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3. Initial experience with transvaginal incisional hernia repair

Author

Jacobsen, G. R., Thompson, K., Spivack, A., Fischer, L., Wong, B., Cullen, J., Bosia, J., Whitcomb, E., Lucas, E., Talamini, M., and Horgan, S.

Subjects
Medicine & Public Health, Abdominal Surgery, Transvaginal, Incisional hernia, NOTES, Natural orifice, Hernia
Abstract

Natural orifice surgery has evolved from a preclinical setting into a common occurrence at the University of California San Diego (UCSD). With close to 40 transvaginal cases, we have become comfortable with this technique and are exploring other indications. One of the perceived advantages in natural orifice surgery is the potential reduction in the incidence of hernia formation. Patients with abdominal wall hernias may be at increased risk of forming additional hernias at incision sites. In addition, patients with recurrent incisional hernias may, likewise, be at increased risk. We believe that reducing or eliminating abdominal wall incisions may be of benefit in the repair of abdominal wall hernias. Here, we describe what we believe to be the first natural orifice transluminal endoscopic surgical (NOTES) approach to the repair of an abdominal wall hernia.The patient is a 38-year-old female with a painful recurrent umbilical hernia, previously repaired 8 years prior with a polypropylene-based mesh. The patient underwent a transvaginal recurrent umbilical hernia repair with one other 5-mm port in the abdomen for safety.The patient had no intraoperative or postoperative complications. At 5 months follow up, the patient had no complaints, no evidence of hernia recurrence, and was very pleased with her result.The repair of primary and incisional hernias of the ventral abdominal wall via a transvaginal approach is technically feasible, and the result of our initial case was exceptional. However, there are still significant obstacles which must be addressed before this approach can be widely utilized. These obstacles include safe entrance into the abdominal cavity via a transvaginal approach, the proper mesh to be placed during the repair, and the risk of infection.

Published
2010

7. Geospatial Distribution and Predictors of Mortality in Hospitalized Patients With COVID-19: A Cohort Study

Author

Mallipattu, S K, Jawa, R, Moffit, R, Hajagos, J, Fries, B, Nachman, S, Gan, T J, Saltz, M, Saltz, J, Kaushansky, K, Skopicki, H, Abell-Hart, K, Chaudhri, I, Deng, J, Garcia, V, Gayen, S, Kurc, T, Bolotova, O, Yoo, J, Dhaliwal, S, Nataraj, N, Sun, S, Tsai, C, Wang, Y, Abbasi, S, Abdullah, R, Ahmad, S, Bai, K, Bennett-Guerrero, E, Chua, A, Gomes, C, Griffel, M, Kalogeropoulos, A, Kiamanesh, D, Kim, N, Koraishy, F, Lingham, V, Mansour, M, Marcos, L, Miller, J, Poovathor, S, Rubano, J, Rutigliano, D, Sands, M, Santora, C, Schwartz, J, Shroyer, K, Spitzer, S, Stopeck, A, Talamini, M, Tharakan, M, Vosswinkel, J, and Wertheim, W

Subjects
medicine.medical_specialty, medicine.medical_treatment, Logistic regression, 01 natural sciences, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Diabetes mellitus, Major Article, medicine, 030212 general & internal medicine, 0101 mathematics, Mechanical ventilation, SARS-CoV-2, business.industry, 010102 general mathematics, Acute kidney injury, COVID-19, Acute Kidney Injury, medicine.disease, Obesity, Ventilation, AcademicSubjects/MED00290, Infectious Diseases, Oncology, Cohort, business, Hyponatremia, Geospatial Distribution, Cohort study
Abstract

BackgroundThe global coronavirus disease 2019 (COVID-19) pandemic offers the opportunity to assess how hospitals manage the care of hospitalized patients with varying demographics and clinical presentations. The goal of this study was to demonstrate the impact of densely populated residential areas on hospitalization and to identify predictors of length of stay and mortality in hospitalized patients with COVID-19 in one of the hardest hit counties internationally.MethodsThis was a single-center cohort study of 1325 sequentially hospitalized patients with COVID-19 in New York between March 2, 2020, to May 11, 2020. Geospatial distribution of study patients’ residences relative to population density in the region were mapped, and data analysis included hospital length of stay, need and duration of invasive mechanical ventilation (IMV), and mortality. Logistic regression models were constructed to predict discharge dispositions in the remaining active study patients.ResultsThe median age of the study cohort (interquartile range [IQR]) was 62 (49–75) years, and more than half were male (57%) with history of hypertension (60%), obesity (41%), and diabetes (42%). Geographic residence of the study patients was disproportionately associated with areas of higher population density (rs = 0.235; P = .004), with noted “hot spots” in the region. Study patients were predominantly hypertensive (MAP > 90 mmHg; 670, 51%) on presentation with lymphopenia (590, 55%), hyponatremia (411, 31%), and kidney dysfunction (estimated glomerular filtration rate < 60 mL/min/1.73 m2; 381, 29%). Of the patients with a disposition (1188/1325), 15% (182/1188) required IMV and 21% (250/1188) developed acute kidney injury. In patients on IMV, the median (IQR) hospital length of stay in survivors (22 [16.5–29.5] days) was significantly longer than that of nonsurvivors (15 [10–23.75] days), but this was not due to prolonged time on the ventilator. The overall mortality in all hospitalized patients was 15%, and in patients receiving IMV it was 48%, which is predicted to minimally rise from 48% to 49% based on logistic regression models constructed to project disposition in the remaining patients on ventilators. Acute kidney injury during hospitalization (odds ratioE, 3.23) was the strongest predictor of mortality in patients requiring IMV.ConclusionsThis is the first study to collectively utilize the demographics, clinical characteristics, and hospital course of COVID-19 patients to identify predictors of poor outcomes that can be used for resource allocation in future waves of the pandemic.

Published
2020
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24. 1992 Scientific Session of the Society of American Gastrointestinal Surgeons (SAGES) Washington, D.C., USA, April 11–12, 1992

Author

Salky, Barry, Bauer, Joel, Easter, D. W., Cuschieri, A., Lavelle-Jones, M., Nathanson, L., Brandt, C. P., Priebe, P. P., Eckhauser, M. L., Henriques, III, Horace F., Deziel, Daniel J., Millikan, Keith W., Staren, Edgar D., Economou, Steven G., Lexer, G. W., Lexer, G. Ch., Lehofer, F., Meiser, G., Boeckl, O., Williams, Mark D., Murr, Peter C., Shimomura, Kazuyuki, Ohtomo, Yumiko, Ishizaki, Yoichi, Noie, Tamaki, Abe, Hideki, Nayeem, Sarder Abdun, Bandai, Yasutsugu, Idezuki, Yasuo, Kam, David, Scheeres, David, Nagai, Hideo, Kondo, Yasuo, Yasuda, Toshihiko, Kasahara, Kogoro, Kanazawa, Kyotaro, Wittgen, C. M., Andrus, J. P., Andrus, C. H., Kaminski, D. L., Fried, G. M., Sigman, H. H., Meakins, J. L., Hinchey, E. J., Garzon, J., Barkun, J. S., Mamazza, J., Wexler, M. J., Bordelon, B. M., Hobday, K. A., Hunter, J. G., Saunders, C. J., Gardiner, B., Leary, B. F., F. N. P., Frey, C. F., Wolfe, B. M., Kozarek, R. A., Traverso, L. W., Ball, T. J., Brandabur, J., Jolly, P. C., Patterson, D. J., Ryan, J. A., Thirlby, R. C., Wechter, D. G., Hunter, J. A., Fletcher, D. P., Molnar, Robert G., Apelgren, Keith N., Kisala, John M., Way, Lawrence W., Wetter, Albert, Pietrafitta, Joseph J., Schultz, Leonard S., Graber, John N., Hickok, David F., Congreve, D., Zinnecker, H., Lohmuller, J., Legrand, M., Detroz, B., Honore, P., Jacquet, N., Yamamoto, M., Stiegmann, G., Durham, J., Berguer, R., Fujiyama, Y., Oba, Y., Downey, J., Miho, O., Green, P., Satava, R., Hill, J., Simon, I., Brodish, R. J., Soper, Nathaniel J., Dunnegan, Deanna L., Peters, Jeffrey H., Innes, Jeffrey T., Front, Mary E., Ellison, E. Christopher, Swanstrom, Lee, Sangster, William, Stoker, Mark E., Phillips, E., Carroll, B., Fallas, M., Daykhovsky, L., Murphy, B., Miller, S., Keiter, N., Halpern, Norman B., Escudero-Fabre, Angel, Sack, Jonathan, Himal, H. S., Luchette F., Doerr R., Kulaylat M., Stephan R., Kelly K., Fowler, Dennis L., White, Sharon A., Church, James M., De Paula, A. L., Hashiba, K., Ambroze, Jr, W. L., Nezhat, C., Nezhat, F., Orangio, G., Brooks, D. C., Becker, J. M., Connors, P. J., Carr-Locke, D. L., Adams, D. B., Borowicz, M. R., Wootton, III, F. T., Cunningham, J. T., Cirocco, W. C., Rusin, L. C., Franceschi, Dido, Pritchard, Timothy, Eckhauser, Marc, Estes, J. M., Szabo, Z., Harrison, M. R., Krishnan, S. M., Goh, P. M. Y., Ambroze, Jr., W. L., Orangio, G. R., Tucker, J. G., Baird, D., Herndon, M., Lucas, G. W., Bell, R. C. W., Stiegmann, G. V., Sun, J., Kim, J., Lucia, M. S., Bender, J. S., Talamini, M. A., Bessler, Marc, Treat, Michael R., Canady, J., Nicolo, E., Jagdeo, C., McQueen, J., Fontana, F., Dewitty, R., Castellano, M., Elmann, E. M., Lobbato, V. J., Cosgrove, John M., Franklin, Howard, Margolis, Irving B., de la Torre, R., Donahue, PE, Schlesinger, P., Sluss, K., Attar, B., Nyhus, L. M., Anan, K., Fletcher, D. R., Flowers, J. L., Zucker, K. A., Graham, S. M., Scovill, W. A., Imbembo, A. L., Bailey, R. W., Gagner, M., Rheault, M., Dubuc, J., Ghobrial, Rafik, MacFadyen, Jr., Bruce V., Catalano, Mark, Raijman, Isaac, Haicken, Barry N., Daijo, Hashimoto, Shuji, Kajiwara, Takanobu, Hoshino, Fukuyo, Tsuneo, Kitano, S., Moriyama, M., Sugimachi, K., Kudo, Shin-ei, Kusaka, Takashi, Nakajima, Kouji, Kimata, Hiroyuki, Miura, Kouji, Takano, Yukio, Lamphier, Jonathan B., Diflo, Thomas, Kondi, Edward S., Larson, G. M., Vitale, G. C., Voight, W., Cheadle, W., Miller, F., Leahy, P. F., Pennino, R. P., Furman, R. H., Libutti, Steven K., Williams, Mathew R., Litwin, D., Johnson, D., Osachoff, J., Gallagher, C., Church, D., Mansour, M. A., Martin, Matt B., Abrams, Arkin, Ballen, Blievernicht, Bowman, Davis, Farley, Hoxworth, Ingram, Leone, Lindsey, Newman, Price, Streck, Weatherly, Young, Miscusi, Route G., Masoni, L., Gasparrini, M., Montori, A., Montori, A., Munakata, Y., Kawasaki, S., Hashikura, Y., Hashimoto, S., Hayashi, K., Numata, M., Makuuchi, M., Mustafa, I. A., Reed, W. P., Coe, N. P. W., Leigh H., Nadler, Nelson, M. T., Nakashima, M., Mulvihill, S. J., Olsen, Douglas O., Corbitt, John D., Edleman, David S., Unger, Stephen, Unger, Harold, Orkin, B. A., Smith, L. E., Paz-Partlow, M., Berci, G., Sackier, J. M., Miller, John, Kieth E., Nichols, Ollila, David, Gibbons, Gregory E., Davanzo, Mark A., Polacek, Michael A., Pons, R., Grannan, K., Welling, R., Pritchard, Timothy J., Richards, William O., Unger, S. W., Rosenbaum, G., Unger, H. M., Edelman, D. S., Schirmer, B. D., Dix, J., Schmieg, Jr., R. E., Aguilar, M., Schirmer, B. D., Dix, J., Scott, T. R., Zucker, K. A., Bailey, R. W., Bergstein, J. M., Seone, D., Wittmann, D. H., Quebbeman, E. J., Aprahamian, C., McGrath, Michael, Shapiro, Stephen, Gordon, Leo, Adashek, Kenneth, Daykhovsky, Leon, Shoop, Stephen A., Sackier, Jonathan, Meakin, J. L., Snyder, Samuel K., Symmonds, Richard E., Roberts, John W., Hendricks, John C., Smith, Randall W., Frazee, Richard C., Soper, Nathaniel J., Brunt, L. Michael, Fleshman, James, Meininger, Thomas A., Dunnegan, Deanna L., RN, Sudan, Debra, Mellinger, John, Miller, Sidney, Sugawa, C., Lucas, C. E., Szabo, Zoltan, Berci, George, Hunter, John G., Unger, S. W., Unger, H. M., Edelman, D. S., Weaver, Donald W., Bouwman, David, Tyburski, James, and Wierson, T. A.

Published
1992
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29. Impact of a third-year surgical apprenticeship model: Perceptions and attitudes compared with the traditional medical student clerkship experience

Author

Reid, Christopher, Kim, D., Mandel, J., Smith, A., Talamini, M., Bansal, V., Reid, Christopher, Kim, D., Mandel, J., Smith, A., Talamini, M., and Bansal, V.

Abstract

Background Current literature suggests that medical students may have negative misconceptions of a surgical career partly due to the traditional hierarchical structure of the surgical clerkship. We hypothesized that a novel medical student apprenticeship would result in positive changes in perceptions of both surgeons and surgical careers. Study Design In the 2011 academic year, third-year medical students were offered a 2-week apprenticeship elective, in addition to the standard 8-week surgical clerkship. Unlike a traditional service, students apprenticed directly with participating faculty on a one-on-one basis. At the clerkship's end, students received a structured questionnaire assessing perceptions and attitudes toward surgeons and a career in surgery. Subjects responded anonymously using a 5-point Likert scale. A Wilcoxon Rank-Sum was performed comparing students who participated vs those who did not participate in the apprenticeship. Results There was a 99% survey response (105 of 106). Of those, 50 (48%) participated in the apprenticeship. Apprenticeship students were more likely to view surgeons as content (p < 0.001), well-balanced (p < 0.01), respectful (p = 0.01), and as role models (p < 0.005). Apprenticeship students were also more likely to participate in the operating room (p < 0.05) and in patient management (p < 0.05). There was no difference in an interest to pursue a surgical career between groups both before and on completion of the clerkship. Conclusions Students participating in a surgical apprenticeship had a more positive view of surgeons and the field of surgery compared with students not participating. An apprenticeship model enhances the surgical clerkship experience and improves medical student perceptions of surgery as a career. © 2014 by the American College of Surgeons Published by Elsevier Inc.

Published
2014

33. Initial experience with transvaginal incisional hernia repair

Author

Jacobsen, G. R., primary, Thompson, K., additional, Spivack, A., additional, Fischer, L., additional, Wong, B., additional, Cullen, J., additional, Bosia, J., additional, Whitcomb, E., additional, Lucas, E., additional, Talamini, M., additional, and Horgan, S., additional

Published
2009
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35. Transgastric endoscopic splenectomy

Author

Kantsevoy, S. V., primary, Hu, B., additional, Jagannath, S. B., additional, Vaughn, C. A., additional, Beitler, D. M., additional, Chung, S. S. C., additional, Cotton, P. B., additional, Gostout, C. J., additional, Hawes, R. H., additional, Pasricha, P. J., additional, Magee, C. A., additional, Pipitone, L. J., additional, Talamini, M. A., additional, and Kalloo, A. N., additional

Published
2006
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37. Thirty robotic adrenalectomies

Author

Winter, J. M., primary, Talamini, M. A., additional, Stanfield, C. L., additional, Chang, D. C., additional, Hundt, J. D., additional, Dackiw, A. P., additional, Campbell, K. A., additional, and Schulick, R. D., additional

Published
2005
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44. Long distance telementoring

Author

Cubano, M., primary, Poulose, B. K., additional, Talamini, M. A., additional, Stewart, R., additional, Antosek, L. E., additional, Lentz, R., additional, Nibe, R., additional, Kutka, M. F., additional, and Mendoza-Sagaon, M., additional

Published
1999
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48. A telerobotic assistant for laparoscopic surgery

Author

Taylor, R.H., primary, Funda, J., additional, Eldridge, B., additional, Gomory, S., additional, Gruben, K., additional, LaRose, D., additional, Talamini, M., additional, Kavoussi, L., additional, and Anderson, J., additional

Published
1995
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49. Women's positive perception of transvaginal NOTES surgery.

Author

Peterson CY, Ramamoorthy S, Andrews B, Horgan S, Talamini M, Chock A, Peterson, Carrie Y, Ramamoorthy, Sonia, Andrews, Barbara, Horgan, Santiago, Talamini, Mark, and Chock, Alana

Abstract

Background: Two decades ago, minimally invasive surgery (MIS) was introduced and led to a revolution in modern surgery. Currently MIS procedures are the standard of care for many surgical interventions and patients often seek out surgeons with special training in MIS. Today, natural orifice transluminal endoscopic surgery (NOTES) appears to be on the threshold of another such revolution. We surmise that its advantages are similar to those of other MIS procedures, but there are no associated abdominal wall complications as there are no abdominal incisions. To date, there is no data evaluating women's perceptions of such a procedure and their willingness to consent to this type of surgical approach.Methods: We surveyed 100 women who were given a written description of MIS and NOTES surgery along with a 10-question survey exploring their concerns and opinions regarding transvaginal surgery.Results: The majority of women (68%) indicated that they would want a transvaginal procedure in the future because of decreased risk of hernia and decreased operative pain (90 and 93%, respectively), while only 39% were concerned with the improved cosmesis of NOTES surgery. Of the women polled, nulliparous women and those under age 45 years were significantly more often concerned with how transvaginal surgery may affect healthy sexual life and fertility issues (p < 0.05). Of the women who would not prefer transvaginal surgery, a significant number indicated concerns over infectious issues (p < 0.05).Conclusions: Our study shows that there is considerable public interest in NOTES surgery and women would be receptive to this new surgical technique. Our study highlights a strong need for early reporting of outcomes data to enlighten ourselves, and our patients, about this exciting new technology. [ABSTRACT FROM AUTHOR]

Published
2009
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50. Thirty robotic adrenalectomies.

Author

Winter, J., Talamini, M., Stanfield, C., Chang, D., Hundt, J., Dackiw, A., Campbell, K., and Schulick, R.

Subjects
ADRENALECTOMY, ADRENAL surgery, MEDICAL robotics, LAPAROSCOPIC surgery, MEDICAL care costs, HOSPITAL charges, HOSPITAL prospective payment
Abstract

Background: Robotic adrenalectomy is a minimally invasive alternative to traditional laparoscopic adrenalectomy. To date, only case reports and small series of robotic adrenalectomies have been reported. This study presents a single institution's series of 30 robotic adrenalectomies, and evaluates the procedure's safety, efficacy, and cost. Methods: Thirty patients underwent robotic adrenalectomy at the Johns Hopkins Hospital between April 2001 and January 2004. Patient morbidity, hospital length of stay, operative time, and conversion rate to traditional laparoscopic or open surgery are presented. Improvement in operative time with surgeon experience is evaluated. Hospital charges are compared to charges for traditional laparoscopic and open adrenalectomies performed during the same time period. Results: Median operative time was 185 min. Patient morbidity was 7%. There were no conversions to traditional laparoscopic or open surgery. The median hospital stay was 2 days. Operative time improved significantly by 3 min with each operation. Hospital charges for robotic adrenalectomy ($12,977) were not significantly different than charges for traditional laparoscopic ($11,599) or open adrenalectomy ($14,600). Conclusions: Robotic adrenalectomy is a safe and effective alternative to traditional laparoscopic adrenalectomy. [ABSTRACT FROM AUTHOR]

Published
2006
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