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Sökning: WFRF:(Arnbjörnsson Einar)

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1.
  • Anderberg, Magnus, et al. (författare)
  • Morgagni Hernia Repair in a Small Child Using da Vinci Robotic Instruments - A Case Report.
  • 2009
  • Ingår i: European Journal of Pediatric Surgery. - : Georg Thieme Verlag KG. - 1439-359X .- 0939-7248. ; 19, s. 110-112
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: The recently introduced use of robotic surgery in minimally invasive surgery procedures facilitates several steps in the operative procedure. We report the first case of a robot-assisted laparoscopic repair of a Morgagni hernia using the da Vinci(R) Surgical System from Intuitive Surgical(R) (Sunnyvale, CA, USA) in a 7.8 kg 18-month-old child. METHODS: Four trocars were used to gain access to the abdomen. The robot-enhanced instruments were used to close the hernia defect with interrupted, absorbable sutures, using intracorporeal knot tying. RESULTS: The operation was completed laparoscopically without a patch. The total setup time for the robotic system was 35 minutes including draping. The operating time at the robotic console was 80 minutes. The child tolerated an oral intake the day after surgery and was discharged home on the third postoperative day. CONCLUSION: Robot-assisted laparoscopic Morgagni hernia repair is feasible in small children.
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2.
  • Anderberg, Magnus, et al. (författare)
  • Paediatric computer-assisted retroperitoneoscopic nephrectomy compared with open surgery.
  • 2011
  • Ingår i: Pediatric Surgery International. - : Springer Science and Business Media LLC. - 1437-9813 .- 0179-0358. ; 27:7, s. 761-767
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE: Computer-assisted laparoscopic surgery (CALS) in children is increasingly used and has proven to be feasible and safe. However, its full potential remains unclear and clinical comparative studies hardly exist. The aim of this study was to prospectively evaluate our experience with CALS for performing retroperitoneal nephrectomies in children when compared with controls undergoing open surgery in terms of safety, operative time, blood loss, opoid requirements, the duration of hospital stay and complications. CHILDREN AND METHODS: Computer-assisted retroperitoneoscopic nephrectomy was undertaken in ten consecutive children, mean age at the time of surgery 6.4 (SD ± 4.5) years, and compared with a retrospectively collected control group of all other children, mean age 3.9 (SD ± 4.6) years, who underwent the same procedure by conventional open surgery between the years 2005 and 2009. The endpoint of the study was 1 month postoperatively. RESULTS: Nephrectomies were performed in all the children and no child was excluded from the study. There was no per-operative complication in any of the groups. The median (range) operative time was 202 (128-325) and 72 (44-160) min for the CALS and open group, respectively. The blood loss was minimal (<20 ml) for all the patients. The postoperative opoid requirements did not differ. The median (range) postoperative hospital stay was 1 (1-4) and 2 (1-7) days for the CALS and the open group, respectively. One complication in the form of an urinoma appeared 5 days after surgery in the CALS group. CONCLUSION: Computer-assisted retroperitoneoscopic nephrectomy is a safe, feasible and effective procedure in children. Even though operative times are longer the patients benefit from the lower morbidity, improved cosmetics and shorter hospitalization associated with the minimally invasive approach.
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3.
  • Anderberg, Magnus, et al. (författare)
  • Paediatric robotic surgery in clinical practice: a cost analysis.
  • 2009
  • Ingår i: European Journal of Pediatric Surgery. - : Georg Thieme Verlag KG. - 1439-359X .- 0939-7248. ; 19:5, s. 311-315
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Since 2006 we have used robotic assistance when performing minimally invasive laparoscopic fundoplications in children. We compared the costs of robotic surgery with the costs for open and laparoscopic surgery to test our hypothesis that the increased costs of the new technology are acceptable. METHOD: Costs were calculated using the regional hospital prices for our first 14 fundoplications in children, performed with the aid of the da Vinci Surgical System from Intuitive Surgical. We compared these costs with those of our ten latest fundoplications performed using open and laparoscopic surgery, respectively. There were no differences in the demographic data, work-up or indications for surgery between the three groups of children. RESULTS: The mean cost of robotic surgical fundoplications (EUR 9 584) was 7% higher than the mean cost of laparoscopic surgery (EUR 8 982) and 9% lower than the mean costs for open surgical procedures (EUR 10 521). These differences can be explained by the increased cost of robotic instruments (EUR 2 081 per operation). The duration of the operation and the duration of in-hospital stay are comparable to those of laparoscopic surgical interventions. The time required for the operative intervention was considerably longer than for the open surgical procedure; the duration of the in-hospital stay was only half of that of the open surgical procedure. The patients seemed to benefit from the use of robotic instruments with less morphine (as a marker of less postoperative pain) and a shorter hospital stay. CONCLUSION: The introduction of robotic assistance into surgical practice involves increased in-hospital costs, mainly because of the cost of the new instruments. This increase in cost can be offset by the shorter hospital stay compared to open surgery. After laparoscopic surgery the hospital stay is about the same as after operations performed with robotic assistance. Cheaper instruments and shorter operating time will make robotic surgery cost efficient in the future. The benefit for the patients is less trauma due to the use of minimally invasive surgery and a shorter hospital stay. Thus, the higher initial costs may be considered worthwhile.
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6.
  • Anderberg, Magnus, et al. (författare)
  • Robotic fundoplication in children
  • 2007
  • Ingår i: Pediatric Surgery International. - : Springer Science and Business Media LLC. - 1437-9813 .- 0179-0358. ; 23:2, s. 123-127
  • Tidskriftsartikel (refereegranskat)abstract
    • Since January 2006, robotic assistance has been used for performing minimal invasive laparoscopic fundoplications in children. These patients were compared with those operated on with either the open surgical technique or the laparoscopic procedure. The first six children operated on with a fundoplication using the operation robot, da Vinci (R) Surgical System from Intuitive Surgical (R), were included prospectively. As controls, data from the latest six children operated on using the open surgical procedure and the latest six children operated on using the minimal invasive laparoscopic technique were selected retrospectively. All the patients were operated on due to gastroesophageal reflux and were comparable in the De Meester score. The main outcome measures were the operating time, the use of postoperative analgesics, the duration of the postoperative hospital stay and the short-term outcome. There was no significant difference between the three groups concerning age, body weight and preoperative 24 h pH measurement. The mean operating time for the robotic group, 213 min, was the longer one, but the operating time for the latest four patients in the robotic group was similar to that for the laparoscopic group, 189 min. The postoperative hospital stay was shorter and a reduction in the use of analgesics postoperatively was noted. The reduction in the postoperative hospital stay and in the use of analgesics had been already noted with the introduction of the minimal invasive laparoscopic technique. There was no difference in short-term clinical outcome; the gastroesophageal reflux symptoms disappeared in all the patients. Robot-assisted laparoscopic fundoplication is comparable with the standard laparoscopic surgical procedure in terms of duration of operation, postoperative hospital stay, use of postoperative analgesics and short-term clinical outcome. The robotic surgery adds qualities to the surgical work when compared with open or laparoscopic surgery. These include better visualisation for the surgeon and greater precision in the movements of the instruments used.
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7.
  • Anderberg, Magnus, et al. (författare)
  • Robotics versus laparoscopy - an experimental study of the transfer effect in maiden users.
  • 2010
  • Ingår i: Annals of Surgical Innovation and Research. - : Springer Science and Business Media LLC. - 1750-1164. ; 4, s. 3-3
  • Tidskriftsartikel (refereegranskat)abstract
    • ABSTRACT: BACKGROUND: Robot-assisted laparoscopy (RL) is used in a wide range of operative interventions, but the advantage of this technique over conventional laparoscopy (CL) remains unclear. Studies comparing RL and CL are scarce. The present study was performed to test the hypothesis that maiden users master surgical tasks quicker with the robot-assisted laparoscopy technique than with the conventional laparoscopy technique. METHODS: 20 subjects, with no prior surgical experience, performed three different surgical tasks in a standardized experimental setting, repeated four times with each of the RL and CL techniques. Speed and accuracy were measured. A cross-over technique was used to eliminate gender bias and the experience gained by carrying out the first part of the study. RESULTS: The task "tie a knot" was performed faster with the RL technique than with CL. Furthermore, shorter operating times were observed when changing from CL to RL. There were no time differences for the tasks of grabbing the needle and continuous suturing between the two operating techniques. Gender did not influence the results. CONCLUSION: The more advanced task of tying a knot was performed faster using the RL technique than with CL. Simpler surgical interventions were performed equally fast with either technique. Technical skills acquired during the use of CL were transferred to the RL technique. The lack of tactile feedback in RL seemed to matter. There were no differences between males and females.
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9.
  • Arnbjörnsson, Einar (författare)
  • A neuromuscular basis for the development of right inguinal hernia after appendectomy
  • 1982
  • Ingår i: The American Journal of Surgery. - : Elsevier BV. - 0002-9610. ; 143:3, s. 367-369
  • Tidskriftsartikel (refereegranskat)abstract
    • Abdominal muscular contractions may have a protective influence against the development of indirect inguinal hernia. A portion of the transversus abdominus muscles acts on the internal inguinal rings and produces a closure mechanism during voluntary abdominal muscular activity. It follows, therefore, that injury or inactivation of this mechanism may be an etiologic factor in the development of indirect inguinal hernia. One cause of injury to this mechanism is denervation and regional muscle paralysis occurring during a surgical procedure. Electromyographic findings support the hypothesis that paralysis of inferior fibers of the transversus abdominus muscle occurred after appendectomy, and may have been important in the development of an inguinal hernia.
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10.
  • Arnbjörnsson, Einar (författare)
  • Acute Appendicitis and Dietary Fiber
  • 1983
  • Ingår i: Archives of Surgery. - : American Medical Association (AMA). - 0004-0010. ; 118:7, s. 868-870
  • Tidskriftsartikel (refereegranskat)abstract
    • The role of dietary fiber in the cause of acute appendicitis was evaluated. By means of food diaries the average daily fiber consumption was determined in 31 patients with acute appendicitis and in 30 control patients, matched for age and sex. The average daily dietary fiber intake was 17.4 g in the group with appendicitis and 21.0 g in the control group. The difference is statistically significant. Adjustment for the total energy intake in each instance did not change this conclusion. The results support the hypothesis that diet, in particular a lack of fiber, may be an important factor in the pathogenesis of acute appendicitis.
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