2005 SAGES Abstracts

EMERGING TECHNOLOGY LUNCH POSTER ABSTRACTS
SAGES 2005
246 http://www.sages.org/
TP021
INTRA-OPERATIVE TELECONSULTATION IN LAPAROSCOPIC
SURGERY: A COST EFFECTIVE ALTERNATIVE FOR THE
DEVELOPING NATIONS, Ajay P Singh MS, Ravinder P Singh
MS,Harinder Kaur MD,Subash Batta MS, Punjab Health
Systems Corporation Civil Hospital, Ludhiana
Objective
The objective of the current presentation is to highlight how
the newer technologies of telementoring, live streaming and
audio video modes of connection can influence the patient
outcome by instant re-sourcing of expert opinion regardless of
time and space. Broadband Internet which forms the platform
for telemedicine in the developed nations is either not easily
available or is very expensive in most parts of the third world
and the required hardware may not be within the reach of
many small centers. Hence we developed a device, which can
communicate using the already existing telecommunication
modes requiring minimum hardware and respecting the financial
constraints.
Method
The basis of this technology is development of an image-synchronizing
device constructed from the available videophones.
This videophone was modified to improve its resolution and
enhance its connectivity, which enabled it to receive and transmit
real time images without compromising the quality, using
the existing cellular and regular telephone networks.
Broadband Internet although worked well was never used.
This device consisted of a camera, a high-resolution screen
and an audio channel. The size of this device is smaller than
that of a Laptop computer. A group of 15 experts in the field of
laparoscopic surgery was constituted and given one such
device each and were requested to carry it at all possible
times. One such device was kept in the operating room connected
to the monitor of the laparoscope. In the time of need
the device was switched on and the expert was contacted as
per the preference order in the roster and was asked to connect
the device to the telephone or the cellular channel used
initially to contact him. He then gave his expert opinion after
seeing the images being transmitted to his device.
Results
We have been using this system for more than six months and
have sought help in 42 cases and received instant response in
36 cases. In 4 cases the expert was unable to comment
because of poor image quality. In the remaining 32 cases the
operating surgeon was benefited by the expert advice.
Conclusion:
This technique is inexpensive and appropriate in procuring
instant intra-operative consultation without having a setup for a
formal video conferencing. It is very useful in the early phase of
learning curve and still has a great potential for its upgradation
TP022
A DUAL-CHANNEL CO2 INSUFFLATOR: A MULTIFUNCTIONAL
DEVICE FOR WIDER CO2 APPLICATIONS, Kiyokazu Nakajima
MD, Keigo Yasumasa MD,Shunji Endo MD,Tsuyoshi Takahashi
MD,Akiko Nishitani MD,Riichiro Nezu MD,Toshirou Nishida
MD, Department of Surgery, Osaka University Graduate
School of Medicine - Osaka Rosai Hospital, Osaka, Japan
Background: Carbon dioxide (CO2), with its rapid absorptive
nature, has been more widely used in various clinical settings.
The authors first proposed simultaneous (i.e. intraoperative)
use of CO2 insufflation for both laparoscopy and colonoscopy
and presented the preliminary data at SAGES 2004 meeting:
CO2-insufflated colonoscopy during laparoscopy is feasible,
safe and is of practical value to minimize persistent bowel distention
without impeding subsequent laparoscopic visualization
and procedure (Nakajima K et al, Surg Endosc 2005, in
press). In that study we used a CO2 feeding system (for
colonoscopy) in addition to a conventional automatic insufflator
(for laparoscopy), since conventional insufflators have
been designed solely for creation and maintenance of CO2
pneumoperitoneum and were not suitable for other purposes.
In collaboration with Olympus R&D department, we therefore
are developing more flexible device, a dual-channel CO2 insufflator,
which provides one channel for standard pneumoperitoneum
and the other for various applications (e.g. CO2-insufflated
colonoscopy, CO2-leak test for rectal anastomosis).
The prototype: The device prototype, sized 295mm (W) x
340mm (D) x 150mm (H), provides one CO2 inlet connected to
a regular CO2 gas cylinder, and two CO2 outlets positioned on
the front and back of the device, respectively. The CO2 gas fed
from the cylinder, is pressure-regulated and divided into two
independent conduits inside the device. The front outlet feeds
CO2 gas for pneumoperitoneum at electronically-controlled
pressure and flow rate. The back channel supplies CO2 gas at
fixed flow rate (1.8 L/min), allowing manual control of insufflation
for various purposes.
Preliminary results: CO2-insufflated colonoscopy was attempted
during laparoscopy on 4 canine models using the above
prototype. Pneumoperitoneum was established and maintained
successfully by utilizing the front channel of the device.
Colonoscopy was performed simultaneously with CO2 gas fed
from the back channel. There was neither device malfunctions
nor device-related complications. The overall performance of
the prototype was satisfactory.
Summary and future directions: The device enables two different
modes of CO2 insufflation at the same time from a single
CO2 cylinder. Although the current prototype provides only
fixed mode of CO2 insufflation from the back channel, the
authors are now improving its function to allow wider use of
CO2 in the operating room.
TP023
TISSUE PRE-COAGULATION WITH THE NEW RADIO FRE-
QUENCY INLINE® DEVICE IMPROVES SURGICAL HEMOSTA-
SIS, Steven A Daniel BS, Koroush S Haghighi MD,Taras Kussyk
MD,David L Morris MD, UNSW Department of Surgery, St
George Hospital, Sydney
Introduction
Achieving adequate hemostasis during liver resections is particularly
difficult due to the vascular nature and complicating
factors including cirrhosis, post chemotherapy fibrosis, and
fatty liver disease. High blood loss during liver resections is
known to result in increased rates of both operative and post
operative morbidity and mortality. The cost of poor hemostatic
control can be significant. This paper presents clinical results
for the InLine®, a new pre-coagulation Radio Frequency (RF)
device that reduces both transection blood loss and transection
time.
Method
45 patients with primary or metastatic liver tumors underwent
open surgical resection with pre-coagulation of the resection
plane using the InLine® RF device (Resect Medical, Inc.,
Fremont, CA) prior to the transection. Standard surgical procedures
were used for all other aspects of the surgeries. These
patients included livers with normal function, cirrhotic livers
(Childs A & B), Fatty livers, and post chemotherapy fibrosis.
Both anatomical and non-anatomical liver resections were performed.
The amount of blood loss during the transection, transection
time, resection method, and the total resected surface
area were noted. Blood loss and transection time were then
calculated based on a per unit of resected surface area.
Results
In all cases a pre-coagulated resection plane was achieved
using the InLine® and without significant patient complications.
Published blood loss during liver transection averaged
20.4 (+/-8.7) mls/cm2 compared to 3.4 (+/-3.8) mls/cm2 for transections
performed after pre-coagulation with the InLine®
device. Similarly, transection time reduced from 50.0 (+/- 28.3)
sec/cm2 compared to 33.2 (+/-24.7) sec/cm2 for transections
performed after pre-coagulation with the InLine® device. In
both cases the results were statically significant
Conclusion
A variety of tools and techniques have been created to help
reduce blood loss during liver surgery, however blood loss
remains a significant complication. This is particularly true for
non-anatomical resections and for those suffering from liver
cirrhosis, post chemotherapy fibrosis, or fatty liver disease.
This study has shown that pre-coagulation of normal, cirrhotic,
fibrotic, or fatty liver tissue with the InLine® device is a safe
and effective technique that helps to reduce blood loss, transection
times, and procedural costs for liver resections.
Additional InLine® work with kidneys & spleens is ongoing