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Biomedical subjects

J M Sackier

Publications and source records attributed to J M Sackier.

At least 19 recordsLinked to original sources
PubMed1995

Comparison of serum C-reactive protein concentrations for laparoscopic versus open cholecystectomy.

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.

Adult↗
PubMed1994

Biofragmentable anastomosis ring for laparoscopic bowel surgery.

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.

Anastomosis, Surgical↗
PubMed1994

Clinical and laboratory evaluation of an electrosurgical laparoscopic trocar.

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.

Abdominal Muscles↗
PubMed1994

Training in laparoscopic cholecystectomy. Quantifying the learning curve.

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.

Animals↗
PubMed1994

Robotically assisted laparoscopic surgery. From concept to development.

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.

Humans↗
PubMed1994

Are elevated liver enzymes and bilirubin levels significant after laparoscopic cholecystectomy in the absence of bile duct injury?

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.

Adult↗
PubMed1994

Laparoscopic surgery: surgical education in the People's Republic of China.

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.

China↗
PubMed1994

Is there a dilemma in adequately training surgeons in both open and laparoscopic biliary surgery?

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.

Biliary Tract Surgical Procedures↗
PubMed1993

Laparoscopic endocorporeal mobilization followed by extracorporeal sutureless anastomosis for the treatment of carcinoma of the left colon.

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.

Adenocarcinoma↗