The document summarizes a presentation given by Dr. C. Daniel Smith at the Florida Gastroenterologic Society Annual Meeting in September 2010. The presentation covered recent innovations in minimally invasive GI surgery, including natural orifice translumenal endoscopic surgery (NOTES), single incision laparoscopic surgery (SILS), minimally invasive esophagectomy, and innovations in antireflux surgery devices. The presentation provided details on the techniques, outcomes, adoption rates, and impacts of these new minimally invasive surgical innovations.
Robotic Surgery(minimally invasive surgery)Sgtm Saha
robotic surgery,minimally invasive surgery,MIS,the vinci surgical process,leproscopy surgey, 5 mins representation,BCDA College of pharmacy, SGTM, Swagatam Saha,WBUT Board,6th sem.
Minimally invasive surgery uses small incisions and miniaturized imaging systems to perform major operations with less trauma than traditional open surgery. The techniques were developed starting in the early 1900s and improved with advances like rod lens endoscopes, flexible instruments, and fluoroscopic imaging. Laparoscopic surgery involves inflating the abdominal cavity with gas to provide space to see and operate. Thoracoscopy may require deflating one lung. Other minimally invasive techniques provide access through subcutaneous tissues or body cavities without requiring incisions into organs. Endoluminal and intraluminal procedures operate from within lumens like blood vessels or the digestive tract.
Robotic Surgery by muthugomathy and meenakshi shetti.Qualcomm
Here is the very animatedly designed Presentation that explains briefly about Robotic Surgery , Uses of Robobic Surgery, Robotic Surgery Advantages and Disadvantages and about its future scope.
What is New In Minimally Invasive Surgery for UrologySiewhong Ho
Dr Ho Siew Hong gave a series of Continous Medical Education lectures to doctors of Gleneagles, Mount Elizabeth and East Shore Hospitals on the latest in Urology surgery
Presentation delivered during a Hospital Efficiency Seminar hosted by Institute for Healthcare Optimization on July 25, 2013. Reviews Mayo Clinic experience and outcomes with using variability theory to re-design the management of the operating rooms at Mayo Clinic Florida.
Early Results With Linx and Lessons for Implementation in PracticeC Daniel Smith
This document discusses the early clinical outcomes of introducing a mechanical sphincter augmentation device called LINX for the treatment of GERD. It summarizes the experience from the first 66 patients treated at a single institution. The procedure had a high rate of successful implantation with no complications. Early outcomes showed 83% of patients were off PPIs with high satisfaction rates. Recovery from dysphagia and esophageal clearance issues took longer than typical anti-reflux surgery due to the constant pressure from the device. Careful patient selection and education as well as differentiated post-op management from fundoplication patients were emphasized for successful adoption of this new therapy into clinical practice.
SureSELECT - Operating Room and Hospital Resource Utilization Schedule Optimi...C Daniel Smith
Optimizing the flow of a surgical patient through the operating room helps ensure the greatest value in the care of that patient. To achieve this optimized flow, the resources needed to provide care through the entire episode of care need to be coordinated.
Coordinating these varied and often disintegrated resources is often nearly impossible without the dedicated time of multiple FTEs to manage the schedules and resources of the different segments of care.
The starting point for the flow of a surgical patient is their placement on the operating room schedule. SureSELECT surveys and assesses all the resources needed for a specific patient’s care and provides the optimized placement on the operating room schedule to achieve optimal flow. Proprietary algorithms assure that all resources are available “just-in-time” throughout the patient’s care.
Re-engineering the Operating Room Using Variability Methodology to Improve He...C Daniel Smith
Hospitals across the country are aggressively pursuing cost-cutting strategies, and the high-value, high-cost environment of the operating room is a prime target for cost reduction.
Applying variability methodology swings the pendulum for access to the hospital’s operating rooms from “whatever and whenever” the surgeon wants, to what is best for the hospital. Put more directly, in this model, the surgeon is asked to compromise to meet the hospital’s financial needs. The resultant tension between a surgeon and hospital administration can become intense and was certainly present during the redesign and implementation detailed in this case study.
Software and information technology tools to help schedule surgical cases within the redesign goals, and reporting tools within a quantitative dashboard are essential to facilitate adoption of this program. Transparency regarding leadership decisions and frequent feedback to all providers about performance improvements should be emphasized. Change management and analytics support should be identified either internally or pursued externally before starting such a program.
Robotic Surgery(minimally invasive surgery)Sgtm Saha
robotic surgery,minimally invasive surgery,MIS,the vinci surgical process,leproscopy surgey, 5 mins representation,BCDA College of pharmacy, SGTM, Swagatam Saha,WBUT Board,6th sem.
Minimally invasive surgery uses small incisions and miniaturized imaging systems to perform major operations with less trauma than traditional open surgery. The techniques were developed starting in the early 1900s and improved with advances like rod lens endoscopes, flexible instruments, and fluoroscopic imaging. Laparoscopic surgery involves inflating the abdominal cavity with gas to provide space to see and operate. Thoracoscopy may require deflating one lung. Other minimally invasive techniques provide access through subcutaneous tissues or body cavities without requiring incisions into organs. Endoluminal and intraluminal procedures operate from within lumens like blood vessels or the digestive tract.
Robotic Surgery by muthugomathy and meenakshi shetti.Qualcomm
Here is the very animatedly designed Presentation that explains briefly about Robotic Surgery , Uses of Robobic Surgery, Robotic Surgery Advantages and Disadvantages and about its future scope.
What is New In Minimally Invasive Surgery for UrologySiewhong Ho
Dr Ho Siew Hong gave a series of Continous Medical Education lectures to doctors of Gleneagles, Mount Elizabeth and East Shore Hospitals on the latest in Urology surgery
Presentation delivered during a Hospital Efficiency Seminar hosted by Institute for Healthcare Optimization on July 25, 2013. Reviews Mayo Clinic experience and outcomes with using variability theory to re-design the management of the operating rooms at Mayo Clinic Florida.
Early Results With Linx and Lessons for Implementation in PracticeC Daniel Smith
This document discusses the early clinical outcomes of introducing a mechanical sphincter augmentation device called LINX for the treatment of GERD. It summarizes the experience from the first 66 patients treated at a single institution. The procedure had a high rate of successful implantation with no complications. Early outcomes showed 83% of patients were off PPIs with high satisfaction rates. Recovery from dysphagia and esophageal clearance issues took longer than typical anti-reflux surgery due to the constant pressure from the device. Careful patient selection and education as well as differentiated post-op management from fundoplication patients were emphasized for successful adoption of this new therapy into clinical practice.
SureSELECT - Operating Room and Hospital Resource Utilization Schedule Optimi...C Daniel Smith
Optimizing the flow of a surgical patient through the operating room helps ensure the greatest value in the care of that patient. To achieve this optimized flow, the resources needed to provide care through the entire episode of care need to be coordinated.
Coordinating these varied and often disintegrated resources is often nearly impossible without the dedicated time of multiple FTEs to manage the schedules and resources of the different segments of care.
The starting point for the flow of a surgical patient is their placement on the operating room schedule. SureSELECT surveys and assesses all the resources needed for a specific patient’s care and provides the optimized placement on the operating room schedule to achieve optimal flow. Proprietary algorithms assure that all resources are available “just-in-time” throughout the patient’s care.
Re-engineering the Operating Room Using Variability Methodology to Improve He...C Daniel Smith
Hospitals across the country are aggressively pursuing cost-cutting strategies, and the high-value, high-cost environment of the operating room is a prime target for cost reduction.
Applying variability methodology swings the pendulum for access to the hospital’s operating rooms from “whatever and whenever” the surgeon wants, to what is best for the hospital. Put more directly, in this model, the surgeon is asked to compromise to meet the hospital’s financial needs. The resultant tension between a surgeon and hospital administration can become intense and was certainly present during the redesign and implementation detailed in this case study.
Software and information technology tools to help schedule surgical cases within the redesign goals, and reporting tools within a quantitative dashboard are essential to facilitate adoption of this program. Transparency regarding leadership decisions and frequent feedback to all providers about performance improvements should be emphasized. Change management and analytics support should be identified either internally or pursued externally before starting such a program.
Improving Surgical Safety and Patient OutcomesC Daniel Smith
Keynote talk delivered at New Jersey Hospital Association Seminary on Improving Surgical Safety & Patient Outcomes held on September 25, 2013 at their Conference Center in Princeton New Jersey. Over physicians, administrators, nurses and perioperative services providers in attendance.
Surgery Grand rounds Presentation at Rush University Medical Center on March 20, 2013. Presentation highlights clinical use of Prone Thoracoscopy, Fluorescence Angiography, Transcervical Videoscopic Esophageal Dissection (TVED) and Linx.
Slides from recent presentation at Mayo Clinic course on advances in gastroenterology. These are the slides that are a part of the video presentation of this same talk.
The document discusses establishing the LINX Reflux Management System as a surgical offering for treating GERD. It provides context on the current treatment landscape including the role and limitations of Nissen fundoplication and PPI therapy. Key points made include defining the typical LINX patient as one with moderate GERD symptoms remaining on PPIs, presenting efficacy data from the pivotal trial showing high rates of PPI independence and symptom improvement, and emphasizing the importance of patient selection and standardized surgical technique for achieving good outcomes.
This document summarizes a presentation on the surgical treatment of achalasia given at the 2012 SAGES Annual Meeting. It provides background on achalasia, including epidemiology and etiology. It discusses current treatment options and their outcomes, with surgical myotomy shown to have the highest long-term success rate of 92%. The presentation explores ongoing controversies in surgical treatment and also discusses emerging endoscopic options like per oral endoscopic myotomy. It emphasizes that patient selection and surgical technique are two key predictors of outcome for treating achalasia.
The Linx Reflux Management System is a bracelet of magnetic beads that is surgically placed around the esophagus. The magnetic force holds the bracelet closed to prevent acid reflux but opens in response to swallowed food. It has been tested in humans for over 4 years and approved by the FDA in 2012. Candidates must have a confirmed GERD diagnosis but no Barrett's esophagus or large hiatal hernia. The procedure is performed laparoscopically and patients can resume a normal diet immediately after. The device is available at centers with GERD expertise.
FDA Advisory Panel Linx Presentation 011112C Daniel Smith
This document provides an agenda and background information for a medical devices panel meeting on the LINX Reflux Management System. The agenda includes presentations on the pathophysiology of GERD, an overview of the LINX device and its pre-clinical testing, results from the LINX feasibility and pivotal clinical trials, post-market studies, and closing comments. The document also provides context on the company that developed LINX, the regulatory timeline for LINX, clinical experience with LINX to date, and an overview of the intended focus of today's meeting.
A study of 97 patients who underwent esophagectomy between 2007-2010 found that:
1) Minimally invasive esophagectomy (MIE) was associated with fewer pulmonary and cardiac complications compared to open approaches, but the differences were not statistically significant.
2) Rates of anastomotic leaks, renal complications, wound infections, and in-hospital mortality were similar between MIE and open approaches.
3) Trans-thoracic approaches to esophagectomy, whether open or minimally invasive, were associated with higher morbidity than cervical or transhiatal approaches.
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
Improving Surgical Safety and Patient OutcomesC Daniel Smith
Keynote talk delivered at New Jersey Hospital Association Seminary on Improving Surgical Safety & Patient Outcomes held on September 25, 2013 at their Conference Center in Princeton New Jersey. Over physicians, administrators, nurses and perioperative services providers in attendance.
Surgery Grand rounds Presentation at Rush University Medical Center on March 20, 2013. Presentation highlights clinical use of Prone Thoracoscopy, Fluorescence Angiography, Transcervical Videoscopic Esophageal Dissection (TVED) and Linx.
Slides from recent presentation at Mayo Clinic course on advances in gastroenterology. These are the slides that are a part of the video presentation of this same talk.
The document discusses establishing the LINX Reflux Management System as a surgical offering for treating GERD. It provides context on the current treatment landscape including the role and limitations of Nissen fundoplication and PPI therapy. Key points made include defining the typical LINX patient as one with moderate GERD symptoms remaining on PPIs, presenting efficacy data from the pivotal trial showing high rates of PPI independence and symptom improvement, and emphasizing the importance of patient selection and standardized surgical technique for achieving good outcomes.
This document summarizes a presentation on the surgical treatment of achalasia given at the 2012 SAGES Annual Meeting. It provides background on achalasia, including epidemiology and etiology. It discusses current treatment options and their outcomes, with surgical myotomy shown to have the highest long-term success rate of 92%. The presentation explores ongoing controversies in surgical treatment and also discusses emerging endoscopic options like per oral endoscopic myotomy. It emphasizes that patient selection and surgical technique are two key predictors of outcome for treating achalasia.
The Linx Reflux Management System is a bracelet of magnetic beads that is surgically placed around the esophagus. The magnetic force holds the bracelet closed to prevent acid reflux but opens in response to swallowed food. It has been tested in humans for over 4 years and approved by the FDA in 2012. Candidates must have a confirmed GERD diagnosis but no Barrett's esophagus or large hiatal hernia. The procedure is performed laparoscopically and patients can resume a normal diet immediately after. The device is available at centers with GERD expertise.
FDA Advisory Panel Linx Presentation 011112C Daniel Smith
This document provides an agenda and background information for a medical devices panel meeting on the LINX Reflux Management System. The agenda includes presentations on the pathophysiology of GERD, an overview of the LINX device and its pre-clinical testing, results from the LINX feasibility and pivotal clinical trials, post-market studies, and closing comments. The document also provides context on the company that developed LINX, the regulatory timeline for LINX, clinical experience with LINX to date, and an overview of the intended focus of today's meeting.
A study of 97 patients who underwent esophagectomy between 2007-2010 found that:
1) Minimally invasive esophagectomy (MIE) was associated with fewer pulmonary and cardiac complications compared to open approaches, but the differences were not statistically significant.
2) Rates of anastomotic leaks, renal complications, wound infections, and in-hospital mortality were similar between MIE and open approaches.
3) Trans-thoracic approaches to esophagectomy, whether open or minimally invasive, were associated with higher morbidity than cervical or transhiatal approaches.
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...Université de Montréal
“Psychiatry and the Humanities”: An Innovative Course at the University of Montreal Expanding the medical model to embrace the humanities. Link: https://www.psychiatrictimes.com/view/-psychiatry-and-the-humanities-an-innovative-course-at-the-university-of-montreal
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdfrightmanforbloodline
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
Ageing, the Elderly, Gerontology and Public Health
Innovations in Minimally Invasive Surgery 2011
1. Innovations in Minimally
Invasive GI Surgery
Florida Gastroenterologic Society
Annual Meeting
September 25, 2010
Lake Buena Vista, Florida
C. Daniel Smith, MD
2
Sunday, November 25, 12
2. Innovations in Minimally Invasive GI Surgery
• Natural Orifice Translumenal
Endoscopic Surgery (NOTES)
• Single Incision Laparoscopic
Surgery (SILS)
• Minimally Invasive Esophagectomy
• Antireflux Surgery
Innovations in MIS. FGS Annual Meeting.
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3
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3. NOTES
• Natural
• Orifice
• Translumenal
• Endoscopic
• Surgery
Innovations in MIS. FGS Annual Meeting.
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4. NOTES
Laparoscopic Surgery
NOTES
Advanced Interventional
Imaging & Endoscopy
Guidance
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5. NOTES
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6. NOTES - U.S. Adoption
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7. NOTES - U.S. Adoption
NOTES Surgery - Elsewhere
Dr. Christine Ren, an associate professor of
surgery at New York University’s school of
medicine, called the vaginal procedure
“repulsive” and said: “As a woman I find it very
invasive, physically and emotionally. To me it’s
quite distasteful. You will really have to prove to
me that there is a benefit.”
Innovations in MIS. FGS Annual Meeting.
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8. NOTES - Future ?
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9. New Treatment Success – Key Elements
Carotid Lap
Lap Chole Lap Nissen
Stenting Colectomy
Clinical Results - +++ ++ +++
Ease of Use - +/- - -
Patient Demand +++++ +++ ++++++ +++
Cost - +/- - +
Reimbursement +/- + +/- ++
Other Rx Options - +++++ - +
WIDELY ADOPTED YES NO YES NO
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10. New Treatment Success – Key Elements
Lap
Lap Chole Lap Nissen NOTES
Colectomy
Clinical Results - +++ +++
Ease of Use - +/- - ---
Patient Demand +++++ +++ +++ ++
Cost - +/- +/- ---
Reimbursement +/- + ++
Other Rx Options - +++++ +/- +++++
WIDELY ADOPTED YES NO NO NO
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11. NOTES - Future ?
Which would you rather have:
A lap chole by a skilled surgeon
OR
A transgastric/vaginal cholecystectomy
Innovations in MIS. FGS Annual Meeting.
September 24-26, 2010
12
Sunday, November 25, 12
12. Closing Comments
MIS vs. NOTES. SAGES Best of NOTES
April 10, 2008
13
Sunday, November 25, 12
13. NOTES – Impact?
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14. NOTES – Impact?
Natural Orifice Surgery Single Incision
Laparoscopic Surgery
Innovations in MIS. FGS Annual Meeting.
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15. Single Incision Laparoscopic Surgery
• Less pain • Earlier return
to work
• Faster
recovery • Superior
cosmesis
Innovations in MIS. FGS Annual Meeting.
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16. Single Incision Laparoscopic Surgery
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17. Single Incision Laparoscopic Surgery
“The Next Lap Chole”
Natural Orifice Surgery
Over 100,000 hits
with Google Search
Laparocopic colectomy -
58,000 hits
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14
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18. Single Incision Laparoscopic Surgery
Laparoscopic surgery performed through a single incision: a
systematic review of the literature. JACS, Jan 2011, In Press
2007-2010 Procedure No. Publications
Cholecystectomy 52
219 publications
Nephrectomy 34
4,585 operations
Appendectomy 28
GYN 19
6 institutions - 57 cits Colectomy 15
1 institution - 26 cits
Inguinal Hernia 11
Innovations in MIS. FGS Annual Meeting.
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14
Sunday, November 25, 12
19. Single Incision Laparoscopic Surgery
Laparoscopic surgery performed through a single incision: a
systematic review of the literature. JACS, Jan 2011, In Press
2007-2010 OUTCOMES
219 publications 48% perioperative outcomes only
4,585 operations 12% compared outcomes to another technique
1 PRCT - Lap chole v. Single incision chole
6 institutions - 57 cits Improved pain scores
1 institution - 26 cits
Longer OR time
Innovations in MIS. FGS Annual Meeting.
Lake Buena Vista. Sept 25, 2010
14
Sunday, November 25, 12
20. New Treatment Success – Key Elements
Lap
Lap Chole Lap Nissen SILS
Colectomy
Clinical Results - +++ +++ -
Ease of Use - +/- - -
Patient Demand +++++ +++ +++ ++
Cost - +/- +/- -
Reimbursement +/- + ++ +/-
Other Rx Options - +++++ +/- +++++
WIDELY ADOPTED YES NO NO NO
Innovations in MIS. FGS Annual Meeting.
Lake Buena Vista. Sept 25, 2010
10
Sunday, November 25, 12
21. Single Incision Lap Surgery – Impact?
Single Incision
Laparoscopic Surgery
“The Next Lap Chole”
????
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Lake Buena Vista. Sept 25, 2010
14
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22. Single Incision Lap Surgery – Impact?
Single Incision Two Field MIE
Laparoscopic Surgery
Innovations in MIS. FGS Annual Meeting.
Lake Buena Vista. Sept 25, 2010
14
Sunday, November 25, 12
23. Esophagectomy Outcomes
Transthoracic Transhiatal
Operative mortality (%) 4 2
Blood loss 1402 847
LOS 19 15
Respiratory complications (%) 57 27
Cardiac complications (%) 26 16
Anastomotic leak (%) 15 14
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24. Minimally Invasive Esophagectomy (MIE)
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25. Minimally Invasive Esophagectomy (MIE)
2-Field Technique
No. patients 8 (3 low risk, 5 high risk)
EBL (cc) 63 (25-400)
Operative time (min) 292 (194-375)
Lymph nodes harvested 23 (13-29)
LOS in ICU (days) 1 (1-5)
LOS overall (days) 7 (5-16)
Use of chest tubes 0
Reoperation 0
Mortality 0
Innovations in MIS. FGS Annual Meeting.
Lake Buena Vista. Sept 25, 2010
16
Sunday, November 25, 12
26. Two-Field MIE - Impact?
Two Field MIE
No. patients 8 (3 low risk, 5 high risk)
EBL (cc) 63 (25-400)
Operative time (min) 292 (194-375)
Lymph nodes harvested 23 (13-29)
LOS in ICU (days) 1 (1-5)
LOS overall (days) 7 (5-16)
Use of chest tubes 0
Reoperation 0
Mortality 0
Innovations in MIS. FGS Annual Meeting.
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27. GERD
• Most common GI condition
• $ 10 billion healthcare
expenditure
• Mechanical defect in valve
• Surgery effective treatment
• Nissen (3600) fundoplication
is gold standard
Innovations in MIS. FGS Annual Meeting.
Lake Buena Vista. Sept 25, 2010
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28. Antireflux Surgery - Failure
No. patients 300 1127 1690
Mortality (%) 0.4 0.2 0.1
Conversion (%) 1.3 0.7 0.4
Intraoperative comp (%) 8 4 4
Early postop comp (%) 17 (transient) 30 (transient) 35 (transient)
Late postop comp (%) 4 5 5
Reoperation (%) - 3.5 2.8
Symptom free 12 months (%) 93 92 90
Continued medical Rx (%) 3 11 18
Satisfied with results (%) 97 95 94
Innovations in MIS. FGS Annual Meeting.
Lake Buena Vista. Sept 25, 2010
4
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29. Antireflux Surgery - Failure
No. patients 166
Follow-up (yrs) 11±1.2
Reoperation 26 (16%)
Failure* 43 (26%)
* Reoperation, patient dissatisfaction,
severe GERD symptoms
Surg Endosc (2007) 21:1978–1984 When Fundoplications Fails: Redo? Ann
Surg (2005) 241: 861-871
Innovations in MIS. FGS Annual Meeting.
Lake Buena Vista. Sept 25, 2010
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30. Antireflux Surgery – New Device
Innovations in MIS. FGS Annual Meeting.
Lake Buena Vista. Sept 25, 2010
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31. Antireflux Surgery – New Device
Innovations in MIS. FGS Annual Meeting.
Lake Buena Vista. Sept 25, 2010
5
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32. Antireflux Surgery – New Device
50.0
Baseline ! Pilot Trial
• 44 patients, 4-centers, US and
Total GERD HRQL Score
Follow-up
37.5 Europe
• Published J of Gastro 2008
25.0 • To be published Annals of
Surgery, November 2010
12.5
0
Pre-Implant 3 months 12 month 24 months
100
Normalized (Total pH < 5.3)
Percent of Patients
75
! Over 160 pts. implanted
to date under clinical 50
protocol
25
Innovations in MIS. FGS Annual Meeting. 0
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3 months 12 months 24 months
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33. Antireflux Surgery – New Device
! FDA Pivotal Trial
• 100 pt, 15-center, USA and Europe
• Jan 09 – Sept 09 (data pending completion of follow-up Sept 10)
University of Southern California
Ohio State University
Policlinico San Donat
University of Washington
Academic Medical Center, Amsterdam
University of Pittsburgh Medical Center
Abbott Northwestern
Knox Community, Ohio
University of California San Diego
Washington University
University of Rochester Medical Center
Phoebe Putney Medical Center
Legacy Health, Portland
Gunderson Lutheran, Wisconsin
Mayo Clinic - Jacksonville
Innovations in MIS. FGS Annual Meeting.
Lake Buena Vista. Sept 25, 2010
Sunday, November 25, 12
34. Antireflux Surgery – New Device - Impact?
100
Normalized (Total pH < 5.3)
Percent of Patients
75
50
25
0
3 months 12 months 24 months
Innovations in MIS. FGS Annual Meeting.
Lake Buena Vista. Sept 25, 2010
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35. Innovations in Minimally Invasive
Surgery
C. Daniel Smith, MD
smith.c.daniel@mayo.edu
404-323-4615
36
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