PubMed Health⌕ Search

Biomedical subjects

Adrian Park

Publications and source records attributed to Adrian Park.

At least 19 recordsLinked to original sources
PubMed2006

Bringing order to the chaos: developing a matching process for minimally invasive and gastrointestinal postgraduate fellowships.

BACKGROUND: Since 1993, there has been an increase in the number of postgraduate fellowships in minimally invasive and gastrointestinal (GI) surgery; from 9 in 1993 to more than 80 in 2004. Early on, there was no supervision or accreditation of these fellowships, and they varied widely in content, structure, and quality. This was widely recognized as being a bad situation for fellow applicants and reflected poorly on the specialties of minimally invasive (MI) and GI surgery. In an effort to bring order to this chaotic situation, the Minimally Invasive Surgery Fellowship Council (MISFC) was founded in 1997. METHOD: In 2003, the MISFC was incorporated with 77 founding member programs. The goal of the MISFC was to develop guidelines for high-quality fellowship training, to provide a forum for the directors of MI and GI fellowships to exchange ideas, formulate training curricula; to establish uniform application and selection dates; and to create an equitable computerized match system for applicants. RESULTS: In 2004, the MISFC has increased to 95 members representing 154 postgraduate fellowship positions. The majority of these positions are primarily laparoscopic in focus, but other aspects of GI surgery including bariatric, general GI, flexible endoscopy, and hepatopancreatobiliary are also represented. Uniform application and selection dates were agreed on in 2001; and in 2003, the Council established a computerized Match, administered by the National Resident Match Program, which was used for the 2004 fellowship selection. A total of 113 positions were open for the match. A total of 248 applicants formally applied to MISFC programs and 130 participated in the match. Ninety-nine positions matched on the December 10th match day, and the remaining 14 programs successfully filled on the following scramble day. Seventeen applicants did not match to a program. Post match polling of program directors and applicants documented a high degree of compliance, usability, and satisfaction with the process. CONCLUSION: The MISFC has been successful at realizing its goals of bringing order to the past chaos of the MIS and GI fellowship situation. Its current iteration, the Fellowship Council, is in the process of introducing an accreditation process to further ensure the highest quality of postgraduate training in the fields of GI and endoscopic surgery.

Endoscopy, Gastrointestinal↗
PubMed2006

Classification of hiatal hernias using dynamic three-dimensional reconstruction.

Hiatal hernias and paraesophageal hernias are common clinical entities and have a well-known classification system. Multiple modalities have been used to illustrate these hernias, most relying on artists' renderings or two-dimensional radiographic studies. However, surgeons would benefit from a comprehensive graphic representation of hiatal hernias based on current imaging technologies. We have applied polygonal mesh surface modeling techniques to render dynamic three-dimensional computed tomography-based models of the four recognized types of hiatal hernias. The resulting images allow nearly real-time navigation in an intuitive and clinically relevant fashion. This model should clarify and eventually advance the existing classification by applying modern and sophisticated image processing to established concepts.

Hernia, Hiatal↗
PubMed2006

Radio frequency identification systems technology in the surgical setting.

Radio frequency identification (RFID) is a technology that will have a profound impact on medicine and the operating room of the future. The purpose of this article is to provide an introduction to this exciting technology and a description of the problems in the perioperative environment that RFID might address to improve safety and increase productivity. Although RFID is still a nascent technology, applications are likely to become much more visible in patient care and treatment areas and will raise questions for practitioners. We also address both the current limitations and what appear to be reasonable near-future possibilities.

Diffusion of Innovation↗
PubMed2005

Laparoscopic curative resection of pheochromocytomas.

PURPOSE: Pheochromocytomas are relatively uncommon tumors whose operative resection has clear medical and technical challenges. While the safety and efficacy of laparoscopic adrenalectomy are relatively well documented, few studies with extended follow-up have been conducted to measure the success of the procedure for the most challenging of the adrenal tumors. In addition, several reports question the applicability of a minimally invasive approach for sizeable pheochromocytomas. The purpose of our investigation was to assess the outcomes of laparoscopic adrenalectomy for pheochromocytomas in the largest study to date when performed by experienced laparoscopic surgeons. METHODS: All pheochromocytomas removed by the authors from January 1995 to October 2004 were reviewed under an Institutional Review Board approved protocol. Eighty-five percent were documented in a prospective fashion. RESULTS: Eighty consecutive patients underwent laparoscopic resection of 81 pheochromocytomas. Seventy-nine were found in the adrenal (42 left, 35 right, 1 bilateral); 2 were extra-adrenal paragangliomas. Eight patients had multiple endocrine neoplasia syndrome. Two lesions were malignant. There were 48 females and 32 males with a mean age of 45 years (range, 15-79 years). Mean tumor size was 5.0 cm (range, 2-12.1 cm); 41 of these lesions were 5 cm in size or larger. Average operative time and blood loss were 169 minutes (range, 69-375 minutes) and 97 mL (range, 20-500 mL), respectively. Intraoperative hypertension (systolic blood pressure, >170 mm Hg) was reported in 53% of patients and hypotension (systolic blood pressure, <90 mm Hg) in 28% of patients. There were no conversions to open surgery. Mean length of stay was 2.3 days (range, 1-10 days). There were 6 perioperative morbidities (7.5%) and no mortalities. No patient required a blood transfusion. No recurrence of endocrinopathy has been documented at a mean follow-up of 21.4 months. CONCLUSION: Laparoscopic resection of pheochromocytomas, including large lesions, can be accomplished safely by experienced surgeons. A short hospital stay with minimal operative morbidity and eradication of endocrinopathy support the minimally invasive approach for adrenalectomy in the setting of pheochromocytoma.

Adolescent↗
PubMed2005

Heterogeneous displays for surgery and surgical simulation.

Instruments and procedures continue to become more complex and challenging, but the display environments to which these technologies are connected have not kept pace. Display real-estate (the size and resolution of the display), the configurability of the display, and the ability for display systems to incorporate, fuse and present diverse informational sources are limiting factors. The capabilities of display technologies are far exceeded by the procedures and instruments that rely on them. In this paper we show how to break free from display constraints by moving forward with a hybrid, heterogeneous display framework that preserves key characteristics of current systems (low latency, specialized devices). We have engineered a hybrid display and are currently using it to build a surgical simulation and training environment within which we can evaluate both the technology and the performance of subjects using the technology.

Computer Simulation↗
PubMed2004

Laparoscopic approach to pancreatic disease.

Minimally invasive techniques in the treatment of pancreatic disease have been revolutionary and provide clinical evidence of decreased morbidity and comparable efficacy to traditional, open surgery. Although the use of other laparoscopic solid organ procedures has outdistanced therapeutic laparoscopy of the pancreas, the advent of laparoscopic pancreatic surgery preceded the general use of laparoscopic cholecystectomy and the popularity of other solid organ procedures. This article describes four main applications of laparoscopic pancreatic procedures, which are staging of pancreatic cancer, palliative bypass procedures for pancreatic cancer, resection of benign and malignant pancreatic disease, and pancreatic drainage procedures.

Humans↗
PubMed2003

Laparoscopic repair of ventral hernias: nine years' experience with 850 consecutive hernias.

OBJECTIVE: To evaluate the efficacy and safety of laparoscopic repair of ventral hernias. SUMMARY BACKGROUND DATA: The recurrence rate after standard repair of ventral hernias may be as high as 12-52%, and the wide surgical dissection required often results in wound complications. Use of a laparoscopic approach may decrease rates of complications and recurrence after ventral hernia repair. METHODS: Data on all patients who underwent laparoscopic ventral hernia repair (LVHR) performed by 4 surgeons using a standardized procedure between November 1993 and October 2002 were collected prospectively (85% of patients) or retrospectively. RESULTS: LVHR was completed in 819 of the 850 patients (422 men; 428 women) in whom it was attempted. Thirty-four percent of completed LVHRs were for recurrent hernias. The patient mean body mass index was 32; the mean defect size was 118 cm2. Mesh, averaging 344 cm2, was used in all cases. Mean operating time was 120 min, mean estimated blood loss was 49 mL, and hospital stay averaged 2.3 days. There were 128 complications in 112 patients (13.2%). One patient died of a myocardial infarction. The most common complications were ileus (3%) and prolonged seroma (2.6%). During a mean follow-up time of 20.2 months (range, 1-94 months), the hernia recurrence rate was 4.7%. Recurrence was associated with large defects, obesity, previous open repairs, and perioperative complications. CONCLUSION: In this large series, LVHR had a low rate of conversion to open surgery, a short hospital stay, a moderate complication rate, and a low risk of recurrence.

Body Mass Index↗
PubMed2003

Advanced devices for the operating room of the future.

The huge changes brought about by minimal access surgery in the last 15 years tell us much about the dynamic state of surgical technology and the need for sudden accommodation to a new item or concept that has captured the public eye. The minimal access technology invites us to extrapolate improvements in ergonomics and visualization and the combination of diagnostic and therapeutic motives in the operating room. The need for proper sensors to provide haptics to our instruments is high. Smart materials, smart catheters, wireless connectivity, and integrated technology for plug-and-play use are very attractive subjects that will draw many resources toward their successful application to operating room issues. Collaboration among institutions and industry will be useful to achieve efficiency, synergy, and the critical mass of talent to solve the significant problems ahead.

Equipment and Supplies↗
PubMed2003

Oxyntomodulin suppresses appetite and reduces food intake in humans.

Oxyntomodulin (OXM) is released from the gut postprandially, in proportion to energy intake, and circulating levels of OXM are elevated in several conditions associated with anorexia. Central injection of OXM reduces food intake and weight gain in rodents, suggesting that OXM signals food ingestion to hypothalamic appetite-regulating circuits. We investigated the effect of iv OXM (3.0 pmol/kg.min) on appetite and food intake in 13 healthy subjects (body mass index, 22.5 +/- 0.9 kg/m(2)) in a randomized, double-blind, placebo-controlled, cross-over study. Infusion of OXM significantly reduced ad libitum energy intake at a buffet meal (mean decrease, 19.3 +/- 5.6%; P < 0.01) and caused a significant reduction in scores for hunger. In addition, cumulative 12-h energy intake was significantly reduced by infusion of OXM (mean decrease, 11.3 +/- 6.2%; P < 0.05). OXM did not cause nausea or affect food palatability. Preprandial levels of the appetite-stimulatory hormone, ghrelin, were significantly suppressed by OXM (mean reduction, 44 +/- 10% of postprandial decrease; P < 0.0001). Elevated levels of endogenous OXM associated with disorders of the gastrointestinal tract may contribute to anorexia.

Adult↗
PubMed2002

Training and educational approaches to minimally invasive surgery: state of the art.

Current training in minimally invasive surgery (MIS) is inadequate given the demands of patients on practitioners and the number of surgeons and residents who still need to be trained. The training that is provided is neither widespread nor is it standardized, resulting in graduate surgeons with a wide range of competence. There is little guidance in what a training program needs to be effective. We provide a brief review of the state of the art of MIS training with some emphasis given to training methods including perceptual motor training, MIS learning laboratories, virtual reality, evaluation and assessment, cost, simulation fidelity, credentialing, certification, privileging, and ergonomics. We conclude that the state of the art is left wanting.

Certification↗
PubMed2002

Live streaming video for medical education: a laboratory model.

At the University of Kentucky (UK), we applied streaming video technology to develop a webcast model that will allow institutions to broadcast live and prerecorded surgeries, conferences, and courses in real time over networks (the Internet or an intranet). We successfully broadcast a prerecorded laparoscopic paraesophageal hernia repair to domestic and international clients by using desktop computers equipped with off-the-shelf, streaming-enabled software and standard hardware and operating systems. A web-based user interface made accessing the educational material as simple as a mouse click and allowed clients to participate in the broadcast event via an embedded e-mail/chat module. Three client computers (two connected to the Internet and a third connected to the UK intranet) requested and displayed the surgical film by means of seven common network connection configurations. Significantly, no difference in image resolution was detected with the use of a connection speed faster than 128 kilobytes per second (kbps). At this connection speed, an average bandwidth of 32.7 kbps was used, and although a 15-second delay was experienced from the time of data request to data display, the surgical film streamed continuously from beginning to end at a mean rate of 14.4 frames per second (fps). The clients easily identified all anatomic structures in full color motion, clearly followed all steps of the surgical procedure, and successfully asked questions and made comments by using the e-mail/chat module while viewing the surgery. With minimal financial investment, we have created an interactive virtual classroom with the potential to attract a global audience. Our webcast model represents a simple and practical method for institutions to supplement undergraduate and graduate surgical education and offer continuing medical education credits in a way that is convenient for clients (surgeons, students, residents, others). In the future, physicians may access streaming webcast material wirelessly with hand-held computers, so that they will be freed from computer stations.

Computer Communication Networks↗
PubMed2002

Transmural migration of a retained laparotomy sponge.

The most common surgically retained foreign body is the laparotomy sponge. The clinical presentation of a retained sponge can vary from an incidental finding on plain radiograph to an intense inflammatory response with obstruction or perforation. In the case described here a patient reported abdominal pain 11 months after her hysterectomy. Although two sponge counts appeared in the operative record one laparotomy sponge had been overlooked. Apparently an inflammatory response created an abscess pocket around the sponge between the abdominal wall and the ileum resulting in perforation of the ileum. Through this opening the sponge migrated into the lumen of the small bowel, from which it was surgically removed. The patient recovered without complications. The case highlights the importance of a thorough exploration of all quadrants of the abdomen at the termination of surgical cases.

Abdominal Pain↗
PubMed2002

Wireless live streaming video of laparoscopic surgery: a bandwidth analysis for handheld computers.

Over the last six years, streaming media has emerged as a powerful tool for delivering multimedia content over networks. Concurrently, wireless technology has evolved, freeing users from desktop boundaries and wired infrastructures. At the University of Kentucky Medical Center, we have integrated these technologies to develop a system that can wirelessly transmit live surgery from the operating room to a handheld computer. This study establishes the feasibility of using our system to view surgeries and describes the effect of bandwidth on image quality. A live laparoscopic ventral hernia repair was transmitted to a single handheld computer using five encoding speeds at a constant frame rate, and the quality of the resulting streaming images was evaluated. No video images were rendered when video data were encoded at 28.8 kilobytes per second (Kbps), the slowest encoding bitrate studied. The highest quality images were rendered at encoding speeds greater than or equal to 150 Kbps. Of note, a 15 second transmission delay was experienced using all four encoding schemes that rendered video images. We believe that the wireless transmission of streaming video to handheld computers has tremendous potential to enhance surgical education. For medical students and residents, the ability to view live surgeries, lectures, courses and seminars on handheld computers means a larger number of learning opportunities. In addition, we envision that wireless enabled devices may be used to telemonitor surgical procedures. However, bandwidth availability and streaming delay are major issues that must be addressed before wireless telementoring becomes a reality.

Computers, Handheld↗