computerized-dynamic-posturography-for-postural-control-assessment

Computerized Dynamic Posturography for Postural Control Assessment in Patients with Intermittent Claudication

Computerized dynamic posturography with the EquiTest is an objective technique for measuring postural strategies under challenging static and dynamic ...

University of Hull

The goal of this study was to determine the maximal tolerated dose (MTD) of topotecan given with external-beam radiotherapy in advanced cervical cancer.

Phase I study of topotecan and radiation therapy in advanced cervical cancer.

We have seen substantial changes in minimally invasive surgery since its development in the early 1900s. Over the past 10 years, the addition of natural orifice transluminal endoscopic surgery and robotics has turned our attention to improved cosmesis and advancements in instrumentation. We have developed a new technique-single port access (SPA) surgery-and have applied it to the cholecystectomy. In this paper, we present and review the application of this access technique to the first 5 consecutive patients that underwent an SPA cholecystectomy. All 5 patients were female, with an average age of 45 years and an average weight of 172 pounds. Indications included biliary dyskinesia and symptomatic cholelithiasis. Average operative time was 121 minutes in these initial 5 cases. All but 1 patient was discharged in 24 hours. At 6 months, no umbilical hernias were observed. This new technique allows for a complete cholecystectomy to be performed entirely through the umbilicus without the need for additional retraction sites or transabdominal sutures. This procedure utilizes the same basic technique of the laparoscopic cholecystectomy already employed by general surgeons. Therefore, the SPA cholecystectomy can be readily learned and performed by many surgeons without the need for expensive or experimental equipment. Using a single portal of entry to the abdominal cavity, the umbilicus, cosmesis, and scar reduction is achieved.

Single port access (SPA) cholecystectomy: a completely transumbilical approach.

The practice of surgical techniques is constantly improving and evolving. In the last two decades, minimally invasive surgery has gained widespread acceptance. Virtually all procedures can now be performed laparoscopically. This trend not only provides better cosmesis, but offers decreased recovery times as well. The initial trend from open to laparoscopic surgery was to use smaller incisions. The natural continuation of this is to now decrease the number of incisions necessary to perform minimal access surgery. To this end, the authors have seen a constantly evolving stream of technology and instrumentation in laparoscopy. New venues, such as robotics and Natural Orifice. Transluminal Endoscopic Surgery (NOTES), have developed as well. As part of this evolution, the authors developed Single Port Access (SPA™) surgery in April 2007 as a novel and innovative platform of minimal access surgery. Its acceptance through our training programs, as well as the subsequent development of modified Single Port techniques, demonstrates the potential to develop a new platform of minimal access surgery. The SPA™ technique is a method of abdominal entry for a wide spectrum of laparoscopic procedures performed by multiple surgical specialties. Using the access techniques we developed, the authors have performed nearly 200 general surgical and gynecologic procedures through a single incision, often <2 cm in length and hidden within the umbilicus. In addition, the development of SPA™ surgery has been focused on using current and standard instrumentation, as well as currently practiced surgical techniques already familiar to surgeons in standard multiport laparoscopy. The "Independence of Motion" attained in this access technique, without the need for any new access or operative devices, allows up to four instruments to be place through a single incision<2 cm in length. We have striven to maintain safety principles of multiport laparoscopy, as well, and have continued to improve the technique to increase the availability and broad application of SPA™ surgery. Out technique and its application, across a broad range of surgical procedures and surgical specialties, are presented herein.

Single Port Access (SPA™) Minimal Access Surgery Through a Single Incision.

Single Port Access (SPA) technique: video summary.

Consensus statement of the consortium for laparoendoscopic single-site surgery.

There has been an emergence of reduced port techniques for laparoscopic surgery over the past three years. Although growing in presentations and papers, few scientific studies have yet to be published demonstrating benefits and risks of these techniques. In particular, very little is mentioned regarding the increased costs. This brings to the forefront the concept that the development of new surgical techniques should adhere to safe standards of surgery and undergo continued evaluation during development to ensure they maintain safety, and are able to be reproduced by our colleagues. Evaluation also needs to focus on costs, both economical and ecological. A review of our first three years experience of single port access surgery has been done. Costs in terms of both the potential economic and environmental impact have also been evaluated as compared with multiport procedures. In the first 36 months of this evolving technique, we were able to mimic multiport procedures with similar results. The costs of single port access are less than comparable multiport procedures, both in terms of dollars as well as medical waste. We are able to now offer "proof of concept" of a novel reduced port procedure from four important aspects in the development of new surgical techniques. We demonstrate comparable results in terms of outcomes and safety, improvement in financial and environmental costs, as well as showing initial success with training and application of the procedure by our colleagues.

Reduced port surgery: an economical, ecological, educational, and efficient approach to development of single port access surgery.

Single-port surgery has seen almost as rapid an application as multiport laparoscopy during the early 1990s. Hopefully, we will learn from our predecessors to apply the dictums of safety and science as we move forward with this new technique to ensure adequate adoption and successful outcomes with limited errors and concerns along the way.

The road to reduced port surgery: from single big incisions to single small incisions, and beyond.

To describe the Single port access (SPA) laparoscopic entry technique for canine ovariectomy (OVE), report complications, and outcomes.

Article	Year
Phase I study of topotecan and radiation therapy in advanced cervical cancer. Gynecologic oncology\| PubMed ID: 11925142	2002
Single port access (SPA) cholecystectomy: a completely transumbilical approach. Journal of laparoendoscopic & advanced surgical techniques. Part A\| PubMed ID: 19260790	2009
Single Port Access (SPA™) Minimal Access Surgery Through a Single Incision. Surgical technology international\| PubMed ID: 19579186	2009
Single Port Access (SPA) technique: video summary. Surgical endoscopy\| PubMed ID: 19997749	2010
Consensus statement of the consortium for laparoendoscopic single-site surgery. Surgical endoscopy\| PubMed ID: 19997938	2010
Reduced port surgery: an economical, ecological, educational, and efficient approach to development of single port access surgery. Surgical technology international\| PubMed ID: 21082547	2010
The road to reduced port surgery: from single big incisions to single small incisions, and beyond. World journal of surgery\| PubMed ID: 21523502	2011
Initial application of reduced port surgery using the single port access technique for laparoscopic canine ovariectomy. Veterinary surgery : VS\| PubMed ID: 22861187	2012

Stephanie A. King

Biography

JoVE Journal Publications

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