A cost-conscious establishment of a robotic abdominal wall reconstruction program in a publicly funded healthcare system.

Purpose: Despite reports of better short-term outcomes, the main criticism for the adoption of the robotic surgery platform for abdominal wall reconstruction (AWR) has been the associated cost, especially in countries with a publicly funded healthcare system such as Canada. We describe our experience in implementation of robotic AWR while ensuring cost-effectiveness.

Methods: This is a retrospective cohort analysis of all patients with ventral hernias ranging between 5 to 15 cm who underwent either open or robotic AWR between January 2020 to August 2022.

Fluorescent Cholangiography in Laparoscopic Cholecystectomy: An Updated Canadian Experience.

Laparoscopic cholecystectomy (LC) is one of the most common general surgery procedures in Canada with approximately 100 000 cases performed per year. Bile duct injury remains a morbid complication with an incidence rate of 0.3% to 0.

Rigid vs articulating instrumentation for task completion in single-port surgery.

Background: Single-port access surgery (SPA) may provide benefits but there is a steep learning curve. We compare traditional in-line instruments with articulating instruments.

Methods: Fundamentals of laparoscopic surgery peg transfer task was performed using a 3-port approach or SPA device.

Analysis of eye gaze: do novice surgeons look at the same location as expert surgeons during a laparoscopic operation?

Introduction: Eye-gaze technology can be used to track the gaze of surgeons on the surgical monitor. We examine the gaze of surgeons performing a task in the operating room and later watching the operative video in a lab. We also examined gaze of video watching by surgical residents.

Laparoscopic management of gastrointestinal stromal tumours: review at a Canadian centre.

Background: Laparoscopic wedge resection has been widely accepted for small benign gastric tumours. Large gastrointestinal stromal tumours (GISTs), however, can be difficult to manipulate laparoscopically and are at risk for capsule disruption, which can then result in peritoneal seeding. Some authors have suggested that large GISTs (> 8 cm) are best approached using an open technique.

Objective assessment of laparoscopic skills: dual-task approach.

Background: Assessment of surgical performance is often accomplished with traditional methods that often provide only subjective data. Trainees who perform well on a simulator in a controlled environment may not perform well in a real operating room environment with distractions. This project uses the ideas of dual-task methodology and applies them to the assessment of performance of laparoscopic surgical skills.

Hand-assisted laparoscopic splenectomy versus open splenectomy for massive splenomegaly: 20-year experience at a Canadian centre.

Background: Multiple techniques for splenectomy are now employed and include open, laparoscopic and hand-assisted laparoscopic splenectomy (HALS). Concerns regarding a purely laparoscopic splenectomy for massive splenomegaly (> 20 cm) arise from potentially longer operative times, higher conversion rates and increased blood loss. The HALS technique offers the potential advantages of laparoscopy, with the added safety of having the surgeon's hand in the abdomen during the operation.

An appendiceal neoplastic lesion: case report and implications for colonoscopic screening and surveillance.

A 65-year-old man with a history of previously resected colonic adenomas had an apparent cecal lesion detected during colonoscopy. The polyp proved to be a tubulovillous adenoma with high-grade dysplasia involving most of the body of the appendix along with the base of the cecum. The appendiceal mucosa is biologically similar to the colonic mucosa, yet remains relatively 'hidden' in screening and surveillance studies, which suggests important implications for evolving detection strategies in the follow-up of patients with a previous colon polyp or cancer resections.

Perioperative analysis of laparoscopic versus open liver resection.

Background: Over the past decade there has been an increasing trend toward minimally invasive liver surgery. Initially limited by technical challenges, advances in laparoscopic techniques have rendered this approach safe and feasible. However, as health care costs approach 50% of some provincial budgets, surgical innovation must be justifiable in costs and patient outcomes.

An 18-year review of open and laparoscopic splenectomy for idiopathic thrombocytopenic purpura.

Background: Laparoscopic splenectomy has become the preferred surgical procedure for the management of idiopathic thrombocytopenic purpura (ITP). However, there studies have directly compared the incidence of recurrent ITP secondary to missed accessory spleens in open versus laparoscopic splenectomy.

Methods: Open and laparoscopic splenectomies performed for ITP at 4 sites over 18 years were analyzed.

Prospective comparison of early and late experience with laparoscopic adrenalectomy.

Background: Laparoscopic adrenalectomy has gained acceptance in the treatment of adrenal tumors. We examine our initial 73 patients and highlight the change in patient selection and outcome that experience brings.

Methods: A prospective study from 2000 to 2005 enrolled 73 consecutive laparoscopic adrenalectomy patients at the University of British Columbia and Vancouver General Hospitals.

Esophageal mucosal damage may promote dysmotility and worsen esophageal acid exposure.

This study determines the relationship among esophageal dysmotility, esophageal acid exposure, and esophageal mucosal injury in patients with gastroesophageal reflux disease (GERD). A total of 827 patients with GERD (confirmed by ambulatory pH monitoring) were divided into three groups based on the degree of mucosal injury: group A, no esophagitis, 493 patients; group B, esophagitis grades I to III, 273 patients; and group C, Barrett's esophagus, 61 patients. As mucosal damage progressed from no esophagitis to Barrett's esophagus, there was a significant decrease in lower esophageal sphincter pressure and amplitude of peristalsis in the distal esophagus, with a subsequent increase in the number of reflux episodes in 24 hours, the number of reflux episodes longer than 5 minutes, and the reflux score.

Local resection of ampullary tumors.

There is no consensus on the appropriateness of local resection for ampullary tumors, because malignant recurrence of what were thought to be benign tumors has been reported. This study examined the role of local resection in the management of ampullary tumors. Thirty patients (mean age 66 years) had transduodenal local resections performed at UCSF-Moffitt Hospital or the San Francisco VA Medical Center (February, 1992 to March, 2004).

Patency of superficial femoral vein employed as a crossover femoral artery bypass conduit.

This study assesses the patency of superficial femoral vein used as a crossover femoral artery bypass conduit in patients presenting either with localized groin sepsis, generalized sepsis or in patients with occluded or heavily diseased superficial femoral artery outflow. Twenty patients were followed prospectively with femoral crossover grafts constructed of superficial femoral vein. Twelve patients presented with sepsis and 8 with chronic ischemia from iliac artery occlusion and severely diseased superficial femoral artery outflow.