PubMed Health⌕ Search

Biomedical subjects

D Litwin

Publications and source records attributed to D Litwin.

10 recordsLinked to original sources
PubMed2001

Hand-assisted laparoscopic donor nephrectomy minimizes warm ischemia.

OBJECTIVES: Traditional open donor nephrectomy is associated with good donor outcomes and excellent allograft function. Laparoscopic donor nephrectomy may accomplish these same goals with less morbidity. We report our initial experience with hand-assisted laparoscopic living donor nephrectomy using a commercially available hand-assist device. METHODS: Donor and allograft outcomes for the first 30 patients undergoing hand-assisted laparoscopic live donor nephrectomy in our institution were prospectively analyzed. RESULTS: Hand-assisted laparoscopic donor nephrectomy was successfully completed in 29 (97%) of 30 donors. Organ dissection was carried out purely laparoscopically. Vessel division and allograft extraction were performed using a hand-assisted technique. The average operative time was 275 minutes (range 193 to 360), with an estimated blood loss of 99 mL (range 50 to 300). Pneumoperitoneum was consistently maintained during the hand-assisted portion of the procedure. The mean warm ischemic time was 72.5 seconds (range 30 to 165). On average, the regular diet was resumed after 2.2 days (range 1 to 3), and patients were discharged home 3.4 days (range 2 to 5) after surgery. Eight minor complications occurred in the donor group. Immediate graft function occurred in all 30 cases. No ureteral complications occurred. The recipient creatinine levels ranged from 0.6 to 2.4 mg/dL at an average follow-up of 11.5 months (range 1 to 23). CONCLUSIONS: Laparoscopic donor nephrectomy is technically feasible and can be performed with minimal morbidity. Hand-assisted kidney extraction may help to facilitate immediate allograft function by minimizing the warm ischemic time.

Adult↗
PubMed1997

Of balloon axilloscopy and avoidance of iatrogenic injury to the long thoracic nerve.

BACKGROUND: Laparoscopic removal of axillary lymph nodes is possible and affords an excellent view of all structures, allowing preservation of vessels and nerves. The technique uses pediatric trocars and a lifting device to maintain the newly created axillary space. OBJECTIVE: To prove that a newly developed technique of balloon axilloscopy can be performed using only one 10-mm and two 5-mm standard trocars and constant carbon dioxide flow to preserve the axillary space and that preservation of all nerves and vessels is possible with this approach. DESIGN: Prospective study on 4 fresh-frozen human cadavers and 7 live porcine models. SETTING: A hospital department of minimal surgery access and a university department of anatomy. RESULTS: The balloon dissection consistently revealed and preserved the nerves and vessels, and exposure and dissection of the first rib could similarly be accomplished. An alternative route to the apex of the axilla has been developed--between the pectoralis minor and pectoralis major muscles--after their careful separation. The axillary content of surgical interest (lymph nodes) is easily separated from the other anatomical elements and is simply dissected under complete visualization and preservation of all vital axillary structures. CONCLUSIONS: Balloon axilloscopy was easy to perform, provided the surgeon with constant visualization of vital anatomical structures, and allowed easy separation and dissection of the axillary lymph nodes and the first rib. As a technical aid prior to a conventional axillary dissection, or as part of a pure endoscopic procedure in the axilla, balloon axilloscopy is 100% reliable in identifying the long thoracic nerve and moving it out of the way, separating the lymph nodes from it and from the intercostobrachial nerve and axillary vein and artery, rendering the whole dissection process safer for both the surgeon and the patient.

Animals↗
PubMed1997

Laparoscopic cryosurgery for hepatic tumors. Experimental observations and a case report.

BACKGROUND: Hepatic cryosurgery has been shown to be a safe technique that may be well suited to a laparoscopic approach. METHODS: The technical feasibility and safety of laparoscopic cryosurgery was explored first in a pig model. Thereafter we performed the first successful case of laparoscopic hepatic cryosurgery at our institution. RESULTS: In the animal model, we found that it is possible to safely identify, target, and cryoablate specific lesions in the liver. Temperature in the peritoneal cavity remained above 35 degrees C, and pathologic examination of the abdominal wall around the cryoprobe site revealed no damage. We also successfully treated a 62-year-old man with a metastatic colorectal carcinoma deep in the right lobe of the liver with laparoscopic cryosurgery using a transpleural approach. CONCLUSION: We conclude that laparoscopic cryosurgery is feasible for lesions anywhere in the liver. For lesions high on the dome of the liver, a transpleural approach may provide better access.

Adenocarcinoma↗
PubMed1995

Laparoscopic approaches to the lumbar vertebrae. An anatomic study using a porcine model.

STUDY DESIGN: This study described and compared retroperitoneal and transperitoneal laparoscopic approaches to the lumbar vertebrae in pigs. Technical and perioperative complications were evaluated for each approach. OBJECTIVES: The objective of this study was to develop a laparoscopic approach to the lumbar vertebrae that is associated with minimal technical and perioperative complications. SUMMARY OF BACKGROUND DATA: Laparoscopic techniques have been used extensively in many surgical fields. Recently, thoracoscopy has been used to perform a number of thoracic spinal procedures, including thoracic discectomy, and anterior osteotomy, release, and fusion. To date, there have been no published reports describing laparoscopic approaches to the lumbar vertebrae. METHODS: With all pigs positioned in left lateral recumbency, retroperitoneal and transperitoneal laparoscopic approaches to the lumbar vertebrae were performed in three pigs. Placement of the insufflation needles and trocar ports were determined for each approach. Dissection of the lumbar vertebrae were performed, and the technical and perioperative complications recorded. Radio-opaque markers were placed to identify the dissected lumbar intervertebral disc spaces, and intraoperative fluoroscopy was used to confirm marker placement. Gross anatomic dissections were performed after the pigs were killed. RESULTS: Loss of pneumoretroperitoneum resulted in surgical termination in two of three pigs undergoing retroperitoneal laparoscopic approach to the lumbar vertebrae. In the remaining pig, difficulty was encountered in mobilization of the psoas major muscle from the lumbar vertebrae, and significant bleeding occurred. The transperitoneal approach to the lumbar vertebrae resulted in rapid mobilization of the psoas musculature and exposure of the lumbar vertebral bodies and discs of L1-L6/L7. Intraoperative complications included minimal bleeding and difficulty encountered in mobilization of the renal vascular pedicle. CONCLUSIONS: The retroperitoneal approach was difficult because of the degree of muscle dissection required for exposure of the lumbar vertebrae. Complications associated with the retroperitoneal approach included loss of pneumoretroperitoneum because of entry into the peritoneal cavity, hemorrhage, and limited exposure of the lumbar vertebrae. The transperitoneal approach was easier technically, allowing identification and access to lumbar vertebral bodies and intervertebral discs from L1-L6/L7. Operative complications associated with the transperitoneal laparoscopic approach were minimal.

Animals↗
PubMed1994

Laparoscopic Ileogastrostomy for Morbid Obesity.

This paper describes the technique of laparoscopic ileogastrostomy which we developed during the summer of 1993. The procedure is identical to that of our 'open' ileogastrostomy except that it is performed laparoscopically. The aim of the surgery is to increase ambulation of the patient, while reducing pain, morbidity, and the chance of apnea (due to impaired breathing in the first 24 h following conventional surgery), by carrying out surgery for the morbidly obese person through a laparoscope. This form of laparoscopic surgery may be completed within 4 h and, as our staff gains more experience with laparoscopic ileogastrostomy, we expect patient stays to be 2-3 days in length. Pulmonary function tests at 24 h show a great advantage in favor of the laparoscopic approach. Response of the medical team to this procedure was that it was more time-consuming and demanding than open surgery.

Journal Article↗
PubMed1992

Postoperative respiratory function after laparoscopic cholecystectomy.

Open cholecystectomy causes changes in pulmonary function test volumes; such changes can be related to respiratory complications of hypoxemia and atelectasis. Little data is available on lung volume changes after laparoscopic cholecystectomy. We measured preoperative and postoperative vital capacity (VC), functional residual capacity (FRC), arterial PO2, and chest X-ray atelectasis in 31 patients undergoing laparoscopic cholecystectomy and found small but significant decreases (p < 0.01) in VC (13 +/- 19%) and FRC (7 +/- 17%). The PO2 decreased from 89 +/- 11 mm Hg to 82 +/- 14 mm Hg, with only one patient's PO2 less than 60 mm Hg. Three patients demonstrated new segmental lobar collapse on postoperative chest X-ray. The postoperative changes in FRC (R2 = 0.40, p < 0.04) and atelectasis (R2 = 0.46, p < 0.03) could be predicted by multiple regression of risk factors, including obesity, smoking, use of narcotics, age, and symptoms of prior respiratory disease. We conclude that the respiratory changes after laparoscopic surgery are small in comparison to those expected after open cholecystectomy.

Cholecystectomy, Laparoscopic↗
PubMed1986

A survey of patient and family satisfaction with social work services.

Client satisfaction can be important indicator of the quality of social work services. This article reports the results of a survey conducted by a social work department of a large urban teaching hospital to elicit patient and family reaction to its services. A random, proportionate sample of in- and out-patient cases in medical and psychiatric programs was used. In general, staff was seen as helpful, although with interesting variations depending on the social work function performed. The findings have implications for education, supervision, quality assurance, levels of staffing and staff's perception of their usefulness.

Attitude of Health Personnel↗
PubMedDate not supplied

Asthma: current controversies and emerging therapies.

Despite advances in understanding the pathogenesis of asthma, a number of controversies regarding the optimal clinical management of asthma remain. This review of recent literature and current controversies, chosen mainly on the basis of relevance to clinical therapy, is directed toward nonspecialists caring for asthmatic patients.

Adrenergic beta-Agonists↗