Biomedical subjects
Dennis L Fowler
Publications and source records attributed to Dennis L Fowler.
Efficacy of novel robotic camera vs a standard laparoscopic camera.
To improve visualization during minimal access surgery, a novel robotic camera has been developed. The prototype camera is totally insertable, has 5 degrees of freedom, and is remotely controlled. This study compared the performance of laparoscopic surgeons using both a laparoscope and the robotic camera. The MISTELS (McGill Inanimate System for the Training and Evaluation of Laparoscopic Skill) tasks were used to test six laparoscopic fellows and attending surgeons. Half the surgeons used the laparoscope first and half used the robotic camera first. Total scores from the MISTELS sessions in which the laparoscope was used were compared with the sessions in which the robotic camera was used and then analyzed with a paired t test (P < .05 was considered significant). All six surgeons tested showed no significant difference in their MISTELS task performance on the robotic camera compared with the standard laparoscopic camera. The mean MISTELS score of 963 for all subjects who used a laparoscope and camera was not significantly different than the mean score of 904 for the robotic camera (P = .17). This new robotic camera prototype allows for equivalent performance on a validated laparoscopic assessment tool when compared with performance using a standard laparoscope.
Therapeutic efficacy of laparoscopic cholecystectomy in the treatment of biliary dyskinesia.
BACKGROUND: The outcome of laparoscopic cholecystectomy for patients who present with "classic" biliary colic without evidence of cholelithiasis or acute inflammation (biliary dyskinesia) is not well documented. This study evaluates whether a cholecystokinin dimethyl iminodiacetic acid (CCK-HIDA) scan can predict relief of symptoms in this group of patients. METHODS: Patients who underwent laparoscopic cholecystectomy after a normal ultrasound and with an abnormal dimethyl iminodiacetic acid scan were retrospectively reviewed. Symptomatic improvement was correlated with degree of dyskinesia, histologic findings, sex, and age. RESULTS: One hundred seventy-six patients were studied and 69% were available for followup at a mean interval of 16 months. One hundred fourteen patients (94%) had complete or partial relief of symptoms. No correlation was found between degree of relief and degree of impaired ejection (31% to 50% versus <30%), the histologic findings, sex, or age. CONCLUSIONS: Abnormal cholecystokinin dimethyl iminodiacetic acid scan effectively predicts relief of symptoms in patients undergoing laparoscopic cholecystectomy for biliary dyskinesia.
Laparoscopic adrenalectomy: there can be no doubt.
Explore the source record for details and available documents.
Bedside diagnostic minilaparoscopy in the intensive care patient.
BACKGROUND: The diagnosis of acute abdominal conditions in the critically ill patient remains difficult. The goal of this study is to demonstrate the use of bedside minilaparoscopy as a diagnostic aid in the intensive care unit (ICU) in patients with possible intra-abdominal catastrophic condition. METHODS: Between February 1998 and May 1999, intensive care patients with abdominal pain, unexplained acidosis or sepsis, or suspected mesenteric ischemia were eligible for bedside diagnostic minilaparoscopy (3.3-mm laparoscope and instruments). The procedure was performed at bedside in the ICU with the patient under local anesthesia and intravenous sedation. Pneumoperitoneum was established with nitrous oxide (N(2)O) to a pressure of 8 to 10 mm Hg. Hemodynamics and ventilatory parameters were monitored before, during, and after the procedure. RESULTS: Nineteen patients underwent bedside diagnostic minilaparoscopy, including 1 patient who underwent 2 diagnostic laparoscopies. Total procedure time was 9 to 68 minutes (mean, 21 minutes). Three patients were found to have extensive mesenteric ischemia and did not undergo laparotomy. One patient found to have questionably viable bowel at laparoscopy underwent a nontherapeutic formal laparotomy. One patient had a gangrenous gallbladder, and another had a small ischemic segment of bowel; each underwent later open laparotomy and resection. The remaining laparoscopic examinations either showed a nonsurgical cause for the patient's condition or were normal. Nontherapeutic laparotomy was avoided in 19 of 20 patients. One gallbladder perforation occurred during laparoscopy in a patient with a necrotic gallbladder. CONCLUSIONS: Bedside minilaparoscopy can be a safe and accurate method to evaluate critically ill patients in whom the possibility of mesenteric ischemia or other intra-abdominal process is entertained. Nontherapeutic laparotomy can be avoided in many critically ill patients. Bedside diagnostic laparoscopy can be a useful replacement for diagnostic laparotomy in the operating room. It should be included in the diagnostic algorithm in the evaluation of the unstable patient in the ICU with a suspected acute intra-abdominal process.