Biomedical subjects

Mohamed R Ali

Publications and source records attributed to Mohamed R Ali.

5 recordsLinked to original sources

PubMed2006

Teaching robotic surgery: a stepwise approach.

BACKGROUND: After an initial institutional experience with 50 robot-assisted laparoscopic Roux-en-Y gastric bypass procedures, a curriculum was developed for fellowship training in robotic surgery. METHODS: Thirty consecutive robotic gastric bypasses were performed using the Zeus robotic surgical system to fashion a two-layer gastrojejunostomy. For teaching purposes, performance of the anastomosis was divided into three discrete tasks. Robotic suturing tasks were assigned to the trainee in cumulative order in ten-case increments. Our patient population averaged 44 years of age and 47 kg/m(2) in BMI. Patients were predominantly female (87%). RESULTS: The robotic training experience of the fellow defines the increases in surgical responsibility over the series of cases. Statistical analysis revealed no significant differences in task times or total robotic operative time as participation of the trainee in performing the gastrojejunostomy increased. No adverse robotic events or surgical complications occurred throughout this series. The learning curve of the fellow compared favorably with the initial experience of the institution. CONCLUSION: Robotic surgery training may be safely implemented in a minimally invasive surgery training program. A gradual introduction of robotic technique appears to maximize the learning experience and minimize the potential for adverse outcomes.

Adult↗

PubMed2006

Robotic cholecystectomy: learning curve, advantages, and limitations.

BACKGROUND: Robotic cholecystectomy is safe, feasible procedure. Initial studies showed significant set up time and operating time but no clear clinical advantage of the robotic involvement. We have investigated the learning curve, advantages and limitation of the procedure. MATERIAL AND METHODS: We reviewed all (n = 51) robotic cholecystectomies performed between July 2004 and December 2005. The surgery was performed using the da Vinci system. We recorded operative time, setup time of robotics instrumentation, conversion to laparoscopic or open cholecystectomy and complication of the procedure. RESULTS: Forty-eight of the 51 procedures (94%) were completed robotically. We did not experience any significant complications directly related to robotics surgery. The mean +/- SD operating time was 77 +/- 22.3 min. The mean setup time for robotics (from incision until robot was in place, including draping the robot) was 24 +/- 8.8 min. However, the setup time significantly improved as we gained more experience: from 30.6 +/- 10.7 min (first 16 cases) to 18.3 +/- 4.0 min (cases 33-48). The mean robotic time was 34 +/- 16.1 min. We observed no significant improvement in robotic procedure time. CONCLUSIONS: Robotic cholecystectomy offers significant advantages such as three-dimensional view, easier instrument manipulations and possibility of remote site surgery. We observed some shortcomings of robotic surgery such as need for larger and additional ports, and need for undocking the machine in case of cholangiography or change of patient position. Our data shows that the learning curve is between 16 to 32 procedures to significantly decrease the setup time and total operating time.

Adolescent↗

PubMed2005

Assessment of obesity-related comorbidities: a novel scheme for evaluating bariatric surgical patients.

BACKGROUND: Bariatric surgery serves as the superior means of achieving sustained weight loss and improvement in obesity-related comorbidities. Results of bariatric surgery have been reported qualitatively without standardized measurement of comorbidity response. The objective of this work was to develop a clinically based, standardized system for scaled assessment of the major comorbidities of obesity in patients undergoing bariatric surgery. STUDY DESIGN: We constructed a standardized grading scheme for the major comorbidities of obesity, with each condition scored from 0 to 5, according to severity. Data were prospectively collected on 226 patients. Ninety patients have already undergone gastric bypass and are being followed at regular intervals postoperatively. Longest current followup interval is 1 year. RESULTS: Preoperative evaluation of comorbidities identified a total of 1,356 medical disorders. Anatomic comorbidities were most prevalent as a category, although psychosocial impairment was the most common single condition. The majority of comorbidities in our patient population were graded mild (score of 1) to moderate (score of 3). Immediate (2 weeks) followup was available for all operated patients and ranged in number to 1 year postoperatively, depending on the date of operation. Statistically significant reduction in the severity of several comorbidities was observed at postoperative evaluation (p < 0.05). CONCLUSIONS: This scheme for assessment of obesity-related comorbidities facilitates evaluation of bariatric surgical patients. The system allows standardized preoperative characterization of a bariatric patient population and uniform postoperative longitudinal assessment of changes in comorbidities after weight reduction operation.

Adult↗

PubMed2005

Bariatric surgical outcomes.

This article describes the procedures that are performed for weight loss and characterizes the associated short-term success (operative safety, in-hospital morbidity/mortality) and long-term efficacy(weight loss, weight loss maintenance, postoperative complications). It discusses each category of procedure and reviews the current outcomes literature. It also addresses the technical challenges that are involved with the performance of each procedure and how these challenges may affect short and long-term outcomes. It concludes by comparatively analyzing the outcomes of the various bariatric surgical procedures and their respective roles in effectively managing the morbidly obese patient.

Biliopancreatic Diversion↗

PubMed2002

Techniques of laparoscopic Roux-en-Y gastric bypass.

Morbid obesity represents a challenge to healthcare as the underlying source of numerous risks and significant expenditure. Gastric bypass surgery has been validated as a means of significant and reproducible reduction in weight. In the laparoscopic era, the minimally invasive approach has been applied to this procedure with promising results. In our technique, we divide the stomach to create a small gastric pouch drained by a retrocolic, retrogastric Roux-en-Y alimentary jejunal limb. The gastrojejunostomy is performed in 2 layers, an inner stapled layer and an outer sutured layer. We, like other groups, have found that laparoscopic gastric bypass provides similar efficacy to open gastric bypass, but offers improved patient acceptance, quality of life, and significantly less wound complications.

Anastomosis, Roux-en-Y↗