Surgical endoscopy
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Comparative Study Controlled Clinical Trial
Transbronchial needle aspiration under direct endobronchial ultrasound guidance of PET-positive isolated mediastinal adenopathy in patients with previous malignancy.
The diagnostic accuracy of endobronchial ultrasound-guided transbronchial needle aspiration for the diagnosis of isolated mediastinal lymphadenopathy in patients with previous malignancy is not well defined. Positron emission tomography scanning has been proven to be a significant advance, but false-positive results are common. The purpose of this prospective and controlled study was to assess the yield of endobronchial ultrasound-guided transbronchial needle aspiration to reveal mediastinal lymph node metastases in patients with previous malignancy and possible mediastinal involvement on computed tomography and positron emission tomography. ⋯ Transbronchial needle aspiration under endobronchial ultrasound guidance is a valuable technique for cytological diagnosis of isolated mediastinal lymphadenopathy in patients with history of malignancy. Tissue sampling by invasive surgical procedures (mediastinoscopy or thoracoscopy) remains mandatory in case of inadequate or negative transbronchial needle aspiration cytology.
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Comparative Study
In situ measurement and modeling of biomechanical response of human cadaveric soft tissues for physics-based surgical simulation.
Development of a laparoscopic surgery simulator that delivers high-fidelity visual and haptic (force) feedback, based on the physical models of soft tissues, requires the use of empirical data on the mechanical behavior of intra-abdominal organs under the action of external forces. As experiments on live human patients present significant risks, the use of cadavers presents an alternative. We present techniques of measuring and modeling the mechanical response of human cadaveric tissue for the purpose of developing a realistic model. The major contribution of this paper is the development of physics-based models of soft tissues that range from linear elastic models to nonlinear viscoelastic models which are efficient for application within the framework of a real-time surgery simulator. ⋯ The data and models presented in this paper together with additional ones based on the principles presented in this paper would result in realistic physics-based surgical simulators.
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Comparative Study
Removal of tracheobronchial foreign bodies in adults using flexible bronchoscopy: experience 1995-2006.
Tracheobronchial foreign body (TFB) removal in adult patients using the combined technique of flexible bronchoscopy (FBSC) through the endotracheal tube as well as using the simple FBSC has not often been described. This study reports our experience with FBSC for removal of TFBs and describes diagnosis, techniques of removal, and types of TFBs. ⋯ Although foreign bodies in the tracheobronchial tree are rare in adults, the clinician must be aware of their likelihood. Foreign body aspiration should be considered especially in the etiology of recurrent lung diseases and in the presence of risk factors for aspiration, in particular with different neurologic and neuromuscular diseases. They can be successfully and safely removed in the majority of patients under local anesthesia by using FBSC. In cases when repeated procedure is needed, endotracheal tube is recommended.
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Comparative Study
Laparoscopic-assisted distal gastrectomy versus open distal gastrectomy for advanced gastric cancer.
Laparoscopic-assisted gastric surgery has become an option for the treatment of early gastric cancer. However, there are few reports of laparoscopic surgery in the management of advanced gastric cancer. In this study we describe our experience with laparoscopic-assisted distal gastrectomy (LADG) for advanced gastric cancer (AGC). ⋯ LADG with extended lymphadenectomy for AGC is a feasible and safe procedure and has several advantages. Moreover, this method can achieve a radical oncologic equivalent resection. Indications for LADG with extended lymphadenectomy could be expanded in the treatment of locally advanced gastric cancer.
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Comparative Study
Laparoscopic Nissen fundoplication assessment: task analysis as a model for the development of a procedural checklist.
Learning an advanced laparoscopic procedure is a complex process that requires clinical exposure, direct teaching, and deliberate practice. Expert surgeons automate their knowledge, making it difficult to teach incremental steps. Our aim was to deconstruct the steps of a laparoscopic Nissen fundoplication (LNF) and develop a procedural checklist assessment instrument. ⋯ The task analysis and Delphi technique was successful in reaching expert consensus on the procedural steps of a LNF and in creating a valid checklist. By capturing automated knowledge in a checklist form, we can scaffold resident learning and improve feedback for an advanced laparoscopic case.