UW CVES: PROJECTS


		CLINICAL STUDIES RESEARCH AND TRAINING AT THE CENTER FOR VIDEOENDOSCOPIC SURGERY The mission of the Center for Videoendoscopic Surgery (CVES) is to foster excellence in clinical videoendoscopic surgical practice. The Center is committed to the training and study of current clinical practice, and the development of new instruments, procedures, and techniques that further the science and the art of videoendoscopic surgery. The CVES was established in the Department of Surgery in 1994 with industry support. Since its inception, CVES has developed a comprehensive training and research program in support of our mission. The CVES research program is organized into three categories: clinical studies, laboratory investigations, and education programs that should indicate the best methods of training surgeons in videoendoscopic skills. CLINICAL STUDIES Continuing efforts are being directed at optimizing competency in performing laparoscopic procedures. In a collaborative study with the University of Pennsylvania and Vanderbilt University, a simple video scoring system was developed for laparoscopic cholecystectomy. Videotapes of procedures from each of these institutions were reviewed and scored by four surgeons in a blinded process using a standardized scoring sheet. The data were then examined for congruence of the evaluations. This project is ongoing with the ultimate goal of developing an objective means of evaluating technical progress and competency. One of the most common advanced videoendoscopic procedures carried out by members of the CVES is laparoscopic antireflux surgery. This has developed into a major clinical interest for the Center. In conjunction with the Swallowing Center, the CVES is engaged in evaluating an extensive database of patients undergoing these procedures for clinical outcome and for the patient’s quality of life (QoL) after surgery. Novel QoL study tools developed for this purpose have been refined and used extensively in an ongoing prospective study. The short and long-term outcome from other advanced videoendoscopic procedures is also being investigated. A recently published review of our experience with laparoscopic adrenalectomy is being expanded with longer term follow-up. We have also prospectively evaluated our experience with laparoscopic colectomy for efficacy in the subset of patients with severe ulcerative colitis undergoing total proctocolectomy and ileoanal J pouch formation. Videoendoscopic technology is expensive. This cost, and the potentially longer operative times have become a significant concern for wider application of advanced videoendoscopic techniques. To address these issues around a common disease process, a cost and human capital study comparing open and laparoscopic appendectomy at Harborview and UWMC is currently under development. Two other studies with similar goals have also been initiated. The first is intended to measure the time expended for resident education during routine laparoscopic cholecystectomy by detailed time analysis of procedures. The second is a micro-costing study of laparoscopic Nissen fundoplication, to supplement data collected over the past 3 years on the overall cost and resource utilization for laparoscopic treatment of gastroesophageal reflux. Together, it is anticipated that these two studies should provide a methodology for measuring the institutional costs of surgical training in the operating room. In addition to these two studies of resource utilization, several other clinical studies began in the fall of 1997. In collaboration with Siemens Corporation, we plan to study the effects of CO2 insufflation during advanced videoendoscopic procedures, testing the hypothesis that the ventilatory parameters and the mode of ventilation during surgery has a significant impact on pulmonary recovery and pulmonary complications in the postoperative period. In combination with this study and in follow-up of a recently completed laboratory investigation of pneumoperitoneum effects on hepatic (as a surrogate for the splanchnic system) perfusion, we will also be initiating a clinical study of anesthetic drug clearance and hepatic perfusion. For this third component of this effort, indocyanin green clearance during CO2 pneumoperitoneum under pressure and volume controlled ventilation will be studied. Our goal is to determine whether pneumoperitoneum alters overall hepatic anesthetic clearance and perfusion, or lung function under clinical conditions.		Educational Studies Laboratory Studies


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