Abstract:
BACKGROUND:Natural orifice endoscopic full-thickness colon resection attempts to overcome the need for invasive surgery in selected colorectal indications. Because basic technical requirements have not been met so far, the aim of this study was to develop a novel technique for endolumenal colon-wedge resection addressing current shortcomings. STUDY DESIGN:Endoscopic full-thickness colon resection was attempted in a human cadaver model (n = 2), explanted porcine colon stumps (n = 10), and 3 acute pig models. A hypothesized colon lesion was created and retracted into an endoscopic clip closure system (ECCS). Initially used endoscopic graspers (n = 2) were replaced by a T-tag suture approach for retraction (n = 13). T-type anchors were deployed circumferentially to the lesion, which simultaneously marked resection margins. The clip was then applied for pre-resection tissue closure. The inverted tissue was excised by snare resection and was removed together with the sutures. Air leak-pressure of tissue closure was tested. RESULTS:Endoscopic full-thickness colon resection was achieved in 14 of 15 attempts. The mean diameter (±SD) of resected animal specimen, including the predetermined margins, was 26 ± 4 mm. Using the T-tag sutures for retraction, the defined lesion was neither touched by an endoscopic grasper nor compromised by puncturing the center. Leak pressure tests revealed a significantly higher air pressure resistance of the pre-resection ECCS closure (61 ± 5 mmHg) compared with the hand-sewn control (26 ± 7 mmHg). CONCLUSIONS:A novel endoscopic technique for full-thickness colon wall resection using tissue anchors for traction and an ECCS for pre-resection tissue closure appears to address several fundamental surgical principles. However, further studies are necessary before initial clinical application.
journal_name
J Am Coll Surgjournal_title
Journal of the American College of Surgeonsauthors
Rieder E,Martinec DV,Dunst CM,Swanström LLdoi
10.1016/j.jamcollsurg.2011.05.015subject
Has Abstractpub_date
2011-09-01 00:00:00pages
422-9issue
3eissn
1072-7515issn
1879-1190pii
S1072-7515(11)00379-6journal_volume
213pub_type
杂志文章abstract:BACKGROUND:Outpatient followup of rural trauma patients is problematic for physicians and patients. Our hypothesis was that telemedicine-based followup of trauma patients discharged to remote areas is feasible and is associated with high patient and physician satisfaction. STUDY DESIGN:We chose 11 counties in Kentucky...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/s1072-7515(01)00796-7
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abstract:BACKGROUND:As compared with open distal pancreatectomy, laparoscopic distal pancreatectomy (LDP) is associated with lower morbidity and shorter hospital stays. Existing reports do not elucidate trends in patient selection, technique, and outcomes over time. We aimed to determine outcomes after LDP at a specialized cent...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
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更新日期:2012-08-01 00:00:00
abstract:BACKGROUND:Vulvar melanoma is a very rare form of cancer. The purpose of this study was to describe practice patterns for the management of vulvar melanoma. STUDY DESIGN:The National Cancer Data Base was reviewed from 1985 through 1994 for patient reports submitted with a diagnosis of vulvar melanoma. RESULTS:Five hu...
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abstract:BACKGROUND:Hospital readmissions are gathering increasing attention as a measure of health care quality and as a cost-saving target. The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) recently began collecting data related to 30-day postoperative readmissions. Our objectives were...
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abstract:BACKGROUND:We sought to determine the clinical factors and tumor characteristics associated with the reported poor prognosis in young patients with carcinoma of the colon and rectum. STUDY DESIGN:A retrospective review was performed of 186 patients younger than 40 years of age who were treated for primary colorectal a...
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abstract:BACKGROUND:In changing our technique to performing needle localization breast biopsies (NLBB) using local anesthesia in an outpatient setting, we investigated whether or not our complication rates with local anesthesia were acceptable when compared with complications from a cohort of biopsies of the breast performed fo...
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doi:
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abstract:BACKGROUND:Stakeholders derive many benefits from cancer clinical trials, including guidance for future oncologic treatment decisions. However, whether enrollment in cancer trials also improves patient survival independently of trial outcomes remains underinvestigated. We hypothesized that cancer trial enrollment is no...
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更新日期:2011-09-01 00:00:00
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journal_title:Journal of the American College of Surgeons
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pub_type: 杂志文章,多中心研究,随机对照试验
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更新日期:2010-06-01 00:00:00
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更新日期:2007-08-01 00:00:00
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更新日期:2010-04-01 00:00:00
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pub_type: 临床试验,杂志文章,随机对照试验
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journal_title:Journal of the American College of Surgeons
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