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Biomedical subjects

J Himpens

Publications and source records attributed to J Himpens.

At least 37 records · Page 2Linked to original sources
PubMed2000

Laparoscopic gastroplasty (adjustable silicone gastric banding).

Until now, for treatment of morbid obesity in the long term, surgery remained as the final option. For 40 years, surgeons looked at the best procedure. Among the restrictive procedures (gastroplasty), the laparoscopic adjustable silicone banding is the least invasive surgical treatment of morbid obesity. Between October 1992 and January 1998, we performed this procedure on 652 patients. Median body mass index was 45 (range, 35-65). Median hospital stay was 3 days (range, 2-10 days). The mean operative time was 80 minutes (range, 40-240 minutes). Four patients (0.6%) presented early complications: bleeding (1 patient), gastric perforation (2 patients), and pneumonia (1 patient). Forty-seven (7.2%) patients presented late complications and needed to be reoperated. There is one case of mortality. Loss of mass body weight was 62% in 2 years. According to these results, laparoscopic adjustable silicone gastric banding seems to be a safe and efficient technique.

Adolescent↗
PubMed1999

Laparoscopic rectopexy according to Wells.

BACKGROUND: The laparoscopic approach usually reduces the morbidity of procedures performed by laparotomy. The aim of this study was to demonstrate the usefulness of laparoscopic rectopexy. METHODS: A total of 37 patients were included in this prospective study. The indication was true rectal prolapse in all patients. Incontinence was seen in 33% of the patients. A slightly modified Wells procedure was performed laparoscopically. Postoperatively, the patients were evaluated for resolution of the prolapse and incontinence. They were also questioned about their satisfaction with the procedure. RESULTS: Laparoscopy was successful in all but one case. Follow-up is available in 32 of 37 patients. Prolapse was cured in all patients, and the incontinence resolved in 11 of 12. In addition, 38% of the patients experienced significant constipation preoperatively versus 5% postoperatively.

Aged↗
PubMed1999

The world's first obesity surgery performed by a surgeon at a distance.

BACKGROUND: In recent years, laparoscopic procedures have gained popularity. The laparoscopic technique is, however, more difficult than the conventional approach, especially in obese patients. The purpose of this article is to demonstrate a solution to these difficulties. METHOD: On September 16, 1998, a laparoscopic gastric banding procedure was performed by a surgeon while he was actually sitting at a distance from his patient. The surgeon's assistant was scrubbed and gowned and stood at the patient's side. The surgeon manipulated handles that were connected to a computer in command of robotic arms mounted on the operating table near the patient. The robotic arms contained surgical tools with articulated tips, well inside the abdominal cavity. The system constituted a master-slave construction called Mona (Intuitive Surgical, Mountain View, CA). The entire procedure (adjustable silicone gastric banding) was performed solely by this system without any other intervention. RESULTS: The entire procedure lasted 90 minutes. The blood loss was 25 mL. The patient left the hospital on the second postoperative day. CONCLUSION: This procedure demonstrates that telesurgical procedures are feasible, can be performed safely even in obese patients, and improve the surgeon's comfort by restoring ergonomically acceptable conditions, by increasing the number of degrees of freedom, and by recreating the eye-hand connection lost in videoendoscopic procedures.

Adult↗
PubMed1999

[Nissen fundoplication done by remotely controlled robotic technique].

Two Nissen fundoplications were performed by a minimally invasive robotic technique on May 19, 1998. The Mona robot, was placed to the left of the patient. It held and activated surgical tools. The surgeon was placed some 3 meters from the patient and was seated at a console. He was not scrubbed. He commanded the 3 robotic arms by manipulating two handles, while observing a 3 dimensional picture recreated by a binocular system. Manipulations of the handles were translated into digital information by a computer. This information was modified by the computer with downscaling of the amplitude of motion by a factor 1 to 3 or 1 to 5. Physiologic tremor was eliminated. The computer delivered an impulse in command of the articulated robot arms via a 5 m long cable. Operating time was 4.30 hours, and 1.30 hours respectively. Blood loss was estimated at 20 and 30 ml. The two patients were discharged on the first postoperative day after a gastrograffin swallow had been performed in order to check the position of the wrap and its patency. Our experience with the Mona device may suggest that surgical robotics could have an increasingly important role in tomorrow's operating theatres. It should allow for more precise procedures, performed under better circumstances.

Adult↗
PubMed1998

[Virtual laparoscopic anatomy of the esophagogastric junction].

The anatomy of the GE junction is represented by computer synthetised pictures. This method allows to represent different organs from different angles, emphasis being put on the laparoscopic angle of vision. This should improve anatomical comprehension. The synthetic pictures have been constructed in a figurative representation. Fatty tissues have been omitted whereas the peritoneal layers covering organs and defining spaces are enhanced.

Anatomy↗
PubMed1998

Endoscopic retroperitoneal surgery.

A minimally invasive approach to the retroperitoneum is described. Basic anatomy, techniques of access and pitfalls related to the technique are discussed. Available procedures are outlined. Extended retroperitoneoscopy is an expanding field and constitutes a safe alternative to the more debilitating open approach in selected indications.

Endoscopy↗
PubMed1997

Conversions and complications in 185 laparoscopic adjustable silicone gastric banding cases.

BACKGROUND: Kuzmak's gastric silicone banding technique is the least invasive operation for morbid obesity. The purpose of this study was to analyze the complications of this approach. METHODS: Between September 1992 and March 1996, 185 patients underwent laparoscopic gastroplasty by the adjustable silicone band technique. A minimally invasive procedure using five trocars was performed. RESULTS: In 11 patients exposure of the hiatus was impeded because of hypertrophy of the left liver lobe which led to conversion in eight patients and abortion of the procedure in three other patients. Anatomical complications: We observed two gastric perforations and one band slippage at the early stage, one infection and three rotations of the access port. Functional complications: There were eight (4%) cases of irreversible total food intolerance resulting in pouch dilation and eight cases (4%) of esophagitis. One fatality on the 45th day in a patient with a Prader-Willi syndrome. CONCLUSION: The most disturbing complications of gastric banding technique are gastric perforation and pouch dilation. Their incidence may be reduced by improving the technique and by considering pitfalls of the procedure.

Adolescent↗
PubMed1997

Laparoscopic adjustable silicone gastric banding (Lap-Band): how to avoid complications.

BACKGROUND: The laparoscopic application of LAP-BAND is gaining widespread acceptance as a gastric restrictive procedure. At the same time the reported morbidities (i.e., gastric perforation, stomach and/or band slippage) are cause for some concern. METHODS: From September 1993 until May 1997, 260 patients underwent LAP-BAND at the Department of Surgery at the University of Padova, Italy. RESULTS: The mortality rate was zero and the morbidity rate requiring reoperation was 3.4% (stomach slippage, gastric perforation, erosion). In order to avoid complications the key points of the technique are reviewed: (1) reference points for dissection (equator of the balloon, left crus); (2) retrogastric tunnel within the layers of the phrenogastric ligament; (3) embedment of the band; (4) proper outlet calibration; and (5) retention sutures. CONCLUSIONS: Attention to technical details is of paramount importance for a safe, standardized and effective operation.

Adolescent↗
PubMed1995

How to avoid esophageal perforation while performing laparoscopic dissection of the hiatus.

An increasing number of surgeons attempt advanced laparoscopic procedures, involving the distal esophagus such as Nissen fundoplication, truncal vagotomy, and Heller's myotomy. At this time, there are probably as many techniques as there are surgeons. The authors have tried to provide a "ready to use" universal strategy that details how to approach the distal esophagus while avoiding the dangerous pitfalls of surgery in that area.

Adolescent↗
PubMed1995

Laparoscopic Adjustable Silicone Gastric Banding: Technique and Results.

BACKGROUND: Kuzmak's Adjustable Silicone Gastric Banding (ASGB) is the least invasive operation available for morbid obesity, and it is one of the more effective. Based on the know-how gained from performing more than 250 'open' procedures, we have developed an original laparoscopic technique, whose main steps are pouch measurement, limited dissection along the lesser and the greater curvature and the application of the retention sutures. METHODS: From September 1993 through October 1994, 30 morbidly obese patients underwent laparoscopic ASGB. RESULTS: Mean operative time was 2 h and the postoperative stay 2-3 days. Only one major perioperative complication (stomach slippage) was observed. The weight loss achieved, reported as a variation of Body Weight, Body Mass Index, per cent Ideal Body Weight and per cent Excess Weight Loss was similar to that obtained with the open procedure. CONCLUSION: This new approach is a major achievement in bariatric surgery, because it combines the minimal invasiveness of laparoscopy with the reversibility and adjustability of ASGB.

Journal Article↗
PubMed1995

Laparoscopic Placement of Adjustable Silicone Gastric Banding: Early Experience.

BACKGROUND: the authors describe a laparoscopic technique for the positioning of stoma adjustable silicone gastric banding (SASGB), which respects the main steps of the open procedure. METHODS: (1) patient position: supine with thighs abducted and 30 degrees reverse Trendelenburg; (2) Four 10 mm trocars (supra-umbilical, sub-xiphoid, right upper quadrant, left upper quadrant) and an 18 mm trocar (left subcostal); (3) exposure of the subcardial area; (4) measurement of the pouch; (5) dissection of the lesser and greater curvatures; (6) retrogastric tunnel; (7) introduction and placement of the band; (8) band closure and stoma calibration; (9) retention sutures. RESULTS: results obtained in a first (1992) series of five patients who underwent the laparoscopic application of the regular SASGB and results of a second series (1993-1994) of seven patients in whom the new LAP-ASGB was utilized are reported. CONCLUSION: this new approach can represent a major achievement in bariatric surgery, as it combines the minimal invasiveness of the laparoscopic approach with the reversibility of SASGB.

Journal Article↗