2005 SAGES Abstracts

POSTER ABSTRACTS
B1.1?}0.3days,
p =0.02),post opeartive hospital stay (Group A 4.5?}2.7
days,?@Group B 3.9?}
2.2days, p =0.01) there was significant difference.
?yCONCLUSION?z This is a not randomized but historical
study.?@Needlescopic cholecystectomy contributed to shorten
the post opeartive hospital stay. The main reason of shorter
hospital stay was faster recovery due to less pain and faster
oral intake.
P203–Hepatobiliary/Pancreatic
Surgery
POST LAPAROSCOPIC CHOLECYSTECTOMY BODY TEMPERA-
TURE, Fumito Kuranishi PhD, Yoshinori Kuroda PhD,Yuuzou
Okamoto PhD,Masahiro Nakahara PhD,Toshikatsu Fukuda
PhD,Hideichi Wada PhD,Manabu Shimomura,Masataka
BAnshoudani,Junnko Nanbu,Taketomo Mizukami, Onomichi
General Hospital
?yINTRODUCTION?zWe have introduced laparoscopic cholecystectomy(LC)
from 1992,and performed it 800 cases. At the
beginning, we have adopted peumoperitoneum(8 mmHg,8
liter/min), we have started combined method(peumoperitoneum
: 4 mmHg,4 liter/min and abdominal wall lifting
method) from 1993. Combined method ?@enables to perform
LC by low pressure. From the standpoint of body temperature(BT)
we report the effect of combined method.
?yOBJECT&METHOD ?zExclusion criteria was combined operation(28cases:Modified
radical mastectomy etc),open conversion(52cases),complication(18cases).
We could?ft confirm the
BTabout 22 cases. Therefore we estimated 680?@?@cases
.?@According to the chart of anesthesia, we classfied these
680 cases into three categories depending on the change of
BT. Group A (162 case) showed increased BT post-operatively.
Group B (448cases) showed decreased BT. Group C(70 cases
)showed no change.
?yRESULT?zBetween three groups(A,B &C) there was no significant
difference about first walking, first flatus, intestinal
murmur, first stool, laboratory data(WBC,CRP), pain killer
usage and post operative hospital stay. There was no significant
difference between Group A & B about oral intake. In the
Group A combined method (0.33?}0.25 ??) showed higher BT
than pneumoperitoneum method (0.25?}0.15??)?iP=0.053?j. In
the Group B the degree of BT decrease showed significant difference
between pneumoperitoneum method (0.56?}0.33 ??)
and combined method(0.44?}0.29??)?iP??0.01?j.
?yCONCLUSION?zNo remarkable effect of post operative BT
change was seen. Combined method method showed more
high BT
tendency. Physiologically speaking post operative high BT may
be better, so far as these data the merit of high BT is unknown.
P204–Hepatobiliary/Pancreatic
Surgery
INTRAOPERATIVE MAGNETIC RESONANCE IMAGING ABLA-
TION OF HEPATIC TUMORS, R Martin BA, S Hushek BA,K
McMasters BA, University of Louisville Department of Surgery
and The Center for Advanced Surgical Technology
Background: The utilization of hepatic ablation of tumors for
both primary and secondary cancers has continued to rise at a
significant rate. The most significant rise in the utilization of
hepatic ablation has come from image guided techniques with
both computer tomography and ultrasound. The limitations of
targeting hepatic lesions by these techniques remain morbid
obesity, abnormal hepatic parenchyma and inability to visualize
lesions without the utilization of intravenous contrast.
Magnetic Resonance Imaging (MRI) on the other hand, has
continued to provide a high contrast of soft tissue to lesion
conspicuity without the need of IV dye. The recent development
of an open configuration magnetic resonance scanners,
which have allowed improved patient access, near real time
imaging, and more available MR compatible equipment, has
opened up an entire new area of image guided surgical and
interventional procedures. Thus the aim of this study was to
evaluate the use of iMRI ablation of hepatic tumors performed
by surgeons.
Method: iMRI hepatic ablation was performed on 10 patients
from 1/2003 to 4/2004 for control of either primary or secondary
hepatic disease. These lesions were defined as inaccessible
by computer tomography and thus were ablated using
real-time intraoperative MRI guidance.
Results: Hepatic ablation was performed on 5 women and 5
men with a median age of 71 (range 51-81) years. Eighteen
hepatic lesions were ablated were successfully ablated, with a
majority of lesions being located in segments 6 and 7. Median
hospital stay was 1 day, with complications occurring in 2
patients.
Conclusions: Image guided hepatic ablations represent a useful
technique in managing hepatic tumors. Intra-operative MRI
(iMRI) represents a new technique with initial success that has
been limited to European centers. Further evaluation in U.S.
centers has demonstrated iMRI to be useful for certain hepatic
tumors that cannot be adequately visualized by ultrasound or
computer tomography. This study demonstrates the importance
of a multi-disciplinary approach involving a surgical
oncologist and interventional radiologist to the integral short
and long-term success of image guided ablations.
P205–Hepatobiliary/Pancreatic
Surgery
LAPAROSCOPIC CHOLECYSTECTOMY IN PATIENTS WITH
SEVERE CARDIAC DISEASE, Meghna Misra MD, Jeffrey Schiff
BS,Gonzalo Rendon MD,Janice Rothschild MD,Steven
Schwaitzberg MD, Tufts-New England Medical Center
Objective:
Cardiac disease is frequently a co-morbidity of patients undergoing
cholecystectomies (CCYs). However, congestive heart
failure (CHF) is often considered a contraindication to laparoscopic
cholecystectomy (LC). As LC is considered the standard
of care for removal of the gallbladder, this reviews the outcome
of LC in this high-risk population.
Methods:
This study is a retrospective review of medical records of 1285
consecutive CCY patients operated from 7/1996-6/2003 in a tertiary
care medical center.
Results:
100 patients in this population had cardiac disease (7.8% of
total population). 86 patients had coronary artery disease
(CAD). 44 of the CAD patients underwent LC. The remaining
patients had open CCYs, or conversions to open surgery. 14
(1.1%) patients in this study had congestive heart failure. 12 of
these patients underwent LC. Pre-operative left ventricular
ejection fraction (LVEF) of the LC CHF patients ranged from
15% to 65%. 8 of the 12 CHF patients had heart transplants. 7
of 8 transplant patients had LC. Indications for surgery for
these patients included biliary colic (n=4), acute cholecystitis
(n=2), and chronic cholecystitis (n=1). The one transplant
patient with an open CCY had acute gangrenous cholecystitis
with hydrops. 3 of the transplant patients had their transplant
before their CCY ? the time period between transplant and
CCY ranged from 1 to 13 years. 5 of the transplant patients
had their CCY before their transplant. Time periods between
transplant and CCY in these patients ranged from 1 to 3 years.
Acute complications of transplant patients included 2 patients
with post-op electrolyte abnormalities, 1 patient with post-op
pneumonia, and 1 patient with retained gallstones. There were
no deaths in the cardiac population. There were no conversions
because of inability to tolerate pneumoperitoneum.
Conclusions:
The severity of gallstone disease in cardiac populations is
greater compared to that of the general population.
Laparoscopy does not increase the risk of intra-operative or
post-operative complications in patients with even severe CHF
compared to the general population. Asymptomatic patients
(from a biliary standpoint) awaiting cardiac transplant can
undergo LC following transplantation with good results. LC is
a safe procedure for gallbladder resection in high-risk populations.
P206–Hepatobiliary/Pancreatic
Surgery
CRYOABLATION OF HEPATIC TUMORS: A COMPARATIVE
STUDY BETWEEN TWO INSTRUMENTS., Alessandro Maria
http://www.sages.org/
SAGES 2005
179