2005 SAGES Abstracts

POSTER ABSTRACTS
In the past we focused on robotic systems development, with
which we were the first to experiment internationally. We continued
research towards the development of a simple mechanical
suturing device, enabling angulation and rotation of the
tip.
The instrument was developed by the company Tuebingen
Scientific in Tuebingen, Germany. The handle system is
designed ergonomically and it is hold by the whole hand.
Angulating the handle means flection of the tip, stretching the
handle means to put the tip in a straight position. Rotation of a
knob at the tip of the handle allows rotation of the tip of the
instrument.
Following experimental evaluation which was highly successful,
we started clinical application. Today we have performed
the suturing of meshes on 10 patients in inguinal hernia. The
technique is based on continuing suture of the mesh to the
inguinal ligament. Also the fixation to the anterior abdominal
wall together with the peritoneum is performed by the use of
the suturing device.
In 3 patients mesh was sutured to the anterior abdominal wall
in patients with abdominal wall hernias. In 2 patients the
mesocolon was closed following right colonic resection.
Conclusions
The new suturing device permits in an easy and ergonomic
way sutures at the front of the tip of the instrument and
sutures at the anterior abdominal wall. The principles of suturing
can be compared to the robotic system DaVinci. Compared
to this, the handling of the RADIUS surgical system is much
more easy, does not need any time for installation of the technology
and the price of the system is much less, compared to
robotic systems.
We are convinced that mechanical manipulators, as the
RADIUS surgical system, will allow better and more precise
manual suturing, compared to conventional straight instruments.
P375–New Techniques
SIS MESH FOR LAPAROSCOPIC INGUINAL HERNIA REPAIR- 5
YEAR FOLLOW UP, David S Edelman MD, Laparoscopic
Surgery Center, Baptist Hospital, Miami, Florida
Intro: Synthetic mesh is routinely used for inguinal hernia
repair. Porcine small intestine submucosa (SIS) mesh has been
successfully tested and used in animal models with excellent
results. This mesh is degradable, resorbable and had significant
fibroblastic ingrowth equal to polypropylene mesh.
Methods: Beginning August, 1999 a prospective study was
begun using SIS mesh and laparoscopy in a pre-peritoneal
approach to repair per-primum hernias. A 7x10 cm mesh was
placed, uncut, over the myopectinate orifice and secured with
5 tacks. Patients have were followed at 2 weeks, 6 weeks, 6
months and yearly.
Results: The surgeon has an experience of over 800 laparoscopic
inguinal hernia operations. There were 50 patients having
61 hernias studied. There were 16 direct, 42 indirect, 2 pantaloon
and 1 femoral hernia repaired. Operative time averaged
32 minutes. There were no major complications. Nine (9)
patients developed seromas, 12 had pain lasting over 7 days
requiring medication, 4 had swelling/orchitis and 5 patients
(10%) developed a recurrent hernia.
Conclusions: The recurrences were technical complications
due to the small mesh size. It is unclear if the pain, seroma
and swelling is a host versus graft reaction to the mesh which
led to the hernia recurrences. The subgroup of 10 Sport?s
Hernia patients did not have the same problems. However, it is
concluded that at 5 years, SIS mesh can be used for inguinal
hernia repairs and further technical modifications along with a
prospective- randomized trial comparing SIS to other mesh is
necessary.
P376–New Techniques
REPAIR OF A COMPLEX FOREGUT HERNIA AIDED BY NOVEL
THREE-DIMENSIONAL SURGICAL RECONSTRUCTION,
Stephen M Kavic MD, Ross D Segan MD,Patricia L Turner
MD,Ivan M George,Adrian E Park MD, University of Maryland,
Baltimore
Recent imaging technology has allowed sophisticated reconstructions
based on high-resolution computerized tomography.
Here, we present a case of complex foregut herniation in
which image reconstruction was invaluable. An 84-year-old
woman was referred with a diagnosis of incarcerated paraesophageal
hernia. Her medical history was significant for a history
of hiatal hernia and a remote motor vehicle collision. She
described left-sided chest pain and nausea, and was found to
have leukocytosis. Polygonal mesh surface modeling techniques
with color enhancement were utilized to render dynamic
three-dimensional (3-D) CT-based models of the patient?s
hernia. Reconstruction revealed a large herniation of both the
stomach and a portion of the liver through a defect in the
diaphragm (see Figure).
Images obtained using this novel technique suggested a posttraumatic
etiology. The accuracy of the predicted anatomic
relationships by 3-D reconstruction was demonstrated at
laparotomy, where the patient was noted to have a diaphragmatic
hernia with incarcerated stomach and liver. After reduction
of the hernia contents, gastropexy with gastrostomy tube
placement was performed in preparation for staged, definitive
repair of the diaphragm. This case illustrates that 3-D anatomic
reconstructions can be a powerful aid in preoperative planning.
P377–New Techniques
LAPAROSCOPIC VERTICAL SLEEVE GASTRECTOMY (VG) FOR
MORBID OBESITY: A NEW RESTRICTIVE BARIATRIC OPERA-
TION, Crystine M Lee BA, Janos Taller BA,John J Feng
BA,Paul T Cirangle MD,Gregg H Jossart MD, Dept. of Surgery,
California Pacific Medical Center
INTRO: The VG is the restrictive part of the technically difficult
biliopancreatic diversion with duodenal switch operation (DS).
The rationale of performing the VG as an independent operation
was as the first stage of a two-stage DS that would reduce
perioperative mortality and morbidity in high-risk super-obese
patients through a shorter OR time and lack of anastomoses.
METHODS: Typically, 5-6 trocars are placed in the supine
patient. Starting at a point 6cm proximal to the pylorus, a
greater curvature gastrectomy is performed along a 32 Fr
bougie, using 5-7 firings of 45-60mm linear 3.5mm GI staplers,
thus creating a 60-80ml gastric tube. Bioabsorbable
Seamguards® are used to buttress the staple-line from the
third firing onwards. A methlyene blue leak test is performed
prior to removal of the bagged stomach from an enlarged trocar
site.
RESULTS: Between Nov 2002 and Sep 2004, 68 patients underwent
VG. The mean age was 46.1±11.2 years and 72% were
female. The mean preop weight and BMI was 335±89 lbs and
53.2±11.9 kg/m2, respectively. Compared to 66 patients who
underwent laparoscopic DS, the mean OR time was 102±29 vs
229±43 for DS; the mean EBL was 44±22 cc vs 94±48 for DS
(P