Biomedical subjects

Resad Pasic

Publications and source records attributed to Resad Pasic.

4 recordsLinked to original sources

PubMed2005

Left upper quadrant entry during gynecologic laparoscopy.

The use of the left upper quadrant technique in establishing a pneumoperitoneum during gynecologic laparoscopy was reviewed retrospectively in 267 patients who underwent gynecologic laparoscopy. The study population included all patients presenting to the University of Louisville Hospital outpatient surgery unit for laparoscopic gynecologic surgery from January 1994 to March 2002. Data sheets were prospectively compiled for each patient that included their demographics as well as the intraoperative insufflation technique used and the number of attempts necessary to achieve successful insufflation. All recognized complications associated with establishment of the pneumoperitoneum or insertion of the primary trocar were recorded. The database included 3314 patients of which 267 underwent insufflation via the left upper quadrant technique. Failure to achieve insufflation using this technique occurred in 4 patients (1.5%). There were no bowel or vessel injuries. Puncture of the left lobe of the liver occurred in 3 patients (1.12%). All injuries were managed without laparotomy, and the patients fully recovered without sequelae. The left upper quadrant entry technique is an effective means of establishing a pneumoperitoneum in patients undergoing gynecologic laparoscopic procedures.

Abdominal Wall↗

PubMed2004

Ectopic pregnancy months after laparoscopic supracervical hysterectomy.

Although it is an easy diagnosis to eliminate, pregnancy is rarely considered in a woman with acute abdominopelvic pain and history of hysterectomy. A 37-year-old woman was seen because of acute onset of pelvic pain. Her history was significant for laparoscopic supracervical hysterectomy performed 4 months previously. A urine pregnancy test was positive. At diagnostic laparoscopy, an area in the right tube was consistent with ectopic pregnancy. Bilateral salpingectomy was performed, and pathology confirmed an ectopic pregnancy in the right tube. A diagnosis of ectopic pregnancy should be entertained in any woman with pain and intact ovaries.

Adult↗

PubMedDate not supplied

The use of lightly embalmed (fresh tissue) cadavers for resident laparoscopic training.

STUDY OBJECTIVE: The value of a cadaver training program in laparoscopic surgery has rarely been studied. As there is a dearth of cadaver training programs, it is important to evaluate them. The goal of this study was to estimate if our cadaver training program significantly and relatively rapidly taught residents laparoscopic surgical skills. DESIGN: Observational, timed comparative study (Canadian Task Force classification II-3). SETTING: University of Louisville School of Medicine, Fresh Tissue Laboratory, Louisville, KY. PARTICIPANTS: Twenty-nine obstetric/gynecology residents (15 postgraduate year PGY 2 and 14 PGY 3) participated in the study. INTERVENTION: During 5 half days, we compared the performance of each postgraduate year (PGY) 2 and PGY 3 obstetric/gynecology resident to his or her own results on five outcome skills before and after training in lightly embalmed cadavers. The testing was performed at the beginning and at the end of the week so that all improvement was secondary only to the training experience with the cadaver. Residents were assessed using laparoscopic techniques in a physical-reality simulator for three outcomes: bead transfer time, number of beads transferred, and suturing time on a stuffed vinyl glove and in two specific areas of the cadaver pelvis, with one slightly more difficult than the other. Assessment of suturing time was made on the two distinct tasks using the embalmed cadavers. Although the number of residents was relatively small, it covered two levels for one year. MEASUREMENTS AND MAIN RESULTS: The residents were assessed on a simulator before and after laparoscopic surgical training on the cadaver. The median decrease in bead transfer time (task I, simulator) was 38.5 seconds (p=.02); 69% of the residents showed some reduction in time to complete this task. The median increase in the number of beads transferred (task II, simulator) was 2.5 beads (p=.0001); 72.4% of the residents transferred at least one more bead after training. The median decrease in suture time (task III, simulator) was 63.5 seconds (p=.001); 79.3% of the residents performed this task more quickly after training. The median decrease in suture time (task IV, cadaver) was 54.5 seconds (p=.001); 72.4% of the residents showed improved performance on this task after training. The median reduction in suture time (task V, cadaver) was 53.5 seconds (p<.001); 82.8% of the residents completed this task more quickly after training. CONCLUSIONS: This cadaver surgical training program appeared to significantly improve laparoscopic surgical techniques in PGY 2 and PGY 3 obstetric/gynecology residents in a relatively short time. This model teaches residents specific training in the handling and manipulation of tissue as well as practice in surgical techniques for adnexal surgery, pelvic dissection, laparoscopic hysterectomy, and dissection within the space of Retzius that is not possible with mechanical trainers.

Cadaver↗

PubMedDate not supplied

Comparison of cervical detachment using monopolar lap loop ligature and conventional methods in laparoscopic supracervical hysterectomy.

OBJECTIVES: Our aim was to evaluate a new electrosurgical instrument (Lap Loop device) that amputates the uterine corpus from the cervix during a laparoscopic supracervical hysterectomy (LSH) and to compare the time required for cervical amputation with traditional methods. METHODS: This comparative trial was conducted at the University of Louisville and Norton Healthcare Hospitals, Louisville, KY. The patients comprised 29 women scheduled for hysterectomy for benign conditions. All patients underwent laparoscopic supracervical hysterectomy. The Lap Loop device was used in 17 patients to section the cervix. Conventional methods with either laparoscopic monopolar scissors or Harmonic scalpel were used in 12 patients. RESULTS: In the control group, the mean cervical cutting time with laparoscopic scissors or Harmonic scalpel was 14.4 minutes. The mean time for the application of the loop electrode and cutting time was 6.6 minutes and was significantly shorter than the cutting time of conventional methods. Two minor complications (7.4% of cases) and one relatively major complication (3.7%), an incisional hernia, occurred in the study patients. None of the complications were related to the new device. CONCLUSION: An electrosurgical loop decreased the time required for resection of the uterine cervix during LSH for benign uterine conditions. This device facilitates and increases the safety of this procedure.

Adult↗