PubMed Health⌕ Search

Biomedical subjects

Timothy D Averch

Publications and source records attributed to Timothy D Averch.

7 recordsLinked to original sources
PubMed2006

Renal pseudoaneurysm following percutaneous nephrolithotomy.

Percutaneous renal surgery can be utilized as treatment for a variety of urologic conditions. Percutaneous nephrolithotomy remains the treatment of choice for many large and complex renal calculi. Despite having a low overall complication rate, postoperative bleeding can occur. We report a case of significant hemorrhage from a renal pseudoaneurysm in a patient requiring anticoagulation following percutaneous nephrolithotomy. The bleeding was controlled by percutaneous coil embolization. Current management recommendations of postoperative hemorrhage following percutaneous renal surgery are reviewed.

Aneurysm, False↗
PubMed2005

Can video games be used to predict or improve laparoscopic skills?

BACKGROUND AND PURPOSE: Performance of laparoscopic surgery requires adequate hand-eye coordination. Video games are an effective way to judge one's hand-eye coordination, and practicing these games may improve one's skills. Our goal was to see if there is a correlation between skill in video games and skill in laparoscopy. Also, we hoped to demonstrate that practicing video games can improve one's laparoscopic skills. SUBJECTS AND METHODS: Eleven medical students (nine male, two female) volunteered to participate. On day 1, each student played three commercially available video games (Top Spin, XSN Sports; Project Gotham Racing 2, Bizarre Creations; and Amped 2, XSN Sports) for 30 minutes on an X-box (Microsoft, Seattle, WA) and was judged both objectively and subjectively. Next, the students performed four laparoscopic tasks (object transfer, tracing a figure-of-eight, suture placement, and knot-tying) in a swine model and were assessed for time to complete the task, number of errors committed, and hand-eye coordination. The students were then randomized to control (group A) or "training" (i.e., video game practicing; group B) arms. Two weeks later, all students repeated the laparoscopic skills laboratory and were reassessed. RESULTS: Spearman correlation coefficients demonstrated a significant relation between many of the parameters, particularly time to complete each task and hand-eye coordination at the different games. There was a weaker association between video game performance and both laparoscopic errors committed and hand-eye coordination. Group B subjects did not improve significantly over those in group A in any measure (P >0.05 for all). CONCLUSION: Video game aptitude appears to predict the level of laparoscopic skill in the novice surgeon. In this study, practicing video games did not improve one's laparoscopic skill significantly, but a larger study with more practice time could prove games to be helpful.

Adult↗
PubMed2005

Prospective, randomized trial comparing shock wave lithotripsy and ureteroscopy for lower pole caliceal calculi 1 cm or less.

PURPOSE: The optimal management of lower pole renal calculi is controversial. We compared shock wave lithotripsy (SWL) and ureteroscopy (URS) for the treatment of patients with small lower pole stones in a prospective, randomized, multicenter trial. MATERIALS AND METHODS: A total of 78 patients with 1 cm or less isolated lower pole stones were randomized to SWL or URS. The primary outcome measure was stone-free rate on noncontrast computerized tomography at 3 months. Secondary outcome parameters were length of stay, complication rates, need for secondary procedures and patient derived quality of life measures. RESULTS: A total of 67 patients randomized to SWL (32) or URS (35) completed treatment. The 2 groups were comparable with respect to age, sex, body mass index, side treated and stone surface area. Operative time was significantly shorter for SWL than URS (66 vs 90 minutes). At 3 months of followup 26 and 32 patients who underwent SWL and URS had radiographic followup that demonstrated a stone-free rate of 35% and 50%, respectively (p not significant). Intraoperative complications occurred in 1 SWL case (unable to target stone) and in 7 URS cases (failed access in 5 and perforation in 2), while postoperative complications occurred in 7 SWL and 7 URS cases. Patient derived quality of life measures favored SWL. CONCLUSIONS: This study failed to demonstrate a statistically significant difference in stone-free rates between SWL and URS for the treatment of small lower pole renal calculi. However, SWL was associated with greater patient acceptance and shorter convalescence.

Adult↗
PubMed2004

Ancillary instrumentation for ureteroscopy.

As the quality of ureteroscopy continues to improve, ancillary instrumentation will advance. The endourologist now has a vast supply of specially designed guidewires, stents, balloons, and baskets. These technologies have expanded the realm of cases that may be managed endoscopically. As the urologist becomes more familiar with the options at his or her disposal, patient care will improve.

Equipment Design↗
PubMed2004

Holmium laser percutaneous nephrolithotomy using a unique suction device.

BACKGROUND AND PURPOSE: Most percutaneous nephrolithotomies are performed with electrohydraulic, ballistic, or ultrasonic lithotripsy, with holmium laser use reserved for ureteroscopy or ureterorenoscopy. We evaluated the feasibility of holmium laser use in percutaneous nephrolithotomy with the assistance of a unique suction device. PATIENTS AND METHODS: The charts of 71 consecutive patients undergoing 90 percutaneous procedures were reviewed. A unique suction device and the holmium laser were used in nearly half the patients. The average stone burden was 3.25 cm. Use of holmium laser, energy settings, stone burden, operative time, complications, and stone-free rate were evaluated. RESULTS: The average operative time was 167 minutes with a complication rate of 14%. A stone-free rate of 83% was achieved with the laser. CONCLUSIONS: With the assistance of a unique suction device, the holmium laser can, in the appropriate situation, be an efficient and successful lithotrite with percutaneous nephrolithotomy.

Humans↗
PubMed2004

15-year experience with the management of extrinsic ureteral obstruction with indwelling ureteral stents.

PURPOSE: We assessed the success of retrograde placement of indwelling ureteral stents in the management of ureteral obstruction due to extrinsic compression. MATERIALS AND METHODS: Between July 1987 and December 2002 adequate followup was available for 101 patients who underwent primary retrograde ureteral stenting for extrinsic ureteral obstruction. Mean age at presentation was 61.4 years (range 33 to 90). Chart review was performed on all patients for primary diagnosis, symptomatology, degree of hydronephrosis, creatinine levels (baseline, treatment and posttreatment), location of compression, size and number of stents used, progression to percutaneous nephrostomy tube (PNT), stent failure, days to stent failure, post-stent therapy and status at last followup. RESULTS: Mean length of followup was 11 months (range 1 to 127). In 101 patients 138 ureteral units (UU) were stented. Total stent failure occurred in 41 (40.6%) patients and 58 (42.0%) UU. A total of 40 (29.0%) UU required PNTs at a mean of 40.3 days (range 0 to 330) with 18 PNTs placed in less than 1 week. Cases of stent failure that did not undergo PNT placement included 18 (13.0%) UU at a mean of 52.4 days (range 3 to 128). A total of 90 (89.1%) patients had metastatic cancer at stenting with 32.2% dead at 5.8 months (range 1 to 32). Univariate and multivariate analyses identified cancer diagnosis, baseline creatinine greater than 1.3 mg/dl and post-stent systemic treatment as predictors of stent failure. Proximal location of compression and treatment creatinine greater than 3.11 mg/dl were marginal predictors of failure on univariate analysis, while proximal location of obstruction was also marginally significant on multivariate analysis. No predictors were identified for early stent failure (less than 1 week). CONCLUSIONS: At almost 1 year followup stent failure due to extrinsic compression occurred in nearly half of treated patients. Analysis of data revealed a diagnosis of cancer, baseline mild renal insufficiency and metastatic disease requiring chemotherapy or radiation as predictors of stent failure. Managing extrinsic compression by retrograde stenting continues to be a practical but guarded decision and should be tailored to each patient.

Adult↗