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Biomedical subjects

Hratch L Karamanoukian

Publications and source records attributed to Hratch L Karamanoukian.

At least 19 recordsLinked to original sources
PubMed2003

A pediatric surgery study: parent usage of the Internet for medical information.

PURPOSE: The goal of this study was to (1) determine parents access to and use of the Internet for information relating to their child's health; (2) investigate parents methods of searching for such information; and (3) evaluate the information found in relation to its readability, accuracy, and influence. METHODS: A study was conducted of 150 parents of outpatients in the Pediatric Surgery Clinic of a local Children's Hospital. Parents completed study surveys over a 6-week time frame. RESULTS: All parents (150 of 150, 100%) completed the surveys. The median age of the parents was 35 years, 83% (124 of 150) were mothers, and most (32%) attained a high school diploma. Of the 128 parents having Internet access, 71% used the Internet to search for health-related information. A majority of parents, 98%, agreed or somewhat agreed that the information they found was comprehensible and helpful. All respondents at least somewhat trusted information found, and 52% were at least somewhat influenced by online information when making a medical decision. CONCLUSIONS: Many parents use the Internet for additional medical information, but they do not access this information frequently. The overwhelmingly positive impression of online health information suggests parents are unaware of the dangers of encountering misleading sources, an issue of special concern when considering the amount of influence this information carries. A movement must be made to create uniform guidelines for health information on the Internet. In the meantime, pediatric surgeons must take a role in guiding parents toward accurate online sources and becoming more Internet proficient themselves.

Adolescent↗
PubMed2003

Minimally invasive mitral valve surgery: from Port Access to fully robotic-assisted surgery.

Currently, there is a growing interest in minimally invasive cardiac surgery, and despite early criticisms, it has become the preferred method of mitral valve repair and replacement in many institutions worldwide with excellent results. The interest in performing cardiac valve operations through minimal incisions was stimulated by Port Access technology and has evolved to include robotically assisted video-enhanced valve surgery. Robotic assistance has led to shorter operating times and represents an ideal tool to prepare for fully robotic-assisted cardiac procedures. This report will highlight minimally invasive mitral valve surgery with its evolution from Port Access techniques to fully robotic-assisted surgery. The nuances, strengths, and shortcomings, as well as the potential to enhance the valvular procedure, the promise to reduce hospital stay, earlier return to normal activity, less pain, better cosmesis, and the rethinking of surgical dogma that wide surgical exposure is essential for such complex intracardiac surgery are discussed.

Cardiac Catheterization↗
PubMed2003

Heparin dose, transfusion rates, and intraoperative graft patency in minimally invasive direct coronary artery bypass.

BACKGROUND: Many investigators have demonstrated the short-term and midterm efficacy of minimally invasive direct coronary artery bypass (MIDCAB). However, the influence of heparin dosing during MIDCAB on postoperative and immediate graft patency is less well defined. This report outlines our experience with MIDCAB employing a variety of heparinization protocols. METHODS: The traditional MIDCAB approach was used in 152 patients who underwent single-vessel off-pump coronary artery bypass. Before the left internal mammary artery was divided, a 150-U/kg bolus of heparin sodium was given to 76 patients (group 1), and 300 U/kg was given to another 76 patients (group 2). Additional heparin was given during the procedures to maintain an activated clotting times of greater than 300 seconds for group 1 and greater than 400 seconds for group 2. RESULTS: On average, patients in group 1 required more boluses of heparin during treatment than patients in group 2. A larger standard deviation from the mean was observed for the activated clotting time in group 1 at any time during treatment than for patients in group 2. The number of revised grafts was smaller in group 2 (1/76, 1.3%) than in group 1 (4/76, 5.2%). All of these revisions revealed thrombus at the site of anastomosis. In addition, noncoronary thrombotic complications were seen in 5 patients in group 1, and none were seen in group 2. CONCLUSION: Coronary artery surgery without cardiopulmonary bypass does not trigger the systemic inflammatory response, but surgical tissue trauma remains a constant. The preserved hemostasis theoretically may lead to a procoagulant state. This study demonstrates that insufficient anticoagulation therapy can lead to intracoronary thrombosis following MIDCAB as well as increased noncoronary thrombotic complications.

Anticoagulants↗
PubMed2003

Are you ready to become a robo-surgeon?

Robotic and minimally invasive surgery represents the future of modern surgical care. However, its role during the training of surgical residents has yet to be investigated. A previous study conducted by our group surveyed program directors at accredited general surgery training programs in the United States to determine the prevalence and application of robotics in their residency programs. This current study is a follow-up survey sent to residents across the United States to see whether they were being adequately trained and exposed to robotic surgery during their training. A survey was sent to 1800 general surgery residents, and their responses were tabulated and analyzed. Twenty-three per cent of the 1800 residents responded to our survey. An overwhelming 57 per cent of the responders indicated a high interest in robotic surgery. However, 80 per cent of the responders indicated not having a robotic training program. Robotic surgery has led to many promising advancements within the surgical subspecialties. With this emerging technology comes the need for a greater emphasis on the training of surgeons in robotics during their residency.

Data Collection↗
PubMed2003

REVIEW: Fast-Tracking Cardiac Surgery.

A "fast track" approach to cardiac surgery can be defined as a perioperative process involving rapid progress from preoperative preparation through surgery and discharge from the hospital. Although highly individualized among the various heart surgery centers, the fast-track process is a team activity. It requires a team of health care providers to interact with the patient at various phases, from admission to discharge. The necessary elements of the fast-track program are choice and the titration of short-acting anesthetic drugs, standardized surgical procedures, early extubation, rewarming and sustained postoperative normothermia, postoperative pain control, early ambulation, alimentation and discharge, and follow-up after discharge. We review the current approaches to some of these aspects of patient care.

Analgesics, Opioid↗
PubMed2003

A porcine beating heart model for robotic coronary artery surgery.

BACKGROUND: The application of robotically assisted coronary artery surgery continues to be investigated clinically. Consequently, there is a need for a simple method to train surgeons in performing these operations. The aim of the present study was to assess a model using an excised porcine heart for the training of surgeons in creating a robotically assisted arterial anastomosis. METHODS: An ex vivo beating heart model was constructed with a porcine heart and was evaluated by 3 cardiac surgeons previously trained in robotic surgery. All anastomoses from the first half of the study were reviewed to measure anastomotic time, the number of sutures placed, and the rate of suture placement per minute and were compared to those completed in the second half of the study by means of a unpaired Student t test. RESULTS: Fifty-seven anastomoses were completed with the beating heart model, 28 in the first half of the study and 29 in the second half. The mean time to create an anastomosis in the first half of the study was 19.3 minutes (range, 10-28 minutes), compared with 15.0 minutes (range, 7-20 minutes) in the second half; the difference did not meet statistical significance. However, the number of sutures placed per minute did increase in the second half of the study with a mean of 0.77 sutures per minute (range, 0.55-1.25), compared with 0.56 sutures per minute (range, 0.40-0.80) in the first half of the study (P <.0001). The number of sutures per anastomosis also decreased in the second half of the study with a mean of 9.0 sutures (range, 8-11), compared with 10.6 sutures (range, 8-16) in the first half of the study (P =.0049). CONCLUSIONS: This preliminary experience demonstrated technical improvements in the second half of the study. Fewer sutures were placed per anastomosis with better precision, implying a learning curve that could be accelerated with our model. This porcine beating heart model represents an inexpensive training method that mimics the beating heart, complete with coronary blood flow, and may be used multiple times to train and assess a surgeon's skill in robotically assisted coronary surgery.

Animals↗
PubMed2002

Hybrid robotic coronary artery surgery and angioplasty in multivessel coronary artery disease.

BACKGROUND: Complete surgical revascularization that includes left internal thoracic artery grafting to the left anterior descending coronary artery remains the gold standard of treatment for coronary artery disease. Not all patients are good candidates for sternotomy. Therefore, we sought to identify a strategy that would combine the long-term advantages of internal thoracic artery grafting to lessen surgical trauma while still allowing complete revascularization. METHODS: A total of 54 consecutive patients from four institutions underwent hybrid revascularization combining surgery and angioplasty. All internal thoracic artery grafts were endoscopically harvested with robotic assistance using either the Aesop or Zeus system, and all anastomoses were manually constructed through a 4- to 6-cm anterior thoracotomy incision. Angioplasty was carried out to achieve total revascularization to ungrafted vessels. RESULTS: There were no early or late deaths, myocardial infarctions, strokes, or wound infections. Of the patients, 37 (69%) were extubated in the operating room. Length of stay in the intensive care unit averaged 24.4 hours and hospital stay 3.45 days. In all, 16 patients (29.6%) required transfusion of packed red blood cells. Late complications included 1 patient with stent occlusion at 3 months and 2 patients with in-stent restenosis. Three patients were treated for postpericardiotomy syndrome. Mean follow-up was 11.7 months. Event-free was survival 87.1% and freedom from recurrent angina 98.3%. CONCLUSIONS: Hybrid endoscopic atraumatic internal thoracic artery to anterior descending coronary artery graft surgery combined with angioplasty is a reasonable revascularization strategy in multiple vessel coronary artery disease in selected patients. Longer follow-up and more patient data in a randomized study are needed to determine the patient cohort most likely to benefit from this approach.

Adult↗