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9. Robotic-Assisted Total Abdominal Colectomy

Author

Harnsberger, Cristina R., Cajas-Monson, Luis Carlos, Oh, Seung Yeop, Ramamoorthy, Sonia, Ross, Howard, editor, Lee, Sang, editor, Champagne, Bradley J., editor, Pigazzi, Alessio, editor, and Rivadeneira, David E., editor

Published
2015
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33. Intraoperative Endoscopic Botox Injection During Total Esophagectomy Prevents the Need for Pyloromyotomy or Dilatation

Author

Fuchs, Hans F., Broderick, Ryan C., Harnsberger, Cristina R., Divo, Francisco Alvarez, Coker, Alisa M., Jacobsen, Garth R., Sandler, Bryan J., Bouvet, Michael, Horgan, Santiago, Fuchs, Hans F., Broderick, Ryan C., Harnsberger, Cristina R., Divo, Francisco Alvarez, Coker, Alisa M., Jacobsen, Garth R., Sandler, Bryan J., Bouvet, Michael, and Horgan, Santiago

Abstract

Background: Esophagectomy may lead to impairment in gastric emptying unless pyloric drainage is performed. Pyloric drainage may be technically challenging during minimally invasive esophagectomy and can add morbidity. We sought to determine the effectiveness of intraoperative endoscopic injection of botulinum toxin into the pylorus during robotic-assisted esophagectomy as an alternative to surgical pyloric drainage. Materials and Methods: We performed a retrospective analysis of patients with adenocarcinoma and squamous cell carcinoma of the distal esophagus or gastroesophageal junction who underwent robotic-assisted transhiatal esophagectomy (RATE) without any surgical pyloric drainage. Patients with and without intraoperative endoscopic injection of 200 units of botulinum toxin in 10 cc of saline (BOTOX group) were compared to those that did not receive any pyloric drainage (noBOTOX group). Main outcome measure was the incidence of postoperative pyloric stenosis; secondary outcomes included operative and oncologic parameters, length of stay (LOS), morbidity, and mortality. Results: From November 2006 to August 2014, 41 patients (6 females) with a mean age of 65 years underwent RATE without surgical drainage of the pylorus. There were 14 patients in the BOTOX group and 27 patients in the noBOTOX group. Mean operative time was not different between the comparison groups. There was one conversion to open surgery in the BOTOX group. No pyloric dysfunction occurred in the BOTOX group postoperatively, and eight stenoses in the noBOTOX group (30%) required endoscopic therapy (P<.05). There were no differences in incidence of anastomotic strictures or anastomotic leaks. One patient in group noBOTOX required pyloroplasty 3 months after esophagectomy. There was one death in the noBOTOX group postoperatively (30-day mortality 2.4%). Mean LOS was 9.6 days, and BOTOX patients were discharged earlier (7.4 versus 10.7, P<.05). Conclusion: Intraoperative endoscopic injection of b

Published
2016

36. Benefits of Bariatric Surgery Do Not Reach Obese Men

Author

Fuchs, Hans F., Broderick, Ryan C., Harnsberger, Cristina R., Chang, David C., Sandler, Bryan J., Jacobsen, Garth R., Horgan, Santiago, Fuchs, Hans F., Broderick, Ryan C., Harnsberger, Cristina R., Chang, David C., Sandler, Bryan J., Jacobsen, Garth R., and Horgan, Santiago

Abstract

Background: Epidemiological studies have shown an equal gender distribution of obesity in the United States; however, literature suggests approximately 80% of patients undergoing bariatric surgery are female. The aim of this study is to identify factors that contribute to this gender disparity. Study Design: A retrospective analysis of the Nationwide Inpatient Sample was performed. Obese patients who underwent open or laparoscopic gastric bypass or sleeve gastrectomy were identified using International Classification of Diseases, 9th edition codes. Patients <18 years of age were excluded. Female gender was used as a dependent variable to determine factors that influence gender distribution. Multivariate analyses adjusted for age, race, state within the United States, Charlson Comorbidity Index, income level, and insurance status. Results: From 1998 to 2010, 190,705 patients underwent bariatric surgery (93% gastric bypass, 7% sleeve gastrectomy). Females made up 81.36% of the population. An 80% to 20% female to male distribution was maintained for every year (1998-2010) and was unchanged within individual states. Patients were more likely to be female if from a lower-income neighborhood or if African American or Hispanic (P<.05). Patients were less likely to be female with increasing age, more comorbidities, or private insurance (P<.05). Conclusions: The unequal gender distribution in bariatric surgery patients is influenced by demographic and socioeconomic factors. This disparity is narrowed in patients who are older and have more comorbidities, whereas the disparity is widened for certain races and lower incomes. Given the equal distribution of obesity in the United States, the widespread gender gap in bariatric surgery may suggest an underuse in obese men.

Published
2015

37. Phase II clinical experience and long-term follow-up using the next-generation single-incision platform FMX314

Author

Berducci, Martin, primary, Fuchs, Hans F., additional, Omelanczuk, Pablo, additional, Broderick, Ryan C., additional, Harnsberger, Cristina R., additional, Langert, Joshua, additional, Nefa, Jorge, additional, Jaureguiberry, Pablo, additional, Gomez, Pablo, additional, Miranda, Laura, additional, Jacobsen, Garth R., additional, Sandler, Bryan J., additional, and Horgan, Santiago, additional

Published
2015
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41. Foramen of Winslow hernia: a minimally invasive approach

Author

Harnsberger, Cristina R., primary, McLemore, Elisabeth C., additional, Broderick, Ryan C., additional, Fuchs, Hans F., additional, Yu, Peter T., additional, Berducci, Martin, additional, Beck, Catherine, additional, Almadani, Moneer, additional, Jacobsen, Garth R., additional, and Horgan, Santiago, additional

Published
2014
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42. Laparo-endoscopic transgastric resection of gastric submucosal tumors

Author

Barajas-Gamboa, Juan S., primary, Acosta, Geylor, additional, Savides, Thomas J., additional, Sicklick, Jason K., additional, Fehmi, Syed M. Abbas, additional, Coker, Alisa M., additional, Green, Shannon, additional, Broderick, Ryan, additional, Nino, Diego F., additional, Harnsberger, Cristina R., additional, Berducci, Martin A., additional, Sandler, Bryan J., additional, Talamini, Mark A., additional, Jacobsen, Garth R., additional, and Horgan, Santiago, additional

Published
2014
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46. Laparoscopic cholecystectomy using a novel single-incision surgical platform through a standard 15mm trocar: initial experience and technical details

Author

Broderick, Ryan C., primary, Omelanczuk, Pablo, additional, Harnsberger, Cristina R., additional, Fuchs, Hans F., additional, Berducci, Martin, additional, Nefa, Jorge, additional, Nicolia, Javier, additional, Almadani, Moneer, additional, Jacobsen, Garth R., additional, Sandler, Bryan J., additional, and Horgan, Santiago, additional

Published
2014
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48. Laparoscopic cholecystectomy using a novel single-incision surgical platform through a standard 15 mm trocar: initial experience and technical details.

Author

Broderick, Ryan C, Omelanczuk, Pablo, Harnsberger, Cristina R, Fuchs, Hans F, Berducci, Martin, Nefa, Jorge, Nicolia, Javier, Almadani, Moneer, Jacobsen, Garth R, Sandler, Bryan J, and Horgan, Santiago

Subjects
GALLSTONES, SURGICAL instruments, PILOT projects, RESEARCH, CLINICAL trials, ANALGESICS, DICLOFENAC, RESEARCH methodology, LAPAROSCOPIC surgery, CHOLECYSTITIS, MEDICAL cooperation, EVALUATION research, CHOLECYSTECTOMY, PRODUCT design, NAVEL, GALLBLADDER diseases, COMPARATIVE studies, ECCHYMOSIS, POSTOPERATIVE pain, LONGITUDINAL method
Abstract

Objective: Single-incision minimally invasive surgery has previously been associated with incisions 2.0-3.0 cm in length. We present a novel single-incision surgical platform compatible for insertion through a standard 15-mm trocar. The objective of this study is to evaluate the safety and feasibility of the platform.Methods: The technology is currently a Phase I investigational device. It features articulating surgical instruments and is inserted through a multiple-use introducer. The platform's introducer requires a standard 15-mm laparoscopic trocar. Cholecystectomy is performed through a 15-mm umbilical incision utilizing an additional epigastric 2-mm needle-port grasper for gallbladder retraction. A prospective feasibility study was performed at a single-center. Inclusion criteria were age 18-75 years and biliary colic. Patients were excluded if they had acute cholecystitis, dilation of the biliary tree, severe coagulopathy, BMI > 40 kg/m(2), or choledocholithiasis. Endpoints included the success rate of the platform, hospital length of stay, post-operative pain medication usage, cosmetic results, and presence of hernia.Results: Six patients (5 female) with an average age of 41 years and BMI 28 kg/m(2) underwent cholecystectomy with the platform. Average OR time was 91 min and umbilical incision length did not exceed 15 mm. One case was converted to standard laparoscopy due to mechanical failure of the clip applier instrument. There were no intraoperative complications. Post-operatively, two patients developed self-resolving umbilical ecchymoses. Average length of stay was 13 h. Pain control was achieved with diclofenac for less than 7 days. At 1 month follow-up there were no complications and no umbilical hernias.Conclusions: This phase I study demonstrates that single-incision cholecystectomy through a 15-mm trocar with the Fortimedix Surgical B.V. single-incision surgical platform is feasible, safe, and reproducible. Additional benefits include excellent triangulation and range of motion as well as exceptional cosmetic results. Further studies will be needed to evaluate long-term hernia rates. [ABSTRACT FROM AUTHOR]

Published
2015
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49. Postoperative Ileus.

Author

Harnsberger CR, Maykel JA, and Alavi K

Abstract

Postoperative ileus (POI) is a common complication following colon and rectal surgery, with reported incidence ranging from 10 to 30%. It can lead to increased morbidity, cost, and length of stay. Although definitions vary considerably in the literature, in its pathologic form, it can be characterized by a temporary inhibition of gastrointestinal motility after surgical intervention due to nonmechanical causes that prevents sufficient oral intake. Various risk factors for development of POI have been identified including increasing age, American Society of Anesthesiologists scores 3 to 4, open approach, operative difficulty, operative duration more than 3 hours, bowel handling, drop in hematocrit or need for a transfusion, increasing crystalloid administration, and delayed mobilization. While treatment is expectant and supportive, significant investigations into strategies to mitigate development of POI or shorten its duration have been undertaken with mixed results. There is significant evidence to suggest that a minimally invasive approach and multimodal pain regimens reduce the development of POI. The beneficial effect of chewing gum, alvimopan, and enhanced recovery after surgery protocols may decrease development of POI in selected groups of patients who undergo elective colorectal surgery, and shorten time to return of bowel function, but overall, the data remain inconclusive.

Published
2019
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50. Comparison of bariatric restrictive operations: laparoscopic sleeve gastrectomy and laparoscopic gastric greater curvature plication.

Author

Broderick RC, Fuchs HF, Harnsberger CR, Sandler BJ, and Jacobsen GR

Abstract

Morbid obesity continues to increase in prevalence, becoming a major socioeconomic and medical problem. The success in treating morbid obesity with surgery has been well documented. The categories of surgical treatment include restrictive, malabsorptive, and combination operations. Two of the restrictive operations at the forefront of today's treatments are laparoscopic sleeve gastrectomy (LSG) and laparoscopic gastric greater curvature plication (LGCP). A literature review has been completed to compare the current technique and results for LSG and LGCP. LSG is a restrictive technique in which reduced gastric volume is achieved by partial greater curvature resection. The benefits of LSG include ease of operation, sustainable weight loss, and low complication rate. The disadvantages include risk for severe complications such as gastric leak and bleeding. LGCP is a novel restrictive technique which reduces gastric volume by plication of the greater curvature; it is still in the investigational stages for use in the United States. A gastric tube is formed with the plication, but no portion of the stomach is excised. The benefits of LGCP include low cost, low risk of complication, such as gastric perforation and bleeding, as well as adequate short term weight loss. The disadvantages include higher risk of nausea and vomiting post-op, a non-zero risk of perforation and bleeding, and likely an unsustainable weight loss. In comparison, LGCP is considered feasible and safe in the short term and especially suited for institutions requiring lower-cost procedures. However, LGCP weight loss may be unsustainable compared to LSG. While LSG complication rates are slightly higher, LGCP is an inferior restrictive procedure for weight loss. Further studies are needed to evaluate the long term outcomes for procedural comparison.

Published
2014

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