Stephen J. Shapiro

Partial splenectomy for nonparasitic splenic cysts

Four cases of partial splenectomy for large, nonparasitic splenic cysts are described. In all four patients it was possible to successfully preserve most of the splenic parenchyma. With the increasing realization of the importance of splenic function, the feasibility of this operative approach to splenic cysts is proposed.

The use of a modular skills center for the maintenance of laparoscopic skills

AbstractBackground: A reliable method supplying graduated experience and practice is needed to develop and refine laparoscopic skills. The laparoscopic surgeon, like the microvascular surgeon, must have ongoing training to refine and maintain his or her skills. Methods: The authors describe a new modular training unit. The unit consists of a box with a built-in television camera, a light source, and a rotating platform. A videotape recorder with a timing device documents the actual “operating time” required for the various exercises. The first phase of training consists of a basic skills board. This initial phase enhances the use of dominant and nondominant hand motor activity. Results: The surgeon then progresses to lifelike models (biliary, suturing, hernia, gynecologic) to simulate the human operative setting. Ten surgeons spent 5 h each working with the module. The specific exercises were recorded and timed. Their progress is described. Conclusions: The modular laparoscopic skills center is an integral part of any laparoscopic educational program. It facilitates the acquisition and maintenance of laparoscopic skills.

Extracorporeal pneumoperitoneum access bubble for endoscopic surgery

The extracorporeal pneumoperitoneum access bubble (EPAB) creates a transparent extension of the pneumoperitoneum and has been developed to facilitate large organ extraction and tissue approximation in patients undergoing endoscopic surgical procedures. When fully deployed, the EPAB excludes the abdominal parietes from the emergent organ and dilates the exit wound by an average of 48.5%, irrespective of its location. It thus eliminates the problems of contamination and tumor seedling implantation during the removal of resected organs, aside from expediting the extraction. The operating version of the EPAB enables the introduction of the surgeons or assistants hands or instruments into the bubble and thence into the peritoneal cavity without deflation of the pneumoperitoneum. By this means, it reduces the technical difficulties required to dissect organs and achieve reconstruction by hand suturing or stapling.

Problem-solving in laparoscopic surgery.

SummaryThe advent of the laparoscopic revolution and the wider applicability of laparoscopic procedures has caused surgeons to re-think the dynamics of intraoperative problem-solving. Problems of body habitus, previous surgery, exposure, bleeding, and anesthesia, as well as the problem cholangiogram, require new and innovative approaches. a practical approach to each of these common laparoscopic problems is presented.

Periampullary duodenal diverticulum in a patient undergoing laparoscopic cholecystectomy

SummaryDuodenal diverticulae are acquired lesions usually found near the papilla of Vater and associated with significant symptoms. We present a case of a patient with obstructive jaundice who had a diverticulum and cholelithiasis. The management of this scenario is explained in the era of laparoscopic cholecystectomy.