This document outlines constraints for an Enhanced Recovery After Surgery (ERAS) program at John Doe Hospital aimed at optimizing patient outcomes and reducing costs for hip and knee replacement surgeries. Constraints are established based on average lengths of stay, operating room times, costs, and variable costs for 461 prior cases. The constraints define acceptable ranges for factors like length of stay being between 1-2 days, total operating room time between 1.5-3 hours, and total costs between $15,630-$22,600. Measuring patient outcomes is difficult without access to outcomes data, but collecting additional clinical data over time could help refine the program and constraints.
This document discusses pediatric day surgery (PDS) and day case laparoscopic surgery (DCLS) at Apollo Children's Hospital in Chennai, India. It provides details on: the history and increasing use of PDS; patient selection criteria for DCLS; anesthesia and surgical protocols used; a retrospective analysis of 85 DCLS cases with no reported complications; and conclusions that DCLS can be performed safely without compromising patient care when a multidisciplinary team approach and clinical care pathway are followed.
A surgical oncologist is a surgeon with additional training in treating cancer patients using a multidisciplinary approach including surgery, radiation, chemotherapy, and other disciplines. The key goals of cancer surgery are to remove the cancerous tissue through procedures like curative resection, debulking, or palliative surgery. Accurate staging of the cancer is also important for surgeons to plan the appropriate treatment and evaluate outcomes.
This document provides information for students on clinical placements about Enhanced Recovery After Surgery (ERAS). It discusses how surgical patient management has changed, with shorter hospital stays and improved outcomes. It summarizes the key aspects of ERAS, including carefully preparing patients before surgery, minimizing risks during surgery, early mobilization after surgery, and careful pain and nutrition management. The goal is for students to better understand modern post-operative care and for improved communication between clinical teams to identify complications early.
The document discusses enhanced recovery after surgery (ERAS) programs. It describes how ERAS utilizes a multimodal approach involving surgeons, nurses, dietitians and others to optimize patient care and recovery through measures like preoperative counseling and nutrition, minimal invasive surgery when possible, reduced use of tubes/drains, early mobilization and feeding, and well-managed postoperative pain control. The goal is to reduce length of stay without increasing complications through evidence-based practices compared to traditional postoperative care methods. Studies show ERAS programs can achieve these outcomes safely and cost-effectively across several surgery types.
Managing Complications; First Prevent Complications
Examples of ComplacencySleeve Gastrectomy Failure:
“Sleeve Gastrectomy & Risk of Leak: Systematic Analysis of 4,888 Patients”
“Risk of leak is low at 2.4%"
Surg Endosc. 2012 Jun;26(6):1509-15. Epub 2011 Dec 17. Aurora AR, Khaitan L, Saber AA. Department of Surgery, University Hospitals Case Medical Center, Cleveland, Ohio
This document summarizes an enhanced recovery care pathway for patients undergoing surgery. It discusses:
- The key components of enhanced recovery pathways for thoracic surgery, maternity care, and medicine based on experiences at various hospitals.
- How enhanced recovery aims to get patients recovering sooner by preparing them before surgery and providing standardized post-operative care and early mobilization.
- Evidence that enhanced recovery pathways improve patient experience and outcomes like reduced length of hospital stay while increasing day-of-surgery admissions without increasing readmissions.
- Future goals of expanding enhanced recovery principles to non-elective care and developing systems to better risk-stratify patients and optimize their fitness before surgery.
1. This document provides guidelines for day case and short stay surgery from a working party established by the Association of Anaesthetists of Great Britain and Ireland and the British Association of Day Surgery.
2. Effective pre-operative preparation and protocol-driven, nurse-led discharge are fundamental to safe and effective day and short stay surgery.
3. Selection of patients for day surgery considers social factors like having a caregiver at home, medical factors like fitness and stability of chronic conditions, and surgical factors like risk of complications requiring immediate medical attention.
This document outlines constraints for an Enhanced Recovery After Surgery (ERAS) program at John Doe Hospital aimed at optimizing patient outcomes and reducing costs for hip and knee replacement surgeries. Constraints are established based on average lengths of stay, operating room times, costs, and variable costs for 461 prior cases. The constraints define acceptable ranges for factors like length of stay being between 1-2 days, total operating room time between 1.5-3 hours, and total costs between $15,630-$22,600. Measuring patient outcomes is difficult without access to outcomes data, but collecting additional clinical data over time could help refine the program and constraints.
This document discusses pediatric day surgery (PDS) and day case laparoscopic surgery (DCLS) at Apollo Children's Hospital in Chennai, India. It provides details on: the history and increasing use of PDS; patient selection criteria for DCLS; anesthesia and surgical protocols used; a retrospective analysis of 85 DCLS cases with no reported complications; and conclusions that DCLS can be performed safely without compromising patient care when a multidisciplinary team approach and clinical care pathway are followed.
A surgical oncologist is a surgeon with additional training in treating cancer patients using a multidisciplinary approach including surgery, radiation, chemotherapy, and other disciplines. The key goals of cancer surgery are to remove the cancerous tissue through procedures like curative resection, debulking, or palliative surgery. Accurate staging of the cancer is also important for surgeons to plan the appropriate treatment and evaluate outcomes.
This document provides information for students on clinical placements about Enhanced Recovery After Surgery (ERAS). It discusses how surgical patient management has changed, with shorter hospital stays and improved outcomes. It summarizes the key aspects of ERAS, including carefully preparing patients before surgery, minimizing risks during surgery, early mobilization after surgery, and careful pain and nutrition management. The goal is for students to better understand modern post-operative care and for improved communication between clinical teams to identify complications early.
The document discusses enhanced recovery after surgery (ERAS) programs. It describes how ERAS utilizes a multimodal approach involving surgeons, nurses, dietitians and others to optimize patient care and recovery through measures like preoperative counseling and nutrition, minimal invasive surgery when possible, reduced use of tubes/drains, early mobilization and feeding, and well-managed postoperative pain control. The goal is to reduce length of stay without increasing complications through evidence-based practices compared to traditional postoperative care methods. Studies show ERAS programs can achieve these outcomes safely and cost-effectively across several surgery types.
Managing Complications; First Prevent Complications
Examples of ComplacencySleeve Gastrectomy Failure:
“Sleeve Gastrectomy & Risk of Leak: Systematic Analysis of 4,888 Patients”
“Risk of leak is low at 2.4%"
Surg Endosc. 2012 Jun;26(6):1509-15. Epub 2011 Dec 17. Aurora AR, Khaitan L, Saber AA. Department of Surgery, University Hospitals Case Medical Center, Cleveland, Ohio
This document summarizes an enhanced recovery care pathway for patients undergoing surgery. It discusses:
- The key components of enhanced recovery pathways for thoracic surgery, maternity care, and medicine based on experiences at various hospitals.
- How enhanced recovery aims to get patients recovering sooner by preparing them before surgery and providing standardized post-operative care and early mobilization.
- Evidence that enhanced recovery pathways improve patient experience and outcomes like reduced length of hospital stay while increasing day-of-surgery admissions without increasing readmissions.
- Future goals of expanding enhanced recovery principles to non-elective care and developing systems to better risk-stratify patients and optimize their fitness before surgery.
1. This document provides guidelines for day case and short stay surgery from a working party established by the Association of Anaesthetists of Great Britain and Ireland and the British Association of Day Surgery.
2. Effective pre-operative preparation and protocol-driven, nurse-led discharge are fundamental to safe and effective day and short stay surgery.
3. Selection of patients for day surgery considers social factors like having a caregiver at home, medical factors like fitness and stability of chronic conditions, and surgical factors like risk of complications requiring immediate medical attention.
Free nipple grafting is proposed as an alternative for patients ineligible for nipple-sparing mastectomy due to anatomical limitations. A retrospective review was conducted of 36 breasts that underwent nipple-sparing mastectomy with immediate reconstruction using free nipple grafting. Average graft take was 93.6% with no complete graft losses. Four nipples lost all projection and 4 experienced hypopigmentation requiring tattooing. For patients ineligible for nipple-sparing mastectomy due to anatomical factors, free nipple grafting in a single stage is an option with acceptable complication rates similar to free nipple grafting in reduction mammaplasties.
The document discusses ambulatory or day surgery. It defines day surgery as when a patient is admitted for a procedure and discharged within 12 hours. Day surgery has advantages over traditional inpatient surgery like lower costs, faster recovery, and less disruption to daily life. The document outlines patient selection criteria, common procedures performed as day surgery, and important considerations for the preoperative, intraoperative, and postoperative periods to facilitate day surgery and recovery.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay
Gian Luca Grazi presented a 20 minute presentation on indications and timing for resection of breast cancer liver metastases. He discussed recent literature reviews on the topic, comparative studies of resection versus other therapies, and cost utility analyses. Literature reviews showed resection can provide long term survival in selected patients. Comparative studies found resection was associated with improved overall and disease-free survival compared to ablation or chemotherapy alone. Resection was shown to provide a survival benefit even in some patients with controlled bone metastases. Patient selection factors like solitary metastases, response to pre-operative chemotherapy, and hormone receptor status were discussed.
C-Spine Collar Clearance In The Obtunded Adult Blunt Trauma PatientSun Yai-Cheng
Cervical Spine Collar Clearance In The Obtunded Adult Blunt Trauma Patient A systematic review and practice management guideline from the Eastern Association for the Surgery of Trauma
J Trauma Acute Care Surg. 2015;78: 430-441.
Enhanced Recovery After Surgery (ERAS®) is the Enhanced Recovery After Surgery (ERAS®) is the implementation of patient-focused, standardized, evidencefocused, standardized, evidencefocused, standardized, evidencefocused, standardized, evidencefocused, standardized, evidencefocused, standardized, evidence-based, interdisciplinary perioperative guidelines.
Learn more about Enhanced Recovery Canada:
http://ow.ly/hR3j30jsnjR
This document discusses day case or ambulatory surgery. It notes that over the last 30 years, there has been rapid expansion in the use of day-case surgery, with the percentage of patients going home the same day increasing from less than 10% to approximately 65%. Suitable procedures are those that take less than 90 minutes, do not cause excessive bleeding or pain, and have minimal postoperative physiological disturbances. The growth of ambulatory surgery has been facilitated by improved anesthetic techniques and shorter-acting drugs that allow for faster recovery.
This document discusses surgical and interventional approaches for gallbladder disease. It describes laparoscopic cholecystectomy as the standard treatment for cholelithiasis and mild-to-moderate acute cholecystitis. Variations like single-incision laparoscopic cholecystectomy aim to reduce scarring but have technical challenges. Natural orifice transluminal endoscopic surgery (NOTES) offers improved cosmesis through transgastric or transvaginal access but requires special equipment. Percutaneous cholecystostomy effectively treats acute cholecystitis in patients who cannot undergo surgery but has frequent complications and diminishes quality of life. The optimal approach considers the patient's condition and disease consequences.
1. This document discusses erectile dysfunction following radical prostatectomy. It addresses factors such as who is a candidate for nerve-sparing surgery, why rates of post-surgery erectile dysfunction vary, and how erectile function should be defined.
2. The document focuses on rehabilitation protocols to preserve erectile function after surgery. It examines questions such as where and when rehabilitation should be used, what protocols should be considered, and when rehabilitation efforts should be stopped.
3. The overall goal of the document is to provide guidance to doctors on discussing risks and managing expectations regarding erectile function with patients undergoing prostatectomy surgery.
The document discusses preoperative evaluation and management. It aims to identify any medical comorbidities that could affect surgical outcomes rather than broadly screening for disease. A thorough history and physical exam are important to understand preexisting conditions and risks. Investigations should be ordered selectively based on medical history. Preoperative preparation includes securing IV access, emptying bowels if needed, and providing thromboprophylaxis or antibiotics if required. Special considerations depend on the surgery and any cardiovascular, respiratory, or other system involvement.
This document discusses ambulatory and fast track anesthesia. It covers topics such as the benefits of ambulatory surgery including lower costs and greater efficiency. It describes different facility designs for ambulatory surgery and lists many common procedures that can be done on an outpatient basis. The document outlines considerations for patient selection and preoperative preparation including pharmacologic and non-pharmacologic techniques. It also discusses various anesthetic techniques for ambulatory surgery like general anesthesia, regional anesthesia, and monitored anesthesia care. Fast tracking approaches to minimize side effects like PONV are also summarized.
Best practices in preventing retained foreign objectsMhmarlin
1) The document describes four case studies related to retained surgical items and issues with surgical counting practices. In the first case study, distraction was identified as the primary cause of a retained sponge during a vaginal repair surgery involving multiple observers.
2) The second case study describes an incident where the circulating nurse documented adding sponges to the field before actually doing so, becoming distracted, and failing to deliver the second pack of sponges, resulting in a missing count.
3) The third case study discusses the increasing reports of retained incisional sponges used during endoscopic saphenous vein harvesting procedures despite their small size.
The document discusses Enhanced Recovery After Surgery (ERAS) protocols. It describes how ERAS aims to reduce surgical stress on patients through multimodal perioperative care, facilitating early recovery. This includes optimizations in pre-, intra-, and postoperative care such as shortened fasting times, carbohydrate loading, minimized fluid administration, and early mobilization. The document provides examples of procedures that can be done as day surgeries and details the key elements of ERAS protocols.
1) A community hospital implemented a process to fast-track eligible ambulatory surgery patients by bypassing the post-anesthesia care unit (PACU) and sending them directly to an ambulatory care unit (ACU).
2) In the reference period before implementation, 81% of patients were eligible for fast-tracking based on a scoring tool. After implementing the fast-tracking process, 79% of patients bypassed the PACU, with decreased incidence and duration of operating room holds.
3) Length of stay in the ACU and total postoperative time were reduced in the implementation period. The process improvement was estimated to save over $1 million annually and demonstrated potential for sustainability through standardized eligibility criteria.
Principles of surgery. Day case surgery is a rapidly evolving surgical sub speciality that seeks to eliminate the need for prolonged admission in surgical patients and the attendant complications of prolonged immobilization. It is based on the documented evidence that most post op patients does not require specialised post op care and hence can be allowed to recover at home. This form of surgery appeals to patients and their families due to the fact that it allows only minimal interruption of patient's social life
This multicenter study analyzed 111 elderly patients (age 80-89) who underwent radical cystectomy for bladder cancer. The complication rate was high, with 50.4% experiencing early complications and 32% late complications. The perioperative mortality rate was 7.2% and 27.2% of patients were readmitted to the hospital. Tumor progression-free survival at 12 months was lower for patients with ≥pT3 disease (36%) compared to ≤pT1 disease (83.9%). Radical cystectomy in elderly patients carries significant risks given high complication rates, mortality, and readmission rates. Careful patient selection is important to minimize risks and balance benefits against life expectancy.
Richard Reisman discusses his experiences commercializing and selling patents over several decades as an inventor and entrepreneur. He obtained patents starting in 1994 for a new approach to online services. After limited success commercializing the technology himself, he pursued "Plan B" of patent licensing and sales. He partnered with firms like BTG and later sold patents to entities like Intellectual Ventures and RPX. The process involved litigation, dealmaking, and realizing value from patents in different ways. Reisman advocates keeping prosecution open, choosing partners carefully, and hedging bets by pursuing multiple commercialization strategies.
- The document discusses the rise in obesity and abdominal obesity in the US population between the 1960s and 2004, and how increased waist circumference is associated with health risks like hypertension.
- It presents a study that aims to evaluate the effects of liposuction on waist-to-hip ratio (WHR), metabolic health markers, and blood pressure in moderately obese patients through non-invasive measurements at various intervals post-surgery.
- The study uses a technique called twin cannula assisted liposuction (TCAL) that aims to more precisely remove fat and thin the waistline area with less trauma compared to other methods.
Free nipple grafting is proposed as an alternative for patients ineligible for nipple-sparing mastectomy due to anatomical limitations. A retrospective review was conducted of 36 breasts that underwent nipple-sparing mastectomy with immediate reconstruction using free nipple grafting. Average graft take was 93.6% with no complete graft losses. Four nipples lost all projection and 4 experienced hypopigmentation requiring tattooing. For patients ineligible for nipple-sparing mastectomy due to anatomical factors, free nipple grafting in a single stage is an option with acceptable complication rates similar to free nipple grafting in reduction mammaplasties.
The document discusses ambulatory or day surgery. It defines day surgery as when a patient is admitted for a procedure and discharged within 12 hours. Day surgery has advantages over traditional inpatient surgery like lower costs, faster recovery, and less disruption to daily life. The document outlines patient selection criteria, common procedures performed as day surgery, and important considerations for the preoperative, intraoperative, and postoperative periods to facilitate day surgery and recovery.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay
Gian Luca Grazi presented a 20 minute presentation on indications and timing for resection of breast cancer liver metastases. He discussed recent literature reviews on the topic, comparative studies of resection versus other therapies, and cost utility analyses. Literature reviews showed resection can provide long term survival in selected patients. Comparative studies found resection was associated with improved overall and disease-free survival compared to ablation or chemotherapy alone. Resection was shown to provide a survival benefit even in some patients with controlled bone metastases. Patient selection factors like solitary metastases, response to pre-operative chemotherapy, and hormone receptor status were discussed.
C-Spine Collar Clearance In The Obtunded Adult Blunt Trauma PatientSun Yai-Cheng
Cervical Spine Collar Clearance In The Obtunded Adult Blunt Trauma Patient A systematic review and practice management guideline from the Eastern Association for the Surgery of Trauma
J Trauma Acute Care Surg. 2015;78: 430-441.
Enhanced Recovery After Surgery (ERAS®) is the Enhanced Recovery After Surgery (ERAS®) is the implementation of patient-focused, standardized, evidencefocused, standardized, evidencefocused, standardized, evidencefocused, standardized, evidencefocused, standardized, evidencefocused, standardized, evidence-based, interdisciplinary perioperative guidelines.
Learn more about Enhanced Recovery Canada:
http://ow.ly/hR3j30jsnjR
This document discusses day case or ambulatory surgery. It notes that over the last 30 years, there has been rapid expansion in the use of day-case surgery, with the percentage of patients going home the same day increasing from less than 10% to approximately 65%. Suitable procedures are those that take less than 90 minutes, do not cause excessive bleeding or pain, and have minimal postoperative physiological disturbances. The growth of ambulatory surgery has been facilitated by improved anesthetic techniques and shorter-acting drugs that allow for faster recovery.
This document discusses surgical and interventional approaches for gallbladder disease. It describes laparoscopic cholecystectomy as the standard treatment for cholelithiasis and mild-to-moderate acute cholecystitis. Variations like single-incision laparoscopic cholecystectomy aim to reduce scarring but have technical challenges. Natural orifice transluminal endoscopic surgery (NOTES) offers improved cosmesis through transgastric or transvaginal access but requires special equipment. Percutaneous cholecystostomy effectively treats acute cholecystitis in patients who cannot undergo surgery but has frequent complications and diminishes quality of life. The optimal approach considers the patient's condition and disease consequences.
1. This document discusses erectile dysfunction following radical prostatectomy. It addresses factors such as who is a candidate for nerve-sparing surgery, why rates of post-surgery erectile dysfunction vary, and how erectile function should be defined.
2. The document focuses on rehabilitation protocols to preserve erectile function after surgery. It examines questions such as where and when rehabilitation should be used, what protocols should be considered, and when rehabilitation efforts should be stopped.
3. The overall goal of the document is to provide guidance to doctors on discussing risks and managing expectations regarding erectile function with patients undergoing prostatectomy surgery.
The document discusses preoperative evaluation and management. It aims to identify any medical comorbidities that could affect surgical outcomes rather than broadly screening for disease. A thorough history and physical exam are important to understand preexisting conditions and risks. Investigations should be ordered selectively based on medical history. Preoperative preparation includes securing IV access, emptying bowels if needed, and providing thromboprophylaxis or antibiotics if required. Special considerations depend on the surgery and any cardiovascular, respiratory, or other system involvement.
This document discusses ambulatory and fast track anesthesia. It covers topics such as the benefits of ambulatory surgery including lower costs and greater efficiency. It describes different facility designs for ambulatory surgery and lists many common procedures that can be done on an outpatient basis. The document outlines considerations for patient selection and preoperative preparation including pharmacologic and non-pharmacologic techniques. It also discusses various anesthetic techniques for ambulatory surgery like general anesthesia, regional anesthesia, and monitored anesthesia care. Fast tracking approaches to minimize side effects like PONV are also summarized.
Best practices in preventing retained foreign objectsMhmarlin
1) The document describes four case studies related to retained surgical items and issues with surgical counting practices. In the first case study, distraction was identified as the primary cause of a retained sponge during a vaginal repair surgery involving multiple observers.
2) The second case study describes an incident where the circulating nurse documented adding sponges to the field before actually doing so, becoming distracted, and failing to deliver the second pack of sponges, resulting in a missing count.
3) The third case study discusses the increasing reports of retained incisional sponges used during endoscopic saphenous vein harvesting procedures despite their small size.
The document discusses Enhanced Recovery After Surgery (ERAS) protocols. It describes how ERAS aims to reduce surgical stress on patients through multimodal perioperative care, facilitating early recovery. This includes optimizations in pre-, intra-, and postoperative care such as shortened fasting times, carbohydrate loading, minimized fluid administration, and early mobilization. The document provides examples of procedures that can be done as day surgeries and details the key elements of ERAS protocols.
1) A community hospital implemented a process to fast-track eligible ambulatory surgery patients by bypassing the post-anesthesia care unit (PACU) and sending them directly to an ambulatory care unit (ACU).
2) In the reference period before implementation, 81% of patients were eligible for fast-tracking based on a scoring tool. After implementing the fast-tracking process, 79% of patients bypassed the PACU, with decreased incidence and duration of operating room holds.
3) Length of stay in the ACU and total postoperative time were reduced in the implementation period. The process improvement was estimated to save over $1 million annually and demonstrated potential for sustainability through standardized eligibility criteria.
Principles of surgery. Day case surgery is a rapidly evolving surgical sub speciality that seeks to eliminate the need for prolonged admission in surgical patients and the attendant complications of prolonged immobilization. It is based on the documented evidence that most post op patients does not require specialised post op care and hence can be allowed to recover at home. This form of surgery appeals to patients and their families due to the fact that it allows only minimal interruption of patient's social life
This multicenter study analyzed 111 elderly patients (age 80-89) who underwent radical cystectomy for bladder cancer. The complication rate was high, with 50.4% experiencing early complications and 32% late complications. The perioperative mortality rate was 7.2% and 27.2% of patients were readmitted to the hospital. Tumor progression-free survival at 12 months was lower for patients with ≥pT3 disease (36%) compared to ≤pT1 disease (83.9%). Radical cystectomy in elderly patients carries significant risks given high complication rates, mortality, and readmission rates. Careful patient selection is important to minimize risks and balance benefits against life expectancy.
Richard Reisman discusses his experiences commercializing and selling patents over several decades as an inventor and entrepreneur. He obtained patents starting in 1994 for a new approach to online services. After limited success commercializing the technology himself, he pursued "Plan B" of patent licensing and sales. He partnered with firms like BTG and later sold patents to entities like Intellectual Ventures and RPX. The process involved litigation, dealmaking, and realizing value from patents in different ways. Reisman advocates keeping prosecution open, choosing partners carefully, and hedging bets by pursuing multiple commercialization strategies.
- The document discusses the rise in obesity and abdominal obesity in the US population between the 1960s and 2004, and how increased waist circumference is associated with health risks like hypertension.
- It presents a study that aims to evaluate the effects of liposuction on waist-to-hip ratio (WHR), metabolic health markers, and blood pressure in moderately obese patients through non-invasive measurements at various intervals post-surgery.
- The study uses a technique called twin cannula assisted liposuction (TCAL) that aims to more precisely remove fat and thin the waistline area with less trauma compared to other methods.
This document discusses best practices for efficient data transfer in Android applications. It covers topics like radio states, bundling data transfers, prefetching data, optimizing download patterns, using SyncAdapters, and Google Cloud Messaging. The document provides resources for analyzing data usage and references papers and guides from AT&T and Google on implementing efficient data strategies.
SSE’s Theory of Change is based on what we do and what we enable. The blue circles illustrate what we do and what we think of as within SSE’s ‘sphere of control’. They show the activities SSE undertakes to support individuals on a learning journey andthe outcomes that are achieved for the student and their organisation. The pink circles illustrate what we enable and what we think of as within SSE’s ‘sphere of influence’. They show the outcomes achieved by the student and their organisation for people and communities and how, by being part of the SSE community, we achieve social change together.
Aberdeen International Corporate Presentation July 2016 Aberdeen_AAB
Aberdeen International Inc. is a mining investment company focused on lithium and platinum group metals. It has two principal investments: a 50% stake in the Sal de los Angeles lithium brine project in Argentina through a JV with Lithium X Energy, and ownership of African Thunder Platinum, a South African PGM producer. Demand for lithium and PGMs is expected to grow due to their use in batteries for electric vehicles and autocatalysts to reduce emissions. The Sal de los Angeles project has a historic resource estimate and favorable preliminary economics indicating potential for low-cost lithium production.
North American StartUps disrupting Wine&Spirits, Food and TravelVincent PRETET
At 33entrepreneurs, we focus on three verticals: Wine&Spirits, Food and Travel. In those fields, we are looking for the most promising teams, the boldest ideas, the most exciting technology. As a consequence, we invest significantly into market analysis and surveys. We have a team of Tech Analysts investigating Wine&SpiritsTech, FoodTech and TourismTech StartUps. We also have some secret sauce...
We are pleased to share some insights here on the 3,200 North American StartUps we are monitoring.
3D printing has the potential to significantly disrupt intellectual property and traditional business models by democratizing manufacturing. As 3D printing capabilities improve and the technology becomes more accessible at home, intellectual property may become increasingly irrelevant. Customization could replace intellectual property as individuals are able to make things with virtually any functionality away from traditional controls. The implications for intellectual property will depend on how quickly 3D printing capabilities spread and manufacturing becomes democratized.
This document discusses the evolution of working with JSON data over time. Early approaches involved writing complex code with many opportunities for errors to parse and validate JSON. Later, better practices emerged such as creating data models to represent the JSON and handle errors. The JSONModel library was created to automate common JSON parsing, validation, and conversion tasks to make working with JSON simpler and more robust.
This report analyzes over 1,600 startups innovating in China, focusing on those in the food, travel, wine and spirits industries. It finds that 63% of startups are in food, with 20% in travel and 17% in wine and spirits. The majority are based in major cities like Beijing and Shanghai, and communicate primarily in Chinese. There has been massive investment totaling $10.8 billion in the top 180 startups, especially in travel. However, seed investments still only make up a small fraction of total financing. The report was produced by 33entrepreneurs, a venture capital firm focused on food, travel and wine/spirits startups based in Bordeaux, France.
Virginia Smith, Researcher, UC Berkeley at MLconf SF 2016MLconf
A General Framework for Communication-Efficient Distributed Optimization: Communication remains the most significant bottleneck in the performance of distributed optimization algorithms for large-scale machine learning. In light of this, we propose a general framework, CoCoA, that uses local computation in a primal-dual setting to dramatically reduce the amount of necessary communication. Our framework enjoys strong convergence guarantees and exhibits state-of-the-art empirical performance in the distributed setting. We demonstrate this performance with extensive experiments in Apache Spark, achieving speedups of up to 50x compared to leading distributed methods on common machine learning objectives.
Alex Dimakis, Associate Professor, Dept. of Electrical and Computer Engineeri...MLconf
A Friendly Introduction To Causality: Causality has been studied under several frameworks in statistics and artificial intelligence. We will briefly survey Pearl’s Structural Equation model and explain how interventions can be used to discover causality. We will also present a novel information theoretic framework for discovering causal directions from observational data when interventions are not possible. The starting point is conditional independence in joint probability distributions and no prior knowledge on causal inference is required.
Global Insights on Venture Capital in 2014Vincent PRETET
At 33entrepreneurs, we focus on three verticals: Wine&Spirits, Food and Travel. In those fields, we are looking for the most promising teams, the boldest ideas, the most exciting technology. As a consequence, we invest significantly into market analysis and surveys. We have a team of Tech Analysts investigating Wine&SpiritsTech, FoodTech and TourismTech StartUps. We also have some secret sauce...
We are pleased to share some insights here on USD 80 billion and more than 7,500 equity financing eventswe are monitoring.
How Ecosystem Economics™ Predicts the Winners in the Digital AgeJulie Meyer
Julie Meyer presents Ecosystem Economics™ - the Ariadne Capital Investment Methodology and EntrepreneurCountry Global Operating System - which she has presented at TED, corporate Board rooms, throughout the business media, and in EC Global workshops
33insights: Investing in WineTech, Global InsightsVincent PRETET
At 33entrepreneurs, we focus on three verticals: wine, food and tourism. In those fields, we are looking for the most promising teams, the boldest ideas, the most exciting technology. As a consequence, we invest significantly into market analysis and surveys. We have a team of Tech Analysts investigating WineTech, FoodTech and TourismTech StartUps. We also have some secret sauce... We are pleased to share some insights here on the 5,500 StartUps we are monitoring.
You will find the following survey based on 550 Wine StartUps worldwide, that we keep up to date on. More is to come on 33insights.
Daniel Shank, Data Scientist, Talla at MLconf SF 2016MLconf
This document discusses neural Turing machines, which are neural networks combined with external memory systems that allow them to be trained end-to-end using backpropagation. Neural Turing machines can learn simple algorithms and generalize well for tasks like language modeling and question answering. However, they are difficult to train due to numerical instability and optimizing memory usage. The document recommends techniques like gradient clipping, loss clipping, and curriculum learning to improve training. It also covers developments like dynamic neural computers that can allocate and deallocate memory.
Scott Clark, Co-Founder and CEO, SigOpt at MLconf SF 2016MLconf
Using Bayesian Optimization to Tune Machine Learning Models: In this talk we briefly introduce Bayesian Global Optimization as an efficient way to optimize machine learning model parameters, especially when evaluating different parameters is time-consuming or expensive. We will motivate the problem and give example applications.
We will also talk about our development of a robust benchmark suite for our algorithms including test selection, metric design, infrastructure architecture, visualization, and comparison to other standard and open source methods. We will discuss how this evaluation framework empowers our research engineers to confidently and quickly make changes to our core optimization engine.
We will end with an in-depth example of using these methods to tune the features and hyperparameters of a real world problem and give several real world applications.
Stephanie deWet, Software Engineer, Pinterest at MLconf SF 2016MLconf
The document describes Pinterest's approach to blending content from different pools (recommendations, social, etc.) in a personalized home feed. It uses a multi-armed bandit model where each arm represents a content pool. For each user, it calculates a utility value for each pool based on the user's prior actions. It maps these utilities to integer ratios to determine the blending proportion. For new users, it enforces an initial blend across all pools. An A/B test showed the model increased positive user engagement while allowing control over the social vs. recommendations proportion.
TravelTech StartUps Survey: Global insights by 33entrepreneursVincent PRETET
At 33entrepreneurs, we focus on three verticals: Wine&Spirits, Food and Travel. In those fields, we are looking for the most promising teams, the boldest ideas, the most exciting technology. As a consequence, we invest significantly into market analysis and surveys. We have a team of Tech Analysts investigating Wine&SpiritsTech, FoodTech and TourismTech StartUps. We also have some secret sauce...
We are pleased to share some insights here on the 2,700 TravelTech StartUps we are monitoring.
Uncoiling the Tightening Obesity Spiralasclepiuspdfs
While an underweight prevalence was once more than twice that of obesity, now more people are obese than underweight. Obesity is one of the leading causes of preventable death in the world. There are an estimated 2,100,000,000 obese people worldwide and that number is forecast to grow to 51% of the world’s population by 2030. Escalating obesity-related disease costs threaten to bankrupt the world’s health-care systems.
General surgeons in 2010 will need to focus on treating diseases comprehensively rather than just performing operations. Technological advances have allowed other specialties to perform procedures traditionally done by surgeons. Surgeons risk losing practice volumes unless they view themselves as treating overall patient health. Training and practice models will need to adapt to changing healthcare systems focused on quality, safety, and meeting patient and societal needs.
There is no question that obesity is the largest epidemic of the 21st century. This explains the explosion of the different methods of weight loss support; chief among them, the utilization of bariatric surgery. Learn how body contouring after major weight loss improves the shape and tone of the underlying tissue that supports fat and skin and removes excess sagging fat and skin.
Laparoscopy in obesity Dr.Nutan Jain Indiajainnutan
This document discusses obesity and minimally invasive surgery in gynecological procedures. It provides definitions of obesity, assessments for obese patients undergoing surgery, and techniques for laparoscopic surgery in obese patients. Key points include the use of longer instruments, perpendicular trocar insertion, and positioning to accommodate excess tissue. Minimally invasive surgery is shown to be as safe for obese patients as non-obese with proper precautions. It can significantly reduce morbidity compared to open surgery for procedures like hysterectomy and lymph node dissection in endometrial cancer.
Should OB/GYNs Offer Vaginal Rejuvenation?Peter Stumpf
1) Vaginal rejuvenation surgery is growing in popularity as a way to improve vaginal tone and sexual gratification, though there is little scientific evidence of its benefits or risks. 2) Proponents argue gynecologists are well-suited to perform this procedure, while critics argue it may do more harm than good for healthy women and could restrict access if patented. 3) There is ongoing debate around the ethics of performing elective cosmetic procedures without evidence of medical need.
Rivision surgery after laparoscopic sleeve gastrectomyIbrahim Abunohaiah
Revision Surgery After Laparoscopic Sleeve Gastrectomy
Introduction to bariatric surgery
When to Revise a Weight Loss Surgery?
Options for redo surgery.
Laparoscopic Roux-en-Y gastric Bypass.
This document reviews emerging endoluminal technologies for the treatment of obesity. Several intragastric balloons and restrictive interventions have been studied in humans, including intragastric balloons, transoral gastroplasty, and endoluminal vertical gastroplasty. The duodenojejunal bypass sleeve is the only endoluminal device that has been studied that promotes weight loss through malabsorption. Early results of these technologies are promising, but long-term data is still lacking. Endoluminal treatments hold promise but need to be rigorously evaluated in clinical trials to determine safety, efficacy, and durability before being widely adopted.
The document discusses considerations for pre-anesthetic evaluation, anesthetic techniques, anesthesia management, and specific procedures for abdominal surgery. It covers assessing a patient's hydration status pre-operatively, regional versus general anesthesia options, intraoperative fluid management and ERAS protocols, and special considerations for appendectomy and cholecystectomy.
The Obstetric Gynaecologis - 2011 - Biswas - Surgical risk from obesity in ...Amer Raza
- Obesity increases surgical risks for gynecological procedures due to technical difficulties, anesthesia challenges, and increased risk of complications like infection and blood clots.
- When surgery is necessary, careful preoperative planning including assessing cardiac and pulmonary risk factors can help reduce risk. Regional anesthesia and prophylactic blood thinners are recommended.
- Alternative, non-surgical treatments should be considered when possible for obese patients, like weight loss programs, medications, or pessaries. Surgery should only be performed if more conservative options fail or for urgent conditions like cancer.
SILS – Single Incision Laparoscopy Surgery involves making a single incision in the belly button to perform minimally invasive surgery using a laparoscope. It has advantages over traditional open surgery and laparoscopic surgery such as less scarring and faster recovery. The surgery allows removal of organs like the kidney or repair of the urinary tract through the single incision and additional small incisions around the belly button.
A presentation by Dr Jacob Chisholm on Developments In Gastrointestinal Therapies.
Jacob Chisholm is an upper gastrointestinal and general surgeon with an interest in weight loss and metabolic surgery. Jacob received his undergraduate degree (MBBS) from the University of Adelaide, a postgraduate research degree (Masters of Surgery) from Flinders University and is a Fellow of the Royal Australasian College of Surgeons. He trained in surgery at the Royal Adelaide and Flinders Medical Centre before completing a bariatric fellowship in 2007. Jacob was appointed chief surgical resident at Flinders Medical Centre in 2008 and has been a consultant surgeon at that institution since 2010. Jacob joined the Adelaide Bariatric Centre in 2010.
The document discusses economic considerations in surgical practice. It notes that while clinical freedom allows choosing the best treatment for patients, this must be tempered by available resources. Both direct and indirect costs of surgery and disease are examined. Strategies to improve cost-effectiveness through appropriate investigations, reduced complications, and specialized care are proposed. Measuring quality-adjusted life years and cost-benefit/cost-effectiveness analyses can help evaluate patient management options.
The document discusses economic considerations in surgical practice. It notes that while clinical freedom allows choosing the best treatment for patients, this must be tempered by appreciating available resources. Both direct and indirect costs of surgery and disease are examined. Strategies to improve cost-effectiveness through appropriate investigations, procedures, complications reduction and resource use are proposed. Managing the potential conflicts between ethics, patient care and health economics is emphasized.
Dr Patrick Treacy on devices for dealing with post-pregnancy baby weightDr. Patrick J. Treacy
Pregnancy leads to many changes in a woman’s
body, mainly through the interaction of steroid
hormones, lactogen and cortisol on the underlying
tissues and structures. The growing foetus itself
causes mechanical change also by stretching
skin, muscle and fascia and demanding an increased
calorific supply. The amount of extra weight gained
during pregnancy varies among women.
A stomach band will only work if you ban unhealthy food and incorporate lifestyle changes. But this procedure helps your body absorb nutrients, a big advantage over other procedures.
Breast reconstruction has become an important part of breast cancer treatment to help restore a woman's body image and self-esteem after mastectomy. There are several options for reconstruction, including implants, flaps of tissue from the abdomen, back, or buttocks, or a combination of procedures. Immediate reconstruction at the time of mastectomy has advantages over delayed reconstruction in terms of cosmetic results and psychological impact. Proper patient selection considering health factors and goals is important to achieve a successful surgical outcome and recovery.
This document provides an overview and table of contents for a textbook on endoscopy in obesity management. The textbook covers the history of bariatric surgery, indications for endoscopy, anesthesia considerations, anatomy of procedures, and management of complications. It aims to provide clinicians knowledge on treatment options and endoscopic management of obese patients. The textbook includes 14 chapters covering topics like acute bleeding, leaks, obstructions, and future endoscopic procedures for obesity.
This study examines fat necrosis as a sequela of fat grafting for postmastectomy breast reconstruction. The study analyzed 278 patients who underwent fat grafting, finding that 23% developed a palpable mass a median of 10 months later. Of those patients, 6% underwent biopsy, confirming fat necrosis in most cases but recurrent carcinoma in one. No clinical or technical variables predicted fat necrosis. The study concludes that fat grafting improves cosmesis but has a significant risk of fat necrosis, and increased awareness can decrease unnecessary imaging/biopsy while managing patients' anxiety.
The document summarizes new guidelines for oncoplastic breast reconstruction developed by a multidisciplinary writing group in response to findings from the National Mastectomy and Breast Reconstruction Audit. The guidelines establish 25 quality criteria across key areas of preoperative care, surgery, and postoperative management based on audit outcomes. The criteria set standards for areas like infection control and pain management to improve clinical outcomes and patient experience based on the best available evidence. A patient version was also developed to clearly communicate expectations of care. The guidelines aim to enhance multidisciplinary care and support at each stage of a patient's breast reconstruction journey.
Similar to Airbrush Bariatric Surgery Alternative2 (20)
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Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
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Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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Airbrush Bariatric Surgery Alternative2
1. A Safer and Faster
Alternative to Bariatric
Surgery
BioSculpture Technology, Inc. October 30, 2008
Serial Twin Cannula Assisted Liposuction in a combined modality
treatment can accomplish an end run to a better body and healthier
metabolic profile in overweight and frankly obese patients.
2. Disclaimer
The information contained in this document is the proprietary and exclusive
property of BioSculpture Technology, Inc. except as otherwise indicated. No part of
this document, in whole or in part, may be reproduced, stored, transmitted, or used
without the prior written permission of BioSculpture Technology, Inc.
The information contained in this document is subject to change without notice.
The information in this document is provided for informational purposes only.
BioSculpture Technology, Inc. specifically disclaims all warranties, express or limited,
including, but not limited, to the implied warranties of merchantability and fitness for a
particular purpose, except as provided for in a separate agreement.
No specific surgical result can be warranted with any specific surgery or
instrumentation and the regimen discussed is not appropriate for all patients. Suitability
of patients for this or any specific treatment regimen must be evaluated on an individual
basis by treating physicians. Procedures should carried out in appropriately equipped
and accredited facilities by properly trained and certified physicians. Any surgery is
accompanied by complications and sequelae that must be assessed by physicians and
fully explained to patients in advance.
Privacy Information
This document may contain information of a sensitive and privileged nature. This
information should not be given to persons other than those who are involved in the
development, sale, or use of the Airbrush Liposculpture® Sytems or who will become
involved during their lifecycle.
Airbrush Liposculpture® for Overweight Patients
2
3. Table of Contents
Executive Summary 4
The Obesity Problem 5
The Airbrush® Advantage 7
The Airbrush® Combined Modality Alternative 9
Case Studies 11
Target Market 13
Metabolic Implications 13
Contact Us 14
More Information 14
Airbrush Liposculpture® for Overweight Patients
3
4. Executive Summary
Overview
Two thirds of Americans are overweight and one third are frankly obese and the
trend towards obesity increasing. The medical conditions associated with obesity
aggravate the health care cost issues facing us today.
Current solutions to the problem are unsatisfactory in that bariatric surgery,
extensive lipectomies with their concomitant hospitalizations, medical management,
convalescences, and complications take a protracted toll on the medical insurance
system, the patient’s finances, and their lives. Even an uneventful course is
accompanied by extensive scarring and metabolic changes that compromise any health
benefit obtained.
There is every indication that we can help these obese and overweight patients
both cosmetically and functionally and do so more cheaply, with less risk, and in a
shorter period of time with serial twin cannula assisted liposuction (TCAL) and limited,
no-undermining skin excisions.
Airbrush Liposculpture® for Overweight Patients
4
5. The Obesity Problem
Increasing Obesity Prevalence and Associated Medical Costs
The U.S. obesity prevalence increased from 13% to 32% between the 1960’s and
2004. According to recent statistics, two-thirds of America is overweight and one-third is
frankly obese. Abdominal obesity as measured by waist to hip circumference ratio
(WHR) is an independent predictor of mortality. Increased WHR is a risk factor for the
metabolic syndrome which is associated with insulin resistant diabetes, hypertension
and coronary artery disease.
Current Treatment – Bariatric Surgery Followed by Panniculectomies
Traditional surgical treatment of obesity first focused on either decreasing the
transit time of food in the digestive tract to reduce the absorption of calories or
decreasing the volume of the stomach to trigger satiety with smaller portions. In either
case, required vitamins and nutrients are lost to the patient’s detriment in addition to the
unwanted calories. Patients dramatically lose large amounts of weight over the next
year, require careful medical monitoring, and not infrequently have accompanying
hepatic or renal complications of their surgery as well as diarrhea. Chronic malnutrition
states of hypoalbuminemia and anemia are not infrequent.
Although patients with BMI (body mass indices > 40) usually have their bariatric
surgeries reimbursed by insurance if the physician is sufficiently persistent in his
appeals, many and those with lower BMI’s are out of pocket for the typical $25,000 for
the currently favored gastric banding as well as the required regular postoperative
Airbrush Liposculpture® for Overweight Patients
5
6. medical monitoring with expensive blood tests. The co-pays alone can be staggering.
And that’s just the beginning if there are complications to the initial surgery.
When these patients inevitably desire cosmetic improvement of their sagging skin
which comes to resemble a deflated balloon or that of a Chinese Shar-Pei dog, they
require hospitalizations for major panniculectomies. The skin has been stretched
beyond the point of no return and rapid weight loss simply leaves it hanging on a
slimmed-down frame in a most unattractive and almost grotesque fashion in some
cases. This redundant skin has to be cut away and incisions must extend the length of
the bulges to be removed to obtain smooth contours - frequently fully circumferential or
near-circumferential about the waist and thighs and linearly down the inside upper arms.
Breast lifts in women and gynecomastia excisions in men are almost always required to
return the patient to satisfactory appearance.
Current Treatment Is Unsatisfactory as Bariatric Surgery Creates New
Problems
Unfortunately at the time of these plastic surgical interventions, many post-
bariatric surgery patients are no longer ideal surgical candidates due to chronic anemia
and hypoalbuminemia related to their gastric surgery and therefore experience
concomitant complications such as poor wound healing and increased infection rates.
These surgeries, hospitalizations, medical management, convalescences, and
complications take a protracted toll on the medical insurance system, the patient’s
finances, and the quality of their lives. Even an uneventful course is accompanied by
extensive scarring and metabolic changes that compromise any health benefit obtained.
Airbrush Liposculpture® for Overweight Patients
6
7. The Airbrush® Advantage
Patented Twin Cannula Technology
Recent advances in power assisted liposuction technology allow it to be employed
earlier as a more direct approach to the obesity problem. Post liposuction flaccidity
previously has been a major complaint of patient and physician alike. This new
technology allows more fat to be removed with better control and speed in each surgical
sitting and the surgeon to safely direct efforts at obtaining improved skin contraction.
This new twin cannula assisted liposuction (TCAL) consists of a reciprocating inner
cannula ensheathed within a stationary outer cannula. A hole in the inner cannula is in
continuity to the traditional vacuum source as with other means of liposuction to aspirate
the fat. This inner cannula aperture is aligned with a slot in the outer cannula sheath
and is mechanically reciprocated to and fro within it. The surgeon may adjust this
excursion from zero to 2” as desired to replicate a manual stroke, but without effort and
with greater precision and control. The patient and the surgeon’s upper extremity are
both spared the battering ram effect of the cannula against the patient’s tissues – about
10,000 times per hour. This translates into lessened bruising and swelling, reduced
blood loss, shortened operating times, briefer convalescences, improved surgical ease
and control, and fewer revisions. Unlike LASER or ultrasound assisted liposuction (LAL
or UAL), the tip of the cannula does not get warm, so burns are not possible and there is
no increased incidence of seromas. Furthermore, the stationary outer cannula acts as a
spacer which allows the surgeon to safely aspirate subdermally to encourage greater
skin contraction.
Airbrush Liposculpture® for Overweight Patients
7
8. Fig. 1 TCAL design in which the aperture of the reciprocating inner cannula is aligned
with the slot of the stationary outer cannula to reduce labor and tissue trauma
from the tip of the moving inner cannula while simulating an adjustable normal
stroke excursion ≤ 2”.
Traditional power assisted liposuction (PAL) offers minimal mechanical assistance
because it consists simply of a single cannula vibrating a small fraction of an inch and
many surgeons find this vibration annoying. In LAL, traditional PAL and UAL the
surgeon must still stroke the cannula back and forth manually to remove the fat in
contrast to TCAL.
More Gentle Liposuction
Since TCAL fat removal is faster and more controlled by design, operations are
shorter, and more fat can be safely removed in sessions that may be scheduled closer
together. Patients tolerate conscious sedation more easily for these shorter surgeries
which allows them to stand during the procedure so the surgeon can appreciate
conditions that are concealed with the patient recumbent on the operating table.
Patients have shorter convalescences, revisions and complications are less frequent,
results are more dramatic, and blood loss is less – allowing more fat to be safely
removed in a session. TCAL removes the fat and leaves the fascial vascular lattice and
dermis uninjured.
Airbrush Liposculpture® for Overweight Patients
8
9. Fig. 2 Vasculature left intact as TCAL removes fat both above
and below the fascia without heat.
The Airbrush® Combined Modality Alternative
Short Interval Serial Liposuction Under Conscious Sedation
It was inevitable that this new technology would be applied to the treatment of
obesity. Serial TCAL may be performed at short intervals of days or weeks between
sessions, each carried out below the limits for safe out patient treatment with aspiration
subdermally to stimulate skin contraction. Rather than sending away a significantly
overweight or frankly obese patients with the statement, “Liposuction is not a treatment
of obesity,” as before, the surgeon can now safely accomplish megaloliposuction (≥8-9
L) with smaller, closely spaced, serial sessions. Each session is carried out below the
safe limits of outpatient fat removal, (generally 5.5-6.5 L or 12-14 lbs) per session, on an
ambulatory basis, and under local anesthesia at intervals of days to weeks. Inches and
pounds come off quickly as adjoining areas are treated as if each were only a “localized
Airbrush Liposculpture® for Overweight Patients
9
10. deposit” of a thinner patient. The patients are fat, but they are otherwise healthy, and
heal from liposuction rapidly as expected without complications.
Skin Excision With Limited Incision Without Undermining
At the final liposuction session, also under conscious sedation on an ambulatory
basis without hospitalization, redundant skin excision can be performed simultaneously
without undermining to enhance the result. In the majority of patients with truncal
obesity, a lower abdominal skin incision below the umbilicus in the bikini line suffices; the
resultant scar is more limited than that of traditional abdominoplasty and without the
necessity of drains since no undermining or deep dissection is required.
The cosmetic result that can be achieved with this combined modality
approach using TCAL in the span of several weeks in these obese patients is nothing
short of dramatic. The results are not only impressive, but doubly so because of the
rapidity with which they are achieved and the fact that they are obtained by operating on
obese but otherwise healthy patients – patients uncompromised by the digestive and
metabolic consequences of prior bariatric surgery. They equal or surpass the results
obtained years after bariatric surgery and can be achieved in weeks with less risk, fewer
complications, and less expense.
Fig. 3 The Airbrush Liposculpture® System has computerized control
and adjustment of stroke using a closed feed back loop for safety.
Airbrush Liposculpture® for Overweight Patients
10
13. Target Market
Surgeons desiring to perform more liposuction, do so with greater ease and control,
and expand their practice can include a large and eager patient population with generally
realistic expectations who can be dramatically improved in a short period of time.
The otherwise healthy members of the overweight two-thirds of American citizenry
all comprise potential candidates for surgery.
Metabolic Implications
Were these cosmetic results not impressive enough alone, we are reminded of the
fact that an elevated waist to hips circumference ratio (WHR) of patients is one of the
risk factors for the metabolic syndrome associated with insulin resistant diabetes and
coronary artery disease. Earlier studies have suggested that reducing elevated WHR of
affected patients renders the metabolism of these patients more normal and tends to
reduce blood pressure. Thus there is every indication that we can help these obese
and overweight patients both cosmetically and functionally and do so more cheaply, with
less risk, and in a shorter period of time.
BioSculpture Technology, Inc. which manufactures the Airbrush Liposculpture®
Systems based on their patented TCAL design instituted the CINCH IT!™ program to
allow physicians to acquire their systems at a discount in an effort to promote this
promising new obesity treatment, encourage physicians to obtain the required clinical
documentation to justify insurance reimbursement, and to reduce the health care costs
associated with America’s growing obesity problem.
Airbrush Liposculpture® for Overweight Patients
13
14. Contact Us
BioSculpture Technology, Inc.
Name:
40 Central Park South
Address:
New York, N.Y. 10019
sales@biosculpturetechnology.com
Email:
www.biosculpturetechnology.com
Web site:
(212) 977-5400
Tel:
(212) 586-9529
Fax:
More Information
Regularly Updated Reference Web Links
For the latest information about our product and services, please see the following
resources.
http://www.biosculpturetechnology.com/products.htm
http://www.biosculpturetechnology.com/news.htm
References
Powered Liposuction. Becker DG, Cucin, RL Powered Instrumentation in
1.
Otolaryngology-Head and Neck Surgery. Yanagisawa E, Christmas DA, Mirante
JP Singular ( 2001)
Airbrush Liposculpture® for Overweight Patients
14
15. Liposuction. Cucin RL Medical Malpractice: Handling Plastic Surgery Cases.
2.
Cucin RL Shepard’s McGraw Hill 1995 1996 1997 1998 1999 2000
3. Perceived Value of Liposuction among Plastic Surgeons. Cucin RL Data from a
Survey of 2,263 ASPRS Member Surgeons. (2002).
4. Serial Twin Cannula Assisted Liposuction can accomplish an end run towards a
better body and healthier metabolic profile in obese patients. Cucin RL, Pelosi II MA
Manuscript in Preparation.
5. Skin Retraction after liposuction in patients over the age of 40. Bank DE, Perez MI
Dermatol Surg. 1999 Sept:25(9): 673-6
Blood loss in major liposuction procedures: a comparison study using suction-
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assisted versus ultrasonically assisted lipoplasty. Karmo FR, Milan MF, Silbergleit
A. Plast Reconstr Surg. 2001 Jul: 108(1) 241-9
Powered liposuction. Coleman WP 3RD Dermatol Surg. 2000 Apr: 26(4): 315-8
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The benefits of powered liposuction versus traditional liposuction: a paired
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comparison analysis. Katz BE, Bruck MC, Coleman WP 3rd. Dermatol Surg. 2001
Oct:27(10): 863-7
Improvements in cardiovascular risk profile with large-volume liposuction: a pilot
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study. Giese SY, Bulan EJ, Commons GW, Spear SL, Yanovski JA. Plastic
Reconstr Surg. 2001 Aug: 108(2) 510-21
10. Large-volume liposuction and extensive abdominoplasty: a feasible alternative for
improving body shape. Cardenas-Camarena L, Gonzalez LE Plast Reconstr
Surg. 1998 Oct: 102(5): 1698-707.
11. Optimization of conscious sedation in plastic surgery. Marcus JR, Tyrone JW, Few
JW, Fine NA, Mustoe TA. Plastic Reconstr Surg 1999 (Oct): 104(5) 1338-45.
12. Body Contouring in the Obese Patient. Hunstad JP Clin Plast Surg. 1996 (Oct)
23(4):647-70.
13. Obesity can be treated by Suction Lipoplasty when Combined with Other
Procedures. Ersek RA, Philips C, Schade K Aesthetic Plast Surg. 1991 15(1):67-
71.
14. Tumescent Technique J. Klein, Mosby Publishers, 2000.
Airbrush Liposculpture® for Overweight Patients
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