Biomedical subjects

Rafael Sierra

Publications and source records attributed to Rafael Sierra.

16 recordsLinked to original sources

PubMed2006

The effects of pulse dye laser double-pass treatment intervals on depth of vessel coagulation.

BACKGROUND AND OBJECTIVE: Multi-pass treatments with pulse dye lasers (PDLs) are avoided due to perceived side effects. Proper multi-pass techniques allow for deeper vascular injury. New extended PDLs allow use of multi-pass procedures. This study evaluates how the time between pulses, inter-pulse interval [IPI] affect extent of vascular treatment. STUDY DESIGN/MATERIALS AND METHODS: Sixteen subjects were exposed to a series of exposures on normal skin to determine depth of injury for various IPI. Subjects were exposed to single pass, and 4 double-pass intervals. Tests included exposures at 0.5 milliseconds, 2-7 j/cm(2). Exposures included one and two passes, IPI of 1, 10, 30, and 60 seconds; 5 and 30 minutes. Treatments were done with PhotoGenica V-Star (595-nm), SmartCool air cooling. Biopsies were taken: single pass and double pass purpuric thresholds; and at 7 j/cm(2) to determine depth of vascular coagulation. RESULTS: Histology revealed increased vascular coagulation depth at purpura threshold for intervals of 1, 10, 30, and 60 seconds between passes compared to single pass treatment, and a significant monotonic increase in depth of vascular injury at 7 j/cm(2) with increasing IPI. CONCLUSIONS: The use of multiple passes increases depth of vascular injury, which may increase the efficacy of treatment without significant increase in purpura or risk of scarring for treatments at purpura threshold. At purpura threshold, the depth of vascular injury increases with increasing IPI up to 60 seconds. Above purpura threshold, there is a monotonic increase in depth of vascular injury for IPI up to 30 minutes. These observations suggest multi-pass treatment methods may be beneficial when employed with PDLs.

Adult↗

PubMed2006

Intensive continuing medical education course training on simulators results in proficiency for laparoscopic suturing.

BACKGROUND: The purpose of this study was to determine the feasibility and effectiveness of implementing a validated suturing curriculum as a free-standing continuing medical education (CME) course. METHODS: Eighteen participants (9 practicing surgeons, 9 surgery residents) attended a 4-hour laparoscopic suturing CME course. After viewing an instructional videotape all participants had their baseline performance measured on a fundamentals of laparoscopic surgery-type videotrainer suture model. Participants then practiced on the model with active instruction from 6 proctors until a previously reported proficiency level was achieved or until the course ended. Performance was scored objectively based on time and errors. Precourse and postcourse questionnaires were collected. RESULTS: Participants trained for 2.6 +/- .8 hours and performed 37 +/- 11 repetitions. Although no participant was proficient at baseline, 72% achieved the proficiency level by the end of the course. Participants showed 44% improvement in objective scores and 34% improvement according to subjective self-rating. CONCLUSIONS: Although 4 hours may be insufficient for some trainees, an intensive half-day CME course is feasible and effective in significantly improving performance and allowing the majority of participants to achieve proficiency.

Adult↗

PubMed2006

Proficiency maintenance: impact of ongoing simulator training on laparoscopic skill retention.

BACKGROUND: Proficiency-based training in laparoscopic suturing and knot tying translates to the operating room, but little is known about the durability of acquired skill. The purpose of this study was to determine the effect of maintenance training on skill retention after demonstration of proficiency. STUDY DESIGN: Medical students (n=18) with no previous laparoscopic or simulator experience were enrolled in an IRB-approved randomized controlled trial. All subjects trained to proficiency (score of 512, based on time and errors) on a previously validated suturing model (Fundamentals of Laparoscopic Surgery videotrainer). Subjects were then randomized to a control group, which received no additional training, and an ongoing training group, which trained again to proficiency at 1 and 3 months (immediately after testing). Simulator testing was repeated at 2 weeks, 1 month, 3 months, and 6 months after initial training. No subject had interval operative experience. RESULTS: Both groups demonstrated excellent skill retention during followup; performance scores, reported as means+/-SD, were 488+/-57 versus 482+/-55 at 2 weeks (p=ns), 483+/-81 versus 491+/-64 at 1 month (p=ns), 467+/-75 versus 470+/-67 at 3 months (p=ns), and 462+/-62 versus 492+/-43 at 6 months (p=0.02) for the control versus ongoing training groups, respectively. At 6 months, the ongoing training group showed better skill retention (95% versus 90%; p=0.02) and a trend for achieving the proficiency level (33% versus 18%; p=0.2) more often than the control group. CONCLUSIONS: Although proficiency-based training results in excellent skill retention, ongoing training substantially enhances performance and minimizes skill loss. Curricula should incorporate training that fosters maintenance of proficiency.

Adult↗

PubMed2006

Psychomotor testing predicts rate of skill acquisition for proficiency-based laparoscopic skills training.

BACKGROUND: Laparoscopic simulator training translates into improved operative performance. Proficiency-based curricula maximize efficiency by tailoring training to meet the needs of each individual; however, because rates of skill acquisition vary widely, such curricula may be difficult to implement. We hypothesized that psychomotor testing would predict baseline performance and training duration in a proficiency-based laparoscopic simulator curriculum. METHODS: Residents (R1, n = 20) were enrolled in an IRB-approved prospective study at the beginning of the academic year. All completed the following: a background information survey, a battery of 12 innate ability measures (5 motor, and 7 visual-spatial), and baseline testing on 3 validated simulators (5 videotrainer [VT] tasks, 12 virtual reality [minimally invasive surgical trainer-virtual reality, MIST-VR] tasks, and 2 laparoscopic camera navigation [LCN] tasks). Participants trained to proficiency, and training duration and number of repetitions were recorded. Baseline test scores were correlated to skill acquisition rate. Cutoff scores for each predictive test were calculated based on a receiver operator curve, and their sensitivity and specificity were determined in identifying slow learners. RESULTS: Only the Cards Rotation test correlated with baseline simulator ability on VT and LCN. Curriculum implementation required 347 man-hours (6-person team) and 795,000 dollars of capital equipment. With an attendance rate of 75%, 19 of 20 residents (95%) completed the curriculum by the end of the academic year. To complete training, a median of 12 hours (range, 5.5-21), and 325 repetitions (range, 171-782) were required. Simulator score improvement was 50%. Training duration and repetitions correlated with prior video game and billiard exposure, grooved pegboard, finger tap, map planning, Rey Figure Immediate Recall score, and baseline performance on VT and LCN. The map planning cutoff score proved most specific in identifying slow learners. CONCLUSIONS: Proficiency-based laparoscopic simulator training provides improvement in performance and can be effectively implemented as a routine part of resident education, but may require significant resources. Although psychomotor testing may be of limited value in the prediction of baseline laparoscopic performance, its importance may lie in the prediction of the rapidity of skill acquisition. These tests may be useful in optimizing curricular design by allowing the tailoring of training to individual needs.

Adult↗

PubMed2006

Measurement of serum testosterone using high-performance liquid chromatography/tandem mass spectrometry.

Low levels of serum testosterone typically found in women and children cannot be reliably measured by immunoassay. We developed a simple and sensitive method using high-performance liquid chromatography/tandem mass spectrometry (HPLC-MS/MS). Sample preparation involved protein precipitation of serum (1.0 mL) with acetonitrile containing the internal standard (testosterone-d3) followed by liquid extraction with methylene chloride. The chromatographic cycle per specimen was 10 min. The performance was evaluated according to the CLSI EP10-A2 protocol. Within- and between-run imprecision was 20.9%, 2.29% and 1.80%, and 1.81%, 3.58% and 2.97% at mean concentrations of 0.17, 14.1 and 28.8 nM, respectively, with no apparent carryover. The method was linear from 0.21 to 53.1 nM and the analytical recovery was 100.5-106.2% across the concentrations tested. There was no interference observed from other steroids that were tested. Correlation using de-identified patient specimens with a commercial HPLC-MS/MS method showed a slope of 0.991, an intercept of -0.017 and a correlation coefficient (R(2)) of 0.998 by linear regression over concentrations ranging from 0.21 to 16.7 nM. In conclusion, we report here an HPLC-MS/MS method suitable for clinical measurement of serum testosterone.

Chromatography, High Pressure Liquid↗

PubMed2005

Developing and testing competency levels for laparoscopic skills training.

HYPOTHESIS: Expert levels can be developed for use as training end points for a basic video-trainer skills curriculum, and the levels developed will be suitable for training. DESIGN: Fifty subjects with minimal prior simulator exposure were enrolled using an institutional review board-approved protocol. As a measure of baseline performance, medical students (n = 11) and surgery residents (n = 39) completed 3 trials on each of 5 validated video-trainer tasks. Four board-certified surgeons established as laparoscopic experts (with more than 250 basic and more than 50 advanced cases) performed 11 trials on each of the 5 tasks. The mean score was determined and outliers (>2 SDs) were trimmed; the trimmed mean was used as the competency level. Baseline performance of each subject was compared with the competency level for each task. SETTING: All research was performed in a laparoscopic skills training and simulation laboratory. PARTICIPANTS: Medical students, surgical residents, and board-certified surgeons. MAIN OUTCOME MEASURES: Expert scores based on completion time and the number of subjects achieving these scores at baseline testing. RESULTS: For all tasks combined, the competency level was reached by 6% of subjects by the third trial; 73% of these subjects were chief residents, and none were medical students. CONCLUSIONS: These data suggest that the competency level is suitably challenging for novices but is achievable for subjects with more experience. Implementation of this performance criterion may allow trainees to reliably achieve maximal benefit while minimizing unnecessary training.

Clinical Competence↗

PubMed2005

Simulator training for laparoscopic suturing using performance goals translates to the operating room.

BACKGROUND: The purpose of this study was to develop a performance-based laparoscopic suturing curriculum using simulators and to test the effectiveness (transferability) of the curriculum. STUDY DESIGN: Surgical residents (PGY1 to PGY5, n = 17) proficient in basic skills, but with minimal laparoscopic suturing experience, were enrolled in an IRB-approved, randomized controlled protocol. Subjects viewed an instructional video and were pretested on a live porcine laparoscopic Nissen fundoplication model by placing three gastrogastric sutures tied in an intracorporeal fashion. A blinded rater objectively scored each knot based on a previously published formula (600 minus completion time [sec] minus penalties for accuracy and knot integrity errors). Subjects were stratified according to pretest scores and randomized. The trained group practiced on a videotrainer suturing model until an expert-derived proficiency score (512) was achieved on 12 attempts. The control group received no training. Both the trained and control groups were posttested on the porcine Nissen model. RESULTS: For the training group, mean time to demonstrate simulator proficiency was 151 minutes (range 107 to 224 minutes) and mean number of attempts was 37 (range 24 to 51 attempts). Both the trained and control groups demonstrated significant improvement in overall score from baseline. But the trained group performed significantly better than the control group at posttesting (389 +/- 70 versus 217 +/- 140, p < 0.001), confirming curriculum effectiveness. CONCLUSIONS: These data suggest that training to a predetermined expert level on a videotrainer suture model provides trainees with skills that translate into improved operative performance. Such curricula should be further developed and implemented as a means of ensuring proficiency.

Adult↗

PubMed2005

Multicenter construct validity for southwestern laparoscopic videotrainer stations.

BACKGROUND: The "Southwestern" videotrainer stations have demonstrated concurrent validity (transferability to the operating room). The purpose of this study was to evaluate the Southwestern stations for construct validity (the ability to discriminate between subjects at different levels of experience). MATERIALS AND METHODS: From two surgical training programs, Institutional Review Board approved protocol data were collected from 142 subjects, including novice (medical students and R1, n = 66), intermediate (R2-R4, n = 67), and advanced (R5 and expert surgeons, n = 9) groups. All participants performed three repetitions on each of five stations. Completion time was scored for each task. Laparoscopic experience was determined from residency case log databases and from expert surgeon personal case logs. Results for the three groups were compared using one-way ANOVA, including relevant pair-wise comparisons. Correlations between number of laparoscopic cases performed and task scores were determined by Pearson's and Spearman's rho-correlation coefficients. RESULTS: The mean number of laparoscopic cases performed prior to completing the five tasks was 0 for novices, 9 for intermediates, and 431 for the advanced group. Significant differences (P < 0.001) were noted between groups for all five tasks and composite score. Task scores and composite scores significantly correlated with laparoscopic experience (P < 0.01). CONCLUSION: These data suggest that differences in laparoscopic ability are detected by performance on the videotrainer; thus, construct validity is demonstrated. Moreover, scores accurately reflect laparoscopic experience. Further validation may allow such simulators to be used for testing and credentialing purposes.

Adult↗

PubMed2005

Skill retention following proficiency-based laparoscopic simulator training.

BACKGROUND: Proficiency-based curricula using both virtual reality (VR) and videotrainer (VT) simulators have proven to be efficient and maximally effective, but little is known about the retention of acquired skills. The purpose of this study was to assess skill retention after completion of a validated laparoscopic skills curriculum. METHODS: Surgery residents (n=14) with no previous VR or VT experience were enrolled in an Institutional Review Board-approved protocol and sequentially practiced 12 Minimally Invasive Surgical Trainer-VR and 5 VT tasks until proficiency levels were achieved. One VR (manipulate diathermy) and 1 VT (bean drop) tasks were selected for assessment at baseline, after training completion (posttest), and at retention. RESULTS: All residents completed the curriculum. Posttest assessment occurred at 13.2 +/- 11.8 days and retention assessment at 7.0 +/- 4.0 months. After an early performance decrement at posttest (17%-45%), the acquired skill was maintained up to the end of the follow-up period. For VR, scores were 81.5 +/- 23.5 at baseline, 33.3 +/- 1.8 at proficiency, 48.4 +/- 9.2 at posttest, and 48.4 +/- 11.8 at retention. For VT, scores were 49.4 +/- 12.5 at baseline, 22.0 +/- 1.4 at proficiency, 25.6 +/- 3.6 at posttest, and 26.4 +/- 4.2 at retention. Skill retention was better for VT, compared with VR (P < .02). The extent of skill deterioration did not correlate with training duration or resident level. CONCLUSIONS: Although residents do not retain all acquired skills (more so for VR than for VT) according to simulator assessment, proficiency-based training on simulators results in durable skills. Additional studies are warranted to further optimize curriculum design, investigate simulator differences, and establish training methods that improve skill retention.

Adult↗

PubMed2005

Determining standards for laparoscopic proficiency using virtual reality.

Laparoscopic training using virtual reality has proven effective, but rates of skill acquisition vary widely. We hypothesize that training to predetermined expert levels may more efficiently establish proficiency. Our purpose was to determine expert levels for performance-based training. Four surgeons established as laparoscopic experts performed 11 repetitions of 12 tasks. One surgeon (EXP-1) had extensive Minimally Invasive Surgical Trainer-Virtual Reality (MIST VR) exposure and formal laparoscopic fellowship training. Trimmed mean scores for each were determined as expert levels. A composite score (EXP-C) was defined as the average of all four expert levels. Thirty-seven surgery residents without prior MIST VR exposure and two research residents with extensive MIST VR exposure completed three repetitions of each task to determine baseline performance. Scores for EXP-1 and EXP-C were plotted against the best score of each participant. On average, the EXP-C level was reached or exceeded by 7 of the 37 (19%) residents. In contrast, the EXP-1 level was reached or exceeded by 1 of 37 (3%) residents and both research residents on all tasks. These data suggest the EXP-C level may be too lenient, whereas the EXP-1 level is more challenging and should result in adequate skill acquisition. Such standards should be further developed and integrated into surgical education.

Clinical Competence↗

PubMed2005

Prevention and diagnosis of ventilator-associated pneumonia: a survey on current practices in Southern Spanish ICUs.

STUDY OBJECTIVES: To assess the implementation of selected ventilator-associated pneumonia (VAP) prevention strategies, and to learn how VAP is diagnosed in the ICUs of Southern Spain. DESIGN: Multicentric survey. SETTING: The ICUs of 32 hospitals of the public health-care system of Southern Spain. PATIENTS OR PARTICIPANTS: Directors of ICUs. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Twenty-eight ICUs (87.5%) returned completed questionnaires. Ventilator circuits were changed every 72 h or longer in 75% of ICUs. Use of heat and moisture exchangers and open endotracheal suction systems were reported in 96% of ICUs. Subglottic secretion drainage was never used, and 57% of ICUs checked endotracheal tube cuff pressure at least daily. Semi-recumbent position was common (93%), and 67.5% of ICUs used frequently noninvasive ventilation. Continuous enteral feeding was reported in all ICUs. Sedative infusions were usually interrupted every day in 11% of ICUs. Seventy-five percent of ICUs had specific guidelines for antibiotic therapy of VAP, but rotation of antibiotics was uncommon (11%). Twenty-nine percent of ICUs diagnosed VAP without microbiological confirmation. The most used technique for microbiologic diagnosis was qualitative culture of endotracheal aspirates (42.8%). The centers with a larger structural complexity reported using VAP therapy guidelines more frequently than the smaller centers, but they did not utilized bronchoscopic techniques for diagnosing VAP. CONCLUSIONS: Common prevention and diagnostic procedures in clinical practice, including large teaching institutions, significantly differed from evidence-based recommendations and reports by research groups of excellence. In addition, our study suggests that clinical practice for preventing and diagnosing VAP is variable and many opportunities exist to improve the care of patients receiving mechanical ventilation.

Critical Care↗

PubMed2004

C-reactive protein used as an early indicator of infection in patients with systemic inflammatory response syndrome.

OBJECTIVE: To assess the diagnostic value of a single determination of serum C-reactive protein as a marker of sepsis in critically ill patients. DESIGN: Prospective, observational study. SETTING: Intensive care unit of a university hospital. PATIENTS AND PARTICIPANTS: One hundred twenty-five adult patients with systemic inflammatory response syndrome (SIRS) (55 patients without evidence of infection and 70 patients with the diagnosis of sepsis confirmed by documented infection). Twenty-five patients with non-complicated acute myocardial infarctions (AMI) and 50 healthy volunteers were used as controls. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Serum C-reactive protein concentration was measured within the first 24 h of SIRS onset. Healthy subjects, AMI and non-infectious SIRS patients showed lower C-reactive protein median values ([(0.21 [95% confidence intervals (95% CI), 0.21-0.4] mg/dl, 2.2 [95% CI, 2.1-4.9] mg/dl and 1.7 [95% CI, 2.4-5.5] mg/dl, respectively) than patients with sepsis (18.9 [95% CI, 17.1-21.8]), p<0.001. The presence of severe sepsis ( r(s)=0.27; p=0.03), SOFA score ( r(s)=0.25; p=0.03) and arterial lactate ( r(s)=0.24; p=0.04) correlated significantly with C-reactive protein concentrations in sepsis cases. The best threshold value for C-reactive protein for predicting sepsis was 8 mg/dl (sensitivity 94.3%, specificity 87.3%). The area under the receiver-operating characteristic curve for C-reactive protein was 0.94 (95% CI, 0.89-0.98). CONCLUSIONS: Determination of serum C-reactive protein can be used as an early indicator of infection in patients with SIRS.

Adolescent↗

PubMed2004

Benefits of minocycline and rifampin-impregnated central venous catheters. A prospective, randomized, double-blind, controlled, multicenter trial.

OBJECTIVE: To determine the efficacy of minocycline and rifampin-impregnated catheters compared to non-impregnated catheters in critically ill patients. DESIGN: Prospective, randomized, double-blind, controlled, multicenter trial. SETTING: Intensive care units of seven acute-care teaching hospitals in Spain. PATIENTS. Intensive care unit patients requiring triple-lumen central venous catheter for more than 3 days. INTERVENTIONS: At catheter insertion, 228 patients were randomized to minocycline and rifampin-impregnated catheters and 237 to non-impregnated catheters. Skin, catheter tip, subcutaneous segment, hub cultures, peripheral blood and infusate cultures were performed at catheter withdrawal. The rate of colonization, catheter-related bloodstream infection (CRBSI) and catheter-related clinical infectious complications (purulence at the insertion site or CRBSI) were assessed. MEASUREMENTS AND MAIN RESULTS: In the intention-to-treat analysis (primary analysis), the episodes per 1000 catheter days of clinical infectious complications decreased from 8.6 to 5.7 (RR =0.67, 95% CI 0.31-1.44), CRBSI from 5.9 to 3.1 (RR =0.53, 95% CI 0.2-1.44) and tip colonization from 24 to 10.4 (RR =0.43, 95% CI 0.26-0.73). Antimicrobial-impregnated catheters were associated with a significant decrease of coagulase-negative staphylococci colonization (RR =0.24, 95% CI 0.13-0.45) and a significant increase of Candida spp. colonization (RR =5.84, 95% CI 1.31-26.1). CONCLUSIONS: The use of antimicrobial-impregnated catheters was associated with a significantly lower rate of coagulase-negative staphylococci colonization and a significant increase in Candida spp. colonization, although a decrease in CRBSI, increase in 30-day survival or reduced length of stay was not observed.

Anti-Bacterial Agents↗

PubMed2004

Laparoscopic virtual reality training: are 30 repetitions enough?

BACKGROUND: Current literature suggests that novices reach a plateau after two to seven trials when training on the MIST VR laparoscopic virtual reality system. We hypothesize that significant benefit may be gained through additional training. MATERIALS AND METHODS: Second-year medical students (n = 12) voluntarily enrolled under an IRB-approved protocol for MIST VR training. All subjects completed pre- and posttraining questionnaires and performed 30 repetitions of 12 tasks. Performance data were automatically recorded for each trial. Learning curves for each task were generated by fitting spline curves to the mean overall scores for each repetition. Scores were assessed for plateaus by repeated measures, slope, and best score. RESULTS: On average, subjects completed training in 7.1 h. (range, 5.9-9.2). Two to seven performance plateaus were identified for each of the 12 MIST VR tasks. Initial plateaus were found for all tasks by the 8th repetition; however, ultimate plateaus were not reached until 21-29 repetitions. Overall best score was reached between 20 and 30 repetitions and occurred beyond the ultimate plateau for 9 tasks. CONCLUSIONS: These data indicate that a lengthy learning curve exists for novices and may be seen throughout 30 repetitions and possibly beyond. Performance plateaus may not reliably determine training endpoints. We conclude that a significant and variable amount of training may be required to achieve maximal benefit. Neither a predetermined training duration nor an arbitrary number of repetitions may be adequate to ensure laparoscopic proficiency following simulator training. Standards which define performance-based endpoints should be established.

Adult↗

PubMed2003

Antiseptic chamber-containing hub reduces central venous catheter-related infection: a prospective, randomized study.

OBJECTIVE: The hub connecting the catheter and the infusion equipment is a common portal of entry for bacteria causing catheter-related sepsis. We assessed the efficacy of a new hub model (Segur-Lock) that incorporates an antiseptic chamber filled with 3% iodinated alcohol in preventing endoluminal catheter contamination and catheter-related bloodstream infection arising at the hub. DESIGN: Prospective, randomized, multicenter study. SETTING: Seven medical and surgical adult intensive care units in Spain. PATIENTS: A total of 230 patients aged 18 yrs or older requiring the insertion of a nontunneled central venous catheter for >or=6 days from January 1, 1998, to April 30, 1999. INTERVENTIONS: Patients were randomized at the time of catheter insertion to receive catheters with standard Luer-lock connector (control group, n = 114) or catheters with the new hub model (n = 116). MEASUREMENTS AND MAIN RESULTS: Skin, catheter tip, and hub cultures were performed at the time the catheter was withdrawn because therapy was terminated or due to suspicion of sepsis, in which case peripheral blood and infusate cultures were simultaneously taken. Catheter-related bloodstream infection was diagnosed in 19 (8.3%) patients. Catheters were more often withdrawn because of suspicion of infection in the control group (43.8%) than in the new hub model group (30.1%, p <.035). The prevalence of culture-positive catheter hubs without associated bacteremia (colonization) was higher in the control group (14.4% vs. 4.3%, p <.001). Catheter-related bloodstream infection from the catheter hub also occurred more frequently in controls than in patients assigned to the new hub model (7% vs. 1.7%; p <.049; relative risk, 4.14; 95% confidence interval, 0.8-19). CONCLUSIONS: This new antiseptic chamber-containing hub has proved to be effective in preventing endoluminal bacterial colonization and catheter-related bloodstream infection from hub contamination in intensive care unit patients with central venous catheters inserted for >or=6 days.

Alcohols↗

PubMedDate not supplied

Laparoscopic marsupialization of a giant posttraumatic splenic cyst.

BACKGROUND AND OBJECTIVE: Nonparasitic cysts are rare clinical lesions of the spleen. Causes include congenital malformations and trauma. Historically, management has entailed partial or total splenectomy using an open approach. Recently, laparoscopic approaches have been developed. In this report, we describe laparoscopic marsupialization of a giant splenic cyst (diameter > 15 cm). METHODS: A 25-year-old African-American man presented with a 9-month history of early satiety, constipation, and left upper quadrant pain. Additionally, he reported blunt trauma to the abdomen 2 years earlier. Physical examination revealed a large, fixed, nontender left upper quadrant mass. Computed tomography scan confirmed a simple cyst within the spleen, measuring 20 x 25 cm. Echinococcus and Entamoeba histolytica serologies were negative. Laparoscopic exploration was performed. Four liters of brown fluid were aspirated and intraoperative cytology confirmed a nonparasitic cyst. The cyst wall was excised and the cavity was packed with omentum. RESULTS: The patient's recovery was uneventful, and he was discharged to home tolerating a regular diet on postoperative day 3. At 6-month follow-up, the patient was asymptomatic and showed no evidence of recurrence. CONCLUSION: Nonparasitic splenic cysts are rare lesions. Laparoscopic marsupialization is safe and effective for giant nonparasitic splenic cysts and should be considered the treatment of choice.

Abdominal Injuries↗