2005 SAGES Abstracts

POSTER ABSTRACTS
CONCLUSION: The success and relative ease of performing
this laparoscopic function preserving procedure will pave the
way for its future use in other selective cases involving splenic
pathology.
P344–Minimally Invasive Other
LAPAROSCOPIC RESECTION OF LYMPH NODE POSITIVE
COLON AND RECTAL CANCER: 24-MONTH FOLLOW-UP OF 90
PATIENTS, Gyu-Seog Choi MD, In-Taek Lee MD,Jong-Ho Lee
MD,Soo-Han Jeon MD, Division of Colorectal Surgery,
Department of Surgery, Kyungpook National University School
of Medicine
Purpose: Despite laparoscopic colon resection for benign and
early malignant lesions is quite acceptable beacause of fast
recovery and minimal morbidity, laparoscopic curative surgery
for advanced colorectal cancer remains controversial. The purpose
of this study was to evaluate the postoperative outcomes,
and short-term survival of laparoscopic resection for
lymph node positive colorectal cancer. Methods: A single-institution
retrospective trial was undertaken between June 1996
and April 2004, during which 266 patients had curative laparoscopic
surgery for colorectal cancer by a single laparoscopic
colorectal surgeon. Lymph node metastasis was confirmed at
postoperative pathology in 90 patients. The surgical outcomes
were evaluated in lymph node positive colorectal cancer
patients, focusing on the results of the surgery, postoperative
complications, oncologic clearance and recurrence rate.
Results: In this study, 30 right hemicolectomies(RHC), 1 left
hemicolectomy, 21 anterior resections(AR), 35 low anterior
resections(LAR, including 5 coloanal hand-sewn anastomosis),
and 3 abdominoperineal resections(APR) were performed. The
tumor site was the ascending colon in 30 cases, the descending
colon in 23 cases, and the rectum in 37 cases, including 15
mid-low rectal cancers. Six laparoscopic procedures (6.7%)
were converted to open surgery. There was no hospital mortality,
and the hospital morbidity was 15.1%. The mean operation
time were 202(125-340) minutes for RHC, 205(145-265)
minutes for AR, 250(135-415) minutes for LAR, and 224(145-
265) minutes for APR. The mean postoperative stay was
10.5(6-42) days. The mean number of lymph nodes retrieved
and metastatic were 25.7(4-91) and 3.3(1-17), respectively. The
mean distal margins were 6.8 (1.5-12.5) cm for AR, 2.7 (1.-3.5)
cm for LAR, and 0.7 (0.5-1) cm for coloanal hand-sewn anastomosis.
Recurrence was identified in eleven patients(three local
recurrences (3.5%) and eight distant metastases (9.3%)). There
was no port site recurrence. One patient was died for distanst
metastasis. Conclusions: Laparoscopic resection for lymph
node positive colorectal cancer is a safe procedure in terms of
postoperative outcome, oncologic clearance, and short-term
survival. However, further follow-up and multicenter, randomized
trials will be required to determine whether the laparoscopic
approach will play a significant role in the treatment of
colorectal cnacer in the future.
P345–Minimally Invasive Other
COMPARATIVE THERMAL SPREAD OF THREE RADIOFRE-
QUENCY BIPOLAR VESSEL SEALING DEVICES, Tanuja Damani
MD, Lawrence W Way MD,Arnold Advincula MD, University of
California at San Francisco, San Francisco, CA; University of
Michigan at Ann Arbor, Ann Arbor, MI
Radiofrequency (RF) bipolar vessel sealing devices facilitate
laparoscopic dissection and surgical hemostasis, but can also
cause undesirable collateral thermal damage. This in vitro
study evaluated the thermal effects on adjacent tissue using
real time infrared thermography during bipolar vessel sealing
in pigs. The following RF vessel sealing devices were compared
: Enseal Vessel Fusion System; Ligasure LS1100; and
Ligasure Atlas V. A thermal imaging camera was used to
record dynamic thermal images of the RF vessel sealing
device in use. A 7.9 mm harvested porcine vessel was sealed
on separate occasions using each of the three devices. Room
temperature was 23.8 C and relative humidity, 50%. Protein
denaturation, with subsequent collagenous tissue breakdown
and reformation into a seal, begins at 54C. Consequently, two
thermal zones lateral to the jaws of the instrument were
defined- a “hot” zone with temperatures greater than 54C
immediately next to the jaws of the instrument, and a “cool”
zone with temperatures equal to or less than 54C distant to the
“hot” zone. Thermal spread was defined as the length of the
“hot” zone. Thermal spread for Enseal, Ligasure Atlas V, and
Ligasure LS1100 was 1.4 mm, 1.6 mm and 5.0 mm, respectively.
Peak temperatures were 83.7C, 82.3C and 92.0C, respectively.
Conclusion: The different thermal vessel sealing devices left
different thermal imprints. In this in vitro study, the SurgRx
Enseal 5 mm laparoscopic vessel sealing device produced the
least thermal spread to surrounding tissues.
P346–Minimally Invasive Other
THE ROLE OF LAPAROSCOPY IN THE DIAGNOSIS AND MAN-
AGEMENT OF CHRONIC SMALL BOWEL OBSTRUCTION: A
CASE REPORT., Alexander J Ernest Jr. MD, M Chung MD,S
Zagorski MD, Department of Surgery, Tripler Army Medical
Center. Honolulu, HI.
Abstract
Background: We present a case of laparoscopic exploration
performed for a chronic small bowel obstruction, which was
diagnostic and therapeutic.
Case Report: A 46-year-old woman with a 20-year history of
chronic abdominal pain presented with frequent nausea, emesis,
and diarrhea. Her past surgical history is significant for a
leiomyoma of the jejunum excised as an infant. The patient is
an avid martial artist so we planned to perform a laparoscopic
resection of the likely stricture at the jejunum versus a limited
incision laparotomy guided by laparoscopy. During the
exploratory laparoscopy we encountered extensive adhesions
and a massively dilated segment of jejunum. Thus, a limited
laparotomy incision was placed in the midline for open exploration,
entailing adhesiolysis and resection of the dilated small
bowel with primary anastomosis. An area of mesenteric
adenopathy was also identified and resected. The pathology
and subsequent work-up revealed stage 1 low-grad follicular
lymphoma for which observation has been recommended. The
patient was discharged on post op day number 5 and has
returned to her normal activities, including martial arts training,
within 6 weeks of the operation.
Conclusion: This case illustrates the role of laparoscopy in the
diagnosis and treatment of chronic small bowel obstruction.
Its use can result in ?minimal laparotomy?, if needed, to facilitate
rapid recovery.
P347–Minimally Invasive Other
THE ROLE OF ERYTHROPOIETIN IN SURGERY, Sameh A Fayek
MD, Raymond L Horwood MD,Joseph Thomas RN, FAIRVIEW
HOSPITAL,DEPARTMENT OF SURGERY, CLEVELAND CLINIC
HEALTH SYSTEM
INTRODUCTION
In surgical patients anemia is a predictor of mortality and morbidity;
its prevalence ranges from 5-75% and is often the only
reason for blood transfusion. Pretreatment hemoglobin (Hb) is
a predictive factor of transfusion (1). Transfusion is a common
practice but blood is a limited resource and is associated with
significant risks (2). Recombinant human erythropoietin
(rHuEPO) stimulates erythropoiesis. Preoperative HuEPO is
proposed to increase preoperative Hb to produce a higher
early postoperative Hb. Also it is expected to accelerate postoperative
erythropoietic recovery hence, preventing anemia
and reducing the need for transfusion.
METHODS AND PROCEDURES
This is an observational study comparing data from two
patient groups. Study group included eighteen patients undergoing
major orthopedic surgery from October 2003 to May
2004, with Hb >10 and