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Biomedical subjects

B Schaeff

Publications and source records attributed to B Schaeff.

At least 19 recordsLinked to original sources
PubMed2002

Use of the robot system Da Vinci for laparoscopic repair of gastro-oesophageal reflux in children.

In adult patients, laparoscopic surgery, using a robot system (Da Vinci, Intuitive Surgical, Mountain View, California), has been recently introduced into surgical practice. To investigate the feasibility of the system in paediatric surgery, laparoscopic fundoplications as well as cholecystectomies have been performed. In July 2000 we used the robot system for the first time on an 11-year-old girl with gastro-oesophageal reflux, and since that time on 7 other children. Altogether 5 Thal and 3 Nissen procedures have been carried out. The average age was 12 years, with a range of 7 to 16 years. All operations were performed without complications and without conversion to open surgery. The medium operating time was 146 min with a range of 105 to 180 minutes. Compared to conventional laparoscopy, the 3-dimensional high-quality vision, the advanced instrument movements and the ergonomic position of the surgeon seems to enhance surgical precision. In our opinion, the use of the robot system is feasible and safe in paediatric surgery. The technique is limited due to the fact that instruments adapted to the size of small children are not yet available.

Adolescent↗
PubMed1999

Tumor seeding following laparoscopy: international survey.

The aim of the study was to determine if tumor seeding during laparoscopic surgery for cancer is a rare event or a typical complication of this procedure. Laparoscopic staging and treatment of intraabdominal tumors is increasing in gastroenterology, gynecology, and general surgery. A total of 1052 questionnaires were mailed to surgical department chairmen, members of the German Society of Surgery, Swiss Association for Laparoscopic and Thoracoscopic Surgery, and Austrian Society of Minimal Invasive Surgery asking them to list their department's experience with tumor seeding after laparoscopy for nonapparent or known malignancy. There were 607 (57.7%) surgeons who reported a total of 117,840 laparoscopic cholecystectomies, 409 incidental gallbladder carcinomas, and 412 laparoscopies on patients with colorectal carcinoma. Altogether 109 patients who developed tumor recurrence in connection with laparoscopic surgery have been reported. Port-site recurrence was identified in 70 of 409 patients (17.1%) with a median of 180 days following laparoscopic cholecystectomy for nonapparent gallbladder carcinoma. In 8 cases (11.5%) a protective plastic bag had been used for gallbladder retrieval. Six patients without port-site metastases were found to have a diffuse peritoneal carcinomatosis a median of 120 days after cholecystectomy. Of 412 laparoscopies for colorectal cancer, 19 cases (4.6%) of tumor seeding have been reported, 16 of which (3.9%) had documented port-site and scar recurrences a median of 196 days after laparoscopy. The tumor specimen was intact, and a plastic bag was used for extraction in seven cases. In 14 patients trocar-site metastases have been reported a median of 70 days after laparoscopy for different nonapparent or known malignancies. The probability of developing abdominal wall metastasis is higher after laparoscopy for cancer than after open surgery. An intact surgical specimen and the use of a plastic retrieval bag do not exclude the risk of port-site recurrences. These facts and the early appearance of peritoneal carcinosis in a few cases of intraabdominal malignancies seem to confirm a specific laparoscopic risk for intraperitoneal tumor cell seeding and implantation.

Adult↗
PubMed1998

Laparoscopic surgery: the effects of insufflation gas on tumor-induced lethality in nude mice.

OBJECTIVE: The aim of the study was to examine the effect of helium (group 2), carbon dioxide (group 3), and heated carbon dioxide (group 4) pneumoperitoneum on survival in case of intraabdominal spread of tumor cells in nude mice. STUDY DESIGN: The pneumoperitoneum was induced by a microhysteroflator with an intraperitoneal pressure of 8 mm Hg for 30 minutes. A washed tumor solution (0.4 ml) of a mesothelioma was injected intraperitoneally. RESULTS: The survival rate of group 3 was significantly reduced compared with the controls (group 1) and group 4. The latter groups showed similar survival rates. In groups 2 and 3 no significant differences in survival rate were observed. CONCLUSION: Clinical observations and the results of this animal study warn against the use of standard unheated carbon dioxide pneumoperitoneum in case of malignant tumors. Heated carbon dioxide seems to be advantageous.

Animals↗
PubMed1998

Port site recurrences after laparoscopic surgery. A review.

Port site metastasis has been a surprising event after laparoscopic procedures in cancer patients. No clear data exist about this phenomenon. The aim of this study is to summarize current epidemiologic knowledge about the risk of this complication. A review of all case reports about port site recurrences was undertaken. To date, 164 cases of port site metastases after videoscopic procedures have been reported in 90 papers. We found 108 cases of implantation after laparoscopy for digestive tumors, 23 after thoracoscopy, 29 after gynecological and 4 after urological laparoscopy. Analysis of the current literature confirms that laparoscopy is associated with abdominal cell mobilization to the trocars and instruments. Also low-staged and highly differentiated tumors have been reported to cause post-laparoscopy tumor seeding. The temporary data of the CAE registry 'port site metastases' (Workgroup for Surgical Endoscopy of the German Society of Surgery) are also reported. The analysis of 80 histologically confirmed cases of port site recurrence shows a particular frequency after laparoscopic cholecystectomy for unsuspected gallbladder cancer (n = 59). Postoperative specimen examination revealed a T1 carcinoma in 9 cases (15%), T2 carcinoma in 33 (21%), T3 in 3 (5%) and T4 in 1 case (1.7%). The mean time to clinical tumor relapse was 6 months. Similar patterns were found in a lower number of port site metastases after laparoscopy for colon cancer (n = 2) and for other cancers (n = 9). Clinical evidence that laparoscopy with CO2 pneumoperitoneum can enhance tumor dissemination is given. Port site metastases seem to be secondary to multiple factors including the gas used, local trauma, tumor manipulation, biologic properties of the tumor, and individual surgical skills.

Colorectal Neoplasms↗
PubMed1997

Small-bowel obstruction and perforation. A rare complication of an esophageal stent.

To bridge a malignant stenosis after esophageal cancer recurrence two silicon-coated wall stents were inplanted in a 52-year-old patient within 6 months. Two weeks after the second stent was implanted, clinical examination showed dislocation of the prosthesis. Intraoperatively the two stents were found sticking in the side-to-side jejunostomy of a former Billroth II operation, leading to perforation there.

Esophageal Neoplasms↗
PubMed1997

Exposure of the operative field in laparoscopic surgery.

Endoscopic surgery, as a result of over 90 years of investigation, has now become the most innovative part of general surgery; every procedure in the thoracic and abdominopelvic cavity, intraperitoneal or extraperitoneal, has been reviewed for feasibility. The basic principles in the management of surgical patients, however, have not changed: adequate exposure and good lighting remain important and may become more important with endoscopic techniques. Historical review shows the dependence of advances in laparoscopy upon technical development in the field of intraabdominal exposure as the result of two objectives: namely abdominal wall displacement and bowel retraction.

Animals↗
PubMed1997

Systems and instruments for laparoscopic surgery without pneumoperitoneum.

The insufflation of carbon dioxide into the peritoneal cavity is a routine technique of abdominal exposure in laparoscopic surgery. Because of adverse physiological effects and technical disadvantages of the pneumoperitoneum, alternative methods of abdominal wall lifting have been explored recently. Two groups of retraction systems exist: intraabdominal lifting and subcutaneous lifting of the abdominal wall. Some systems require additional pneumoperitoneum, because the extent of intraabdominal exposure is not sufficient. Other systems are working completely without gas insufflation. Two systems combine abdominal wall lifting with pressure on the internal organs. Every method allows the use of standard laparoscopic instruments, which originally were designed for a regular pneumoperitoneum. The use of a low-pressure pneumoperitoneum in combination with mechanical augmentation of the peritoneal cavity reduces physiological disadvantages of laparoscopy. But technical advantages, such as combination of laparoscopic and open techniques, can be realized only without gas insufflation. Conventional instruments have been designed to fit the ergonomical needs of isopneumic laparoscopy and to be employed with simple valveless cannulae.

Humans↗
PubMed1996

[Endosonographic anatomy of the pelvic floor].

With the aim of gaining a precise anatomical view of the anal canal, of the pelvic floor and his pathological changes, endorectal sonography was performed in 188 patients with carcinoma of the rectum without infiltration of the sphincter muscles. Based on our photographic material we designed a sonographic "map" of the pelvic floor. Transducer: Endo-P-Sonde, Siemens, with 5, 6 and 7, 5 MHz frequence and the possibility to obtain longitudinal and transversal sections. The following muscles were constantly seen: sphincter ani internus et externus, levator ani, obturator internus, ischiocavernosus, transversus perinei prof. et sup. and thereby ischiorectal and pelvirectal fossa were defined. On the basis of these exact knowledges diagnosis and therapy of perianal abscesses and fistulas can be improved.

Anal Canal↗
PubMed1995

Gasless laparoscopy in abdominal surgery.

Pneumoperitoneum, as a necessary precondition of laparoscopic procedures, represents a restriction of the surgeon's freedom of movement and can lead to rare but typical complications. We describe our first experiences with laparoscopic surgery without using pneumoperitoneum. Under direct vision and digital control a fan-formed wall retractor, which is attached to an electric lift arm, is introduced into the abdominal cavity. After raising the abdominal wall, the scope is introduced through the same access and the laparoscopic procedure can be started without the technical and physiopathological problems which may occur using a pneumoperitoneum. In this gasless laparoscopic procedure, simple valveless trocars and instruments can be used. Furthermore, an unlimited suction can be obtained without a loss of exposure. During anesthesia, neither increased ventilation nor increased ventilation pressure is necessary, and the surgeon has increased freedom of action. Not only special laparoscopic instruments, but the conventional instruments, used in open surgery, can also be employed in gasless laparoscopy. In this way we performed gasless laparoscopic surgery on 54 patients: cholecystectomy (n = 37), abdominal exploration for NSAP (n = 5) or tumor staging (n = 4), fenestration of liver cysts (n = 5), and appendectomy (n = 3). We did observe three wound infections as related complications. Six times, we had to change the surgical procedure. Compared to the traditional procedure with a CO2 pneumoperitoneum, the results of the first gasless procedures demonstrate potential advantages.

Abdomen↗
PubMed1995

[The 100th birthday of Heinz Kalk. A breakthrough in laparoscopy].

The method of laparoscopy, mainly being introduced as a diagnostic tool, has developed into an important therapeutic procedure during the last decade. This development is associated with the name of the German gastroenterologist Heinz Kalk. Born in Frankfurt/Main in 1895 he first published about laparoscopy in 1929 and also designed a new laparoscope with a prograde optic. He realized the great value of laparoscopy in the differential diagnosis of liver diseases. During the 40's Kalk introduced laparoscopically guided liver biopsy and was involved to a great extent in research of hepatic diseases, especially Hepatitis epidemica. The work of Kalk was of decisive influence for the development of laparoscopy in Europe. In 1949 he became chief of the Department of Internal Medicine of Kassel's hospital "Stadtkrankenhaus", making it one of the most interesting places to be in for hepatologists and laparoscopically working internists. Heinz Kalk died in 1973.

Animals↗
PubMed1995

The gasless laparoscopic cholecystectomy.

The pneumoperitoneum, generally used for all laparoscopic procedures, can lead to specific disadvantages and result in complications, and it furthermore represents a restriction of the surgeon's freedom of movement. In July, 1993 we started doing laparoscopic surgery without the pneumoperitoneum. Under direct vision and digital control, a fan-shaped wall retractor, which is attached to an electric lift arm, is introduced into the abdominal cavity. After raising the abdominal wall, the scope is introduced through the same access and the laparoscopic procedure can be started without the technical and pathophysiological problems which may occur when using a pneumoperitoneum. In this gasless laparoscopic procedure, simple valveless trocars and instruments can be used. During anaesthesia, neither an increased ventilation nor an enlarged ventilation pressure is necessary in this way we performed gasless laparoscopic cholecystectomy in 50 patients. We observed 5 wound infections as related complications. We had to change the surgical procedure seven times. The retraction technique creates a sufficient but not optimal exposure to the gallbladder. Intraoperative changes of the instruments, suction and specimen removal appeared easier. Both conventional and laparoscopic surgical instruments were introduced through the valveless trocars. Our experience demonstrates the practicability of this technique and potential advantages.

Cholecystectomy, Laparoscopic↗
PubMed1995

[Disposable versus reusable instruments in laparoscopic surgery--a controlled study].

The instruments for laparoscopic surgery are usually available in a disposable and in a reusable type. We performed a prospective, randomized study, based on the most frequent laparoscopic operation, the cholecystectomy, in order to directly quantify and compare the advantages and disadvantages of both types of instruments. 158 patients, who planned to undergo a cholecystectomy, were randomly distributed into two groups. 80 patients (group A) underwent surgery with reusable instruments and 78 patients (group B) with disposable instruments. We investigated the following parameters and compared them for both groups: length of operation, complications, conversion rate to open surgery, subjective postoperative pain, length of inability to work, technical problems during operation, postoperative hospitalization time, satisfaction of operating room personnel. The analysis of the results demonstrates no difference in the postoperative hospitalization time, in the postoperative complication rate, subjective pain sensation and postoperative inability to work. Differences in favour for the group of patients, operated with disposable instruments, were found in the conversion rate, in the length of operation and, statistically significant, in the amount of intraoperative problems, caused by instrument-technical reasons. Even if considering the greater expenses in time and personnel costs, operations with reusable instruments are in average 1015 DM cheaper.

Adolescent↗
PubMed1994

Laparoscopic drainage of a lymphocele after renal transplantation.

Lymphoceles are a well-known complication of renal transplantation, with incidence rates up to 18%. The management of symptomatic lymphocele remains controversial. We report the case of a lymphocele which was successfully drained into the peritoneal cavity using laparoscopic surgery.

Drainage↗
PubMed1994

[Potentially dangerous moments in use of esophageal balloon tamponade. 4 case reports with critical analysis of the literature].

In general, balloon tamponade is still part of the therapy of bleeding esophageal varices, despite effective sclerotherapy. Four case reports demonstrate that the application of balloon tamponade may be associated with severe complications. Moreover, a critical analysis of the literature shows a very different handling with respect to volume of gastric balloon, duration of blockade and traction to the tube. To prevent serious side effects, a safe way is described in detail when using balloon tamponade.

Aged↗
PubMed1994

[Gasless laparoscopic cholecystectomy].

The pneumoperitoneum as a precondition of laparoscopic procedures represents a restriction of the surgeons freedom of movement and causes rare but typical complications. In July 1993 we started doing laparoscopic cholecystectomy without using a pneumoperitoneum. Under direct vision and digital control the retractor blades are introduced into the abdominal cavity via minilaparotomy. The retractor is attached to an electrically powered mechanical arm and raised. The scope is introduced through the same access and the laparoscopic cholecystectomy can be performed using the established technique without instilling a pneumoperitoneum. Both conventional and laparoscopic surgical instruments were introduced through valveless trocars and unlimited suction without loss of gas and exposure is possible. Metabolic and hemodynamic alterations associated with the intraperitoneal insufflation of carbon dioxide are omitted. So far we did gasless laparoscopic cholecystectomy in 22 patients. We didn't see any related complications. Four times we had to change the surgical procedure. In comparison to the traditional laparoscopic cholecystectomy with a CO2-pneumoperitoneum the results of the first gasless procedures demonstrate possible advantages.

Adult↗
PubMed1994

[Color doppler ultrasound in intensive care monitoring after liver transplantation].

The aim of this study was to investigate whether vascular complications after liver transplantation can be diagnosed prior to their clinical and/or biochemistral appearance. Therefore color coded ultrasonography was performed daily in 22 liver patients with altogether 27 transplanted organs. We found 2 arterial thromboses, one partial thrombosis of the portal vein and one thrombosis of the lower vena cava and another two stenoses of the lower vena cava. Angiography was performed in all patients with positive findings after duplex-sonography, except in the 2 patients with cava stenosis. In our experience angiography can be avoided in all patients after a normal duplex-sonogram. However, the early diagnosis of vascular complications prior to the manifestation of a dysfunction of the transplant could not be reached in this study.

Adult↗