2005 SAGES Abstracts

POSTER ABSTRACTS
SAGES 2005
obstruction prompted a re-exploration but no abnormalities
were found and his ileus resolved by post-op day 5. He was
discharged on post-op day 6. He has since undergone bone
marrow transplant and is still in therapy.
Conclusion: Robotic surgery is a safe and effective method for
resecting malignancies in selected pediatric patients.
Dissection can be facilitated by the ability to articulate the
robotic instruments and the magnified 3-D image. Further
study of this technology is warranted as it may increase the
variety of procedures which can be safely performed using a
minimally invasive approach.
P387–Robotics
ROBOTIC-ASSISTED HELLER MYOTOMY REDUCES THE INCI-
DENCE OF ESOPHAGEAL PERFORATION, Carlos Galvani MD,
Santiago Horgan MD,M V Gorodner MD,F Moser MD,M
Baptista MD,A Arnold MD,G Jacobsen, University of Illinois at
Chicago
Background: Laparoscopic Heller myotomy has become the
standard treatment option for achalasia. The incidence of
esophageal perforation reported is about 5 to 10%. Data about
the safety and utility of the robotically assisted approach are
scarce. The aim of this study is to assess the efficacy and safety
of the robotically assisted Heller myotomy (RAHM) for treatment
of esophageal achalasia.
Methods: Review of prospectively maintained database was
performed. We analyzed demographic data, symptoms, esophagogram,
esophageal manometry, intraoperative and postoperative
data of all the RAHM performed at our institution
between 9/02 and 2/04.
Results: 54 patients underwent RAHM for achalasia; 26 were
men, mean age of 43 years (14-75). Dysphagia was present in
100% of patients.
Of the 26 patients (48%) who had previous treatment, 17
patients had pneumatic dilation, 4 patients had BOTOX injections,
and 5 patients had both. The dissection was performed
laparoscopically and the robotic surgical system was used for
the myotomy. Operative time averaged 162 minutes (62-210),
including robotic setup time. Blood loss averaged 24 ml (10-
80). No mucosal perforations were observed. Average length
of hospital stay was 1.5 days. There were no deaths. At the
average follow-up of 17 months, 93% of patients had relief of
their dysphagia.
Conclusions: this study proved RAHM to be a safe and effective
alternative at our institution, since it decreases the incidence
of esophageal perforation to 0% and provides relief of
symptoms in 93% of the patients.
P388–Robotics
LAPAROSCOPIC ROBOTIC ASSISTED SWENSON PULL-
THROUGH FOR HIRSCHSPRUNG?S DISEASE IN INFANTS,
Andre Hebra MD, Claudia B Moore MPA,Beverly McGuire
RN,Gail Kay MD,Richard Harmel MD, All Children’s Hospital,
University of South Florida
Purpose: Infants with Hirschsprung?s disease can be treated
with a one stage laparoscopic colo-anal pull-through without a
colostomy. However, the feasibility and benefits of performing
this operation using robotic technology has not yet been evaluated.
Methods: We reviewed our experience with 10 infants (age
less than 7 months of age) treated with either laparoscopic
pull-through (n=5, group 1) or robotic pull through (n=5, group
2). The average age was 16 weeks for patients in group 1 and
20 weeks for group 2.
Results: The average operative time was 190 minutes for
group 1 and 260 minutes for group 2. Group 1 patients
received a modification of the Soave technique (partial proctectomy
with mucosectomy) and group 2 received a modification
of the Swenson operation (total proctectomy). Average
length of stay was 3 days for patients in either group. No complications
were recorded. All patients in group 1 required postoperative
rectal dilations for management of rectal strictures.
Only 3 patients in group 2 required dilations.
Conclusions: Our experience indicates that robotic assisted
pull-through can be safely performed in young infants.
Operative time was longer in patients treated with robotic surgery
and length of hospital stay was the same. An important
228 http://www.sages.org/
observation was the fact that the robotic technology provided
superior dexterity and visualization, essential in performing a
more complete rectal dissection beyond the peritoneal reflection.
Thus a complete proctectomy, as originally described by
Swenson, could be accomplished. This may account for the
fact that rectal strictures were less common in patients of
group 2. Although our experience is limited because of the
small number of patients, we were able to identify technical
advantages unique to the use of robotic technology that will
likely be of great benefit to pediatric patients undergoing
laparoscopic colo-rectal surgery.
P389–Robotics
LAPAROSCOPIC ULTRASOUND NAVIGATION IN LIVER
SURGERY - TECHNICAL ASPECTS AND ACCURACY, Markus
Kleemann MD, Phillipp Hildebrand MD,Hans-Peter Bruch
MD,Matthias Birth MD, University Hospital of Schleswig-
Holstein - Campus Lübeck, Germany
Introduction: Despite recent advances in laparoscopic techniques
and instrumentation, laparoscopic liver surgery is still
limited to selected patient population. One major reason may
be the lack of orientation during dissection of liver parenchyma.
After establishing an ultrasound navigated system for
open liver surgery with online-navigation, we will use this
technique also in laparoscopic surgery to navigate under
laparoscopic ultrasound control e.g. interventional ablation
procedures or liver resections.
Material and Methods: We used a six-degrees-of-freedom electromagnetic
tracking system. First the adapter was placed at
the head of the laparoscopic ultrasound probe to connect the
electromagnetique tracker to the adapter. For calibration with
an ultrasound phantom, the distance between adapter and
ultrasound probe has to be determined and calibrated with the
software of the navigation system. Then the other tracker was
placed at a laparoscopic dissection instrument built for laser
dissection and calibrated as mentioned above. In phantom
testing and in a liver organ model the virtual resection line is
then overlain to the laparoscopic ultrasound picture and offers
the possibility of navigated ablation or resection. In a second
step the system was integrated in a liver organ model to
detect disturbances due to trocar and camera instruments.
Results: Laparoscopic navigation of the dissection instrument
under ultrasound navigation is technically feasible. Even in
cases of angulation of the tip of the ultrasound probe no disturbances
of the navigation system were obvious, due to close
approximation of the laparoscopic ultrasound head and electromagnetique
sensor. Anatomic landmarks in liver tissue
could be safely reached. No interaction of the electromagnetique
tracking system and the lapaoscopic equipment could be
seen.
Conclusions: Laparoscopic navigation opens a new field in
minimally invasive liver procedures.
P390–Robotics
THE EFFECTS OF TRAINING ON THE PERFORMANCE OF
ROBOTIC SURGERY: WHAT ARE THE OBJECTIVE VARIABLES
TO QUANTIFY LEARNING?, Kenji Narazaki BS, Dmitry
Oleynikov MD,Jesse J Pandorf BS,Benjamin M Solomon
BS,Nicholas Stergiou PhD, University of Nebraska Medical
Center and University of Nebraska at Omaha
Computer assisted surgery promises ease of use and mechanical
precision. However, little is known about the learning
strategies for this new surgical technique. The aim of this
study is to evaluate the effects of a training program on
enhancing surgical performance using the da Vinci surgical
system and to identify objective variables to quantify the
extent of learning and dexterity.
Seven medical students, completely novice users of the system,
were asked to participate in a designed training protocol.
Each subject practiced three inanimate surgical tasks, bimanual
carrying (BC), needle passing (NP) and suture tying (ST),
with the robotic system for a total of six training sessions during
a three weeks period. Kinematic data from the force transducers
built within the system were collected with the help of
a computerized user interface. Task completion time (T), correlation
of variation between cyclic intervals in a task (CVI) and
between maximum velocities in respective intervals (CVV),