2005 SAGES Abstracts

POSTER ABSTRACTS
MS,Susan Hallbeck PhD, University of Nebraska Medical
Center
Introduction:A prototype articulating laparoscopic grasper tool
which includes an articulating end effector, an ergonomic handle,
and an intuitive hand/tool interface has been developed.
This study investigated the evaluation of the prototype tool by
surgeons and comparison with existing tools.
Methods: A questionnaire was developed to ask surgeons
about problems they experience associated with use of conventional
tools and then query their opinions of the prototype
tool. Generalized results were obtained through use of a
Wilcoxon Signed Rank Test utilizing ranking with zeros for
each hypothesis test. Results: Tests on problems such as
hand/wrist pain, shoulder pain, finger tingling/numbness, etc.
produced significant results for the number of surgeons experiencing
each of the queried problems. A significant number of
surgeons (p=0.045) identified the prototype handle as either
comfortable or extremely comfortable. A significant number of
surgeons (p=0.015) preferred the prototype tool over conventional
tools, based on general impression. Fifteen of the 18
surgeons queried said they would try a commercially available
version of the prototype tool.
Conclusion: Articulation of the tip has been successfully
designed in the prototype and 90% of the respondents
believed the articulation to be a useful addition to laparoscopic
graspers. The new shape of the handle is considered comfortable
by a significant number of respondents. Most respondents
believe the new design will relieve at least one problem
currently experienced during surgery.
P360–Minimally Invasive Other
PERCUTANEOUS GASTROJEJUNOSTOMY AFTER LAPARO-
SCOPIC ROUX-EN-Y GASTRIC BYPASS FOR MALNUTRITION,
Anthony E Pucci MD, Alexander Abkin MD,Nicholas Bertha
MD,Sean Calhoun MD,Fred Brody MD,Edward A Pucci MD,
Department of Surgery and Interventional Radiology,
Morristown Memorial Hospital, Morristown, NJ and The
Department of Surgery, The George Washington University
Medical Center, Washington, D.C.
In the severely malnourished postoperative patients, nutritional
support is necessary to maintain normal body structure and
function. Currently, percutaneous placement of feeding
catheters for these patients is performed utilizing an endoscopic
approach. However, a Roux-en-Y gastric bypass prohibits
endoscopic techniques and other methods must be considered.
This paper documents a patient that required a CT
guided placement of a feeding catheter following a Roux-en-Y
gastric bypass.
A 49-year-old male with a history of atrial fibrillation, morbid
obesity, and insulin dependant diabetes mellitus, underwent
an uneventful laparoscopic Roux-en-Y gastric bypass. One
month post operatively, the patient was readmitted with nausea
and vomiting. Laboratory data revealed that the patient
was profoundly coagulopathic with an INR of 6. His workup
included an upper gastrointestinal series which was negative
for a leak. A CT scan of the abdomen and pelvis revealed a
large mesenteric hematoma. The patient was resuscitated with
fresh frozen plasma, packed red blood cells and crystalloid.
Subsequently, he developed ARDS requiring prolonged ventillatory
support. The patient then had a protracted course in the
intensive care unit for secondary complications including sepsis
and malnutrition. Parenteral nutrition was initially started.
Nasoenteric tube feeds were started. However, a permanent
feeding catheter was required for nutritional support.
Subsequently, the patient underwent a CT guided placement
of a 14 French gastrostomy tube. This tube was placed into the
gastric remnant with interventional radiology. However, due to
high gastric residuals and poor gastric emptying, the gastrostomy
tube was converted to a gastrojejunostomy tube utilizing
fluoroscopy. An 18 French, 30 cm gastrojejunostomy tube was
placed. Enteric feeds were resumed through the jejunostomy
port while the gastric remnant was decompressed via the gastric
port.
CT guided percutaneous gastrojejunostomy offers a minimally
invasive way to provide enteral feeding as well as gastric remnant
decompression after Roux-en-Y gastric bypasses. This
method provides a safe alternative to conventional open surgery
in high risk patients and should be considered over gastrostomy.
As the number of gastric bypasses continues to
increase, this technique may become more prevalent.
P361–Minimally Invasive Other
WHO GETS LAPAROSCOPY FOR APPENDICITIS, DO DISPARI-
TIES EXIST?, R Ricciardi MD, R J Town PhD,T A Kellogg MD,S
Ikramuddin MD,N N Baxter MD, Department of Surgery,
University of Minnesota, Minneapolis, MN
INTRODUCTION: Laparoscopic approaches to appendectomy
are feasible and are associated with reduced pain, faster
recovery, and fewer complications. Utilization of laparoscopic
approaches for the treatment of appendicitis has increased
steadily since its introduction. No previous research has evaluated
the utilization of laparoscopic techniques or potential factors
influencing access to laparoscopic appendectomy (LA).
METHODS: We used data from the Nationwide Inpatient
Sample (NIS), a 20% stratified random sample of US community
hospitals in 33 states. Utilizing standard ICD-9-CM diagnostic
and procedure codes, we identified patients who were
admitted to the hospital with a diagnosis of uncomplicated
appendicitis and subsequently underwent appendectomy from
2001 to 2002. Standard procedure codes were utilized to identify
patients who underwent LA or open appendectomy (OA).
We determined the influence of demographic factors, such as
gender, race, payer information, and provider factors such as
hospital size, rural or urban setting, geographic location, funding
structure, teaching status, and hospital procedure volume
on the utilization of LA. A multivariate model was constructed
to determine the influence of demographic and provider factors
on utilization of LA. RESULTS: A total of 77,909 patients
were admitted with a diagnosis of uncomplicated appendicitis
and underwent appendectomy during the two year time period,
of these 33.9% underwent LA. In multivariate analysis
women, older patients, and patients with private health insurance
were more likely to undergo LA while African-Americans
were less likely to undergo LA. Private for profit hospitals and
hospital procedure volume were associated with increased utilization
of LA, but teaching status, geographic location, and
hospital size were not. CONCLUSIONS: Overall, despite known
advantages, in 2001-2002 only one third of patients with
appendicitis underwent LA in the US. Utilization of LA appears
to be influenced by demographic and provider factors, a number
of which (including race and hospital financial structure)
are unlikely to be related to disease severity. These data indicate
disparities in the application of laparoscopic techniques.
P362–Minimally Invasive Other
LAPAROSCOPIC SUTURING OF TENCKHOFF CATHETER TO
PREVENT RE-OPERATION FOR DISPLACEMENT, Sam Rossi
MD, Dai Nghiem MD,Chris Haughn MD,Roberto Bergamaschi
PhD, Minimally Invasive Surgery Center and Transplantation
Service, Allegheny General Hospital, Pittsburgh, PA
Patients with end-stage renal disease (ESRD) may need to
undergo placement of a Tenckhoff catheter for peritoneal dialysis.
The prevention of displacement of the catheter has been
traditionally based on the length of the tunnel within the
abdominal wall. However, re-operation rates due to displacement
of the catheter have not been low. This study aims to
evaluate prospectively the impact of laparoscopic suturing of
Tenckhoff catheter on rates of re-operation for displacement.
From 1986 to 2003, 216 patients underwent Tenckhoff catheter
placement for ESRD at Allegheny General Hospital. Over these
18 years, there was a re-operative rate of 16.6% (32/216
patients) due to persistent abdominal pain with displacement
of the catheter towards the upper abdominal quadrants.
Laparoscopic suturing of Tenckhoff catheter was started in
2003. The surgical technique involves general or local anesthesia,
CO2 pneumoperitoneum and three ports. A Hasson port is
placed below the umbilicus to establish the pneumoperitoneum.
Two 5-mm ports are placed in the upper quadrants.
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SAGES 2005
221