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1.
J Robot Surg ; 14(1): 95-99, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30830569

RESUMEN

A social media group, the International Hernia Collaboration (IHC), facilitates professional development among surgeons interested in hernia disease. The purpose of this study was to assess practice pattern differences among IHC surgeon members regarding a ventral incisional hernia (VIH) scenario. A single multiple-choice question, posted for 1 month on the IHC, assessed which operation was preferred for a healthy patient with a symptomatic, reducible primary VIH (5 × 6 cm). Responses were compared by surgeon practice location (US vs. World). In total, 371 IHC surgeons completed the survey. More respondents practicing in the US completed the survey (57.1% vs. 42.9%, P < 0.01). Respondents in the US cohort would select a robotic-assisted approach more frequently than World colleagues (47.6% vs. 8.8%, P < 0.01). More IHC surgeons in the US cohort would offer a robotic-assisted approach for primary VIH repair compared to World colleagues. Studies are warranted to investigate practice pattern differences related to VIH repair.


Asunto(s)
Hernia Incisional/cirugía , Procedimientos Quirúrgicos Robotizados , Humanos , Cooperación Internacional , Pautas de la Práctica en Medicina , Ubicación de la Práctica Profesional , Procedimientos Quirúrgicos Robotizados/métodos , Encuestas y Cuestionarios
2.
Surg Endosc ; 33(1): 1-7, 2019 01.
Artículo en Inglés | MEDLINE | ID: mdl-30421077

RESUMEN

INTRODUCTION: Closed social media groups (CSMG), including closed Facebook® groups, are online communities providing physicians with platforms to collaborate privately via text, images, videos, and live streaming in real time and optimize patient care. CSMG platforms represent a novel paradigm in online learning and education, so it is imperative to ensure that the public and patients trust the physicians using these platforms. Informed consent is an essential aspect of establishing this trust. With the launch of several of its own CSMG, Society of Gastrointestinal and Endoscopic Surgeons (SAGES) sought to define its position on CSMG platforms and provide an informed consent template for educating and protecting patients, surgeons, and institutions. METHODS: A review of the literature (2012-2018) discussing the informed consent process for posting clinical scenarios, photography, and/or videography on social media was performed. Pertinent articles and exemplary legal counsel-approved CSMG policies and informed consent forms were reviewed by members of the SAGES Facebook® Task Force. RESULTS: Eleven articles and two institutional CSMG policies discussing key components of the informed consent process, including patient transparency and confidentiality, provider-patient partnerships, ethics, and education were included. Using this information and expert opinion, a SAGES-approved statement and informed consent template were formulated. CONCLUSIONS: SAGES endorses the professional use of medical and surgical CSMG platforms for education, patient care optimization, and dissemination of clinical information. Despite the growing use of social media as an integral tool for surgical practice and education, issues of informed consent still exist and remain the responsibility of the physician contributor. Responsible, ethical, and compliant use of CSMG platforms is essential. Surgeons and patients embracing CSMG for quality improvement and optimized outcomes should be legally protected. SAGES foresees the use of this type of platform continuing to grow.


Asunto(s)
Procedimientos Quirúrgicos del Sistema Digestivo/educación , Educación Médica Continua/métodos , Endoscopía/educación , Consentimiento Informado , Privacidad , Derivación y Consulta/organización & administración , Medios de Comunicación Sociales , Sociedades Médicas , Confidencialidad , Humanos , Cirujanos
3.
Surg Endosc ; 31(8): 3061-3071, 2017 08.
Artículo en Inglés | MEDLINE | ID: mdl-28634631

RESUMEN

BACKGROUND: Postgraduate training has been haphazard to date. Surgeons have relied on attendance to annual meetings and multiple choice study guides to demonstrate maintenance of certification and continuing medical education. METHODS: SAGES held a retreat to develop the concept and scope of the Masters Program. Surveys were sent to SAGES members to guide curriculum development and selection of anchoring operations. RESULTS: SAGES has developed an educational curriculum across eight domains (Acute Care, Biliary, Bariatric, Colorectal, Hernia, Foregut, Flex Endoscopy, and Robotic Surgery) incorporating SAGES educational materials and guidelines, social media, coaching and mentoring. CONCLUSIONS: Deliberate, lifelong learning should be a better way to teach and learn.


Asunto(s)
Curriculum , Educación Médica Continua , Endoscopía/educación , Cirugía General/educación , Cirugía Bariátrica/educación , Procedimientos Quirúrgicos del Sistema Biliar/educación , Certificación , Cirugía Colorrectal/educación , Herniorrafia/educación , Humanos , Aprendizaje , Tutoría , Procedimientos Quirúrgicos Robotizados/educación , Medios de Comunicación Sociales , Sociedades Médicas , Cirujanos , Encuestas y Cuestionarios , Universidades
4.
Surg Technol Int ; 29: 109-117, 2016 Oct 26.
Artículo en Inglés | MEDLINE | ID: mdl-27466869

RESUMEN

Laparoscopic ventral hernia repair (LVHR) remains a safe, reproducible, and popular method employed by surgeons to repair abdominal wall hernias. Patient selection, operative technique, instrumentation, and implant choice all remain surgeon dependent. Inherent in the technique is the option of using mesh. The decision of where to place the mesh and how to optimally fixate the mesh in the onlay, sublay, or intraabdominal positions also remain surgeon dependent and has been the subject of ongoing debates for the past two decades. In an ongoing effort to develop new methods for securing mesh to minimize pain without increased recurrence rates, novel mesh fasteners and mesh textiles have been developed. With increasing surgeon responsibility to improve value, surgeons should concentrate more on choosing the novel options that not only improve outcomes, but also reduce overall costs. This chapter reviews some of the emerging markets for these technologies.


Asunto(s)
Herniorrafia/instrumentación , Mallas Quirúrgicas , Hernia Ventral , Humanos , Laparoscopía , Prótesis e Implantes , Recurrencia
5.
Surg Endosc ; 28(3): 886-90, 2014 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-24232132

RESUMEN

BACKGROUND: Although still experimental, natural orifice translumenal endoscopic surgery (NOTES) aims to use the natural orifices for intraabdominal surgery. Pure transvaginal umbilical hernia repair has been reported. However, mesh protection devices were used to minimize mesh contamination during mesh insertion. The authors believe that before widespread implementation of this technique, more foundational research is indicated to establish the sterility of hernia mesh insertion through this route. This prospective study aimed to compare transvaginal ventral hernia mesh insertion sterility with laparoscopic trocar-site insertion sterility to establish baseline data to help promote the safety of NOTES tranvaginal hernia repair. METHODS: This was a prospective descriptive study (Canadian Task Force classification 2A). With institutional review board approval, 10 patients undergoing laparoscopic surgery for benign gynecologic disease were enrolled in the study. Atrium Prolite mesh (polypropylene monofilament) was inserted into the vagina before and after standard surgical preparation with 10 % povidone­iodine. As a control, mesh also was inserted through a prepped laparoscopic port site. The mesh was cultured for bacterial, fungal, and viral contamination. All patients received standard infection prophylaxis that included preoperative intravenous cefazolin and metronidazole. RESULTS: The unprepped vaginal canal was cultured and demonstrated normal multiorganism vaginal flora in all 10 cases. Of the 10 skin incision mesh samples, 3 (30 %) grew bacteria, including Staphylococcus lugdunensis, a potentially pathogenic organism. In contrast, none of the prepped vaginal mesh specimens yielded any growth of microorganisms or potential pathogens. CONCLUSIONS: This study showed that a surgically prepped vaginal canal can be a sterile conduit for insertion of polypropylene mesh for transvaginal ventral hernia repair without the use of additional mesh protection. Surprisingly, the prepped vaginal conduit in our patients was more sterile than a prepped skin incision.


Asunto(s)
Hernia Ventral/cirugía , Herniorrafia/métodos , Laparoscopía/métodos , Cirugía Endoscópica por Orificios Naturales/métodos , Esterilización/métodos , Mallas Quirúrgicas , Infección de la Herida Quirúrgica/prevención & control , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Estudios Prospectivos , Resultado del Tratamiento , Vagina/microbiología
7.
J Endourol ; 24(10): 1613-6, 2010 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-20858052

RESUMEN

The laparoscopic management of difficult adhesions can be quite challenging for even the most experienced of laparoscopic surgeons. We describe a case of managing a suspected enterotomy with a laparotomy during a robot-assisted radical prostatectomy and the surgical options after repair. The case was complicated by a Meckel's diverticulum fused and continuous with a urachal cyst, itself a rare occurrence. After the excision of the Meckel's diverticulum­urachal complex, the laparotomy incision was closed, and the prostatectomy was performed robotically. We discuss the controversies regarding continuation of a planned robotic procedure after a midline laparotomy.


Asunto(s)
Laparotomía , Prostatectomía/métodos , Robótica , Humanos , Masculino , Persona de Mediana Edad
9.
Surg Endosc ; 23(4): 884, 2009 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-19118417

RESUMEN

The use of laparoscopic sleeve gastrectomy (LSG) as a procedure for morbid obesity has recently increased. The LSG procedure is used most often as a part of a biliopancreatic diversion with duodenal switch (BPDDS) or as a first stage that can be converted to a BPDDS or Roux-en-Y gastric bypass (RYGB). However, the surgical indications for LSG have rapidly expanded, and some centers use the sleeve as the primary operation for morbid obesity.The utility of LSG as a primary procedure is controversial, with consensus lacking in the literature. Whether the etiology of failed sufficient weight loss is the result of an inadequate sleeve or attributable to dilation or hypertrophy of the sleeve, the incidence of failed sleeve gastrectomies may be significant.In the treatment of a patient with a failed LSG, the options typically include creation of a tighter sleeve or conversion to biliopancreatic diversion or RYGB. These procedures, however, are complex and can carry significant morbidity.The authors report a case of a morbidly obese 42-year-old man who failed to lose sufficient weight after an LSG. Because the patient was dependent on several oral antipsychotic medications, he refused any malabsorptive procedure, and a decision was made to proceed with laparoscopic adjustable gastric banding (LAGB). The case proceeded successfully, and at this writing, 9 months after surgery, the patient has achieved a 57% excess weight loss from an original weight of 390 lb.The insertion of an LAGB into its normal anatomic position is feasible after a sleeve gastrectomy, and its use can induce sufficient restriction and weight loss results equivalent to those of a sleeve or band alone and possibly better.


Asunto(s)
Gastrectomía/efectos adversos , Gastroplastia/instrumentación , Laparoscopía/métodos , Obesidad Mórbida/cirugía , Grabación en Video , Adulto , Remoción de Dispositivos , Diseño de Equipo , Estudios de Seguimiento , Gastrectomía/instrumentación , Humanos , Masculino , Reoperación/métodos , Insuficiencia del Tratamiento , Pérdida de Peso
11.
Ann Emerg Med ; 47(2): 160-6, 2006 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-16431226

RESUMEN

Morbid obesity is an epidemic in this country. An increasing number of patients are undergoing weight loss surgery in an effort to combat the negative physical and psychological impact of morbid obesity. Fueling the increasing interest in surgical treatment of morbid obesity has been the development of new laparoscopic techniques. There are several surgical approaches to morbid obesity, and each has its own unique set of risks and potential complications. As more patients have weight loss surgery, clinicians working in the emergency department will frequently encounter complications of these procedures. To ensure timely diagnosis and optimal care, clinicians should be familiar with the standard weight loss approaches and the potential complications of these interventions.


Asunto(s)
Cirugía Bariátrica/efectos adversos , Medicina de Emergencia/métodos , Obesidad Mórbida/cirugía , Anastomosis en-Y de Roux/efectos adversos , Cirugía Bariátrica/métodos , Migración de Cuerpo Extraño/diagnóstico , Migración de Cuerpo Extraño/etiología , Migración de Cuerpo Extraño/terapia , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/terapia , Hernia/diagnóstico , Hernia/etiología , Hernia/terapia , Humanos , Desnutrición/diagnóstico , Desnutrición/etiología , Desnutrición/terapia , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/etiología , Embolia Pulmonar/terapia , Gastropatías/diagnóstico , Gastropatías/etiología , Gastropatías/terapia , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/etiología , Trombosis de la Vena/terapia
12.
Surg Innov ; 12(2): 107-21, 2005 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-16034493

RESUMEN

Optimal management of the super-obese patient (body mass index>50 kg/m2) undergoing weight loss surgery in the new era of laparoscopic treatment is more controversial than ever before. Newer laparoscopic options for treatment of the super obese, including laparoscopic adjustable gastric banding, sleeve gastrectomy, and staging of gastric bypass, are technically easier and may be safer. Concerns that weight loss may be suboptimal or that the procedures will require revision, or both, make these choices controversial. Open access/conversion for established procedures such as long-limb gastric bypass and biliopancreatic diversion with or without duodenal switch are the traditional alternatives when laparoscopic access fails or is deemed too difficult to undertake. The following debate was presented by invited experts in laparoscopic and open bariatric surgery at the 2005 Annual Meeting of the Society of American Gastrointestinal and Endoscopic Surgeons in Florida. The presenters put forth arguments for the various modern options for treatment of the super obese, which are presented in written form. Interactive audience response technology provided a mechanism for polling the audience before and after the presentations. A review of the audience's responses provides insight into the decision-making considerations of a population of laparoscopically oriented bariatric surgeons.


Asunto(s)
Bariatria , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Obesidad Mórbida/cirugía , Anastomosis en-Y de Roux/métodos , Gastrectomía/métodos , Derivación Gástrica/métodos , Gastroplastia/métodos , Humanos , Laparoscopía/métodos , Pérdida de Peso
13.
Obes Surg ; 15(6): 782-7, 2005.
Artículo en Inglés | MEDLINE | ID: mdl-15978147

RESUMEN

BACKGROUND: In this porcine survival model, we compared laparoscopic computer-mediated flexible circular stapled (SurgASSIST) gastro-jejunostomies in Roux-en-Y gastric bypass (RYGBP) to open hand-sewn (HS) and laparoscopic end-to-end (EEA) anastomosis. METHODS: RYGBP was performed in 15 pigs. Depending on the technique used to create the gastro-jejunostomy, the pigs were divided in 3 groups. In group A, a standard two-layer hand-sewn anastomosis were performed. In group B and C, gastro-jejunostomies using EEA (B) or SurgASSIST (C) were attempted. Operation time, intraoperative technical failure, postoperative anastomotic leakage, and necropsy results were measured. RESULTS: 14 pigs survived surgery. One leakage from the gastro-jejunostomy was detected intraoperatively in group B. There was no evidence of leakage postoperatively from the proximal gastro-jejunostomy in any groups. No statistical difference was found between the groups concerning the operation time or the diameter and degree of healing of the anastomosis. CONCLUSION: We found the SurgASSIST system safe for performing gastro-jejunostomies in laparoscopic RYGBP. There were no anastomotic failures intra- or postoperatively. At necropsy, there was no evidence of anastomotic stricture or delayed healing processes.


Asunto(s)
Anastomosis Quirúrgica/métodos , Derivación Gástrica , Gastrostomía/métodos , Yeyunostomía/métodos , Grapado Quirúrgico , Animales , Laparoscopía , Porcinos , Cicatrización de Heridas
14.
Surg Technol Int ; 11: 119-26, 2003.
Artículo en Inglés | MEDLINE | ID: mdl-12931292

RESUMEN

Since the gastric bypass was first described for weight-reduction surgery almost 50 years ago, a number of remarkable contributions have been made to the field. These advances have led to significant modifications of the technique, evolution of laparoscopic bariatric surgery equipment, and improvement of long-term results. Despite the currently wide-spread practice of laparoscopic bariatric surgery, the precise technique for laparoscopic gastric bypass still varies from institution to institution, and the surgery continues to carry a morbidity rate. Advances in laparoscopic equipment, technology, and our understanding of the pathophysiology behind weight loss, have allowed surgeons to modify the procedure described originally to minimize the morbidity and maximize long-term weight loss. This chapter describes the technique of laparoscopic gastric bypass used at a major academic center that performs over 1000 bariatric procedures each year. In addition, the many recent advances in methodology and pathophysiology are described in detail.


Asunto(s)
Derivación Gástrica/métodos , Obesidad Mórbida/cirugía , Robótica , Adaptación Fisiológica , Anastomosis en-Y de Roux , Anastomosis Quirúrgica , Femenino , Estudios de Seguimiento , Derivación Gástrica/instrumentación , Humanos , Laparoscopía/efectos adversos , Laparoscopía/métodos , Masculino , Obesidad Mórbida/diagnóstico , Complicaciones Posoperatorias , Medición de Riesgo , Técnicas de Sutura , Resultado del Tratamiento , Pérdida de Peso
15.
Surg Clin North Am ; 83(6): 1405-19, 2003 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-14712875

RESUMEN

Robotics are now being used in all surgical fields, including general surgery. By increasing intra-abdominal articulations while operating through small incisions, robotics are increasingly being used for a large number of visceral and solid organ operations, including those for the gallbladder, esophagus, stomach, intestines, colon, and rectum, as well as for the endocrine organs. Robotics and general surgery are blending for the first time in history and as a specialty field should continue to grow for many years to come. We continuously demand solutions to questions and limitations that are experienced in our daily work. Laparoscopy is laden with limitations such as fixed axis points at the trocar insertion sites, two-dimensional video monitors, limited dexterity at the instrument tips, lack of haptic sensation, and in some cases poor ergonomics. The creation of a surgical robot system with 3D visual capacity seems to deal with most of these limitations. Although some in the surgical community continue to test the feasibility of these surgical robots and to question the necessity of such an expensive venture, others are already postulating how to improve the next generation of telemanipulators, and in so doing are looking beyond today's horizon to find simpler solutions. As the robotic era enters the world of the general surgeon, more and more complex procedures will be able to be approached through small incisions. As technology catches up with our imaginations, robotic instruments (as opposed to robots) and 3D monitoring will become routine and continue to improve patient care by providing surgeons with the most precise, least traumatic ways of treating surgical disease.


Asunto(s)
Robótica , Procedimientos Quirúrgicos Operativos/métodos , Adrenalectomía/instrumentación , Adrenalectomía/métodos , Colecistectomía Laparoscópica/instrumentación , Colecistectomía Laparoscópica/métodos , Procedimientos Quirúrgicos del Sistema Digestivo/instrumentación , Procedimientos Quirúrgicos del Sistema Digestivo/enfermería , Diseño de Equipo , Humanos , Robótica/instrumentación , Robótica/métodos
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