Research is a critical tool for determining the safety and efficacy of new surgical techniques and technologies. Additionally, research helps us understand the pathophysiology of disease and allows us to develop treatments that are more effective. Legacy is involved in a wide variety of research endeavors, ranging from basic science (molecular and cellular biology) to the development of new procedures and technologies.
The single most important tool, however has been an outcomes database project. By means of a carefully designed computer database, preoperative and postoperative patient data is collected and analyzed. (Patient confidentiality is strictly maintained.) The analysis of this data allows surgeons to scrutinize their techniques and optimize patient results. Procedures performed each year within Legacy Health are added to the database.
The following documents describe the methodology and results of recent clinical research studies.
- The Significance of Preoperative Testing for Anti-Reflux Surgery Planning: This study concludes that routine use of preoperative testing with endoscopy and motility studies being mandatory and 24-hour pH studies and UGI being advisable for patients referred for consideration of anti-reflux surgery.
- Does the Use of an Esophageal Stent During a Nissen Fundoplication Decrease Long-Term Dysphagia Rate?: This study concludes that it is possible to create a loose, short Nissen without the placement of an esophageal stent with no apparent increase in long-term rates of postoperative dysphagia. This approach avoids the possibility of a GI tract injury related to stent use.
- Evaluation and Follow-Up Algorithm for Laparoscopic Adrenalectomy: This study demonstrates that laparoscopic adrenalectomy can be done safely, even in large lesions, with minimal morbidity. This decrease in morbidity may make more patients with intermediate-sizes adrenal lesions operative candidates and result in the earlier treatment of some adrenal carcinomas.
- Cost and Benefit of the Trained Laparoscopic Team: A Comparative Study of a Designated Nursing Team vs. a Non-Trained Team and Advanced Laparoscopic Surgeon vs. Basic Laparoscopic Surgeon: This study demonstrates that having a designated laparoscopic trained team provides a time savings to both advanced and basic laparoscopic surgeons.
- Participant Perception of the Role and Benefits of Study Coordinators: Results of a Pilot Study: This study explores ways to increase participants' adherence and retention in long-term clinical trials by increasing understanding of the participants' motivations and perceptions of the benefits and barriers to successful completion of the trials.
Ongoing Research Projects
1. Short and Long Term Outcomes of Surgery for Gastroesophageal Reflux
- Database evaluations
- Bougie versus no bougie
- 5mm versus 10 mm port sites
- Dor versus Toupet with Heller myotomy
- Hill fundoplication versus Nissen fundoplication
- Nissen versus Toupet in patients with esophageal motility disorders
2. Liver Tumors - Ablation
- Radiofrequency ablation
- Hepatic artery pumps
- Laparoscopic liver resections
- Cancer staging with laparoscopy and ultrasound
- Tissue bank
3. Colorectal Surgery
- National Cancer Institute multi-institutional randomized trial of open versus laparoscopic colon resections
- Evaluations of transanal tumor resections
4. Vascular Surgery
- Endoscopic vein harvest
- Abdominal aortic reconstruction
- 3mm laparoscopic tubal project
- 3mm laparoscopic cholecystectomy project
6. Laprosocopic Hernia Repair
- Cost analysis project
- Outcomes project
Basic Science Research
- Achalasia and esophageal stimulation
2. Hepatobiliary and Pancreatic Surgery
- Laparoscopic versus open staging cases for advanced cancer
- Effect of carbon dioxide on tumor growth
- Effective liver resection versus tumor ablation on tumor growth
- Port site cancer implementation
- Development of endorectal staplers
4. Laparoscopic Vascular Surgery
- Development of bowel retraction devices
- Endoluminal aortic stent development
5. General Laparoscopy