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C Gracia

Publications and source records attributed to C Gracia.

10 recordsLinked to original sources
PubMed2005

Robot-assisted laparoscopic aortobifemoral bypass for aortoiliac occlusive disease: early clinical experience.

BACKGROUND: Robotic technology may facilitate laparoscopic aortic reconstruction. We present our early clinical experience with laparoscopic aortobifemoral bypass, aided by two different robotic surgical systems. METHODS: Between February 2002 and April 2004, we performed eight robot-assisted laparoscopic aorto-bifemoral bypasses for aortoiliac occlusive disease. All patients were male; median age was 55 years (range: 36-64). Dissection was performed laparoscopically and the robotic system was used to construct the aortic anastomosis. RESULTS: A robot-assisted anastomosis was successfully performed in seven patients. Median operative time was 405 min (range: 260-589), with a median clamp-time of 111 min (range: 85-205). Median blood loss was 900 ml (range: 200-5800). Median anastomosis time was 74 min (range 40-110). In two patients conversion was necessary, one due to bleeding of an earlier clipped lumbar artery after completion of the anastomosis, the other because of difficulties with the laparoscopic exposure of the aorta. On post-operative day 3 one patient died unexpectedly as a result of a massive myocardial infarction. Median hospital stay was 7.5 days (range: 3-57). CONCLUSION: Our initial experience with robotic assisted laparoscopic surgery (RALS) shows it is a feasible technique for aortoiliac bypass surgery. However, laparoscopic aortoiliac surgery demands considerable experience and operative times need to be reduced before this technique can be widely implemented.

Adult↗
PubMed2003

Robotic surgery and resident training.

BACKGROUND: Robotic technology promises to have an important future in surgery, but few residency programs incorporate robotics into surgical training. We sought to compare the speed and accuracy with which junior residents could perform laparoscopic tasks using both a robotic surgical device (Zeus MicroWrist) and conventional laparoscopic instruments. METHODS: Twelve residents performed exercises of progressive difficulty in an inanimate model using both the robot and conventional laparoscopy. Analysis of variance statistical analysis was used to compare task time and suturing accuracy scores. RESULTS: Grasping and suturing exercises were performed significantly faster with conventional laparoscopic instruments than with the robot. However, no difference in task time was noted for intracorporeal knot tying. Accuracy scores for suturing were higher for the robot. CONCLUSIONS: Junior residents can be instructed easily and quickly in both robotic and conventional advanced laparoscopic skills. The utility of robotic surgical devices in resident training requires further investigation.

Humans↗
PubMed1999

Effect of maternal diabetes on the fetal exocrine pancreas.

To test the hypothesis that fetal pancreatic exocrine and endocrine function are stimulated in parallel in the diabetic pregnancy, 68 mothers with gestational and pregestational diabetes who underwent amniocenteses after 34 weeks' for the evaluation of fetal lung maturity were enrolled. Amniotic fluid specimens were analyzed for C-peptide and trypsin content. Amniotic fluid specimens were obtained from 92 non-diabetic women undergoing amniocenteses for lung maturity, preterm labor, or premature rupture of membranes. Groups were compared using the Wilcoxon rank-sum test, Kruskal Wallis rank sum test, and Spearman's rank correlation test. C-peptide amniotic fluid concentrations were significantly greater in diabetics (median 0.6 ng/ml) than non-diabetics (median 0.4 ng/ml, P= 0.0001), in pregestational (median 0.6 ng/ml) vs. gestational diabetics (median 0.4 ng/ml, P = 0.006), and greater in proportion to severity of disease according to diabetic class (A1 = 0.4 ng/ml, A2 = 0.55 ng/ml, B = 0.6 ng/ml, C = 0.7 ng/ml, D = 0.85 ng/ml, P = 0.04). No significant differences were detected in amniotic fluid trypsin between the diabetic and non-diabetic or the gestational and non-gestational diabetic groups. There was no correlation between C-peptide and trypsin within the diabetic groups. Stimulation of the exocrine and endocrine pancreas does not occur in parallel in the fetus of the diabetic mother. Although originating as a single organ, pancreatic exocrine and endocrine functions are distinct in both physiologic and pathologic conditions.

Adult↗
PubMed1999

Experimental laparoscopic aortobifemoral bypass with end-to-side aortic anastomosis.

The goal of this animal experiment was to demonstrate the feasibility of laparoscopic end-to-side aortic anastomosis, which is mandatory in certain cases presenting with aortoiliac occlusive disease. Six piglets were submitted to laparoscopic approach of the aortoiliac vessels using the "apron" technique. After clamping the infrarenal aorta with a laparoscopic Satinsky clamp, a 3-cm end-to-side laparoscopic aortic anastomosis was constructed. Mean operative and dissection times were 198 (170-240) and 92 (75-105) min, respectively, with a mean blood loss of 86 (50-120) mL. Mean preoperative and postoperative hematocrits were 38 (3448) and 38 (34-46). Aortic cross-clamp and anastomotic times were 51 (40-65) and 44 (35-60) min, respectively. No extra sutures were needed to secure the anastomoses. At autopsy, all the anastomoses were patent without stenoses. Results indicate the feasibility of laparoscopic aortobifemoral bypass with an end-to-side aortic anastomosis.

Anastomosis, Surgical↗
PubMed1996

Experimental laparoscopic aortic aneurysm resection and aortobifemoral bypass.

The purpose of the present study was to develop a technique for laparoscopic aortic aneurysm resection and aortobifemoral bypass through an anterior retroperitoneal approach. Eight piglets weighing between 75 and 80 kg were anesthetized. The concepts of Shumacker's anterior retroperitoneal exposure of the aorta were modified to allow laparoscopic exposure of the aorta in the first four animals. The other four animals were treated as if they had an aortic aneurysm. The piglet is placed in a supine position. The first port (1.5 cm) is placed laterally near the tip of the 12th rib. As much dissection of the retroperitoneum as possible is performed digitally through this port. A second port (1.5 cm), through which an abdominal lift device and a peritoneal retractor will be inserted, is created superiorly just lateral to the left rectus sheath, and a plane is developed that joins the original dissected space. Two other ports (1.5 cm) are placed in the flanks in a plane inferosuperior to the first port. The surgeon will use two of the lateral ports, and the third one is for the laparoscope. The last two ports (1.5 cm), from which the assistant will work, are placed in the left paramedian region. Using this approach, we performed four aortobifemoral bypasses in an average of 4.5 h after conventional i.v. heparinization (100 IU/kg) with minimal bleeding (blood loss < 550 cc). After infrarenal aortic cross-clamping, the external iliac and caudal vessels were either tied with 0-chromic or occluded with laparoscopic bull-dogs. The aorta was opened, and bleeding lumbar arteries and the aortoiliac junction were sutured with 4-0 Prolene. The vascular graft was sutured end-to-end to the aortic stump with running 4-0 Prolene. Tunneling to the femoral regions was made easy by the position of the animal. No mortality occurred before sacrifice of the animals. This laparoscopic animal model paves the way for human aortic aneurysm replacement.

Animals↗
PubMed1984

Diagnosis and management of ingested foreign bodies: a ten-year experience.

Ingested gastrointestinal foreign bodies may be managed by observation, endoscopy, and/or surgical intervention. We retrospectively reviewed 87 consecutive cases of foreign body ingestion. In 49 patients the ingested foreign body had passed beyond the gastroesophageal junction, and these cases form the basis of this study. Of the 49 patients, 19 (38.7%) required surgical intervention for removal of the swallowed object. Nearly 75% of these patients had swallowed objects that were more than 6.5 cm in length. Of 30 adults, more than 50% required surgery for removal of the foreign body. However, fewer than 16% of children who had swallowed and retained foreign bodies required surgery for ultimate cure. Based on these findings, guidelines are presented for the management of foreign body ingestion.

Adolescent↗