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Biomedical subjects

Steven D Schwaitzberg

Publications and source records attributed to Steven D Schwaitzberg.

9 recordsLinked to original sources
PubMed2006

Effects of cognitive distraction on performance of laparoscopic surgical tasks.

HYPOTHESIS: To quantify the effects of cognitive distraction on surgical task performance in residents and medical students using a laparoscopic surgical simulator. DESIGN: Within-subjects design. SETTING: A surgical skills laboratory. PARTICIPANTS: Thirteen surgical residents and medical students who volunteered for the study. METHODS AND MATERIALS: Subjects performed six tasks on the Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR), under two different conditions (distracted and undistracted). Task order remained the same for all subjects, but the order of distraction was counterbalanced. In the distracted condition, distractions consisted of mental arithmetic problems posed sequentially so that subjects were continually distracted. MAIN OUTCOME MEASURES: Time to task completion, surgical errors committed, economy of motion, and overall performance scores were generated by the MIST-VR program software. Arithmetic error was not a factor in the overall performance score. RESULTS: Time to task completion was significantly greater when subjects were distracted for all six tasks performed. Overall score and economy of motion were negatively affected by distraction but the effect did not reach th level of statistical significance. There was no effect of distract on surgical errors. CONCLUSION: Cognitive distraction appears to negatively influence the performance of laparoscopic surgical tasks by increasing task completion time. Further study is required to determine what the effects would be on experienced surgeons and actual surgical outcomes.

Analysis of Variance↗
PubMed2005

Utility of a voice-activated system in minimally invasive surgery.

BACKGROUND: Advances in computer enhancements for surgery, including a voice-activated control system for minimally invasive surgery, are being introduced into clinical practice. Few reports have objectively evaluated the utility of the voice-activated control system. The aim of this study was to evaluate the utility of a voice-activated control system for delivery of commands to specific operating room (OR) equipment. MATERIALS AND METHODS: We evaluated a total of 30 laparoscopic procedures: 15 laparoscopic hernia repairs, 10 laparoscopic cholecystectomies, and 5 laparoscopic fundoplications performed with the HERMEStrade mark Operating Room Control Center (Computer Motion, Santa Barbara, California) voice-activated control system. When the voice command (VC) to the HERMES system was given, the circulating nurse was observed and her location was recorded. The 3 locations were A, the nurse was immediately available in the OR, not engaged in any other tasks; B, the nurse was in the OR but engaged in other tasks; or C, the nurse was outside the OR. RESULTS: The 30 cases were performed by the same surgeon and completed laparoscopically. For 170 VCs for gas insufflation, the location of the circulating nurse was: A=50, B=98, and C=22. For 135 light source adjustments, the locations were A=34, B=82, and C=19. In 76 white balance VCs: A=16, B=51, and C=9. In 128 VCs for camera adjustment: A=27, B=77, and C=24. Eight video capture VCs: A=1, B=3, and C=4. For 69 image capture VCs: A=5, B=41, and C=23. The total number of VCs was 586: A=133 (22.7%), B=352 (60%), and C=101(17.3%). All VCs were accurately interpreted by the HERMES system. CONCLUSION: Voice-activated control systems improve communication with and efficiency of OR staff. The surgeon is afforded the most timely equipment adjustment possible. Circulating nurses are allowed to concentrate on patient care instead of equipment adjustment during the course of the surgery.

Humans↗
PubMed2004

Comparison of poly-N-acetyl glucosamine with commercially available topical hemostats for achieving hemostasis in coagulopathic models of splenic hemorrhage.

BACKGROUND: The hemostatic quality of the poly-N-acetyl glucosamine (p-GlcNAc) patch was compared with a fibrin sealant, fibrin bandage, and cellulose patch. METHODS: A 2 x 2-cm capsular strip to a depth of 3 mm of the swine spleen was used as a source of bleeding. Splenic lacerations were created in hemophilia B dogs and treated with p-GlcNAc and Surgicel. Wounds were created in rabbits and treated with p-GlcNAc at 37degreesC and after keeping body core temperature at 29degreesC. RESULTS: Poly-N-acetyl glucosamine was able to achieve hemostasis with greater efficacy than either of the fibrin-based bandages. In the hemophilia B dog study, p-GlcNAc significantly outperformed Surgicel, with p-GlcNAc achieving hemostasis in 75% of the treated wounds compared with 17% for the cellulose patch. The hypothermia study demonstrated that p-GlcNAc is equally effective at 29degreesC and at 37degreesC. CONCLUSION: Poly-N-acetyl glucosamine was effective at controlling bleeding in animals with experimentally induced or genetic coagulopathic disorders.

Acetylglucosamine↗
PubMed2003

Hypertensive crisis inducing rhabdomyolysis during laparoscopic resection of a large pheochromocytoma: a case report.

Intense vasospasm during hypertensive crisis as a cause for rhabdomyolysis has been described in ambulatory patients with pheochromocytoma. We report this phenomenon as an intraoperative complication in a patient during laparoscopic pheochromocytoma resection and discuss patient and procedure related risk factors. Unexplained intraoperative hyperkalemia following a severe hypertensive episode during surgery may be a first sign of rhabdomyolysis. Anesthesiologists should be aware of such a possibility. Intra- and postoperative serial electrolyte determinations and if suspected, timely screening for myoglobiuria, may aid in early detection and treatment of intraoperative rhabdomyolysis during pheochromocytoma resections.

Adrenal Gland Neoplasms↗
PubMed2003

An extrahepatic biliary anomaly.

Several variations in intrahepatic and extrahepatic accessory biliary ducts have been reported in the past. An accessory extrahepatic biliary duct connecting the lateral segment of the left lobe to the medial segment of the left lobe is described. A review of the literature reveals that this anomaly has rarely been reported in the past. Knowledge of such anomalies is critical in the prevention of iatrogenic injuries during surgery.

Aged↗
PubMed2003

Laparoscopic devascularization of the lower esophagus and upper stomach: experimental study in the pig.

BACKGROUND: Esophagogastric devascularization is an alternative treatment for bleeding gastroesophageal varices. The aim of this experimental study was to develop an approach for laparoscopic devascularization of the lower esophagus and upper stomach. MATERIALS AND METHODS: We used six swine pigs weighing 25 to 25 kg. With the use of five trocars, the steps of the procedure are as follows: (1). dissection of the gastroesophageal junction and mobilization of the esophagus; (2). encircling the abdominal esophagus with umbilical tape; (3). devascularization of the fundus and upper two thirds of the greater curvature of the stomach; and (4). identification and ligation of the left gastric vessels and devascularization of the lesser curvature of the stomach. RESULTS: The mean operative time was 100 minutes (80-120 minutes), and the mean blood loss was 60 mL (40-80 mL). All procedures were completed laparoscopically. CONCLUSION: Laparoscopic devascularization of the lower esophagus and upper stomach is a technically feasible procedure.

Animals↗
PubMed2002

Diagnostic laparoscopy.

Diagnostic laparoscopy is a powerful tool in the surgeon's armamentarium when used appropriately. There is a low complication rate and high diagnostic sensitivity. In addition to conventional operating room procedures, this technique can be applied in a variety of other settings, often without general anesthesia. Many patients can be spared invasive nontherapeutic laparotomies particularly in the area of trauma and cancer diagnosis. The surgeon must become a superior visual anatomist in order to be able to take maximum advantage of this technique.

Abdomen↗