, ongoing pain that does not resolve over time.
Methods: Four patients have come under our care in the past year with severe, postoperative inguinodynia after TAPP laparoscopic inguinal hernia repairs with helical tack fixation of polypropylene mesh. All patients reported inguinal pain that continued despite maximal conservative therapy, including physical therapy, wound massage, ilioinguinal blocks, COX-2 inhibitors, and Neurontin. All patients were explored through transverse inguinal incisions. Implanted mesh and all tacks were identified and removed in all patients. Tack impingement of intramuscular segments of iliohypogastric nerves were identified in all cases. Neurolysis of the affected nerves was performed in all patients. In all of the patients, more than 10 fixation tacks were used, and tacks were placed lateral and superior to the inguinal ring.
Results: All patients experienced “significant” to “complete” permanent (>6 month) pain relief.
Conclusion: Removal of mesh and tacks and neurolysis of affected nerves is of benefit in the treatment of refractory inguinal pain after laparoscopic inguinal hernia repair. Further, there is likely a benefit in minimizing tack use and avoiding the superior and lateral quadrant of the inguinal floor to minimize the risk of injury to an intramuscular segment of the iliohypogastric nerve.
6130 General Surgery
The Impact of Routine Use of Preoperative ERCP in Gallstone Pancreatitis
Jonathan Laryea, MD, Jeffrey Sedlack, MD
Introduction: Despite over a decade of experience, the use of preoperative ERCP for the treatment of gallstone pancreatitis remains controversial. The purpose of this study is to determine whether preoperative ERCP is necessary in all patients with gallstone pancreatitis.
Methods: Charts of 30 patients admitted to Waterbury Hospital with a diagnosis of gallstone pancreatitis between 1998 and 2000 were reviewed for demographic data, length of stay, laboratory values (lipase, bilirubin, amylase, alkaline phosphatase levels), and results of radiographic studies. These patients were divided into 2 groups based on whether they underwent preoperative ERCP (n=20) or not (n=10). Differences between the groups in length of stay, complications, and laboratory data were analyzed with the Student t test and Fisher's exact text where appropriate (significance = P<0.05).
Resu
