Laparoscopic Placement of Gastric Electro Stimulator

Slides:

Advertisements

Similar presentations

Today’s Agenda Discuss the prevention and management of cardiovascular complications of diabetes Mention the other complications along with prevention.

Advertisements

You Can Get Your Weight Under Control SMR124 Rev. 2 10/26/10.

Swallowing Difficulties

Understanding Gastroparesis Enterra ® Therapy. 2 Anatomical Overview.

University of Tennessee College of Veterinary Medicine Department of Large Animal Clinical Sciences Esophageal Choke Horse Owners Seminar March 17, 2007.

THE DIGESTIVE SYSTEM. Parotid gland Sublingual gland Submandibular gland Esophagus Stomach Liver Gallbladder Large intestine Small intestine Appendix.

Enterra ® Therapy N’vision ® Programmer. 2 | MDT Confidential N’Vision: Therapy Management easy to use and transport programming efficiency reduces the.

Enterra® Therapy Partnering for Gastric Health

Nutrition Therapy Nutrition Therapy for Cancer Patients Fatima Chaudhry.

-George Kresovich -Justin Goodridge

Peptic ulcer disease.

Peptic Ulcer Disease Biol E /11/06. From: Current Diagnosis & Treatment in Gastroenterology - 2nd Ed. (2003)

Compartment Syndrome N540B Spring 2007 Mary Gaspar.

Communicable and Chronic Disease - Day 3

BIOLOGY OF THE HUMAN DENTITION

“FIRST DO NO HARM”. Brain Anatomy  Brain disorder  Repeated spontaneous seizures (fits, convulsions)  Abnormal electrical signals in the brain.

GaNGRENE By Shawn Lahodny.

Compartment Syndrome Kyle Miller. Compartment Syndrome Definition Definition Compartment Syndrome involves the compression of nerves and blood vessels.

To know the importance of regulating our bodies. Success criteria- State what is meant by homeostasis. Identify what causes blood sugar levels to change.

Stomach Ulcer(Peptic Ulcer) Stomach ulcer or peptic ulcer is the damage of the protective layer (lining) of stomach or gastrointestinal tract It may be.

Digestive System Diseases/Complications

 Circulatory System (heart, blood, vessels)  Respiratory System (nose, trachea, lungs) Skeletal System (bones)  Excretory System (lungs, large intestine,

MANAGING FATIGUE during treatment Since fatigue is the most common symptom in people receiving chemotherapy, patients should learn ways to manage the fatigue.

Spinal Cord Stimulators in Neuropathic Pain. Introduction Chronic pain is very common Immense physical, psychological, societal impact Financial burden.

Overview of Neurostimulation

Fall  There are two types of diabetes ◦ Type 1 and 2  Blood sugar is involved  Insulin is involved  You might need to take your blood sugar.

The Tissue Level of Organization Lecture Outline

The Digestive System… -An organ system made up of the digestive tract and accessory organs. - Is responsible for taking in, and digesting food. - Is also.

Advances in Gastroparesis Dmitry Oleynikov M.D, F.A.C.S Associate Professor of Surgery Joseph and Richard Still Faculty Fellow in Medicine Director of.

NERVOUS SYSTEM.

Skeletal System Disorders. Osteomyelitis Infection of the bone Causes include: invading bacteria, pneumonia, typhoid, inflammation of teeth, and injury.

By: Anson Wong and Jaryd Knight. What is it? Is a chronic disease caused when the pancreas is unable to produce insulin or to use the insulin produced.

Digestive Disorders. Crohn’s Disease Chronic inflammatory bowel disease. Most common in small/large intestine. Causes: –Possible hereditary link to autoimmune.

Type 1 Type 1 diabetes is what we most commonly see when children get diabetes. “According to the American Diabetes Association, type 1 diabetes is one.

Digestive Disorders Lesson 2. Constipation Infrequent bowel movements Stools are dry, small and difficult to eliminate Can be caused by –inadequate water.

LOU GEHRIG’S DISEASE.  Also known as Amyotrophic Lateral Sclerosis  Is a disease of the nerve cells in the brain and spinal cord that control voluntary.

ELECTRODES FOR STIMULATION. Cardiac Pacemakers and Defibrillators  The heart is a natural example of a critical Bioelectromagnetic system.  An electrocardiogram.

Overview – March 7  Clinical Applications  Sjogren’s Syndrome  Acid Reflux Disease  GERD: Gastroesophageal Reflux Disease  Gall Bladder Disease 

Ethical Dilemma? Controversial Surgeries Overview  Gastric Bypass Surgery is a controversial surgery used to treat obesity.

Gastroparesis Edmond Tai, Kar Yi Lim, Vivian Lin, Chan Park.

Principles of Drug Action Medical Math Chapter 2 Buffy Ryan, RN.

Written Final Review. Describe wound location First picture only Lateral – toward the side (away from the midline) Anterior – toward the front Superior.

Unit 5, Lesson 29 National Health Standards1.5, 1.7, 3.4.

Burns Degree of Burns 1 st superficial partial-thickness burn 2 nd deep partial- thickness burn 3 rd full-thickness burn.

1 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc. Nursing Management: Nutritional Problems Chapter 40.

1. Ingestion 2.Secretion of fluids and digestive enzymes 3.Mixing and movement of food and wastes through the body 4.Digestion 5.Absorption 6.Excretion.

Electromyography Tatiana Steinwarz.

Noninfectious / Noncommunicable Diseases (Lifestyle Diseases) Cardiovascular Diseases, Cancer, Diabetes A disease that is not transmitted by another person.

Laparoscopic Appendectomy.

Diabetes. The background The body is able to adjust to the fluctuating internal and external environment with a process called HOMEOSTASIS (like a feedback.

Complications of Diabetes Sarine Trochakerian, M.S. MD Candidate 2015 Eastern Virginia Medical School.

Neuromodulation; A new Frontier for Neuroradiologists Bassem A. Georgy, M.D., North County Radiology Assistant Clinical Professor, University of California,

Electric Currents Part 2 By B. Nelson. Clinical Applications of Electric Current Muscle contraction of innervated muscles Muscle contraction of denervated.

INTERSTIM ® THERAPY for Urinary Control. What are Bladder Control Problems? Broad range of symptoms –May leak small or large amount of urine –May leak.

Diabetes University of Houston – Downtown By: Marlene Trevino Biology 1310 M/W Professor: David Lang.

Understanding Your Gastroesophageal Reflux Disease (GERD)

Difficult Case on T2Diabetes Management 2

Ulcers & Stomach Cancer

a revolutionary weight loss device

Implantable Cardiac Monitor (Heart Loop Recorder)

Deviated nasal septum.

Medical Devices Maria P. Gonzalez Puente

Connor Elliott and Clark Hammer Tuesday, March 27, 2018 SNC2D Period B

Savio C. Reddymasu, Irene Sarosiek, Richard W. McCallum

Cholelithiasis Pathophysiology Pigment stones Cholesterol stones

Divisions of the Nervous System

Supported in part by Arkansas Blue Cross and Blue Shield

The Hierarchy… Alveolar cells Alveolar tissue Lung (organ)

Gastric electrical stimulation for medically refractory gastroparesis

Presentation transcript:

Laparoscopic Placement of Gastric Electro Stimulator Performed by Jody Johnson, M.D. Presentation by Jonathan Powell, M1

Patient Hx Female Type 1 diabetes has lead to peripheral neuropathy Resulted in gastroparesis Peripheral neuropathy: In this case the patient has diabetic peripheral neuropathy in which the high blood sugar levels damaged her peripheral nerves Can cause pain (or sometimes lack of sensation) and loss of motor control

Gastroparesis A stomach disorder in which a full thickness loss of cells of Cajal (neuroconducting cells of the stomach) leads to a decrease in gastric emptying Stomach muscles function poorly Food digested slowly, results in a lot of pain Common causes: Idiopathic in most cases Type 1 or 2 diabetes

Treatment of Gastroparesis Proper nutrition/diet changes: restrict fats, frequent but small meals, lots of fluids Drugs: Prokinetic: improve rate of stomach emptying ex. Methylnaltrexone Antiemetic: control nausea and vomiting, no effect of stomach emptying ex. Prochlorperazine Surgery: the last resort Pyroplasty: widening of pyloric valve Gastric ESTIM

Gastric ESTIM: General Principles Enterra neurostimulator implanted beneath the skin Anode and cathode implanted in wall of stomach along the Greater Curvature Handheld programming device is used to alter the degree and frequency of stimulation (catered to each patient) Effectiveness has not been demonstrated

Preparation Patient Position Equipment Used Scissors Marilyn dissector O-suture 3-O silk R01 Suture Debakey Enterra neurostimulator Two trochars (size 5) One trochar (size 10) Laparoscope Hand held programming device to set frequency and degree of current discharge by the device Patient Position Equipment Used

Patient Position

Procedure Initial incisions: one midline incision between abdominal quadrants one and two for placement of scope Two lateral incisions for size 5 trochars (5s are free) One in each abdominal quadrant

Procedure ID the pylorus Deflate stomach Mark point 10cm along Greater Curve of Stomach starting from pylorus Insert leads into stomach wall Caudal lead at 9.5cm from pylorus Rostral lead at 10.5 cm from pylorus

Procedure Make pocket at Left mid- quadrant for subcutaneous placement of battery Externalize leads Close up Interrogation: device that, when placed above ESTIM site, can be used to measure battery life and set the current released during each discharge of the device

Post Op Care/Complications Patient can be sent home that day Possible complications: Pain, lack of healing, or infection where device was implanted Parts of device could wear through skin Allergic rxn to device Leads may perforate your stomach or device components may become entangled with or obstruct other internal organs Tissue damage from improper stimulation setting or malfunction

ESTIM today Gastric ESTIM is no longer being performed because the effectiveness of this procedure could not be demonstrated Currently, ESTIM procedures are used for maladies such as: Xerostomia- dry mouth due to lack of saliva Intraoral electrostimulation device increases salivary output of Parotid Gland Function electrical stimulation- use electrical stimulation to activate peripheral nerves affected by paralysis from spinal cord injury, head injury, stroke, etc Sometimes referred to as neuromuscular electrical stimulation

References Buckles, MD, Daniel, Jameson Forster, MD, and Richard McCallum, MD. "The Treatment of Gastroparesis in the Age of the Gastric Pacemaker: A Review." Medscape 5.4 (2003): 6. Web. 15 Apr 2011. <http://www.medscape.com/viewarticle/460632>. "About Gastroparesis." Medtronic. Medtronic Inc., 22 09 2010. Web. 15 Apr 2011. <http://www.medtronic.com/your-health/gastroparesis/index.htm>. McCallum, MD, Richard, William Snape, MD, Fredrick Brody, MD, and John Wo, MD. "Gastric Electrical Stimulation With Enterra Therapy Improves Symptoms From Diabetic Gastroparesis in a Prospective Study." Clinical Gastroenterology andHepatology 8.11 (2010): 947-954.e1. Web. 15 Apr 2011. <http://www.cghjournal.org/article/s1542-3565(10)00545- 8/abstract>. Douglas, David. "Electrostimulation Relieves Xerostomia." Medscape News (2010): n. pag. Web. 15 Apr 2011.< http://www.medscape.com/viewarticle/731503>. Abell, MD, Thomas. "Gastric Electrical Stimulation for Medically Refractory Gastroparesis." University of California San Francisco. University of California San Francisco College of Medicine, 2003. Web. 15 Apr 2011. <http://sadieo.ucsf.edu/course/old/Abell1.pdf>.