Biomedical subjects

B D Seifman

Publications and source records attributed to B D Seifman.

7 recordsLinked to original sources

PubMed2001

Prospective comparison between hand-assisted laparoscopic and open surgical nephroureterectomy for urothelial cell carcinoma.

OBJECTIVES: To prospectively compare open surgical and the new hand-assisted approach to laparoscopic nephroureterectomy for urothelial cell carcinoma. Previous retrospective studies have suggested that standard laparoscopic nephroureterectomy provides a briefer convalescence than open surgical nephroureterectomy. METHODS: Between March 1997 and September 1999, 16 hand-assisted laparoscopic and 11 open surgical nephroureterectomies were performed, without randomization. Validated questionnaires were prospectively administered preoperatively and 2 and 6 weeks postoperatively. RESULTS: The operative time was longer with the laparoscopic approach (320 versus 199 minutes, P <0.001), but the hospital stay was shorter (3.9 versus 5.2 days, P = 0.03). Patient recovery favored the laparoscopic group with regard to time to drive (17.1 versus 37.7 days), time to normal, nonstrenuous activity (18.2 versus 38.1 days), and the mental component score of the SF-12 survey at 6 weeks (57.1 versus 43.0) (P <0.05 for all). Minor complications occurred in 19% of the laparoscopic and 45% of the open surgical procedures; major complications occurred in 19% of laparoscopic and 27% of open surgical procedures (P >0.1 for both). Cancer control was similar between both groups. The mean operating room cost was 56% more for the laparoscopic group (P <0.001), but the overall hospital cost was only 8% greater (P >0.3). CONCLUSIONS: Hand-assisted laparoscopic nephroureterectomy is a safe and effective alternative to an open surgical approach. Indexes of patient recovery suggest that patient convalescence is less than after an open surgical nephroureterectomy. Increased operative costs may be offset by a shorter hospital stay and fewer complications, resulting in similar overall hospital costs.

Aged↗

PubMed2001

Functional effects of unilateral laser papillectomy in the pig.

OBJECTIVES: To evaluate the use of endoscopic laser papillectomy in a multi-papillary animal model to unilaterally impair concentrating ability and increase the urinary flow rate. METHODS: Domestic pigs underwent unilateral retrograde flexible nephroscopy. With a holmium:yttrium-aluminum-garnet laser, varying numbers of papillae were ablated. Four weeks after the procedure, renal function studies were performed during hydropenia and after hydration, the animals were killed, and the kidneys were examined histologically. RESULTS: The urine flow rate per 100 mL creatinine clearance was significantly increased in the papillectomized kidney compared with the control kidney during hydropenia (1.50 versus 0.94, P <0.01). The papillectomized kidneys were unable to concentrate the urine as well as the control kidneys during both hydropenia (urine osmolarity 430 versus 534 mOsm/L, P <0.01) and after hydration (329 versus 362 mOsm/L, P = 0.02). The free water reabsorption per 100 mL creatinine clearance was impaired in the papillectomized kidneys compared with the control kidneys (0.48 versus 1.00, P = 0.02) after hydration. A significant correlation existed between the percentage of papillae ablated and the difference in osmolarity between the operated and control kidneys (r(2) = 0.50, P = 0.015). Histologic examination demonstrated transitional re-epithelialization with moderate collecting duct dilation and medullary fibrosis underlying the ablated papillae early in the series; however, the histologic features normalized and the creatinine clearance was less impaired with a more proficient technique later in the series. CONCLUSIONS: Endoscopic laser papillectomy results in increased urine flow and impaired urinary concentrating ability. This surgical technique should be investigated further for its role in the prevention of nephrolithiasis.

Animals↗

PubMed2001

Use of bowel in laparoscopic urology.

Minimally invasive urology is a rapidly expanding field. What once was thought technically impossible is now becoming a reality, especially with the advent of intracorporeal stapling and automated suturing devices. Laparoscopic assistance and pure laparoscopy improve convalescence and cosmesis in comparison with open surgical procedures. Minimally invasive continent urinary stomas, ACE procedures, bladder augmentation, urinary diversion, and urinary undiversion have all been described in clinical practice. Continent urinary diversions and ileal bladder augmentations are being developed. Eventually, even the most challenging urologic procedures will be performed in a minimally invasive manner.

Animals↗

PubMed2001

A canine model to assess the biochemical stress response to laparoscopic and open surgery.

PURPOSE: To develop an animal model to assess the stress response to open and laparoscopic surgery. Such a model would allow objective physiologic assessment of the putative benefits of laparoscopy and provide a framework in which to compare modifications in operative and anesthetic technique that might decrease the stress of surgery. MATERIALS AND METHODS: Mongrel dogs underwent laparoscopic (N = 12) or open surgical (N = 12) left nephrectomy. In 11 control animals, after induction of anesthesia and line placement, the animal underwent either no intervention (open surgery sham; N = 6) or pneumoperitoneum only (laparoscopic sham; N = 5). Serum glucose and cortisol were measured preoperatively, at skin closure, and at 4, 8, and 24 hours postoperatively. Values at each time point were compared in the laparoscopic and open surgical nephrectomy groups and in each of the two nephrectomy groups and their respective shams. RESULTS: Compared with baseline, there was a sharp rise in serum cortisol at the time of skin closure, with a gradual decline to baseline values by 24 hours, in all experimental animals. Significantly lower serum cortisol concentrations were seen at 4 and 8 hours postoperatively in the laparoscopic group than in the open surgery group. Cortisol was significantly higher in the open group than in the sham-open group at all time points, whereas cortisol was greater in the laparoscopic group than in the pneumoperitoneum-only group only at the 4-hour time point. No differences were seen in serum glucose between groups. CONCLUSIONS: The serum cortisol concentration appears to be a good measure of surgical stress in the canine model. The rapid decline in serum cortisol after laparoscopy compared with open surgery may indicate a lesser degree, or quicker resolution, of surgical stress in the former. Furthermore, the similarity in cortisol curves between laparoscopy and pneumoperitoneum only suggests that surgical stress in laparoscopic surgery may be attributable mainly to the effects of pneumoperitoneum.

Animals↗

PubMed2000

Nephron sparing surgery for suspected malignancy: open surgery compared to laparoscopy with selective use of hand assistance.

PURPOSE: Laparoscopic nephron sparing surgery has been reported rarely, likely due to technical difficulty when using only laparoscopic instrumentation. Hand assisted techniques may facilitate the procedure in select cases while maintaining the benefits of minimally invasive surgery. We prospectively compared the laparoscopic with selective hand assistance and open surgical approaches to nephron sparing surgery for suspected malignancy. MATERIALS AND METHODS: We compared our initial 10 laparoscopic nephron sparing procedures for suspected malignancy, including 8 with hand assistance, in 9 patients (11 tumors) with 11 consecutive open surgical procedures for similar indications. Standard laparoscopic technique was used in cases of an exophytic mass with shallow penetration into the parenchyma. Otherwise hand assistance was used. Recovery data were obtained prospectively using self-administered questionnaires. RESULTS: Although mean operative time was 24% greater in the laparoscopic group, recovery was more favorable than in the open surgical group, as evidenced by 62% less parenteral narcotic use, 43% shorter hospital stay, 64% more rapid return to normal nonstrenuous activity, and improved pain and physical health scores 2 and 6 weeks postoperatively. In each group mean lesion diameter was 2.4 cm., 8 of 11 neoplasms were malignant and no margins were positive for malignancy. There were no conversions to open surgery and no major complications in the laparoscopic group. CONCLUSIONS: Laparoscopic nephron sparing surgery appears to have an advantage over open surgery in terms of patient recovery. Facilitation by hand assistance may make laparoscopic nephron sparing surgery a more widely available, minimally invasive alternative to open surgery for small, favorably located renal tumors.

Adult↗

PubMed2000

Technical advances in laparoscopy: hand assistance, retractors, and the pneumodissector.

Technology is crucial to the laparoscopic surgeon. Reducing the technical difficulty of laparoscopic procedures is beneficial on many fronts: training is facilitated, operative time is reduced, and the practice of minimally invasive surgery can be further disseminated. Many advances in urologic laparoscopic surgery are attributable to the development of new operative instruments that reduce the technical difficulty. In this article, we highlight three technical advances in laparoscopy. Hand assistance can simplify many laparoscopic procedures. Because the surgeon retains tactile sensation, operative times are reduced compared with standard laparoscopic surgery, with minimal, if any, increase in patient morbidity. Other advances in instrumentation include various laparoscopic retractors and the Pneumodissector, a unique dissecting device. The breadth of retractors extends from reusable metal "fans" to disposable inflated "paddles," with many in between. The metal retractors may be more traumatic to delicate tissues than the inflatable ones but also are more versatile. The Pneumodissector facilitates tissue dissection by releasing short burst of carbon dioxide. It is a safe and effective instrument for blunt tissue dissection. These technical advances have contributed to the progression of laparoscopic urologic procedures. Technology will continue to have a significant impact on the advancement of laparoscopic urology and its potential widespread dissemination.

Equipment Design↗

PubMed1999

Unilateral obstruction of the vas deferens diagnosed by seminal vesicle aspiration.

Causes of vasal obstruction include vasectomy, inguinal surgery, scrotal surgery, and congenital anomalies. The incidence of unilateral obstruction in various clinical situations is unknown because sperm from the contralateral testicle usually is present in the ejaculate. Vasography is the standard technique used to diagnose a unilateral vas deferens obstruction. We used the technique of seminal vesicle aspiration to accurately diagnose unilateral vas deferens obstruction in a man who had a previous inguinal hernia repaired with mesh. Surgical exploration confirmed the impression of vasal obstruction, and successful vasovasostomy was performed. We believe that seminal vesicle aspiration may be helpful in the diagnosis of unilateral vas deferens obstruction and has potential benefits over vasography.

Adult↗