- medical evidence

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> ... if anyone could present medical evidence to show why a specialist is a

prefered. ...

Laparoscopic Myotomy for Achalasia

Predictors of Successful Outcome After 200 Cases

Alfonso Torquati, MD, MSCI, O. s, MD, D. Holzman,

MD, MPH, and W. Sharp, MD

From the Department of Surgery, Vanderbilt University Medical Center,

Nashville, TN.

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1570561

" ..., I think we had a learning curve. We had six perforations in the

first 50 patients, and then six in the last 150. Definitely, there was a

learning curve in terms of perforation. Also, we had four conversions in

our first 50 patients and zero conversions in the last 150. That is

definitely a learning curve in terms of conversion and perforation. We

did not have a learning curve in terms of dysphasia relief. We believe

all our patients had a common denominator. All were done under endoscopy

guidance. We feel that you can achieve a good relief of dysphagia if you

use endoscopic visualization. "

Minimally Invasive Surgery for Achalasia

An 8-Year Experience With 168 Patients

Marco G. Patti, MD, A. Pellegrini, MD, Santiago Horgan, MD,

Massimo Arcerito, MD, Pablo Omelanczuk, MD, Tamburini, MD, Urs

Diener, MD, R. Eubanks, MD, and Lawrence W. Way, MD

From the Departments of Surgery at the University of California, San

Francisco, California, and the University of Washington, Seattle, Washington

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1420907

" Attention to the details of the surgical technique is important to

success, and many of the technical refinements are difficult to convey

in words. Our rate of persistent dysphagia dropped substantially after

approximately 40 operations, but the minimum learning curve is probably

less than this, because we were in the process of developing the

laparoscopic methods. "

The " learning curve " in videoscopic Heller myotomy.

Bloomston M, Serafini F, Boyce HW, Rosemurgy AS.

Department of Surgery, University of South Florida College of Medicine,

Tampa, USA.

http://www.ncbi.nlm.nih.gov/pubmed/12002295

" CONCLUSION: Outcome following videoscopic Heller myotomy, like other

videoscopic operations, improves as surgeons progress along the

videoscopic " learning curve. " After approximately 20 videoscopic Heller

myotomies, surgeons can expect fewer conversions to open procedures,

shorter hospital stays, and better symptomatic relief. "

100 Consecutive Minimally Invasive Heller Myotomies: Lessons Learned

W. Sharp, MD, Leena Khaitan, MD, Stefan Scholz, MD, D.

Holzman, MD, and O. s, MD

From the Department of Surgery, Vanderbilt University Medical Center,

Nashville, Tennessee

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1422488

" Most of the perforations in our series occurred in the first 50

procedures, with six perforations in the first 50 cases and only two in

the last 50 cases, and all conversions to open procedure occurred in the

first 50 procedures. Operative times decreased significantly in the last

20 procedures compared with the first 20, from 144 ± 7 minutes to 110 ±

5 minutes (/P/ < .03). As with most advanced laparoscopic procedures, a

substantial learning curve is associated with laparoscopic myotomy. We

have not noticed a difference in outcome with this learning curve with

respect to patient satisfaction or relief of dysphagia. "

Achalasia Treatment

Improved Outcome of Laparoscopic Myotomy With Operative Manometry

R. Chapman, MD; J. Joehl, MD; Kenric M. Murayama, MD;

P. Tatum, MD; Guoxiang Shi, MD, PhD; Ikuo Hirano, MD; P.

, MD; E. Pandolfino, MD; J. Kahrilas, MD

Arch Surg. 2004;139:508-513.

http://archsurg.ama-assn.org/cgi/content/full/139/5/508

" Figure 4. Learning curve. The numbers of myotomy perforations and

residual manometric high-pressure zones (HPZ) detected are shown for

consecutive groups of 20 patients. ... While we found operative

manometry, conducted by interested and skilled clinicians, to be

helpful, it requires a level of expertise that may not be available in

many institutions. "

Laparoscopic Heller myotomy for achalasia.

The Australian and New Zealand journal of surgery 2000;70(8):582-6.

http://www.biomedexperts.com/Abstract.bme/10945552/Laparoscopic_Heller_myotomy_f\

or_achalasia

" The 'learning curve' contributed significantly to the length of the

procedure, and the need for reoperation. "

VIDEO-ASSISTED SURGICAL MANAGEMENT OF ACHALASIA OF THE ESOPHAGUS

J. Wiechmann, MDa, Mark K. Ferguson, MDb, S. Naunheim, MDc,

R. Hazelrigg, MDd, J. Mack, MDe, J. Aronoff, MDe,

J. Weyant, DMD, DrPHf, Tibetha Santucci, RNa, Robin Macherey,

RNa, Rodney J. Landreneau, MDa

http://jtcs.ctsnetjournals.org/cgi/content/full/118/5/916

" I^ think there is a learning curve. In fact, our numbers at all^

institutions increased significantly with time, and there was^ clearly a

progression of the procedure with time. As to avoiding^ pitfalls of the

learning curve, as we become more experienced^ with all laparoscopic and

thoracoscopic techniques, then we^ are able to avoid the pitfalls of

this procedure. It is essential^ to understand the pathophysiology of

achalasia and to be accomplished^ in the open management of this disease

process before one begins^ to use minimally invasive techniques. "

Journal of Pediatric Gastroenterology and Nutrition:Volume 44(5)May

2007p 587-591

Minimally Invasive Surgery for Achalasia: Combined Experience of Two

European Centers

http://www.jpgn.org/pt/re/jpgn/abstract.00005176-200705000-00009.htm

" Possible complications of these procedures are intraoperative

lacerations of the herniated esophageal mucosa or nearby organs. In our

series 1 case of macroscopic mucosal perforation was diagnosed (8.3%),

which was promptly repaired during surgery. Noticeably, the patient with

perforation and the one with insufficient myotomy were the first cases

of achalasia treated with the minimally invasive approach. The

interventions were carried out during the learning curve period for this

specific intervention, which is one of the most important problems for

minimally invasive techniques. "