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Kevin T Watkins

Publications and source records attributed to Kevin T Watkins.

4 recordsLinked to original sources
PubMed2006

Analysis of respiratory complications after minimally invasive esophagectomy: preliminary observation of persistent aspiration risk.

Minimally invasive (MI) esophageal resection (ER) has the theoretical advantage of reduced postoperative complications compared with standard ER. However, the impact of MIER on rates and severity of pulmonary complications is unclear. Four patients underwent laparoscopic gastroesophageal mobilization and resection followed by gastric pull-up and cervical esophageal anastomosis (MIER). Videofluoroscopic swallowing studies (VFSS) assessed pharyngolaryngeal function postoperatively. All postoperative complications were documented. Each MIER was completed successfully without intraoperative complications. Mean operative time was 4.3 +/- 2 h. Postoperatively, VFSS detected laryngeal penetration, vocal cord paralysis, and/or aspiration in three patients, two of whom experienced severe respiratory complications. MIER patients are susceptible to aspiration, likely due to transient denervation of the pharynx and laryngeal structures. Following MIER, aggressive pulmonary toilet and aspiration precautions are emphasized to reduce pulmonary complications. Furthermore, serial evaluation of deglutition is encouraged to guide the safe and appropriate resumption of oral feeding.

Deglutition↗
PubMed2006

Laparoscopic hepatic resection using saline-enhanced electrocautery permits short hospital stays.

Laparoscopic hepatic resection has been reported to yield lower morbidity and shorter hospital stays than open resection. However, few studies have evaluated patient and technical factors associated with short hospital stays. We conducted a retrospective review of patients undergoing laparoscopic hepatic resection at our institution from May 2002 to February 2004. Patient and operative factors were analyzed with respect to time to discharge. Seventeen patients underwent 10 wedge resections and seven segmentectomies or bisegmentectomies. There were no mortalities, conversions to open procedure, clinically evident bile leaks, or transfusion requirements. Eleven patients were discharged within 24 hours. When compared with those discharged later than 24 hours, there were fewer patients with advanced ASA classification (0 versus 3 in ASA class 3, p < 0.05). With appropriate patient selection, laparoscopic hepatic resections may be safely performed, result in short hospital stays, and are facilitated by technologies such as saline-enhanced electrocautery and endoscopic ultrasound. Information reflected in advanced ASA class may predict patients unlikely to be discharged within 24 hours.

Adult↗
PubMed2005

Case report: serial percutaneous cholangioscopy with laser ablation for the management of locally recurrent biliary intraductal papillary mucinous tumor.

We present a case of serial cholangioscopic laser fulguration of a biliary recurrence of pancreatic intraductal papillary mucinous tumor in a 76-year-old man. Through established percutaneous biliary drain tracts, the aseptic use of a standard 6.9 F ureteroscope and holmium laser fiber facilitated visual ablation within the biliary tree. Quarterly cholangioscopic laser ablation provided safe and effective local control without biliary infectious complications. This case appears to be the first treatment of recurrent intrabiliary intraductal papillary mucinous tumor by serial antegrade choledocoscopy and laser photocoagulation. Effective local control appears possible with minimal morbidity. Standard ureteroscopic equipment facilitates safe and efficient percutaneous antegrade choledocoscopy.

Aged↗