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Alfred Cuschieri – One of the best experts on this subject based on the ideXlab platform.

  • Development of force measurement system for clinical use in minimal Access Surgery.
    Surgical endoscopy, 2007
    Co-Authors: George B. Hanna, Tim Drew, Graham P Arnold, Morkos Fakhry, Alfred Cuschieri

    Abstract:

    Background
    Analysis of force in minimal Access Surgery (MAS) is important for instrument design, surgical simulators, and in the understanding of tissue trauma incurred during Surgery. The aim of this study is to develop a force measuring system for use with different instruments in clinical practice.

  • Force-sensitive tactile sensor for minimal Access Surgery.
    Minimally invasive therapy & allied technologies : MITAT : official journal of the Society for Minimally Invasive Therapy, 2004
    Co-Authors: N. Kattavenos, Tim Frank, B. Lawrenson, M.s. Pridham, R. P. Keatch, Alfred Cuschieri

    Abstract:

    A new approach to detecting abnormalities in organ tissue, particularly in relation to minimal Access Surgery, is presented. Prototype sensors, based on piezoresistive material, were developed and assembled into a forceps for evaluation on simulated diseased tissue. Data on the resilience and location of phantom tumours were recorded and displayed visually for ease of interpretation. Both single sensor and multiple sensor arrays (one‐ and two‐dimensional) were manufactured and tested.

  • Technology for minimal Access Surgery
    BMJ (Clinical research ed.), 1999
    Co-Authors: Alfred Cuschieri

    Abstract:

    One of the important changes in medical practice over the past two decades has been the reduction in traumatic insult inherent in surgical interventions. The new surgical and interventional approaches are usually referred to as minimally invasive. However, this terminology is inappropriate for two reasons. Firstly, it carries connotations of increased safety, which is not the case. Secondly, it is semantically incorrect since to invade is absolute, and indeed such interventions are as invasive as open Surgery in terms of reach of the various organs and tissues. The hallmark of the new approaches is the reduction in the trauma of Access. Hence, a more appropriate generic term is minimal Access therapy.1

    #### Summary points

    Minimal Access therapy comprises minimal Access Surgery, interventional flexible endoscopy, and percutaneous interventional radiology

    The main advantage is reduced trauma of Access, which allows more rapid recovery

    Imaging systems which allow surgeons to look down on the operating field help overcome mapping problems and improve performance

    New instruments are being developed that give surgeons greater freedom of movement

    Operating theatres need to be specially designed to cope with the new equipment

    Minimal Access therapy comprises several approaches, involves various disciplines, and cuts across the various specialties within these disciplines. In essence, however, it has three arms: minimal Access Surgery, interventional flexible endoscopy, and percutaneous interventional radiology. These therapeutic approaches are largely complementary, and increasingly they are used together to treat individual cases. The advent of minimal Access therapy has emphasised the need to regroup existing specialists from different disciplines to form multidisciplinary disease related treatment groups—for example, gastrointestinal, cardiovascular, or musculoskeletal groups. Such groups would facilitate real progress and efficiency in management and treatment of many diseases.

    Minimal Access therapy aims to minimise the traumatic insult to the patient without compromising the safety and efficacy of the treatment …

Markus M. Heiss – One of the best experts on this subject based on the ideXlab platform.

  • Comparison of Laparoscopic vs. Open Access Surgery in Patients with Rectal Cancer: A Prospective Analysis
    Diseases of the Colon & Rectum, 2008
    Co-Authors: Michael A. Ströhlein, Klaus-uwe Grützner, Karl-walter Jauch, Markus M. Heiss

    Abstract:

    Purpose Laparoscopic Surgery of colon cancer has been accepted to be oncologically adequate compared with open resection. However, the situation in rectal cancer remains unclear, because anatomy and complex surgical procedures might specifically influence the long-term outcome. This study was designed to analyze perioperative and long-term outcome of patients with rectal cancer after laparoscopic vs. open Access Surgery. Methods A total of 389 patients (1998–2005) were prospectively analyzed; 114 patients had laparoscopic beginning, and 25 patients had conversion and were separately analyzed. Eighty-nine patients remained in the laparoscopic group and 275 had open Access Surgery. Results Both groups were comparable regarding age, gender, tumor localization, stage, and complications. Differences were found in harvested lymph nodes (laparoscopic 13.5/open Access 16.9; P  = 0.001) and hospitalization (15.1/18.7 days; P  = 0.037). Local recurrence rate and metachronous metastasis were comparable. In patients with deep anterior resection with total mesenteric excision, favorable long-term survival in the laparoscopic group was found ( P  = 0.035, log-rank). Conclusions Minimally invasive Surgery is equivalent in the treatment of rectal cancer and shows advantages of shorter hospitalization and faster recovery. Especially in patients with low rectal cancer, minimally invasive Surgery with exact preparation of the total mesenteric excision seems to be favorable compared with open Access Surgery.

  • comparison of laparoscopic vs open Access Surgery in patients with rectal cancer a prospective analysis
    Diseases of The Colon & Rectum, 2008
    Co-Authors: Michael A. Ströhlein, Klaus-uwe Grützner, Karl-walter Jauch, Markus M. Heiss

    Abstract:

    Purpose
    Laparoscopic Surgery of colon cancer has been accepted to be oncologically adequate compared with open resection. However, the situation in rectal cancer remains unclear, because anatomy and complex surgical procedures might specifically influence the long-term outcome. This study was designed to analyze perioperative and long-term outcome of patients with rectal cancer after laparoscopic vs. open Access Surgery.

Gerald Schulman – One of the best experts on this subject based on the ideXlab platform.

  • Care pathway reduces hospitalizations and cost for hemodialysis vascular Access Surgery
    American Journal of Kidney Diseases, 1997
    Co-Authors: Bryan N. Becker, Randee Breiterman-white, William Nylander, David H. Van Buren, Chris Fotiadis, Richie Re, Gerald Schulman

    Abstract:

    Hemodialysis vascular Access-related hospitalizations account for more than 20% of United States end-stage renal disease (ESRD) hospitalizations, with an annual cost approximating $675 million. Limiting Access-related costs while delivering similar degrees of quality care thus would enhance alternative utilization of ESRD funding. We implemented a vascular Access care pathway emphasizing coordinated patient evaluation and outpatient Surgery to determine whether such an intervention affected outcomes associated with vascular Access Surgery. Data examining hospitalization and vascular Access Surgery charges, complications, and patient satisfaction (determined by questionnaire) were analyzed, comparing patients who underwent vascular Access Surgery in 1994 and 1995 as inpatients (non-care pathway patients) and patients who underwent vascular Access Surgery via the care pathway in 1995. Inpatient days declined in 1995 (1994: 582 days; 1995: 85 days; P < 0.03) and the average charges per patient for the care pathway cohort were significantly less than charges per patient in 1994 and charges for non-care pathway patients in 1995 (1994 patients: $10,524 ± $5,209; 1995 non-care pathway patients: $11,196 ± $5,806; 1995 care pathway patients: $4,686 ± $2,912/patient; P < 0.02). Incidence rates for major (life-threatening) complications were not significantly different between 1994 patients and care pathway patients in 1995. However, the 1995 non-care pathway patients had a higher incidence of major complications (15.4%). Forty-seven repeat Access procedures were performed in 29 patients in 1994 versus 35 repeat Access procedures in 22 care pathway patients in 1995, and 12 repeat Access procedures were performed in eight non-care pathway patients in 1995. Finally, a majority of the patients entered into the care pathway who responded to a survey stated that they were satisfied with Access Surgery via the care pathway. These data suggest that a vascular Access care pathway can reduce hospital days and costs while achieving acceptable outcomes for Access Surgery.

  • Care pathway reduces hospitalizations and cost for hemodialysis vascular Access Surgery
    American Journal of Kidney Diseases, 1997
    Co-Authors: Bryan N. Becker, Randee Breiterman-white, William Nylander, David H. Van Buren, Chris Fotiadis, Richie Re, Gerald Schulman

    Abstract:

    Hemodialysis vascular Access-related hospitalizations account for more than 20% of United States end-stage renal disease (ESRD) hospitalizations, with an annual cost approximating $675 million. Limiting Access-related costs while delivering similar degrees of quality care thus would enhance alternative utilization of ESRD funding. We implemented a vascular Access care pathway emphasizing coordinated patient evaluation and outpatient Surgery to determine whether such an intervention affected outcomes associated with vascular Access Surgery. Data examining hospitalization and vascular Access Surgery charges, complications, and patient satisfaction (determined by questionnaire) were analyzed, comparing patients who underwent vascular Access Surgery in 1994 and 1995 as inpatients (non-care pathway patients) and patients who underwent vascular Access Surgery via the care pathway in 1995. Inpatient days declined in 1995 (1994: 582 days; 1995: 85 days; P < 0.03) and the average charges per patient for the care pathway cohort were significantly less than charges per patient in 1994 and charges for non-care pathway patients in 1995 (1994 patients: $10,524 ± $5,209; 1995 non-care pathway patients: $11,196 ± $5,806; 1995 care pathway patients: $4,686 ± $2,912/patient; P < 0.02). Incidence rates for major (life-threatening) complications were not significantly different between 1994 patients and care pathway patients in 1995. However, the 1995 non-care pathway patients had a higher incidence of major complications (15.4%). Forty-seven repeat Access procedures were performed in 29 patients in 1994 versus 35 repeat Access procedures in 22 care pathway patients in 1995, and 12 repeat Access procedures were performed in eight non-care pathway patients in 1995. Finally, a majority of the patients entered into the care pathway who responded to a survey stated that they were satisfied with Access Surgery via the care pathway. These data suggest that a vascular Access care pathway can reduce hospital days and costs while achieving acceptable outcomes for Access Surgery.