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PubMed1999

[Dorso-posterior extraperitoneal pelviscopy (DEP). From experiment to initial clinical application].

BACKGROUND: Dorsoposterior and/or perineal access to pelvic connective tissue spaces has lost its importance due to improved transabdominal techniques. Because of the development of minimally invasive surgery towards "soft-tissue endoscopy" we were interested in whether the video-assisted technique could give new impetus to the perineal approach. Successful experiments on corpses were followed by the first clinical application. METHODS: After the dilation of the retrorectal, rectovaginal and rectoprostatical spaces with a dissecting balloon, pneumoextraperitoneum was established and all extraperitoneal structures of the pelvis could be dissected. RESULTS: In the experimental and in the clinical situation the spaces could be perfectly surveyed. EXPERIMENTALLY: Complete, circular preparation of the rectum was achieved. Parts of the bladder, vagina and prostate were visualized ventrally. Laterally both ureters and the paraproctal and iliacal vessels could be dissected. In the clinical application the retrorectal space could be dilated without problems and it could be rinsed and drained. Postoperatively no complications were recorded. The patient could be discharged on the 17th postoperative day. CONCLUSION: The described method is suitable for clinical use. Besides the described indication, further surgical applications exists.

Diverticulitis, Colonic↗
PubMed2003

A lay person versus a trained endoscopist: can the preop endoscopy simulator detect a difference?

The purpose of this study was to establish construct validation of a flexible sigmoidoscopy simulator by comparing training-level grouped subjects. These included clerical staff (n = 10), residents (n = 19), and experts (n = 5). Each participant performed 3 scopes. The ANOVA group-based results for trainer-measured variables are shown in Table 1. These results demonstrate that the flexible sigmoidoscopy simulator distinguished the trained from the untrained and the resident from the expert. Although there was no statistically significant differences between the senior residents and the experts, the expert commonly outperformed the residents. Establishing the transferability of simulator training to real life is next. If the transfer of skill can be established, it may give rise to a new skills training approach.

Administrative Personnel↗
PubMed1997

Flexible sigmoidoscopy. A reliable determinant of colonic ischemia following ruptured abdominal aortic aneurysm.

BACKGROUND: The development of colonic ischemia following repair of ruptured abdominal aortic aneurysm (AAA) is associated with significant morbidity and timely diagnosis is essential. The purpose of this study was to determine the efficacy of endoscopy in the diagnosis of colonic ischemia and in prediction of need for resection. METHODS: Patients who underwent postoperative lower endoscopy after ruptured AAA from 1986 to 1995 were reviewed for endoscopic findings, clinical course, and patient outcome. RESULTS: A total of 80 patients had ruptured AAA during the study period, of which 56 survived for longer than 24 h postoperatively. Flexible lower endoscopy was done in 18 patients (32%) on an average of 4.4 days following AAA repair (range 1-16). Indications for initial endoscopy included early or bloody stools in 12 (67%), hemodynamic instability or sepsis in eight (44%), and acidosis in four (22%). The extent of the examination was sigmoid or descending colon in 13, cecum in four, and transverse colon in one. Endoscopic findings were normal in four patients. Five examinations showed only areas of hemorrhagic mucosa. Absence of full-thickness ischemia was confirmed by clinical course or autopsy in these nine patients. Two examinations demonstrated full-thickness necrosis which was confirmed at subsequent laparotomy. In six examinations, ischemia was noted but judged to be limited to mucosa only. Absence of full-thickness disease was demonstrated by laparotomy in three and subsequent course in three. Eight patients (57%) with initial abnormal examinations underwent repeat endoscopy showing improved interval appearance in seven cases and progression to full-thickness ischemia in one patient. CONCLUSIONS: Flexible sigmoidoscopy reliably predicts full-thickness colonic ischemia following repair of ruptured aortic aneurysms. Patients with non-confluent ischemia limited to the mucosa can be safely followed by serial endoscopic examinations.

Aged↗
PubMed1987

Cecal perforation following fiberoptic flexible sigmoidoscopy.

The superiority of flexible to rigid sigmoidoscopy is resulting in its increasing utilization by primary care physicians. The procedure is relatively risk-free, but complications including perforations may occur. An unusual case of cecal perforation as a result of flexible sigmoidoscopy is presented in order to draw attention to this complication.

Cecum↗
PubMed1975

An inexpensive laparoscopy system for female sterilization.

Laparoscopy has become an established procedure for female sterilization. The cost of the equipment remains excessively high, thereby reducing its availability to all physicians and patients who desire and need it. We have described an inexpensive--but highly effective--female sterilization system utilizing equipment that should cost in the range of $400.00.

Adult↗
PubMed2006

Barriers to colorectal cancer screening among Medicare consumers.

BACKGROUND: Few studies have examined lack of physician recommendation and other reasons for under-utilization of colorectal cancer (CRC) screening in the Medicare population. METHODS: Data from a telephone survey conducted in 2001 in a random sample of Medicare consumers residing in North and South Carolina were used to examine barriers to CRC screening, focusing on consumers' reports of receiving a physician's recommendation to obtain CRC screening and reasons for not being screened. Analyses were restricted to respondents with no history of CRC (n = 1901). Descriptive statistics were used to characterize respondents' CRC screening status, receipt of a physician's recommendation for screening, and reasons for not being screened. Logistic regression modeling was used to examine factors associated with receiving a physician recommendation for fecal occult blood test, sigmoidoscopy, colonoscopy, any endoscopy, and any CRC test. RESULTS: Thirty-one percent of Medicare consumers had never been tested for CRC, and 18% had been tested but were not current with Medicare-covered intervals. Overall, 28% reported not receiving a physician recommendation for screening. Predictors of receiving a physician recommendation included sociodemographic (younger age, white race, more education), health status (increased CRC risk, comorbidity), and healthcare access (had a routine/preventive care visit in the past 12 months) factors. Lack of knowledge/awareness and the physician not ordering the test were commonly cited reasons for not having CRC tests. CONCLUSIONS: Colorectal cancer screening was under-utilized by Medicare consumers in two states, and lack of physician recommendation was an important contributing factor. Providing a benefit under the Medicare program does not ensure its widespread use by consumers or their physicians.

Aged↗
PubMed2004

Acceptance of flexible sigmoidoscopy screening for colorectal cancer.

This study was conducted in the Kaiser Permanente Medical Care Program of Northern California to identify patient characteristics that explain interest in flexible sigmoidoscopy (FS) screening. A mailed screening invitation to 6837 age-eligible patients elicited responses from 49%. Efforts to reach and interview both eligible respondents and non-respondents resulted in 2728 computer-assisted telephone interviews (CATI), with 60% indicating interest in FS screening. Five components of the Integrated Behavioral Model were measured with respect to FS screening: attitude, affect, social influence, facilitators/barriers, and perceived risk of colorectal cancer. All five model components were significantly and independently associated with interest in FS, with patient attitude being the strongest predictor. Of the 32 items comprising the model components, nine items having the highest correlations with FS interest were identified as potentially important issues to address by efforts to increase interest in screening. Six of these were attitudinal beliefs. The findings from this theory-driven study provide specific targets for the design of interventions to increase FS interest and screening rates.

Adult↗
PubMed2004

Factors associated with colorectal cancer screening among Chinese-Americans.

OBJECTIVE: To investigate factors associated with receipt of colorectal cancer (CRC) screening among urban senior Chinese-Americans. METHODS: Two hundred three men and women from three senior centers completed a questionnaire that included sections on demographics, fecal occult blood testing (FOBT) and sigmoidoscopy use, and potential barriers to screening. RESULTS: Receipt of a FOBT within the prior 12 months (37.9% of sample) was associated with fewer years of US residency, lower level of worries or fears of test results, and higher level of perceived susceptibility to CRC. Receipt of a flexible sigmoidoscopy within the past 5 years (22.2% of sample) was associated with higher levels of education, lower levels of worries or fears of test results, and higher level of perceived susceptibility of CRC. CONCLUSIONS: Intervention programs may target these areas to facilitate CRC screening in Chinese-Americans so that national goals can be met for all Americans.

Aged↗
PubMed2001

Achieving quality in flexible sigmoidoscopy screening for colorectal cancer.

BACKGROUND: Sigmoidoscopy screening, which can dramatically reduce colorectal cancer mortality, is supported increasingly by physicians and payers, and is likely to be performed more frequently in the future. As more physicians and nonphysician medical personnel learn how to perform this procedure, and with attention to quality standards, the overall impact of sigmoidoscopy screening may improve. This review describes elements that characterize high-quality examinations and identifies resources for in-depth information on performing flexible sigmoidoscopy. METHODS: The domains of quality were identified from textbooks, articles, and the professional opinions of gastroenterologists and primary care physicians. Information was obtained from MEDLINE, bibliographies in recent articles, medical professional organizations, equipment manufacturers' representatives, and focus groups of primary care physicians. RESULTS: Nine domains of quality are identified and discussed: training, logistical start-up, patient interaction, bowel preparation, examination technique, lesion recognition, complications, reporting, and processing (equipment cleaning and disinfection). CONCLUSIONS: Persons learning how to perform and to implement flexible sigmoidoscopy may use this information to help ensure the quality of screening examinations.

Colorectal Neoplasms↗