PubMed Health⌕ Search

Biomedical subjects

S D Schwaitzberg

Publications and source records attributed to S D Schwaitzberg.

At least 19 recordsLinked to original sources
PubMed2006

The emergence of radiofrequency identification tags: applications in surgery.

Radiofrequency identification (RFID) is a wireless method of automatic identification. Currently, RFID tags are emerging into our environment in many aspects of our lives. Applications are being developed in a variety of fields, including health care. Aspects of surgical care will lend themselves to this approach. This technology could provide large amounts of data that not only carry the promise of improving health care, but also may have an impact on personal aspects of our daily lives. Each of us must become familiar with the risks and benefits of RFID use.

Electronic Data Processing↗
PubMed2005

Comparison of the sensitivity of physical and virtual laparoscopic surgical training simulators to the user's level of experience.

BACKGROUND: The recent focus on quality of care and patient safety has been accompanied by increased interest in standardizing the training for laparoscopic surgeons. Studies have shown that laparoscopic simulators can be used to train surgical skills. Therefore, we designed an experiment to compare the effectiveness of two popular training systems. One system was based on a physical model, whereas the other used a virtual reality model. METHODS: A total of 32 medical students and residents were tested on both simulators. Time required for task completion and number of errors committed were recorded and compared. RESULTS: The physical training system differentiated among experience levels on three of the five tasks when time was used as a measure and four of five tasks when score was used, whereas the virtual reality system yielded statistically significant results in eight of 13 tasks for time and in five of 13 tasks for score. CONCLUSION: The physical model is more sensitive than the virtual reality one in detecting differences in levels of laparoscopic surgical experience.

Computer Simulation↗
PubMed2004

Multimedia presentations in the age of the Health Insurance and Accountability Act.

The privacy rule of the Health Insurance Portability and Accountability Act (HIPAA) has made all physicians think more about their patients' privacy. In addition to safeguarding health information in routine office practice, doctors now are starting to consider the effects of the regulations on other professional activities including professional clinical multimedia presentations. This article explains specifically where and how multimedia (e.g., images, video) patient information may be used and shared. Although HIPAA itself is a lengthy and detailed document, a few simple rules can be extracted, which when followed, ensure that neither presentations nor patient privacy need to be sacrificed.

Confidentiality↗
PubMed2003

Laparoscopic esophagogastric devascularization in bleeding varices.

BACKGROUND: Bleeding from esophageal varices is the major cause of death in patients with portal hypertension. The ideal surgical procedure should effectively control bleeding and maintain liver function with low rates of encephalopathy. Based on this objective, laparoscopic devascularization of the lower esophagus and upper stomach was studied. METHODS: Eighteen patients were studied prospectively who underwent a laparoscopic esophagogastric devascularization procedure for variceal hemorrhage. The diaphragmatic hiatus and esophagus are dissected. The lower 7 or 8 cm of esophagus is devascularized. Devascularization of the gastric fundus is then accomplished by meticulous dissection and ligation of the short gastric vessels. The hepatogastric ligament is opened, permitting identification and isolation/ligation of the left gastric vessels. The dissection and ligation of the vessels at lesser curvature proceeded up to the diaphragmatic hiatus with devascularization of the external varices from the retroperitoneum or mediastinum at the esophagogastric junction. RESULTS: Mean operating room time was 111 min (range, 80-140 min) (6 emergent/12 elective). Mean blood loss 388 ml (range, 150-650 ml). Intensive care unit stay averaged 48 h, with a mean hospitalization of 11 days. Liver function and coagulation parameters remained stable postoperatively. Duplex sonography on the portal and splenic veins revealed patency in all patients. The flow velocity in the portal vein decreased from 15.5 +/- 4.1 to 13.4 +/- 3.5 cm/s postoperatively ( p = 0.021). Splenic vein velocity was unchanged. Bleeding recurred in 6 patients, and grade 1 encephalopathy developed in 1 patient. Follow-up endoscopy (8-24 months) demonstrated substantial reduction in variceal grade. CONCLUSION: Laparoscopic devascularization of the lower esophagus and the upper stomach is technically feasible and promising. Rapid recovery and control of variceal hemorrhage are accomplished in most patients without exposing them to the risk of open surgery.

Adult↗
PubMed2003

A comparison of holding strength of various surgical clips.

Due to advances in clip design, new types of surgical ligation clips are available that may reduce clip failure and improve function, especially for 5-mm clip appliers. We tested a preformed spring clip based on a 5-mm applier against other commonly used clips from 5- and 10-mm multiloading clip appliers. Five different clips were compared using a digital force gauge to test perpendicular pulloff force after application to tubing of varying thickness and compliance. The average pull-off force for commonly used 5-mm and 10-mm clip appliers was 0.29 +/- 0.06 and 0.35 +/- 0.05 kg, respectively. Average pull-off force for the new preformed spring clip was 0.53 +/- 0.07 kg (p <0.0001). The new clip technology has significantly higher pull-off force than other currently used clips. This may be particularly beneficial in procedures requiring 5-mm clip appliers, which are known to place clips with lower holding force.

Equipment Failure↗
PubMed2001

Transballoon trocar insertion during preperitoneal hernia repair.

Trocar insertion during laparoscopic preperitoneal hernia repair (TEP) can be troublesome because the space into which the trocars are inserted is smaller than that available for transabdominal approaches. Insertion of the trocars directly into the balloon used to dissect the preperitoneal space can facilitate this process. The insertion of a 5-mm trocar into the balloon does not usually result in balloon deflation, and a second trocar can be placed into the balloon as well. Removing the balloon, despite the trocars inside it, is straightforward, allowing the placement of a cannula at the balloon insertion site and initiation of the hernia repair.

Hernia, Ventral↗
PubMed2001

Imaging systems in minimally invasive surgery.

The imaging system is the eye of the laparoscopic surgeon. The success or failure of a minimally invasive procedure depends on the quality and working order of the imaging system used. The components that work together to produce an image on the monitor is called the imaging chain. The image displayed will be good as the chain's weakest component. Understanding how the pieces of this process work together will allow the surgeon to troubleshoot basic system problems, leading to improved image displays and safer operating environments. Continuous refinement of laparoscopes, lighting systems, cameras, monitors, and displays lead to an ever-improving operating environment.

Data Display↗
PubMed2000

Comparison of poly-N-acetyl glucosamine (P-GlcNAc) with absorbable collagen (Actifoam), and fibrin sealant (Bolheal) for achieving hemostasis in a swine model of splenic hemorrhage.

OBJECTIVE: To compare the hemostatic capabilities of poly-Nacetylglucosamine (p-GlcNAc) with three currently available products: Actifoam, Surgicel, and Bolheal fibrin glue. This study was conducted in a controlled animal model, with monitoring of hematologic parameters over the course of the study. Two series were conducted, one in unheparinized animals comparing Bolheal fibrin sealant, Actifoam (absorbable collagen, AC), and Surgicel (ORC) with p-GlcNAc, and the second in systemically heparinized animals comparing p-GlcNAc with AC. METHODS: This study was performed in immature female Yorkshire White swine. Splenic lacerations controlled for length and depth of wound were used as sources of bleeding, with one material used per wound to assess hemostatic effectiveness. A total of 97 wounds in 12 animals were created for the study, 74 wounds in unheparinized animals, and 23 wounds in the heparinized animals. In the heparinized animals, hemostatic efficacy was judged by number of applications needed to achieve complete hemostasis. In the unheparinized animals, hemostatic efficacy was judged by length of time required to achieve complete hemostasis (p-GlcNAc vs. fibrin sealant) or the number of applications needed to achieve complete hemostasis (p-GlcNAc vs. AC or ORC). RESULTS: In systemically heparinized animals, p-GlcNAc demonstrated greater hemostatic efficacy (72.7 %) in one application than did the control material (0%), p < 0.01. In the unheparinized animals, p-GlcNAc took less time to achieve hemostasis (mean, 22.9 seconds) than fibrin sealant (mean, 172.9 seconds), p < 0.01. p-GlcNAc achieved hemostasis with a greater efficacy (79.2%) in one application than did the AC or ORC (16.7%), p < 0.01, whereas there was no difference in the efficacy of the control materials. CONCLUSION: The results of the previous series in unheparinized animals demonstrated that p-GlcNAc in the form of a membrane is a more effective topical hemostatic agent than Bolheal fibrin glue, AC or ORC. The results in the anticoagulated animals similarly demonstrate that p-GlcNAc is a more effective topical hemostatic agent than the control material AC. These data indicate that p-GlcNAc is a promising hemostatic agent as evaluated in this model.

Acetylglucosamine↗
PubMed1999

The 3-D monitor and head-mounted display. A quantitative evaluation of advanced laparoscopic viewing technologies.

BACKGROUND: Stereoscopic (3-D) monitors and head-mounted displays have promised to facilitate laparoscopic surgery by increasing positional accuracy and decreasing operative time. To test this hypothesis, we evaluated the performance of subjects using these displays to perform standardized laparoscopic dexterity drills. METHODS: Fifty laparoscopic novices worked within an abdominal cavity simulator using four videoscopic display configurations: (1) standard (2-D) monitor; (2) 3-D monitor; (3) 2-D head-mounted display; and (4) 3-D head-mounted display. Subjects repeated 3 standardized training exercises 2 times. We measured time to complete each drill and number of errors committed. RESULTS: Mean total times to complete all 3 drills were 455, 459, 485, and 449 sec for configurations 1-4, respectively. Mean total errors committed numbered 11.3, 10.4, 12.3, and 10.8, respectively. Neither comparison reached statistical significance (p < 0.05). When 3-D configurations were compared to 2-D configurations overall, a small but statistically significant reduction in errors was noted for 1 drill only (4.3 vs 5.0, p = 0.018). CONCLUSIONS: Three-dimensional imaging slightly reduced the number of errors committed by laparoscopic novices during one test drill; this improvement, however, was not clinically significant. Neither the 3-D monitor nor the head-mounted display decreased task performance time. Widespread adoption of this technology awaits future improvement in display resolution and ease of use.

Clinical Competence↗
PubMed1999

Tack entrapment of the ilioinguinal nerve during laparoscopic hernia repair.

Nerve injury has a reported incidence of 2% during laparoscopic hernia repair. These injuries usually involve the femoral branch of the genitofemoral nerve and the lateral cutaneous nerve of the thigh. Recently, in an effort to decrease the size of the port sites, surgeons have been using 5-mm tacking devices. These devices penetrate tissue more deeply and in so doing may injure nerves not classically at risk, such as the ilioinguinal and the iliohypogastric. We report the first documented injury to the ilioinguinal nerve during laparoscopic hernia repair. In addition, we review the anatomy and technique in an effort to help avoid this complication in the future.

Adult↗
PubMed1999

A pilot study evaluating the efficacy of a fully acetylated poly-N-acetyl glucosamine membrane formulation as a topical hemostatic agent.

BACKGROUND: Topical hemostatic agents are frequently needed for control of intraoperative bleeding. Currently available topical products each have potential drawbacks, making a more effective topical hemostatic agent desirable. This study was performed to evaluate the effectiveness of a particular formulation of a newly available polysaccharide polymer, poly-N-acetyl glucosamine (p-GlcNAc), as a topical hemostatic agent for use in the operating room. Swine splenic incision and splenic capsular stripping hemorrhage models were initially used, with a subsequent pilot human study then performed. METHODS: For the swine splenic incision model, anesthetized immature female Yorkshire white swine had a 3 x 8 mm incision created on the spleen. One of 3 agents (p-GlcNAc membrane, oxidized cellulose, or absorbable collagen) was sequentially applied to individual wounds and digitally compressed for 20 seconds. The wound was observed without pressure for 2 minutes. Up to 8 wounds per animal were created in 7 animals. For the swine splenic capsular stripping model a 2 x 2 cm area of capsular stripping on the surface of the spleen to a depth of 3 mm was created. Either p-GlcNAc membrane or oxidized cellulose was applied and digitally compressed for 60 seconds, followed by observation without pressure for 2 minutes. Six wounds per animal were created in 2 animals. If bleeding persisted in either model, a new cycle of compression was applied. These steps were repeated until hemostasis was achieved. No change in hemodynamics or coagulation factors was observed in either model. Subsequently, 10 consecutive patients undergoing elective small-bowel surgery were enrolled on pilot study. A 5 x 3 x 3 mm cruciate incision was created midway between the mesenteric and antimesenteric borders of the small bowel. Either p-GlcNAc membrane formulation or oxidized cellulose was applied (the sequence alternated per patient) with a 400-mg weight used for even, direct pressure. A second cruciate incision was then created on the contralateral side of the bowel to evaluate the second material. The number of applications required for hemostasis was assessed. Hemodynamics, small-bowel pathologic condition, and hematologic parameters were evaluated. RESULTS: The p-GlcNAc membrane required fewer cycles of compression in the swine splenic incision model to achieve hemostasis than either absorbable collagen or oxidized cellulose (1.25 vs 2.58 and 3.41, respectively; P < .01) and caused more effective immediate cessation of bleeding (79% for p-GlcNAc vs 17% for both absorbable collagen and oxidized cellulose). With the more traumatic splenic capsular stripping model, p-GlcNAc required fewer cycles of compression to achieve hemostasis than oxidized cellulose (average, 2.5 versus 6.8 respectively; P < .01) and was able to achieve hemostasis with greater efficacy (50%) in 2 applications than did oxidized cellulose (0%; P < .01). When used in the human pilot study, p-GlcNAc membranes required fewer cycles of compression than oxidized cellulose (2.5 vs 5.4, respectively; P < .002), was able to stop bleeding with greater efficacy in 1 cycle of compression (50% vs 0%, respectively; P < .01), and ultimately accomplished hemostasis in 80% of the cases as opposed to 20%. CONCLUSIONS: On the basis of its greater hemostatic efficacy as compared with collagen or oxidized cellulose-based products, p-GlcNAc holds promise as an effective topical hemostatic agent and deserves further evaluation.

Acetylation↗
PubMed1998

Microwave applications in clinical medicine.

Over the last fifty years, energy has been applied to various human tissues for both the diagnosis and therapy of numerous diseases. However, in general, the medical community remains uninformed about the many potential applications of this energy source. We review the many areas in which microwave energy has shown clinical utility.

Adult↗
PubMed1998

Liver hematoma and rupture in pregnancy.

Liver hematoma and rupture is a rare but devastating complication of pregnancy. The majority of cases have been associated with severe preeclampsia, but unlike typical preeclampsia, it is a disease of older, multiparous patients. Although there are predictable findings on liver pathology, the underlying pathophysiology is poorly understood. Early recognition and prompt surgical intervention are crucial to reduce the high fetal and maternal mortality rate associated with this disease.

Female↗
PubMed1998

Comparison of coagulation modalities in surgery.

The increase in laparoscopic surgery has resulted in an increased need for a safe and reliable method of obtaining minimally invasive operative hemostasis. Because the traditional "open" methods of controlling bleeding (pressure, tying, and suture ligating) are not as easily applied in the laparoscopic arena, a heavy reliance on forms of tissue and vessel coagulation is necessary. To better assess these forms, we compare monopolar, bipolar, and ultrasound energy, in addition to laser energy used in a novel application. In the first part, 20 rabbit mesenteric arteries that measured 1 to 1.5 mm in diameter were coagulated using each of the technologies. We measured the time to coagulation, the efficacy of hemostasis, lateral tissue damage, and local tissue temperature of the vessels when exposed. Part 2 consisted of a survival study using 12 New Zealand white rabbits. In each of these two groups splenectomies were performed. A laser-heated forceps was compared to a monopolar electrosurgery device for the speed of the operation, blood loss, and adhesion grade at necrosectomy. In addition, the speed to cauterization of the iliac vessels and the amount of tissue damage was measured. These vessels were also examined for the extent of microscopic damage. Bipolar electrosurgery was much slower than the other modalities, while monopolar electrosurgery caused significantly more tissue damage and elevation in lateral tissue temperature. The ultrasound technology and the laser-heated forceps were equally safe and efficacious instruments. There was no significant difference in the ability of the laser-heated forceps or the monopolar cautery to perform the splenectomy safely. However, the forceps cauterized the iliac vessels faster and with less lateral thermal injury than the ultrasound device. Although each instrument has its place in the surgical armamentarium, the ultrasound technology appears to be the safest and most efficacious commercially available device for obtaining hemostasis. The laser, as it is applied in this setting, was also highly effective, but still a prototype device.

Animals↗