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Biomedical subjects

E C Poulin

Publications and source records attributed to E C Poulin.

At least 55 records · Page 3Linked to original sources
PubMed1998

Splenic artery embolization before laparoscopic splenectomy. An update.

BACKGROUND: This study assessed preoperative splenic artery embolization before laparoscopic splenectomy. METHODS: Preoperative splenic artery embolization was used in 26 of 54 patients (48%) undergoing laparoscopic splenectomy. Between 1992 and 1994, this procedure was used in all patients with spleens shorter than 20 cm (group I), except the first two (18/20). An anterior surgical approach was used. After 1994 (group II), embolization was not used for these patients (0/26), and a lateral surgical approach was used. Throughout the study period, all patients with spleens longer than 20 cm had embolization (8/8). RESULTS: Five complications occurred, three related to the use of small-particle embolic material (microspheres, gelatin foam powder). In group I, the conversion rate was lower than that of most current series, largely because of embolization. In group II, similar results were obtained because of experience and a better surgical approach (i.e., lateral). CONCLUSIONS: Preoperative splenic artery embolization is not necessary for spleens shorter than 20 cm. Increased experience and mostly the lateral surgical approach have permitted a shorter operation and a low conversion rate (4%) similar to the rate achieved with embolization and the anterior approach in the initial stages of the study. Embolization is used for 20- to 30-cm spleens. The conversion rate is higher (17%), and blood replacement is required frequently (83%). Despite embolization, laparoscopic splenectomy for spleens longer than 30 cm is futile at this time (100% conversion).

Angiography↗
PubMed1998

Laparoscopic splenectomy: lessons from the learning curve.

OBJECTIVE: Initial reports suggest that laparoscopic splenectomy is a difficult procedure with a steep learning curve and limited scope. The objective of this study was to review various approaches to simplify the operation. DESIGN: A descriptive study of a prospective database. SETTING: A tertiary care teaching hospital. PATIENTS: Fifty-one consecutive patients, seen over a 4-year period, who underwent laparoscopic splenectomy (partial laparoscopic splenectomy in 1 patient) for a wide variety of disorders. INTERVENTIONS: Anterior and lateral surgical approaches to laparoscopic splenectomy and the selective use of preoperative splenic artery embolization. MAIN OUTCOME MEASURES: Blood loss, morbidity, mortality and rate of conversion to open splenectomy, operating time and postoperative hospital stay. RESULTS: The morbidity (11%), death rate (2%), and rate of conversion were low. The recovery rate of accessory spleens was high (24%). Average operating time (3 hours), postoperative stay (3 days) and volume of blood loss improved with time. CONCLUSIONS: Laparoscopic splenectomy is a reliable procedure for patients with spleens less than 20 cm long. For spleens 20 to 30 cm long, preoperative embolization is advisable, and the surgeon should be experienced. Laparoscopic splenectomy should not be performed for spleens more than 30 cm long. The lateral approach has eliminated most of the difficulty with this procedure for spleens less than 20 cm long (no embolization). The anterior approach is reserved for large spleens and partial laparoscopic splenectomy (with embolization).

Adolescent↗
PubMed1998

Surgery for peptic strictures.

Benign peptic stricture of the esophagus is a complex disorder which results from persistent gastroesophageal reflux. Its successful management depends on an accurate preoperative evaluation of the stricture and the patient. Surgical management of peptic strictures can be quite effective in relieving the symptoms and halting the pathologic gastroesophageal reflux that accompanies this disorder. This article reviews the general principles of evaluation and surgical treatment of benign peptic esophageal strictures.

Barrett Esophagus↗
PubMed1998

Operative treatment of malignancy.

The overall prognosis of patients afflicted with cancer of the esophagus is dismal and has not changed greatly over the last few decades. Improvements have largely been due to better perioperative care rather than new surgical techniques. There remain, about the optimal treatment of these patients, and these differences are summarized in this article. The principal elements required to make an appropriate surgical decision also are outlined. Until new markers for early detection and effective systematic therapy emerge, improvement is likely to occur only in subsets of patients referred early and treated in an environment that guarantees low operative mortality.

Esophageal Neoplasms↗
PubMed1997

Fully thoracoscopic pulmonary lobectomy and specimen extraction through rib segment resection. Preliminary report.

BACKGROUND: A technique of fully thoracoscopic pulmonary lobectomy with rib-segment resection for specimen extraction is described, and preliminary results in 18 patients are presented. METHODS: Surgery is performed through four 15-mm ports. For all lobes except one, the surgeon operates in front of the patient, where the rib spaces are widest and rib-space trauma is less. When lobar dissection is complete, specimen extraction is performed after resection of a rib segment proportional to tumor size. Muscle section is kept to a minimum. There is no rib retraction. RESULTS: There were no deaths, three conversions to open surgery, and three major complications. Average postoperative stay was 5.4 days for patients without complications and 9.6 days for patients with complications. In total six patients presented with some degree of air leaks, and two had post-thoracotomy pain (>2 month's duration). The literature is reviewed to analyze current techniques and to define parameters of a truly minimally invasive pulmonary lobectomy. CONCLUSIONS: This technique is safe and promising; however, thoracoscopic lobectomy still needs refining. Before valid randomized studies comparing thoracoscopic lobectomy and muscle-sparing thoracotomy or posterolateral thoracotomy can be credible, technical issues related to the production of a truly minimally invasive procedure should be resolved.

Cohort Studies↗
PubMed1996

Preliminary study of electrocautery smoke particles produced in vitro and during laparoscopic procedures.

BACKGROUND: The objective of this preliminary study was to describe the particles contained in cautery smoke produced during five laparoscopic procedures and verify the collection method during three laboratory experiments on ex vivo animal tissue. METHODS: A cascade impactor collected the smoke according to particle size, and particle weights were calculated on an electronic microbalance. Electron microscopic analysis and energy dispersive X-ray evaluation were used to determine particle morphology and elemental composition. RESULTS: The particles, distributed according to size on the seven rotating trays of the impactor, had diameters ranging from 0.05 to >25 micro m, with most being 0.1-1 micro m. In vitro experiments yielded more particles, especially larger (>5 micro m) ones, than the surgical procedures, because the cauterized specimens could be placed much closer to the cascade impactor in the laboratory environment, eliminating most obstacles to particle recovery. In the laparoscopic surgery patients, larger particles, because of their physical properties, were more likely to remain trapped in the abdomen or to drop off in the collection apparatus. Uniformly, two populations of particles were demonstrated--either large, irregular fragments (2-25 micro m) rich in carbon and oxygen, suggesting structural cellular components, or small homogeneous spheres (0.1-0.5 micro m) composed of sodium, magnesium, calcium, and potassium salts. CONCLUSIONS: This study demonstrates the presence of breathable aerosols and cell-size fragments in the cautery smoke produced during laparoscopic procedures. Their exact chemical composition and potential adverse effects for patients and personnel are not known.

Cautery↗
PubMed1996

Reuse of disposable laparoscopic instruments: cost analysis.

OBJECTIVE: To evaluate the cost benefits of reusing disposable laparoscopic instruments. DESIGN: A cost-analysis study based on a review of laparoscopic and thoracoscopic procedures performed between August 1990 and January 1994, including analysis of disposable instrument use, purchase records, and reprocessing costs for each instrument. SETTING: The general surgery department of a 461-bed teaching hospital where disposable laparoscopic instruments are routinely reused according to internally validated reprocessing protocols. METHODS: Laparoscopic and thoracoscopic interventions performed between August 1990 and January 1994 for which the number and types of disposable laparoscopic instruments were standardized. MAIN OUTCOME MEASURES: Reprocessing cost per instrument, the savings realized by reusing disposable laparoscopic instruments and the cost-efficient number of reuses per instrument. RESULTS: The cost of reprocessing instruments varied from $2.64 (Can) to $4.66 for each disposable laparoscopic instrument. Purchases of 10 commonly reused disposable laparoscopic instruments totalled $183,279, and the total reprocessing cost was estimated at $35,665 for the study period. Not reusing disposable instruments would have cost $527,575 in instrument purchases for the same period. Disposable laparoscopic instruments were reused 1.7 to 68 times each. CONCLUSIONS: Under carefully monitored conditions and strict guidelines, reuse of disposable laparoscopic and thoracoscopic instruments can be cost-effective.

Cost-Benefit Analysis↗
PubMed1995

Laparoscopic splenectomy.

We describe the clinical course of 23 patients considered for laparoscopic splenectomy. One patient was excluded on the basis of preoperative angiography findings, and two (9%) were converted to open surgery. In the remaining 20 patients who successfully underwent laparoscopic splenectomy, no mortality was reported; four postoperative complications (20% morbidity) occurred. Mean operating time was 3 h 35 min (135-300 min). After a mean postoperative stay of 3.9 days (2-9 days), all patients except two were back to normal activities within 2 weeks of hospital discharge. Preoperative splenic artery embolization, begun with the third patient, helped to reduce operative blood loss and made the procedure easier to perform. Laparoscopic splenectomy has become our procedure of choice for elective removal of normal-sized (< 11 cm long) or moderately enlarged (11-20 cm long) spleens.

Adolescent↗
PubMed1995

Residual organic debris on processed surgical instruments.

This preliminary study describes the degree of cleanliness of three categories of surgical instruments after processing (ie, decontamination, inspection, sterilization). The three categories were reusable laparoscopic, reused disposable laparoscopic, and conventional surgical instruments. The objective of the study was to identify from visual inspection and microscopic examination residual particles, stains, or liquid on processed instruments. The investigators studied 32 instruments selected at random from a hospital's supply of processed surgical instruments. On visual inspection, 90.6% (29/32) of the instruments appeared clean. Microscopic examination with a photomicrographic system, however, revealed residual debris on 84.3% (27/32) of the instruments. The quantity of residual debris on both types of laparoscopic instruments (ie, reusable, reused disposable) was equivalent. The conventional instruments contained less residual debris than the laparoscopic instruments. Sites that contained residual debris included junctions between insulating sheaths and activating mechanisms of laparoscopic instruments and articulations and grooves of forceps. More research is needed to determine the prevalence and clinical significance of these findings.

Alberta↗
PubMed1995

Reuse of disposable laparoscopic instruments: a study of related surgical complications.

OBJECTIVE: To determine the rate of surgical complications related to reuse of disposable laparoscopic instruments. DESIGN: A review of all laparoscopic and thoracoscopic procedures done between August 1990 and January 1994 in which disposable laparoscopic instruments were reused. SETTING: Department of general surgery in a 461-bed teaching hospital. PATIENTS: Patients who underwent 874 laparoscopic and thoracoscopic procedures in which disposable laparoscopic instruments were reused according to validated reprocessing protocols. MAIN OUTCOME MEASURES: The incidence of superficial and deep wound infections and complications related to instrument malfunction. RESULTS: The combined rate for deep and superficial infections was 1.8%. No complications related to a disposable instrument malfunction were found. CONCLUSION: Disposable laparoscopic instruments may be safely reused under carefully monitored conditions and with strict guidelines.

Disposable Equipment↗
PubMed1995

Partial laparoscopic splenectomy for trauma: technique and case report.

We describe the course of a patient who underwent partial laparoscopic splenectomy after a fall while skiing. Computed tomography revealed intact liver and kidneys with fragmentation of the upper third of the spleen and a left upper quadrant hematoma. Splenic artery angiogram showed devascularization of the superior pole, and selective cannulation of the superior polar artery demonstrated extravasation of contrast media. The superior polar artery was embolized with three coils to control bleeding. After laparoscopic exploration, the patient underwent partial laparoscopic splenectomy of the superior pole, which consisted of ligating the short gastric vessels and incising the splenic parenchyma 6 to 8 mm above the ischemic demarcation line produced by embolization of the superior polar artery, where a deep transverse laceration was located. The specimen was retrieved in a plastic bag. Intraoperative blood loss was less than 50 ml, and the patient left the hospital on the 3rd postoperative day after an uneventful recovery. Partial laparoscopic splenectomy can be performed safely, and its role needs to be delineated.

Adolescent↗
PubMed1995

Laparoscopic splenectomy for massive splenomegaly: operative technique and case report.

Although laparoscopic splenectomy is the preferred technique for the elective removal of normal-sized and moderately enlarged spleens, its value in the management of massive splenomegaly has not been defined. A 33-year-old woman with massive splenomegaly was managed by laparoscopic splenectomy. The splenic vessels were embolized preoperatively to reduce operative blood loss. Laparoscopic surgery involved dissection of the suspensory ligaments at the lower pole of the spleen followed by dissection and ligation of all splenic branches near the splenic parenchyma. The operative field was explored manually through a 10-cm long Pfannenstiel incision at the public hairline, and under videoscopic control the remaining structures were safely secured. The spleen was delivered into the pelvis, fragmented and removed in large pieces. The incisions were closed after proper irrigation and laparoscopic inspection of the operative field. Further clinical evaluation is required to determine if the procedure is more efficacious than the open technique for massive splenomegaly.

Adult↗
PubMed1995

Total laparoscopic proctocolectomy and laparoscopy-assisted proctocolectomy for inflammatory bowel disease: operative technique and preliminary report.

We present the operative technique of laparoscopic proctocolectomy along with the clinical course of the first four patients to undergo this procedure. The operation was conducted through five 12-mm ports. In total laparoscopic proctocolectomy, the dissection began with the sigmoid, left colon, and rectum. The gastrocolic ligament was opened at the level of the midtransverse colon and dissected along with the transverse mesocolon toward the splenic flexure. The attachments and vessels of the right side of the gastrocolic ligament and the right colon were taken last. This sequence was followed because gradual mobilization of the colon displaced all structures in the middle of the abdomen and obscured vision. The specimen was extracted through the anus. In laparoscopy-assisted proctocolectomy, it was necessary to incise only the white line of Toldt of the ascending and descending colon, mobilize the hepatic and splenic flexures, and ligate the vessels of the gastrocolic ligament. Then the vessels of the mesentery were ligated near the bowel wall through a 6.5-cm midline subumbilical incision from which the abdominal colon was also extracted. The rectum was then completely dissected and sectioned at 10-15 cm from the anus, everted, and resected at the dentate line. Mean operative time was 7 h, 18 min, and average blood loss was 493 ml. One patient had urinary retention. Return to liquid diet took a mean of 4 days. Average postoperative stay, which depended on full return of bladder function and teaching of stoma care, was 10 days.

Adult↗
PubMed1993

The anatomical basis for laparoscopic splenectomy.

The anatomy of the splenic blood supply is extremely variable. Two principal patterns, the distributed and the magistral types, include the majority of variations. These two types differ with respect to the length of the splenic trunk, the number of arterial branches and the proportion of the medial surface of the spleen occupied by the branches as they enter the organ. The suspensory ligaments of the spleen, including the sustentaculum lienis, are usually avascular except for the gastrocolic and lienorenal ligaments on the medial side. The tail of the pancreas touches the spleen in 30% of cases and lies within 1 cm of the spleen in 73%. Knowledge of these basic anatomic facts and the variations should contribute to the safety of laparoscopic splenectomy.

Humans↗
PubMed1992

[Endoscopic retrograde cholangiopancreatography in the context of cholecystectomy under celioscopy].

This descriptive cohort study documents the results of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES) in the perioperative period of laparoscopic cholecystectomy (LC). Of 630 consecutive patients undergoing LC, 83 (13.2%) sustained 96 ERCP, of which 65 were performed preoperatively (67.7%) and 31 postoperatively (32.3%). The common bile duct cannulation rate was 96.9% after the first attempt and 100% after the second in three patients. Common duct stones were found in 40 patients (6.3%) and three other anomalies were demonstrated ES was performed in 42 patients and 100% clearance of the common bile duct was achieved after 45 extraction procedures. Six patients (1%) were found at follow-up with unsuspected common duct stones and were all successfully treated with ES. At present time, the morbidity of ERCP and ES (7.2% and 11.9%) make them worthwhile adjuncts to perative cholangiography for the diagnosis and treatment of common bile duct stones found during the perioperative period of LC.

Adolescent↗