2005 SAGES Abstracts

EMERGING TECHNOLOGY LUNCH POSTER ABSTRACTS
TP024
A RETROSPECTIVE STUDY COMPARING STOMAL STENOSIS
RATES OF THE GASTROJEJUNOSTOMY IN LAPAROSCOPIC
ROUX-EN-Y GASTRIC BYPASS WITH AND WITHOUT THE USE
OF NITINOL SUTURES (U-CLIP) James M Kane MD, James M
Kane, Jr MD, Peter C Rantis MD, Paul J Guske MD, Stuart R
Verseman MD, Jonathan W Wallace MD, Alexian Brothers
Medical Center
Laparoscopic gastric bypass is becoming the most common
bariatric procedure performed in the United States. Certain
complications, such as stomal stenosis, have been reported at
a higher prevalence. We have noted an increase in our
patients. In an attempt to reduce our stomal stenosis rate, we
started performing an interrupted reinforcement of the stapled
GJ anastomosis using nitinol clip sutures (U-CLIP).
Method - A retrospective review of 364 patients undergoing
laparoscopic gastric bypass. Two methods of performing a GJ
anastomosis were compared in order to determine a difference
in stomal stenosis rates. The initial GJ anastomosis were
reinforced with interrupted running 2-0 Polysorb sutures (Auto
Suture) and the later group with interrupted 3.00 mm U-CLIPs.
Results - Three hundred and sixty four patients underwent
laparoscopic gastric bypass during the study period. There
were 213 patients in the initial group and 151 patients in the U-
CLIP group. The two groups were comparable with respect to
age, sex and BMI. There were 21 stomal stenosis in the non U-
CLIP group and 4 in the U-CLIP group with a rate of 9.85% and
2.6 respectively (p=0.00067). The operative times were not statistically
different.
Conclusions - The interrupted U-CLIP suture reinforcement of
the circular stapled GJ resulted in a significant reduction in the
stomal stenosis rate. The U-CLIP provided an easy and fast
method of interrupted suturing laparoscopically that better
replicated our open gastric bypass method without increasing
the length of the operation.
TP025
INTERACTIVE BIOMATERIALS, M C Hiles PhD, J P Hodde MS,
Cook Biotech Incorporated
Natural scaffold biomaterials hold the promise of recapitulating
strong and functional patient tissues without the need for a
long-term foreign body. The SIS Technology uses the extracellular
matrix from mammalian intestinal tissues to provide a
tissue repair scaffold into which the patient?s cells rapidly
grow and actively restore natural tissue structure and function.
The potential surgical applications of this natural mesh material
are endless and current usage is already quite broad. The
healing of chronic wounds, multi-year relief from incontinence,
and successful hernia repairs in grossly contaminated fields all
attest to the uniqueness and applicability of this technology.
Future applications ranging from vascular valves and conduits
to plastic and reconstructive tissue bulking can all benefit from
the potential of these devices to grow with pediatric patients.
The wide range of surgical applications of this biomaterial
technology will be explored with examples of current uses and
futuristic endeavors that hold great potential for advancing
human medicine.
TP026
NEEDS BASED, “INTELLIGENT” SURGICAL SKILLS TRAINING
SYSTEM David Earle MD, David Hananel BS, Neal Seymour
MD, Baystate Medical Center
OBJECTIVE Technologic advances have made it possible to
enhance surgical training within the current framework of
mainstream residency programs. Missing from curriculum
design is a strategy to tailor training among residents, and for
an individual resident over time. We will use an automated
system based on individual performance to guide the surgeon
educator inside the operating room, and the trainee utilizing
simulation lab outside the operating room.
DESCRIPTION Surgical residents are required to perform a
series of tasks using a virtual reality, surgical education platform
(SEP) in a simulation lab. The SEP includes didactic content
and manual skills exercises. The assessment information
from the lab will interface automatically with our online
assessment form present in each operating room. Immediately
before an operation, the surgeon educator will review this
data, and during the operation, focus on areas identified as not
being mastered. Immediately after the operation, the surgeon
can give the trainee feedback on performance using the online
assessment. The clinical performance data will then automatically
interface with the SEP to guide the trainee to areas of
need at the next self-guided lab session.
CONCLUSION A feedback loop between the clinical setting
and simulation lab will enhance both efficiency and safety of
patient care taking place in teaching hospitals. It will help
objectively quantify what surgeons deem competent behavior
– something that is easily recognized, but difficult to define. It
will help foster an environment where honest feedback from
educators is constructively used by trainees.
FUTURE DIRECTIONS Incorporation of emergency resuscitation,
and procedures such as central venous access, airway
management, and wound management. Access to an online
surgical video library and additional didactic material will also
be incorporated to enhance the educational experience.
Additionally, data could be used to promote or re-direct
trainees.
TP027
WWW.LAPSEARCH.NET, A SEARCH ENGINE FOR LAPARO-
SCOPIC EQUIPMENT AVAILABLE IN THE UNITED STATES, M J
Weiner MD, S A Laker MD, New York University, New York, NY,
Hackensack University Medical Center, Hackensack, NJ
Objection: To create an objective source for surgeons, nurses
and OR purchasers to obtain information on all laparoscopic
devices for use in the United States.
Description: LapSearch (www.lapsearch.net) is a laparoscopic
device search engine that was created to make the process of
obtaining information about laparoscopic instruments more
manageable. Surgeons can use LapSearch to find devices
based on their physical dimensions, function or characteristics
(i.e. all ligature devices 5mm in diameter with that use ultrasonic
cutting). Currently there are over 1000 devices in the
database, with plans to expand if there is interest. Lapsearch is
continuing to add new features including the ability to store
lists of devices, the option to view the most popular devices of
the day, week or month and an upcoming option that will
allow surgeons to share their experiences with one another
and discuss the strengths and weaknesses of particular
devices. Lapsearch intends to work together with the device
companies allowing them to continually update the database,
ensuring its currency. Lapsearch was designed by physicians
for physicians and is and always will be free to all health care
practitioners.
Preliminary Results: The website serves as the only search
engine available that allows the physician to obtain objective
information on available laparoscopic equipment from multiple
manufacturers.
Conclusion: The website, www.lapsearch.net, aids the surgeon,
nurse and hospital purchaser in making an informed
decision on the products they choose to purchase and use. In
addition, the site acts as a platform for the introduction of new
devices and technologies by the manufacturers. Lapsearch
ultimately hopes to serve as a platform for educating surgeons
and providing timely, critical product information.
http://www.sages.org/
SAGES 2005
247