Biomedical subjects

Kevin Piercey

Publications and source records attributed to Kevin Piercey.

3 recordsLinked to original sources

PubMed2026

Standardized visual overlays enhance laparoscopic instruction: A mixed-methods evaluation.

Effective communication during laparoscopic procedures is frequently undermined by spatial disorientation and inconsistent terminology between instructors and trainees. This study examined whether standardized visual overlays on endoscopic monitors could enhance communication and learning. We conducted a three-phase mixed-methods study: qualitative observation of 20 laparoscopic teaching cases; a randomized trial of 63 second-year medical students assigned to control, clock, or alphanumeric grid (AG) overlays during three trials of a standardized transfer task; and intraoperative implementation in 44 cases (30 AG, 14 clock) with post-case surveys and qualitative feedback. In simulation, the clock overlay produced the fastest completion times, whereas the AG yielded the lowest error scores, and both overlays outperformed the control. Intraoperatively, the AG was rated higher than the clock for communication clarity, spatial orientation, perceived operative efficiency, and trainee confidence. Standardized visual overlays, particularly the AG, appear to support intraoperative teaching by providing a shared spatial frame of reference.

Laparoscopy↗

PubMed2005

Terminal loop cutaneous ureterostomy in renal transplantation: an under utilized urinary diversion technique.

PURPOSE: We evaluated the effectiveness of terminal loop cutaneous ureterostomy as a means of urinary drainage in kidney transplant recipients during a 20-year period. MATERIALS AND METHODS: Five cadaveric and 2 living related patients underwent kidney transplantation with terminal loop cutaneous ureterostomy between 1984 and 2004. These patients had no usable bladder or they were not suitable candidates for intermittent catheterization. RESULTS: Followup was 20 months to 17 years. One patient underwent stomal revision 5 months after renal transplantation. Current serum creatinine 4 years later was 166 mumol/l. The remaining 6 patients had no evidence of ureteral obstruction and rarely had bacteriuria or urinary tract infections. Four patients had a functioning allograft with normal serum creatinine. One patient died with a normally functioning allograft and the remaining patient lost his graft due to chronic rejection. No patient in this series lost the graft due to a urological cause. Overall outcomes included excellent allograft function with minimal infection or stomal stenotic complications. CONCLUSIONS: Terminal loop cutaneous ureterostomy is a simple, safe and alternative means of urinary diversion in patients with renal transplant and a defunctionalized lower urinary tract.

Adult↗

PubMed2004

McMaster experience with laparoscopic pyeloplasty.

PURPOSE: Laparoscopic pyeloplasty has been developed as a minimally invasive alternative to open pyeloplasty for the treatment of ureteropelvic junction obstruction (UPJO). Several series have been published with similar success rates for the two procedures. We present our initial experience with laparoscopic pyeloplasty. MATERIAL AND METHODS: A retrospective review of 29 consecutive patients (mean age 37 years) who underwent Laparoscopic dismembered Hynes-Anderson pyeloplasty in our institution between January 2001 to April 2003 was performed. All patients had flank pain with radiologic findings consistent with ureteropelvic junction obstruction and impaired drainage on diuretic renal scan. Patients were assessed at 6 weeks with an ultrasound and assessment of pain, then an intravenous pyelogram (i.v.p.) and diuretic renogram were completed at 6 months along with a repeat clinical assessment. RESULTS: Twenty-nine patients underwent the procedure with one patient converted to an open procedure due to difficulties with the anastomosis. Mean operating time was 225 minutes, which decreased with experience. Mean blood loss was 50 cc and no patient required transfusion. Mean hospital stay was 2.5 days. Mean follow-up was 12 months. Twenty-six patients had complete resolution of their pain and an improvement on ultrasound was demonstrated, but only six patients showed improvement in function on i.v.p. or renogram at 6 months. In five patients with 25% or less differential renal function preoperatively, the function was worse or negligible despite complete resolution of symptoms. One patient developed stent migration requiring repositioning and another developed calcification on the distal end of the stent requiring cystolithalopaxy prior to stent removal. CONCLUSIONS: In our experience, laparoscopic pyeloplasty offers excellent symptomatic relief in a minimally invasive fashion with low morbidity for adult patients with ureteropelvic junction obstruction. In patients with borderline function (25% or less) preoperatively and with a normal functioning contralateral kidney, nephrectomy should be a consideration.

Adolescent↗