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Biomedical subjects

E Schwierz

Publications and source records attributed to E Schwierz.

8 recordsLinked to original sources
PubMed2006

Total laparoscopic iliac artery aneurysm repair using endoscopic techniques and endovascular balloon occlusion.

UNLABELLED: We present a novel total laparoscopic technique to treat patients with iliac and aorto iliac aneurysms. The laparoscopic procedure does not require clamping of the iliac arteries because of a hybrid approach. REPORT: Laparoscopic exposure of the aorta is performed using transperitoneal left retrorenal access. A transfemorally placed balloon catheter blocks the external iliac artery. Two haemostatic sheaths are inserted directly through the skin into the abdominal cavity. Balloons are passed through these sheaths to block the common iliac artery and the hypogastric artery, allowing bypass grafting to be performed with appropriate haemostatic control. DISCUSSION: The technique described preserves inflow into the hypogastric arteries . This is accomplished by a combination of laparoscopic and endovascular techniques reducing the problems that can be caused by clamping diseased arteries.

Anastomosis, Surgical↗
PubMed2000

Video-assisted aortic surgery.

BACKGROUND: There are several laparoscopic techniques that can be used to perform a total or video-assisted aorto-femoral bypass grafting procedure. Major drawbacks of laparoscopic aortic surgery are the long operating times and the steep learning curve required for these procedures. Hand-assisted laparoscopy is a novel technique that allows surgeons to use their hands and laparoscopic instruments in the operative field while maintaining a pneumoperitoneum. STUDY DESIGN: A prospective nonrandomized study was conducted in a community medical center. Any patient with aortoiliac occlusive disease or an abdominal aortic aneurysm who was determined to be suitable for a laparoscopic aorto-femoral bypass grafting procedure was included in the study. The main outcomes measured were: operating time, aortic cross-clamp time, incision size, complications, conversion rate to an open procedure, length of stay in the ICU, and postprocedural hospital stay. A concurrent control group of 20 patients was compared with the minimally invasive group. RESULTS: Forty-one consecutive patients were scheduled for the laparoscopic operation. Conversion to an open procedure was necessary in three patients. There were two major complications, including the development of renal failure in one patient who died 28 days postoperatively. The mean postprocedural hospital stay was 4.5 +/- 2.5 days (range 2 to 15 days). The mean operating time was 163.1 +/- 38.7 minutes, including an aortic cross-clamp time of 38.3 +/- 9.7 minutes. Postoperative hospital stay and the time required in the ICU were significantly shorter after the laparoscopic procedure compared with a conventional bypass grafting procedure. CONCLUSIONS: Hand-assisted laparoscopy is a minimally invasive technique with operating times and outcomes similar to those of conventional procedures. The possibilities of this technique in patients with aortoiliac disease should be evaluated in a prospective randomized study.

Aged↗
PubMed2000

Descending aorta-to-femoral artery bypass: preliminary experience with a thoracoscopic technique.

Descending aorta-to-femoral artery bypass is a durable procedure with excellent long-term patency rates. The operation is usually performed using a lateral thoracotomy combined with retroperitoneal tunneling of the graft. Assuming that a smaller incision would reduce the operative trauma, minimally invasive video endoscopic techniques were used to perform a thoracoscopic bypass operation. In all patients, exposure of the descending aorta was obtained using thoracoscopy. This was accomplished with a maximum of four ports. For placing the conventional side-biting aortic clamp, a 3- to 4-cm incision was necessary. Using this incision as an access port, the proximal anastomosis was sutured endoscopically. Retroperitoneal tunneling was performed using laparoscopically guided balloon dissection. Eleven consecutive patients underwent surgery. In two patients, conversion to a standard thoracotomy was necessary because of extensive intrathoracic adhesions. There were no major complications, except for one hematoma. After a mean follow-up of 9.5 months, all bypass grafts were still patent. Patients could be discharged after a mean postprocedural hospital stay of 7.4 days (range, 5-12). Thoracoscopic descending aorta-to-femoral artery bypass is an operation with excellent patency rates; however, it is a novel technique that still requires further technical improvements. Clinical studies are needed to prove the safety and efficacy of this minimally invasive technique.

Abdomen↗
PubMed1999

Redone endoscopic perforator surgery: feasibility and failure analysis.

PURPOSE: In many hospitals and medical practices, subfascial endoscopic perforator surgery (SEPS) has become the treatment of choice in patients with incompetent perforator veins and active venous ulcers. A substantial number of surgeons consider SEPS to be an operation that can be performed only once because extensive scarring and narrowing of the subfascial space make a second endoscopic operation impossible. It is the purpose of this report to prove the feasibility, efficacy, and safety of a second SEPS procedure. METHODS: Within a period of 30 months, 105 primary SEPS procedures were performed in patients with healed or still active ulcers. In addition to these cases, within a period of 30 months, a consecutive number of 19 patients were examined and scheduled for a second SEPS procedure. All patients were in class 5 with healed ulcers or in class 6 with still active ulcers. The CEAP classification of the American Venous Forum was used to evaluate the results and to calculate the clinical, disability, and outcome scores. The redone operation was performed by using CO(2) insufflation, a dual-port technique, and subfascial balloon dissection. RESULTS: In two patients conversion to a conventional procedure was necessary. There were no major complications, but there was a 21% incidence of minor problems, such as hematoma or cellulitis. The mean total clinical score improved after surgery from 7.91 to 3.23 (P <.01), the disability score changed from 1.10 to 0.57 after surgery (P <.02), and the clinical outcome score was 1. 47 after surgery (P <.001). Cumulative ulcer healing could be achieved in 85.8% of class 6 patients. Failure analysis revealed that an incomplete subfascial dissection had been performed during the first endoscopic operation. A septum intermusculare medialis or an intact deep posterior fascia with incompetent Cockett II perforators were major factors contributing to the initial treatment failures. In addition to incompetent perforators, postthrombotic deep venous reflux was seen in eight (42.1%) patients, and four (21%) patients had a combination of secondary reflux and obstruction. CONCLUSION: Subfascial endoscopic procedures can be redone safely. In addition to exploring the superficial posterior compartment, the deep posterior compartment must be opened to prevent recurrent symptoms in patients with incompetent perforator veins.

Adult↗
PubMed1998

[Dependence of surgical trauma in aortic interventions on the approach chosen. A prospective study].

Transabdominal aortic replacement is the most widely accepted approach for aortic surgery. Several controlled studies report a more favorable outcome after an extraperitoneal incision, yet there are an equal number of papers with contradictory results. The aim of our study was to assess operative trauma after aortic surgery, depending on whether transperitoneal or extraperitoneal access was used. As a parameter for the extent of the surgical trauma the concentration of Interleukin 6 and acute phase proteins (CRP) was measured pre-, 6 h and 24 h after aortic surgery. One group consisted of 34 patients scheduled for aortic surgery for exclusion of an abdominal aortic aneurysm. The second group consisted of 26 patients who were operated on for aorto-iliac occlusive disease. Each group was subdivided into an equal group of patients operated on either extra- or transperitoneally. In the retroperitoneal aneurysm patients, a posterolateral access was favored, and in patients with occlusive disease an extraperitoneal anterolateral approach was chosen. As a result patients with an extraperitoneal incision and aorto-iliac occlusive disease required less postoperative respiratory support than those operated on transperitoneally. In this subgroup of patients there was a significantly reduced synthesis of Interleukin 6 and CRP. When a retroperitoneal posterolateral approach was required in aneurysm patients, there was no difference between groups. We conclude from our data that only patients with limited infrarenal aortic access can benefit, from the retroperitoneal incision in terms of a reduced immunological reaction.

Acute-Phase Proteins↗
PubMed1998

Reducing the operative trauma in aortoiliac reconstructions--a prospective study to evaluate the role of video-assisted vascular surgery.

OBJECTIVE: To evaluate the role of the surgical access with regard to the generation of proinflammatory proteins in patients with aortoiliac occlusive disease. DESIGN: Non-random, prospective study of patients undergoing an aortobifemoral bypass procedure. MATERIALS: Twenty-six patients were divided into three groups. In the first group of eight patients, a transperitoneal median laparotomy was used. The second group comprised 10 patients in whom a laparoscopically assisted extraperitoneal minilaparotomy was performed and, in the third group, eight patients were operated on using a retroperitoneal access. METHODS: Biochemical analysis of acute phase proteins and the cytokines interleukin-6 (Il 6), interleukin-8 (Il 8) and tumour necrosis factor (TNF). RESULTS: Aortic cross-clamp and total operative time were significantly longer in the laparoscopic group. After 24 h Il-6 concentrations were significantly higher in the transperitoneal (p < 0.05) and the retroperitoneal group (p < 0.006). After 6 h there was a reduced Il-8 concentration in the laparoscopic group compared to patients with a standard retroperitoneal access. Neither TNF nor acute phase proteins showed any significant alterations. CONCLUSION: Laparoscopic-assisted vascular surgery allows for a smaller incision and reduces the surgical trauma, as it is reflected by interleukin levels.

Acute-Phase Proteins↗