Biomedical subjects

C N Gutt

Publications and source records attributed to C N Gutt.

44 records · Page 3Linked to original sources

PubMed1996

Experiences with percutaneous endoscopic gastrostomy.

Today the procedure of choice for long-term enteral tube feeding in patients with prolonged swallowing difficulties or inabilities is percutaneous endoscopic gastrostomy (PEG). The primary indications are head and neck cancers, neurologic dysphagia, cancer cachexia, and obstruction of the esophagus and pharynx with enough space for an endoscopic procedure. This technique requires no general anesthesia and is possible in patients with contraindications to surgical gastrostomy. Between September 1994 and April 1995 a total of 115 patients underwent PEG placement attempts. We employed the pull-technique with 15-Freka PEG tubes. The average procedure time, including esophagogastroduodenoscopy, was 17 minutes. In nine cases PEG insertion was impossible owing to severe obstruction of the esophagus. In 46 (40%) patients local abdominal pains started on the first or second postoperative day; 7 of these patients required surgical consultation, and no further intervention was needed. In only one patient was there a serious complication that required surgical intervention: a presumed perforation that turned out to have no correlate upon review. All patients received single-shot antibiotic prophylaxis; and only in those patients with abdominal symptoms do we recommend a prolonged antibiosis. The abdominal symptoms reported were due to a slight leak of gastric fluid causing a topical peritonitis, which required no further treatment. In our experience PEG is a useful alternative to surgical gastrostomy. The simplicity of this procedure leads to low complication rates, short hospitalization, and is possible on an outpatient basis. It is cost-efficient and has a much better psychological tolerance than nasogastric tubes.

Adult↗

PubMed1995

Gasless laparoscopy in abdominal surgery.

Pneumoperitoneum, as a necessary precondition of laparoscopic procedures, represents a restriction of the surgeon's freedom of movement and can lead to rare but typical complications. We describe our first experiences with laparoscopic surgery without using pneumoperitoneum. Under direct vision and digital control a fan-formed wall retractor, which is attached to an electric lift arm, is introduced into the abdominal cavity. After raising the abdominal wall, the scope is introduced through the same access and the laparoscopic procedure can be started without the technical and physiopathological problems which may occur using a pneumoperitoneum. In this gasless laparoscopic procedure, simple valveless trocars and instruments can be used. Furthermore, an unlimited suction can be obtained without a loss of exposure. During anesthesia, neither increased ventilation nor increased ventilation pressure is necessary, and the surgeon has increased freedom of action. Not only special laparoscopic instruments, but the conventional instruments, used in open surgery, can also be employed in gasless laparoscopy. In this way we performed gasless laparoscopic surgery on 54 patients: cholecystectomy (n = 37), abdominal exploration for NSAP (n = 5) or tumor staging (n = 4), fenestration of liver cysts (n = 5), and appendectomy (n = 3). We did observe three wound infections as related complications. Six times, we had to change the surgical procedure. Compared to the traditional procedure with a CO2 pneumoperitoneum, the results of the first gasless procedures demonstrate potential advantages.

Abdomen↗

PubMed1995

The gasless laparoscopic cholecystectomy.

The pneumoperitoneum, generally used for all laparoscopic procedures, can lead to specific disadvantages and result in complications, and it furthermore represents a restriction of the surgeon's freedom of movement. In July, 1993 we started doing laparoscopic surgery without the pneumoperitoneum. Under direct vision and digital control, a fan-shaped wall retractor, which is attached to an electric lift arm, is introduced into the abdominal cavity. After raising the abdominal wall, the scope is introduced through the same access and the laparoscopic procedure can be started without the technical and pathophysiological problems which may occur when using a pneumoperitoneum. In this gasless laparoscopic procedure, simple valveless trocars and instruments can be used. During anaesthesia, neither an increased ventilation nor an enlarged ventilation pressure is necessary in this way we performed gasless laparoscopic cholecystectomy in 50 patients. We observed 5 wound infections as related complications. We had to change the surgical procedure seven times. The retraction technique creates a sufficient but not optimal exposure to the gallbladder. Intraoperative changes of the instruments, suction and specimen removal appeared easier. Both conventional and laparoscopic surgical instruments were introduced through the valveless trocars. Our experience demonstrates the practicability of this technique and potential advantages.

Cholecystectomy, Laparoscopic↗

PubMed1994

Laparoscopic colon surgery in a rat model. A preliminary report.

The effects of laparoscopic colectomy on immune function require further study. Because the rat has been widely used to investigate the immune system we studied the feasibility of laparoscopic sutured colon anastomoses in a rat model. We used a low-pressure CO2 pneumoperitoneum, a 2.7-mm 30 degree wide-angle arthroscope and video system, and microotologic forceps and scissors to perform two-handed dissection and suturing of the rat colon. The procedures included laparoscopic division of the colon and colostomy (group A, n = 3), laparoscopic closure of a colotomy (group B, n = 4), and complete laparoscopic division and reanastomosis of the colon (group C, n = 4). One anesthetic death occurred in group C. Necropsy performed 1-15 days postoperatively revealed no anastomotic leaks and two anastomotic strictures. Laparoscopic sutured colon anastomosis in the rat is feasible and may provide a new model for the physiologic study of laparoscopic colon surgery.

Anastomosis, Surgical↗

PubMed1993

[Laparoscopic surgery in the rat: description of a new technique].

We report a method of laparoscopic surgery in the rat. Our technique is illustrated by gastric fundoplication requiring two handed dissection, suturing, and knot tying. This animal model for laparoscopic surgery is relatively inexpensive, can be extended to other operations, and makes use of an extensively studied animal. These factors may facilitate investigation of the physiologic effects of minimal access surgery.

Animals↗

PubMed1990

[Steroid hormone receptor status of colorectal cancers].

Tumor samples of 26 consecutive colorectal carcinomas were studied for the presence of steroid hormone receptors for estrogen and progesterone. In all cases, the estradiol receptor binding capacity was below 2 fmol/mg cytosol protein. In 4 of 26 samples, progesterone receptor levels from 13 to 23 fmol/mg cytosol protein were observed. Because of the identification of steroid receptors in some cases and single reports in literature about tumor regression under hormone therapy of colorectal carcinoma, further investigations seem indicated to study the hormone sensitivity of colorectal carcinoma.

Aged↗

PubMedDate not supplied

A review of various techniques of orthotopic liver transplantation in the rat.

Orthotopic liver transplantation (OLT) in rat is a demanding procedure, which has become a popular model to investigate various problems. Our aim was to review and analyze the various techniques of experimental OLT in the rat. A review of the literature revealed 30 techniques or technical modifications. Each modification represented a change or a simplification of the reconstruction method of five anatomical structures, which are cornerstones of a successful OLT: the suprahepatic inferior vena cava (SHVC), portal vein (PV), infrahepatic inferior vena cava (IHVC), hepatic artery (HA), and bile duct (BD). SHVC is anastomosed via microsuture or cuff. The PV anastomosis is performed by microsuture, cuff, or a microsuture-temporary splint technique. IHVC is reconstructed by a microsuture, cuff, or microsuture-temporary splint technique. Arterialization has been accomplished via microsuture (aortic segment, celiac segment, or aortic patch), cuff, splint, sleeve, or telescopic method. Nonarterialization of the graft has also been described. Methods for BD reconstruction include pull-through, telescopic, splint, and T-tube. Although a high level of microsurgical skill is the basic requirement in the microsuture technique which provides the most physiological situation and concomitantly reduces thrombosis, it increases anhepatic time compared to the cuff procedure. The learning curve of microsuture techniques is flat; beginners need much practice to become expert. The most physiologic techniques for anastomoses are preferred for long-term survival studies, while the faster techniques are options for short-term survival studies. Each research group must choose techniques according to study defined aims.

Animals↗

PubMedDate not supplied

Disposable versus reusable instruments in laparoscopic cholecystectomy. A prospective, randomised study.

We quantified and compared the advantages and disadvantages of disposable and reusable laparoscopic instruments in a prospective, randomised study of 158 cholecystectomies. The patients were randomly divided into two groups: 80 underwent surgery with reusable instruments, 78 with disposable instruments. The following parameters were recorded in both groups: duration of surgery, number of complications, technical problems during surgery, rate of conversion to open surgery, subjective postoperative pain, postoperative hospitalisation time, length of inability to work, and postoperative evaluation by the operating room personnel. No overall differences were found in subjective pain, postoperative complications, postoperative hospitalisation time, or time before returning to work. Surgery with disposable instruments was on the whole faster, with fewer conversions to open surgery, but this was statistically non-significant. Reusable instruments were associated with a statistically significant increase in the rate of intraoperative, instrument-related difficulties. In spite of longer operation times and higher personnel costs with reusable instruments, we found that cholecystectomy with reusable instruments costs an average of 1,015 DM less per procedure.

Cholecystectomy, Laparoscopic↗