Biomedical subjects

Garth H Ballantyne

Publications and source records attributed to Garth H Ballantyne.

At least 19 recordsLinked to original sources

PubMed2006

Peptide YY(1-36) and peptide YY(3-36): Part I. Distribution, release and actions.

Peptide YY (PYY) is a 36 amino acid, straight chain polypeptide, which is co-localized with GLP-1 in the L-type endocrine cells of the GI mucosa. PYY shares structural homology with neuropeptide Y (NPY) and pancreatic polypeptide (PP), and together form the Neuropeptide Y Family of Peptides, which is also called the Pancreatic Polypeptide-Fold Family of Peptides. PYY release is stimulated by intraluminal nutrients, including glucose, bile salts, lipids, short-chain fatty acids and amino acids. Regulatory peptides such as cholecystokinin (CCK), vasoactive intestinal polypeptide (VIP), gastrin and GLP-1 modulate PYY release. The proximal GI tract may also participate in the regulation of PYY release through vagal fibers. After release, dipeptidyl peptidase IV (DPP-IV; CD 26) cleaves the N-terminal tyrosine-proline residues forming PYY(3-36). PYY(1-36) represents about 60% and PYY(3-36) 40% of circulating PYY. PYY acts through Y-receptor subtypes: Y1, Y2, Y4 and Y5 in humans. PYY(1-36) shows high affinity to all four receptors while PYY(3-36) is a specific Y2 agonist. PYY inhibits many GI functions, including gastric acid secretion, gastric emptying, small bowel and colonic chloride secretion, mouth to cecum transit time, pancreatic exocrine secretion and pancreatic insulin secretion. PYY also promotes postprandial naturesis and elevates systolic and diastolic blood pressure. PYY(1-36) and PYY(3-36) cross the blood-brain barrier and participate in appetite and weight control regulation. PYY(1-36) acting through Y1- and Y5-receptors increases appetite and stimulates weight gain. PYY(3-36) acting through Y2-receptors on NPY-containing cells in the arcuate nucleus inhibits NPY release and, thereby, decreases appetite and promotes weight loss. PYY may play a primary role in the appetite suppression and weight loss observed after bariatric operations.

Adenosine Deaminase↗

PubMed2006

Peptide YY(1-36) and peptide YY(3-36): Part II. Changes after gastrointestinal surgery and bariatric surgery.

Peptide YY (PYY) is secreted as a 36 amino acid, straight chain polypeptide, and is found in greatest concentrations in the terminal ileum, colon and rectum. After secretion, dipeptidyl peptidase IV (DPP-IV) cleaves the N-terminal Tyrosine-Proline residues from PYY(1-36), producing PYY(3-36). PYY(1-36) acts at all four human Y receptors, Y1, Y2, Y4 and Y5, while PYY(336) is a specific Y2 receptor agonist. PYY participates in the regulation of appetite and weight balance through hypothalamic-based mechanisms. PYY(1-36) stimulates appetite and weight gain through Y1 and Y5 receptors. PYY(3-36) suppresses appetite and stimulates weight loss through Y2 receptors. GI diseases that cause malabsorption increase both basal and meal-stimulated PYY levels. In contrast, obesity decreases both basal and meal-stimulated PYY levels. Mutations in the human PYY and Y2 receptor genes may contribute to the development of obesity. Small bowel resection elevates PYY levels in humans. Colon resections increase PYY levels in animal models but not in man. PYY changes following bariatric operations are incompletely studied. Vertical banded gastroplasty, open Roux-en-Y gastric bypass and jejunoileal bypass significantly elevate basal and meal-stimulated PYY levels. In dogs with Pavlov pouches, Roux-en-Y duodenojejunostomy (duodenal switch) increases PYY levels compared to Roux-en-Y gastrojejunostomy. DPP-IV activity is increased in obese individuals and remains increased after biliopancreatic diversion. Thus, diseases or operations which cause malabsorption, elevate basal and meal-stimulated PYY levels. Bariatric operations also increase basal and meal-stimulated PYY levels. This suggests that the combination of increased PYY levels and elevated levels of DPP-IV observed after bariatric operations may generate increased circulating levels of PYY(3-36), leading to hypothalamic-mediated suppression of appetite and promotion of weight loss through Y2 receptor mediated mechanisms.

Animals↗

PubMed2005

The learning curve measured by operating times for laparoscopic and open gastric bypass: roles of surgeon's experience, institutional experience, body mass index and fellowship training.

BACKGROUND: Surgeons must overcome a substantial learning curve before mastering laparoscopic Roux-en-Y gastric bypass (LRYGBP). This learning curve can be defined in terms of mortality, morbidity or length of surgery. The aim of this study was to compare the learning curves in terms of surgical time for the first 3 surgeons performing LRYGBP in our hospital with the length of surgery for open gastric bypass (CONTROLS). METHODS: We compared 494 primary LRYGBPs performed by 3 surgeons (393 by 1st SURGEON, 57 by 2nd SURGEON and 44 by 3rd SURGEON) to 159 open vertical banded gastroplasty-Roux-en-Y gastric bypasses (CONTROLS). Data for LRYGBP patients were prospectively obtained. Factors that significantly affected the length of surgery were identified by univariate and multivariate linear regression analysis. RESULTS: LRYGBP and CONTROL patients were similar in age, height, weight and BMI, although more CONTROLS were male. Median time for the 1st SURGEON performing LRYGBP dropped for each subsequent 100 operations: 1st 100 - 190 min, 2nd 100 - 135 min, 3rd 100 - 110 min and 4th 100 - 100 min. Median time for 2nd SURGEON performing LRYGBP was 120 min, 3rd SURGEON 173 min and CONTROLS 64 min. Length of surgery significantly correlated with surgical experience in terms of numbers of operations and BMI of patient. Times for 2nd SURGEON, a fellowship trained laparoscopic surgeon, started significantly faster than 1st SURGEON's, but did not significantly improve with experience. 3rd SURGEON's initial times were similar to 1st SURGEON's, but his times improved more rapidly with experience. Times for CONTROLS were significantly faster than all laparoscopic groups and did not correlate with operation number or patient BMI. CONCLUSIONS: The length of surgery for LRYGBPs continued to shorten beyond 400 operations for the first surgeon performing LRYGBP in our hospital. Previous fellowship training in LRYGBP shortened surgical times during initial clinical experience as an attending for the second surgeon. The learning curve was truncated because of the already established LRYGBP program.

Adult↗

PubMed2005

Patient characteristics impacting excess weight loss following laparoscopic adjustable gastric banding.

BACKGROUND: Weight loss is more variable after laparoscopic adjustable gastric banding (LAGB) than after gastric bypass. Subgroup analysis of patients may offer insight into this variability. The aim of our study was to identify preoperative factors that predict outcome. METHODS: Demographics, co-morbid conditions and follow-up weight were collected for our 1st 200 LapBand patients. Linear regression determined average %EWL. Logistic regression analysis identified factors that impacted %EWL. RESULT: 200 patients returned for 778 follow-up visits. Median age was 44 years (21-72) and median BMI 45 kg/m2 (31-76). 140 (80%) were women. Average %EWL was y % = 0.007 %/day (days since surgery) + 0.12% (correlation coef. 0.4823; P<0.001). %EWL at 1 year was 37%. The best-fit logistic regression model found 7 factors that significantly changed the odds of achieving average %EWL. Older patients, diabetic patients and patients with COPD had greater odds of above average %EWL. Female patients, patients with larger BMIs, asthmatic patients and patients with hypertension had increased odds of below average %EWL. CONCLUSION: Specific patient characteristics and comorbid conditions significantly altered the odds of achieving satisfactory %EWL following gastric banding.

Adult↗

PubMed2005

Changes in insulin resistance following bariatric surgery: role of caloric restriction and weight loss.

The prevalence of type 2 diabetes mellitus (T2DM) and obesity in the western world is steadily increasing. Bariatric surgery is an effective treatment of T2DM in obese patients. The mechanism by which weight loss surgery improves glucose metabolism and insulin resistance remains controversial. In this review, we propose that two mechanisms participate in the improvement of glucose metabolism and insulin resistance observed following weight loss and bariatric surgery: caloric restriction and weight loss. Nutrients modulate insulin secretion through the entero-insular axis. Fat mass participates in glucose metabolism through the release of adipocytokines. T2DM improves after restrictive and bypass procedures, and combinations of restrictive and bypass procedures in morbidly obese patients. Restrictive procedures decrease caloric and nutrient intake, decreasing the stimulation of the entero-insular axis. Gastric bypass (GBP) operations may also affect the entero-insular axis by diverting nutrients away from the proximal GI tract and delivering incompletely digested nutrients to the distal GI tract. GBP and biliopancreatic diversion combine both restrictive and bypass mechanisms. All procedures lead to weight loss and decrease in the fat mass. Decrease in fat mass significantly affects circulating levels of adipocytokines, which favorably impact insulin resistance. The data reviewed here suggest that all forms of weight loss surgery lead to caloric restriction, weight loss, decrease in fat mass and improvement in T2DM. This suggests that improvements in glucose metabolism and insulin resistance following bariatric surgery result in the short-term from decreased stimulation of the entero-insular axis by decreased caloric intake and in the long-term by decreased fat mass and resulting changes in release of adipocytokines. Observed changes in glucose metabolism and insulin resistance following bariatric surgery do not require the posit of novel regulatory mechanisms.

Biomarkers↗

PubMed2005

Changes in insulin resistance following bariatric surgery and the adipoinsular axis: role of the adipocytokines, leptin, adiponectin and resistin.

The fat mass participates in the regulation of glucose and insulin metabolism through the release of adipocytokines in a mechanism called the adipoinsular axis. Putative adipocytokines include leptin, adiponectin and resistin. Obesity plays an important role in the pathogenesis of insulin resistance and type 2 diabetes mellitus (T2DM). Bariatric surgery for morbidly obese patients leads to rapid and prolonged improvement in insulin resistance and T2DM in the vast majority of patients. We have previously proposed that the rapid improvement in insulin resistance observed following bariatric surgery is mediated by changes in incretin levels of the entero-insular axis and that long-term improvement is modulated by fat mass loss and changes in adipocytokine levels of the adipoinsular axis. In this review, we examine the information that supports a role of leptin, adiponectin and resistin in the development of insulin resistance and T2DM. Increasing levels of leptin and decreasing levels of adiponectin correlate with worsening insulin resistance in obese individuals. We also explore the relationship between changes in adipocytokines following bariatric surgery and long-term improvement in insulin resistance and T2DM. Leptin levels drop and adiponectin levels rise following laparoscopic adjustable gastric banding, gastric bypass and biliopancreatic diversion. These changes correlate with weight loss and improvement in insulin. Although resistin may play an important role in explaining insulin resistance, animal and human studies currently show conflicting results.

Adiponectin↗

PubMed2004

Hand-assisted laparoscopic colectomy: evolution to a clinically useful technique.

PURPOSE: Hand-assisted laparoscopic colectomy has traversed three phases of distinct development. This review was designed to trace the evolution of hand-assisted colectomy from an infrequently used technique to a clinically useful surgical approach to diseases of the colon and rectum. METHODS: This review compiles previously reported and published experiences with hand-assisted laparoscopic colectomy. RESULTS: During the first phase of development of hand-assisted laparoscopic colectomy, surgeons explored what could be accomplished by a hand inserted into the abdomen through the specimen extraction site as an adjunct to laparoscopic techniques. Case reports and small trials found that manually assisted laparoscopic techniques permitted more rapid completion of laparoscopic-assisted colectomies. In the second phase, surgeons used early devices that facilitated the insertion of the surgeon's hand into the abdomen and helped to maintain the pneumoperitoneum. Larger series and small, randomized trials indicated a time-saving advantage to hand-assisted techniques and similar short-term outcomes as laparoscopic-assisted colectomies. In the current third phase, surgeons are using a new generation of hand-access devices that extend the options for hand-assisted techniques. These devices, like earlier devices, facilitate hand insertion, protect the wound, act as the retrieval site for the specimen, and serve as the portal for construction of extracorporeal anastomoses. In addition, these new devices can serve as laparoscopic trocar sites. This permits selective use of hand-assisted and laparoscopic-assisted techniques at various times in the same operation. These new devices have not undergone clinical trials, and therefore, a final appraisal must await future publication of outcomes. CONCLUSIONS: Hand-assisted laparoscopic colectomy has evolved into a clinically useful surgical technique. New devices facilitate the performance of these operations and permit the surgeon to switch between hand-assisted and laparoscopic techniques.

Colectomy↗

PubMed2004

Robots in the operating room--the history.

The history of robotics can be traced back to the automata of ancient Greece, but it has only been within the last 50 years that machines have been made to mimic human actions in order to perform labor rather than to entertain and amuse. Furthermore, it has been only within the last 20 years that robotic technology has been applied to the practice of surgery. The goal of this technology has not been to replace the surgeon, but rather to enhance his or her performance with highly advanced tools. We present a brief history of some of the key points in the development of surgical robotics and discuss the advantages and disadvantages of the various US Food and Drug Administration-approved robotic surgical systems and surgical robots in general.

General Surgery↗

PubMed2004

Predictors of prolonged hospital stay following open and laparoscopic gastric bypass for morbid obesity: body mass index, length of surgery, sleep apnea, asthma, and the metabolic syndrome.

BACKGROUND: The number of weight reduction operations performed for type II and type III obesity is rapidly escalating. Risk of surgery has been infrequently stratified for patient subgroups. The purpose of this study was to identify patient characteristics that increased the odds of a prolonged hospital length of stay (LOS) following open or laparoscopic Roux-en-Y gastric bypass (RYGBP). METHODS: The hospital records of 311 patients who underwent RYGBP in a 6-month period were retrospectively reviewed. Patient characteristics including the presence of significant obesity-related medical conditions were recorded. Analysis was based on intent to treat. Univariate and step-wise logistic regression analysis was used to identify the odds ratio (OR) and adjusted odds ratio (AOR) for predictors of an increased hospital LOS. RESULTS: Datasets for 311 patients were complete.159 patients underwent open vertical banded gastro-plasty-Roux-en-Y gastric bypass (VBG-RYGBP) and152 laparoscopic RYGBP (LRYGBP). 78% of patients were female. Median age was 40 years (range 18-68). Median BMI was 49 kg/m2 (range 35-82). 17% of patients had sleep apnea, 18% asthma, 19% type 2 diabetes, 13% hypercholesterolemia and 44% hypertension. Median length of surgery for open VBG-RYGBP (64 minutes) was significantly faster than forLRYGBP (105 minutes). Median length of stay was significantly shorter for LRYGBP (2 days) than openVBG-RYGBP (3 days). Univariate logistic regression analysis identified 6 predictors of increased LOS:open surgery (0.4 OR); increasing BMI (60 kg/m2 0.38 OR; BMI 70 kg/m2 0.53 OR); increasing length of surgery (120 min 0.33 OR; 180 min 0.48 OR); sleep apnea (2.25 OR); asthma (3.73 OR); and hypercholesterolemia (3.73 OR). Subset analysis identified patients with the greatest odds for a prolonged hospital stay: women with asthma (2.47 AOR) or coronary artery disease (8.65 AOR); men with sleep apnea (5.54 OR) or the metabolic syndrome (6.67-10.20 OR); and patients undergoing a laparoscopic operation with sleep apnea (11.53 AOR) or coronary artery disease(12.15 AOR). CONCLUSIONS: Open surgery, BMI, length of surgery,sleep apnea, asthma and hypercholesterolemia all increased the odds of a prolonged LOS. Patients with the greatest odds of long LOS were women with asthma or coronary disease, men with sleep apnea or the metabolic syndrome, and patients undergoing laparoscopic surgery with sleep apnea or coronary artery disease. Patients at high-risk for prolonged hospital stay can be identified before undergoingRYGBP. Surgeons may wish to avoid high-risk patients early in their bariatric surgery experience.

Adolescent↗

PubMed2003

The da Vinci telerobotic surgical system: the virtual operative field and telepresence surgery.

The United States Department of Defense developed the telepresence surgery concept to meet battlefield demands. The da Vinci telerobotic surgery system evolved from these efforts. In this article, the authors describe the components of the da Vinci system and explain how the surgeon sits at a computer console, views a three-dimensional virtual operative field, and performs the operation by controlling robotic arms that hold the stereoscopic video telescope and surgical instruments that simulate hand motions with seven degrees of freedom. The three-dimensional imaging and handlike motions of the system facilitate advanced minimally invasive thoracic, cardiac, and abdominal procedures. da Vinci has recently released a second generation of telerobots with four arms and will continue to meet the evolving challenges of surgery.

Equipment Design↗

PubMed2003

Robotic versus telerobotic laparoscopic cholecystectomy: duration of surgery and outcomes.

This study found that robotic and telerobotic operations were accomplished with the same mortality, morbidity, blood loss, length of operations and length of stay. The DaVinci operations required longer total operating room time than the AESOP operations. Telerobotic laparoscopic cholecystectomy achieved the same clinical outcomes as standard robotic laparoscopic cholecystectomy in this small trial. This study justifies further comparison of these techniques in a randomized prospective trial.

Body Mass Index↗

PubMed2003

Measuring outcomes following bariatric surgery: weight loss parameters, improvement in co-morbid conditions, change in quality of life and patient satisfaction.

Restrictive and particularly malabsorptive bariatric operations achieve significant sustained weight loss. Results from different operations have been difficult to compare. The aims of this review are: 1) to indicate the limitations of outcomes reported as weight-related parameters; 2) to document some of the patient characteristics that impact weight loss; 3) to assess the literature documenting improvement in obesity-related medical conditions; and 4) to review studies that quantitate changes in health-related quality of life (QoL). Weight-related parameters such as body mass index and % excess weight inconsistently correlate with body fat. Direct determination of body fat with bioelectric impedance may offer more reliable outcome parameters. Patient characteristics such as gender, age, weight, body mass index, ethnicity, race and socioeconomic status affect weight loss following bariatric operations. Improvements in co-morbid conditions are poorly documented in many studies. Standardized instruments that assess health-related QoL have shown differing values. SF-36 has given inconsistent results following bariatric operations. Both BAROS and IWQoL-Lite have demonstrated significant improvements after surgery. Bariatric surgeons have rarely used patient satisfaction as an outcome parameter. This review suggests that bariatric operations should be judged by change in fat mass or fat mass index, improvement in obesity-related medical conditions, change in health-related QoL as judged by standardized instruments, and level of patient satisfaction. In addition, surgeons should characterize their study population and report outcomes for sub-populations.

Adipose Tissue↗

PubMed2002

Telerobotic-assisted laparoscopic right and sigmoid colectomies for benign disease.

PURPOSE: Telerobotic surgical systems attempt to provide technological solutions to the inherent limitations of traditional laparoscopic surgery. In this article, we present the first two reported cases of telerobotic-assisted laparoscopic colectomies performed on March 6 and 8, 2001. METHODS: In the first patient we performed a telerobotic-assisted laparoscopic sigmoid colectomy for diverticulitis. In the second patient, we accomplished a telerobotic-assisted laparoscopic right hemicolectomy for cecal diverticulitis. The Da Vinci telerobotic surgical system was used in both cases to mobilize the bowel. The mesenteric division, bowel transection, and anastomoses were accomplished with standard laparoscopic-assisted techniques. Both operations were completed with a three-trocar technique. RESULTS: We found that the Da Vinci system adequately replaced the camera holder. The three-dimensional virtual operative field helped to maintain the surgeon's orientation during the operation. The combination of three-dimensional imaging and the hand-like motions of the telerobotic surgical instruments facilitated dissection. The Da Vinci console offered an ergonomically comfortable position for the surgeon. Operative times for the sigmoid colectomy was 340 minutes and for the right hemicolectomy 228 minutes. Telerobotic-assisted laparoscopic colectomy is feasible, but required a longer operative time than our standard laparoscopic-assisted technique. CONCLUSION: Telerobotic-assisted laparoscopic colectomy is feasible and warrants further investigations in controlled trials.

Adult↗

PubMed2002

The pitfalls of laparoscopic surgery: challenges for robotics and telerobotic surgery.

After its debut in 1988, laparoscopic cholecystectomy rapidly became the standard of care for cholelithiasis, yet very few surgeons use minimally invasive techniques for other abdominal operations. Why do most surgeons continue to perform traditional open gastrointestinal operations? We believe that the answer to this question lies in the fact that advanced laparoscopic operations are difficult to learn, perform, and master. A number of inherent pitfalls of laparoscopy hinder the performance of these operations even after the surgeon has accumulated years of experience. These pitfalls include an unstable video camera platform, limited motion (degrees of freedom) of straight laparoscopic instruments, two-dimensional imaging, and poor ergonomics for the surgeon. Inexperienced or bored laparoscopic camera-holders move the camera frequently and rotate it away from the horizon. The long, straight laparoscopic instruments are limited in their motion by the fixation enforced by the abdominal wall trocars. Similarly, the standard two-dimensional video imaging used in most laparoscopic operations impedes the surgeon's depth perception, compounding the limitations of laparoscopic instruments. In addition, surgeons are forced to assume ergonomically awkward stances in performing many laparoscopic operations. These four factors hinder a surgeon's efforts to learn and to perform advanced laparoscopic operations, significantly lengthening the learning curve. The articles presented in this issue suggest that robotics and telerobotics offer solutions to these nagging pitfalls of laparoscopic surgery.

Cholecystectomy, Laparoscopic↗

PubMed2002

Granting clinical privileges for telerobotic surgery.

Surgeons can now perform operations on their patients while sitting at a remote site. During telerobotic operations, the surgeon sits at a computer console. The computer translates the motions of the surgeon's hands into motions of the robotic instruments. Introduction of telerobotics into clinical practice raises issues comparable to those generated by the rapid introduction of laparoscopic cholecystectomy in the late 1980s. As a result, we have instituted processes in our hospitals for the granting of clinical privileges for telerobotic surgery. These processes are derived from the guidelines of the Society of American Gastrointestinal Endoscopic Surgeons for granting clinical privileges for laparoscopic general surgery. Our hospitals require the following: (1) board certification or board eligibility for the appropriate surgical board; (2) clinical privileges for the open and laparoscopic operations that will be performed telerobotically; (3) satisfactory completion of the Food and Drug Administration-mandated training course in the safe use of the robotic surgical system; (4) performance of telerobotic operations in animate models; (5) observation of clinical cases of telerobotic surgery by an expert surgeon; (6) acting as bedside assistant surgeon in telerobotic operations or supervision by a preceptor during the surgeon's initial operations; (7) observation by a proctor of the surgeon's initial clinical telerobotic operations; and (8) ongoing monitoring of surgical outcomes of telerobotic operations. This process has facilitated the safe and orderly introduction of telerobotics operations into clinical practice in our hospitals.

Education, Medical, Continuing↗

PubMed2002

Comparison of laparoscopic colectomy with and without the aid of a robotic camera holder.

The use of a robotic camera holder (AESOP 3000; Computer Motion, Inc., Santa Barbara, CA, U.S.A.) during laparoscopic surgery is slowly becoming more popular with laparoscopic surgeons. However, few published reports document the effects of the robot on operative outcomes or operative times. In the current study, we compared the use of a voice-controlled robotic camera holder to a human camera holder in a series of laparoscopic colectomies. The outcome data measured included the number of patients with postoperative complications, the patients' length of stay at the hospital, and the operative times for the procedures. There were 2 complications among the 11 patients in group 1 (colectomies performed without a robotic camera holder), versus 2 complications among the 15 patients in group 2 (colectomies performed with a robotic camera holder) (P = NS). Patients in group 1 had an average length of stay of 4.1 days, versus 4.4 days for those in group 2 (P = NS). The operative time for group 1 was 235 minutes, compared with 213 minutes for group 2 (P = NS). The use of a voice-controlled robotic camera holder does not alter the length of the operative procedure, the patient's length of stay, or postoperative morbidity. However, surgeons often have a subjective sense that there is less smudging, fogging, and inadvertent movements of the laparoscope when it is controlled by a robotic system. In addition, using a voice-controlled robot as a camera holder does eliminate the need for a surgical assistant.

Adult↗

PubMed2002

Short-term results of laparoscopic gastric bypass in patients with BMI > or = 60.

BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGBP) has been shown to be safe and effective. Little information is available about the subgroup of patients with BMI > or = 60. The goal of this study was to evaluate the feasibility and safety of LRYGBP for patients with BMI > or = 60. METHODS: The study consisted of the first 300 attempted LRYGBPs performed by one surgeon (HJS). This population was analyzed as 2 groups of patients: those with BMI < 60 and those with BMI > or = 60. Outcome variables included mortality, complications, conversion, and operative time. RESULTS: Of the first 300 LRYGBP patients, 261 had BMI < 60 and 39 had BMI > or = 60. Age, comorbidity rate, and gender distribution were similar in both BMI groups. Conversion rates were < 3% in both groups. Mean operative time for the BMI > or = 60 group was 156 minutes vs 139 minutes in the lighter group (P = 0.04). Major complications occurred more commonly in the BMI > or = 60 group (10% vs 6%) but this difference was not significant. The types of complications differed between the 2 groups, with infectious complications and gastrointestinal leak occurring more frequently in the heavier group. The mortality rate was higher in the heavier group (5% vs 0.4%, P = 0.055). CONCLUSION: LRYGBP is feasible for patients with BMI > or = 60. Our data suggest that these patients are at a higher risk for GI leak, postoperative infection, and death.

Adult↗

PubMedDate not supplied

Telerobotic laparoscopic repair of incisional ventral hernias using intraperitoneal prosthetic mesh.

Laparoscopic ventral hernia repair shortens the length of hospital stay and achieves low rates of hernia recurrence. The inherent difficulties of performing advanced laparoscopy operations, however, have limited the adoption of this technique by many surgeons. We hypothesized that the virtual operative field and hand-like instruments of a telerobotic surgical system could overcome these limitations. We present herein the first 2 reported cases of telerobotic laparoscopic ventral hernia repair with mesh. The operations were accomplished with the da Vinci telerobotic surgical system. The hernia defects were repaired with dual-sided, expanded polytetrafluoroethylene (ePTFE) mesh. The mesh was secured in place with 8 sutures that were passed through the abdominal wall, and 5-mm surgical tacks were placed around the circumference of the mesh. The 2 operations were accomplished with total operative times of 120 and 135 minutes and total operating room times of 166 and 180 minutes, respectively. The patients were discharged home on postoperative days 1 and 4. The surgeon sat in an ergonomically comfortable position at a computer console that was remote from the patient. Immersion of the surgeon within the 3-dimensional virtual operative field expedited each stage of these procedures. The articulation of the wristed telerobotic instruments greatly facilitated reaching the anterior abdominal cavity near the abdominal wall. This report indicates that telerobotic laparoscopic ventral hernia repair is feasible and suggests that telepresence technology facilitates this procedure.

Female↗