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Bittner JG, Baghai M, Jacob BP. Management of a primary ventral incisional hernia: a survey of the International Hernia Collaboration. J Robot Surg 2019; 14:95-99. [PMID: 30830569 DOI: 10.1007/s11701-019-00940-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 02/25/2019] [Indexed: 11/27/2022]
Abstract
A social media group, the International Hernia Collaboration (IHC), facilitates professional development among surgeons interested in hernia disease. The purpose of this study was to assess practice pattern differences among IHC surgeon members regarding a ventral incisional hernia (VIH) scenario. A single multiple-choice question, posted for 1 month on the IHC, assessed which operation was preferred for a healthy patient with a symptomatic, reducible primary VIH (5 × 6 cm). Responses were compared by surgeon practice location (US vs. World). In total, 371 IHC surgeons completed the survey. More respondents practicing in the US completed the survey (57.1% vs. 42.9%, P < 0.01). Respondents in the US cohort would select a robotic-assisted approach more frequently than World colleagues (47.6% vs. 8.8%, P < 0.01). More IHC surgeons in the US cohort would offer a robotic-assisted approach for primary VIH repair compared to World colleagues. Studies are warranted to investigate practice pattern differences related to VIH repair.
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Affiliation(s)
- James G Bittner
- Department of Surgery, St. Francis Hospital and Medical Center, 114 Woodland Street, Hartford, CT, 06105, USA.
| | - Mercedeh Baghai
- Department of Surgery, Torrence Memorial Medical Center, Torrence, CA, USA
| | - Brian P Jacob
- Department of Surgery, Mount Sinai Health System, New York, NY, USA
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Bittner JG, Logghe HJ, Kane ED, Goldberg RF, Alseidi A, Aggarwal R, Jacob BP. A Society of Gastrointestinal and Endoscopic Surgeons (SAGES) statement on closed social media (Facebook®) groups for clinical education and consultation: issues of informed consent, patient privacy, and surgeon protection. Surg Endosc 2019; 33:1-7. [PMID: 30421077 DOI: 10.1007/s00464-018-6569-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 10/26/2018] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Closed social media groups (CSMG), including closed Facebook® groups, are online communities providing physicians with platforms to collaborate privately via text, images, videos, and live streaming in real time and optimize patient care. CSMG platforms represent a novel paradigm in online learning and education, so it is imperative to ensure that the public and patients trust the physicians using these platforms. Informed consent is an essential aspect of establishing this trust. With the launch of several of its own CSMG, Society of Gastrointestinal and Endoscopic Surgeons (SAGES) sought to define its position on CSMG platforms and provide an informed consent template for educating and protecting patients, surgeons, and institutions. METHODS A review of the literature (2012-2018) discussing the informed consent process for posting clinical scenarios, photography, and/or videography on social media was performed. Pertinent articles and exemplary legal counsel-approved CSMG policies and informed consent forms were reviewed by members of the SAGES Facebook® Task Force. RESULTS Eleven articles and two institutional CSMG policies discussing key components of the informed consent process, including patient transparency and confidentiality, provider-patient partnerships, ethics, and education were included. Using this information and expert opinion, a SAGES-approved statement and informed consent template were formulated. CONCLUSIONS SAGES endorses the professional use of medical and surgical CSMG platforms for education, patient care optimization, and dissemination of clinical information. Despite the growing use of social media as an integral tool for surgical practice and education, issues of informed consent still exist and remain the responsibility of the physician contributor. Responsible, ethical, and compliant use of CSMG platforms is essential. Surgeons and patients embracing CSMG for quality improvement and optimized outcomes should be legally protected. SAGES foresees the use of this type of platform continuing to grow.
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Affiliation(s)
- James G Bittner
- Department of Surgery, St. Francis Hospital and Medical Center, Hartford, CT, USA
| | - Heather J Logghe
- Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Erica D Kane
- Department of Anesthesia, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ross F Goldberg
- Department of Surgery, Maricopa Integrated Health System, Phoenix, AZ, USA
| | - Adnan Alseidi
- Department of Surgery, Virginia Mason Medical Center, Seattle, WA, USA
| | - Rajesh Aggarwal
- Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University Hospitals, Philadelphia, PA, USA.,Jefferson Strategic Ventures, Jefferson Health, Philadelphia, PA, USA
| | - Brian P Jacob
- Laparoscopic Surgical Center of New York, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Jones DB, Stefanidis D, Korndorffer JR, Dimick JB, Jacob BP, Schultz L, Scott DJ. Erratum to: SAGES University MASTERS Program: a structured curriculum for deliberate, lifelong learning. Surg Endosc 2017; 31:4863. [PMID: 28799074 DOI: 10.1007/s00464-017-5825-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Daniel B Jones
- Department of Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA.
| | - Dimitrios Stefanidis
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - James R Korndorffer
- Department of Surgery, Tulane University Health Sciences Center, New Orleans, LA, USA
| | - Justin B Dimick
- Department of Surgery, University of Michigan Health Systems, Ann Arbor, MI, USA
| | - Brian P Jacob
- Department of Surgery, Mount Sinai Health System, New York, NY, USA
| | - Linda Schultz
- Society of American Gastrointestinal and Endoscopic Surgeons, Boston, MA, USA
| | - Daniel J Scott
- Department of Surgery, UT Southwestern Medical Center, Dallas, TX, USA
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Jones DB, Stefanidis D, Korndorffer JR, Dimick JB, Jacob BP, Schultz L, Scott DJ. SAGES University MASTERS Program: a structured curriculum for deliberate, lifelong learning. Surg Endosc 2017. [DOI: 10.1007/s00464-017-5626-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Berler DJ, Cook T, LeBlanc K, Jacob BP. Next Generation Mesh Fixation Technology for Hernia Repair. Surg Technol Int 2016; 29:109-117. [PMID: 27466869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Laparoscopic ventral hernia repair (LVHR) remains a safe, reproducible, and popular method employed by surgeons to repair abdominal wall hernias. Patient selection, operative technique, instrumentation, and implant choice all remain surgeon dependent. Inherent in the technique is the option of using mesh. The decision of where to place the mesh and how to optimally fixate the mesh in the onlay, sublay, or intraabdominal positions also remain surgeon dependent and has been the subject of ongoing debates for the past two decades. In an ongoing effort to develop new methods for securing mesh to minimize pain without increased recurrence rates, novel mesh fasteners and mesh textiles have been developed. With increasing surgeon responsibility to improve value, surgeons should concentrate more on choosing the novel options that not only improve outcomes, but also reduce overall costs. This chapter reviews some of the emerging markets for these technologies.
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Affiliation(s)
- David J Berler
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Thomas Cook
- Our Lady of the Lake Physician Group, Minimally Invasive Surgery Institute, Baton Rouge, Louisiana
| | - Karl LeBlanc
- Our Lady of the Lake Physician Group, Minimally Invasive Surgery Institute, Baton Rouge, Louisiana
| | - Brian P Jacob
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
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Jacob BP, Inabnet WB. Biliopancreatic Diversion With Duodenal Switch. Surg Innov 2016. [DOI: 10.1177/155335060501200206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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DeMaria EJ, Schauer P, Patterson E, Nguyen NT, Jacob BP, Inabnet WB, Buchwald H. The Optimal Surgical Management of the Super Obese Patient: The Debate. Surg Innov 2016; 12:107-21. [PMID: 16034493 DOI: 10.1177/155335060501200202] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Optimal management of the super-obese patient (body mass index >50 kg/M2) undergoing weight loss surgery in the new era of laparoscopic treatment is more controversial than ever before. Newer laparoscopic options for treatment of the super obese, including laparoscopic adjustable gastric banding, sleeve gastrectomy, and staging of gastric bypass, are technically easier and may be safer. Concerns that weight loss may be suboptimal or that the procedures will require revision, or both, make these choices controversial. Open access/conversion for established procedures such as long-limb gastric bypass and biliopancreatic diversion with or without duodenal switch are the traditional alternatives when laparoscopic access fails or is deemed too difficult to undertake. The following debate was presented by invited experts in laparoscopic and open bariatric surgery at the 2005 Annual Meeting of the Society of American Gastrointestinal and Endoscopic Surgeons in Florida. The presenters put forth arguments for the various modern options for treatment of the super obese, which are presented in written form. Interactive audience response technology provided a mechanism for polling the audience before and after the presentations. A review of the audience's responses provides insight into the decision-making considerations of a population of laparoscopically oriented bariatric surgeons.
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Affiliation(s)
- Eric J DeMaria
- Virginia Commonwealth University, Center for Minimally Invasive Surgery, Richmond 23298-480, USA.
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Brajtbord JS, Lavery HJ, Jacob BP, Mccash S, Samadi DB. Continuing robotically? The completion of a robot-assisted radical prostatectomy after laparotomy. J Endourol 2011; 24:1613-6. [PMID: 20858052 DOI: 10.1089/end.2009.0528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The laparoscopic management of difficult adhesions can be quite challenging for even the most experienced of laparoscopic surgeons. We describe a case of managing a suspected enterotomy with a laparotomy during a robot-assisted radical prostatectomy and the surgical options after repair. The case was complicated by a Meckel's diverticulum fused and continuous with a urachal cyst, itself a rare occurrence. After the excision of the Meckel's diverticulum–urachal complex, the laparotomy incision was closed, and the prostatectomy was performed robotically. We discuss the controversies regarding continuation of a planned robotic procedure after a midline laparotomy.
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Affiliation(s)
- Jonathan S Brajtbord
- Department of Urology, The Mount Sinai Medical Center, New York, New York 10022, USA
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Jacob BP. Comment on: Adjustable gastric banding outcomes with and without gastrogastric imbrication sutures: a randomized controlled trial. Surg Obes Relat Dis 2011; 7:31-2. [PMID: 21255734 DOI: 10.1016/j.soard.2010.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 11/04/2010] [Indexed: 10/18/2022]
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Jacob BP, Vine AJ. Abdominal pain 1 month after adjustable gastric banding: an unusual complication caused by connecting tubing. Surg Obes Relat Dis 2010; 6:554-6. [PMID: 20674509 DOI: 10.1016/j.soard.2010.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Revised: 06/09/2010] [Accepted: 06/10/2010] [Indexed: 11/25/2022]
Affiliation(s)
- Brian P Jacob
- Laparoscopic Surgical Center of New York, Mount Sinai Medical Center, New York, New York 10028, USA.
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Greenstein AJ, Vine AJ, Jacob BP. When sleeve gastrectomy fails: adding a laparoscopic adjustable gastric band to increase restriction. Surg Endosc 2009; 23:884. [DOI: 10.1007/s00464-008-0293-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2007] [Accepted: 05/03/2008] [Indexed: 10/21/2022]
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Greenstein AJ, Jacob BP. Placement of a laparoscopic adjustable gastric band after failed sleeve gastrectomy. Surg Obes Relat Dis 2008; 4:556-8. [PMID: 18586565 DOI: 10.1016/j.soard.2008.05.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2007] [Revised: 04/03/2008] [Accepted: 05/02/2008] [Indexed: 01/07/2023]
Affiliation(s)
- Alexander J Greenstein
- Department of Surgery, Mount Sinai Medical Center, 1010 Fifth Avenue, New York, NY 10028, USA
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Jacob BP, Hogle NJ, Durak E, Kim T, Fowler DL. Tissue ingrowth and bowel adhesion formation in an animal comparative study: polypropylene versus Proceed versus Parietex Composite. Surg Endosc 2007; 21:629-33. [PMID: 17285369 DOI: 10.1007/s00464-006-9157-9] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2006] [Revised: 08/28/2006] [Accepted: 10/09/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND The optimal prosthesis for laparoscopic ventral hernia repair would combine excellent parietal surface tissue ingrowth with minimal visceral surface adhesiveness. Currently, few data are available from randomized trials comparing the commercially available prostheses. METHODS In a pig model designed to incite adhesions, three 10 x 15-cm pieces of mesh (Proceed, Parietex Composite [PCO], and polypropylene [PPM]) were randomly positioned intraperitoneally in each of 10 animals using sutures and tack fixation. After a 28-day survival, the amount of shrinkage, the area and peel strength of visceral adhesions, the peak peel strength, the work required to separate mesh from the abdominal wall, and a coefficient representing the adhesiveness of tissue ingrowth were averaged for each type of mesh and then compared with the averages for the other prostheses. The histologic appearance of each prosthesis was documented. RESULTS Proceed had more shrinkage (99.6 cm2) than PCO (105.8 cm2) or PPM (112 cm2), although the difference was not statistically significant. The mean area of adhesions to PCO (11%) was significantly less than for Proceed (48%; p < 0.008) or PPM (46%; p < 0.008). Adhesion peel strength was significantly less for PCO (5.9 N) than for Proceed (12.1 N; p < 0.02) or PPM (12.9 N; p < 0.02). According to a filmy-to-dense scale of 1 to 5, adhesions were more filmy with PCO (1.7) than with PPM (2.9) or Proceed (3.7) (p < 0.007). Peak peel strength from the abdominal wall was significantly higher for PCO (17.2 N) than for Proceed (10.7 N) or PPM (10 N; p < 0.002). The histology of each prosthesis showed a neoperitoneum only with PCO. CONCLUSIONS With less shrinkage, fewer and less dense adhesions to the viscera, and significantly stronger abdominal wall adherence and tissue ingrowth at 28 days in this animal study, PCO was superior to both Proceed and PPM in all categories. Furthermore, PCO demonstrated all the favorable qualities needed in an optimal prosthesis for laparoscopic ventral hernia repair, including the rapid development of a neoperitoneum.
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Affiliation(s)
- B P Jacob
- Department of Surgery, Mount Sinai School of Medicine, 1010 Fifth Avenue, New York, NY, USA
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Edwards ED, Jacob BP, Gagner M, Pomp A. Presentation and management of common post-weight loss surgery problems in the emergency department. Ann Emerg Med 2005; 47:160-6. [PMID: 16431226 DOI: 10.1016/j.annemergmed.2005.06.447] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2005] [Revised: 06/23/2005] [Accepted: 06/29/2005] [Indexed: 02/02/2023]
Abstract
Morbid obesity is an epidemic in this country. An increasing number of patients are undergoing weight loss surgery in an effort to combat the negative physical and psychological impact of morbid obesity. Fueling the increasing interest in surgical treatment of morbid obesity has been the development of new laparoscopic techniques. There are several surgical approaches to morbid obesity, and each has its own unique set of risks and potential complications. As more patients have weight loss surgery, clinicians working in the emergency department will frequently encounter complications of these procedures. To ensure timely diagnosis and optimal care, clinicians should be familiar with the standard weight loss approaches and the potential complications of these interventions.
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Affiliation(s)
- Eric D Edwards
- Department of Surgery, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, NY, USA
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Abstract
Reduction of a large rectal prolapse may be difficult because of significant edema that collects in the rectal tissues. If reduction is unsuccessful, an emergent laparotomy and internal reduction is required. A wide elastic wrap applied around the prolapsed rectum provides progressive compression, which reduces the amount of edema, allowing subsequent manual reduction. This novel technique is simple, safe, inexpensive, and can easily be performed in the emergency department setting. Manual reduction, by this or other described methods, should be attempted before emergent laparotomy for incarcerated rectal prolapse is performed.
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Affiliation(s)
- Umut Sarpel
- Department of Surgery, Mount Sinai School of Medicine, New York, New York, USA.
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Waage A, Gagner M, Biertho L, Jacob BP, Kim WW, Faife B, Sekhar N, del Genio G. Comparison between Open Hand-sewn, Laparoscopic Stapled and Laparoscopic Computer-mediated, Circular Stapled Gastro-Jejunostomies in Roux-en-Y Gastric Bypass in the Porcine Model. Obes Surg 2005; 15:782-7. [PMID: 15978147 DOI: 10.1381/0960892054222704] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND In this porcine survival model, we compared laparoscopic computer-mediated flexible circular stapled (SurgASSIST) gastro-jejunostomies in Roux-en-Y gastric bypass (RYGBP) to open hand-sewn (HS) and laparoscopic end-to-end (EEA) anastomosis. METHODS RYGBP was performed in 15 pigs. Depending on the technique used to create the gastro-jejunostomy, the pigs were divided in 3 groups. In group A, a standard two-layer hand-sewn anastomosis were performed. In group B and C, gastro-jejunostomies using EEA (B) or SurgASSIST (C) were attempted. Operation time, intraoperative technical failure, postoperative anastomotic leakage, and necropsy results were measured. RESULTS 14 pigs survived surgery. One leakage from the gastro-jejunostomy was detected intraoperatively in group B. There was no evidence of leakage postoperatively from the proximal gastro-jejunostomy in any groups. No statistical difference was found between the groups concerning the operation time or the diameter and degree of healing of the anastomosis. CONCLUSION We found the SurgASSIST system safe for performing gastro-jejunostomies in laparoscopic RYGBP. There were no anastomotic failures intra- or postoperatively. At necropsy, there was no evidence of anastomotic stricture or delayed healing processes.
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Affiliation(s)
- Anne Waage
- Department of Surgery, Karolinska University Hospital, Stockholm, Sweden
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Jacob BP, Salky B. Laparoscopic colectomy for colon adenocarcinoma: an 11-year retrospective review with 5-year survival rates. Surg Endosc 2005; 19:643-9. [PMID: 15789256 DOI: 10.1007/s00464-004-8921-y] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2004] [Accepted: 12/02/2004] [Indexed: 01/11/2023]
Abstract
BACKGROUND Laparoscopic colectomy for the management of colon cancer remains a controversial therapeutic option, especially when the outcomes are compared with the historically accepted survival data and recurrence rates after open surgery. The purpose of this study was to evaluate the 5-year overall and disease-free survival rates after laparoscopic colon resection for invasive colon adenocarcinoma. METHODS A total of 129 patients underwent consecutive laparoscopic colectomies for colon adenocarcinoma (between April 1992 and 2004 January) by a single surgeon at a single institution. Records were analyzed retrospectively and follow-up data was obtained. The Student t-test, Cox regression analysis, and Kaplan-Meier survival data were used for statistical analysis. RESULTS After patients with noninvasive disease on final pathology were excluded, the study population comprised 88 patients who underwent laparoscopic colectomies for invasive colon cancer with > 2 years of follow-up. Of these cases, 81 (93%) were amenable for complete follow-up at 11years (41 women and 40 men; mean age, 76 years). Mean follow-up was 61 months. There was one perioperative death (1.2%), and the overall postoperative morbidity rate was 13.6%. The average number of lymph nodes harvested was 10.1 (+/-6). There were no port site recurrences. The Kaplan-Meier survival data were as follows for 5-year overall survival and 5-year disease-free survival, respectively stage I (n = 34) 89% and 89%; stage II (n = 22), 65% and 59%; stage III (n = 19), 72% and 67%; stages I-III combined, (n = 75), 77% and 73%. CONCLUSIONS For this specific cohort of patients undergoing curative laparoscopic colectomies for invasive colon adenocarcinoma, the mean follow-up was > 5 years. Overall survival and disease-free survival for stage I, II, and III colon cancer as well as for stages I-III combined are favorable and comparable to historically acceptable open colectomy survival rates. Overall survival and disease-free survival after laparoscopic colectomy for invasive colon cancer is no worse, and perhaps better than, the previously reported rates for the same procedure done by an open technique.
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Affiliation(s)
- B P Jacob
- Department of Laparoscopic Surgery, Mount Sinai School of Medicine, 5 East 98th Street, New York, NY 10029, USA
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Jacob BP, Gagner M. New developments in gastric bypass procedures and physiological mechanisms. Surg Technol Int 2004; 11:119-26. [PMID: 12931292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Since the gastric bypass was first described for weight-reduction surgery almost 50 years ago, a number of remarkable contributions have been made to the field. These advances have led to significant modifications of the technique, evolution of laparoscopic bariatric surgery equipment, and improvement of long-term results. Despite the currently wide-spread practice of laparoscopic bariatric surgery, the precise technique for laparoscopic gastric bypass still varies from institution to institution, and the surgery continues to carry a morbidity rate. Advances in laparoscopic equipment, technology, and our understanding of the pathophysiology behind weight loss, have allowed surgeons to modify the procedure described originally to minimize the morbidity and maximize long-term weight loss. This chapter describes the technique of laparoscopic gastric bypass used at a major academic center that performs over 1000 bariatric procedures each year. In addition, the many recent advances in methodology and pathophysiology are described in detail.
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Affiliation(s)
- Brian P Jacob
- Division of Laparoscopic Surgery, Department of Surgery, Mount Sinai School of Medicine, New York, NY, USA
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Jacob BP, Gagner M, Hung TI, Fukuyama S, Waage A, Biertho L, Kim WW, Sekhar N. Dual endoscopic-assisted endoluminal colostomy reversal: a feasibility study. Surg Endosc 2004; 18:433-9. [PMID: 14752656 DOI: 10.1007/s00464-003-8914-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2003] [Accepted: 07/28/2003] [Indexed: 11/25/2022]
Abstract
BACKGROUND Emergent colostomies are associated with increased morbidity related to second closure operations. The purpose of this canine pilot study was to create a minimally invasive procedure that would reduce the time interval and morbidity involved with colostomy reversals after left colon end colostomies. METHODS Six mongrel dogs underwent modified laparoscopic Hartmann's procedures in which the stapled end of the rectal stump was approximated to the left colon proximal to the stoma. After 1 week, they underwent an endoluminal colostomy reversal with a computer-mediated, circular stapling device and varying anvil insertion methods. Variables recorded included anvil insertion technique and feasibility, OR time, complications, and number of days to first meal and bowel movement. A contrast enema performed 1 week post colostomy reversal ruled out anastomosis leaks and stenosis. The dogs were euthanized and subjected to necropsy. RESULTS Of four anvil insertion techniques tested, the most feasible employed a large-bore needle to perforate through the stapled end of the Hartmann pouch into the lumen of the left colon. Simultaneous endoluminal views of the rectal stump with a sigmoidoscope and the left colon lumen with an endoscope permitted a controlled and safe needle puncture. Through the needle, a guide wire was inserted to withdraw the anvil via the colostomy into place. A transanally inserted stapler was then married to the anvil under fluoroscopic guidance, thus completing the anastomosis. The colostomy was then taken down and transected at the level of the colocolostomy. Average operating time was 126 min (range 90-180), diet was tolerated within 1.5 days, and average number of days to first bowel movement was 2.5. The absence of stenosis, leaks, and inadvertent visceral injuries confirmed feasibility. CONCLUSIONS In this canine model, a dual endoscopic-assisted colostomy reversal with a computer-mediated, circular stapling device is feasible. Using this technique, colostomy reversals can possibly be performed 1 week post-colostomy without entering the peritoneal cavity, thus reducing the number of invasive operations and subsequent morbidity required to manage emergent colon perforations.
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Affiliation(s)
- B P Jacob
- Division of Laparoscopic Surgery, Department of Surgery, Mount Sinai School of Medicine, 5 E 98th Street, 15th Floor, New York, NY 10029, USA
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Abstract
Robotics are now being used in all surgical fields, including general surgery. By increasing intra-abdominal articulations while operating through small incisions, robotics are increasingly being used for a large number of visceral and solid organ operations, including those for the gallbladder, esophagus, stomach, intestines, colon, and rectum, as well as for the endocrine organs. Robotics and general surgery are blending for the first time in history and as a specialty field should continue to grow for many years to come. We continuously demand solutions to questions and limitations that are experienced in our daily work. Laparoscopy is laden with limitations such as fixed axis points at the trocar insertion sites, two-dimensional video monitors, limited dexterity at the instrument tips, lack of haptic sensation, and in some cases poor ergonomics. The creation of a surgical robot system with 3D visual capacity seems to deal with most of these limitations. Although some in the surgical community continue to test the feasibility of these surgical robots and to question the necessity of such an expensive venture, others are already postulating how to improve the next generation of telemanipulators, and in so doing are looking beyond today's horizon to find simpler solutions. As the robotic era enters the world of the general surgeon, more and more complex procedures will be able to be approached through small incisions. As technology catches up with our imaginations, robotic instruments (as opposed to robots) and 3D monitoring will become routine and continue to improve patient care by providing surgeons with the most precise, least traumatic ways of treating surgical disease.
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Affiliation(s)
- Brian P Jacob
- Department of Surgery, Weill-Cornell College of Medicine 525 East 68th Street, New York, NY 10021, USA
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Abstract
BACKGROUND The technique of thyroidectomy mandates adequate visualization of the operative field to identify pertinent anatomical structures. The purpose of this prospective review was to assess the feasibility and safety of endoscopic thyroidectomy by a cervical approach. METHODS All patients who underwent endoscopic thyroidectomy were assessed by retrospective review of a prospective database. RESULTS Thirty-eight patients underwent endoscopic thyroidectomy by a cervical approach. Thirty-five of 38 cases were successfully completed endoscopically with a mean OR time of 190 min. One patient experienced a permanent recurrent laryngeal palsy. CONCLUSION Endoscopic thyroidectomy by a cervical approach is a feasible procedure. As in conventional thyroid surgery, great care should be exercised when dissecting the recurrent laryngeal nerve.
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Affiliation(s)
- W B Inabnet
- Division of Laparoscopic Surgery, Department of Surgery, Mount Sinai Medical Center, 5 East 98th Street, Box 1259, New York, NY 10029, USA.
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Feng JJ, Gagner M, Pomp A, Korgaonkar NM, Jacob BP, Chu CA, Voellinger DC, Quinn T, Herron DM, Inabnet WB. Effect of standard vs extended Roux limb length on weight loss outcomes after laparoscopic Roux-en-Y gastric bypass. Surg Endosc 2003; 17:1055-60. [PMID: 12728380 DOI: 10.1007/s00464-002-8933-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2002] [Accepted: 09/18/2002] [Indexed: 11/29/2022]
Abstract
BACKGROUND Increasing the length of the Roux limb in open Roux-en-Y gastric bypass (RYGB) effectively increases excess weight loss in superobese patients with a body mass index (BMI) >50 kg/m2. Extending the RYGB limb length for obese patients with a BMI < 50 could produce similar results. The purpose of this study was to compare the outcomes of superobese patients undergoing laparoscopic RYGB with standard (< or =100-cm) with those undergoing the procedure with an extended (150-cm) Roux limb length over 1-year period of follow-up. METHODS Retrospective data over 2.5 years were reviewed to identify patients with a BMI < 50 who underwent primary laparoscopic RYGB with 1-year follow-up ( n = 58). Forty-five patients (sRYGB group) received limb lengths < or = 100 cm, including 45 cm ( n = 1), 50 cm ( n = 2), 60 cm ( n = 6), 65 cm ( n = 1), 70 cm ( n = 1), 75 cm ( n = 3), and 100 cm ( n = 31). Thirteen patients (eRYGB group) received 150-cm limbs. Postoperative weight loss was compared at 3 weeks, 3 months, 6 months, and 1 year. RESULTS Comparing the sRYGB vs the eRYGB group (average +/- SD), respectively: There were no significant differences in age (41.5 +/- 11.0 vs 38.0 +/- 11.9 years), preoperative weight (119.2 +/- 11.9 vs 127.8 +/- 12.5 kg), BMI (43.7 +/- 3.0 vs 45.2 +/- 3.5 kg/m2), operative time (167.1 +/- 72.7 vs 156.5 +/- 62.4 min), estimated blood loss (129.9 +/- 101.1 vs 166.8 +/- 127.3 cc), or length of stay (median, 3 vs 3 days; range, 2-18 vs 3-19). Body weight decreased over time in both groups, except in the sRYGB group between 3 and 6 months and 6 and 12 months after surgery and in the eRYGB group between 6 and 12 months. BMI also decreased over time, except in the eRYGB group between 6 and 12 months. Absolute weight loss leveled out between 6 and 12 months in both groups, with no increase after 6 months. Percent of excess weight loss did not increase in the eRYGB group after 6 months. An extended Roux limb did not significantly affect body weight, BMI, absolute weight loss, or precent of excess weight loss at any time point when the two groups were compared. A trend toward an increased proportion of patients with >50% excess weight loss ( p = 0.07) was observed in the extended Roux limb group. CONCLUSIONS In this series, no difference in weight loss outcome variables were observed up to 1 year after laparoscopic RYGB. Thus, extending Roux limb length from < or =100 cm to 150 cm did not significantly improve weight loss outcome in patients with a BMI < 50 kg/m2.
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Affiliation(s)
- J J Feng
- Minimally Invasive Surgery Center, Department of Surgery, Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1103, 5 East 98th Street, New York, NY 10029-6574, USA
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Jacob BP, Dakin G, Divino C, Kim W, Gagner M. Long-term follow-up evaluation for a canine model of gastroesophageal reflux disease. Surg Endosc 2003; 17:354; author reply 355. [PMID: 12577174 DOI: 10.1007/s00464-002-8558-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kim WW, Gagner M, Fukuyama S, Hung TI, Biertho L, Jacob BP, Gentileschi P. Laparoscopic harvesting of small bowel graft for small bowel transplantation. Surg Endosc 2002; 16:1786-9. [PMID: 12239647 DOI: 10.1007/s00464-001-8249-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2002] [Accepted: 06/13/2002] [Indexed: 10/27/2022]
Abstract
BACKGROUND Small bowel transplantation represents a valid therapeutic option for patients with intestinal failure, obviating the need for long-term total parenteral nutrition. Recently, reports have shown the feasibility of performing living related intestinal transplantation using segmental small bowel grafts. The limitations of this technique include inadequate harvested small bowel lengths, as compared with the lengths obtained in cadaveric small bowel harvests, and large incisions for the donor. In this pilot study, we evaluated the feasibility of laparoscopically harvesting long segments of proximal jejunum for small bowel transplantation using a porcine model. The results can be used to evaluate the potential for applying this technique in human cases. METHODS For this study 10 yorkshire pigs were used. Under general anesthesia, each pig underwent laparoscopic segmental resection of 200 cm of proximal jejunum on a vascular pedicle. The harvested graft then was autoreimplanted using an open technique by anastomosing the vascular pedicle to the superior mesenteric vessels. Success was determined 2 hours after anastomosis by visually identifying a pink graft with viable-appearing mucosa, an artery with a strong thrill, and palpable venous flow. The animals were then sacrificed. RESULTS The mean operation time required to laparoscopically harvest the small bowel graft was 80 min (range, 35-120 min), and the mean length of harvested graft was 220 cm (range, 200-260 cm). The mean length of the graft's vascular pedicle was 4.5 cm (range, 4-5 cm). All 10 grafts were successfully harvested laparoscopically and then reimplanted using an open technique. All the grafts maintained good vascular flow, and showed no evidence of mucosal necrosis at necropsy. Obviously, further studies would be required to examine the long-term results of reimplanting a laparoscopically harvested small bowel graft, but proposals for such studies is beyond the scope of this report. CONCLUSION Minimally invasive techniques can be used to harvest proximal small bowel grafts for living related small bowel transplantation.
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Affiliation(s)
- W W Kim
- Division of Laparoscopic Surgery, Department of Surgery, Mount Sinai School of Medicine, One Gustave L. Levy Place, P.O. Box 1103, New York, NY 10029, USA
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Jacob BP, Leupin K. [Sterilization of dry ampules of chlordiazepoxide hydrochloride with gamma rays]. Pharm Acta Helv 1974; 49:1-11. [PMID: 4849769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Jacob BP, Leupin K. [Sterilization of eye-nose salves with gamma rays]. Pharm Acta Helv 1974; 49:12-20. [PMID: 4849770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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