Biomedical subjects

James F Borin

Publications and source records attributed to James F Borin.

5 recordsLinked to original sources

PubMed2006

Construct validity testing of a laparoscopic surgical simulator.

BACKGROUND: We present initial data on the construct, content, and face validity of the LAPMentor (Simbionix), virtual reality laparoscopic surgical simulator. STUDY DESIGN: Medical students (MS), residents and fellows (R/F), and experienced laparoscopic surgeons (ES), with < 30 laparoscopic cases per year (ES<30) and those with > 30 laparoscopic cases per year (ES>30), were tested on 9 basic skill tasks (SK) including manipulation of 0-degree and 30-degree cameras (SK1, SK2), eye-hand coordination (SK3), clipping (SK4), grasping and clipping (SK5), two-handed maneuvers (SK6), cutting (SK7), fulguration (SK8), and object-translocation (SK9). RESULTS: Mean MS (n=23), R/F (n=24), ES<30 (n=26), and ES>30 (n=30) ages were 26 years (range 21 to 32 years), 31 years (range 27 to 39 years), 49 years (range 31 to 70 years) and 47 years (range 34 to 69 years), respectively. In the lower level skill tasks (SK3, SK4, SK5, and SK6) the ES>30, ES<30, and R/F had similar scores, but were all substantially better than the MS scores. In the higher level skill tasks (SK7, SK8, and SK9), the ES>30 scores tended to be better than the R/F and ES<30, which were similar, and these, in turn, were markedly better than the MS. The ES>30 had notably higher SK8 scores than the R/F and ES<30, who had similar scores, and these had notably better scores than the MS. CONCLUSIONS: The noncamera skills (SK3 to 9) of the LAPMentor surgical simulator can distinguish between laparoscopically naive and ES. SK8 showed the highest level of construct validity, by accurately differentiating among the MS, R/F, ES<30 and ES>30.

Adult↗

PubMed2006

Initial experience with full-length metal stent to relieve malignant ureteral obstruction.

Ureteral obstruction caused by extrinsic compression by a malignancy generally can be overcome initially with a ureteral stent. However, the long-term failure rate is high, usually necessitating placement of a nephrostomy tube. Herein, we present the initial case, in this country, of intractable ureteral obstruction managed successfully with the newly developed all-metal Resonance stent (Cook Ireland Ltd., Limerick, Ireland) constructed of MP35N alloy, a composite of nonmagnetic nickel-cobalt-chromium-molybdenum. The patient is a 64-year-old woman with metastatic breast cancer causing retroperitoneal fibrosis and ureteral obstruction diagnosed laparoscopically. The obstruction failed to respond to placement of a single 7F double-J stent and then of two 6F double-J stents in the left ureter. As a last resort, in order to avoid nephrostomy-tube placement, the 6F metal stent was placed; this provided unobstructed flow of urine, as documented on a subsequent Whitaker test and, most recently, on a renal scan, 4 months after initial stent placement.

Alloys↗

PubMed2006

Endoscopically guided percutaneous renal access: "seeing is believing".

Image-guided percutaneous nephrostomy tube placement can be a challenging procedure, particularly in a nondilated system or in the morbidly obese patient. Herein, we report the routine use of ureteroscopy-guided percutaneous renal access. With this method, rapid, accurate creation and dilation of the nephrostomy tract is assured in all patients regardless of body habitus or stone burden.

Endoscopes↗

PubMed2006

Comparison of resolution, contrast, and color differentiation among fiberoptic and digital flexible cystoscopes.

BACKGROUND AND PURPOSE: Advances in electro-optics continue to improve the urologist's ability to perform minimally invasive procedures. While the development of flexible fiberoptic cystoscopes more than 20 years ago greatly impacted the practice of urology, distal-sensor digital technology may represent the next step in the evolution of endoscopy. We compared a new distal-sensor digital flexible cystoscope with two standard fiberoptic flexible cystoscopes. MATERIALS AND METHODS: We evaluated the resolution, contrast, and color discrimination of a new ACMIICN distal-sensor digital cystoscope with >165,000 effective pixels in its clear aperture (viewing area), a new ACMI-ACN II fiberoptic cystoscope with <15,000 pixels in its clear aperture, and a Storz 1127 office fiberoptic cystoscope. Five subjects compared each cystoscope across 13 test parameters. RESULTS: There was no difference in the performance of the two fiberoptic cystoscopes. The ICN cystoscope was statistically superior to one or both fiberoptic cystoscopes across 12 of the 13 tests, including color differentiation between shades of dark red (P < 0.05), contrast discrimination along a 15-step grayscale gradient (P < 0.001 compared with the 1127 fiberoptic cystoscope only), resolution at 10 mm (7.52 line pairs/mm [lp/mm] (ICN) nu 3.58 lp/mm for both fiberoptic cystoscopes; (P < 0.001), and clear resolution of a 1-mm target at a distance of 6.1 cm (ICN) nu 3.3 cm (1127) and 3.8 cm (ACN II) (P < 0.001). CONCLUSIONS: The ICM distal-sensor all-digital cystoscope was clearly superior to two representative fiberoptic cystoscopes in vitro in terms of resolution, contrast discrimination, and red color differentiation. In-vivo performance remains to be assessed.

Calibration↗

PubMedDate not supplied

Tubeless percutaneous nephrolithotomy using hemostatic gelatin matrix.

We describe using hemostatic gelatin matrix (FloSeal; Baxter Inc., Irvine, CA) to provide hemostasis of the tract after percutaneous nephrolithotomy, thereby obviating a nephrostomy tube. For patients who are rendered stone free, a 7F, 11.5-mm occlusion balloon catheter, passed retrograde, is used to occlude the collecting system at the level of entry of the 30F Amplatz sheath. FloSeal is then injected through the partially retracted Amplatz sheath while withdrawing the applicator and the sheath in tandem. The guidewire is withdrawn per urethra until its tip resides in the renal pelvis. A 36-cm, 7F tail stent is passed retrograde, and the skin is closed with cyanoacrylate adhesive (Ethicon, Somerville, NJ). A Foley catheter is placed, to be removed the next morning; the patient can be discharged on postoperative day 1. The ureteral stent is removed in 5 to 7 days as an outpatient procedure.

Balloon Occlusion↗