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Biomedical subjects

H Feussner

Publications and source records attributed to H Feussner.

At least 19 recordsLinked to original sources
PubMed2001

[Reduction of surgical access trauma: reliable advantages].

Minimizing the trauma of surgical access is becoming an essential task in modern surgery. The treatment has to become more comfortable for the patient and financial resources have to be considered. Minimally invasive surgery is one of the attempts to achieve this goal. A comparison of surgical procedures, such as cholecystectomy, fundoplication and sigmoid resection in diverticulitis, which are already routinely performed laparoscopically, should be suitable for evaluating whether minor access surgery is really advantageous. The value of minor access may be quantified by different parameters such as influence upon the immunologic function, lung function, postoperative pain, time of hospitalization, return to work and duration of convalescence, as well as a comparison of the effects upon the quality of life index. The data concerning the effects upon immunology are not unequivocal. All in all, the degree of postoperative inflammation seems to be lower after laparoscopic surgery. There is no doubt that there is far less impairment on lung function, the results are better as far as postoperative pain is concerned, and hospitalization and duration of convalescence are shorter. It is also evident that immediately after the operation the quality of life index is superior, which, however, levels out in the course of time. The advantage of minimally invasive surgery is really apparent only after the mastering of the so-called "learning curve" and in cases of benign malignancies. The role of the minor access approach in oncological surgery is, however, not yet defined.

Humans↗
PubMed2000

[Second opinion in tumor surgery. Valuable--but needing improvement].

In complicated oncological cases, a second opinion is desirable, also in the view of the care-providing surgeon. It serves interdisciplinary therapeutic planning, and helps improve the quality of treatment. In the case of highly consequential interventions, the patient has a legal right to a second opinion. On a practical level, however, the implementation of this possibility encounters problems: organizational shortcomings, incomplete patient documentation, the stresses of patient transportation, loss of valuable time, in particular in the case of postal consultation, following consultation in a center the carrying out of treatment there, whether at the urging of the doctors there or the patient himself, lack of remuneration for the efforts of the consultants. Today, however, all the necessary technical facilities are in place to enable various experts to be consulted, virtually simultaneously, on any case, via video-conferencing.

Germany↗
PubMed2000

[Rationale and selection for combined procedures in colonic dysplasias and T1 carcinomas. Laparoscopic-endoscopic local wall excision and segment resection].

Combined endoscopic-laparoscopic procedures may offer an interesting therapeutic option in cases of benign colonic lesions and early T 1 carcinoma where endoluminal resection is not feasible, but oncological resection is not (yet) required. Combined procedures such as the laparoscopically assisted endoscopic resection, the endoscopically assisted laparoscopic wedge or transluminal resection, or the segmental resection can be performed. Experience with this technique is still limited, but has shown that the invasiveness can be reduced by endoscopically guided local excision. If it is possible to keep the incidence of secondary operations low, combined laparoscopic/endoscopic interventions could occupy a valuable place in the therapeutic spectrum.

Adult↗
PubMed2000

The relationship between gastroesophageal reflux, intestinal metaplasia and adenocarcinoma of the esophagus.

Currently available data indicate a clear and probably causal relationship between long-lasting gastroesophageal reflux disease, the development of long segments with specialized intestinal metaplasia in the distal esophagus and subsequent progression to adenocarcinoma. To a lesser degree, this also appears to be the case for short segments of specialized intestinal metaplasia in the distal esophagus. In contrast, epidemiological data and classic parameters for the diagnosis of gastroesophageal reflux disease do not currently support a causal role of gastroesophageal reflux in the pathogenesis of specialized intestinal metaplasia at the gastric cardia. Despite its high prevalence and malignant potential, many questions about the prevention and management of intestinal metaplasia in the distal esophagus remain unsolved. In patients with chronic gastroesophageal reflux, current modes of medical therapy do not appear to prevent the development of intestinal metaplasia, while effective anti-reflux surgery seems to have a protective effect. Formal studies with adequate follow-up are, however, still lacking. Neither acid-suppression therapy nor anti-reflux surgery, with or without mucosal ablation, can reliably prevent the malignant degeneration of established intestinal metaplasia of the esophagus. Close endoscopic surveillance with extensive biopsies, therefore, remains mandatory in such patients, irrespective of the treatment modality.

Adenocarcinoma↗
PubMed2000

Experimental evaluation of the safety and biocompatibility of a new antireflux prosthesis.

Previous studies have shown that encircling of the esophagogastric junction by a semiabsorbable scarf effectively prevents gastroesophageal reflux. The present study was performed to assess the long-term safety and biocompatibility of this type of scarf. The semiabsorbable scarf was implanted into 20 dogs either laparoscopically or via laparotomy. Pre- and post-operatively, contrast radiography, esophageal manometry, and upper gastrointestinal endoscopy were performed. No cases of perforation, stricture formation or other adverse effects were found after 1 and 2 years. It is concluded that the new type of scarf is without any adverse side-effects. Functional evaluation in reflux patients appears to be warranted.

Animals↗
PubMed1999

[Traditional extraluminal operation for Zenker's diverticulum].

The classical surgical approach for the treatment of Zenker's diverticulum consists of diverticulectomy and cervical myotomy. In very small diverticula myotomy alone is sufficient. The complication rate of the procedure is tolerable. Long-term functional results are good in as much 90% and more. Despite the increasing importance of alternative approaches, the conventional extraluminal surgical operation for Zenker's diverticulum will remain the treatment of choice in stage I-III cases.

Endoscopy↗
PubMed1999

[Modern diagnostic workup of blunt abdominal trauma].

Lethality and morbidity of blunt abdominal trauma are directly dependent on the immediately valid diagnostic work-up. Since blunt abdominal trauma usually occurs in the setting of multisystem injury and patients are no longer cooperative, clinical methods of diagnosis are unreliable. In regard to the imaging procedures, the practical approach has been simplified and standardized in the last few years. Initially, ultrasonography of the abdomen is performed. If the patient is hemodynamically unstable because of intra-abdominal loss of blood, this can be reliably detected by ultrasound and emergency laparotomy is indicated. If patients are hemodynamically stable, more sophisticated assessment of the abdomen can be achieved by computed tomography. The next step depends on direct or indirect signs of an intra-abdominal lesion. Angiography may be indicated in injuries to the liver, spleen, kidney, mesenteric root or caval vein. If lesions to the liver, biliary or pancreas are detected, ERCP may be required. Lacerations of hollow organs are identified by fine-needle aspiration of free intra-abdominal fluid. Findings on computed tomography are usually reliable enough to support a more conservative approach in the treatment of parenchymal lesions in blunt abdominal trauma. Since the facilities to perform ultrasound are provided in all emergency units and knowledge of ultrasonography is an essential part of surgical training, competitive diagnostic procedures like peritoneal lavage have completely lost their former important clinical role. Similarly, diagnostic laparoscopy is - in contrast to abdominal perforations - no longer of importance.

Abdominal Injuries↗
PubMed1999

Endoscopic stapling diverticulostomy for Zenker's diverticulum.

Endoscopic stapling diverticulostomy (ESD) using an endostapler is a modification of the standard endoscopic treatment of Zenker's diverticulum (ZD). It is characterized by complete myotomy of the upper esophageal sphincter, with division of the common wall between diverticulum and esophagus, followed by immediate simultaneous closure of the divided edges with the staples. ESD was performed on 21 patients with ZD between January 1996 and October 1997. The results were then evaluated. Operation time averaged 22 min. Wide opening of the diverticulum and excellent hemostasis were achieved. All of the patients but one, who died postoperatively of myocardial infarction, resumed oral intake without any evidence of cervical sepsis or mediastinitis. Complete relief of dysphagia was achieved in all 20 patients. Hospital stay averaged 4.7 days (range, 2-7 days). The patients were followed up after ESD for a median time period of 12 months. No relapses were recorded. ESD is an effective endoscopic treatment for ZD that entails a low risk of complications and requires only a short period of hospitalization.

Adult↗
PubMed1999

Self-guided robotic camera control for laparoscopic surgery compared with human camera control.

BACKGROUND: In laparoscopic surgery, the surgeon no longer has direct visual control of the operation area, and a camera assistant who maneuvers the laparoscope is essential. Problems of cooperation between the two naturally arise, and a robotic assistant that automatically controls the laparoscope can offer a highly desirable alternative to this situation. METHODS: A self-guided robotic camera control system (SGRCCS) based upon a color tracking method has been developed and its use evaluated in 20 cases of laparoscopic cholecystectomy and compared with using human camera control. RESULTS: In 83% of the patients the procedures were successfully completed with the SGRCCS. Set-up time for the robot averaged 21 minutes; and the surgical time with and without the robot averaged 54 and 60 minutes, respectively. Using the robot instead of a human camera assistant significantly reduced both the frequency of the camera correction, 2.2 per hour compared with 15.3 per hour, and frequency of the lens cleaning, 1.0 per hour compared with 6.8 per hour. Subjective assessment by the surgeon revealed that the robot performed better than the human assistant in 71 % of the cases. CONCLUSIONS: In laparoscopic surgery, the SGRCCS offered optimal camera guidance and helped to maintain the surgeon's concentration during the operation.

Cholecystectomy, Laparoscopic↗
PubMed1999

Laparoscopic procedures.

Laparoscopic procedures are increasingly used in clinical surgery because of significantly faster convalescence than occurs with open surgery. These advances have been facilitated not least by modern gastroenterological procedures and the co-operation between surgeons and gastroenterologists. Laparoscopic cholecystectomy is the most evident example of such surgery. The widespread use of this minimally invasive approach was essentially made possible by the availability of endoscopic retrograde cholangiography (ERC) and ERT, since the laparoscopic removal of bile duct stones is still difficult and not always reliable. Further instances of so-called 'therapeutic splitting' are palliative procedures and the combined endoscopic/endoluminal and laparoscopic/intracavitary approach in cases of early cancer. Additionally, laparoscopic procedures are described that might be a surgical alternative to medical treatment (e.g. fundoplication and cardiomyotomy).

Digestive System Neoplasms↗
PubMed1999

Pretherapeutic laparoscopic staging in advanced gastric carcinoma.

BACKGROUND AND STUDY AIMS: Direct visualization of the abdominal cavity by laparoscopy prior to multimodal treatment may be capable of improving the diagnostic precision of gastric cancer staging. The aim of this study was to evaluate whether diagnostic laparoscopy can influence treatment strategies in gastric cancer staged T3 and T4 by preoperative diagnostic tests. PATIENTS AND METHODS: Extended diagnostic laparoscopy (EDL) was carried out in 111 patients with advanced gastric cancer staged T3 or T4 by computed tomography (CT) and endoluminal ultrasound (EUS). On Lauren's classification of gastric cancer, 46% of the lesions were of the intestinal type and 54% of the nonintestinal type. EDL was carried out with the patients under general anesthesia, and included visual inspection of the abdomen, with surgical exploration of initially inaccessible regions, laparoscopic ultrasound examination, peritoneal lavage, and biopsies. The information provided by laparoscopy was classified as 1) no additional information, 2) important additional findings independent of the tumor stage, 3) downgrading of the tumor to a more favorable stage, and 4) upgrading of the tumor to a less favorable stage. The results of EDL were then compared with those obtained by sonography, CT and EUS in combination. RESULTS: EDL was performed successfully in 107 patients. In 56 of the 111 patients (50.5%), no additional findings were obtained. In 5.4% of cases, additional unforeseen information was found, not connected with the tumor but altering the management. EDL altered the preoperative diagnosis in 51 of the 111 patients (46.0%), leading to changes in management in 45 of them (40.5%). EUS provided additional information in eight cases (7.2% of the whole group, or 15.7% of those in whom the diagnosis had to be changed). Four metastases were detected using EDL. It was possible to rule out peritoneal spread in four patients, but it was newly detected in 26. CONCLUSIONS: Additional information by EDL about the tumor stage in gastric cancer led to a modification of the therapeutic strategy in 40% of patients, in spite of earlier comprehensive diagnostic work-up using modern imaging procedures. EDL should therefore be mandatory if neoadjuvant treatment is planned, in order to avoid either undertreatment or overtreatment of this type of tumor.

Adult↗
PubMed1998

[Indications for antireflux surgery of the esophagus].

In the Western world gastroesophageal reflux disease constitutes the single most common benign disorder of the upper gastrointestinal tract. Current medical therapy with proton pump inhibitors allows physicians to provide complete symptom relief and healing of acute esophageal mucosal injury in practically all affected patients. However, up to 50% of patients require maintenance therapy to prevent relapse. In these patients laparoscopic antireflux surgery offers an attractive and cost-effective alternative to potentially life-long medical therapy. Consequently, every patient with persistent or recurrent symptoms and/or complications of gastroesophageal reflux who depends on maintenance medical therapy to remain in remission is a potential candidate for laparoscopic antireflux surgery, particularly if of young age, suffering from side effects of medical therapy or worrying about long-term safety of the conservative treatment alternatives. A careful selection of patients, objective documentation of gastroesophageal reflux disease by 24-h esophageal pH monitoring, and meticulous attention to the technical details of the procedure are essential for a successful outcome of antireflux surgery.

Anti-Ulcer Agents↗
PubMed1998

[Teleconsultation].

Teleconsultation is a consultation between two or more physicians about the diagnostic work-up and therapeutic strategy in the treatment of an individual case by means of modern telematics. Due to more complex therapeutic strategies and legally defined formal requirements, the need for teleconsultation will increase significantly in the future. Rapid technical improvements in telematics will progressively facilitate the practical performance of teleconsultation (based upon an ISDN network in the beginning, later on by the use of a national health network). The medicolegal aspects of teleconsultation have already been defined sufficiently for use in surgery. However, the question of adequate financial compensation for this type of medical service is still unclear.

Computer Communication Networks↗