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Biomedical subjects

A Darzi

Publications and source records attributed to A Darzi.

177 records · Page 10Linked to original sources
PubMed1991

Laparoscopic cholecystectomy: a hundred consecutive cases.

Laparoscopic cholecystectomy is a new, minimaly invasive technique for removing the gallbladder which has several advantages over the traditional laparotomy cholecystectomy. We reviewed our initial experience with 100 consecutive patients in whom laparoscopic cholecystectomy was attempted. The indications for operation were biliary colic, chronic cholecystitis, acute gallbladder and gallstone pancreatitis. Laparoscopic cholecystectomy was successfully performed in 87 patients. Anaesthesia time was 144 +/- 52 min. There was no mortality while overall morbidity was 14%. One patient had a retained common bile duct stone. Postoperative hospital stay was 4.1 +/- 2.2 days and the mean time to full activity in a random sample of 25 patients was 13.7 +/- 11.7 days. Laparoscopic cholecystectomy is a safe effective procedure which removes the gallbladder. We suggest that this technique be considered in all patients undergoing cholecystectomy.

Adolescent↗
PubMed1991

Combined ultrasound-guided extracorporeal shockwave lithotripsy and MTBE instillation in the treatment of common bile duct stones.

We report on our initial experience in the treatment of 4 patients with common bile duct stones with extracorporeal shockwave lithotripsy, either alone or in combination with methyl-tert-butyl ether. In four patients, common bile duct stones were successfully fragmented employing a second-generation ultrasound-guided piezoelectric lithotripter (EDAP LT-01). In two of these patients direct application of methyl-tert-butyl ether to the gallstone was utilized to assist in dissolution. There was no mortality or morbidity attributable to either treatment modality. In this first report of this combination of treatments we conclude that ESWL probably has a complementary role to play in the management of patients with common bile duct stones.

Adult↗
PubMed1990

Gallstone clearance: a randomized study of extracorporeal shock wave lithotripsy and chemical dissolution.

Following extracorporeal shock wave lithotripsy it is not known whether gallstone fragments are cleared from the gallbladder without the use of oral dissolution therapy. To assess the efficacy of lithotripsy and dissolution therapy, alone or in combination, 35 patients were randomized to one of three treatment groups: lithotripsy alone, dissolution therapy alone or combined lithotripsy and dissolution therapy. All patients had symptomatic gallstones, functioning gallbladders and comparable stone profiles. Lithotripsy was administered using a piezoelectric lithotripter. Dissolution therapy consisted of combined bile acid and terpene. Clearance was assessed at 6 months using ultrasound and oral cholecystography. Patients with less than 50 per cent stone clearance at the end of 6 months were considered failures. The number of patients with total or partial clearance in the combined group (7/10) was significantly greater than those in the lithotripsy alone group (0/10, P less than 0.002). Gallstone clearance following lithotripsy appears to be dependent upon dissolution therapy.

Adult↗
PubMed1990

Biliary intervention via minicholecystostomy.

Minicholecystostomy was performed in 24 elderly patients, under local anaesthesia. All had symptomatic gallstones removed utilizing endoscopy and fluoroscopy. These procedures were well tolerated, with no significant complications, despite severe coexistent disease. One patient has had recurrent problems due to gallstones and one has died from disseminated malignancy. The remaining 22 are well and symptom-free. This combined surgical and radiological approach is a useful alternative procedure for patients with gallstones who are a poor risk for general anaesthesia.

Aged↗
PubMed1990

Piezoelectric lithotripsy and soft tissue injury. Safety limits in the experimental and clinical setting.

Controversy surrounds the capacity of extracorporeal shock wave lithotripsy to cause soft tissue injury. This study examines the influence of different dosages of shock waves on the gall bladder in both humans and an animal model. Sixty one guinea pigs were divided into groups and subjected to different numbers of shock waves (6,000, 24,000, and 48,000) at different frequencies (2.5, 5.0, 10, 20 shock waves per second) and sacrificed at different intervals. Soft tissue damage after lithotripsy seemed to be related to the number of shock waves administered. In addition, repeated administration of low dose lithotripsy (at weekly intervals for six weeks) did not seem to produce a cumulative injury. Finally, in the animals sacrificed one month after receiving high dose lithotripsy, no soft tissue damage was evident, indicating satisfactory healing. Thirty patients were subjected to either high dose (36,000 shock waves) or low dose (6,000 shock waves) lithotripsy 24 hours before elective cholecystectomy. Both macroscopic and microscopic evidence of soft tissue injury were detected in a significantly higher percentage of patients who received a high dose in a single treatment (p less than 0.05). The group who received repeated low dose lithotripsy showed no evidence of cumulative injury. We conclude that low dose lithotripsy produces minimal soft tissue injury and is safe when repeated up to six times at weekly intervals.

Animals↗
PubMedDate not supplied

Interventional MR-guided excisional biopsy of breast lesions.

Interventional MR (IMR) machines have produced unique opportunities for image-guided surgery. The open configuration design and fast pulse sequences allow intraoperative scanning to monitor procedures. This study was undertaken to assess the potential use of IMR for image-guided surgery. Benign breast lesion excision was chosen as an uncomplicated surgical model. Ten female patients with known benign tumors underwent excision biopsy under general anesthesia in a Signa SP10 .5-T IMR machine (General Electric Medical Systems, Milwaukee, WI). Lesions were localized with precontrast and postcontrast (intravenous gadolinium-diethylenetriamine pentaacetic acid, .2 mmol/kg) fast multiplanar spoiled gradient-recalled acquisition in the steady state (GRASS) sequences. Preoperative "real-time" fast gradient-recalled sequences were also obtained using the Flashpoint (General Electric Medical Systems, Milwaukee, WI) tracker device. The maximum dimensions of each lesion were measured from the resulting images. Excision was performed using titanium instruments and an ultrasonically activated scalpel. Intraoperative real-time scanning demonstrated the resection margin and confirmed complete excision. The maximum dimensions of the macroscopic specimens were compared with those from the MR images. All tumors were visualized with the Signa scanner and real-time imaging and the images were enhanced after intravenous contrast. Maximum dimensions on histologic examination were not significantly different from those measured from Signa (P > .17) or real-time images (P > .4). There was no significant difference between lesion size from Signa and real-time images (P > .25). All postprocedure scans demonstrated complete excision. There were six fibroadenomas, two foci of sclerosing adenosis, one area of fibrocystic disease, and one schwannoma. Intraoperative MR scanning reliably identifies palpable breast tumors and can accurately guide surgical excision. Further work using MR guidance can now be performed in other general surgical areas.

Adult↗
PubMedDate not supplied

Evaluation of virtual reality bronchoscopy as a learning and assessment tool.

BACKGROUND: Conventional training in bronchoscopy involves a trainee performing on a real patient under supervision. This method of training is not only expensive, but there is also potential for increased patient discomfort. Simulators permit the acquisition of necessary technical skills required for the procedure. Virtual reality (VR) has been an integral part of training in aviation, and the application of this technology in medical training needs to be evaluated. OBJECTIVE: This study was conducted to evaluate the efficacy of a VR bronchoscopy simulator as a learning and assessment tool. METHODS: The bronchoscopic simulator (HT Medical Systems, Maryland, USA) is a VR computer programme. The simulator has the ability to assess competence by a set of parameters, which formed the data for the study. Nine novices without previous bronchoscopic experience formed the study group (group 1). Nine experienced bronchoscopists having performed between 200 and 1000 bronchoscopies formed the other group (group 2). We assessed the efficacy of the system as a learning tool by studying whether there was a significant difference between the first and subsequent sessions of the subjects from group 1 and by comparing the performance of the two groups. Statistical analysis was done using the Mann-Whitney U test and the Wilcoxon signed ranks test. RESULTS: There was a significant difference in performance between the first attempt of group 1 and the performance of the experts in terms of percentage of segments visualised and number of wall collisions and the economy of performance. Among the subjects from group 1, there was a significant improvement in percentage of segments visualised by the third attempt (p = 0.04), in the economy of performance by the sixth attempt (0.008) and in the number of wall collisions by the sixth attempt (0.024). When each attempt of the novices was compared with the performance of group 2, the significance in the difference of the percentage of segments studied (p = 0.09) and the economy of performance disappeared by the third attempt (0.06), while the difference in the number of wall collisions disappeared by the fifth attempt (p = 0.06). CONCLUSIONS: This study has been able to establish the face, construct and content validity of the simulator and the potential for it to be an effective training tool.

Bronchoscopy↗
PubMedDate not supplied

[Laparoscopic +proctopexy].

BACKGROUND: Although not common, rectal prolapse in adults can often be a debilitating conditions. Its only effective treatment is surgical. Among the many procedures described for the treatment of rectal prolapse, abdominal rectopexy is one of the preferred. It consists of fixation of the rectum to the sacrum and does not require any intestinal resection or anastomosis. However, like all open abdominal surgery associated with a large incision this operation may result in significant morbidity which is exacerbated by the advanced age of the patient. METHODS: An abdominal rectopexy carried out completely laparoscopically is described. The rectum is fully mobilised down to the pelvic floor and then fixed to the sacrum employing a polypropylene mesh. The mesh is first stapled to the sacral hollow and then sutured on both sides of the rectum. Thus the mesh is wrapped around the lateral aspects of the rectum, but the anterior rectal wall is left free. Laparoscopic techniques have been applied to a wide range of benign and malignant colorectal procedures. RESULTS: However most of colorectal laparoscopic techniques involving bowel resection, are technically demanding and require often an abdominal incision to deliver the specimen and fashion the anastomosis. CONCLUSIONS: Without the need for bowel resection, the laparoscopic rectopexy may constitute an optimal application of laparoscopic colorectal techniques and may soon become the gold standard for the treatment of rectal prolapse.

Humans↗