Automated distal connecting devices have been recently introduced to facilitate coronary anastomo... more Automated distal connecting devices have been recently introduced to facilitate coronary anastomosis. This could have a large impact on the capacity of robotic systems to perform completely endoscopic off-pump bypass, where the quality of anastomosis and the prolonged operative time for the performance of the anastomosis have until now been cause for concern. Our group tried to determine the feasibility and efficacy of the JoMed distal graft connector using the ZEUS robotic system. Six swine, with a mean weight of 25.8 (standard deviation [SD] 2.2) kg, underwent endoscopic off-pump internal thoracic artery-left anterior descending (ITA-LAD) anastomosis with a special stabilizing system using ZEUS robotic assistance. The anastomosis was performed with the JoMed distal connector. The connector was employed successfully in 4 of 6 cases using a special delivery instrument. Two animals fibrillated within 2 minutes after the application of proximal occluding snares and were excluded from ...
Automated distal connecting devices have been recently introduced to facilitate coronary anastomo... more Automated distal connecting devices have been recently introduced to facilitate coronary anastomosis. This could have a large impact on the capacity of robotic systems to perform completely endoscopic off-pump bypass, where the quality of anastomosis and the prolonged operative time for the performance of the anastomosis have until now been cause for concern. Our group tried to determine the feasibility and efficacy of the JoMed distal graft connector using the ZEUS robotic system. Six swine, with a mean weight of 25.8 (standard deviation [SD] 2.2) kg, underwent endoscopic off-pump internal thoracic artery-left anterior descending (ITA-LAD) anastomosis with a special stabilizing system using ZEUS robotic assistance. The anastomosis was performed with the JoMed distal connector. The connector was employed successfully in 4 of 6 cases using a special delivery instrument. Two animals fibrillated within 2 minutes after the application of proximal occluding snares and were excluded from ...
Annals of Thoracic and Cardiovascular Surgery, 2004
Innominate artery injury after blunt trauma is uncommon. We present a case of innominate artery i... more Innominate artery injury after blunt trauma is uncommon. We present a case of innominate artery injury, successfully treated with aorto-innominate bypass.
Annals of Thoracic and Cardiovascular Surgery, 2004
Innominate artery injury after blunt trauma is uncommon. We present a case of innominate artery i... more Innominate artery injury after blunt trauma is uncommon. We present a case of innominate artery injury, successfully treated with aorto-innominate bypass.
OBJECTIVES The goal of this study was to determine if parasympathetic nerves in the anterior fat ... more OBJECTIVES The goal of this study was to determine if parasympathetic nerves in the anterior fat pad (FP) can be stimulated at the time of coronary artery bypass surgery (CABG), and if dissection of this FP decreases the incidence of postoperative atrial fibrillation (AF). BACKGROUND The human anterior epicardial FP contains parasympathetic ganglia and is often dissected during CABG. Changes in parasympathetic tone influence the incidence of AF. METHODS Fifty-five patients undergoing CABG were randomized to anterior FP preservation (group A) or dissection (group B). Nerve stimulation was applied to the FP before and after surgery. Sinus cycle length (CL) was measured during stimulation. The incidence of postoperative AF was recorded. RESULTS Of the 55 patients enrolled, 26 patients were randomized to group A, and 29 patients were randomized to group B. In all of the 55 patients, the FP was identified before initiating cardiopulmonary bypass by CL prolongation with stimulation (865.5...
OBJECTIVES The goal of this study was to determine if parasympathetic nerves in the anterior fat ... more OBJECTIVES The goal of this study was to determine if parasympathetic nerves in the anterior fat pad (FP) can be stimulated at the time of coronary artery bypass surgery (CABG), and if dissection of this FP decreases the incidence of postoperative atrial fibrillation (AF). BACKGROUND The human anterior epicardial FP contains parasympathetic ganglia and is often dissected during CABG. Changes in parasympathetic tone influence the incidence of AF. METHODS Fifty-five patients undergoing CABG were randomized to anterior FP preservation (group A) or dissection (group B). Nerve stimulation was applied to the FP before and after surgery. Sinus cycle length (CL) was measured during stimulation. The incidence of postoperative AF was recorded. RESULTS Of the 55 patients enrolled, 26 patients were randomized to group A, and 29 patients were randomized to group B. In all of the 55 patients, the FP was identified before initiating cardiopulmonary bypass by CL prolongation with stimulation (865.5...
Background. Outcomes may be improved by purposefully delaying surgical intervention of the trauma... more Background. Outcomes may be improved by purposefully delaying surgical intervention of the traumatically ruptured descending thoracic aorta. Methods. Fifty-seven patient records identified through the Trauma Registry of a level 1 trauma center between January 1993 and April 2002 were retrospectively analyzed between groups who underwent "clampand-sew" versus partial left heart bypass repair techniques and between emergent versus delayed repair. Results. Thirty-two (56%) of 57 patients were male. The mean age among survivors and nonsurvivors was 41 ؎ 18 (range 13 to 70) and 52 ؎ 23 (range 18 to 92; p ؍ 0.04) years, and Injury Severity Score was 31 ؎ 13 (range 17 to 75) and 40 ؎ 16 (range 16 to 75; p ؍ 0.04) points, respectively. Thirty-one (54%) underwent surgical intervention, 20 (35%) died during their initial resuscitation, and 6 (11%) were managed nonoperatively. Seventeen (55%) were repaired using partial left heart bypass and 14 (45%) using the clamp technique. Twenty-one (68%) had emergent repair and 10 (32%) had delayed repair. The rates of paraplegia, renal failure, and mortality were 12% (2 of 17), 0%, and 24% (4 of 17) in the bypass group, 0% (p ؍ 0.29), 0%, and 36% (5 of 14, p ؍ 0.36) in the clamp group, 9.5% (2 of 21), 0%, and 38% (8 of 21) in the emergent group (<24 hours after admission), and 0% (p ؍ 0.45), 0%, and 10% (1 of 10, p ؍ 0.12) in the delayed group (>24 hours after admission), respectively. Mean clamp times for the bypass and clamp groups were 44 ؎ 18 (21 to 90) and 30 ؎ 10 (14 to 52) minutes, respectively (p ؍ 0.02). Overall operative mortality was 29% (9 of 31). Conclusions. Purposefully delaying surgical intervention in selected cases of descending thoracic aortic rupture and using the clamp technique does not increase mortality or morbidity over immediate operation and use of partial left hear bypass.
During resuscitation of patients in hemorrhagic shock (e.g., trauma, surgical bleeding), the anes... more During resuscitation of patients in hemorrhagic shock (e.g., trauma, surgical bleeding), the anesthesiologist must infuse normothermic fluid and blood products in order to maintain thermal homeostasis and tissue oxygen delivery. Occasionally, it may be necessary to pressurize the intravenous (IV) fluid or blood product bag in order to increase flow to the patient. Several fluid warming systems use a pneumatic external compressor that auto-matically squeezes the IV fluid or blood bag. 1,2 While these systems have been used for many years to provide faster and easier fluid delivery, problems do arise such as accidental IV delivery of air to the patient, 3–6 and extravasation of fluid, causing a compart-ment syndrome. 7,8 The FMS2000 fluid warming system (Belmont Instrument Corp., Billerica, MA) is a new IV fluid and blood warmer that uses an integrated peristaltic pump to eliminate the requirement for compression and pressurization of the fluid bag (Fig. 1). The system automatically h...
Annals of thoracic and cardiovascular surgery: official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia
Innominate artery injury after blunt trauma is uncommon and mostly observed at its origin from th... more Innominate artery injury after blunt trauma is uncommon and mostly observed at its origin from the aorta. We report here an unusual case of distal innominate artery injury associated with acute right subclavian occlusion. MEDLINE search of blunt traumatic injury to the innominate artery revealed a total of 132 case reports by the end of 2003, including this case report, and all these published studies were reviewed.
Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia, 2004
Stenosis of the aorta observed after descending aorta replacement for traumatic aortic injury was... more Stenosis of the aorta observed after descending aorta replacement for traumatic aortic injury was managed by a placement of a bypass between the left subclavian artery and the distal descending aorta with success.
Canadian journal of surgery. Journal canadien de chirurgie, 2006
Automated distal connecting devices have been recently introduced to facilitate coronary anastomo... more Automated distal connecting devices have been recently introduced to facilitate coronary anastomosis. This could have a large impact on the capacity of robotic systems to perform completely endoscopic off-pump bypass, where the quality of anastomosis and the prolonged operative time for the performance of the anastomosis have until now been cause for concern. Our group tried to determine the feasibility and efficacy of the JoMed distal graft connector using the ZEUS robotic system. Six swine, with a mean weight of 25.8 (standard deviation [SD] 2.2) kg, underwent endoscopic off-pump internal thoracic artery-left anterior descending (ITA-LAD) anastomosis with a special stabilizing system using ZEUS robotic assistance. The anastomosis was performed with the JoMed distal connector. The connector was employed successfully in 4 of 6 cases using a special delivery instrument. Two animals fibrillated within 2 minutes after the application of proximal occluding snares and were excluded from ...
The surgical approach to transmyocardial laser revascularization (TMR) via thoracotomy has been a... more The surgical approach to transmyocardial laser revascularization (TMR) via thoracotomy has been approved for the treatment of angina in inoperable patients, but it has had limited use as a stand-alone procedure. To assess the feasibility and efficacy of robotically assisted endoscopic TMR using the Zeus robotic surgical system (Computer Motion, USA) and an excimer TMR system (Spectranetics, USA) in a porcine model. Five pigs weighing 20 kg to 40 kg were used. A 10 mm endoscope, two 5 mm instrument ports and a 1.4 mm TMR probe were introduced into the left hemithorax. Endoscopic TMR was performed on the anterolateral or lateral left ventricular wall using Zeus instruments to hold and guide the TMR probe. The mean system set-up time was 4.2+/-0.6 min, the mean port placement time was 11+/-1.7 min, the mean TMR procedure time was 5.0+/-0.7 min and the mean number of transmural TMR channels was 10+/-3.6. All pigs tolerated the entire procedure. Histological examination showed that trans...
Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia, 2004
Innominate artery injury after blunt trauma is uncommon. We present a case of innominate artery i... more Innominate artery injury after blunt trauma is uncommon. We present a case of innominate artery injury, successfully treated with aorto-innominate bypass.
The Journal of Trauma: Injury, Infection, and Critical Care, 2006
The standard management for patients with blunt aortic injury is surgery; however, a small number... more The standard management for patients with blunt aortic injury is surgery; however, a small number of patients have been medically managed. The outcome of these nonoperatively managed patients is unknown. Seven patients diagnosed as blunt aortic injury were managed without aortic surgery between January 1993 and April 2002, and their outcomes were retrospectively investigated. There were three men and four women, with a mean age of 48.7+/-22.7 years and Injury Severity Score of 37.7+/-16.9. The reason for nonoperative management was refusal of surgery (2), do-not-resuscitate order (1), diffuse brain injury (2), small intimal tear (1), and technical difficulty (1). Two patients died resulting from associated injuries. Five patients are alive, and in three patients complete resolution of aortic injury was observed. In selected patients with multiple associated injuries or severe comorbidity, nonoperative management after blunt aortic injury can be a treatment of choice.
Automated distal connecting devices have been recently introduced to facilitate coronary anastomo... more Automated distal connecting devices have been recently introduced to facilitate coronary anastomosis. This could have a large impact on the capacity of robotic systems to perform completely endoscopic off-pump bypass, where the quality of anastomosis and the prolonged operative time for the performance of the anastomosis have until now been cause for concern. Our group tried to determine the feasibility and efficacy of the JoMed distal graft connector using the ZEUS robotic system. Six swine, with a mean weight of 25.8 (standard deviation [SD] 2.2) kg, underwent endoscopic off-pump internal thoracic artery-left anterior descending (ITA-LAD) anastomosis with a special stabilizing system using ZEUS robotic assistance. The anastomosis was performed with the JoMed distal connector. The connector was employed successfully in 4 of 6 cases using a special delivery instrument. Two animals fibrillated within 2 minutes after the application of proximal occluding snares and were excluded from ...
Automated distal connecting devices have been recently introduced to facilitate coronary anastomo... more Automated distal connecting devices have been recently introduced to facilitate coronary anastomosis. This could have a large impact on the capacity of robotic systems to perform completely endoscopic off-pump bypass, where the quality of anastomosis and the prolonged operative time for the performance of the anastomosis have until now been cause for concern. Our group tried to determine the feasibility and efficacy of the JoMed distal graft connector using the ZEUS robotic system. Six swine, with a mean weight of 25.8 (standard deviation [SD] 2.2) kg, underwent endoscopic off-pump internal thoracic artery-left anterior descending (ITA-LAD) anastomosis with a special stabilizing system using ZEUS robotic assistance. The anastomosis was performed with the JoMed distal connector. The connector was employed successfully in 4 of 6 cases using a special delivery instrument. Two animals fibrillated within 2 minutes after the application of proximal occluding snares and were excluded from ...
Annals of Thoracic and Cardiovascular Surgery, 2004
Innominate artery injury after blunt trauma is uncommon. We present a case of innominate artery i... more Innominate artery injury after blunt trauma is uncommon. We present a case of innominate artery injury, successfully treated with aorto-innominate bypass.
Annals of Thoracic and Cardiovascular Surgery, 2004
Innominate artery injury after blunt trauma is uncommon. We present a case of innominate artery i... more Innominate artery injury after blunt trauma is uncommon. We present a case of innominate artery injury, successfully treated with aorto-innominate bypass.
OBJECTIVES The goal of this study was to determine if parasympathetic nerves in the anterior fat ... more OBJECTIVES The goal of this study was to determine if parasympathetic nerves in the anterior fat pad (FP) can be stimulated at the time of coronary artery bypass surgery (CABG), and if dissection of this FP decreases the incidence of postoperative atrial fibrillation (AF). BACKGROUND The human anterior epicardial FP contains parasympathetic ganglia and is often dissected during CABG. Changes in parasympathetic tone influence the incidence of AF. METHODS Fifty-five patients undergoing CABG were randomized to anterior FP preservation (group A) or dissection (group B). Nerve stimulation was applied to the FP before and after surgery. Sinus cycle length (CL) was measured during stimulation. The incidence of postoperative AF was recorded. RESULTS Of the 55 patients enrolled, 26 patients were randomized to group A, and 29 patients were randomized to group B. In all of the 55 patients, the FP was identified before initiating cardiopulmonary bypass by CL prolongation with stimulation (865.5...
OBJECTIVES The goal of this study was to determine if parasympathetic nerves in the anterior fat ... more OBJECTIVES The goal of this study was to determine if parasympathetic nerves in the anterior fat pad (FP) can be stimulated at the time of coronary artery bypass surgery (CABG), and if dissection of this FP decreases the incidence of postoperative atrial fibrillation (AF). BACKGROUND The human anterior epicardial FP contains parasympathetic ganglia and is often dissected during CABG. Changes in parasympathetic tone influence the incidence of AF. METHODS Fifty-five patients undergoing CABG were randomized to anterior FP preservation (group A) or dissection (group B). Nerve stimulation was applied to the FP before and after surgery. Sinus cycle length (CL) was measured during stimulation. The incidence of postoperative AF was recorded. RESULTS Of the 55 patients enrolled, 26 patients were randomized to group A, and 29 patients were randomized to group B. In all of the 55 patients, the FP was identified before initiating cardiopulmonary bypass by CL prolongation with stimulation (865.5...
Background. Outcomes may be improved by purposefully delaying surgical intervention of the trauma... more Background. Outcomes may be improved by purposefully delaying surgical intervention of the traumatically ruptured descending thoracic aorta. Methods. Fifty-seven patient records identified through the Trauma Registry of a level 1 trauma center between January 1993 and April 2002 were retrospectively analyzed between groups who underwent "clampand-sew" versus partial left heart bypass repair techniques and between emergent versus delayed repair. Results. Thirty-two (56%) of 57 patients were male. The mean age among survivors and nonsurvivors was 41 ؎ 18 (range 13 to 70) and 52 ؎ 23 (range 18 to 92; p ؍ 0.04) years, and Injury Severity Score was 31 ؎ 13 (range 17 to 75) and 40 ؎ 16 (range 16 to 75; p ؍ 0.04) points, respectively. Thirty-one (54%) underwent surgical intervention, 20 (35%) died during their initial resuscitation, and 6 (11%) were managed nonoperatively. Seventeen (55%) were repaired using partial left heart bypass and 14 (45%) using the clamp technique. Twenty-one (68%) had emergent repair and 10 (32%) had delayed repair. The rates of paraplegia, renal failure, and mortality were 12% (2 of 17), 0%, and 24% (4 of 17) in the bypass group, 0% (p ؍ 0.29), 0%, and 36% (5 of 14, p ؍ 0.36) in the clamp group, 9.5% (2 of 21), 0%, and 38% (8 of 21) in the emergent group (<24 hours after admission), and 0% (p ؍ 0.45), 0%, and 10% (1 of 10, p ؍ 0.12) in the delayed group (>24 hours after admission), respectively. Mean clamp times for the bypass and clamp groups were 44 ؎ 18 (21 to 90) and 30 ؎ 10 (14 to 52) minutes, respectively (p ؍ 0.02). Overall operative mortality was 29% (9 of 31). Conclusions. Purposefully delaying surgical intervention in selected cases of descending thoracic aortic rupture and using the clamp technique does not increase mortality or morbidity over immediate operation and use of partial left hear bypass.
During resuscitation of patients in hemorrhagic shock (e.g., trauma, surgical bleeding), the anes... more During resuscitation of patients in hemorrhagic shock (e.g., trauma, surgical bleeding), the anesthesiologist must infuse normothermic fluid and blood products in order to maintain thermal homeostasis and tissue oxygen delivery. Occasionally, it may be necessary to pressurize the intravenous (IV) fluid or blood product bag in order to increase flow to the patient. Several fluid warming systems use a pneumatic external compressor that auto-matically squeezes the IV fluid or blood bag. 1,2 While these systems have been used for many years to provide faster and easier fluid delivery, problems do arise such as accidental IV delivery of air to the patient, 3–6 and extravasation of fluid, causing a compart-ment syndrome. 7,8 The FMS2000 fluid warming system (Belmont Instrument Corp., Billerica, MA) is a new IV fluid and blood warmer that uses an integrated peristaltic pump to eliminate the requirement for compression and pressurization of the fluid bag (Fig. 1). The system automatically h...
Annals of thoracic and cardiovascular surgery: official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia
Innominate artery injury after blunt trauma is uncommon and mostly observed at its origin from th... more Innominate artery injury after blunt trauma is uncommon and mostly observed at its origin from the aorta. We report here an unusual case of distal innominate artery injury associated with acute right subclavian occlusion. MEDLINE search of blunt traumatic injury to the innominate artery revealed a total of 132 case reports by the end of 2003, including this case report, and all these published studies were reviewed.
Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia, 2004
Stenosis of the aorta observed after descending aorta replacement for traumatic aortic injury was... more Stenosis of the aorta observed after descending aorta replacement for traumatic aortic injury was managed by a placement of a bypass between the left subclavian artery and the distal descending aorta with success.
Canadian journal of surgery. Journal canadien de chirurgie, 2006
Automated distal connecting devices have been recently introduced to facilitate coronary anastomo... more Automated distal connecting devices have been recently introduced to facilitate coronary anastomosis. This could have a large impact on the capacity of robotic systems to perform completely endoscopic off-pump bypass, where the quality of anastomosis and the prolonged operative time for the performance of the anastomosis have until now been cause for concern. Our group tried to determine the feasibility and efficacy of the JoMed distal graft connector using the ZEUS robotic system. Six swine, with a mean weight of 25.8 (standard deviation [SD] 2.2) kg, underwent endoscopic off-pump internal thoracic artery-left anterior descending (ITA-LAD) anastomosis with a special stabilizing system using ZEUS robotic assistance. The anastomosis was performed with the JoMed distal connector. The connector was employed successfully in 4 of 6 cases using a special delivery instrument. Two animals fibrillated within 2 minutes after the application of proximal occluding snares and were excluded from ...
The surgical approach to transmyocardial laser revascularization (TMR) via thoracotomy has been a... more The surgical approach to transmyocardial laser revascularization (TMR) via thoracotomy has been approved for the treatment of angina in inoperable patients, but it has had limited use as a stand-alone procedure. To assess the feasibility and efficacy of robotically assisted endoscopic TMR using the Zeus robotic surgical system (Computer Motion, USA) and an excimer TMR system (Spectranetics, USA) in a porcine model. Five pigs weighing 20 kg to 40 kg were used. A 10 mm endoscope, two 5 mm instrument ports and a 1.4 mm TMR probe were introduced into the left hemithorax. Endoscopic TMR was performed on the anterolateral or lateral left ventricular wall using Zeus instruments to hold and guide the TMR probe. The mean system set-up time was 4.2+/-0.6 min, the mean port placement time was 11+/-1.7 min, the mean TMR procedure time was 5.0+/-0.7 min and the mean number of transmural TMR channels was 10+/-3.6. All pigs tolerated the entire procedure. Histological examination showed that trans...
Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia, 2004
Innominate artery injury after blunt trauma is uncommon. We present a case of innominate artery i... more Innominate artery injury after blunt trauma is uncommon. We present a case of innominate artery injury, successfully treated with aorto-innominate bypass.
The Journal of Trauma: Injury, Infection, and Critical Care, 2006
The standard management for patients with blunt aortic injury is surgery; however, a small number... more The standard management for patients with blunt aortic injury is surgery; however, a small number of patients have been medically managed. The outcome of these nonoperatively managed patients is unknown. Seven patients diagnosed as blunt aortic injury were managed without aortic surgery between January 1993 and April 2002, and their outcomes were retrospectively investigated. There were three men and four women, with a mean age of 48.7+/-22.7 years and Injury Severity Score of 37.7+/-16.9. The reason for nonoperative management was refusal of surgery (2), do-not-resuscitate order (1), diffuse brain injury (2), small intimal tear (1), and technical difficulty (1). Two patients died resulting from associated injuries. Five patients are alive, and in three patients complete resolution of aortic injury was observed. In selected patients with multiple associated injuries or severe comorbidity, nonoperative management after blunt aortic injury can be a treatment of choice.
Uploads
Papers by Inderjit Gill