GENERAL SURGERY NEWS / AUGUST 2022
New Device May Improve Outcomes After Cardiac Arrest By MONICA J. SMITH
‘We haven’t changed the egardless of setting, cardiac arrest outcomes are dismal. A novel, easy-to-use device that increasbasic way we resuscitate es blood perfusion to the heart and brain when used cardiac arrest patients since in tandem with cardiopulmonary resuscitation (CPR) may prove to be the first breakthrough in a long time. 1960, and it isn’t because we “We haven’t changed the basic way we resuscitate have great outcomes. Cardiac cardiac arrest patients since 1960, and it isn’t because we have great outcomes. Cardiac arrest seemed like arrest seemed like an obvious an obvious and deserving condition for innovation. and deserving condition for We sought to use creative and user-friendly ways to improve outcomes,” said Kristen Quinn, MD, a generinnovation. We sought to use al surgery resident at the Medical University of South creative and user-friendly Carolina (MUSC), in Charleston, and the CEO and co-founder of Heartbeat Technologies, a new mediways to improve outcomes.’ cal device startup. —Kristen Quinn, MD When MUSC’s Human Centered Design Stu- The SAVER device directs blood to support vital organs during cardiopulmonary resuscitation. dio chairman Prabhakar Baliga, MD, encouraged Dr. Quinn and other participants to consider clinical pain points that could be better optimized, poor car- data in a pig model that shows SAVER increases carot“From there, it should be in every airport, office, stadiac arrest outcomes were identified as an area of focus. id arterial blood pressure. Their next step is to inves- dium and other public spaces, since more than 50% “One of our co-inventors, Dr. T. Konrad Rajab, a pedi- tigate use of SAVER in a pig model during cardiac of cardiac arrest cases occur in the community,” Dr. atric cardiothoracic surgeon, described being nagged by arrest. Brain and heart perfusion will be quantified with Quinn said. this thought throughout his whole training: Why can’t fluorescent microspheres to compare with or without Dr. Baliga, the chairman who encouraged residents to we do something to preferentially perfuse the heart and SAVER as the animal undergoes CPR with an auto- think about human-centered design initiatives, believes the brain during this critical time?” Dr. Quinn said. Heartbeat Technologies has tremendous potential to mated piston-driven device. Based on the idea that blood could be better directIf that investigation pans out, Dr. Quinn and her col- make a difference in patient outcomes, “which is the ed to support the vital organs, they developed the Safe- leagues will distribute SAVER to ICUs and emergency whole point of the Human Centered Design Program.” ty Adjunct for Vascular Extremity Occlusion During departments, where many cardiac arrests occur. SAVER will need further testing “to make sure that Resuscitation (SAVER) device. “Another thing that makes SAVER innovative is that it’s as effective as we think it is,” Dr. Baliga said, “but I The device consists of an unfolding strapping sys- it can be put on a patient without being activated. If think the premise and rationale behind it make intuitive tem designed to be used while chest compressions are we can identify patients at high risk for a cardiac arrest sense, and that it has tremendous potential to go forongoing, over clothing, by sliding under the patient’s and have SAVER already on them along with the arte- ward.” Dr. Baliga was not involved in the development low back and securing around their legs. rial monitoring devices, we can capture the effects of of SAVER and has no investment or financial stake in Once activated, SAVER deploys pneumatic bulbs SAVER on their pressure and survival,” Dr. Quinn said. Heartbeat Technologies. that apply focal pressure to the femoral vessels, redi“The beauty of this is that it’s coming from our resiFrom there, they plan to start collaborating with recting blood flow from the legs toward the heart and academic medical centers, “because they’re often open dents, from young minds. Some of us get kind of stuck in brain. Sensors in these bulbs give feedback on wheth- to adopting new technologies, furthering the field our ways, but when these fresh young minds examine a er the compressions are generating adequate pressure. of research and participating in clinical trials,” Dr. problem, it’s refreshing to see what happens,” he said. ■ “The idea is that it’s intuitive to use for all comers: Quinn said. inpatient hospital settings, but also out in the commuUltimately, Dr. Quinn and her team want to partner nity, by laypersons and people who have never given with emergency medical services and medical centers Column Editor: CPR before,” Dr. Quinn said. to acquire enough strong data to pitch SAVER to the Michael A. Goldfarb, MD, clinical professor At this point, Dr. Quinn and her colleagues have American Heart Association as standard-of-care thera- of surgery, Rutgers University Medical School, in New Brunswick, N.J. made a minimal viable prototype and conducted pilot py for cardiac arrest.
Single-Port Robotic Colorectal Surgery ‘Safe, Feasible,’ With Good Outcomes Single-Surgeon Study of 133 Patients By KATE O’ROURKE
phase 2 clinical trial of single-port robotic colorectal surgery shows it to be feasible and safe with good clinical outcomes, according to new research. The findings were presented at the 2022 annual meeting of the American Society of Colon and Rectal Surgeons (abstract S29). John Marks, MD, of the Division of Colorectal Surgery at Lankenau Medical Center, in Wynnewood, Pa., described the short- and long-term outcomes of the first phase 2 trial using the singleport robot for colorectal surgery. From
October 2018 to August 2021, researchers selected consecutive patients who underwent single-port robotic surgery at Lankenau Medical Center. Study inclusion required patients to have had a need for colorectal resection. Patients who had emergency surgery, were pregnant, were younger than 18 years of age, had stage IV carcinoma or had an inability to provide consent were excluded from the study. All operations were performed by one surgeon at Lankenau Medical Center. The study cohort included 133 patients. The mean age was 59.7 years
and 57.9% of patients were women. The mean body mass index was 27.5 kg/m2. Sixty-five patients had adenocarcinoma, 27 had diverticulitis, 21 had adenoma polyps, seven had ulcerative colitis and the rest had other conditions. The procedure was performed via transanal excision in 57.1% of the cases and an abdominal approach in 42.9%. The single-port colorectal surgery case mix represented a full spectrum of operations. Single-port colorectal surgery was completed without laparoscopic ports in 96.9% of the cases. There were no conversions to open surgery and four (3%)
to laparoscopy. There were no intraoperative complications and no transfusions were necessary. Median docking time was 6.1 minutes, median console time was 215 minutes and median operative time was 307.0 minutes. The mean abdominal incision was 5.5 cm. Ninety-seven percent were completed with one incision. Overall morbidity was 13.5% and included urinary retention (n=2), anastomotic leak (n=1) and pelvic abscess (n=2). In terms of oncologic outcomes, there were no local recurrences and negative margins were 100%. There continued on page 12