2005 SAGES Abstracts

POSTER ABSTRACTS
J Lomax MD,Christine L MacKenzie PhD, Simon Fraser
University, BC, Canada
In performing a complex endoscopic task, surgeons tend to
work with the two hands, stabilizing the target with an instrument
in the nonpreferred hand and manipulating the target
using the preferred hand. The benefits of bimanual collaboration
in the endoscopic cutting task were quantified using video
analysis technology.
Twelve participants were required to perform three pseudoendoscopic
tasks in counterbalanced order, reaching and cutting
a 1 cm thread using endoscopic scissors in the preferred
hand, with and without having the thread held by a grasper in
the nonpreferred hand, and simply reaching and grasping the
thread with an endoscopic grasper in the preferred hand. The
image of the work plane was displayed vertically or superimposed
over the work plane. In half the conditions, the camera
was rotated 45 degrees, causing misalignment between the
actual and displayed work plane. Movements were videotaped
and decomposed into subtasks. Durations of subtasks performed
by the preferred hand were analyzed using 3 (task) X 2
(display) X 2 (camera rotation) within subject MANOVA.
Cutting with the thread being held by the nonpreferred hand
had shorter total time (6.6 s) than when the thread was not
stabilized by the nonpreferred hand (7.6 s). However, due to
the individual difference, the difference was not significant.
Rather, reaching and grasping the thread with the preferred
hand was preformed in 5.4 s, significantly shorter than the two
cutting tasks above. Rotation of the camera degraded task performances
over all movement phases. The superimposed
image display shortened the total execution time (5.8) compared
to the vertical image display (7.3 s). This addressed the
benefits of superimposing the display on the workspace to
facilitate endoscopic task performance.
P242–Esophageal/Gastric Surgery
LAPAROSCOPIC RESECTION OF GASTRIC GISTS: NOT ALL
TUMORS ARE CREATED EQUAL, Eric Bedard MD, Christopher
M Schlachta MD,Joseph Mamazza MD, The Centre for
Minimally Invasive Surgery, St. Michael’s Hospital, University
of Toronto, Toronto, Ontario, Canada
INTRODUCTION: Laparoscopic resection has become an
accepted approach to gastric GIST tumors with acceptable
early results published in the literature. Long term recurrence
rates, however, are still unclear and the management of
tumors in challenging locations requires exploration.
METHODS: A retrospective analysis of all patients undergoing
a laparoscopic resection of gastric GIST in our institution
between November 1997 and July 2004 was performed.
RESULTS: A total of 12 patients (13 tumors) were evaluated: 5
tumors were located high on the lesser curve, 7 on the fundus/greater
curve and 1 in the distal antrum. The mean patient
age was 62+/-14 years. Symptoms at initial presentation, in
order of frequency, were dyspepsia, upper GI hemorrhage and
early satiety. All patients had an attempted laparoscopic
approach with the following procedures performed: stapled
wedge excision (8), excision and manual sewing technique (4)
and distal gastrectomy (1). Overall, there was a 15% (2) conversion
rate. As reported by others, lesions found in the fundus/greater
curvature area were easily resected via simple stapled
wedge excision. High lesser curve tumors, on the other
hand, were more difficult to manage and required a combination
of modalities for complete excision and preservation of
the GE junction. These included: intra-operative resection margin
localization via gastroscopy (4/5, 80%), excision and manual
sewing technique (4/5, 80%) and reconstruction over an
esophageal bougie (5/5, 100%). One patient with a high lesser
curve GIST required conversion due to size and proximity to
the GE junction, as did one patient with a lesion adjacent to
the pylorus. Overall, the mean tumor diameter was 3.9 +/- 2.7
cm with 75% spindle and 17% epithelioid types. There were no
post-operative complications and length of stay was 4.8 +/- 2.1
days. At median follow-up of 48 months (mean 37.1+/- 25
months) one patient has suffered a recurrence (18 months
post-op) with eventual disease-related death.
CONCLUSION: The laparoscopic approach to gastric GIST
tumors is safe and associated with acceptable short and intermediate
term results. High lesser curve GISTs can be safely
approached laparoscopically by utilizing various techniques to
ensure an adequate resection margin without compromising
the GE junction.
P243–Esophageal/Gastric Surgery
THE INFLUENCE OF PSYCHOLOGICAL DISORDERS ON THE
OUTCOMES OF LAPAROSCOPIC NISSEN FUNDOPLICATION:
PRELIMINARY RESULTS, Laurent Biertho MD, Sanjeev Dutta
MD,Herawaty Sebajang MD,Martin Antony PhD,Mehran Anvari
PhD, St. Joseph’s Healthcare, McMaster University, Hamilton,
Ontario, Canada
Background: Psychological disorders have been associated
with functional dysfunction of the digestive system. The aim of
this study was to evaluate the influence of psychological factors
on the outcomes of Laparoscopic Nissen Fundoplication
(LNF) for documented GastroEsophageal Reflux Disease
(GERD).
Methods: This is a prospective, single Institution, controlled
trial. 17 patients (13 females and 4 males) with documented
GERD underwent psychological testing before LNF, 3 months
and 6 months after surgery (LNF Group). The results were
compared with 10 patients (9 females and 1 male) who underwent
a Laparoscopic Cholecystectomy (Control Group).
Psychological assessment was performed using the Symptom
CheckList-90 (SCL-90), the Depression Anxiety Stress Scale,
Anxiety screening test, Illness attitude testing and Beck
Depression Inventory II. GERD symptoms were evaluated
using a specific scoring system based on 5 major GERD symptoms
(score 0 to 60).
Results: 7 patients in the LNF Group had ongoing reflux symptoms
with GERD Symptom Score >12 at 6 months after surgery.
In comparison to the remaining LNF patients with excellent
outcome (minimal or no GERD symptoms) and to the
Laparoscopic Cholecystectomy patients, this group had significantly
higher preoperative SCL-90 scores (p