2005 SAGES Abstracts

ABSTRACTS Thursday, April 14, 2005
group (8/13 vs 3/16, p=0.02). In addition, mean number of
biopsy levels containing HGD was more identified in cancer
than in non-cancer group (2.2+/-0.32 vs 1.26+/-0.22, p=0.02)
and the percent length of columnar epithelium containing HGD
was also higher in cancer than in non-cancer group (50.7+/-
7.5% vs 27+/-4.5%, p=0.01). Median age was 72 years (IQR,
61.5-76) for cancer group and 62 years (IQR, 61.5-76) for noncancer
group (p=0.05). The gender and length of Barrett?s
mucosa was not different between 2 groups.
Conclusions: In patients with HGD, the presence of a visible
lesion on endoscopy and the presence of HGD in multiple
biopsy levels are associated with an increased risk of the
occult cancer. These patients should be considered for early
esophagectomy.
S043
PER-ORAL TRANSGASTRIC ENDOSCOPIC SPLENECTOMY
√ IS IT POSSIBLE?, Sergey V Kantsevoy MD, Bing Hu
MD,Sanjay B Jagannath MD,Cheryl A Vaughn RN,Mark A
Talamini MD,Anthony N Kalloo MD, Johns Hopkins University
School of Medicine
BACKGROUND: We have previously reported the feasibility of
diagnostic and therapeutic peritoneoscopy including liver
biopsy, gastrojejunostomy and tubal ligation by a per-oral
transgastric approach. We now present results of per-oral
transgastric splenectomy in a porcine model. AIM: To determine
the technical feasibility of per-oral transgastric splenectomy
using a flexible endoscope. METHODS: We performed
acute experiments on 50-kg pigs. All animals were fed liquids
for 3 days prior to procedure. The procedures were performed
under general anesthesia with endotracheal intubation. The
flexible endoscope was passed per-orally into the stomach and
puncture of the gastric wall was performed with a needle-type
sphincterotome. The puncture was extended to create a 1.5-cm
incision using a pull-type sphincterotome and a double-channel
endoscope was advanced into the peritoneal cavity. The
peritoneal cavity was insufflated with air through the endoscope.
The spleen was visualized. The splenic vessels were ligated
with endoscopic loops and then mesentery was dissected
using blunt electrocautery. RESULTS: Endoscopic splenectomy
was performed on 3 pigs. There were no complications during
gastric incision and entrance into the peritoneal cavity. The
visualization of the spleen and other intraperitoneal organs
was very good. Ligation of the splenic vessels and mobilization
of the spleen was easily achieved using already commercially
available devices and endoscopic accessories. The
spleen was then removed in toto without significant bleeding.
All animals remained hemodynamically stable during splenic
removal.
CONCLUSION: Transgastric endoscopic splenectomy in a
porcine model appears technically feasible. Further long-term
survival experiments are planned.
S044
THE ROLE OF TELEMENTORING AND TELROBOTIC ASSIS-
TANCE IN THE PROVISION OF LAPAROSCOPIC COLORECTAL
SURGERY IN RURAL AREAS, Herawaty Sebajang MD, Patrick
Trudeau MD,Allan Dougall MD,Susan Hegge MD,Craig
McKinley MD,Mehran Anvari PhD, Centre for Minimal Access
Surgery, McMaster University, Hamilton Ontario Canada;
Centre Hospitalier de la Sagami, Chicoutimi Quebec Canada;
North Bay District Hospital, North Bay Ontario Canada
PURPOSE: The aim of this study was to assess whether telementoring
and telerobotic assistance would improve the range
and quality of laparoscopic colorectal surgery being performed
by community surgeons.
METHODS: We present a series of 18 patients who underwent
telementored or telerobotically assisted laparoscopic colorectal
surgery in two community hospitals between December
2002 and December 2003. Four community surgeons with no
formal advanced laparoscopic fellowship were assisted by an
expert surgeon from a tertiary care center. Telementoring was
achieved with real time two way audio-video communications
over various bandwidths and it included 1 redo ileocolic resection,
2 right hemicolectomies, 2 sigmoid resections, 3 low
anterior resections, 1 subtotal colectomy, 1 reversal of
Hartmann and 1 abdomino-perineal resection. A Zeus TS
microjoint system (Computer Motion Inc, Santa Barbara CA)
was used to provide telepresence for the telerobotically assisted
laparoscopic procedures: 3 right hemicolectomies, 3 sigmoid
resections and 1 low anterior resection.
RESULTS: There were no major intraoperative complications.
There were two minor intraoperative complications involving
serosal tears of the colon from the robotic graspers. In the
telementored cases, there were two postoperative complications
requiring reoperation (intraabdominal bleeding and small
bowel obstruction). Two telementored procedures were converted
because of the mentee?s inability to find the appropriate
planes of dissection. One telerobotically assisted procedure
was completed laparoscopically with telementoring from
the expert surgeon. The median length of stay was 4 days. The
surgeons considered telementoring useful in all cases (median
score 4 out 5). The use of remote telerobotic assistance was
also an enabling tool.
CONCLUSION: Telementoring and remote telerobotic assistance
is an excellent tool for supporting community surgeons
and providing better access to advanced surgical care. In the
future, Telesurgery may cut health care costs by proving a way
to export medical expertise.
S045
MOBILE IN VIVO ROBOTS CAN ASSIST IN ABDOMINAL
EXPLORATION, Mark E Rentschler MS,Jason Dumpert
MS,Stephen R Platt PhD,Shane M Farritor PhD, Dmitry
Oleynikov MD, University of Nebraska - Lincoln, University of
Nebraska Medical Center
In vivo robot-assisted laparoscopy offers distinct benefits compared
to conventional robot-assisted laparoscopic approaches.
These remotely controlled miniature robots provide the surgeon
with an enhanced field of view from multiple angles and
in the near future they will provide dexterous manipulators not
constrained by small incisions in the abdominal wall. We created
remotely controlled mobile robots that can traverse the
abdominal organs, while providing video and sensor feedback
of the abdominal cavity from multiple, unobstructed angles.
The miniature mobile robots were equipped with a camera
and environment sensors that provided real-time measurements
of temperature, humidity, and pressure. These robots
were inserted through a small incision into the insufflated
abdominal cavity of an anesthetized pig. Then, the mobile
camera robot was used to visualize trocar insertion and other
laparoscopic tool placements. Next, the mobile robots traversed
the abdominal organs as the surgeon explored the
abdominal environment. Finally, during the cholecystectomy,
the robot provided the surgeon with several different views of
the gallbladder.
These robots have shown that in vivo robots can overcome
some of the limitations of current rigid, single view cameras.
The robots were not confined by the entry point, and were free
to move around the abdominal cavity to attain optimal camera
angles and sensor readings. This approach limited the procedure
to two incisions, allowed ease of exploration before the
cholecystectomy and helped improve orientation and define
depth during the cholecystectomy. Future work will provide a
mobile manipulator that will provide task assistance which will
enhance the capabilities of the surgeon. The outcome will be
that patient trauma during laparoscopic abdominal surgery
will be reduced to a single entry port where the robots are
inserted into the abdominal environment.
S046
VIRALLY-DIRECTED FLUORESCENT IMAGING (VFI) CAN
FACILITATE ENDOSCOPIC STAGING AND MINIMALLY INVA-
SIVE CANCER SURGERY, Prasad S Adusumilli MD, David P
Eisenberg MD,Brendon M Stiles MD,Stephen F Stanziale
MD,Mei-Ki Chan BS,Michael Hezel BS,Rumana Huq BS,Valerie
http://www.sages.org/
SAGES 2005
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