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Biomedical subjects

F L Greene

Publications and source records attributed to F L Greene.

At least 19 recordsLinked to original sources
PubMed2001

Initial results with an electrothermal bipolar vessel sealer.

BACKGROUND: An electrothermal bipolar vessel sealer (EBVS; Ligasure, Valleylab, Boulder, CO, USA) was developed as an alternative to suture ligatures, hemoclips, staplers, and ultrasonic coagulators for ligating vessels and tissue bundles. The EBVS seals vessels up to 7 mm in diameter by denaturing collagen and elastin within the vessel wall and surrounding connective tissue. This study is the first to determine the clinical efficacy and safety of this instrument and delineate its potential timesavings in both experimental (animal) and clinical scenarios. METHODS: A prospective review of the author's clinical experience with the EBVS in laparoscopic and open operations from October 1998 to March 2000 was performed. In addition, five Yorkshire domestic pigs underwent 150-cm small intestine resections (n = 10) using the EBVS (n = 5) and suture ligatures (n = 5). Measurements included time to complete intestinal resection, the number of applications per minute for each method, and the presence of postapplication bleeding. Statistical analysis was performed using Student's t-test. RESULTS: The EBVS was used in 98 cases (46 laparoscopic and 52 open) with a mean of 43 applications (range, 10-150 applications) per case. The operations included 53 colon and/or small bowel resections (54.1%), 24 fundoplications (24.5%), 12 gastric resections (12.2%), 3 splenectomies, 2 pancreatectomies, 1 adrenalectomy, 1 bilateral salpingo-oopherectomy, 1 pancreatic cyst-jejunostomy, and 1 vagotomy with gastrojejunostomy. In all these cases, the EBVS was intended to be the only means of vessel ligation. An alternative ligation technique was required for bleeding in only 13 (0.3%) of more than 4,200 applications of the EBVS. No postoperative hemorrhagic complications occurred. There was an estimated mean reduction in operative time of 39 min per open procedure, and a mean prolongation in operative time of 8 min per laparoscopic procedure when the EBVS was used in lieu of suture ligatures, hemoclips, staplers, or ultrasonic coagulators. In the animal model, the mean time for completion of the intestinal resection was 251.9 s for the EBVS and 702.0 s for ligatures (p < 0.001). The mean number of applications per minute was 7.6 for the EBVS and 1.8 for ligatures (p < 0.001). No postapplication bleeding was seen. CONCLUSIONS: Initial clinical results from the use of EBVS in laparoscopic and open procedures demonstrate it to be safe and effective, reducing operative time in open procedures. Suture ligatures, ties, hemoclips, and other ligating techniques were used rarely (0.3%) after an application of the EBVS. In an experimental animal model, the EBVS was significantly faster and more efficient (more applications per minute) than ligatures for intestinal resection.

Animals↗
PubMed2001

Optimal teaching environment for laparoscopic splenectomy.

BACKGROUND: Traditional surgical teaching depends on graduated acquisition of skill learned in residency. The introduction of minimal access techniques after residency training has created a new paradigm dependent on animate course experiences and limited preceptor training. The outcome of performance of a new skill "learned" in these settings has not been assessed. The purpose of this study was to test the benefit of an animate course compared with a precepted operating room experience in learning to perform a laparoscopic splenectomy. METHODS: All attending surgeons who had taken a 1-day course to learn laparoscopic splenectomy (n = 37) and those who had undergone an intraoperative preceptorship (in their hospital) by the lead author (n = 15) were polled to ascertain their previous experience with laparoscopy and with laparoscopic splenectomy since the intervention. The course included lectures, operative videos, and an animal lab. Statistical differences were measured using a t test. RESULTS: Thirty-two of the 37 (86.5%) taking the course and all 15 of the precepted surgeons responded. There was no difference between the groups regarding prior laparoscopic experience (P = 0.73), laparoscopic training during residency (P = 0.74), academic or private practice (P = 0.48), or follow-up since the intervention (P = 0.36). The participants graded the courses (1 to 5, 5 = excellent) at an average of 4.72. Fourteen of 15 precepted surgeons have performed laparoscopic splenectomy as compared with 2 of 32 taking courses (nonprecepted surgeons; P <0.0001). The number of laparoscopic splenectomies performed totaled 112 for precepted surgeons and 4 for nonprecepted surgeons (P = 0.0003). The nonprecepted surgeons performed significantly more open splenectomies than laparoscopic (95 versus 13 respectively, P = 0.02). Reasons quoted not to proceed with laparoscopic splenectomy included waiting for the perfect patient, concern of hilar management, and splenic size. CONCLUSION: Surgeons precepted in their own operating room performed a laparoscopic splenectomy more readily than those gaining experience from a course only (93% versus 6%, respectively) despite no difference in their preintervention experience and having the opportunity to do so. The expectation of the eventual performance of advanced laparoscopic techniques depends on a precepted experience.

Education, Medical, Continuing↗
PubMed2000

Role of laparoscopy in the staging of malignant disease.

Although diagnostic laparoscopy has been used by surgeons and gastroenterologists since the early 1900s, today's surgical oncologists have been relatively slow to embrace this technology. Together with the fervor and benefits afforded by laparoscopic therapeutic interventions in the management of patients with benign disease and the diagnostic usefulness in blunt trauma and abdominal pain, awareness has been rekindled regarding the advantages of laparoscopy for the staging of abdominal malignancy. As surgeons begin to realize that extirpative procedures are doomed to failure in curing patients with diffuse abdominal metastases disclosed on laparoscopic assessment, palliative measures, such as stent placement, ablative procedures, balloon dilatation, intraluminal high-dose radiation, and laser techniques will be used commonly by surgical endoscopists and gastroenterologists. Similarly, it is hoped that the use of systemic chemotherapy will achieve better specificity in cell destruction in patients identified laparoscopically to have uncontained disease in the abdominal cavity. The sensitivity of sonography combined with laparoscopy has been shown to approach that of celiotomy in the evaluation of solid organs, thereby avoiding unnecessary laparotomy and its associated morbidities. Using sonography as a complement to laparoscopy will extend the usefulness of both techniques. The application of laparoscopy and the advent of miniaturized laparoscopic instrumentation (Fig. 7), both diagnostic and therapeutic, in the management of patients with abdominal malignancy will be limited only by the creativity and expertise of physicians and instrument makers.

Colorectal Neoplasms↗