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Hepatic grooves:An observational study at laparoscopic surgery

World Journal of Experimental Medicine 2024年第2期14卷 97-102页

作者： Shamir O Cawich dexter a thomas Fawwaz Mohammed Michael T Gardner Marlene Craigie Shaneeta Johnson Ramnanand S Kedambady Department of Surgery University of the West IndiesSt Augustine 000000Trinidad and Tobago Department of Surgery Port of Spain General HospitalPort of Spain 000000Trinidad and Tobago Section of Anatomy Basic Medical SciencesUniversity of the West IndiesKingston 000000Jamaica Department of Radiology University of the West IndiesKingston 000000Jamaica Department of Surgery Morehouse School of MedicineAtlantaGA 30310United States Section of Anatomy Department of Basic Medical SciencesUniversity of the West IndiesKingston KIN7Jamaica

BACKGROUND In traditional descriptions,the upper surface of the liver is smooth and convex,but deep depressions are variants that are present in 5%-40%of *** sought to determine the relationship between surface depressions and the *** To use exploratory laparoscopy to determine the relationship between surface depressions and the *** An observational study was performed in all patients undergoing laparoscopic upper gastro-intestinal operations between January 1,2023 and January 20,2024.A thirty-degree laparoscope was used to inspect the liver and *** surface depressions were present,we recorded patient demographics,presence of diaphragmatic bands,rib protrusions and/or any other source of compression during *** Of 394 patients,343 had normal surface anatomy,and 51(12.9%)had prominent surface depressions on the *** was no significant relationship between the presence of surface depressions and gender nor the presence of rib ***,there was significant association between the presence of surface depressions and diaphragmatic muscular bands(P<0.001).CONCLUSION With these data,the diaphragmatic-band theory has gained increased importance over other theories for surface *** studies are warranted using cross sectional imaging to confirm relationships with intersectional planes as well as beta-catenin assays in the affected liver parenchyma.

关键词： Liver Variant Vein Hepatic Surgery

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Whipple’s pancreaticoduodenectomy at a resource-poor,low-volume center in Trinidad and Tobago

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World Journal of Clinical Oncology 2022年第9期13卷 738-747页

作者： Shamir O Cawich dexter a thomas Neil W Pearce Vijay Naraynsingh Department of Surgery Port of Spain General HospitalPort of Spain 000000Trinidad and Tobago Department of Surgery Southampton General Hospital National Health Services TrustSouthampton SO166YDUnited Kingdom

BACKGROUND Many authorities advocate for Whipple’s procedures to be performed in highvolume centers,but many patients in poor developing nations cannot access these *** sought to determine whether clinical outcomes were acceptable when Whipple’s procedures were performed in a low-volume,resource-poor setting in the West *** To study outcomes of Whipple’s procedures in a pancreatic unit in the West Indies over an eight-year period from June 1,2013 to June 30,*** This was a retrospective study of all patients undergoing Whipple’s procedures in a pancreatic unit in the West Indies over an eight-year period from June 1,2013 to June 30,*** This center performed an average of 11.25 procedures per *** were 72 patients in the final study population at a mean age of 60.2 years,with 52.7%having American Society of Anesthesiologists scores≥III and 54.1%with Eastern Cooperative Oncology Group scores≥*** Whipple’s procedures were performed in 70 patients and laparoscopic assisted procedures in *** vein resection/reconstruction was performed in 19(26.4%)*** patients undergoing open procedures there was 367±54.1 min mean operating time,1394±656.8 mL mean blood loss,5.24±7.22 d mean intensive care unit stay and 15.1±9.53 d ***(8.3%)patients experienced minor morbidity,10(14%)major morbidity and there were 4(5.5%)*** This paper adds to the growing body of evidence that volume alone should not be used as a marker of quality for patients requiring Whipple’s *** volume centers in resource poor nations can achieve good short-term *** is largely due to the process of continuous,adaptive learning by the entire hospital.

关键词： Pancreas Surgery Pancreatectomy Whipple’s Pancreaticoduodenectomy

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Clinical outcomes after major hepatectomy are acceptable in low-volume centers in the Caribbean

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World Journal of Hepatology 2019年第2期11卷 199-207页

作者： Shamir O Cawich Ravi Maharaj Vijay Naraynsingh Neil Pearce Wesley Francis Kimon O Bonadie dexter a thomas Department of Clinical Surgical Sciences University of the West Indies Department of Surgery University Hospital Southampton NHS Trust Department Surgery University of the West Indies Department Surgery Cayman Islands Health Service Authority

BACKGROUND Major hepatectomies are routinely performed because they are often the only curative treatment for metastatic liver *** has been a trend to concentrate major hepatectomies in referral hospitals that perform these operations at high *** high volume referral centers are usually located in developed countries,but many patients in developing nations are not able to access these centers because of financial limitations,lack of social support and/or travel ***,local hospitals are often the only options many of these patients have for surgical treatment of metastatic liver *** is the situation in many Caribbean *** To determine the clinical outcomes after major liver resections in a low-resource hepatobiliary center in the *** We prospectively studied all patients who underwent major liver resections over five *** following data were extracted:patient demographics,diagnoses,ECOG status,operation performed,post-operative morbidity and *** analyses were performed using SPSS ver 16.0 RESULTSThere were 69 major liver resections performed by two teams at a mean case volume of 13.8 major resections/***-nine major hepatic resections were performed for:colorectal liver metastases 40(58%),non-colorectal metastases 9(13%),hepatocellular carcinoma 8(11.6%),ruptured adenomas 4(5.8%),hilar cholangiocarcinomas 4(5.8%),hemangiomata 2(2.9%),trauma 1(1.5%) and hepatoblastoma 1(1.5%).Twenty-one patients had at least one complication,for an overall morbidity rate of 30.4%.There were minor complications in 17(24.6%)patients,major complications in 11(15.9%) patients and 4(5.8%) *** There are unique geographic,political and financial limitations to healthcare delivery in the ***,clinical outcomes are acceptable in the established,low-volume hepatobiliary centers in the Eastern Caribbean.

关键词： Liver Surgery Resection Caribbean Volume Outcomes

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Review of minimally invasive pancreas surgery and opinion on its incorporation into low volume and resource poor centres

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World Journal of Gastrointestinal Surgery 2021年第10期13卷 1122-1135页

作者： Shamir O Cawich Michael D Kluger Wesley Francis Rahul R Deshpande Fawwaz Mohammed Kimon O Bonadie dexter a thomas Neil W Pearce Beth A Schrope Clinical Surgical Sciences University of the West IndiesTunapuna 331333Trinidad and Tobago Department of Surgery New York Presbyterian Hospital/Columbia University Medical CenterNew YorkNY 10032United States Department of Surgery University of the West IndiesNassau N-1184Bahamas Department of Surgery Manchester Royal InfirmaryManchester M139WLUnited Kingdom Department of Clinical Surgical Sciences University of the West IndiesTunapuna 331333Trinidad and Tobago Department of Surgery Health Service AuthorityGeorgetown 915 GTCayman Islands Department of Surgery Southampton General HospitalSouthampton SO166YDUnited Kingdom Department of Surgery Columbia University College of Physicians and SurgeonsNew YorkNY 10032United States

Pancreatic surgery has been one of the last areas for the application of minimally invasive surgery(MIS)because there are many factors that make laparoscopic pancreas resections *** concept of service centralization has also limited expertise to a small cadre of high-volume centres in resource rich ***,this is not the environment that many surgeons in developing countries work *** patients often do not have the opportunity to travel to high volume centres for ***,we sought to review the existing data on MIS for the pancreas and to *** this paper,we review the evolution of MIS on the pancreas and discuss the incorporation of this service into low-volume and resource-poor countries,such as those in the *** paper has two ***,we performed a literature review evaluating all studies published on laparoscopic and robotic surgery of the *** data in the Caribbean is examined and we discuss tips for incorporating this operation into resource poor hospital *** pancreatic case volume in the Caribbean,and financial barriers to MIS in general,laparoscopic distal pancreatectomy,enucleation and cystogastrostomy are feasible operations to integrate in to a resource-limited healthcare *** is because they can be performed with minimal to no consumables and require an intermediate MIS skillset to complement an open pancreatic surgeon’s peri-operative experience.

关键词： Pancreas Surgery Laparoscopic Minimally invasive Pancreatectomy Whipple’s Pancreaticoduidenectomy

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Responses to disrupted operative care during the coronavirus pandemic at a Caribbean hospital

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World Journal of Meta-Analysis 2022年第3期10卷 74-80页

作者： Shamir O Cawich Gordon Narayansingh Michael J Ramdass Marlon Mencia dexter a thomas Shaheeba Barrow Vijay Naraynsingh Department of Surgery Port of Spain General HospitalPort of SpainTrinidad and Tobago Department of Clinical Surgical Sciences University of the West IndiesSt.JosephTrinidad and Tobago

The coronavirus pandemic was thrust upon all nations in the year 2020 and required swift public health ***-poor health care facilities,such as those in the Caribbean,were poorly prepared but had to respond to the *** this experience report we examined the response by the surgical specialty to evaluate the lessons learned and to identify positive changes that may continue post-pandemic.

关键词： Public health Surgery Pandemic Coronavirus

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