Journal of laparoendoscopic & advanced surgical techniques. Part A
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J Laparoendosc Adv Surg Tech A · Sep 2017
Understanding Enhanced Recovery After Surgery Guidelines: An Introductory Approach.
Enhanced Recovery After Surgery (ERAS®) is a multimodal, multidisciplinary approach to surgical care. The ERAS Society has issued recommendations for many surgical procedures that address best practices in preoperative, intraoperative, and postoperative management. ⋯ In this study, the general principles of the ERAS guidelines are summarized and workload is distributed among the different members of the care team. This compartmentalized approach provides an easier way to involve key personnel in the ERAS process and assigns a role for everyone in making ERAS a success.
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J Laparoendosc Adv Surg Tech A · Aug 2017
Case ReportsEsophageal Penetration of the Magnetic Sphincter Augmentation Device: History Repeats Itself.
An alternative approach to the treatment of gastroesophageal reflux disease (GERD) has recently been introduced in clinical practice, involving the implantation of a magnetic sphincter augmentation device (MSAD). This "magnetic ring" is implanted laparoscopically around the lower esophageal sphincter to improve its barrier function. The literature is still limited on the midterm results achieved in controlling reflux because the MSAD is a very new procedure. So far, only a few cases of the MSAD causing erosion of the esophagus have been reported. ⋯ Judging from the literature, MSAD implantation may be an effective way to control GERD, but the method can carry major complications, such as migration of the device into the esophagus (as in the two cases reported here). Endoscopic removal of a device possibly penetrating inside the esophagus is feasible and safe, and may later be followed up with a laparoscopic antireflux procedure without any particular difficulty.
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J Laparoendosc Adv Surg Tech A · Aug 2017
Far from Standardized: Using Surgical Videos to Identify Variation in Technique for Laparoscopic Sleeve Gastrectomy.
Video assessment is an emerging tool for understanding variation in surgical technique. ⋯ LSG technique is not uniform. Video analysis identified variation in (1) time to complete each step of the procedure, (2) hiatal hernia repair technique, (3) stapling technique, and (4) post-transection staple line management. Future efforts linking video analysis with clinical outcomes can provide objective evidence to support best practices.
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J Laparoendosc Adv Surg Tech A · Aug 2017
Case ReportsTwo-Stage Explantation of a Magnetic Lower Esophageal Sphincter Augmentation Device Due to Esophageal Erosion.
Implanting a magnetic lower esophageal sphincter augmentation device (LINX, Torax Medical) has become an increasingly common option in the surgical management of gastroesophageal reflux disease. As the enthusiasm for placing this device increases, experience in the management of device-related complications-including erosion-is necessary. ⋯ Transmural erosion of the LINX device into the esophageal lumen is a rare occurrence, with only five such complications reported in the published literature. We present the first account of LINX explantation for esophageal erosion in the United States. We demonstrated that a staged laparoendoscopic approach to LINX removal in these cases is feasible with minimal morbidity.
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J Laparoendosc Adv Surg Tech A · Jul 2017
Robotic Thymectomy: Learning Curve and Associated Perioperative Outcomes.
Recently, robotic-assisted thymectomy (RAT) has emerged as an alternative to either, an open transsternal approach or to a video-assisted thoracoscopic approach, for both thymic tumors and benign lesions. We have reviewed our early experience with RAT to assess the associated learning curve as well as the short-term perioperative outcomes. ⋯ Robotic thymectomy is feasible and safe, and is associated with comparable perioperative outcomes to the traditional transsternal approach in patients undergoing thymomectomy. An initial learning curve of 15-20 robotic thymectomy cases may be required by the surgeons to adequately perform this relatively novel technique.