2005 SAGES Abstracts

EMERGING TECHNOLOGY LUNCH ORAL ABSTRACTS
actions at the home location which are communicated back to
the remote station over the Internet. The RP6? system allows
the remote party (physician, etc.) to control the movements of
the robot itself, see and hear at the home location (hospital),
and be seen and heard at the home location (hospital) while
not physically being there.
Results: Deployment of the system at the hospital was accomplished
in less than a day. The wireless network at the institution
was already in place. Control station setup ranged from 1
to 4 hours and was mostly dependent on the quality of the
Internet connection (bandwidth) at the remote locations.
Patients visited with the RP6? on their discharge day were able
to be discharged > 4 hours earlier than with conventional visits,
thereby freeing up hospital beds on a busy med-surg floor.
Patient visits during ?off hours? (nights and weekends) were 3
times more efficient than conventional visits during these
times, (20 minutes/visit vs. 40 minutes round trip travel + 20
minute visit). Patients and nursing personnel both expressed
tremendous satisfaction with the remote presence interaction.
Conclusions: Our early experience suggests a significant benefit
to patients, hospitals, and physicians. The implications for
future development are enormous.
ET008
ULTRASOUND-GUIDED LAPAROSCOPIC SURGERY SYSTEM,
Philip Bao MD, Robert Galloway PhD,Alan Herline MD,
Vanderbilt University Hospital
Objective: Metastatic and primary liver tumors pose a significant
clinical problem for patients and cancer surgeons. Only
approximately 20% of these lesions are resectable with standard
open surgery, and this has motivated interest in less invasive
alternative procedures such as laparoscopic radiofrequency
ablation (RFA). Intra-operative imaging with ultrasound is
critical to successful positioning of the RFA probe especially
during laparoscopic surgery, as the surgeon cannot rely easily
upon tactile cues. Also, needle placement is important for
tumors larger than 3cm because they are often more irregular
in shape and require multiple overlapping ablations. To augment
tumor visualization and targeting, we have developed a
tracked laparoscopic ultrasound targeting system for liver RFA.
Description of technology and application: A laparoscopic
ultrasound probe has been modified to permit tracking by an
infrared camera. By tracking the standard two-dimensional
images output from the ultrasound machine, we are able to
reconstruct three-dimensional ultrasound volumes that can be
examined from multiple views much like computer tomography
reconstructions of the spine or blood vessels. Moreover,
this volume is spatially related to the physical space of the
patient and can be used to guide a tracked RFA probe. After
the tumor is identified in the volume and an insertion point for
the RFA needle is selected, a targeting system is activated
which displays the proposed trajectory to the tumor and its
distance from insertion. The user may then inspect the path to
ensure that no critical structures intervene. A new insertion
point and needle path may be chosen, or if satisfactory, the
probe is advanced until the distance between target and probe
reaches zero. Preliminary results using this system on an
experimental model show that we can target the center of a
tumor within 10mm.
Conclusions: Image-guided technology has a future role in
assisting surgeons particularly during complex laparoscopic
procedures which already depend to some degree on intraoperative
imaging. This technology is a powerful and relatively
cost-effective tool that has the potential to allow surgeons to
perform procedures more efficiently and safely. In the future,
we hope to apply this tracked ultrasound system to laparoscopic
liver resections as well.
ET009
REFLUX (ACID OR NON-ACID) DETECTED BY MULTICHANNEL
INTRALUMINAL IMPEDANCE-PH TESTING PREDICTS GOOD
SYMPTOM RESPONSE FROM FUNDOPLICATION, Inder Mainie
MD, Radu Tutuian MD,Amit Agrawal MD,Amine Hila
MD,Janice Freeman RN,Donald O Castell MD, Medical
Universtity of South Carolina
Background: Combined Multichannel Intraluminal Impedance
(MII) detects gastroesophageal reflux (GER), of all types and is
used in the diagnosis of typical and atypical symptoms persisting
despite PPI therapy. Laproscopic Nissen fundoplication
(LNF) is a recognized treatment for patients with a diagnosis
of GER.
Aim: To determine the outcome of LNF as a treatment for
patients with persistent symptoms identified as due to reflux
by MII-pH on PPI BiD.
Method: 14 patients (Female 12; mean age 40; range 8 months
? 78 years) evaluated using MII-pH were followed after LNF. All
patients except one had a positive symptom index (SI) for acid
(AR) or non-acid (NAR) reflux during pre-operative testing.
Chart review or contact by phone was used to document
patient response to surgery.
Results: Mean period of follow-up was 6.5 months (1 month ?
15 months). Eleven patients after LNF were asymptomatic and
off anti-reflux medication. Of the 11 asymptomatic patients 6
were diagnosed with a positive SI for cough with NAR, 3 with
a positive SI for heartburn with acid reflux, 1 with a positive SI
for nausea with acid reflux and 1 with a positive SI for regurgitation
with NAR. 1 patient did improve after surgery but at 10
months was taking a proton pump inhibitor on a required
basis and 1 patient had a recurrence of her symptoms
(hoarseness) 8 months after surgery. One patient had a recurrence
of symptoms (heartburn) at 8 months but was noted to
have a negative symptom index on MII-pH evaluation.
Conclusion: A positive SI for non-acid or acid reflux using MIIpH
predicts successful response to laproscopic Nissen fundoplication.
ET010
LAPAROSCOPIC TREATMENT OF EARLY STAGE COLORECTAL
TUMORS CHASED BY MAGNETIC CLIP DETECTING AND
CHASING SYSTEM (MCDCS): USEFULNESS OF A MAGNETIC
FORCE CHANGEABLE FORCEPS, Takeshi Ohdaira MD, Hideo
Nagai MD, Jichi Medical School Hospital
Aim: In laparoscopic surgical treatment of early stage colorectal
carcinomas, intraoperative tumor site identification is often
difficult. We have developed a novel detecting and grasping
device of laparoscopic usage. We used a magnetic clip for the
marking and the staying point of the lesion. Methods: We
applied a 300 mT magnetic marking clip near the oral edge of
the tumor during preoperative colonoscopy and identified the
clip by using a magnetic clip detecting and chasing system
(MCDCS) with magnetic force changeable ability. At first, during
operation, we identified the lesions under a condition of a
weak magnetic force of MCDCS. Then the magnetic force level
of MCDCS was increased to obtain efficient holding power,
and the colon was resected under simultaneous chasing and
grasping of the marking site. Results: In a basic ex vivo study,
100 mT magnetic force was easily detected with 100% of
detection ratio and 600mT magnetic force was necessary to
constantly chase and grasp the lesion. In a clinical study, the
marking site was detected in all the 13 patients. The mean
length between the detected site and the clip along the longitudinal
bowel axis was 10.8 mm (S. D., 4.6). The mean detection
time was 8.4 seconds (S. D., 2.5). Even the marking clip
on the retroperitoneal and mesenteric side, MCDCS can readily
detect the site through the anti-mesenteric bowel wall.
Conclusion: MCDCS accurately identifies a tumor site and easily
treats the colon and rectum with chasing tumor site. This
device may be useful to easily resect the tumor in laparoscopic
surgery.
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SAGES 2005
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