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Biomedical subjects

G Kazemier

Publications and source records attributed to G Kazemier.

At least 19 recordsLinked to original sources
PubMed2006

Successful endoscopic treatment of chronic groin pain in athletes.

BACKGROUND: Chronic groin pain, especially in professional sportsmen, is a difficult clinical problem. METHODS: From January 1999 to August 2005, 55 professional and semiprofessional sportsmen (53 males; mean age, 25 +/- 4.5 years; range, 17-36 years) with undiagnosed chronic groin pain were followed prospectively. All the patients underwent an endoscopic total extraperitoneal (TEP) mesh placement. RESULTS: Incipient hernia was diagnosed in the study athletes: 15 on the right side (27%), 12 on the left side (22%), and 9 bilaterally (16%). In 20 patients (36%), an inguinal hernia was found: 3 direct inguinal hernias (5%) and 17 indirect hernias (31%). All the athletes returned to their normal sports level within 3 months after the operation. CONCLUSIONS: A TEP repair must be proposed to patients with prolonged groin pain unresponsive to conservative treatment. If no clear pathology is identified, reinforcement of the wall using a mesh offers good clinical results for athletes with idiopathic groin pain.

Adolescent↗
PubMed2006

Securing the appendiceal stump in laparoscopic appendectomy: evidence for routine stapling?

BACKGROUND: This metaanalysis aimed to compare endoscopic linear stapling and loop ligatures used to secure the base of the appendix. METHODS: Randomized controlled trials on appendix stump closure during laparoscopic appendectomy were systematically searched and critically appraised. The results in terms of complication rates, operating time, and hospital stay were pooled by standard metaanalytic techniques. RESULTS: Data on 427 patients from four studies were included. The operative time was 9 min longer when loops were used (p = 0.04). Superficial wound infections (odds ratio [OR], 0.21; 95% confidence interval (CI), 0.06-0.71; p = 0.01) and postoperative ileus (OR, 0.36; 95% CI, 0.14-0.89; p = 0.03) were significantly less frequent when the appendix stump was secured with staples instead of loops. Of 10 intraoperative ruptures of the appendix, 7 occurred in loop-treated patients (p = 0.46). Hospital stay and frequency of postoperative intraabdominal abscess also were comparable in loop-treated and staple-treated patients. CONCLUSIONS: The clinical evidence on stump closure methods in laparoscopic appendectomy favors the routine use of endoscopic staplers.

Appendectomy↗
PubMed2006

[Incidental cystic structures in the upper abdomen: to remove or not to remove?].

An abdominal cystic structure was diagnosed incidentally in two women aged 44 and 52 years, respectively. The first patient had a mesenteric cyst that was removed because of its malignant potential. The second had a duodenal duplication cyst which was not removed due to the minor risk of complications. Two other patients, a man aged 19 years and a woman aged 40 years, were referred with mechanical complaints due to a splenic cyst and a hepatic cyst, respectively. The splenic cyst was removed surgically and the hepatic cyst was treated by sclerotherapy. Cysts are fluid-filled cavities that can develop throughout the abdomen. They are often discovered by coincidence. These four patients show that cysts in the upper abdomen may be due to various disorders and that the decision to treat is based on the risk of complications, such as bleeding, rupture or malignant potential, as well as the symptoms related to the size ofthe cyst.

Adult↗
PubMed2005

Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial.

BACKGROUND: The safety and short-term benefits of laparoscopic colectomy for cancer remain debatable. The multicentre COLOR (COlon cancer Laparoscopic or Open Resection) trial was done to assess the safety and benefit of laparoscopic resection compared with open resection for curative treatment of patients with cancer of the right or left colon. METHODS: 627 patients were randomly assigned to laparoscopic surgery and 621 patients to open surgery. The primary endpoint was cancer-free survival 3 years after surgery. Secondary outcomes were short-term morbidity and mortality, number of positive resection margins, local recurrence, port-site or wound-site recurrence, metastasis, overall survival, and blood loss during surgery. Analysis was by intention to treat. Here, clinical characteristics, operative findings, and postoperative outcome are reported. FINDINGS: Patients assigned laparoscopic resection had less blood loss compared with those assigned open resection (median 100 mL [range 0-2700] vs 175 mL [0-2000], p<0.0001), although laparoscopic surgery lasted 30 min longer than did open surgery (p<0.0001). Conversion to open surgery was needed for 91 (17%) patients undergoing the laparoscopic procedure. Radicality of resection as assessed by number of removed lymph nodes and length of resected oral and aboral bowel did not differ between groups. Laparoscopic colectomy was associated with earlier recovery of bowel function (p<0.0001), need for fewer analgesics, and with a shorter hospital stay (p<0.0001) compared with open colectomy. Morbidity and mortality 28 days after colectomy did not differ between groups. INTERPRETATION: Laparoscopic surgery can be used for safe and radical resection of cancer in the right, left, and sigmoid colon.

Adult↗
PubMed2004

[Liver transplantation in a HIV-positive patient receiving potent antiretroviral therapy; the first case in The Netherlands].

In a 49-year-old woman infected with HIV who was receiving highly-active antiretroviral treatment (HAART), terminal liver failure developed. She also had an acute exacerbation of hepatitis B. She was treated by means of liver transplantation and was in good condition two years later. At that time she was treated with tacrolimus, lamivudine, tenofovir, nelfinavir and hepatitis-B immunoglobulin. HIV-RNA and the DNA of hepatitis-B virus could not be detected, her CD4-count was not abnormal and the liver transplant functioned well. No opportunistic infections had developed. HIV infection has long been considered an absolute contraindication to solid organ transplantation, due to the increased risk of infection and rapid progression to AIDS. With HAART, restoration of immune function is possible. Currently, international experience with liver transplantation for HIV-positive patients that are not infected with hepatitis C has shown promising results. Specifically, the risks of transplant rejection, opportunistic infections and progression to AIDS are not increased. Therefore, criteria have been defined for solid organ transplantation in HIV-positive recipients.

Antiretroviral Therapy, Highly Active↗
PubMed2004

[Liver transplantation from a living donor].

Recently the first three liver transplantations from living donors were performed in The Netherlands. The motivations to proceed with this new procedure were threefold; the existing shortage of post-mortem organ donors, the successful transplants reported in the literature and the supposedly better organ quality and favourable-logistics of the procedure. This new procedure is in line with a recent advisory report on organ donation from the National Health Council of The Netherlands. As long as there is a shortage of post-mortem donors, living donation is a necessary treatment for patients with otherwise fatal liver insufficiency. However this should not keep public and governmental organisations from its continuing efforts to promote post-mortem donation. These should also include a discussion regarding changes to the organ donation law.

Humans↗
PubMed2004

Hematological long-term results of laparoscopic splenectomy for patients with idiopathic thrombocytopenic purpura: a case control study.

BACKGROUND: Laparoscopic splenectomy (LS) for idiopathic thrombocytopenic purpura (ITP) appears, when compared to open splenectomy (OS), associated with immediate important advantages. However, in a number of patients splenectomy does not lead to an adequate response, or after initial adequate response a relapse occurs after some time. A relapse may be associated to the presence of accessory spleens and splenosis. The purpose of this study was to compare the operative outcome and the hematological results on the long term of a series of LS with a historic series of OS for the treatment of ITP. METHODS: A retrospective review was done of 50 consecutive patients who underwent LS for ITP. Patient characteristics, outcome of surgery, and hematological results were compared to a historical group of patients who underwent conventional splenectomy for ITP (n = 31). Response to splenectomy was defined in three groups: complete remission, partial remission, and no response. Grouping was based on hematological data. RESULTS: Concerning operative outcome and postoperative complications, there was a significant difference in favor of LS. Moreover, the hematological outcome of both groups showed no differences after a median period of 66 months (OS) and 35 months (LS), respectively. CONCLUSIONS: Hematological results after laparoscopic splenectomy for ITP are comparable to those after open splenectomy in both the short and the long term.

Adolescent↗
PubMed2004

Surgical validation of unenhanced helical computed tomography in acute appendicitis.

BACKGROUND: Surgery for pain in the right lower quadrant of the abdomen remains a clinical dilemma. This prospective study assessed the accuracy of preoperative unenhanced helical computed tomography (CT) in the evaluation of patients with suspected acute appendicitis. METHODS: One hundred and three adult patients with suspected acute appendicitis underwent unenhanced helical CT of the abdomen. Subsequently, all patients underwent laparoscopic inspection of the abdominal cavity by a surgeon who was blinded to the diagnosis suggested by CT. Patients underwent appropriate surgical therapy accordingly. Follow-up was at least 6 weeks. RESULTS: Appendicitis was diagnosed by CT in 83 patients (80.6 per cent). Acute appendicitis was identified during laparoscopy in 87 patients (84.5 per cent). Prospective interpretation of CT images yielded a sensitivity of 95.4 per cent and a specificity of 100 per cent for the diagnosis of acute appendicitis. There were four false-negative scans. In 12 of 20 patients without signs of appendicitis on CT, the scan established the presence of other pathology. At operation no additional pathology was observed in this group and all other diagnoses proved to be correct. CONCLUSION: Plain helical CT in patients with suspected acute appendicitis provides an accurate diagnosis without the disadvantages of contrast enhancement.

Abdominal Pain↗
PubMed2003

Improvement of foot pedals used during surgery based on new ergonomic guidelines.

BACKGROUND: This study aims to create new ergonomic guidelines for the design of foot pedals used during surgery. METHODS: Observations in the operating room, a questionnaire among 45 laparoscopic surgeons/residents, an ergonomic literature study, and clog measurements were used to assess the problems occurring during use and to compile new guidelines for foot pedals. Based on these guidelines a new foot pedal was designed and a prototype was manufactured. RESULTS: During the surgical procedure 91% of the subjects occasionally loses contact with the foot pedal, which 56% experience as very annoying. All subjects think that the current foot pedals obstruct their freedom of movement; 75% occasionally hit the wrong switch and 53% experience physical discomfort in their legs and/or feet. Therefore, 93% of the subjects would like to control the diathermy in a different way. The new prototype of a foot pedal was evaluated in a pilot test and proved to be ergonomically better than the currently used foot pedals. CONCLUSION: The new guidelines for foot pedals result in an ergonomic improvement in their design.

Equipment Design↗
PubMed2003

Improvement of the laparoscopic needle holder based on new ergonomic guidelines.

BACKGROUND: The aim of this study is to create new ergonomic guidelines for the design of laparoscopic needle holders. METHODS: An ergonomic literature study, observations in the operating room, handle-shaft angle measurements, and anthropometric data were used to compile new ergonomic criteria, specified to the function of a laparoscopic needle holder. Based on these guidelines a new needle holder was designed. The prototype and three currently available needle holders were evaluated according to the new guidelines. In addition, a pelvi-trainer test was done to measure the extreme wrist excursions. RESULTS: The ergonomic evaluation of three commonly used handles and the new prototype indicate that the new handle is an ergonomic improvement in the field of laparoscopic needle holders: only the new handle satisfies all criteria. This is validated by the results of the pelvi-trainer test, which showed that the new prototype significantly (p <0.001) reduced the extreme wrist excursions. CONCLUSION: The new design guidelines for a laparoscopic needle holder result in an ergonomic improvement of the instrument.

Equipment Design↗
PubMed2003

Laparoscopic resection of colonic cancer.

Laparoscopic resection of colonic cancer can be regarded as a safe and efficacious procedure. Short-term outcome is better after laparoscopic colectomy than after open colectomy. Long-term results of the first published randomized clinical trial indicate improved cancer related survival following laparoscopic resection of colonic cancer. However, patients included in this single center study were operated on by highly experienced laparoscopic surgeons and included relative small numbers of patients. Results of other large randomized controlled trials have to be awaited before laparoscopic resection can be recommended for colonic cancer. Higher in-hospital costs and a long learning curve hinder rapid implementation of laparoscopic colectomy into general surgical practice. Integration of laparoscopic surgery into surgical training programs is mandatory.

Colectomy↗
PubMed2002

[Pancreas-preserving total duodenectomy due to familial adenomatous polyposis in 4 patients].

In 4 patients with familial adenomatous polyposis (FAP) and multiple severe dysplastic adenomas in the duodenum (a 42-year-old woman and 3 men aged 44, 53 and 33 years, respectively), pancreas-preserving total duodenectomy (PPTD) was carried out. In 2 of the patients, serious early post-operative complications arose (leakage and haemorrhage of the gastrojejunostomy, respectively), and 1 patient developed a late complication (attacks of pancreatitis). During the 1-5-year follow-up period, small villous adenomas were seen in the jejunum (neoduodenum) of 1 of the patients. PPTD is a technically possible procedure which allows targeted treatment to be carried out if duodenum polyps are found upon endoscopic examination.

Adenomatous Polyposis Coli↗
PubMed2002

Technical considerations and pitfalls in laparoscopic live donornephrectomy.

BACKGROUND: Recent developments in laparoscopic solid organ surgery suggest a possible reduction in postoperative discomfort and disability for kidney donors. Technical aspects and the influence of surgical experience in laparoscopic donor nephrectomy were evaluated. METHODS: The clinical outcome of 57 laparoscopic donor nephrectomies (LapNx) was compared with that for a historic control group of 27 open donor nephrectomies (OpenNx). RESULTS: Three conversions to open nephrectomy (5.2%) were necessary. Postoperative complications were minor and comparable in both groups. Patients who underwent laparoscopic surgery demonstrated significantly less postoperative pain and a shorter hospital stay, but operative time and warm ischemia time were significantly longer. Graft survival after LapNx was 100% during a median follow-up period of 13 months. Operative time for LapNx decreased considerably with experience gained and seemed to be less for right nephrectomy. Stenotic ureter-bladder anastomoses occurred after LapNx in four patients during the first half year (7.0%), but this problem seemed to be resolved after modification of the technique. CONCLUSION: LapNx is associated with less postoperative discomfort and improved convalescence.

Case-Control Studies↗
PubMed2002

[The treatment of colorectal liver metastases: good 5 year survival chance after partial liver resection at the Rotterdam University Hospital, 1984/1999].

OBJECTIVE: To evaluate the results of partial liver resection in patients with liver metastases. DESIGN: Retrospective. METHOD: All of the patients who underwent a partial liver resection at the Rotterdam University Hospital during the period June 1984-August 1999 due to one or more metastases of a colorectal carcinoma were traced in the computerised hospital archive. Data concerning the primary tumour, the diagnostics carried out, the liver resection carried out and the clinical outcome after the operation were analysed using the statistical software SPSS. The actuarial survival was determined according to the Kaplan-Meier method. RESULTS: In total 163 patients underwent an operation: 108 men and 55 women, with a mean age of 58 years (range: 32-77). Postoperative morbidity occurred in 34 patients (21%), mostly infections and gall leakage. During the hospital admission 10 patients died (6%). In the follow-up period, mean 30.2 months (median: 23.8) there was a recurrence of colorectal carcinoma in 82 of the patients (50%). The actuarial 5-year survival chance was 37%. The only statistically significant unfavourable prognosis factor for survival, was a larger tumour volume in the liver at the time of the hepatectomy.

Adult↗
PubMed2002

Assessment of the ergonomically optimal operating surface height for laparoscopic surgery.

PURPOSE: The aim of this study was to find the ergonomically optimal operating surface height for laparoscopic surgery in order to reduce discomfort in the upper extremities of the operators and the assistants. The operating surface height was defined as the level of the abdominal wall of a patient with pneumoperitoneum. MATERIALS AND METHODS: Two pelvi-trainer tests were performed. One test was performed on six different operating surface heights. The (extreme) joint excursions of the shoulder, elbow, and wrist were measured by a video analysis method. Another test was performed by holding a laparoscope for 15 minutes while an electromyelograph of the biceps brachii was made. The results of both tests were evaluated subjectively by a questionnaire. RESULTS: The ergonomically optimal operating surface height lies between a factor 0.7 and 0.8 of the elbow height of the operator/assistant. At this height, the joint excursions stay in the neutral zone for more than 90% of the total manipulation time, and the activity of the biceps brachii when holding the laparoscope stays within 15% of the maximum muscle activity. CONCLUSIONS: The operating surface height influences the (extreme) upper joint excursions of the surgeon. The ergonomically optimal operating surface height reduces the discomfort in the shoulders, back, and wrists of the surgeon during laparoscopic surgery. This optimal table height range for laparoscopic surgery is lower than those currently available.

Electromyography↗
PubMed2001

Prevention of compensatory hyperhidrosis after thoracoscopic sympathectomy for hyperhidrosis.

BACKGROUND: Compensatory hyperhidrosis is a troublesome complication of thoracoscopic sympathectomy for hyperhidrosis. After extensive resection of the second through the fourth ganglion (T2-4), as well as after limited resection of the second ganglion (T2), the reported incidence of compensatory hyperhidrosis ranges as high as 50-97%. The purpose of this study was to determine whether the incidence of compensatory hyperhidrosis can be reduced by limiting the thoracoscopic sympathectomy to another level, the third ganglion. METHODS: We analyzed 28 thoracoscopic sympathectomies for palmar and/or axillary hyperhidrosis. In all patients, the sympathetic chain was transected cranially and caudally to the third ganglion (T3 dissection). Long-term follow-up was conducted by interviewing patients using standardized questionnaires. RESULTS: The surgery was effective in all patients. After a median follow-up of 3.5 years, compensatory hyperhidrosis was not recorded in any of the patients. There were no recurrences of hyperhidrosis. CONCLUSION: Limited thoracoscopic sympathectomy at the level of the third ganglion is effective and seems to prevent compensatory hyperhidrosis.

Adult↗