Biomedical subjects
Publications and source records attributed to Carol Schneider.
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BACKGROUND: Minimally invasive Roux-en-Y gastric bypass is a procedure that is being performed with increasing frequency. It is an advanced laparoscopic procedure with a steep learning curve. With experience, it can be performed in a reasonable amount of time with minimal morbidity. METHODS: We first performed minimally invasive gastric bypass with the hand-assisted laparoscopic surgery (HALS) technique. After significant experience with HALS, we changed our approach to completely laparoscopic (LS). Our technique for all cases involves a circular stapled gastrojejunostomy with a 25-mm anvil passed transgastrically. RESULTS: From June 1998 to January 2002, 304 patients underwent minimally invasive gastric bypass. Our first 81 cases were with HALS, and the rest were LS. The incidence of early major and minor perioperative complications for the entire series was 5.6% and 7.9%, respectively. Early reoperation (less than 30 days) was required in 4.6% of all patients. There was 1 leak (1.2%) in the HALS group and 4 anastomotic leaks (1.8%) in the LS group. Other measured outcomes were similar in each group with the exception of wound hernia (16% HALS vs 0.9% LS). Weight loss after 1 year was 44% for HALS and 56% for LS. We have not had any deaths in our series. CONCLUSIONS: HALS may have certain advantages in selected patients and early in a surgeon's experience with minimally invasive gastric bypass. With experience, good results are possible with either approach.
Computer-assisted telesurgical devices have recently been approved in the United States for general surgery. To determine the safety and efficacy of these procedures, we performed a prospective trial of computer-enhanced "robotic" fundoplication compared to standard laparoscopic control procedures. Consecutive patients undergoing surgical treatment for gastroesophageal reflux were included. The operating surgeon worked at a console using a three-dimensional image and manipulated hand controls. Operative times, complications, and length of hospital stay were recorded. A standardized questionnaire was administered to evaluate symptoms. Twenty patients were entered into each group. There were no differences in age, preoperative weight, or sex. Operative times were significantly longer in the robot group (97 vs. 141 minutes). There were no complications and most patients went home the first postoperative day. At follow-up, symptoms were similar in both groups; however, there was a significant difference in the number of patients taking antisecretory medication--none in the robotic group but six in the laparoscopic group reported regular use. Computer-assisted laparoscopic antireflux surgery is safe. However, operative times are longer, with little difference in outcomes. At the current level of technology and experience, robotic antireflux surgery appears to offer little advantage over standard laparoscopic approaches.