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Find video protocols related to scientific articles indexed in Pubmed.
Endoscopic myotomy for achalasia.
Adv Surg
PUBLISHED: 10-09-2014
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POEM is an effective treatment of functional manometric esophageal outflow obstructive disorders with excellent relief of dysphagia. Reflux rates seem to be similar to that seen with traditional Heller myotomy with fundoplication. The POEM technique provides a true surgical esophageal myotomy without incisional pain. As such, POEM represents the first truly practical application of natural orifice surgery.
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Management of early-stage esophageal neoplasia (MESEN) consensus.
World J Surg
PUBLISHED: 09-06-2014
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Treatment of esophageal adenocarcinoma often involves surgical resection. Newer technologies in interventional endoscopy have led to a substantial paradigm shift in the management of early-stage neoplasia in Barrett's esophagus comprising high-grade dysplasia (HGD), intramucosal carcinoma, and, in some cases, submucosal carcinoma. However, there has been no consensus regarding the indications for esophageal preservation in these cases. In this work, consensus guidelines were established for the management of early-stage esophageal neoplasia considering clinically relevant aspects (age, comorbidities, and social environment) in each scenario.
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Peroral Endoscopic Myotomy (POEM) for Esophageal Primary Motility Disorders: Analysis of 100 Consecutive Patients.
J. Gastrointest. Surg.
PUBLISHED: 09-03-2014
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Peroral endoscopic myotomy (POEM) is a flexible endoscopic approach to the lower esophageal sphincter (LES) providing access for a  myotomy to relieve dysphagia. The technique has been adopted worldwide due to reports of excellent short-term clinical outcomes. We report on a consecutive patient cohort with clinical and objective outcomes representing the establishment of a POEM program within a busy esophageal surgical practice.
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Early human experience with per-oral endoscopic pyloromyotomy (POP).
Surg Endosc
PUBLISHED: 08-09-2014
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Gastroparesis is a condition characterized by delayed gastric emptying, and a constellation of symptoms, including nausea, vomiting, early satiety, and bloating. Although current surgical options such as pyloroplasty have been shown to be effective, an endoscopic submucosal myotomy technique may be applied to divide the pyloric sphincter without surgical access. Such endoscopic technique may provide the benefits of a natural orifice procedure, and improve gastric emptying in gastroparetic patients.
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Per-oral endoscopic myotomy (POEM) for esophageal achalasia.
Curr Gastroenterol Rep
PUBLISHED: 08-05-2014
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Per-oral endoscopic myotomy (POEM) is a new minimally invasive endoscopic treatment for achalasia. Since the first modern human cases were published in 2008, around 2,000 cases have been performed worldwide. This technique requires advanced endoscopic skills and a learning curve of at least 20 cases. POEM is highly successful with over 90 % improvement in dysphagia while offering patients the advantage of a low impact endoscopic access. The main long-term complication is gastroesophageal reflux (GER) with an estimated incidence of 35 %, similar to the incidence of GER post-laparoscopic Heller with fundoplication. Although POEM represents a paradigm shift in the treatment of achalasia, more long-term data are clearly needed to further define its role in the treatment algorithm of this rare disease.
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Gastro-bronchial fistula closed by endoscopic fistula plug (with video).
Surg Endosc
PUBLISHED: 05-21-2014
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Fistulae between the tracheobronchial tree and the gastric conduit post-esophagectomy are a rare but sometimes fatal complication. Clinical presentation can range from asymptomatic to acute pulmonary decompensation. Traditional management options, such as esophageal exclusion alone or combined with transthoracic fistula division, and closure (with tissue interposition), are highly invasive, technically difficult, and associated with variable success rates. This video presents closure of highly complex, chronic esophagobronchial fistula (EBF) using simultaneous bronchoscopic and upper endoscopic techniques.
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Probe-based confocal laser endomicroscopy and fluorescence-based enhanced reality for real-time assessment of intestinal microcirculation in a porcine model of sigmoid ischemia.
Surg Endosc
PUBLISHED: 05-06-2014
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Surgeons currently rely on visual clues to estimate the presence of sufficient vascularity for safe anastomosis. We aimed to assess the accuracy of endoluminal confocal laser endomicroscopy (CLE) and laparoscopic fluorescence-based enhanced reality (FLER), using near-infrared imaging and fluorescence from injected Indocyanine Green, to identify the transition from ischemic to vascular areas in a porcine model of mesenteric ischemia.
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Surgical team composition differs between laparoscopic and open procedures.
Surg Endosc
PUBLISHED: 03-27-2014
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Performing laparoscopic procedures requires different skill sets and team dynamics compared with open procedures. We evaluated team composition and procedure time between these two surgical approaches using data collected from hospitals in the United State and Canada.
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Technique of per-oral endoscopic myotomy (POEM) of the esophagus (with video).
Surg Endosc
PUBLISHED: 02-26-2014
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Per-Oral Endoscopic Myotomy (POEM) is becoming an acceptable alternative to laparoscopic cardiomyotomy for esophageal motility disorders. The aim of this video is to provide key technical steps to completing this procedure.
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Acta from the EndoFLIP(R) Symposium.
Surg Innov
PUBLISHED: 12-30-2013
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Laparoscopic fundoplication (LF) is a surgical treatment for gastroesophageal reflux disease (GERD) that has been performed for more than 20 years. High-volume centers of excellence report long-term success rates greater than 90% with LF. On the other hand, general population-based outcomes are reported to be markedly worse, leading to a nihilistic perception of the procedure on the part of the medical referral population. The lack of standardization of the technique and the lack of tools to calibrate objectively the repairs are probably among the causes of variability in the outcomes and may explain the decline in the number of LF procedures in recent years. The functional lumen imaging probe (EndoFLIP(®)) device is essentially a "smart bougie" in the form of a balloon catheter that measures shape and compliance of the gastroesophageal junction (GEJ) during surgery using impedance planimetry. With approximately 3 years of international experience gained with this tool, a symposium was convened in October 2012 in Strasbourg, France, with the aim of determining if intraoperative EndoFLIP use could provide standardization of surgical treatment of GERD through the understanding of physiological changes occurring to the GEJ during fundoplication. This article provides a brief history of the EndoFLIP system and reviews data previously published on the use of EndoFLIP to characterize the GEJ in normal subjects. It then summarizes the data from the 5 high-volume international sites with expert surgeons performing LF presented in Strasbourg to objectively profile the characteristics of a normal postoperative GEJ.
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Causes and treatments of achalasia, and primary disorders of the esophageal body.
Ann. N. Y. Acad. Sci.
PUBLISHED: 10-15-2013
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The following on achalasia and disorders of the esophageal body includes commentaries on controversies regarding whether patients with complete lower esophageal sphincter (LES) relaxation can be considered to exhibit early achalasia; the roles of different mucle components of the LES in achalasia; sensory neural pathways impaired in achalasia; indications for peroral endoscopic myotomy and advantages of the technique over laparoscopic and thorascopic myotomy; factors contributing to the success of surgical therapy for achalasia; modifications to the classification of esophageal body primary motility disorders in the advent of high-resolution manometry (HRM); analysis of the LES in differentiating between achalasia and diffuse esophageal spasm (DES); and appropriate treatment for DES, nutcracker esophagus (NE), and hypertensive LES (HTLES).
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The neurophysiology of the esophagus.
Ann. N. Y. Acad. Sci.
PUBLISHED: 10-15-2013
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This paper reports on the neurophysiology of the esophagus, including on the uneven distribution of innervation in the esophagus, reflected by the increased sensitivity and perception of gastroesophageal reflux disease (GERD) events in the proximal rather than distal esophagus; the role of the enteric nervous system (ENS) in swallowing; the role of the physiological stress-responsive systems, including the autonomic nervous system (ANS) and the hypothalamic-pituitary-adrenal (HPA) axis in mediating esophageal pain; the advances in understanding pain mechanisms and brain structure provided by technological imaging advances; investigations into the efficacy of the descending-pain control system, including diffuse noxious inhibitory control (DNIC); the role of abnormal nervous signaling in afferent pathways in the pathogenesis of Barretts esophagus (BE); and the contribution of the esophageal mucosa to reflux symptoms.
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Outcomes of esophageal surgery, especially of the lower esophageal sphincter.
Ann. N. Y. Acad. Sci.
PUBLISHED: 10-15-2013
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This paper includes commentaries on outcomes of esophageal surgery, including the mechanisms by which fundoduplication improves lower esophageal sphincter (LES) pressure; the efficacy of the Linx™ management system in improving LES function; the utility of radiologic characterization of antireflux valves following surgery; the correlation between endoscopic findings and reported symptoms following antireflux surgery; the links between laparoscopic sleeve gastrectomy and decreased LES pressure, endoscopic esophagitis, and gastroesophageal reflux disease (GERD); the less favorable outcomes following fundoduplication among obese patients; the application of bioprosthetic meshes to reinforce hiatal repair and decrease the incidence of paraesophageal hernia; the efficacy of endoluminal antireflux procedures, and the limited efficacy of revisional antireflux operations, underscoring the importance of good primary surgery and diligent work-up to prevent the necessity of revisional procedures.
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Endoscopic Therapies for Leaks and Fistulas After Bariatric Surgery.
Surg Innov
PUBLISHED: 08-26-2013
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Bariatric surgery is the most effective treatment for the medical comorbidities associated with morbid obesity. Though uncommon, staple line or anastomotic leaks after bariatric surgery are highly morbid events and challenging to treat. In selected patients without severe sepsis or distant pollution, endoscopic transluminal peritoneal drainage may provide source control. For leaks within 3 days of surgery, endoscopic stenting does not appear to speed closure but does permit oral nutrition. In uncomplicated situations, the risk of migration and resulting complications of enteric stents appear to overshadow the benefits. Initial treatment failures and leaks presenting more than 48 hours after surgery respond to enteric diversion by endoscopic stenting. Occlusion of the leak by injection of fibrin glue also shows promise; however, these case series are limited to a small number of patients. Endoclips may work best to occlude leaks and close fistulas if the epithelium is debrided. As suturing technology improves, direct internal closure of fistulas may prove feasible. Therapeutic endoscopy offers several technologies that can assist in the closure of early leaks and that are essential to the treatment of late leaks and fistulas after bariatric surgery.
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Radiofrequency ablation in the management of Barretts esophagus: present role and future perspective.
Expert Rev Med Devices
PUBLISHED: 07-31-2013
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Esophageal adenocarcinoma is the most rapidly increasing gastrointestinal cancer. Barretts esophagus has been identified as a precancerous condition and major risk factor for esophageal cancer. Radiofrequency ablation has been shown to be a highly efficient in promoting remission of intestinal metaplasia. This technology has seen widespread clinical use since 2005. Radiofrequency ablation is common with all other ablative techniques; the concern that sound oncological principles are not being adhered to, that is, appropriate pathological staging, followed by appropriate definitive therapy. Endoscopic mucosal excision techniques are technically demanding; however, they are more attractive from an oncological perspective. Future research endeavors focusing on facilitation of large population screening, the identification of high risk phenotypes, endoscopic mucosal resection techniques will combat the esophageal adenocarcinoma epidemic.
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Subxyphoid Thyroidectomy: A Feasibility Study.
Surg Innov
PUBLISHED: 07-30-2013
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Objective. The cultural desire to avoid cervical incisions and increasing concern for cosmetic outcomes has motivated surgeons to develop alternative approaches to thyroid surgery. The Direct Drive Endoscopic System (DDES) platform combines a flexible endoscope with a pair of separately controlled articulating instruments through a single, flexible, access system. We hypothesized that the DDES platform would permit single-incision minimally invasive thyroid lobectomy without robotic assistance. Methods. This is a single-cadaver feasibility study. A single, 2.2-cm subxyphoid incision was used for access. The platforms 55-cm flexible sheath was secured to the operating table rails and introduced into the subcutaneous space. A flexible pediatric endoscope was simultaneously introduced with 2 interchangeable 4-mm instruments. Blunt dissection and electrocautery were used to create the tunnel in the otherwise free central plane. The thyroid was dissected using a superior to inferior technique while maintaining the critical steps of traditional thyroid surgery. A Veress needle introduced through the lateral neck provided additional retraction. Results. The total operating time was 2.5 hours. The subcutaneous tunnel was safe and accommodated the DDES well. Visualization was adequate. Graspers, scissors, and hook cautery were used to complete the lobectomy. The ergonomics, articulation, and strength of the instrumentation were sufficient. Conclusions. Subxyphoid thyroidectomy is technically possible and avoids the difficulties inherent to a transaxillary approach while still avoiding cosmetically unappealing cervical scars. Continued technological refinement will only expand the therapeutic possibilities of flexible endoscopy while minimizing the physical insult to patients and maximizing aesthetics for patients.
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Defining "the elderly" undergoing major gastrointestinal resections: receiver operating characteristic analysis of a large ACS-NSQIP cohort.
Ann. Surg.
PUBLISHED: 07-18-2013
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"The elderly" is an often used but poorly defined descriptor of surgical patients. Investigators have used varying subjectively determined age cutoffs to report outcomes in the elderly. We set out to use objective outcomes data to determine the "at-risk" elderly population.
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Esophagectomies with thoracic incisions carry increased pulmonary morbidity.
JAMA Surg
PUBLISHED: 06-21-2013
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Thoracic incisions are not required for all esophagectomies and may increase pulmonary morbidity.
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Endoscopic suture repair of full-thickness esophagotomy during per-oral esophageal myotomy for achalasia.
Surg Endosc
PUBLISHED: 04-26-2013
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Per-oral endoscopic myotomy (POEM) requires advanced flexible endoscopic skills, especially in the management of complications.
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Peroral endoscopic myotomy (POEM) is safe and effective in the setting of prior endoscopic intervention.
J. Gastrointest. Surg.
PUBLISHED: 03-27-2013
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We aimed to determine the safety and feasibility of peroral endoscopic myotomy (POEM) in the setting of prior endoscopic interventions.
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Preoperative diagnostic workup before antireflux surgery: an evidence and experience-based consensus of the Esophageal Diagnostic Advisory Panel.
J. Am. Coll. Surg.
PUBLISHED: 03-12-2013
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Gastroesophageal reflux disease (GERD) is a very prevalent disorder. Medical therapy improves symptoms in some but not all patients. Antireflux surgery is an excellent option for patients with persistent symptoms such as regurgitation, as well as for those with complete symptomatic resolution on acid-suppressive therapy. However, proper patient selection is critical to achieve excellent outcomes.
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Asian-Chinese patient perceptions of natural orifice transluminal endoscopic surgery cholecystectomy.
Dig Endosc
PUBLISHED: 02-21-2013
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Patient and physician perceptions of natural orifice transluminal endoscopic surgery (NOTES) have been reported for the Western population. However, whether Asian-Chinese patients share the same perspectives as compared to the Western population is unknown.
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Peroral endoscopic esophageal myotomy: defining the learning curve.
Gastrointest. Endosc.
PUBLISHED: 02-05-2013
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Peroral endoscopic myotomy (POEM) is an endoscopic alternative to laparoscopic esophageal myotomy. It requires a demanding skill set that involves both advanced endoscopic skills and knowledge of surgical anatomy and complication management.
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Partial anterior vs partial posterior fundoplication following transabdominal esophagocardiomyotomy for achalasia of the esophagus: meta-regression of objective postoperative gastroesophageal reflux and dysphagia.
JAMA Surg
PUBLISHED: 01-18-2013
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To review transabdominal esophagocardiomyotomy (surgical treatment of achalasia) of the esophagus and to compare outcomes of partial anterior vs partial posterior fundoplication.
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Does morbid obesity worsen outcomes after esophagectomy?
Ann. Thorac. Surg.
PUBLISHED: 01-08-2013
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With worldwide increases in esophageal cancer and obesity, esophagectomies in the morbidly obese (MO) will only increase. Risk stratification and patient counseling require more information on the morbidity associated with esophagectomy in the obese.
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Interventional endoscopy and single incision surgery.
Ann. N. Y. Acad. Sci.
PUBLISHED: 09-29-2011
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The following on interventional endoscopy and single incision surgery contains commentaries on transluminal endoscopic esophageal surgery, flexible endoscopy, triangulation, advanced flexible operating platforms, experimental transesophageal procedures, and para- and intra-esophageal endoscopic surgery.
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A stepwise approach and early clinical experience in peroral endoscopic myotomy for the treatment of achalasia and esophageal motility disorders.
J. Am. Coll. Surg.
PUBLISHED: 07-12-2011
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Peroral endoscopic myotomy (POEM) has recently been described in humans as a treatment for achalasia. This concept has evolved from developments in natural orifice translumenal endoscopic surgery (NOTES) and has the potential to become an important therapeutic option. We describe our approach as well as our initial clinical experience as part of an ongoing study treating achalasia patients with POEM.
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Paraesophageal hernia repair with biomesh does not increase postoperative dysphagia.
J. Gastrointest. Surg.
PUBLISHED: 06-20-2011
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Laparoscopic techniques have led to hiatal procedures being performed with less morbidity but higher failure rates. Biologic mesh (biomesh) has been proposed as an alternative to plastic mesh to achieve durable repairs while minimizing stricturing and erosion. This paper documents the lack of significant dysphagia after the placement of biomesh during hiatal hernia repair.
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Postoperative impedance-pH testing is unreliable after Nissen fundoplication with or without giant hiatal hernia repair.
J. Gastrointest. Surg.
PUBLISHED: 06-20-2011
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Combined 24-h multichannel intralumenal impedance-pH monitoring (MII-pH) is gaining popularity as a diagnostic tool for gastroesophageal reflux. Since the surgical reduction of hiatal hernias and creation of a fundoplication anatomically restores the gastroesophageal reflux barrier, one would assume that it effectively stops all reflux regardless of composition. Our aim is to evaluate the results of routine MII-pH testing in successful Nissen fundoplication patients.
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Concomitant endoscopic radiofrequency ablation and laparoscopic reflux operative results in more effective and efficient treatment of Barrett esophagus.
J. Am. Coll. Surg.
PUBLISHED: 06-15-2011
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Barrett esophagus (BE) caused by gastroesophageal reflux disease can lead to esophageal cancer. The success of endoscopic treatments with BE eradication depends on esophageal anatomy and post-treatment acid exposure.
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Laparoscopic Dor versus Toupet fundoplication following Heller myotomy for achalasia: results of a multicenter, prospective, randomized-controlled trial.
Surg Endosc
PUBLISHED: 05-18-2011
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The type of fundoplication that should be performed in conjunction with Heller myotomy for esophageal achalasia is controversial. We prospectively compared anterior fundoplication (Dor) with partial posterior fundoplication (Toupet) in patients undergoing laparoscopic Heller myotomy.
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Quantifying mental workloads of surgeons performing natural orifice transluminal endoscopic surgery (NOTES) procedures.
Surg Endosc
PUBLISHED: 05-02-2011
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During natural orifice transluminal endoscopic surgery (NOTES), surgeons often have difficulties orienting the surgical view and manipulating instruments accurately, which increases their level of mental and physical fatigue. This study quantified mental workload by measuring the spared mental resources of surgeons performing NOTES training tasks.
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Video. Transanal specimen retrieval using the transanal endoscopic microsurgery (TEM) system in minimally invasive colon resection.
Surg Endosc
PUBLISHED: 04-24-2011
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During laparoscopic colectomy, the specimen is retrieved through substantial incisions, which increase postoperative pain, wound infections, and incisional hernias. In the era of natural orifice transluminal endoscopic surgery (NOTES), incisionless transrectal approaches for colon resections have been investigated with promising results [4-6]. Transanal retrieval of the colonic specimen in laparoscopic colectomy has been described but not widely adopted, although it seems to be an appealing step towards NOTES colectomy. We have used the TEM rectoscope (Richard Wolf Medical Instruments Corporation, Vernon Hills, IL, USA) as a retrieval conduit, which facilitates transanal extraction of the specimen, and protects the rectal edge and anal sphincter during laparoscopic left colectomy.
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Quantifying surgeons contribution to team effectiveness on a mixed team with a junior surgeon.
Surgery
PUBLISHED: 04-22-2011
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A surgical team often consists of an experienced surgeon and surgeons in training. This project quantified the contribution of the experienced surgeon to the teamwork in a team comprised of 1 experienced and 1 novice surgeon (Mixed Team).
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Short esophagus: selection of patients for surgery and long-term results.
Surg Endosc
PUBLISHED: 04-12-2011
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After improvements in antireflux surgery (ARS), a percentage of reherniations still has cause of failure attributed to a reopening of the hiatal closure or to an untreated short esophagus. However, the existence of short esophagus and its treatment results still are matters of debate.
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Laparoscopic and endoscopic pyloroplasty for gastroparesis results in sustained symptom improvement.
J. Gastrointest. Surg.
PUBLISHED: 04-08-2011
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Gastroparesis is a chronic digestive disorder with symptoms of nausea, vomiting, bloating, and abdominal pain resulting in a poor quality of life. Surgeons are increasingly asked to treat patients with gastroparesis as medical options have become limited due to safety concerns of many prokinetics. Surgical options include gastric stimulator implantation, sub-total gastrectomy, and pyloroplasty. We report our experience with minimally invasive pyloroplasty as sole surgical treatment for adult gastroparesis.
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Postoperative dysphagia is not predictive of long-term failure after laparoscopic antireflux surgery.
Surg Endosc
PUBLISHED: 04-03-2011
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Dysphagia is a common postoperative symptom after laparoscopic antireflux surgery, usually attributed to postoperative edema or a "too tight" fundoplication. Although it is usually self-limited, it occasionally requires endoscopic dilation and rarely revisionary surgery. It has not been previously described whether postoperative dysphagia is associated with poorer long-term reflux control after fundoplication.
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Flexible endoscopic Zenkers diverticulotomy with a novel bipolar forceps: a pilot study and comparison with needleknife dissection.
Surg Endosc
PUBLISHED: 03-26-2011
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Zenkers diverticulum (ZD) is the most common diverticulum of the upper gastrointestinal tract. Various flexible endoscopic techniques have been used for division of the septum. However, the learning curve associated with these techniques might be difficult to overcome given the overall rarity of this condition. This can lead either to complications or to potential recurrence of symptoms. The authors hypothesized that a flexible bipolar hemostasis forceps developed for natural orifice translumenal surgery (NOTES) procedures would facilitate precise endoscopic diverticulotomy and simultaneously enable sealing of divided tissue edges.
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Biologic prosthesis to prevent recurrence after laparoscopic paraesophageal hernia repair: long-term follow-up from a multicenter, prospective, randomized trial.
J. Am. Coll. Surg.
PUBLISHED: 03-24-2011
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In 2006, we reported results of a randomized trial of laparoscopic paraesophageal hernia repair (LPEHR), comparing primary diaphragm repair (PR) with primary repair buttressed with a biologic prosthesis (small intestinal submucosa [SIS]). The primary endpoint, radiologic hiatal hernia (HH) recurrence, was higher with PR (24%) than with SIS buttressed repair (9%) after 6 months. The second phase of this trial was designed to determine the long-term durability of biologic mesh-buttressed repair.
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Surgical management of breast cancer liver metastases.
HPB (Oxford)
PUBLISHED: 03-23-2011
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Selected patients with isolated breast cancer liver metastases (BCLM) may benefit from surgical management; however, indications remain unclear and the risks may outweigh the benefits in patients with a generally poor prognosis.
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Efficacy of using a novel endoscopic lens cleaning device: a prospective randomized controlled trial.
Surg Innov
PUBLISHED: 02-22-2011
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Clear visualization of the surgical field is critical in laparoscopic surgery. The authors evaluated a device that does not necessitate an external cleaning process for the laparoscope. It was hypothesized that it will minimize the interruption in operative workflow.
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Maintaining forward view of the surgical site for best endoscopic practice.
Stud Health Technol Inform
PUBLISHED: 02-22-2011
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Endoscopic surgery performed through patients natural orifices (NOTES procedures) often require some degree of retroflexion of the operating system. This can cause a misalignment between the displayed image and the actual work plane, leading to performance difficulties. This study investigated the impact of retroflexion on task performance in a simulated environment. Surgeons were required to perform an aiming and pointing task under two experimental conditions: forward-view vs. retroflexed-view. Results showed that both expert and novice surgeons required significantly longer time for completing the task when the scope was retroflexed, compared to when the scope faced forwards. Results address the importance of careful selection of the surgical approach to avoid image retroflexion. Further analysis revealed that the novices were more vulnerable than experts to image distortion with the retroflexed view. This addresses the necessity for surgeons to go through extensive endoscopic training to overcome the visual-motor challenges before they can perform NOTES procedures safely and effectively.
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A natural orifice transrectal approach for oncologic resection of the rectosigmoid: an experimental study and comparison with conventional laparoscopy.
Surg Endosc
PUBLISHED: 02-11-2011
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A transrectal (TR) approach for natural orifice translumenal endoscopic surgery (NOTES) makes sense for colorectal surgery because the colotomy can be incorporated into subsequent anastomosis. Because cancer is a primary indication for left-sided colon resection, oncologic standards will have to be met by a NOTES procedure. This study aimed to assess whether pure TR rectosigmoidectomy can be performed with strict adherence to oncologic principles compared with a conventional laparoscopically assisted approach (LAP).
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A novel technique for natural orifice endoscopic full-thickness colon wall resection: an experimental pilot study.
J. Am. Coll. Surg.
PUBLISHED: 01-24-2011
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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.
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Advances in cancer surgery: natural orifice surgery (NOTES) for oncological diseases.
Surg Oncol
PUBLISHED: 09-15-2010
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Natural orifice transluminal endoscopic surgery (NOTES) is a new concept that attempts to reduce the impact of surgery on the patient. In surgical oncology several studies have already revealed that a minimally invasive approach provides at least the same, if not a better, long-term outcome. One could hypothesize that a less invasive approach such as NOTES could further enhance such advantages. Since its initial description, NOTES has become clinical reality and today nearly every organ is accessible by a transluminal approach, in at least the experimental setting. Subsequent to published research, first clinical studies on NOTES in oncology were reported and the accuracy of transgastric peritoneoscopy for staging of pancreas cancer was shown to be similar to laparoscopy in humans. A NOTES gastro-jejunostomy via transgastric access has also been proposed to decrease invasiveness of palliative treatment of duodenal, biliary and pancreatic cancers. Colorectal cancer resection via transanal access would offer a clear-cut patient advantage over laparoscopic and would not be subject to the frequent criticism of violating an innocent second organ, as the colon or rectum is always breached in a colectomy. Natural orifice endoluminal therapies, such as endoscopic submucosal dissection, already have been clinically applied for several years. Improved techniques or instruments evolving from NOTES technology might enhance its widespread use for the treatment of early malignancies and thereby again will provide a tremendous benefit for the patient. Although still somewhat controversial, the subject of natural orifice surgery in oncological disease indicates that current laboratory efforts to introduce NOTES into cancer surgery could be ready for cautious clinical investigations. The final determination of patient benefit will need well-constructed prospective study.
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Computed tomography (CT)-guided versus laparoscopic radiofrequency ablation: a single-institution comparison of morbidity rates and hospital costs.
Surg Endosc
PUBLISHED: 08-09-2010
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Computed tomography (CT)-guided radiofrequency ablation (RFA) is presumed to be less morbid and less costly than laparoscopic RFA. This analysis investigates the 30-day morbidity, hospital cost, and reimbursement for CT-guided RFA versus laparoscopic RFA used to manage hepatocellular carcinoma (HCC) and colorectal liver metastases (CRLM).
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A triangulating operating platform enhances bimanual performance and reduces surgical workload in single-incision laparoscopy.
J. Am. Coll. Surg.
PUBLISHED: 08-03-2010
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Single-site laparoscopy (SSL) attempts to further reduce the surgical impact of minimally invasive surgery. However, crossed instruments and the proximity of the endoscope to the operating instruments placed through one single site leads to inevitable instrument or trocar collision. We hypothesized that a novel, single-port, triangulating surgical platform (SPSP) might enhance performance by improving bimanual coordination and decreasing the surgeons mental workload.
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Trends and results of the first 5 years of Fundamentals of Laparoscopic Surgery (FLS) certification testing.
Surg Endosc
PUBLISHED: 05-21-2010
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FLS is an educational program developed by the Society of American Gastrointestinal and Endoscopic Surgeons and endorsed by the American College of Surgeons. The goal of the FLS program is to teach and assess the basic cognitive and psychomotor skills required to perform laparoscopic surgery. The purpose of this study is to review the results from the first 5 years of FLS certification testing.
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Surgeon volume versus morbidity and cost in patients undergoing pancreaticoduodenectomy in an academic community medical center.
J. Gastrointest. Surg.
PUBLISHED: 03-16-2010
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Despite trends toward regionalization of care, the majority of pancreaticoduodenectomies (PD) are performed in community hospitals by surgeons with varying degrees of experience. We analyzed the impact of several variables, including surgeon volume, on outcomes following PD within a high-volume community-based teaching hospital system.
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Transcervical heller myotomy using flexible endoscopy.
J. Gastrointest. Surg.
PUBLISHED: 02-22-2010
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Esophageal achalasia is most commonly treated by laparoscopic myotomy. Transesophageal approaches using flexible endoscopy have recently been described. We hypothesized that using techniques and flexible instruments from our NOTES experience through a small cervical incision would be a safer and less traumatic route for esophageal myotomy. The purpose of this study was to evaluate the feasibility, safety, and success rate of using flexible endoscopes to perform anterior or posterior Heller myotomy via a transcervical approach.
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A comparison of early learning curves for complex bimanual coordination with open, laparoscopic, and flexible endoscopic instrumentation.
Surg Endosc
PUBLISHED: 02-21-2010
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This study takes an initial step towards understanding the learning process of flexible endoscopic surgery. Bimanual coordination learning curves were contrasted between three different surgical paradigms. We hypothesized that use of an open or laparoscopic paradigm would result in better performance and a shorter learning process (reaching a learning plateau earlier) than an endoscopic paradigm.
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Incisionless revision of post-Roux-en-Y bypass stomal and pouch dilation: multicenter registry results.
Surg Obes Relat Dis
PUBLISHED: 02-13-2010
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Surgical revision for weight regain after Roux-en-Y gastric bypass (RYGB) has been tempered by the high complication rates associated with standard approaches. Endoluminal revision of stoma and pouch dilation should intuitively confer a better risk profile. However, questions of clinical safety, durability, and weight loss need to be answered. We report our multicenter intraoperative experience and postoperative follow-up to date using the Incisionless Operating Platform for this patient subset.
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Global Assessment of Gastrointestinal Endoscopic Skills (GAGES): a valid measurement tool for technical skills in flexible endoscopy.
Surg Endosc
PUBLISHED: 01-29-2010
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Simulators may improve the efficiency, safety, and quality of endoscopic training. However, no objective, reliable, and valid tool exists to assess clinical endoscopic skills. Such a tool to measure the outcomes of educational strategies is a necessity. This multicenter, multidisciplinary trial aimed to develop instruments for evaluating basic flexible endoscopic skills and to demonstrate their reliability and validity.
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How should we establish the clinical case numbers required to achieve proficiency in flexible endoscopy?
Am. J. Surg.
PUBLISHED: 01-28-2010
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Recommended procedure numbers for upper endoscopy (UE) and colonoscopy (C) are 35 and 50 for surgical residents, and 130 and 140 for gastroenterology fellows, respectively. The purpose of this study was to challenge the methods used to determine proficiency in flexible endoscopy.
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Clinical experience with a multifunctional, flexible surgery system for endolumenal, single-port, and NOTES procedures.
Surg Endosc
PUBLISHED: 01-20-2010
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Single-port and incisionless surgical approaches hold the promise of fewer complications, reduced pain, faster recovery, and improved cosmesis compared with traditional open or laparoscopic approaches. The ability to select an access approach (i.e., endolumenal, single-port, transvaginal, or transgastric) with one platform may be important to optimization of individual patient results. The authors report their results using these four separate surgical approaches tailored to three different therapeutic procedures, all with the use of a single flexible platform, the Incisionless Operating Platform (IOP).
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Use of flexible endoscopes for NOTES: sterilization or high-level disinfection?
Surg Endosc
PUBLISHED: 10-30-2009
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Natural orifice translumenal endoscopic surgery (NOTES) involves the use of flexible endoscopes to perform intra-abdominal or intra-thoracic surgeries. Surgery in the operating room usually involves sterile instrumentation, whereas in the endoscopy suite high-level disinfection seems to be sufficient. Our objective was to assess the necessity for endoscope sterilization for clinical NOTES and to develop an endoscope processing protocol based on a score for the available processing options.
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Outcomes of Nissen fundoplication in patients with gastroesophageal reflux disease and delayed gastric emptying.
Arch Surg
PUBLISHED: 10-03-2009
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To investigate the effect of delayed gastric emptying (DGE) on subjective and objective outcomes of gastroesophageal reflux disease following Nissen fundoplication with or without pyloroplasty.
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Mesh complications after prosthetic reinforcement of hiatal closure: a 28-case series.
Surg Endosc
PUBLISHED: 08-19-2009
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Primary laparoscopic hiatal hernia repair is associated with up to a 42% recurrence rate. This has lead to the use of mesh for crural repair, which has resulted in an improved recurrence rate (0-24%). However, mesh complications have been observed.
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Minimally invasive esophagectomy.
J. Gastrointest. Surg.
PUBLISHED: 07-15-2009
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Minimally invasive esophagectomy has gained popularity over the past two decades. The procedural goal is to decrease the high overall morbidity of a traditional open esophageal resection. The entire spectrum of open esophagectomy techniques has been successfully replicated in a minimally invasive fashion.
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Endoscopic closure of gastrogastric fistulas by using a tissue apposition system (with videos).
Gastrointest. Endosc.
PUBLISHED: 05-21-2009
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Gastrogastric fistulas (GGFs) are seen in 1.5% to 12.5% of patients after Roux-en-Y gastric bypass (RYGB) bariatric surgery, often leading to failure to lose adequate weight.
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Bimanual coordination in natural orifice transluminal endoscopic surgery: comparing the conventional dual-channel endoscope, the R-Scope, and a novel direct-drive system.
Gastrointest. Endosc.
PUBLISHED: 05-05-2009
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The devices used for natural orifice transluminal endoscopic surgery procedures are endoscopes or inspired by endoscopic design, which makes it difficult to accomplish bimanual coordination.
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Development and validation of a new generation of flexible endoscope for NOTES.
Surg Innov
PUBLISHED: 05-01-2009
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The concept of intraperitoneal flexible endoscopy has created much interest and investigation. Both gastroenterologists with a surgical leaning and surgeons with advanced endoscopy interests are researching the feasibility of this new approach. Current flexible scopes and instruments are extremely limited for use in natural orifice transluminal endoscopic surgery (NOTES). We describe the development of an endoscopic system specifically designed for endoluminal and NOTES procedures and demonstrates benefits and efficacy in benchtop and cadaver models.
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Surgeon perceptions of Natural Orifice Translumenal Endoscopic Surgery (NOTES).
J. Gastrointest. Surg.
PUBLISHED: 04-28-2009
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If proven feasible and safe, Natural Orifice Translumenal Endoscopic Surgery (NOTES) would still need acceptance by surgeons if it were to become a mainstream approach.
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Evaluation of a manually driven, multitasking platform for complex endoluminal and natural orifice transluminal endoscopic surgery applications (with video).
Gastrointest. Endosc.
PUBLISHED: 04-25-2009
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The Direct Drive Endoscopic System (DDES) is a multitasking platform developed to overcome the limitations of the currently available rigid and flexible endoscopic systems in application to natural orifice transluminal endoscopic surgery (NOTES), single-port laparoscopy, and advanced endoluminal procedures. The system consists of a 3-channel, steerable guide sheath accepting a 6-mm endoscope and two 4-mm articulating instruments. The systems overall design enables the interventionalist to operate instruments bimanually from a stable platform, conveying a laparoscopic paradigm to the functional working space at the distal end of the flexible guide sheath.
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An observational study of surgery-related activities between nurses and surgeons during laparoscopic surgery.
Am. J. Surg.
PUBLISHED: 04-15-2009
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In the operating room (OR), nurse-surgeon coordination is essential to the success of a surgery.
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Patient attitudes and expectations regarding natural orifice translumenal endoscopic surgery.
Surg Endosc
PUBLISHED: 04-03-2009
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Natural orifice translumenal endoscopic surgery (NOTES) has theoretical patient advantages. Because public attitude toward NOTES will influence its adoption, this study aimed to assess patients opinions regarding the NOTES procedure.
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Surgical time independently affected by surgical team size.
Am. J. Surg.
PUBLISHED: 03-12-2009
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Team size and composition provide essential data for the study of operating room (OR) efficiency.
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Future applications of flexible endoscopy in esophageal surgery.
J. Gastrointest. Surg.
PUBLISHED: 03-04-2009
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Flexible endoscopy has long played a role in esophageal surgery, and procedures like perforation closure, stenting of occluding malignancies, antireflux procedures, and removal of Barretts are increasingly replacing open and laparoscopic procedures. We present early results of a series of acute animal experiments studying the feasibility of using flexible endoscopes for complex esophageal surgery such as Heller myotomy and esophagectomy.
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What is Visualize?

JoVE Visualize is a tool created to match the last 5 years of PubMed publications to methods in JoVE's video library.

How does it work?

We use abstracts found on PubMed and match them to JoVE videos to create a list of 10 to 30 related methods videos.

Video X seems to be unrelated to Abstract Y...

In developing our video relationships, we compare around 5 million PubMed articles to our library of over 4,500 methods videos. In some cases the language used in the PubMed abstracts makes matching that content to a JoVE video difficult. In other cases, there happens not to be any content in our video library that is relevant to the topic of a given abstract. In these cases, our algorithms are trying their best to display videos with relevant content, which can sometimes result in matched videos with only a slight relation.