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Sackier JM. Adverse reactions to antihistamine-decongestant. Ann Allergy Asthma Immunol 1995; 74:356. [PMID: 7536615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Halevy A, Lin G, Gold-Deutsch R, Lavi R, Negri M, Evans S, Cotariu D, Sackier JM. Comparison of serum C-reactive protein concentrations for laparoscopic versus open cholecystectomy. Surg Endosc 1995; 9:280-2. [PMID: 7597598 DOI: 10.1007/bf00187768] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In an attempt to quantify the difference in tissue damage between open cholecystectomy (OC) and laparoscopic cholecystectomy (LC), we have compared in a prospective manner the pre- and post-operative concentrations of serum C-reactive protein (CRP) in 17 patients undergoing LC and 13 patients undergoing OC. In addition, we measured the pre- and postoperative white blood cell counts (WBC), the postoperative body temperature, and the postoperative duration of hospitalization. There were no differences in the preoperative serum CRP concentrations--5.9 +/- 2.62 mg/l (mean +/- SD) for the LC group and 6.12 +/- 2.38 mg/l for the OC group. Serum CRP rose markedly following OC compared to that of patients who underwent LC (128.6 +/- 45.1 mg/l vs 26.8 +/- 10.5 mg/l) (P < 0.001). There were also significant differences in the postoperative WBC count (14,000 +/- 2,900 cells for the OC group vs 10,600 +/- 3,000 cells for the LC group), the postoperative body temperature (37.5 +/- 0.3 degrees C vs 37.0 +/- 0.3 degrees C), and the postoperative hospital stay (5.5 +/- 1.5 days vs 1.9 +/- 0.9 days). There was no correlation between serum CRP concentrations and the other postoperative parameters. These results provide us with biochemical evidence supporting the clinical observation that LC is far less traumatic to the patient than OC.
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Abstract
As eloquently stated by Dr. Richard Bucholz in his introduction to the first edition of this journal, "the concept of image guidance in surgery may initially be deemed a non-sequitur: by definition, we use images perceived by our optic systems to lead us to our surgical decisions and actions." However, the thrust of this journal is to define the relationships between Homo sapiens and the technology that is now an interface between surgeon and patient. In this article I will discuss how such technology effects the general surgeon, including devices and designs currently in use and those that are mere speculation. A leader in this field, Colonel Richard Satava, has stated succinctly, "Predicting the future-trends in any profession jeopardizes the credibility of the author." I have been guilty of such speculation and it is amazing how rapidly concepts move from probability to possibility to implausibility. This is another reason why a journal in this electronic format is so appealing.
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Abstract
Laparoscopy was first performed at the turn of the century, but it was not until the introduction of laparoscopic cholecystectomy that the procedure became widely adopted by general surgeons. Since then, traditional open procedures, including cholecystectomy, exploratory laparotomy, colectomy, hernia repair, and appendectomy, are being widely performed laparoscopically. The advantages of laparoscopic surgery, including less postoperative pain due to smaller surgical incisions, shorter hospital stay, quicker return to preoperative activity, and superior cosmesis, resulted in widespread popularity with both surgeons and patients. In certain situations, the traditional method may be superior to the laparoscopic approach, as may be the case with laparoscopic hernia repair. It is difficult to justify converting a local, extraperitoneal, 45-minute, outpatient inguinal hernia repair in a virgin groin into a general anesthetic, transperitoneal, 2-hour plus, possibly inpatient laparoscopic procedure with the implantation of mesh. However, data may indicate that this operation does indeed have benefits. We must, therefore, carefully study such new operations. With the advent of a new surgical procedure, both surgeons and anesthesiologists must be familiar with the various complications unique to this technique. If recognized early, potentially life-threatening complications, including gas embolization and tension pneumothorax, can be corrected.
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Sackier JM, Jessup G, Krenz H, Allen W, Ahari F. Biofragmentable anastomosis ring for laparoscopic bowel surgery. Surg Endosc 1994; 8:1190-4. [PMID: 7809803 DOI: 10.1007/bf00591048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Laparoscopic surgery is now being applied for colonic resection, and one of the key challenges is fashioning a sound anastomosis. The biofragmentable anastomosis ring, a modern version of the Murphy Button, has been utilized in a series of experiments to develop and evaluate laparoscopic anatomotic techniques. A series of purpose-built devices were used to fashion left and right simulated colectomies as well as for a variety of other anastomoses. Survival animal experiments were performed and demonstrate the feasibility of this technique.
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Waxman K, Birkett DH, Sackier JM, Este-McDonald J, Duquette J. Clinical and laboratory evaluation of an electrosurgical laparoscopic trocar. Surg Endosc 1994; 8:1076-9. [PMID: 7992179 DOI: 10.1007/bf00705723] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Electrosurgical energy may be utilized as an adjunct to mechanical force for insertion of laparoscopic trocars. The advantage of this approach may be better operator control of insertion, with less risk of intraperitoneal and retroperitoneal injury. To assess the safety and efficacy of electrosurgical trocars, we compared them to mechanical trocars in clinical and animal trials. During 100 trocar introductions in 25 laparoscopic cholecystectomies, insertion force was measured. In contrast to mechanical trocars, which required progressively more force to insert as size increased, electrosurgical trocars required the same low insertion force regardless of size. No wound complications occurred. In animal experiments, wound healing (measured histologically and by bursting strength) was normal and equivalent for mechanical and electrosurgical insertions. We conclude that electrosurgical trocars require less force for insertion and do not impair wound healing. Electrosurgical trocars may thus offer important safety advantages over mechanical trocars.
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Dunham R, Sackier JM. Is there a dilemma in adequately training surgeons in both open and laparoscopic biliary surgery? Surg Clin North Am 1994; 74:913-21; discussion 923-9. [PMID: 8047949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
It is apparent that no inherent dilemma exists in training surgeons in both open and laparoscopic techniques. The important point is that surgeons are trained: a solid foundation in the basic sciences, well-developed technical skills, a large clinical experience on which to base future decisions, and the insight to know when one's skills require improvement. The principles of biliary surgery should be adhered to, and in one's haste to become proficient at laparoscopic techniques, one must not abandon the most basic of these-the unequivocal identification of all structures before ligating, dividing, clipping, or otherwise sacrificing tissues.
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Unger SW, Olsen DO, Nagy AG, Zucker KA, Fitzgibbons RJ, Soper NJ, Petelin JB, Sackier JM, Katkhouda N, Edelman DS. Laparoscopic surgery: surgical education in the People's Republic of China. Surg Laparosc Endosc Percutan Tech 1994; 4:277-83. [PMID: 7952438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In 1991, because of the international emphasis on laparoscopic surgery, a large contingency of surgeons took on the task of introducing laparoscopy to the People's Republic of China. This trip was a technological feat, since all of the equipment and instrumentation had to be carried into the country. This necessitated a major coordinated effort among professional teaching staff and industry representatives with their transported equipment. This unique educational opportunity is detailed in this article, which highlights, in particular, the contrast between the new "high-tech" surgery and the reality of a developing country.
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Sackier JM. Laparoscopic surgery comes of age. Int Surg 1994; 79:186-7. [PMID: 7883489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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Halevy A, Gold-Deutch R, Negri M, Lin G, Shlamkovich N, Evans S, Cotariu D, Scapa E, Bahar M, Sackier JM. Are elevated liver enzymes and bilirubin levels significant after laparoscopic cholecystectomy in the absence of bile duct injury? Ann Surg 1994; 219:362-4. [PMID: 8161261 PMCID: PMC1243152 DOI: 10.1097/00000658-199404000-00006] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Increased aspartate aminotransferase (AST), alanine aminotransferase (ALT), and bilirubin levels were noted incidentally after a laparoscopic cholecystectomy. The percentage in which such elevation occurs and its clinical significance in the absence of bile duct injury were investigated. SUMMARY BACKGROUND DATA Bile duct injury is the most feared complication of laparoscopic cholecystectomy. Some laboratory tests may be indicative of this complication, such as increases in liver enzyme (AST, ALT, and alkaline phosphatase [ALP]) and bilirubin. These parameters have not been investigated in patients who had laparoscopic cholecystectomy and in whom no damage to the bile duct was noted. METHODS Sixty-seven patients with normal results of preoperative liver function test were entered into the study. Blood was collected 24 hours after laparoscopic cholecystectomy, and AST, ALT, ALP, and bilirubin levels were measured. RESULTS A mean 1.8-fold increase in AST occurred in 73% of patients; 82% showed a 2.2-fold increase in ALT. A statistically nonsignificant increase was noted in 53% of patients (ALP remained within normal limits), and in 14% of patients bilirubin levels were increased (they were primarily of the unconjugated type). CONCLUSIONS In many patients a significant increase in AST and ALT levels occurred after laparoscopic cholecystectomy, but they returned to normal values within 72 hours. The cause of this is unclear, and these elevations appear to have no clinical significance.
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Sackier JM. EndoScope: world literature reviews. Surg Endosc 1994. [DOI: 10.1007/bf00591835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Szabò Z, Sackier JM. Laparoscopic fixation and guiding devices. Surg Technol Int 1994; 3:149-152. [PMID: 21319083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Since the new advances in video technology in the mid 1980's and the couplmg of the video camera to the laparoscope the surgeon no longer needs to control the laparoscope with his own hands. The advantage of this new development in laparoscopic surgery is that (1) it is not as tiring to perform (i.e., he no longer had to bend over the patient to look through the laparoscope's ocular), (2) the whole operating team could follow the progress of the surgery (for better or worse), and (3) that the surgeon is then enabled to operate with two hands, a new skill which must be learned since it is one of the keys to being more effective and efficient under the laparoscope. One of these advanced skills, intracorporeal suturing, is an especially demanding skill and requires a well-centered, and steady camera support for the technique to be performed efficiently. The disadvantage is that he must give oral commands to the individual who is now charged with guiding the laparoscope within the operative field and this disadvantage alone is sometimes thought the tip the balance in the wrong direction.
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Hunter JG, Sackier JM, Berci G. Training in laparoscopic cholecystectomy. Quantifying the learning curve. Surg Endosc 1994; 8:28-31. [PMID: 8153861 DOI: 10.1007/bf02909489] [Citation(s) in RCA: 57] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
There is no clear consensus on the best way to train general surgeons to perform laparoscopic cholecystectomy (LC). We attempted to quantify the "learning curve" for 86 surgeons attending eight consecutive 3-day, three-pig courses in LC. Each step of the operation was scored by the instructor for successful performance: Uncomplicated pneumoperitoneum (p), cystic duct and artery dissection (cd), artery and duct clipping (cc), operative cholangiography (oc), gallbladder dissection without holes (gd), liver bed hemostasis (h), gallbladder removal in one piece (i), and no abdominal organ injury (in). As well, operative time, method of dissection, and contact Nd: YAG or electrocautery were recorded. The percentage of students successfully completing each task for the first and third pigs on which they acted as surgeon was as follows: [table: see text] The operative time for the first and third pigs was 1.3 +/- 0.56 and 0.70 +/- 0.34 (mean +/- SD) h, respectively (P < 0.01). When students were trained with the contact Nd: YAG laser there was more blood loss than with electrosurgery (P < 0.001). Statistically significant improvement could only be demonstrated in the most difficult task, gallbladder dissection without perforation, but that task had not been mastered by the end of 3 days. The flat portion of the laparoscopic cholecystectomy "training curve" had not been reached by the end of the program.
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Abstract
The evolution of laparoscopy from a monocular view to the video screen has enabled all in the operating room to see the procedure. This has meant the surgeon must rely on an assistant to hold the scope, which has many drawbacks. Robotic enhancement technology creates a symbiotic relationship between the surgeon and robot and leads to great improvement in the performance of the case.
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Sackier JM, Furumoto NL. Laparoscopy in the trauma patient. Surg Technol Int 1993; 2:101-104. [PMID: 25951549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The first laparoscopic exam of the abdominal viscera was done by Keillng in 1902. Since that time, laparoscopy has been used more extensively in abdominal and pelvic disorders by gynecologists and gastroenterologists than general surgeons. However, since the introduction of laparoscopic cholecystectomy in the 1980s by Mouret in France and Muhe in Germany, laparoscopy has been embraced by the general surgeon and has exponentially increased in number and types of procedures being done. New technology, such as the enhancement of video image along with better instrumentation, has further accelerated the acceptance of "minimally invasive" surgery in all surgical specialties.
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Sackier JM. Laparoscopic abdominoperineal resection of the rectum. Br J Surg 1993; 80:1349. [PMID: 8242322 DOI: 10.1002/bjs.1800801045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Shoop SA, Sackier JM. Laparoscopic cecopexy for cecal volvulus. Case report and a review of the literature. Surg Endosc 1993; 7:450-4. [PMID: 8211629 DOI: 10.1007/bf00311742] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A case of intermittent cecal volvulus in an immunocompromised patient is presented. This patient, whose bowel was viable, was managed successfully by laparoscopic cecopexy. As a clinical entity, cecal volvulus usually presents as either an unrelenting process, culminating in gangrenous bowel, or as an intermittent, recurrent condition with spontaneous resolution but which also may lead to loss of intestinal viability. Surgical management is required in almost every case; however, a review of the literature reveals considerable controversy as to what constitutes the best operation for cases in which the bowel is viable. The most appropriate operation is usually dictated by the clinical circumstances, and in many settings cecopexy is a satisfactory choice of procedure; resection is obviated, bowel need not be opened, and the operation can be performed laparoscopically relatively rapidly.
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Sackier JM, Berci G. Laparoscopic bile duct injuries. Ann Surg 1993; 218:215-6. [PMID: 8343004 PMCID: PMC1242940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Sackier JM, Slutzki S, Wood C, Negri M, Moor EV, Halevy A. Laparoscopic endocorporeal mobilization followed by extracorporeal sutureless anastomosis for the treatment of carcinoma of the left colon. Dis Colon Rectum 1993; 36:610-2. [PMID: 8043037 DOI: 10.1007/bf02049871] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Surgery has become progressively more reliant on technology. The technique of colonic anastomosis utilizing the biofragmentable anastomotic ring (BAR) is one such example. The benefits of therapeutic laparoscopy have been applied to the arena of colorectal surgery. A case is presented that combines these two modalities in a patient with colon cancer, laparoscopic mobilization of the large bowel, exteriorized resection, and BAR anastomosis.
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