|
|
|
|
| Scoring System Predicts Weight-Loss Surgery Risk
|
|
In a video presentation delivered on the closing day of the Society of American Gastrointestinal and Endoscopic Surgeons' annual meeting in Las Vegas earlier this month, Marc Bessler, MD, demonstrated the removal of a 66-year-old female patient's gallbladder using a flexible endoscope passed through an incision in her vagina, which was then sutured.
During the presentation, Dr. Bessler, the director of Laparoscopic Surgery at New York Presbyterian Hospital, Columbia University Medical Center, promoted this "natural orifice" procedure as an example of the future of minimally invasive surgery.
"Internal incisions, such as in the vaginal wall, are less painful and may allow for quicker recovery than incisions in the abdominal wall," he says, noting that the patient whose procedure was depicted in the video presentation is recovering well.
Some proponents of this type of operation are considering its possibilities through the formation of the Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR).
Others, however, question the safety of puncturing internal organs for surgical access. In published reports about the presentation, Christine Ren, MD, assistant professor of surgery at New York University Medical Center describes the procedure as "repulsive."
"As a woman, I find it invasive, physically and emotionally," she says. "To me it's quite distasteful."
|
|
 |
^ Back to Top |
|
|
|
|
| Study: Virtual Colonoscopy Provides Most Effective Screening
|
|
When performing colorectal cancer screenings, a "virtual colonoscopy" followed by the removal of larger lesions provides the most effective treatment with the fewest complications at the best value, according to a study by researchers at the University of Wisconsin at Madison and the Nuovo Regina Margherita Hospital in Rome, Italy.
The study, appearing online in advance of its publication in the June 1 issue of Cancer, the journal of the American Cancer Society, suggests that the surgical removal of lesions smaller than 6mm has little effect in reducing the incidence of colorectal cancer, since such "diminutive polyps" have a low malignancy rate.
In addition, their removal adds significant financial expense — and the potential for abdominal pain, bowel perforation, bleeding and other complications of conventional colonoscopy — to a patient's care for this questionably effective result, the study says.
However, researchers say that computed tomography colonography — a "virtual colonoscopy" that delivers two- and three-dimensional imaging of the digestive tract — provides as accurate a view as optical colonscopy or flexible sigmoidoscopy with less of a risk for complications.
In a cost-benefit analysis study comparing CT colonography against flexible sigmoidoscopy and optical colonoscopy, as measured by the cost per life-year gained, the "virtual" method came out on top. Examining the cases of 100,000 patients over 50 years old, researchers found that CT with a 6mm threshold for optical colonoscopy follow-up cost $4,361 per life-year gained. Without the polyp-size threshold, the cost was $7,138. In contrast, flexible sigmoidoscopy cost $7,407 and optical colonoscopy $9,180.
In cases where CT colonographies led to the removal of lesions 5mm and smaller, the costs totaled $118,440 per life-year gained while reducing the incidence of cancer only 1.3 percent, from 37.8 percent to 36.5 percent.
|
|
|
^ Back to Top |
|
|
|
|
| In Pa., Missteps Down, Recovery Up
|
|
When performing colorectal cancer screenings, a "virtual colonoscopy" followed by the removal of larger lesions provides the most effective treatment with the fewest complications at the best value, according to a study by researchers at the University of Wisconsin at Madison and the Nuovo Regina Margherita Hospital in Rome, Italy.
The study, appearing online in advance of its publication in the June 1 issue of Cancer, the journal of the American Cancer Society, suggests that the surgical removal of lesions smaller than 6mm has little effect in reducing the incidence of colorectal cancer, since such "diminutive polyps" have a low malignancy rate.
In addition, their removal adds significant financial expense — and the potential for abdominal pain, bowel perforation, bleeding and other complications of conventional colonoscopy — to a patient's care for this questionably effective result, the study says.
However, researchers say that computed tomography colonography — a "virtual colonoscopy" that delivers two- and three-dimensional imaging of the digestive tract — provides as accurate a view as optical colonscopy or flexible sigmoidoscopy with less of a risk for complications.
In a cost-benefit analysis study comparing CT colonography against flexible sigmoidoscopy and optical colonoscopy, as measured by the cost per life-year gained, the "virtual" method came out on top. Examining the cases of 100,000 patients over 50 years old, researchers found that CT with a 6mm threshold for optical colonoscopy follow-up cost $4,361 per life-year gained. Without the polyp-size threshold, the cost was $7,138. In contrast, flexible sigmoidoscopy cost $7,407 and optical colonoscopy $9,180.
In cases where CT colonographies led to the removal of lesions 5mm and smaller, the costs totaled $118,440 per life-year gained while reducing the incidence of cancer only 1.3 percent, from 37.8 percent to 36.5 percent.
|
|
|
^ Back to Top |
|
|
|
|
| News and Notes
|
|
When performing colorectal cancer screenings, a "virtual colonoscopy" followed by the removal of larger lesions provides the most effective treatment with the fewest complications at the best value, according to a study by researchers at the University of Wisconsin at Madison and the Nuovo Regina Margherita Hospital in Rome, Italy.
The study, appearing online in advance of its publication in the June 1 issue of Cancer, the journal of the American Cancer Society, suggests that the surgical removal of lesions smaller than 6mm has little effect in reducing the incidence of colorectal cancer, since such "diminutive polyps" have a low malignancy rate.
In addition, their removal adds significant financial expense — and the potential for abdominal pain, bowel perforation, bleeding and other complications of conventional colonoscopy — to a patient's care for this questionably effective result, the study says.
However, researchers say that computed tomography colonography — a "virtual colonoscopy" that delivers two- and three-dimensional imaging of the digestive tract — provides as accurate a view as optical colonscopy or flexible sigmoidoscopy with less of a risk for complications.
In a cost-benefit analysis study comparing CT colonography against flexible sigmoidoscopy and optical colonoscopy, as measured by the cost per life-year gained, the "virtual" method came out on top. Examining the cases of 100,000 patients over 50 years old, researchers found that CT with a 6mm threshold for optical colonoscopy follow-up cost $4,361 per life-year gained. Without the polyp-size threshold, the cost was $7,138. In contrast, flexible sigmoidoscopy cost $7,407 and optical colonoscopy $9,180.
In cases where CT colonographies led to the removal of lesions 5mm and smaller, the costs totaled $118,440 per life-year gained while reducing the incidence of cancer only 1.3 percent, from 37.8 percent to 36.5 percent.
|
|
|
^ Back to Top |
|
|
|
|
|
|
