Biomedical subjects
Publications and source records attributed to G J Jako.
The minimally invasive direct access surgical technology (MIDAST) has grown out of previous experience applied in otolaryngology and endoscopic microsurgery. From the time of Ambroise Pare and for centuries surgeons have made large incisions to gain adequate access for manipulation with large, straight, bulky instruments and achieved adequate illumination by the sun and later by artificial lighting.
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UNLABELLED: Despite improvements in surgical practice and postoperative care, the large vertical midline or transverse transperitoneal approaches used in abdominal aortic surgery are still associated with a relatively high perioperative morbidity and mortality rate even in patients who are considered good risks for undergoing aortic surgery. This significant perioperative morbidity is partly caused by the major surgical trauma. To decrease the surgical stress on these patients we have developed a less-extensive procedure for this type of vascular reconstruction. TECHNIQUE: The abdominal aorta is explored using a special retractor through a short upper median minilaparotomy utilizing modified conventional surgical hand instruments. For an aortobifemoral graft implantation, a retroperitoneal tunnel is necessary. During the creation of this tunnel special care should be exercised to avoid troublesome hemorrhage with iliac and other vein lacerations. To overcome these difficulties, we have developed a new tunneling device, which allows us to have visual control of the tunneling procedure. This prototype device contains a semiflexible tube with an inflatable balloon and a flexible videoendoscope. It is introduced along the external iliac artery into the retroperitoneal space and creates a tunnel through step-by-step inflation of the balloon. After this, the graft is implanted in the usual manner. To date, 19 abdominal vascular reconstructions have been performed with this method.
A new minimally invasive ureterolithotomy is herein described which utilizes a 3 cm long skin incision. Surgery is performed with the aid of a newly developed bivalve retractor endoscope (Jakoscope) which provides excellent illumination with built-in double fiberoptic light cables and high intensity light source. The new surgical technique can be utilized in the rare cases of ureteral stone when other standard modalities may not work or when the patient demands definitive rapid treatment, and cannot be followed postoperatively.
The authors describe a newly developed minimal access method for nephrectomy. The mini approach-a 5 cm skin incision-can be performed with a special retractorscope, which is an open lumen "scope" with fiberoptic light system.
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An alternative surgical instrumentation and technique to laser laparoscopic cholecystectomy (LLC) with a case report is presented. Thousands of patients have benefited from the conceptual and practical revolution brought about through LLC (i.e., minimal surgical trauma). The minimal invasiveness of this procedure also can help make surgical treatment more acceptable by the public. The instruments and technique presented are redesigns of ones used in laryngology for 30 years. Utilizing them would provide major cost reduction. Most hospitals around the world already have operating microscopes, electrocoagulation equipment, and CO2 lasers. Some of these are underutilized. The presented patient case shows that the procedure can have similar benefits to LLC, in some respects even more. This open endoscopic technique and instrumentation may be suitable to other abdominal or thoracic procedures.
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A new application of magnetic resonance (MR) imaging to map the spatial and temporal distribution of the effects of Nd:YAG lasers on tissues was studied. The temperature dependence of MR relaxation mechanisms and the high sensitivity of MR to changes in the mobility and distribution of tissue water make it particularly suitable for the demonstration and control of thermal energy deposition in tissues. In heterogeneous tissues, MR imaging does not follow changing temperatures directly because even in the case of reversible thermal interactions, there is a hysteresis in the dynamic relationship between MR signal intensity and temperature. Appropriate matching of the laser and MR pulse sequences can, however, optimize the detection of relatively small laser energy deposition, and reversible and irreversible tissue changes can be distinguished. There is a potential for the integration of MR imaging and lasers for three-dimensional control and monitoring of laser-tissue interactions.
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The article "Reagan seeks expansion of Soviet ties" by R. Jeffrey Smith (News and Comment, 13 July, p. 145) erroneously stated that the U.S. Senate had passed a resolution calling for a U.S.-Soviet summit "without preconditions or assurances of success." Shortly before midnight on 19 June, the resolution was amended to call for a summit at "the earliest practical time following thorough preparation." It was approved in this form.
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A group of mice implanted with squamous cell carcinoma (CA1025) and melanoma (B16) were irradiated with a cw krypton laser using 3374A (total dosage 346 j/cm2, and 660 j/cm2), and 3507A (total dosage 367 j/cm2), and a pulse N2 laser 3371a (total dosage 471 j/cm2, 660 j/cm2, and 165 j/cm2). In all groups, tumorous mice were used as controls. Regression of tumors was observed at wavelengths of 3374A and 3371A (total dosage 471 j/cm2 and 660 j/cm2). No regression was observed at 3507A. The regression in some cases was very impressive. The preliminary work on N2 laser irradiation of basal cell carcinoma (in human beings) and of BEL 7404 liver carcinoma cells in vitro and irradiation of one patient with an N2 laser performed in China will also be reported.
The anatomical limitations of CO2 laser cordectomy in an experimental setting with maximal exposure are presented. The major limitation is the thyroid cartilage. This is reached in the area of anterior commissure tendon by removal of only 2 to 3 mm of soft tissue. Most posteriorly in the larynx, the distance to the thyroid cartilage becomes progressively greater, being 5.3 mm at mid-cord and 9.0 mm at the anterior end of the vocal process of the arytenoid. The inferior limitation is the cricothyroid membrane. Anteriorly this is avoided by not extending laser excision more inferiorly than 5 mm's. Posterolaterally, the limitation is the para-arytenoid musculature. Excisional biopsy or staging with the laser must be within the framework of these limitations.