PubMed Health⌕ Search

Biomedical subjects

C T Frantzides

Publications and source records attributed to C T Frantzides.

At least 19 recordsLinked to original sources
PubMed2006

Prospective randomized controlled trial of laparoscopic trainers for basic laparoscopic skills acquisition.

BACKGROUND: Laparoscopic surgery requires a different set of skills than traditional open surgery. The acquisition of basic laparoscopic skills may help novices when learning laparoscopic procedures. This study tested the hypothesis that the combination of virtual reality and box trainers leads to better basic laparoscopic skill acquisition than either method alone or no training. METHODS: A randomized control trial involving preclinical medical students with no prior operative experience was performed. The students were grouped according to four training methods: virtual reality training, inanimate box training, a combination of both, and no training (control). The pre- and posttraining scores for four skills in the porcine laboratory were the metrics chosen for this study. RESULTS: A total of 65 students participated in this study. There were no differences among any of the pretraining scores (p > 0.05). The posttraining times differed between the four groups. Post hoc analyses showed statistically significant differences (p < 0.05) between the participants trained with both trainers and the control subjects. CONCLUSIONS: Our data demonstrate that the combination of virtual reality training and inanimate box training leads to better laparoscopic skill acquisition than either training method alone or no training at all. Optimal preclinical laparoscopic training should incorporate both virtual reality trainers and inanimate box trainers.

Adult↗
PubMed2006

Prosthetic closure of the esophageal hiatus in large hiatal hernia repair and laparoscopic antireflux surgery.

BACKGROUND: Laparoscopy has become the standard surgical approach to both surgery for gastroesophageal reflux disease and large/paraesophageal hiatal hernia repair with excellent long-term results and high patient satisfaction. However, several studies have shown that laparoscopic hiatal hernia repair is associated with high recurrence rates. Therefore, some authors recommend the use of prosthetic meshes for either laparoscopic large hiatal hernia repair or laparoscopic antireflux surgery. The aim of this article was to review available studies regarding the evolution, different techniques, results, and future perspectives concerning the use of prosthetic materials for closure of the esophageal hiatus. METHODS: A search of electronic databases, including Medline and Embase, was performed to identify available articles regarding prosthetic hiatal closure for large hiatal or paraesophageal hernia repair and/or laparoscopic antireflux surgery. Techniques and results as well as recurrence rates and complications related to the use of prosthetics for hiatal closure were reviewed and compared. Additionally, recent experiences and recommendations of experienced experts in this field were collected. RESULTS: The results of 42 studies were analyzed in this review. Some techniques of mesh hiatal closure were evaluated; however, most authors prefer posterior mesh cruroplasty. The type and shape of hiatal meshes vary from small angular meshes to A-shaped, V-shaped, or complete circular meshes. The most frequently utilized materials are polypropylene, polytetrafluoroethylene, or dual meshes. All studies show a low rate of postoperative hernia recurrence, with no mortality and low morbidity. In particular, comparative studies including two prospective randomized trials comparing simple sutured hiatal closure to prosthetic hiatal closure show a significantly lower rate of postoperative hiatal hernia recurrence and/or intrathoracic wrap migration in patients who underwent prosthetic hiatal closure. CONCLUSIONS: Laparoscopic large hiatal/paraesophageal hernia repair with prosthetic meshes as well as laparoscopic antireflux surgery with prosthetic hiatal closure are safe and effective procedures to prevent hiatal hernia recurrence and/or postoperative intrathoracic wrap migration, with low complication rates. The type of mesh, particularly the size and shape, is still controversial and is a matter for future research in this field.

Esophagus↗
PubMed2005

Self-reported versus observed scores in laparoscopic skills training.

BACKGROUND: Education in basic laparoscopic skills training is performed ideally in an inanimate laboratory. Monitoring of basic skills progression, which is essential during this tranining, often may be difficult because of the resources and manpower. This study investigated the differences between self-reported and observed scores during basic laparoscopic exercises. METHODS: First-and second-year medical students involved in practice sessions using the LTS 2000 box trainer were included in the study. All the students were allowed to practice four tasks: placing pegs with their dominant and nondominant hands, transferring pegs from one hand to another starting with the dominant and nondominant hands, cannulating a pipe cleaner into a plastic tube, and progressing from one end of a rope to the other. Each student recorded his or her times and errors for each task. After these practice sessions, each student underwent an observed session (OS), performing all of the tasks, and was graded by a surgeon involved in laparoscopic education. All the students were asked to record another practice session. The self-reported performances from the session immediately before the OS (pre-OS) and the session immediately after the OS (post-OS) were compared with the performance in the OS. RESULTS: A total of 36 students were included in this study. The mean time and mean error were similar between all the sessions. Although the scores in the OS did slightly differ from the scores in the pre-OS and post-OS, post hoc analysis showed that there was no statistically significant difference between the OS score and either the pre-OS or the post-OS score for any of the laparoscopic exercises. CONCLUSIONS: No differences between observed scores and self-reported scores were noted. The use of self-reported scores may be a good method for monitoring performance during training in laparoscopic basic skills. The self-reporting of basic laparoscopic exercises may conserve resources.

Adult↗
PubMed2004

Predicting baseline laparoscopic surgery skills.

BACKGROUND: Laparoscopic surgery requires specialized dexterity even beyond that required for open surgery. Decreased tactile feedback, different eye-hand coordination, and translation of a two-dimensional video image into a three-dimensional working area are just some of the obstacles in the performance of laparoscopic surgery. Possession of certain nonsurgical skills may help in overcoming some of these obstacles. Prediction of baseline laparoscopic surgery skills may help further to refine the education of basic laparoscopic surgery skills. This investigation explores whether nonsurgical skills and demographic data can predict baseline laparoscopic surgery tasks. METHODS: First- and second-year students were given a survey regarding nonsurgical dexterity skills. The survey inquired about typing skills, play with computer games, ability to sew, skill with music instruments, use of chopsticks, and experience operating tools. Demographic data were requested as well. All the students underwent four tasks: placing a piece of bowel in a retrieval bag, placing a stapler on the bowel, measuring a piece of bowel, and performing a liver biopsy in a porcine animal model. Both objective (time and error) and subjective evaluation were assessed for all the tasks. Statistical analysis using analysis of variances (ANOVA) Kruskal-Wallis test with post hoc tests, two-tailed unpaired t-tests/Mann-Whitney test, and Fischer's exact tests/chi-square tests was performed when appropriate. RESULTS: There were 68 students in this investigation. Gender, medical student year, ethnicity, desire to enter a surgical field, and age were not associated with increased performance in any of the tasks. Chopstick use was associated with statistically significantly better mean time in placing a piece of bowel in a retrieval bag and measuring a piece of bowel (p < 0.04). The other nonsurgical dexterity skills did not statistically increase performance, as indicated by time, errors, or subjective scores, for the four tasks. CONCLUSIONS: It is difficult to predict baseline laparoscopic surgery skills.

Adult↗
PubMed2004

Minimally invasive incisional herniorrhaphy: a review of 208 cases.

BACKGROUND: Minimally invasive incisional herniorrhaphy has become an accepted approach for incisional hernia. However, the ideal technique for this procedure is not known. The authors present their technique and personal experience with minimally invasive incisional herniorrhaphy. METHODS: A retrospective review investigated 208 consecutive patients who underwent minimally invasive incisional hernia repair under the supervision of a single surgeon between 1995 and 2002. RESULTS: An intraperitoneal mesh repair was performed in all cases. There were no conversions. The mean operative time was 2.1 h (range, 0.8-4.5 h). The mean length of hospital stay was 2.5 days (range, 0-13 days). There were six complications, including two bowel perforations, and zero mortality. There were three recurrences during the follow-up period, which ranged from 6 to 72 months (median, 24 months). CONCLUSIONS: Minimally invasive incisional herniorrhaphy yielded an acceptable morbidity and recurrence rate during the follow-up period. The outcome compares favorably with that for open incisional hernia repair. Although long-term follow-up evaluation is desirable, the data support the contention that the minimally invasive approach is an appropriate option for incisional hernia.

Adult↗
PubMed2003

The myth of the short esophagus.

BACKGROUND: The advent of laparoscopic surgery has increased the number of fundoplications performed today. With the increase in laparoscopic fundoplications, the reports of short esophagus continue to increase. This investigation was undertaken to review our data regarding the entity described as "short esophagus." METHOD: All charts of patients who had laparoscopic fundoplications performed from 1991 to 2000 were reviewed. Patients with laparoscopic fundoplications received esophagrams at 3 months postoperatively and then at 6 months. RESULTS: A total of 628 fundoplications were performed, with 351 requiring hiatal hernia repair. After appropriate esophageal mobilization was performed, no further esophageal lengthening procedure was needed. There were 4 conversions, 16 recurrences, and 7 complications, and no deaths. Recurrences were due to "slipped fundoplications" ( n = 3), ineffective valves ( n = 5), and hiatal hernia disruptions ( n = 8). CONCLUSIONS: In our series of fundoplications and hiatal hernia repairs, no short esophagus was noted. With proper esophageal mobilization, clinically the entity described as "short esophagus" may not exist.

Barrett Esophagus↗
PubMed2003

The quality of information about laparoscopic bariatric surgery on the Internet.

BACKGROUND: Although easy access to the Internet can provide much information for patients, the quality and accuracy of information are uncertain. This investigation evaluated information concerning laparoscopic bariatric surgery available via the Internet. METHODS: Searches on the six most popular search engines and two metasearch engines were performed. The first 20 "hits" for each separate search were included in the study. RESULTS: A total of 602 "hits" were found. Only 119 unique Web sites were found. Although 63 of the 119 sites discussed some procedure related to laparoscopic obesity surgery, 18 of the 63 had biased or misleading information, 30 did not discuss the details of the procedure, 37 did not discuss other procedures, 30 did not discuss complications, 37 did not discuss death as a risk, and 7 did not discuss laparoscopic procedure as an option. Only 89 of the original 602 "hits" led to Web sites that discussed laparoscopic obesity surgery, details of the procedure, and complications in an unbiased manner. CONCLUSIONS: A large amount of information is available via the Internet. However, it is difficult for the patient to identify the unbiased information. The Internet is not a dependable source of information for patients.

Humans↗
PubMed1999

Laparoscopic repair of large hiatal hernia with polytetrafluoroethylene.

BACKGROUND: Several studies have shown that large hiatal hernias are associated with a high recurrence rate. Despite the problem of recurrence, the technique of hiatal herniorrhaphy has not changed appreciably since its inception. In this 3-year study we have evaluated laparoscopic hiatal hernia repair in individuals with a hernia defect greater than 8 cm in diameter. METHODS: A series of 35 patients with sliding or paraesophageal hiatal hernias was prospectively randomized to hiatal hernia repair with (n = 17) or without (n = 18) polytetrafluoroethylene (PTFE). All patients had an endoscopic and radiographic diagnosis of large hiatal hernia. Both repairs were performed by using interrupted stitches to approximate the crurae. In the group randomized to repair with prosthesis, PTFE mesh with a 3-cm "keyhole" was positioned around the gastroesophageal junction with the esophagus through the keyhole. The PTFE was stapled to the diaphragm and crura with a hernia stapler. RESULTS: Patients were followed with EGD and esophagogram at 3 months postoperatively, and with esophagogram every 6 months thereafter. Individuals with PTFE had a longer operation time, but the 2-day hospital stay was the same in both groups. The cost of the repair was $1050 +/- $135 more in the group with the prosthesis. There were two complications (1 pneumonia, 1 urinary retention) in the group repaired with PTFE and one complication (pneumothorax) in the group without prosthesis. The group without PTFE was notable for three (16.7%) recurrences within the first 6 months of surgery. CONCLUSION: On the basis of these preliminary results it appears that repair with PTFE may confer an advantage, with lower rates of recurrence in patients with large hiatal hernia defects.

Adult↗
PubMed1999

Laparoscopic prosthetic reinforcement of hiatal herniorrhaphy.

BACKGROUND/AIMS: Primary repair of a large hiatal hernia is associated with a published recurrence rate of up to 10%; anecdotal rates even higher than this have been reported to the authors. The use of prosthetic material in the repair of other abdominal wall defects has often produced better results than primary repair. We wanted to compare laparoscopic primary repair of large hiatus hernias with laparoscopic primary repair reinforced with prosthetic. METHODS: Thirty-one patients with symptomatic gastroesophageal reflux and a hiatal defect 8 cm or greater were randomized to Nissen fundoplication with posterior cruroplasty (n = 16) or Nissen cruroplasty, and onlay of polytetrafluoroethylene (PTFE) mesh (n = 15). All patients underwent preoperative esophagogastroduodenoscopy (EGD) and barium esophagography. After posterior cruroplasty with interrupted nonabsorbable suture, the mesh reinforcement group had an onlay of PTFE placed around the hiatus. A radial slit with 3 cm 'keyhole' (to accommodate the esophagus) was cut into the PTFE. The prosthetic was stapled to the diaphragm, and the two leaves of the slit were stapled to each other. All patients underwent EGD at 3 months and all had esophagrams every 6 months postoperatively. Follow-up ranged from 12 to 36 months. RESULTS: Length of hospital stay was equal in both groups (2 days). The average cost to the patient with PTFE was USD 1,050 higher than to the patient with primary repair. There were 2 complications (1 pneumonia, 1 urinary retention) in the PTFE group, and 1 complication (pneumothorax) in the primary repair group. There were 3 recurrences (18.8%) in the primary group (p = 0.08, chi(2) test). CONCLUSION: The use of PFTE reinforcement for primary repair of large hiatal hernias may result in a lower rate of recurrent herniation compared to primary repair alone.

Adult↗
PubMed1998

A study of 362 consecutive laparoscopic Nissen fundoplications.

BACKGROUND: Open Nissen fundoplication has been shown to be a very effective operation in the treatment of intractable gastroesophageal reflux. Because of its technical rather than amputative nature, this procedure offers itself to a completely laparoscopic approach. Several studies have shown the feasibility; however, very few have dealt with the effectiveness of the laparoscopic approach. METHODS: Results of laparoscopic Nissen fundoplications performed during a 6-year period were reviewed including duration of operation, number of hospital days, number of conversions to open procedures, complications, and symptoms. All 362 patients had evidence of gastroesophageal reflux disease documented by radiographic, endoscopic, or pH monitoring testing before the operation. Patients with dysphagia or odynophagia underwent manometric evaluation before operation. Postoperative evaluation included esophagography and endoscopy at 2 to 3 months with an esophagogram yearly thereafter. Follow-up time was 6 months to 6 years. RESULTS: The mean time of operation decreased from 2.7 +/- 0.4 hours during the period from 1991 to 1994 to 1.8 +/- 0.3 hours from 1994 to 1997. During those same periods, the number of days of hospitalization decreased from 2.2 days to a mean of 1.5 days. Manometric studies done before the operation (n = 58) showed a pressure of 4 +/- 1.2 mm Hg compared with postoperative values (n = 39) of 14 +/- 1.8 mm Hg. The conversion rate was 0.8% (n = 3), and the complication rate of 1.9% (n = 7) included the 3 conversions, 2 pneumothoraces, 1 patient with postoperative bleeding, and 1 patient with a large abdominal wall hematoma. There were 5 failures of the procedure (1.2%). Thirteen patients (3.6%) described postoperative symptoms that persisted beyond 2 months, including bloating, flatulence, dysphagia, and diarrhea. CONCLUSIONS: With strict selection criteria and increasing experience and standardization of technique, laparoscopic Nissen fundoplication can provide both safe and effective results for patients with chronic symptoms of gastroesophageal reflux disease.

Adolescent↗
PubMed1998

Early experience with laparoscopic splenectomy.

BACKGROUND: Laparoscopic splenectomy is an example of the recent continued advancement in laparoscopic surgery as techniques are adapted for procedures previously done only via a laparotomy. METHODS: We analyzed our initial experience with laparoscopic splenectomy for details of the operative procedure and the clinical outcome including length of stay and complication rates. RESULTS: Two surgeons performed 11 laparoscopic splenectomies for cancer or hematologic disorders. In two instances (18%) conversion to open splenectomy was necessary due to bleeding at the splenic hilum. There were no mortalities. Two patients developed pancreatic fluid collections that were successfully drained percutaneously. The seven patients who had an uncomplicated course resumed eating a regular diet in 2.0 +/- 0.6 days (mu +/- SD) and had a hospital stay of 2.7 +/- 1.1 days. Hospital stay was significantly longer for the patients who had complications 9.7 +/- 7.2 days (p < 0.05) and for the 11 patients undergoing on elective uncomplicated open splenectomy during the same time period, 6.5 +/- 2.0 days (p < 0.05). For the 9 patients who had a completed laparoscopic splenectomy, the mean operative blood loss was 263.9 +/- 241.4 cc. The mean operative time was 293.3 +/- 91.4 minutes. The spleens removed laparoscopically weighed an average of 390 grams (range 17 to 1584 grams). CONCLUSIONS: Laparoscopic splenectomy can be performed safely and is associated with a rapid resumption of oral alimentation and shortened hospital stay compared to open splenectomy. Complications experienced in our early experience included conversion to open splenectomy and fluid collections from pancreatic leakage.

Adult↗
PubMed1997

Prosthetic reinforcement of posterior cruroplasty during laparoscopic hiatal herniorrhaphy.

Symptomatic gastroesophageal reflux after Nissen fundoplication may occur if the wrap herniates into the thorax. In an attempt to prevent recurrent hiatal hernia we employed polytetrafluoroethylene (PTFE) mesh reinforcement of posterior cruroplasty during laparoscopic Nissen fundoplication and hiatal herniorrhaphy. Three patients with symptomatic gastroesophageal reflux and a large (>==8 cm) hiatal defect underwent laparoscopic posterior cruroplasty and Nissen fundoplication. The cruroplasty was reinforced with a PTFE onlay. No perioperative complications occurred, and in follow-up (<==11 months) the patients are doing well. When repairing a large defect of the esophageal hiatus during fundoplication, the surgeon may consider reinforcement of the repair with PTFE mesh.

Fundoplication↗
PubMed1997

Canine intestinal myoelectric activity after open versus laparoscopically assisted right hemicolectomy.

BACKGROUND: It is a common belief that a laparoscopic procedure results in a shorter duration of postoperative ileus compared with the equivalent open procedure. This study was undertaken to determine whether laparoscopically assisted right hemicolectomy in the dog results in a shorter duration of ileus compared with open right hemicolectomy. METHODS: Eight bipolar serosal electrodes (4 on the small bowel, 4 on the left colon) were implanted in each dog (n = 10). Three weeks after electrode implantation baseline recording was made for 5 days; then 5 dogs underwent laparoscopically assisted right hemicolectomy and 5 underwent open right hemicolectomy. Myoelectric activity was recorded continuously for 72 hours postoperatively. Tracings were analyzed for the time of reappearance, duration, migration velocity, and cycle length of phase 2, phase 3, and the migrating colonic complex. The criteria used for the resolution of postoperative ileus were the return of phase 2, phase 3, and the migrating colonic complex. RESULTS: All dogs had temporary loss of organized myoelectric activity postoperatively. The mean reappearance time (minutes +/- standard deviation) for phase 3 was 857 +/- 574 versus 761 +/- 600; the phase 2 reappearance time was 1,845 +/- 610 versus 1,590 +/- 668; and the migrating colonic complex reappearance time was 534 +/- 365 versus 572 +/- 552, open versus laparoscopically assisted right hemicolectomy, respectively. The times were not different (Wilcoxon rank sum test, P > 0.05). The time required for phase 3, phase 2, and the migrating colonic complex to attain preoperative configuration also was not different between the open and laparoscopically assisted group. CONCLUSION: Myoelectric resolution of postoperative ileus did not occur earlier in the dog undergoing laparoscopically assisted right hemicolectomy compared to the dog undergoing open right hemicolectomy. This data does not support the hypothesis that a laparoscopically assisted colectomy results in a shorter duration of postoperative ileus than the equivalent open procedure.

Animals↗
PubMed1997

Minimally invasive ventral herniorrhaphy.

Three types of minimally invasive ventral herniorrhaphies were performed in eight patients: primary repair with sutures (1 case), single-layer prosthesis repair with polytetrafluoroethylene (4 cases), and bilayer prosthesis repair with polytetrafluoroethylene and polypropylene (3 cases). One patient undergoing the bilayer repair developed a small hematoma in the subcutaneous tissue at the site of the repair, which resolved without intervention. There were no other complications, and no recurrence was noted in follow-up of 14 to 20 months.

Follow-Up Studies↗