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Biomedical subjects

J Bruyns

Publications and source records attributed to J Bruyns.

At least 19 recordsLinked to original sources
PubMed2004

Totally laparoscopic transhiatal esophago-gastrectomy without thoracic or cervical access. The least invasive surgery for adenocarcinoma of the cardia?

BACKGROUND: The recent progress of minimally invasive surgery has allowed esophagectomy to be performed by both combined laparoscopic/thoracoscopic and totally laparoscopic transhiatal approaches. All these techniques imply a thoracic and/or cervical access for the creation of the esophagogastric anastomosis. METHODS: Five surgical ports are introduced in the abdomen. The stomach is mobilized, divided, and tubulized, preserving the right arteries. The lymphadenectomy of the celiac trunk and the hepatic pedicle is achieved. The dissection and resection of distal esophagus and a two-fields mediastinal lymphadenectomy are performed by means of harmonic scalpel. The realization of the intrathoracic esophago-gastrostomy is accomplished by means of a circular stapler. RESULTS: Three patients underwent the procedure. Mean operating time and blood loss were 347 min and 360 cc. There were no intraoperative or postoperative complications. Mean postoperative stay was 9 days. CONCLUSION: In selected cases, it is possible to perform a distal esophagectomy entirely by laparoscopy, without the need for any thoracic or cervical access.

Adenocarcinoma↗
PubMed2002

Laparoscopic right posterior hepatic bisegmentectomy (Segments VII-VIII).

The role of laparoscopy in liver surgery is still a subject of debate. Up to now, isolated hepatic lesions requiring a segmental (or bisegmental) resection have been considered to be an indication for laparoscopic surgery only when they are located in the left lobe or in the right lower lobe, whereas an open approach by laparotomy or thoracotomy is still preferred for lesions of the upper right lobe. Here we report a case of a right posterior hepatic bisegmentectomy (segments VII-VIII) performed for a hepatic hemangioma that was carried out entirely laparoscopically. In our opinion, there is not an a priori contraindication to the laparoscopic resection of any hepatic benign lesion, wherever it is located in the liver parenchyma. Nevertheless, major hepatic resections still have to be performed by expert surgeons in specialized centers.

Adult↗
PubMed2001

Evaluation of telesurgical (robotic) NISSEN fundoplication.

BACKGROUND: The laparoscopic surgical approach has proven its benefit for the patient. There are however several shortcomings, which have triggered considerable research for improvement. One improvement may be the introduction of telesurgery by the interposition of a computer interface between surgeon and patient. MATERIAL AND METHODS: A prospective randomized study was conducted in an advanced laparoscopic procedure, Nissen fundoplication. The control group underwent the conventional laparoscopic approach, while the investigational group underwent the telesurgical approach. RESULTS: Feasibility was 100%. The procedure was more time consuming in the Telesurgical group, at all stages of the operation. Mortality was nil and morbidity was comparable in both groups. CONCLUSION: The telesurgical approach is feasible in advanced laparoscopic procedures like Nissen fundoplication. At the present time there is however no obvious added benefit from this new technique.

Adolescent↗
PubMed2001

Feasibility of robotic laparoscopic surgery: 146 cases.

Theoretically, in laparoscopic surgery, a computer interface in command of a mechanical system (robot) allows the surgeon: (1) to recover a number a number of lost degrees of freedom, thanks to intraabdominal articulations; (2) to obtain better visual control of instrument manipulation, thanks to three-dimensional vision; (3) to modulate the amplitude of surgical motions by downscaling and stabilization; (4) to work at a distance from the patient. These advances improve the quality of surgical tasks in a perfect ergonomic position. The purpose of this paper is to evaluate the feasibility of utilizing a robot in laparoscopic surgery. The first robot-assisted procedure in humans was performed in March 1997 by our team. One hundred forty-six patients underwent robot-assisted laparoscopic surgery. Between March 1997 and February 2001 a nonconsecutive series was performed of 39 antireflux procedures, 48 cholecystectomies, 28 tubal reanastomoses, 10 gastroplasties for obesity, 3 inguinal hernias, 3 intrarectal procedures, 2 hysterectomies, 2 cardiac procedures, 2 prostactectomies, 2 arteriovenous fistulas, 1 lumbar sympathectomy, 1 appendectomy, 1 laryngeal exploration, 1 varicocele ligation, 1 endometriosis cure, 1 neosalpingostomy, 1 deferent canal. The robot (Da Vinci system, Intuitive Surgical, Mountain View, CA), consists of a console and a cart with three articulated robot arms. The surgeon sits in front of the console, manipulating joysticklike handles while observing the operative field through binoculars that provide a three-dimensional picture. This computer is capable of modulating these data by eliminating physiologic tremor and by downscaling the amplitude of motions by a factor 5 or 3 to one. This study has demonstrated the feasibility of several laparoscopic robotic procedures. There is no morbidity related to the system. Operating time and the hospital stay were within acceptable limits. The system seems most beneficial in intra-abdominal microsurgery or for manipulations in a very small space. Optimized ergonomics and increased mobility of the instrument tips are beneficial in many steps of abdominal surgical procedures.

Feasibility Studies↗
PubMed1999

Laparoscopic rectopexy according to Wells.

BACKGROUND: The laparoscopic approach usually reduces the morbidity of procedures performed by laparotomy. The aim of this study was to demonstrate the usefulness of laparoscopic rectopexy. METHODS: A total of 37 patients were included in this prospective study. The indication was true rectal prolapse in all patients. Incontinence was seen in 33% of the patients. A slightly modified Wells procedure was performed laparoscopically. Postoperatively, the patients were evaluated for resolution of the prolapse and incontinence. They were also questioned about their satisfaction with the procedure. RESULTS: Laparoscopy was successful in all but one case. Follow-up is available in 32 of 37 patients. Prolapse was cured in all patients, and the incontinence resolved in 11 of 12. In addition, 38% of the patients experienced significant constipation preoperatively versus 5% postoperatively.

Aged↗
PubMed1999

[Nissen fundoplication done by remotely controlled robotic technique].

Two Nissen fundoplications were performed by a minimally invasive robotic technique on May 19, 1998. The Mona robot, was placed to the left of the patient. It held and activated surgical tools. The surgeon was placed some 3 meters from the patient and was seated at a console. He was not scrubbed. He commanded the 3 robotic arms by manipulating two handles, while observing a 3 dimensional picture recreated by a binocular system. Manipulations of the handles were translated into digital information by a computer. This information was modified by the computer with downscaling of the amplitude of motion by a factor 1 to 3 or 1 to 5. Physiologic tremor was eliminated. The computer delivered an impulse in command of the articulated robot arms via a 5 m long cable. Operating time was 4.30 hours, and 1.30 hours respectively. Blood loss was estimated at 20 and 30 ml. The two patients were discharged on the first postoperative day after a gastrograffin swallow had been performed in order to check the position of the wrap and its patency. Our experience with the Mona device may suggest that surgical robotics could have an increasingly important role in tomorrow's operating theatres. It should allow for more precise procedures, performed under better circumstances.

Adult↗
PubMed1997

Conversions and complications in 185 laparoscopic adjustable silicone gastric banding cases.

BACKGROUND: Kuzmak's gastric silicone banding technique is the least invasive operation for morbid obesity. The purpose of this study was to analyze the complications of this approach. METHODS: Between September 1992 and March 1996, 185 patients underwent laparoscopic gastroplasty by the adjustable silicone band technique. A minimally invasive procedure using five trocars was performed. RESULTS: In 11 patients exposure of the hiatus was impeded because of hypertrophy of the left liver lobe which led to conversion in eight patients and abortion of the procedure in three other patients. Anatomical complications: We observed two gastric perforations and one band slippage at the early stage, one infection and three rotations of the access port. Functional complications: There were eight (4%) cases of irreversible total food intolerance resulting in pouch dilation and eight cases (4%) of esophagitis. One fatality on the 45th day in a patient with a Prader-Willi syndrome. CONCLUSION: The most disturbing complications of gastric banding technique are gastric perforation and pouch dilation. Their incidence may be reduced by improving the technique and by considering pitfalls of the procedure.

Adolescent↗
PubMed1995

How to avoid esophageal perforation while performing laparoscopic dissection of the hiatus.

An increasing number of surgeons attempt advanced laparoscopic procedures, involving the distal esophagus such as Nissen fundoplication, truncal vagotomy, and Heller's myotomy. At this time, there are probably as many techniques as there are surgeons. The authors have tried to provide a "ready to use" universal strategy that details how to approach the distal esophagus while avoiding the dangerous pitfalls of surgery in that area.

Adolescent↗
PubMed1995

[Nissen's fundoplication by celiovideoscopy].

One hundred and sixty two laparoscopic fundoplications were performed between may 1991 and december 1993 by the first author. No perioperative death was observed. There were 4 intraoperative complications (3%): 1 gastric perforation, 2 pleural perforations and 1 liver laceration. There were 3 conversions to laparotomy: 2 for left liver hypertrophy and 1 for needle holder defect. The duration of the operation ranged from 40 minutes to 5 hours (median 120 minutes). The median postoperative stay was 2 days. Five postoperative complications occurred: 2 cases of pneumonia and 3 cases necessitating second-look laparatomy (1 necrosis of the valve, 1 small bowel perforation and 1 obstruction due to migration of the entire stomach into the chest). The follow-up ranges from 4 to 897 days (median 10 months). Long-term complications were: one recurrence of heartburn reoperated laparoscopically and two cases of long-term postoperative dysphagia.

Adolescent↗
PubMed1995

Totally preperitoneal laparoscopic approach combined with minianterior dissection in the treatment of indirect inguinal hernias.

Totally preperitoneal laparoscopic hernioplasty has become more popular recently and will possibly replace the transabdominal preperitoneal procedure. This procedure, however, is more demanding for the surgeon, especially in large indirect hernias. We describe an alternative technique derived from Darzi's anterior endoscopic approach. To date, it has been used in 15 patients, all with good success. The technique results in a shorter operative time and is easier for the surgeon.

Adult↗
PubMed1994

Laparoscopic Nissen fundoplication: technique and preliminary results.

Between May 1991 and November 1992, 80 consecutive patients with gastro-oesophageal reflux disease underwent laparoscopic Nissen fundoplication. The technique used was exactly the same as for the conventional open approach. There were no deaths but there were four peroperative complications: one gastric perforation, two pleural perforations and one hepatic laceration. Three conversions to laparotomy were necessary, one because of a defective needle holder and two as a result of left hepatic lobe hypertrophy. The duration of operation ranged from 40 to 300 (median 150) min. The median postoperative stay was 3 days, but increased to 10 days in two patients who developed pulmonary infection. One major postoperative complication (necrosis of the wrap) required a laparotomy on day 8 after operation. No recurrence of heartburn has been observed and there were no instances of long-term dysphagia after surgery. These findings indicate that laparoscopic Nissen fundoplication can be performed safely if the team is well trained.

Adolescent↗
PubMed1994

Operative strategy in laparoscopic splenectomy.

BACKGROUND: Laparoscopic splenectomy was attempted in 17 consecutive patients and was successful in 15. STUDY DESIGN: This study is a critical analysis of the operative strategy in laparoscopic splenectomy, as reviewed in the operative video recordings and operative summaries of the 17 patients discussed. RESULTS: The 15 successful laparoscopic splenectomies were all conducted according to the same strategy: mobilization of both the upper and lower pole of the spleen, division of the short gastric vessels close to the spleen, and dissection and separate ligation of the main trunk of the splenic artery and vein. An erroneous strategy that diverged from the one proposed, resulted in parenchymatous hemorrhage and open conversion in two patients. CONCLUSIONS: In this series of 15 successful laparoscopic splenectomies, the most important technical aspect seems to be full mobilization of the spleen before the hilum is dissected.

Adolescent↗
PubMed1994

Laparoscopic proximal gastric vagotomy.

Proximal gastric vagotomy, considered the conventional surgical treatment of choice for peptic ulcer disease, is now performed laparoscopically. Thirty-three patients underwent the procedure. Seven patients were treated on an emergency basis for perforated peptic ulcer. Morbidity and mortality of the procedure were zero. Patient acceptance (Visick staging) was good to excellent in 22 of 25 patients in follow-up. Laparoscopic proximal gastric vagotomy appears to be a good treatment in chronic peptic ulcer disease even when complicated by an acute perforation.

Adult↗
PubMed1986

Carnitine metabolism during fasting in dogs.

During starvation, a series of changes in whole body fuel use occur that result in conservation of fuel, particularly protein. Use of fat stores for ketone production and direct oxidation of fat as a primary fuel are characteristic of starvation. However, the mechanism by which this change develops is unclear. Carnitine is an important compound in the control of fat metabolism, since long-chain free fatty acids must be coupled with it to cross the mitochondrial membrane. This study attempts to define, in the fasting dog model, the interaction between plasma and muscle carnitine, its acyl esters, and the energy substrates available. Eight adult beagle dogs were studied during an 8-day period of starvation. Muscle and plasma were analyzed for free carnitine (FC), acid-soluble fraction, and long-chain esters (LCE), as well as substrate hormone profiles. Total carnitine (TC) and short-chain esters (SCE) were calculated. Muscle was analyzed for carnitine palmityl transferase activity (CPT). These measurements were performed on days 3, 5, and 8. There was a significant (p less than 0.05) loss in weight on days 3, 5, and 8. TC and FC increased significantly (p less 0.05) only on day 8; this occurred simultaneously with a significant (p less than 0.05) decrease in CPT. It was preceded by a significant (p less than 0.05) and persistent increase in plasma TC, FC, and LCE that developed on day 3. During starvation there was an increase in plasma carnitine levels before changes in muscle. The increase in muscle carnitine occurred between days 5 and 8 of starvation and seemed to be associated with a fall in CPT. This may be responsible either for or secondary to the decrease in metabolic rate that occurs during prolonged starvation.

3-Hydroxybutyric Acid↗