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Jeffrey M Marks

Publications and source records attributed to Jeffrey M Marks.

5 recordsLinked to original sources
PubMed2006

The future of teaching surgical endoscopy.

Gastrointestinal surgery, with its emphasis on endoscopy, has renewed interest in teaching surgical endoscopy. The field is rapidly evolving, with innovative techniques emanating from the laboratory to the operating room and endoscopy suite. To ensure that surgeons spearhead the field of endoscopic surgery, a new strategy for teaching surgical endoscopy to residents and practicing surgeons must be developed.

Education, Medical, Graduate↗
PubMed2005

Validation of a flexible endoscopy simulator.

BACKGROUND: Virtual reality (VR) simulation is a rapidly proliferating adjunct of surgical training. Numerous devices have evolved as educational tools in a variety of fields. Whether these tools can be used for validation of physicians' skills has yet to be determined. The objective of this study was to determine whether the GI Mentor (Simbionix, Lod, Israel) flexible endoscopy simulator construct could distinguish experienced endoscopists from beginners. METHODS: Seventy-five surgical attendings, fellows, and residents were recruited for participation in the study. Two cohorts were used and these groups were selected from 2 separate scientific sessions. Participants completed a standardized questionnaire documenting their endoscopic training and experience. Physicians subsequently were designated as experienced or beginner after their endoscopic training and experience were evaluated. All participants completed 1 of 2 colonoscopic simulations. The GI Mentor objectively evaluated performance on the basis of programmed data points, including the time to reach the cecum, the percentage of mucosa visualized, the completed polypectomy rate, the percentage of time spent in clear view through the lumen, the percentage of time that the patient was in pain, and overall efficiency. RESULTS: In both simulations, experienced endoscopists were more efficient than beginners (.32%/s vs. .26%/s, P=.02; and .53%/s vs. .37%/s, P=.03) and achieved a greater polypectomy rate (78% vs. 43%, P=.03; and 87% vs. 48%, P=.01). Furthermore, experienced endoscopists visualized more of the colonic surface (86% vs. 82%, P=.02) and spent a greater proportion of the time in clear view of the lumen (55% vs. 47%, P=.05) than beginners completing the first simulation. In the second simulation, experienced participants reached the cecum more rapidly than beginners (175 vs. 262 s, P=.01). CONCLUSIONS: The G1 Mentor VR colonoscopy construct appears valid. Significant performance differences were shown between the experienced and beginner cohorts. The beginner participants in this study were all physicians with some degree of endoscopic experience. Therefore, the G1 Mentor distinguished endoscopists of varying experience and exposure. Further validation studies are needed to evaluate the breadth of programs inherent to this simulator and to determine whether it may be used in the future for qualification and certification purposes.

Clinical Competence↗
PubMed2002

Sphincter of Oddi injection with botulinum toxin is as effective as endobiliary stent in resolving cystic duct leaks in a canine model.

BACKGROUND: Current management of biliary fistulae includes percutaneous drainage and transpapillary endoscopic biliary stent placement. This study compared time to bile leak resolution for endoscopic stent insertion versus injection of botulinum toxin into the sphincter of Oddi. METHODS: Thirty dogs underwent laparotomy and cholecystectomy without cystic duct closure. After a duodenotomy, dogs were randomized to the control group (Group 1) or one of two treatment groups. Treated dogs either underwent transpapillary stent placement (Group 2) or botulinum toxin injection into the sphincter of Oddi (Group 3). Drains were placed adjacent to the cystic duct stump and output was recorded daily. Resolution of bile leaks was defined as an output of less than 10 mL/day. Necropsy was performed to identify undrained intraperitoneal bile. RESULTS: Data from 28 dogs were available for analysis. The numbers of days for resolution of bile leaks in Groups 1, 2, and 3 were, respectively, 9.3 (2.1) days, 2.3 (1.1) days, and 2.6 (1.1) days. There were significant differences in time to resolution of bile leak between Group 1 and both Groups 2 (p < 0.001) and 3 (p < 0.001). There was no significant difference between Groups 2 and 3 (p > 0.25). CONCLUSION: Sphincter of Oddi injection with botulinum toxin is as effective as endobiliary stent placement in resolving cystic duct leaks in this canine model.

Animals↗