2005 SAGES Abstracts

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POSTER ABSTRACTS <strong>SAGES</strong> <strong>2005</strong> 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),
POSTER ABSTRACTS total traveling distance of the tips of the surgical instruments (D), and mean absolute relative phase between both instrument tips (MARP) were measured and statistically analyzed. The results revealed significant reduction in T for all three tasks and in D for the NP and ST tasks (p
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POSTER ABSTRACTS Posters of Distinc
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POSTER ABSTRACTS P076 MURPHY, JASON
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POSTER ABSTRACTS P152 CHOKKI, ADEL
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POSTER ABSTRACTS P235 YASUI, M “L
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POSTER ABSTRACTS P312 AGRESTA, FERD
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POSTER ABSTRACTS FUNDOPLICATION TO
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POSTER ABSTRACTS In two groups of 5
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POSTER ABSTRACTS Carvalho PhD, Debo
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POSTER ABSTRACTS tive procedures on
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POSTER ABSTRACTS invasive procedure
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POSTER ABSTRACTS allows identificat
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POSTER ABSTRACTS Laparoscopic gastr
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POSTER ABSTRACTS Results: A total o
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POSTER ABSTRACTS P054-Bariatric Sur
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POSTER ABSTRACTS laparoscopic Gastr
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POSTER ABSTRACTS P070-Bariatric Sur
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POSTER ABSTRACTS becomes increasing
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POSTER ABSTRACTS MD,Ajay K Chopra M
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POSTER ABSTRACTS to have a fewer co
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POSTER ABSTRACTS RESULTS: The mean
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POSTER ABSTRACTS surgeons working i
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POSTER ABSTRACTS One patient had un
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POSTER ABSTRACTS operative time, na
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POSTER ABSTRACTS divided to two maj
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POSTER ABSTRACTS tomies during this
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POSTER ABSTRACTS tumor. Discussion:
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POSTER ABSTRACTS to avoid dissemina
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POSTER ABSTRACTS sure of a gastric
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POSTER ABSTRACTS subjects had used
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POSTER ABSTRACTS (CS2) tasks, and 5
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POSTER ABSTRACTS P180-Education/Out
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POSTER ABSTRACTS laparoscopic equip
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Page 107 and 108: POSTER ABSTRACTS J Lomax MD,Christi
Page 109 and 110: POSTER ABSTRACTS METHODS: A databas
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Page 115 and 116: POSTER ABSTRACTS Introduction Radic
Page 117 and 118: POSTER ABSTRACTS and GERD symptom s
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Page 123 and 124: POSTER ABSTRACTS Esophageal aperist
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Page 127 and 128: POSTER ABSTRACTS LIHR group (27.5%
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Page 135 and 136: POSTER ABSTRACTS CONCLUSION: The su
Page 137 and 138: POSTER ABSTRACTS Results: 7 perfora
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2005 SAGES Abstracts

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