Gas leaks through laparoscopic energy devices and robotic instrumentation - a video vignette.
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ABSTRACT:
SUBMITTER: Dalli J
PROVIDER: S-EPMC7405145 | biostudies-literature |
REPOSITORIES: biostudies-literature
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| S-EPMC9392696 | biostudies-literature
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| S-EPMC7362043 | biostudies-literature
Project description:Sacrocolpopexy has been dubbed the “gold standard” repair for apical pelvic organ prolapse (POP). This study sought to determine a genetic cause for sacrocolpopexy failure by comparing genotypes from 10 women who suffered from early POP reoccurance after sacrocolpopexy surgery, versus 40 randomly selected women with long term success after the same procedure. We objectively defined early overt failure after robotic-assisted laparoscopic sacrocolpopexy as having a pelvic organ prolapse quantification system examination (POP-Q) of stage III or IV occurring in more than one compartment within six months after surgery. All medical records identified during this process were then reviewed by a panel of urogynecology attendings and fellows to select patients who were truly clinical outliers. By this method we identified 10 patients (cases) who experienced early overt surgical failure. We also randomly selected 40 controls from our research database which includes greater than 500 patients who underwent robotic-assisted laparoscopic sacrocolpopexy during the same time period and had been objectively and subjectively assessed for ≥ 12 months with surgical success at ≥ 12 months that did not undergo prolapse re-operation or re-treatment. Demographics and peri-operative details were compared between cases and controls. Exclusion criteria for controls included use of other graft material besides polypropylene mesh, prior surgery for prolapse involving graft material, and conversion to laparotomy. DNA from the 10 cases and 40 controls was isolated from buccal swabs and genotyped on a single nucleotide polymorphism (SNP) array that contains 250,000 markers (NspI 250K SNP array, Affymetrix, Santa Clara, CA). All women in this study identified as Caucasian. All subjects provided written informed consent to study participation and data release. This was a case-control study approved by the Institutional Review Board at the Atlantic Health System in Morristown New Jersey (R11-10-004).
2016-06-01 | GSE63236 | GEO
Project description:BackgroundThe laparoscopic Roux en-Y gastric bypass (LRYGB) is performed worldwide and is considered by many the gold standard treatment for morbid obesity. However, the difficult access to the gastric remnant and duodenum represents intrinsic limitations. The functional laparoscopic gastric bypass with fundectomy and gastric remnant exploration (LRYGBfse) is a new technique described in attempt to overcome the limitations of the LRYGB. The purpose of this video was to demonstrate the LRYGBfse in a 48-year-old man with type II diabetes and hypertension.MethodsAn intraoperative video has been anonymized and edited to demonstrate the feasibility of LRYGBfse.ResultsThe operation started with the opening of the gastrocolic ligament. Staying close to the gastric wall, the stomach is prepared up to the angle of His. After the placement of a 36-Fr orogastric probe, gastric fundectomy is completed in order to create a 30cc gastric pouch. A polytetrafluoroethylene banding (ePTFE) is placed at the gastro-gastric communication, 7cm below the cardia, and gently closed after bougie retraction. The bypass is completed by the creation of an antecolic Roux-en-Y 150cm alimentary and 150cm biliopancreatic limb.ConclusionThe LRYGBfse is a feasible and safe technique. The possibility to endoscopically explore the excluded stomach with an easy access to the Vater's papilla is a major advantage. Further studies are warranted to deeply explore and compare outcomes with the standard LRYGB.
| S-EPMC8041701 | biostudies-literature
Project description: Not available
| S-EPMC7436878 | biostudies-literature
Project description:PURPOSE:Bariatric-metabolic surgery in superobese patients (BMI >?50 kg/m2) is very challenging indeed with little room for error. In many cases, a two-step procedure is required, since more complex primary bariatric procedures can be technically demanding and bearing a relevant risk for the patient. At our institution, laparoscopic sleeve gastrectomy (SG) is the preferred primary procedure, followed by a conversion to either SADI-S or Roux-en-Y gastric bypass (RYGB) after initial weight loss is achieved [1, 2]. This video aims at demonstrating the conversion from primary SG to RYGB due to an adverse event in a 45-year-old superobese female patient (weight, 170 kg; BMI, 73 kg/m2). METHODS:An intraoperative laparoscopic video has been anonymized and edited to demonstrate the course of the operation on the patient mentioned above. RESULTS:The start of the procedure was uneventful. After a successful mobilization of the greater curvature, the stomach was resected with an electronic stapling device guided by a firm 36-french bougie (Rüsch, Germany) towards the angle of His. Due to a limited view, a stapler was placed over the bougie, which resulted in the stomach being subtotally transected, the staples attaching the bougie to the sleeve about 5 cm from the gastroesophageal junction. Salvage surgery after removing the remnants of the bougie was a conversion to RYGB. CONCLUSION:When performing a bariatric-metabolic surgery in superobese patients, an extended skill level is required to provide a solution, should anything go wrong. Therefore, we suggest bariatric-metabolic surgery in superobese patients to be performed solely and specifically at high-volume centres.
| S-EPMC7467964 | biostudies-literature
Project description:Sacrocolpopexy has been dubbed the âgold standardâ repair for apical pelvic organ prolapse (POP). This study sought to determine a genetic cause for sacrocolpopexy failure by comparing genotypes from 10 women who suffered from early POP reoccurance after sacrocolpopexy surgery, versus 40 randomly selected women with long term success after the same procedure. We objectively defined early overt failure after robotic-assisted laparoscopic sacrocolpopexy as having a pelvic organ prolapse quantification system examination (POP-Q) of stage III or IV occurring in more than one compartment within six months after surgery. All medical records identified during this process were then reviewed by a panel of urogynecology attendings and fellows to select patients who were truly clinical outliers. By this method we identified 10 patients (cases) who experienced early overt surgical failure. We also randomly selected 40 controls from our research database which includes greater than 500 patients who underwent robotic-assisted laparoscopic sacrocolpopexy during the same time period and had been objectively and subjectively assessed for ⥠12 months with surgical success at ⥠12 months that did not undergo prolapse re-operation or re-treatment. Demographics and peri-operative details were compared between cases and controls. Exclusion criteria for controls included use of other graft material besides polypropylene mesh, prior surgery for prolapse involving graft material, and conversion to laparotomy. DNA from the 10 cases and 40 controls was isolated from buccal swabs and genotyped on a single nucleotide polymorphism (SNP) array that contains 250,000 markers (NspI 250K SNP array, Affymetrix, Santa Clara, CA). All women in this study identified as Caucasian. All subjects provided written informed consent to study participation and data release. This was a case-control study approved by the Institutional Review Board at the Atlantic Health System in Morristown New Jersey (R11-10-004). This case-control study compared single genotypes of 10 cases to 40 controls. All subjects were identified as Caucasian. Cases were women who experienced early overt POP recurrence after robotic sacrocolpopexy, and controls were randomly selected women with long term success after the same procedure.
2016-06-01 | E-GEOD-63236 | biostudies-arrayexpress
Project description: Not available
| S-EPMC7339795 | biostudies-literature
Project description:From wellhead to burner tip, each component of the natural gas process chain has come under increased scrutiny for the presence and magnitude of methane leaks, because of the large global warming potential of methane. Top-down measures of methane emissions in urban areas are significantly greater than bottom-up estimates. Recent research suggests this disparity might in part be explained by gas leaks from one of the least understood parts of the process chain: behind the gas meter in homes and buildings. However, little research has been performed in this area and few methods and data sets exist to measure or estimate them. We develop and test a simple and widely deployable closed chamber method that can be used for quantifying indoor methane emissions with an order-of-magnitude precision which allows for screening of indoor large volume ("super-emitting") leaks. We also perform test applications of the method finding indoor leaks in 90% of the 20 Greater Boston buildings studied and indoor methane emissions between 0.02-0.51 ft3 CH4 day-1 (0.4-10.3 g CH4 day-1) with a mean of 0.14 ft3 CH4 day-1 (2.8 g CH4 day-1). Our method provides a relatively simple way to scale up indoor methane emissions data collection. Increased data may reduce uncertainty in bottom-up inventories, and can be used to find super-emitting indoor emissions which may better explain the disparity between top-down and bottom-up post-meter emissions estimates.
| S-EPMC10688665 | biostudies-literature
Project description:BACKGROUND:An increasing body of literature is supporting the safety of minimally invasive pancreaticoduodenectomy compared to open pancreaticoduodenectomy, but there are limited comparative studies between laparoscopic and robotic pancreaticoduodenectomy. The aim of this study was to compare the rate of postoperative 30-day overall complications between laparoscopic and robotic pancreaticoduodenectomy. METHODS:Patients who underwent laparoscopic and robotic pancreaticoduodenectomy were abstracted from the 2014-2015 pancreas-targeted American College of Surgeons National Surgical Quality Improvement Program. A multivariable logistic regression model was developed to determine if the type of minimally invasive approach was associated with 30-day overall complications. RESULTS:We identified 428 minimally invasive pancreaticoduodenectomy cases, of which 235 (55%) were performed laparoscopically and 193 (45%) robotically. Patients who underwent the robotic approach were more likely to be white compared to those who underwent the laparoscopic approach and were less likely to have pulmonary disease, undergo preoperative radiotherapy, and have vascular and multivisceral resection. On multivariable analysis, we found that the type of minimally invasive approach, whether laparoscopic or robotic, was not associated with overall complications. The predictors of 30-day overall complications were higher body mass index (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.02-1.09), vascular resection (OR, 2.10; 95% CI, 1.23-3.58), and longer operative time (OR, 1.002; 95% CI, 1.001-1.004). CONCLUSIONS:Robotic pancreaticoduodenectomy was associated with a similar 30-day overall complication rate to laparoscopic pancreaticoduodenectomy. Further studies are needed to corroborate these findings and to establish the best approach to perform this complex operation.
| S-EPMC5789456 | biostudies-literature