Biomedical subjects

S Troxel

Publications and source records attributed to S Troxel.

4 recordsLinked to original sources

PubMed2001

Hand-assisted laparoscopic approach to multiple-organ removal.

BACKGROUND: Over the past decade, laparoscopy has matured to a common, and in some cases, standard surgical approach. Over this time period, many technological advances have contributed to this progression, one of which is hand assistance. Hand-assisted laparoscopy allows a shortened technical learning curve, security and ease in dissection, the ability to remove organs en bloc, and shorter operative times while maintaining the postoperative advantages of laparoscopy. PATIENTS AND METHODS: We present our experience with a hand-assisted laparoscopic approach for two patients requiring bilateral nephrectomy in preparation for renal transplantation and a third patient having concurrent right simple nephrectomy and simple cystectomy for chronic pyocystis. RESULTS: The hand-assisted approach allowed for utilization of one anesthetic, repositioning of the patient without violating the sterile field, and a short convalescent time. The average hospital stay was 5 days, including two patients who required postoperative revascularization of their clotted arteriovenous fistulas. CONCLUSION: The established indications for hand-assisted laparoscopy include removal of large surgical specimens en bloc, anticipated difficult dissection, and failure of standard laparoscopic procedure progression. We propose that removal of multiple organs should be added to this list.

Adult↗

PubMed2000

Laparoscopic surgeries for the bladder.

Various reparative, reconstructive, extirpative, and miscellaneous surgeries of the bladder with laparoscopic techniques are in the process of evolution. Our increasing expertise enhanced by improved instrumentation make these procedures feasible and encourage us to venture into this relatively less explored arena of laparoscopic urology.

Humans↗

PubMed1994

Comparative financial analysis of laparoscopic versus open pelvic lymph node dissection for men with cancer of the prostate.

Laparoscopic pelvic lymph node dissection has been applied as a minimally invasive staging technique for men with prostate cancer. This procedure has been shown to shorten markedly postoperative hospitalization, decrease analgesic requirements and shorten convalescence period compared to open pelvic node dissection. However, the laparoscopic procedure takes longer to perform and many disposable instruments are used, thus increasing the cost. We determine the overall cost of laparoscopic versus open pelvic lymph node dissection. Between January 1989 and April 1992, 61 men underwent only staging pelvic lymph node dissection for cancer of the prostate at a single university teaching hospital. Of these patients 11 and 50 underwent open and laparoscopic pelvic lymph node dissection, respectively. Information from the hospital business office was reorganized into preoperative, intraoperative and postoperative expenses. All individual charges were transformed up or down to the dollar amounts of the 1990 to 1991 fiscal year so as to correct for inflationary changes. Preoperative costs were not significantly different between the 2 operative approaches. Intraoperative expenses were 52% greater if laparoscopic pelvic lymph node dissection was performed and can be explained by the longer operative times and use of disposable instrumentation. However, the postoperative period lasted an average of 1.61 days following laparoscopic pelvic lymph node dissection. Postoperative nursing and analgesic requirements were significantly more for patients undergoing open pelvic lymph node dissection. The overall postoperative costs following open pelvic lymph node dissection were 280% more expensive than for the laparoscopic procedure. The overall total costs were approximately $1,250 more for laparoscopic pelvic lymph node dissection. Wages lost or earned during this period and rapid return to normal activity following laparoscopic pelvic lymph node dissection would, in our opinion, justify this additional cost.

Aged↗

PubMed1991

Treatment of exophthalmos.

Current procedures for Graves' exophthalmos fail to achieve complete correction. The standard orbital decompressions were therefore modified to maximize the degree of volumetric increase behind the axis of the globe. In 15 orbits, the preoperative exophthalmos averaged 9.5 mm, whereas the postoperative exophthalmos was 4.1 mm. Postoperative CT study demonstrated that the remaining posterior orbital wall, combined with the persistently increased intraocular muscle volume, blocked retrodisplacement of the globe, despite adequate total volumetric increase. The increased muscle volume varied from 2 to 5 cc. Despite this residual exophthalmos, the modified four-wall expansion provides excellent aesthetic results with visual improvement and resolution of chemosis and exposure keratitis.

Female↗