Approach to the Diagnostic Workup and Management of Small Bowel Lesions at a Tertiary Care Center.

Background: Small bowel lesions (SBL) are rare, representing diagnostic and management challenges. The purpose of this cross-sectional study was to evaluate diagnostic modalities used and management practices of patients with SBL at an advanced endoscopic referral center.

Methods: We analyzed patients undergoing surgical management for SBL from 2005 to 2015 at a single tertiary care center.

Cholecystostomy Treatment in an ICU Population: Complications and Risks.

Background: Percutaneous cholecystostomy tube placement has widely been used as an alternative treatment to cholecystectomy, especially in advanced disease or critically ill patients. Reported postprocedural complication rates have varied significantly over the last decade. The goal of this study is to evaluate the safety of percutaneous cholecystostomy tube treatment in critically ill patients.

Timing and choice of intervention influences outcome in acute cholecystitis: a prospective study.

Purpose: Determine which management strategy is ideal for patients with acute cholecystitis.

Materials And Methods: Prospective enrollment between August 2009 and March 2011. Large academic center.

Use of cholecystostomy tubes in the management of patients with primary diagnosis of acute cholecystitis.

Background: Management of patients with severe acute cholecystitis (AC) remains controversial. In settings where laparoscopic cholecystectomy (LC) can be technically challenging or medical risks are exceedingly high, surgeons can choose between different options, including LC conversion to open cholecystectomy or surgical cholecystostomy tube (CCT) placement, or initial percutaneous CCT. We reviewed our experience treating complicated AC with CCT at a tertiary-care academic medical center.

Single-incision laparoscopic cholecystectomy using a modified dome-down approach with conventional laparoscopic instruments.

Introduction: Single-incision laparoscopic cholecystectomy (SILC) may increase the risk of bile duct injury due to compromised operative exposure. Dome-down laparoscopic cholecystectomy provides the ability to evaluate the cystic duct circumferentially prior to its division, thus minimizing the risks of bile duct injury. This study assesses the feasibility and safety of SILC using a modified dome-down approach with all conventional laparoscopic instruments.

Transforming the culture of surgical education: promoting teacher identity through human factors training.

Context: Promoting a culture of teaching may encourage students to choose a surgical career. Teaching in a human factors (HF) curriculum, the nontechnical skills of surgery, is associated with surgeons' stronger identity as teachers and with clinical students' improved perception of surgery and satisfaction with the clerkship experience.

Objective: To describe the effects of an HF curriculum on teaching culture in surgery.

Evaluation of serum cytokine release in response to hand-assisted, laparoscopic, and open surgery in a porcine model.

Background: Although the immunologic benefits of laparoscopic surgery have been established, effects from hand-assisted (HA) surgery have not been investigated thoroughly. We hypothesized that the HA approach maintains the immunologic advantage of laparoscopic surgery compared with the open (O) approach.

Methods: Six O, HA, and laparoscopic (L) transabdominal left nephrectomies were performed on pigs.

Athletic pubalgia (sports hernia).

Athletic pubalgia or sports hernia is a syndrome of chronic lower abdomen and groin pain that may occur in athletes and nonathletes. Because the differential diagnosis of chronic lower abdomen and groin pain is so broad, only a small number of patients with chronic lower abdomen and groin pain fulfill the diagnostic criteria of athletic pubalgia (sports hernia). The literature published to date regarding the cause, pathogenesis, diagnosis, and treatment of sports hernias is confusing.

Surgical management of acute cholecystitis at a tertiary care center in the modern era.

Hypothesis: The advent of laparoscopy has changed the paradigm of surgical training and care delivery for the treatment of patients with acute cholecystitis (AC).

Design: Retrospective data collection and analysis.

Setting: Hospital admissions with a primary diagnosis of AC at a tertiary care center from January 1, 2002, to January 1, 2007.

Trends in adrenalectomy: a recent national review.

Background: Adrenalectomy remains the definitive therapy for most adrenal neoplasms. Introduced in the 1990s, laparoscopic adrenalectomy is reported to have lower associated morbidity and mortality. This study aimed to evaluate national adrenalectomy trends, including major postoperative complications and perioperative mortality.

Laparoscopic cholecystectomy.

Laparoscopic cholecystectomy (LC) has supplanted open cholecystectomy for most gallbladder pathology. Experience has allowed the development of now well-established technical nuances, and training has raised the level of performance so that safe LC is possible. If safe cholecystectomy cannot be performed because of acute inflammation, LC tube placement should occur.

Use of laparoscopy in evaluation and treatment of penetrating and blunt abdominal injuries.

Use of laparoscopy in penetrating trauma has been well established; however, its application in blunt trauma is evolving. The authors hypothesized that laparoscopy is safe and feasible as a diagnostic and therapeutic modality in both the patients with penetrating and blunt trauma. Trauma registry data and medical records of consecutive patients who underwent laparoscopy for abdominal trauma were reviewed.

Perioperative mortality for pancreatectomy: a national perspective.

Objective: To analyze in-hospital mortality after pancreatectomy using a large national database.

Summary And Background Data: Pancreatic resections, including pancreaticoduodenectomy, distal pancreatectomy, and total pancreatectomy, remain the only potentially curative interventions for pancreatic cancer. The goal of this study was to define factors affecting outcomes after pancreatectomy for neoplasm.

Metabolic characterization of nondiabetic severely obese patients undergoing Roux-en-Y gastric bypass: preoperative classification predicts the effects of gastric bypass on insulin-glucose homeostasis.

Introduction: Obese individuals may have normal insulin-glucose homeostasis, insulin resistance, or diabetes mellitus. Whereas gastric bypass cures insulin resistance and diabetes mellitus, its effects on normal physiology have not been described. We studied insulin resistance and beta-cell function for patients undergoing gastric bypass.

National outcomes after gastric resection for neoplasm.

Hypothesis: That factors affecting outcomes of surgical resection in the treatment of gastric cancer can be identified using a large US database.

Design: Retrospective observational study.

Setting: The Nationwide Inpatient Sample from January 1, 1998, through December 31, 2003.

Optimizing laparoscopic task efficiency: the role of camera and monitor positions.

Background: Alterations of video monitor and laparoscopic camera position may create perceptual distortion of the operative field, possibly leading to decreased laparoscopic efficiency. We aimed to determine the influence of monitor/camera position on the laparoscopic performance of surgeons of varying skill levels.

Methods: Twelve experienced and 12 novice participants performed a one-handed task with their dominant hand in a modified laparoscopic trainer.

Advantages of laparoscopic transabdominal preperitoneal herniorrhaphy in the evaluation and management of inguinal hernias.

Background: Laparoscopic transabdominal preperitoneal (TAPP) herniorrhaphy provides an opportunity to definitively evaluate both inguinal areas without the need for additional dissection. We aimed to establish the rates and contributing patient factors to errors in the preoperative assessment.

Methods: A retrospective review of consecutive patients undergoing laparoscopic TAPP herniorrhaphy at 2 tertiary-care centers.

Benefits of laparoscopic adrenalectomy: a 10-year single institution experience.

Introduction: We aimed to compare the outcomes of laparoscopic and open adrenalectomies and to assess the impact of the availability of advanced laparoscopy on adrenal surgery at our institution.

Materials And Methods: A retrospective analysis of data of all patients who underwent adrenalectomy at the University of Massachusetts Medical Center over a 10-year period.

Results: Sixty-four consecutive patients underwent adrenalectomy during the study periods.

Advantages of mini-laparoscopic vs conventional laparoscopic cholecystectomy: results of a prospective randomized trial.

Hypothesis: The use of smaller instruments during laparoscopic cholecystectomy (LC) has been proposed to reduce postoperative pain and improve cosmesis. However, despite several recent trials, the effects of the use of miniaturized instruments for LC are not well established. We hypothesized that LC using miniports (M-LC) is safe and produces less incisional pain and better cosmetic results than LC performed conventionally (C-LC).

Immunologic effects of hand-assisted surgery on peritoneal macrophages: comparison to open and standard laparoscopic approaches.

Background: Exaggerated activation of peritoneal immunity after major abdominal surgery activates peritoneal macrophages (PMs), which may lead to a relative local immunosuppression. Although laparoscopy (L) is known to elicit a smaller attenuation of peritoneal host defenses, compared with open (O) surgery, effects of the hand-assisted (HA) approach have not been investigated to date.

Methods: Eighteen pigs underwent a transabdominal nephrectomy via O, HA, or L approach.

Preoperative computed tomography-guided hookwire needle localization of a peritoneal multilocular inclusion cyst.

Preoperative hookwire localization of breast lesions is a well established technique to aid surgeons in localizing breast tumors. We describe the innovative use of a standard hookwire with CT guidance to localize an intraperitoneal inclusion cyst.

Laparoscopic curative resection of pheochromocytomas.

Purpose: Pheochromocytomas are relatively uncommon tumors whose operative resection has clear medical and technical challenges. While the safety and efficacy of laparoscopic adrenalectomy are relatively well documented, few studies with extended follow-up have been conducted to measure the success of the procedure for the most challenging of the adrenal tumors. In addition, several reports question the applicability of a minimally invasive approach for sizeable pheochromocytomas.

Staple line bleeding following laparoscopic splenectomy: intraoperative prevention and postoperative management with splenic artery embolization.

Laparoscopic splenectomy (LS) has become the procedure of choice for a variety of hematologic disorders and non-traumatic splenic pathology. Perioperative hemorrhage remains one of the most feared complications. We report 2 cases of postoperative splenic artery hemorrhage following vascular division using 2.

Hand-assisted laparoscopic surgery.

The introduction of hand-assisted laparoscopic surgery (HALS) has occurred in several surgical specialties. It allows the laparoscopic surgeon to insert a hand into the peritoneal cavity, through a small incision, while maintaining pneumoperitoneum. This technique has been made possible through the engineering of several unique devices.