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Biomedical subjects

L Kavoussi

Publications and source records attributed to L Kavoussi.

10 recordsLinked to original sources
PubMed2005

Robotic assisted radio-frequency ablation of liver tumors--randomized patient study.

The minimally invasive treatment of liver tumors represents an alternative to the open surgery approach. Radio-frequency ablation destroys a tumor by delivering radio-frequency energy through a needle probe. Traditionally, the probe is placed manually using imaging feedback. New approaches use robotic devices to accurately place the instrument at the target. The authors developed an image-guided robotic system for percutaneous interventions using computed tomography. The paper presents a randomized patient study comparing the manual versus robotic needle placement for radio-frequency ablation procedures of liver tumors. The results of this study show that in our case robotic interventions were a very viable solution. Several treatment parameters such as radiation exposures and procedure-times were found to be significantly improved in the robotic case.

Algorithms↗
PubMed2002

[Telerobotic surgery between Baltimore and Munich].

The rapid development of laparoscopy in urology necessitates the training of specialists to guarantee the high standard of patient care. The real-time data communication of medical information between physicians in different locations is known as telemedicine. Telementoring describes the assistance of an experienced surgeon, while telerobotics requires the use of robots. Two robots, the established AESOP and the PAKY + RCM developed at the Johns Hopkins Hospital (JHH), were used to perform a telerobotic laparoscopic renal cyst ablation in cooperation between Baltimore and Munich. The telementor maneuvered the robots over a distance of 8000 km using eight ISDN lines and a PC. AESOP moved the camera, while PAKY allowed the use of a fan retractor in the abdomen. The telerobotic operation was performed without complications or system and communication failures. Telementoring can be used for training purposes but also for consultation between specialists in emergency settings.

Baltimore↗
PubMed2001

Laparoscopic ureteral reimplantation for ureteral lesion secondary to transvaginal ultrasonography for oocyte retrieval.

Transvaginal ultrasound-guided follicular puncture for oocyte retrieval is a highly efficient and minimally invasive method for assisted reproductive techniques. Complications related to this procedure are rare. We report the case of a ureteral stricture secondary to ultrasound-guided follicular puncture for oocyte retrieval that was corrected by a laparoscopic approach. This approach can minimize postoperative pain, the length of hospitalization, and the period of convalescence and should be considered a minimally invasive option in the management of this rare complication of oocyte retrieval.

Adult↗
PubMed2001

The laparoscopic Boari flap.

PURPOSE: Laparoscopic management of ureteral pathologies, such as ureteropelvic junction obstruction, ureteral calculi and retroperitoneal fibrosis, has proved to be highly effective. We present our initial experience with the laparoscopic Boari flap in regard to feasibility, safety and short-term results. MATERIALS AND METHODS: Three patients who presented with distal ureteral obstruction underwent preoperative radiographic evaluation, including excretory urography, computerized tomography and retrograde pyelography, that showed upper urinary tract dilatation at the site of obstruction. The contralateral upper urinary tract was normal in all cases. Ureteroureterostomy and ureteroneocystostomy was not feasible because of stricture length and a laparoscopic Boari flap procedure was performed. Renal function, symptom improvement and radiological studies, including excretory urography and cystography, were assessed 3 and 6 months postoperatively. RESULTS: All procedures were successfully performed without any intraoperative complications or need for open conversion. Excretory urography showed good drainage with no obstruction of urine flow and all patients had grade I vesicoureteral reflux on cystography. CONCLUSIONS: The laparoscopic Boari flap is feasible using currently available laparoscopic suturing techniques. Longer followup and larger series of patients are necessary to provide data comparable to that of the open approach.

Adult↗
PubMed1997

Telesurgical mentoring. Initial clinical experience.

BACKGROUND: Minimally invasive surgical techniques yield significant individual, economic, and social benefits when performed by experienced surgeons. Unfortunately, many of these techniques, such as laparoscopy, are associated with steep learning curves, and the incidence of complications has clearly been shown to be inversely related to experience. The initial high complication rate and the dearth of experienced endoscopic surgeons have raised concerns over training, granting of hospital privileges, and most importantly patient safety. The goal of this study was to employ current telecommunications technology in a system for the mentoring of relatively inexperienced surgeons. Therefore, we created a telesurgical system that would allow an endoscopic specialist at a central site to offer guidance and assistance to a surgeon during a laparoscopic procedure. METHODS: We developed a system that connected a central site and an operative site, a distance of approximately 3.5 miles, via a single T1 (1.54 Mbs) point-to-point communications link. The system provided real-time video display from either the laparoscope or an externally mounted camera located in the operating room, full duplex audio, telestration over live video, control of a robotic arm that manipulated the laparoscope, and access to electrocautery for tissue cutting or hemostasis. RESULTS: Seven patients underwent laparoscopic procedures using the telesurgical consultation system over the communications link. In all cases, the primary surgeon had limited experience with the laparoscopic approach but still had the basic skills required to obtain intraperitoneal access. All seven cases were completed successfully without complications. CONCLUSION: These initial studies have demonstrated the feasibility, effectiveness, and safety of telementoring. Telesurgical applications have the potential to greatly improve surgical education credentialing, and patient care by offering patients and their surgeons global access to surgical specialists.

Humans↗
PubMed1996

Laparoscopic complications in markedly obese urologic patients (a multi-institutional review)

OBJECTIVES: Significant obesity is considered to be a relative contraindication to laparoscopic surgery. This study reviews the complications encountered in massively obese patients undergoing urologic laparoscopic surgery. METHODS: Body mass index (BMI) was used as an objective index to indicate massive obesity. Eleven institutions compiled retrospective data on 125 patients having a BMI greater than 30. Procedures performed included 76 pelvic lymph node dissections, 14 nephrectomies, 7 bladder neck suspensions, and 28 miscellaneous procedures. RESULTS: For the group as a whole, the mean BMI was 35.1 (range 30.1 to 57.2). Mean operative time was 202 minutes (range 60 to 480). Conversion to open surgery occurred in 15 of the 125 patients (12%). Complication rates (minor and major) were 22% (27 occurrences in 125 patients) intraoperatively and 26% (33 occurrences in 125 patients) postoperatively. The major complications included 2 trocar injuries to abdominal wall vessels, 1 bladder injury, 3 peripheral nerve injuries, 1 dysrhythmia, 1 deep vein thrombosis, 1 wound seroma, 1 nephrocutaneous fistula, 1 incisional hernia, and 1 death. CONCLUSIONS: In this review, complication rates for urologic laparoscopic surgery on massively obese patients were higher than in the general population undergoing laparoscopic surgery (0.3% to 21%).

Adolescent↗
PubMed1990

Ureteronephroscopic endopyelotomy.

The percutaneous nephrostomy tract has provided urologists with antegrade access to the upper urinary tract. Via this approach ureteropelvic junction obstruction has been treated with an endoscopically controlled incision with a cold knife. While less invasive than an open operation, we have noted significant discomfort from the 24 to 32F percutaneous tract. Accordingly, we sought to achieve the same results by using a less invasive approach, that is retrograde ureteronephroscopic endopyelotomy. A total of 10 patients (9 women and 1 man) with 5 primary and 5 secondary ureteropelvic junction obstructions underwent ureteroscopic endopyelotomy with a 3 or 5F Greenwald cutting electrode passed through a 12F rigid, 10.8F flexible or 9.8F flexible deflectable ureteronephroscope. Preoperatively, ureteropelvic junction obstruction was documented by a furosemide washout renal scan and/or a Whitaker test in 8 of 10 patients. In 2 patients an excretory urogram or retrograde pyelography was diagnostic. Duration of the procedure averaged 180 minutes (245 minutes with a concurrent Whitaker test). At the conclusion of the procedure a 7/14F indwelling ureteral stent was placed. The nephrostomy tube was removed after 3 days and average hospital stay was 5 days. The ureteral stents were routinely left in place for 6 weeks. Followup in 10 patients averaged 12 months. Flank pain was largely resolved in all patients. A followup Whitaker test, excretory urogram or renal scan ultimately has demonstrated decreased or no obstruction in 9 of 10 patients. In summary, early results with retrograde ureteronephroscopic endopyelotomy, specifically in female patients, appear to be promising. Morbidity is minimal and efficacy is satisfactory given the favorable objective response noted in 90% of the patients.

Adult↗
PubMed1989

Flexible, actively deflectable fiberoptic ureteronephroscopy.

We performed 76 flexible, actively deflectable ureteronephroscopic procedures in 68 patients. Of the patients 61 were examined transurethrally, 3 via an ileal loop, 2 percutaneously and 2 via ureterostomy. Indications for flexible, actively deflectable ureteronephroscopy included urolithiasis in 28 patients, upper tract filling defect in 25, lateralizing hematuria in 8, retrograde endopyelotomy in 2, post-endopyelotomy evaluation in 6, surveillance for transitional cell carcinoma in 4 and other reasons in 3. The area of interest was accessed successfully in 96% of the patients. In 57 instances an attempt was made to inspect all calices and was successful in two-thirds of the patients. However, greater than 75% of the collecting system was accessed in all but 2 of these 57 patients. Over-all, diagnostic and/or therapeutic maneuvers were successful in 84% of the patients. Flexible, actively deflectable ureteronephroscopy provides the urologist with a minimally invasive means to evaluate and treat pathological conditions of the upper urinary tract.

Adolescent↗