Omar Yusef Kudsi

Carbon dioxide embolism in a 3-week-old neonate during laparoscopic pyloromyotomy: a case report

Laparoscopic pyloromyotomy has gained popularity in the treatment of hypertrophic pyloric stenosis. This is the first case report of carbon dioxide embolism during laparoscopic pyloromyotomy. We describe a case of carbon dioxide embolism in a 3-week-old neonate during laparoscopic pyloromyotomy by injection of carbon dioxide into a patent umbilical vein. The diagnosis of carbon dioxide embolism was made on the basis of the abrupt decrease in end-tidal CO(2), sudden decreased Spo(2), hypotension, and cyanosis. Portable x-ray with the clinical presentation was sufficient for a diagnosis of carbon dioxide embolism. Treatment included termination of CO(2) insufflation, placing the patient in Durants position, and adequate resuscitation as necessary. Despite the fact that the insufflation pressure was in the recommended range, a carbon dioxide embolism was thought to be caused by injection of carbon dioxide into a patent umbilical vein. Although laparoscopic pyloromyotomy has demonstrated to be a safe and effective procedure, this is a serious and rare complication causing prolonged length of stay and skewed hospital charges.

Laparoscopic Distal Pancreatectomy

The laparoscopic approach for benign and malignant lesions in the tail of the pancreas is becoming a more widely used approach. Multiple prospective studies have shown the feasibility and safety of laparoscopic distal pancreatectomy in single-center and multi-center settings. Laparoscopic distal pancreatectomy is a challenging procedure, because the pancreas is surrounded by critical structures and located in the retroperitoneum. Pancreatic fistula remains a common complication in the laparoscopic approach. Distal pancreatic aggressive tumors may not be appropriate for the laparoscopic approach due to the lack of oncologic safety studies.

Social Media as a Platform for Surgical Learning: Use and Engagement Patterns among Robotic Surgeons

&NA; In response to technological advances and growing dispersion of surgical practice around the globe, social media platforms have emerged in recent years as channels for surgeons to share experiences, ask questions, and learn from one another. To better understand surgeons’ engagement with these platforms, we analyzed data from a closed-membership Facebook group for robotic surgeons. Our analysis revealed that surgeons posted more frequently on midweek days, and further that text posts received significantly more comments, and significantly fewer “likes,” than posts containing links, photos, or videos. We discuss the implications of these use and engagement patterns for the viability of social media platforms as tools for surgeons to learn vicariously from their peers’ experiences and expertise.

Masters Program Foregut Pathway: Robotic Fundoplications

Gastroesophageal reflux disease (GERD) is the most common gastrointestinal-related diagnosis in the United States. Its prevalence varies from 8 to 28% in Western countries and reduces health-related quality of life and imposes a significant economic burden on the healthcare system. It is defined as “a condition that develops when reflux of gastric contents causes troublesome symptoms or complications”. Initial management of GERD consists of life style modifications and medical therapy directed at neutralizing acid. Despite improvement in surgical techniques, there is significant debate surrounding optimal surgical management. Appropriate patient selection and knowledge of principles of surgical therapy is important to obtain a good surgical outcome. Minimally invasive fundoplication is the current standard in surgical approach to GERD with 3% of all fundoplications being performed laparoscopically with robotic assistance and 79% being performed by the conventional laparoscopic approach. The goal of this chapter is to provide a thorough overview of robotic-assisted laparoscopic fundoplications, including indications for the procedure, preoperative evaluation, various operative techniques, and potential complications.