Is obesity a contraindication for kidney donation?

Introduction: To enlarge the donor pool, kidney donors with obesity have been considered. We hypothesized that it is safe for patients with obesity to serve as living kidney donors.

Methods: In this single-center retrospective analysis, we examined the effect of obesity (body mass index (BMI) of 30-35 kg/m) on glomerular filtration rate (GFR) and creatinine in patients undergoing laparoscopic donor nephrectomy.

Laparoscopic-Assisted Transversus Abdominis Plane Block for Postoperative Pain Control in Laparoscopic Ventral Hernia Repair: A Randomized Controlled Trial.

Background: Laparoscopic ventral hernia repair (LVHR) is associated with considerable postoperative pain. Transversus abdominis plane (TAP) blocks have proven effective in controlling postoperative pain in a variety of laparoscopic abdominal operations. To date, no studies have focused on TAP blocks in LVHR.

Safety of outpatient laparoscopic cholecystectomy in the elderly: analysis of 15,248 patients using the NSQIP database.

Background: Studies have shown that laparoscopic cholecystectomy (LC) in an ambulatory setting is a safe alternative to the traditional overnight hospital stay. However, there are limited data on the morbidity and mortality of outpatient LC in elderly patients. We evaluated the safety of ambulatory LC in the elderly and identified risk factors that predict inpatient admission.

What circumstances prompt a workplace discussion in medical evaluations for back pain?

Purpose: To determine how frequently workplace topics emerge in the interactions between patients and providers in an evaluation for low back pain (LBP) and to determine its association with patient and provider characteristics.

Methods: Adults with work-related LBP (N = 97; 64 % male; median age = 38) completed a demographic questionnaire and a survey of disability risk factors, then agreed to audio-taping of their visits with a participating occupational healthcare provider (n = 14). Utterance-level verbal exchanges were categorized by trained coders using the Roter interaction analysis system.

Laparoendoscopic single site (LESS) splenectomy with a conventional laparoscope and instruments.

Background And Objectives: We present 2 cases of laparoendoscopic single site surgery (LESS) splenectomy performed with a conventional laparoscope and instruments, and the use of a novel internal retraction device.

Methods: One patient underwent LESS splenectomy for idiopathic thrombocytopenia purpura (ITP), and a pediatric patient with sickle cell disease underwent LESS splenectomy and cholecystectomy. In each case, a 2-cm vertical incision was made within the confines of the umbilical ring, and a SILS port (Covidien, Norwalk CT) inserted.

Laparoscopic single site adrenalectomy using a conventional laparoscope and instrumentation.

Background And Objectives: We present a case of Laparoendoscopic Single Site Surgery (LESS) left adrenalectomy performed with a conventional laparoscope and instruments.

Methods: A 45-year-old male was diagnosed with hyperaldosteronism. Computed tomography detected a left adrenal nodule.

Laparoendoscopic single site surgery can be performed completely with standard equipment.

Purpose: To determine the feasibility of laparoendoscopic single site surgery (LESS) with nonarticulating instruments and conventional trocars.

Methods: After Institutional Review Board approval, a prospective database was used to identify 30 patients who underwent LESS. All procedures were begun using three 5 mm trocars, nonarticulating instruments, and a 5 mm, 30-degree laparoscope.

Risk factors for anastomotic leak following colorectal surgery: a case-control study.

Objective: To assess anastomotic leak (AL) risk factors in a large patient series.

Design: Case-control study.

Setting: The Mount Sinai Hospital.

Laparoscopic removal of a large gastric trichobezoar in a 4-year-old girl.

Background: Standard treatment of large gastric bezoars not amenable to medical or endoscopic management is surgical removal. The optimal operative approach, laparotomy versus laparoscopy, is a contested subject. Though laparoscopic removal has been described, it remains a relatively new technique for surgical management with outcome literature limited to case reports.

A novel laparoscopic ventral herniorrhaphy training system.

Surgical simulation offers a safe opportunity to develop the skills required for the operating room. Box trainers are an excellent low-cost training option but there are limited options for teaching laparoscopic ventral hernia repair. We developed a realistic and cost-effective box system for laparoscopic ventral herniorrhaphy that will enhance training experience before entering the operating theater.

Factors that predict outcome of abdominal operations in patients with advanced cirrhosis.

Background & Aims: Patients with cirrhosis have an increased risk of complications during surgery that is relative to the severity of liver disease; it is a challenge to determine which patients are the best candidates for surgery. We performed a hospital-based study to identify factors that might facilitate selection of operative candidates and guide their management.

Methods: A retrospective review was performed of 100 cirrhotic patients (50 classified as Child-Turcotte-Pugh [CTP] A, 33 as CTP B, and 17 as CTP C) who underwent abdominal surgery at an institution specializing in liver medicine and transplant from 2002-2008.

Selective management of patients with acute biliary pancreatitis.

Background: Detection of common bile duct (CBD) stones in patients with acute biliary pancreatitis (ABP) proves challenging. We hypothesized that grouping clinically significant predictors would increase reliability of detection.

Methods: A retrospective review was performed of 144 consecutive patients who presented to a single tertiary care institution from 2002 to 2007 with ABP.

Diagnosis of gastrointestinal anastomotic dehiscence after hospital discharge: Impact on patient management and outcome.

Background: Anastomotic leaks are inevitable complications of gastrointestinal surgery. Early hospital discharge protocols have increased concern regarding outpatient presentation with anastomotic leaks.

Methods: One hundred anastomotic leaks in 5,387 intestinal operations performed at a single institution from 2002 to 2007 were identified from a prospectively maintained database.

Laparoscopic resection of giant adrenal cavernous hemangioma.

Background: Large adrenal tumors were initially believed to be a relative contraindication to laparoscopic adrenalectomy.

Methods: Here we discuss the case of a 42-year-old female with a 12-cm adrenal mass.

Results: The patient underwent successful laparoscopic resection, and pathology revealed a cavernous hemangioma, a rare benign tumor of the adrenal gland.

The first decade of a laparoscopic donor nephrectomy program: effect of surgeon and institution experience with 512 cases from 1996 to 2006.

Background: Although the procedure is generally safe, significant morbidity and even mortality have occurred after laparoscopic donor nephrectomy (LDN). The learning curves for both surgeons and institutions with LDN have not been well delineated, and longterm donor data are not well reported.

Study Design: A retrospective study of the initial 512 patients undergoing LDN performed at Mount Sinai Medical Center between October 1996 and March 2006 was performed.

Current recommendations on diagnosis and management of right-sided diverticulitis.

We present the case of a 52-year-old female with recurrent symptomatic ascending colon diverticulitis who ultimately underwent elective laparoscopic right hemicolectomy. The following is a case report and literature review pertaining to right colonic diverticular disease.

Laparoscopic and open reversal of Hartmann's procedure--a comparative retrospective analysis.

Background: Restoration of intestinal continuity after Hartmann's procedure has traditionally required laparotomy. This study compares our experience with laparoscopic and open reversal of Hartmann's procedure.

Study Design: All laparoscopic and open Hartmann's reversal procedures performed between January 1998 and June 2006 were reviewed.

Recurrence after laparoscopic ventral hernia repair: a prospective pilot study of suture versus tack fixation.

Mesh fixation in laparoscopic ventral hernia repair requires the use of tacks and/or permanent transabdominal sutures. Sutures pass through all fascial and muscle layers of the anterior abdominal wall, whereas tacks secure the mesh simply to peritoneum. Controversy exists regarding the optimal fixation method.

Laparoscopic cortical-sparing adrenalectomy for bilateral pheochromocytoma.

A 32-year-old female with asthma was hospitalized for pneumonia in 2/06. She underwent a CT scan of the chest which revealed an incidental finding of bilateral adrenal masses. On further questioning, she admitted to palpitations and flushing.

Comparison of iatrogenic splenectomy during open and laparoscopic colon resection.

Iatrogenic splenic injury requiring splenectomy is a well-recognized and potentially serious complication of colon resection. Iatrogenic splenectomy is associated with significant morbidity and mortality, including bleeding and the postsplenectomy sepsis syndrome. Our study aims to compare the incidence of iatrogenic splenectomy in laparoscopic colon resection with that of open colon resection over an 11-year-period at Mount Sinai.

A ten-year experience with laparoscopic treatment of splenic cysts.

Background And Objectives: The management of symptomatic splenic cysts lacks clear, evidence-based guidelines due to its low incidence. Recently, laparoscopic treatment has been described. We present our experience with the laparoscopic management of solitary splenic cysts with a review of the existing literature, and recommendations for therapy.

Laparoscopic retrieval of intraabdominal foreign bodies.

Unlabelled: The use of laparoscopy has been described as the means of removing intraabdominal foreign bodies, both intraperitoneal and intraluminal, from the stomach or bowel. An early report detailed the laparoscopic removal of translocated intrauterine devices from the peritoneal cavity. Laparoscopic removal of a retained surgical sponge also has been reported.

Selective clearance of glycoforms of a complex glycoprotein pharmaceutical caused by terminal N-acetylglucosamine is similar in humans and cynomolgus monkeys.

To understand how the carbohydrate moieties of a recombinant glycoprotein affected its pharmacokinetic (PK) properties, the glycan distribution was directly assessed from serial blood samples taken during PK studies in cynomolgus monkeys and humans. The protein studied was an immunoadhesin (lenercept), containing an Fc domain from human immunoglobulin G (IgG-1) and two copies of the extensively glycosylated extra cellular domain of tumor necrosis factor receptor p55. The protein was recovered in pure form using a dual column, immunoaffinity-reversed-phase high-performance liquid chromatography method.

Laparoscopic donor nephrectomy: intraoperative safety, immediate morbidity, and delayed complications with 500 cases.

Background: Several large series of laparoscopic donor nephrectomy (LDN) have been published, largely focusing on immediate results and short-term complications. The aim of this study was to examine the results of LDN and collect medium-term and long-term donor followup.

Methods: We examined the results of two surgeons who performed 500 consecutive LDNs from 1996 to 2005.