Abstract:

The human hand-arm system provides seven degrees of freedom for the manipulation of objects in space. In open surgery these motion axes can be used fully when guiding the surgical instrument. In endoscopic procedures the surgical instrument is fixed to the point of trocar insertion, resulting in only four degrees of freedom. This leads to a loss of instrumental functionality in endoscopic procedures. Robotics and telemanipulator technology can be used to restore the full spatial mobility of the endoscopic instrument. A functional model of an endoscopic master-slave manipulator system has been developed and is under experimental surgical evaluation. Allied technologies include new tactile sensor and vision systems that can enhance the application of robotic systems in surgery for the future.

Authors:

Marc O. Schurr, M.D.; Gerhard Buess, M.D., Ph.D., F.R.C.S. (Ed); Bernhard Neisius, Ph.D. - Eberhard-Karls University, Tübingen, Germany; Udo Voges, Ph.D. - Institute of Applied Informatics, Karlsruhe Research Center, Karlsruhe, Germany

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Abstract:

Endoscopic ultrasound (EUS) provides high resolution images of the gastrointestinal wall and the surrounding structures. Currently, EUS is the most sensitive technique for staging of upper GI-tract tumors. Several authors have reported accuracy rates of approximately 85% in the assessment of the infiltration depth of esophageal and gastric cancer.

Authors:

Michael Hünerbein, M.D.; Bijan M. Ghadimi, M.D.; Cathleen Below, M.D.; Wolfgang Haensch, M.D.; Peter M. Schlag, M.D., Ph.D. - Virchow Hospital, Robert-Rössle Hospital and Tumor Institute, Humboldt University, Berlin, Germany

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Abstract:

Coagulation or fulguration of lesions is a technique that has long been used in medicine. A variety of thermal devices are available for coagulation and tissue destruction. In flexible endoscopy, tissue coagulation is performed by introducing a supplementary instrument through the accessory channel, which is also used for suctioning debris and fluid from the hollow structure of the GI-tract. Most tissue coagulation is performed in a monopolar mode with a ball-electrode, electrically activated biopsy forceps (hot biopsy), or utilizing a wire snare during polypectomy. Bipolar electrodes, which do not require a patient return late, but pass the electrical current from closely spaced alternating positive and negative electrodes on the instrument tip, are useful for cautery of bleeding sites and superficial desiccation of tissues, and they are available for snare polypectomy devices. Another thermal device is the heater probe, which consists of a long plastic tube with a Teflon-coated metal tip, which, when activated, becomes as hot as 200°C. This, too, can be used for thermal application directly to tissues of the GI-tract but derives its coagulation power from heat generated in the metal tip. Laser energy produces heat by molecular excitation. Laser use in the GI-tract enjoyed great popularity a decade ago, but because of its cost, its lack of portability, the need to wear protective glasses, and the variable depth of penetration, this modality has decreased in popularity among gastroenterologists. With the exception of the laser, all of the heat-producing coagulation modalities required direct tissue contact for transfer of energy from the source to tissues.

Authors:

Jerome D. Waye, M.D. - Mount Sinai Medical Center, Lenox Hill Hospital, New York, N.Y.

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Abstract:

Obesity is the second leading cause of preventable death in the United States according to C. Everett Koop, M.D., former Surgeon General of the United States. The use of tobacco is the leading cause, but in the near future, obesity will become the first. Estimates of the percentage of adult Americans who are overweight range from 35% to 50%. Those who are morbidly obese (100 pounds or more overweight), number approximately 8 million. There is no doubt that obesity is a significant public health problem, particularly when its comorbidities are considered: diabetes, hyperlipidemia, hypertension, gastroesophageal reflux, cardiovascular disease, degenerative arthritis, cholelithiasis, respiratory insufficiency, cancer, sleep apnea, and many others. Serious medical problems are usually present in patients with morbid obesity. When significant long-term weight loss is accomplished for these patients, the comorbidities almost always improve or disappear entirely.

Authors:

S. Ross Fox, M.D. - The Surgical Weight Control Clinic; Katherine M. Fox, R.N., M.P.H. - Balanced Weight Wellness and Weight Management Clinics, Tacoma, Wa.

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Abstract:

Minimally invasive surgery has become the dominant surgical procedure for cholecystectomy and many gynecological procedures. It is also gaining ground over the conventional procedures of herniorrhaphe, appendectomy. pelvic lymph node dissections, colectomies. lysis of adhesions, abdominal explorations, spleenectomy as well as thoracic, vascular and coronary bypass, and cardiac procedures.

Authors:

George C. Christoudias, M.D., F.I.C.S. - Holy Name Hospital, Teaneck, N.J.

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Abstract:

Gastroesophageal reflux disease (GERD) is the most common foregut disorder, with 7% of Americans experiencing heartburn daily. Symptoms of GERD are many and varied, including heartburn, chest pain, regurgitation, dysphagia, nocturnal aspiration, morning hoarseness, chronic cough, and wheezing. Fifty percent of symptomatic patients develop esophagitis, while 20% of patients with esophagitis develop complications, including ulceration, stricture, Barrett's esophagus, and aspiration pneumorritis.

Authors:

Robert L. Soares, Jr., M.D.; Joseph F. Amaral, M.D., F.A.C.S. - Brown University, Providence, R.I.

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Abstract:

Traditionally, inguinal hernia repair uses autogenous tissues (Shouldice, Bassini, Cooper's). While dedicated hernia clinics have shown low recurrence rates using autogenous tissues, most studies show recurrence rates in the 5% to 15% range. In addition, these tension producing repairs may lead to a longer recovery due to increased discomfort. For these reasons, the recent trend in inguinal hernia surgery has been towards using a mesh-based tensionless repair. There are three main tension-free approaches using mesh that are presently receiving the majority of attention.

Authors:

Guy Voeller, M.D., F.A.C.S. - University of Tennessee, Memphis, Tenn.

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Abstract:

The preoperative diagnosis of Meckel's diverticulum in adults is uncommon, and even more infrequent is the presentation of a bleeding Meckel's diverticulum after childhood. The case of a 22-year old, otherwise healthy male is presented here. The diagnosis was made by barium examination of small bowel and confirmed by diagnostic laparoscopy, followed by complete laparoscopic resection using an Endo-GIA Stapler (United States Surgical Corp., Norwalk, Conn.]. Histopathological examination of the specimen showed inflammed ileal mucosa with hemorrhages in several foci. The literature of Meckel's diverticula and its complications are reviewed here. Based on data from the reviewed literature and our own experience, we suggest that laparoscopic resection is the treatment of choice for Meckel's diverticulum, if it is diagnosed preoperatively or during diagnostic laparoscopy. The procedure allows for a smooth postoperative course, early discharge from the hospital, and arapid return to normal activity.

Authors:

István Gal, M.D., Ph.D.; István Kovács, M.D.; Lajos Szabó, M.D. - Bugát Pál University Teaching Hospital, Gyöngyös, Hungary; Zoltán Szabó, Ph.D., F.I.C.S. - Microsurgery and Operative Endoscopy Training Institute, San Francisco, Calif.

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Abstract:

Thoracoscopic sympathectomy was first described in 1951 but was not popularized until this decade. With the advent of videoendoscopic techniques and advances in minimally invasive surgery, thoracoscopic sympathectomy has been shown to be a safe and effective therapy in the treatment of various autonomically mediated disorders. Furthermore, numerous investigators have reported high rates of technical success and patient satisfacrion. These minimally invasive techniques used to resect the sympathetic ganglia significantly reduces the morbidity and mortality often associated with conventional open procedures. In addition, endoscopic techniques provide a magnified view of the surgical field and allow for precise identification of the sympathetic chain and points of resection.

Authors:

Samuel Ahn, M.D., F.A.C.S.; Kyung M. Ro, B.S. - Section of Vascular Surgery, University of California, Los Angeles Center for the Health Sciences, Los Angeles, Calif.

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Abstract:

In recent years, we have seen minimally invasive surgery used for a number of procedures once thought improbable if not impossible. Increased technical skills and improved instrumentation have broken down many of the early barriers to performing minimally invasive liver surgery. Improvements in imaging technologies, particularly videoscopy and laparoscopic ultrasound, have made laparoscopy the gold standard for assessment of liver pathology. Instruments and approaches for more advanced hepatic procedures (resections, tumor ablations) are currently being developed and refined.

Authors:

Paul D. Hansen, MD.; Lee Swanstrom, M.D., F.A.C.S. - Legacy Portland Hospitals, Oregon Health Sciences University, Portland, Ore.

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Abstract:

In the past, many ultrasound phantoms, with tissue-mimicking material, have been created for routine testing and calibration ultrasound scanning systems, especially to decide the accuracy of transducers in a standardized medium. Following the introduction of the color doppler, several phantoms were developed for validating quantitative measurements such as blood flow. In addition to these applications, phantoms are available to enhance the learning process in echografical skills in general.

Authors:

Guido N.M. Stultiëns, M.D.; Jack J. Jakimowicz, M.D., Ph.D., F.R.C.S. (Ed); John Creusen, M.D.; Harm J.T. Rutten, M.D., Ph.D. - Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands

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