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Hicks J, Mutowo M. Streamlining Endoscopy Cleaning: The Impact of a New Detergent on Time and Water Use. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2025; 13:23. [PMID: 40416336 PMCID: PMC12101361 DOI: 10.3390/jmahp13020023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2025] [Revised: 04/23/2025] [Accepted: 04/28/2025] [Indexed: 05/27/2025]
Abstract
Reprocessing reusable flexible endoscopes is resource-intensive and involves high water consumption. This study evaluated the impact of replacing a standard detergent with EndoPreZyme™, a novel detergent, at Blackpool Teaching Hospitals NHS Foundation Trust. We assessed manual cleaning times, water usage, costs, and technician experiences. A direct observational time system analysis was conducted over two one-week periods to record technician tasks before and after implementing EndoPreZyme™, allowing for the omission of the final rinse after manual cleaning. Technician surveys captured user experiences during the transition. The results showed that removing the final rinse after manual cleaning reduced water consumption by 25 litres per endoscope, resulting in an estimated saving of 725,000 L annually. The average manual cleaning time decreased from 13 min 10.2 s to 11 min 10.7 s-a reduction of 1 min 59.5 s per endoscope (15%). This efficiency gain translated to approximately 962.9 fewer technician hours being required annually for manual cleaning. Cost analysis revealed a slight per-endoscope cost reduction (GBP 4.88 vs. GBP 4.90). Technicians reported improved productivity, reduced workload, and an awareness of water conservation. These findings demonstrate that EndoPreZyme™ supports NHS sustainability goals by decreasing water usage and enhancing operational efficiency in healthcare delivery.
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Affiliation(s)
- Joshua Hicks
- Olympus KeyMed Group Ltd., Southend-on-Sea SS2 5QH, UK
| | - Mutsa Mutowo
- Olympus Australia, Notting Hill, Melbourne, VIC 3168, Australia
- Macquarie University Centre for the Health Economy, Sydney, NSW 2113, Australia
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Catalfumo F, Gupta R, Crapanzano-Sigafoos R. Acknowledging the gaps in endoscope reprocessing-A call for research to inform real-world practice. Am J Infect Control 2025:S0196-6553(25)00285-8. [PMID: 40158627 DOI: 10.1016/j.ajic.2025.03.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2025] [Accepted: 03/26/2025] [Indexed: 04/02/2025]
Affiliation(s)
- Frankie Catalfumo
- Center for Research, Practice, & Innovation, Association for Professionals in Infection Control and Epidemiology, Arlington, VA.
| | - Ria Gupta
- Center for Research, Practice, & Innovation, Association for Professionals in Infection Control and Epidemiology, Arlington, VA
| | - Rebecca Crapanzano-Sigafoos
- Center for Research, Practice, & Innovation, Association for Professionals in Infection Control and Epidemiology, Arlington, VA
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Davies E. 'Why Don't We Get Counselling?': Comparing NICE Guidelines for Morphological and Genetic Cancer Risk Diagnoses. Cancer Med 2025; 14:e70607. [PMID: 39812114 PMCID: PMC11733675 DOI: 10.1002/cam4.70607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2024] [Revised: 12/10/2024] [Accepted: 01/03/2025] [Indexed: 01/16/2025] Open
Abstract
BACKGROUND In the UK's National Health Service (NHS), there is specific psychosocial care offered to people with genetic cancer risk conditions but not morphological cancer risk conditions. As researchers develop new ways to diagnose morphological risk conditions, including precancers and in situ cancers, it is important to consider the psychosocial care that those diagnosed might require. OBJECTIVES This study compares the National Institute for Health and Care Excellence's guidelines for BRCA1/2, which are genetic risk conditions, and Barrett's oesophagus (BO), a morphological risk condition. It then theorises reasons for the similarities and differences made visible by this comparative work. METHODS The author completed an in-depth analysis of two sets of NICE guidelines, before carrying out a review of historical and social scientific literature on cancer risk to offer potential explanations for the disparities identified. RESULTS The 'right not to know' is protected in the case of BRCA1/2 diagnoses, but not BO. Additionally, specialist counselling is required for people receiving diagnoses of genetic risk but not offered for those diagnosed with morphological risk conditions. The paper offers four possible reasons for these disparities, concluding that they appear to be in large part due to historic genetic exceptionalism, rather than differences in patients' needs. CONCLUSION There may be a need to consider offering further psychosocial care to people with morphological risk conditions like BO. Lessons might be learnt from the field of genetic counselling.
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Affiliation(s)
- Elspeth Davies
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
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4
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Alberton A, Peltz ED. Cholecystectomy. Surg Clin North Am 2024; 104:1203-1215. [PMID: 39448122 DOI: 10.1016/j.suc.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2024]
Abstract
In this article, we discuss preoperative clinical evaluation, diagnostic considerations, and the role/choice of antibiotics. Operative planning is discussed with attention to patient characteristics/disease condition as they may inform consideration of alternative operative approaches. Detailed steps of laparoscopic, robotic-assisted, and open cholecystectomy are discussed. Indications and operative steps for intraoperative cholangiogram and laparoscopic transcystic common bile duct exploration are included. We conclude with postoperative care, including evaluation of common complications and necessary management considerations.
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Affiliation(s)
- Allison Alberton
- Department of Surgery, Logan Health, 1333 Surgical Services Drive, Kalispell, MT 59901, USA.
| | - Erik D Peltz
- Department of Surgery, Logan Health, 1333 Surgical Services Drive, Kalispell, MT 59901, USA
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Hamitoglu AE, Fawaz V, Elawad SOM, Assker MM, Nader TM, Wellington J, Uwishema O. Trends and Outcomes of Laparoscopic Surgery in Low-Resource Settings: Lessons From Two African Healthcare Systems-A Narrative Review. Health Sci Rep 2024; 7:e70304. [PMID: 39720243 PMCID: PMC11667220 DOI: 10.1002/hsr2.70304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 11/09/2024] [Accepted: 12/05/2024] [Indexed: 12/26/2024] Open
Abstract
Introduction Laparoscopic surgery (LS) has been a promising development in surgical practice globally ever since its introduction. LS has exhibited many an advantage, including bettering patient outcomes, lowering the risk of postoperative infection, and displaying economical affluence. However, its implementation in the African continent still faces various challenges. In this review, we investigated the status of laparoscopic surgery integration in Africa. Objectives In this review, we aimed to investigate the challenges posed by the implementation of LS in low resource countries as well as critically evaluating initiatives and their impact within said domiciles. We also provide recommendations that may assist in LS prosperity in these settings by focusing efforts on improving training and financial incentives. Methods A comprehensive literature review was conducted to garner up-to-date evidence concerning the fate of LS adoption in low- to middle-income countries. This comprised the analysis of different case studies from countries including Nigeria and Botswana, and investigated relevant recommendations and policies provided by other African countries. Results Various challenges face the implementation of LS in countries with low resources comprising poor infrastructure, scarce training programs, and expert training personnel alongside financial boundaries. The adoption of LS in Africa has proved its benefits in improving patient outcomes and reducing hospital admissions. From a perspective of policy, it is crucial to sustain strong ties amongst institutions, stressing the importance of dynamic collaboration and locally tailored policies. Conclusion It has been demonstrated that LS implementations in African nations lower infection rates and expedite recovery. A strong collaboration between governments, stakeholders, and healthcare providers is fundamental for successful integration of LS. Such extension in low-resource environments may be achieved by providing proper training programs, funding infrastructure and equipment, and fostering effective financial initiatives.
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Affiliation(s)
- Ali Emir Hamitoglu
- Department of Research and EducationOli Health Magazine OrganizationKigaliRwanda
- Department of General Medicine, Faculty of MedicineNamık Kemal UniversityTekirdagTurkey
| | - Violette Fawaz
- Department of Research and EducationOli Health Magazine OrganizationKigaliRwanda
- Faculty of PharmacyBeirut Arab UniversityBeirutLebanon
| | - Shaima Omer Mohamed Elawad
- Department of Research and EducationOli Health Magazine OrganizationKigaliRwanda
- Department of General Medicine, Faculty of MedicineUniversity of KhartoumKhartoumSudan
| | - Mohamad Monif Assker
- Department of Research and EducationOli Health Magazine OrganizationKigaliRwanda
- Department of EducationSheikh Khalifa Medical CityAbu DhabiUAE
| | - Thea Maria Nader
- Department of Research and EducationOli Health Magazine OrganizationKigaliRwanda
- Faculty of PharmacyLebanese American UniversityJbeilLebanon
| | - Jack Wellington
- Department of Research and EducationOli Health Magazine OrganizationKigaliRwanda
- Bradford Teaching Hospitals NHS Foundation TrustBradfordUK
| | - Olivier Uwishema
- Department of Research and EducationOli Health Magazine OrganizationKigaliRwanda
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Cassidy BP, Stingl CS, Méndez N, Machain GM, Vega-Rivera F, Ribeiro MAF, Sacoto H, Ottolino P, Beitia SK, Quiodettis M, Rodas EB, Mallah MM. Surgical training trends in the Americas: A cross-continental assessment of minimally invasive surgery and open surgery among surgical trainees. World J Surg 2024; 48:2686-2696. [PMID: 39425677 DOI: 10.1002/wjs.12378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 10/09/2024] [Indexed: 10/21/2024]
Abstract
INTRODUCTION Minimally invasive surgery (MIS) has become standard of care in many high-income countries, but its adoption in low- and middle-income countries (LICs/MICs) has been impeded by resource- and training-related barriers. We hypothesized that trainees in MICs perform MIS procedures less often, and that as procedure complexity increases, the rate of MIS decreases. METHODS A 22-question survey, distributed to representative leaders across Latin America, collected country-specific graduating trainee case requirements and volumes for four index procedures (cholecystectomy, appendectomy, inguinal hernia repair, colectomy) using MIS or open surgery (OS). USA data was obtained from the Accreditation Council for Graduate Medical Education. Kruskal-Wallis and Mann-Whitney U tests were performed to determine whether the rate of MIS differed across all countries, procedure complexity classes, and high income countries (HICs)/MICs. RESULTS Seven experts (70% response rate) completed the survey, representing: Brazil, Chile, Ecuador, Guatemala, Mexico, Panama, and Paraguay. The percentage of MIS completed by trainees varied with mean and interquartile ranges as follows: cholecystectomy (60% ± 54%), appendectomy (41% ± 69%), inguinal hernia repair (19% ± 23%), colectomy (16% ± 29%). There was a significant difference in mean MIS experience across the eight countries (H = 17.6, p = 0.014) and between most complex and least complex procedures (p = 0.039). No difference was found between MICs and HICs (p = 0.786). CONCLUSIONS We found a significant difference of general surgery trainee exposure to MIS versus OS across the Americas, but the difference was not significantly associated with World Bank Income Groups. Different trainee experiences with MIS and OS may highlight an opportunity for international and bidirectional collaboration.
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Affiliation(s)
- Benjamin P Cassidy
- Acute Care and Systems Strengthening in Low-Resource Settings (ACCESS) Program, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - C Sierra Stingl
- Division of Plastic & Reconstructive Surgery, Stanford University, Stanford Medicine, Palo Alto, California, USA
| | - Napoleón Méndez
- Departamento de Emergencia de Cirugía, Hospital General San Juan de Dios, Guatemala City, Guatemala
| | - Gustavo M Machain
- Universidad Nacional de Asunción, Facultad de Ciencias Médicas, Hospital de Clínicas, Segunda Cátedra de Clínica Quirúrgica, San Lorenzo, Paraguay
| | - Felipe Vega-Rivera
- Departamento de Cirugía, Hospital Angeles Lomas, Estado de México, México
| | - Marcelo A F Ribeiro
- Division of Trauma, Critical Care, and Acute Care Surgery, Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, UAE
| | - Hernan Sacoto
- Cirugía de Trauma y Emergencias, Hospital Vicente Corral Moscoso, Universidad del Azuay, Cuenca, Ecuador
| | - Pablo Ottolino
- Trauma Surgery Department, Hospital Sótero del Río, Santiago, Chile
| | - Susan K Beitia
- Ministerio de Salud, Panamá, Panamá
- Universidad de Panamá, Panamá, Panamá
| | - Martha Quiodettis
- Division of Trauma and Acute Care Surgery, Hospital Santo Tomas, Panama City, Panama
| | - Edgar B Rodas
- Acute Care and Systems Strengthening in Low-Resource Settings (ACCESS) Program, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
- Division of Acute Care Surgical Services, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia, USA
- Program for Global Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia, USA
| | - Mike M Mallah
- Division of General and Acute Care Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
- Global Surgery Program, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Srivastava M, ODonoghue K, Sidun A, Jaeger HA, Ferro A, Crowley D, Bosch CVD, Kennedy M, OHare D, Cantillon-Murphy P. 3D Position Tracking Using On-Chip Magnetic Sensing in Image-Guided Navigation Bronchoscopy. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2024; 18:1123-1139. [PMID: 38568765 DOI: 10.1109/tbcas.2024.3384016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
This paper presents a compact and low-cost on-chip sensor and readout circuit. The sensor achieves high-resolution 5-degrees-of-freedom (DoF) tracking (x, y, z, yaw, and pitch). With the help of an external wire wound sensor, it can also achieve high-resolution 6-degrees-of-freedom (DoF) tracking (x, y, z, yaw, pitch, and roll angles). The sensor uses low-frequency magnetic fields to detect the position and orientation of instruments, providing a viable alternative to using X-rays in image-guided surgery. To measure the local magnetic field, a highly miniaturised on-chip magnetic sensor capable of sensing the magnetic field has been developed incorporating an on-chip magnetic sensor coil, analog-front end, continuous-time ∆Σ analog-to-digital converter (ADC), LVDS transmitter, bandgap reference, and voltage regulator. The microchip is fabricated using 65 nm CMOS technology and occupies an area of 1.06 mm 2, the smallest reported among similar designs to the best of our knowledge. The 5-DoF system accurately navigates with a precision of 1.1 mm within the volume-of-interest (VOI) of 15 ×15 ×15 cm 3. The 6-DoF system achieves a navigation accuracy of 0.8 mm and an angular error of 1.1 degrees in the same VOI. These results were obtained at a 20 Hz update rate in benchtop characterisation. The prototype sensor demonstrates accurate position tracking in real-life pre-clinical in-vivo settings within the porcine lung of a live swine, achieving a reported worst-case registration accuracy of 5.8 mm.
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Wu R, He C, Liang P, Liu Y, Huang Y, Liu W, Shu B, Xu P, Chang Q. MCF-SMSIS: Multi-tasking with complementary functions for stereo matching and surgical instrument segmentation. Comput Biol Med 2024; 179:108923. [PMID: 39053335 DOI: 10.1016/j.compbiomed.2024.108923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 06/03/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024]
Abstract
Stereo matching and instrument segmentation of laparoscopic surgical scenarios are key tasks in robotic surgical automation. Many researchers have been studying the two tasks separately for stereo matching and instrument segmentation. However, the relationship between these two tasks is often neglected. In this paper, we propose a model framework for multi-tasking with complementary functions for stereo matching and surgical instrument segmentation (MCF-SMSIS). We aim to complement the features of instrument prediction segmentation to the parallax matching block of stereo matching. We also propose two new evaluation metrics (MINPD and MAXPD) for assessing how well the parallax range matches the migrated domain when the model used for the stereo matching task undergoes domain migration. We performed stereo matching experiments on the SCARED , SERV-CT dataset as well as instrumentation segmentation experiments on the AutoLaparo dataset. The results demonstrate the effectiveness of the proposed method. In particular, stereo matching supplemented with instrument features reduced EPE, >3px and RMSE Depth in the surgical instrument section by 9.5%, 12.7% and 6.51%, respectively. The instrumentation segmentation performance also achieves a DSC value of 0.9233. Moreover, MCF-SMSIS takes only 0.14 s to infer a set of images. The model code and model weights for each stage are available from https://github.com/wurenkai/MCF-SMSIS.
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Affiliation(s)
- Renkai Wu
- School of Microelectronics, Shanghai University, Shanghai, China; Department of Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Changyu He
- Department of Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Pengchen Liang
- School of Microelectronics, Shanghai University, Shanghai, China; Department of Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yinghao Liu
- Department of Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiqi Huang
- Department of Mathematics, Imperial College London, London, United Kingdom
| | - Weiping Liu
- Shanghai Microport Medbot (Group) Co., Ltd., Shanghai, China
| | - Biao Shu
- Shanghai Microport Medbot (Group) Co., Ltd., Shanghai, China
| | - Panlong Xu
- Shanghai Microport Medbot (Group) Co., Ltd., Shanghai, China
| | - Qing Chang
- School of Microelectronics, Shanghai University, Shanghai, China; Department of Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Li L, Liang Y, Li C, Huang M, Liang W, Qin T. Comparison of endoscopic breast-conserving surgery versus conventional breast-conserving surgery for the treatment of early-stage breast cancer: a meta-analysis. Front Oncol 2024; 14:1419123. [PMID: 39165683 PMCID: PMC11333215 DOI: 10.3389/fonc.2024.1419123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 07/23/2024] [Indexed: 08/22/2024] Open
Abstract
Introduction This meta-analysis seeks to evaluate the efficacy and safety of endoscopic breast-conserving surgery (E-BCS) compared to conventional breast cancer surgery (C-BCS) in patients diagnosed with early-stage breast cancer. Materials and methods Four databases (Medline, Embase, Web of Science and CENTRAL) were searched published from establishment of database to January 30,2024, for articles studying E-BCS compared to C-BCS in patients diagnosed with early-stage breast cancer. Meta-analyses of procedure time, blood loss, length of incision, drainage duration, total postoperative drainage volume, average duration of hospital stay, positive rate of margin, complication rate, recurrence rate, metastasis rate and cosmetic scoring were performed. Results Totally 11 studies were included for meta-analysis. Compared with C-BCS, E-BCS exhibited significantly reduced incision length (WMD = -6.44, 95%CI: -10.78 to -2.11, P=0.004, I2 = 99.0%) and superior cosmetic scoring (WMD = 2.69, 95%CI: 1.46 to 3.93, P=0.001, I2 = 93.2%), but had significantly longer operation time (WMD = 34.22, 95%CI: 20.89~47.55, P=0.000, I2 = 90.7%) and blood loss (WMD = 3.65, 95%CI: -3.12 to 10.43, P=0.291, I2 = 86.8%). There was no significant difference in terms of recurrence rate, metastasis rate, positive rate of tumor resection margins, drainage duration, drainage volume, complication rate and hospital days. Conclusions Our research findings indicate that E-BCS is a viable and secure method for treating breast cancer in its early stages. E-BCS provides distinct advantages in terms of the length of the incision and the aesthetic result, without demonstrating an elevated recurrence rate or metastasis rate. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024535164, identifier CRD42024535164.
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Affiliation(s)
| | | | | | | | - Weiming Liang
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, China
| | - Tian Qin
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, China
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Conrad PV, Mehdorn AS, Alkatout I, Becker T, Beckmann JH, Pochhammer J. The Combination of Laparoscopic and Robotic Surgery: First Experience with the Dexter Robotic System™ in Visceral Surgery. Life (Basel) 2024; 14:874. [PMID: 39063627 PMCID: PMC11277731 DOI: 10.3390/life14070874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/03/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
INTRODUCTION For over two decades, abdominal surgical procedures have been safely performed robotically. After the first patent expiration, alternative robotic systems entered the market. The Dexter Robotic System™ is a small-format, modular, and robotic platform consisting of a surgeon's console, two patient carts with instrument arms, and one endoscope arm. We report our initial experiences with Dexter since its installation at our visceral surgery department. METHODS The system and surgical setup are described. Demographic and perioperative data of all operated patients as well as the system docking times were analyzed. RESULTS From 56 procedures performed with Dexter, the most common ones included cholecystectomy (n = 15), inguinal hernia repair (TAPP; unilateral n = 15; bilateral n = 3), and right oncologic hemicolectomy (n = 15). The median docking time was 6 min (2-16 min) and was reduced to 4 min in the last tertile of procedures performed. CONCLUSIONS In our experience, Dexter can be implemented without any major challenges, and visceral surgical procedures of simple to medium complexity can be performed safely. The simplicity and accessibility of the system along with the ease of switching between robotics and laparoscopy could be particularly suitable for beginners in robotic surgery.
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Affiliation(s)
- Pernilla Virginia Conrad
- Department of General, Visceral, Thoracic, Transplantation and Pediatric Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Anne-Sophie Mehdorn
- Department of General, Visceral, Thoracic, Transplantation and Pediatric Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Ibrahim Alkatout
- Clinic for Gynecology and Obstetrics, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Thomas Becker
- Department of General, Visceral, Thoracic, Transplantation and Pediatric Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Jan Henrik Beckmann
- Department of General, Visceral, Thoracic, Transplantation and Pediatric Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Julius Pochhammer
- Department of General, Visceral, Thoracic, Transplantation and Pediatric Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
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11
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Hoffman D, Cool C. Costs involved in compliance with new endoscope reprocessing guidelines. Clin Endosc 2024; 57:534-541. [PMID: 38273218 PMCID: PMC11294847 DOI: 10.5946/ce.2023.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND/AIMS In March 2022, the Association for the Advancement of Medical Instrumentation (AAMI) released the American National Standards Institute (ANSI)/AAMI ST91:2021, their latest update on comprehensive, flexible, and semirigid endoscope reprocessing. These updated standards recommend the sterilization of high-risk endoscopes when possible and provide new recommendations for the precleaning, leak testing, manual cleaning, visual inspection, automated reprocessing, drying, storage, and transport of endoscopes. METHODS ANSI/AAMI ST91:2021 was compared with ANSI/AAMI ST91:2015 for major reprocessing differences that result in either time and/or cost increases. Time estimates were captured by explicit recommendation inclusion or taken from the literature. All the costs were estimated using publicly available resources. RESULTS The updated standards represent a potential 24.3-minute and 52.35 to 67.57 United States dollars increase per procedure in terms of reprocessing time and spending, respectively, not including capital investments. Capital costs per procedure were highly dependent on the procedure volume of the facility. CONCLUSIONS The new AAMI standards recommend several major changes, such as sterilization, for facilities to reprocess and manage endoscopes between uses. As more facilities increase their reprocessing methods to reflect the updated standards, they do so at a cost and introduce several delays. As the reprocessing landscape evolves, facilities should consider their true costs and alternative solutions, such as single-use endoscopes.
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Affiliation(s)
- David Hoffman
- Health Economics Outcomes Research and Market Access, Ambu USA, Columbia, MD, USA
| | - Christina Cool
- Health Economics Outcomes Research and Market Access, Ambu USA, Columbia, MD, USA
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12
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Iguchi K, Numata M, Sugiyama A, Saito K, Atsumi Y, Kazama K, Sugano N, Sato T, Rino Y, Saito A. Influence of proficiency in conventional laparoscopic surgery in colorectal cancer on the introduction of robotic surgery. Langenbecks Arch Surg 2024; 409:189. [PMID: 38896303 DOI: 10.1007/s00423-024-03380-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 06/12/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE Although there have been many reports on learning curves for robotic surgery, it is unclear how surgeons' conventional laparoscopic surgical skills influence their ability in performing robotic surgery for colorectal cancer (CRC). The aim of this study was to determine the surgical outcomes of robotic surgery for CRC during the induction phase by skilled laparoscopic surgeons. METHODS Surgical outcomes of consecutive CRC cases between January 2021 and March 2023 following the skilled phase of laparoscopic surgery and introductory phase of robotic surgery performed by three skilled laparoscopic surgeons were compared. RESULTS Overall, 77 consecutive patients diagnosed with sigmoid colon or rectosigmoid cancer were analysed, including 50 in the laparoscopy group (LAP) and 27 in the robotic group (Ro). Patient characteristics, including age, sex, body mass index, and tumour progression, did not differ between the groups. The median operation time was 204 min in the robotic group and 170 min in the laparoscopic group (p < 0.001). Blood loss was significantly lower in the robotic group (p = 0.0059). The incidence of grade 2 or higher complications did not differ between the two groups (LAP, 10.0% vs. Ro, 7.4%, p = 1). In the robotic group, the time required for lymph node dissection had a greater impact on operative duration. CONCLUSION Skills acquired from performing conventional laparoscopic surgery may contribute to the safe and reliable performance of robotic surgery for CRC. TRIAL REGISTRATION UMIN000050923.
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Affiliation(s)
- Kenta Iguchi
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, 4-57, Urafune-cho, Minami-ku, Yokohama-shi, 232-0024, Japan.
| | - Masakatsu Numata
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, 4-57, Urafune-cho, Minami-ku, Yokohama-shi, 232-0024, Japan
| | - Atsuhiko Sugiyama
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, 4-57, Urafune-cho, Minami-ku, Yokohama-shi, 232-0024, Japan
| | - Kentaro Saito
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, 4-57, Urafune-cho, Minami-ku, Yokohama-shi, 232-0024, Japan
| | - Yosuke Atsumi
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, 4-57, Urafune-cho, Minami-ku, Yokohama-shi, 232-0024, Japan
| | - Keisuke Kazama
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Nobuhiro Sugano
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Tsutomu Sato
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, 4-57, Urafune-cho, Minami-ku, Yokohama-shi, 232-0024, Japan
| | - Yasushi Rino
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Aya Saito
- Department of Surgery, Yokohama City University, Yokohama, Japan
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13
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Jang HJ, Lee SM. Influence of Surgery Preparation Time on Patient Outcomes. J Nurs Manag 2024; 2024:6753210. [PMID: 40224736 PMCID: PMC11919024 DOI: 10.1155/2024/6753210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 05/10/2024] [Accepted: 05/14/2024] [Indexed: 04/15/2025]
Abstract
Aims This study aimed to analyze the effects of the surgery preparation time on patient outcomes. Background Postoperative complications have a decisive effect on postoperative survival. The anesthesia time is a crucial determinant of such complications. Competent operating room nurses can shorten the surgery preparation time, which is the time from when anesthesia is first administered to the making of the surgical incision. The shortening of this preparation time can shorten the anesthesia time and may reduce postoperative complications. However, discussion of this preparation time is insufficient. Therefore, this study analyzed the effect of the surgery preparation time on patient outcomes. Methods From electronic health records data, this retrospective cohort study used the data of 1,944 patients who had been immediately admitted to the ICU after their surgery between 2017 and 2020. The patients were divided into two groups: ≥30 minutes preparation time and <30 minutes preparation time groups. We performed chi-squared tests and t-tests to determine differences in preoperation, intraoperation, and postoperation characteristics of the patients and patient outcomes based on the surgery preparation time. Furthermore, we performed a multiple logistic regression by including 12 adjusted variables to determine the influence of the surgery preparation time on patient outcomes. Results Among the 1,944 patients, 820 were in the ≥30 minutes preparation time group and 1,124 in the <30 minutes preparation time group. The multiple logistic regression analysis showed that the surgery preparation time affects alertness (OR = 1.44; 95% CI: [1.09, 1.90]), ventilator application (OR = 1.32; 95% CI: [1.03, 1.70]), and length of stay in the ICU (OR = 1.69; 95% CI [1.16, 2.47]). Conclusions The surgery preparation time affects postoperative patient outcomes. The competence of operating room nurses is the most essential aspect of the surgery preparation time. Implications for Nursing Management. It is important to analyze operating room nurses' tasks, standardize the tasks, and educate nurses according to their experience level to reduce the surgery preparation time and improve patient outcomes.
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Affiliation(s)
- Hey-Jin Jang
- College of Nursing, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sun-Mi Lee
- College of Nursing, The Catholic University of Korea, Seoul, Republic of Korea
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14
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Patil M, Gharde P, Reddy K, Nayak K. Comparative Analysis of Laparoscopic Versus Open Procedures in Specific General Surgical Interventions. Cureus 2024; 16:e54433. [PMID: 38510915 PMCID: PMC10951803 DOI: 10.7759/cureus.54433] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/17/2024] [Indexed: 03/22/2024] Open
Abstract
Laparoscopic and open surgeries are two distinct surgical approaches with significantly different procedures and outcomes. Minimally invasive surgery, also known as laparoscopic surgery, utilizes small incisions and specialized instruments like the laparoscope to perform procedures. This contrasts with open surgery, which requires larger incisions to directly access the surgical site. Open surgery was the preferred approach for any invasive procedure until the introduction of new technological advances in the form of laparoscopy. While laparoscopy is still evolving, preliminary results demonstrate promise for various operations. Open surgery provides the healthcare professional with more liberty in the form of increased visualization, but it also increases tissue damage and hospital stays. Laparoscopic and open procedures are both valuable surgical methods with advantages and disadvantages. While open surgery is favored for difficult patients, laparoscopic surgery offers a quicker recovery and fewer scars. The choice between the two approaches depends on the patient's condition, surgical demands, and the surgeon's skills. As these methods develop, they become increasingly important for offering safe and efficient surgical treatments across a range of medical specialties.
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Affiliation(s)
- Mihir Patil
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pankaj Gharde
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Kavyanjali Reddy
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Krushank Nayak
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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15
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Cheong C, Kim NW, Lee HS, Kang J. Intracorporeal versus extracorporeal anastomosis in minimally invasive right hemicolectomy: systematic review and meta-analysis of randomized controlled trials. Ann Surg Treat Res 2024; 106:1-10. [PMID: 38205092 PMCID: PMC10774696 DOI: 10.4174/astr.2024.106.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/13/2023] [Accepted: 10/26/2023] [Indexed: 01/12/2024] Open
Abstract
Purpose Compared with extracorporeal anastomosis (ECA), intracorporeal anastomosis (ICA) is expected to provide some benefits, including a shorter operation time and less intraoperative bleeding. Nevertheless, the benefits of ICA have mainly been evaluated in nonrandomized studies. Owing to the recent update of randomized controlled trials (RCTs) for minimally invasive surgery (MIS) of right hemicolectomy (RHC), the need to measure the actual effect by synthesizing the outcomes of these studies has emerged. Methods We performed a comprehensive search of the PubMed, Embase, and Cochrane databases (from inception to January 30, 2023) for studies that applied ICA and ECA for RHC with MIS. We included 7 RCTs. The operation time, intraoperative blood loss, conversion rate, length of incision, and postoperative outcomes such as ileus, anastomosis leakage, length of hospitalization, and postoperative pain were compared between ICA and ECA. Results A total of 740 patients were included in the study. Among them, 377 and 373 underwent ICA and ECA, respectively. There were significant differences in age (P = 0.003) and incision type (P < 0.001) between ICA and ECA. ICA was associated with a significantly longer operation time (P = 0.033). Although the postoperative pain associated with ICA was significantly lower than that associated with ECA on postoperative day 2 (POD 2) (P = 0.003), it was not different on POD 3 between the groups. Other perioperative outcomes were similar between the 2 groups. Conclusion In this meta-analysis, ICA did not significantly improve short-term outcomes compared to ECA; other advantages to overcome ICA's longer operation time are not clear.
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Affiliation(s)
- Chinock Cheong
- Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Na Won Kim
- Yonsei University Medical Library, Seoul, Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Jeonghyun Kang
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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16
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Stokes K, Clark K, Odetade D, Hardy M, Goldberg Oppenheimer P. Advances in lithographic techniques for precision nanostructure fabrication in biomedical applications. DISCOVER NANO 2023; 18:153. [PMID: 38082047 PMCID: PMC10713959 DOI: 10.1186/s11671-023-03938-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/04/2023] [Indexed: 01/31/2024]
Abstract
Nano-fabrication techniques have demonstrated their vital importance in technological innovation. However, low-throughput, high-cost and intrinsic resolution limits pose significant restrictions, it is, therefore, paramount to continue improving existing methods as well as developing new techniques to overcome these challenges. This is particularly applicable within the area of biomedical research, which focuses on sensing, increasingly at the point-of-care, as a way to improve patient outcomes. Within this context, this review focuses on the latest advances in the main emerging patterning methods including the two-photon, stereo, electrohydrodynamic, near-field electrospinning-assisted, magneto, magnetorheological drawing, nanoimprint, capillary force, nanosphere, edge, nano transfer printing and block copolymer lithographic technologies for micro- and nanofabrication. Emerging methods enabling structural and chemical nano fabrication are categorised along with prospective chemical and physical patterning techniques. Established lithographic techniques are briefly outlined and the novel lithographic technologies are compared to these, summarising the specific advantages and shortfalls alongside the current lateral resolution limits and the amenability to mass production, evaluated in terms of process scalability and cost. Particular attention is drawn to the potential breakthrough application areas, predominantly within biomedical studies, laying the platform for the tangible paths towards the adoption of alternative developing lithographic technologies or their combination with the established patterning techniques, which depends on the needs of the end-user including, for instance, tolerance of inherent limits, fidelity and reproducibility.
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Affiliation(s)
- Kate Stokes
- Advanced Nanomaterials Structures and Applications Laboratories, School of Chemical Engineering, College of Engineering and Physical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Kieran Clark
- Advanced Nanomaterials Structures and Applications Laboratories, School of Chemical Engineering, College of Engineering and Physical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - David Odetade
- Advanced Nanomaterials Structures and Applications Laboratories, School of Chemical Engineering, College of Engineering and Physical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Mike Hardy
- School of Biological Sciences, Institute for Global Food Security, Queen's University Belfast, Belfast, BT9 5DL, UK
- Centre for Quantum Materials and Technology, School of Mathematics and Physics, Queen's University Belfast, Belfast, BT7 1NN, UK
| | - Pola Goldberg Oppenheimer
- Advanced Nanomaterials Structures and Applications Laboratories, School of Chemical Engineering, College of Engineering and Physical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
- Healthcare Technologies Institute, Institute of Translational Medicine, Mindelsohn Way, Birmingham, B15 2TH, UK.
- Cavendish Laboratory, Department of Physics, University of Cambridge, JJ Thomson Avenue, Cambridge, CB3 0HE, UK.
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17
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Charondo LB, Brian R, Syed S, Chern H, Lager J, Alseidi A, O'Sullivan P, Bayne D. Confronting new challenges: Faculty perceptions of gaps in current laparoscopic curricula in a changing training landscape. Surg Open Sci 2023; 16:1-7. [PMID: 37731731 PMCID: PMC10507640 DOI: 10.1016/j.sopen.2023.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 09/08/2023] [Indexed: 09/22/2023] Open
Abstract
Background Opportunities for residents to develop laparoscopic skills have decreased with the rise in robotic operations and the development of complex, subspecialized laparoscopic operations. Given the changing training landscape, this study aimed to identify laparoscopic surgeons' perceptions of gaps in current laparoscopic skills in general surgery, obstetrics-gynecology, and urology residency programs. Methods Laparoscopic surgeons who operate with residents participated in semi-structured interviews. Questions addressed expectations for resident proficiency, deficits in laparoscopic surgical skills, and barriers to learning and teaching. Two authors independently coded de-identified transcripts followed by a conventional content analysis. Results Fourteen faculty members from thirteen subspecialties participated. Faculty identified three main areas to improve laparoscopic training across specialties: foundational knowledge, technical skills, and cognitive skills. They also recognized an overarching opportunity to address faculty development. Conclusions This qualitative study highlighted key deficiencies in laparoscopic training that have emerged in the current, changing era of minimally invasive surgery. Key message This qualitative study identified laparoscopic educators' perceptions of deficiencies in laparoscopic training. Findings emphasized the importance of incorporating high quality educational practices to optimize training in the current changing landscape of laparoscopic surgery.
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Affiliation(s)
| | - Riley Brian
- University of California, San Francisco, Department of Surgery, San Francisco, CA, USA
| | - Shareef Syed
- University of California, San Francisco, Department of Surgery, San Francisco, CA, USA
| | - Hueylan Chern
- University of California, San Francisco, Department of Surgery, San Francisco, CA, USA
| | - Jeannette Lager
- University of California, San Francisco, Department of Obstetrics, Gynecology, & Reproductive Sciences, San Francisco, CA, USA
| | - Adnan Alseidi
- University of California, San Francisco, Department of Surgery, San Francisco, CA, USA
| | - Patricia O'Sullivan
- University of California, San Francisco, Department of Surgery, San Francisco, CA, USA
| | - David Bayne
- University of California, San Francisco, Department of Urology, San Francisco, CA, USA
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18
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Marcelissen T, Vijgen GHEJ. The endoscope. Br J Surg 2023; 110:1641-1643. [PMID: 37537900 DOI: 10.1093/bjs/znad220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 06/17/2023] [Indexed: 08/05/2023]
Affiliation(s)
- Tom Marcelissen
- Department of Urology, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
| | - Guy H E J Vijgen
- Department of Surgery, Laurentius Hospital, Monseigneur Driessenstraat 6, 6043 CV, Roermond, the Netherlands
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19
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Van de Steene T, Tanghe E, Martens L, Garripoli C, Stanzione S, Joseph W. Optimal Frequency and Wireless Power Budget for Miniature Receivers in Obese People. SENSORS (BASEL, SWITZERLAND) 2023; 23:8084. [PMID: 37836914 PMCID: PMC10574982 DOI: 10.3390/s23198084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023]
Abstract
This study investigates wireless power transfer for deep in-body receivers, determining the optimal frequency, power budget, and design for the transmitter and receiver. In particular, the focus is on small, in-body receivers at large depths up to 20 cm for obese patients. This enables long-term monitoring of the gastrointestinal tract for all body types. Numerical simulations are used to investigate power transfer and losses as a function of frequency and to find the optimal design at the selected frequency for an obese body model. From all ISM-frequencies in the investigated range (1 kHz-10 GHz), the value of 13.56 MHz yields the best performance. This optimum corresponds to the transition from dominant copper losses in conductors to dominant losses in conductive tissue. At this frequency, a transmitting and receiving coil are designed consisting of 12 and 23 windings, respectively. With a power transfer efficiency of 2.70×10-5, 18 µW can be received for an input power of 0.68 W while still satisfying exposure guidelines. The power transfer is validated by measurements. For the first time, efficiency values and the power budget are reported for WPT through 20 cm of tissue to mm sized receivers. Compared to WPT at higher frequencies, as commonly used for small receivers, the proposed system is more suitable for WPT to large depths in-body and comes with the advantage that no focusing is required, which can accommodate multiple receivers and uncertainty about receiver location more easily. The received power allows long-term sensing in the gastrointestinal tract by, e.g., temperature, pressure, and pH sensors, motility sensing, or even gastric stimulation.
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Affiliation(s)
- Tom Van de Steene
- Department of Information Technology, Ghent University/imec, B-9052 Ghent, Belgium
| | - Emmeric Tanghe
- Department of Information Technology, Ghent University/imec, B-9052 Ghent, Belgium
| | - Luc Martens
- Department of Information Technology, Ghent University/imec, B-9052 Ghent, Belgium
| | | | | | - Wout Joseph
- Department of Information Technology, Ghent University/imec, B-9052 Ghent, Belgium
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20
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Chen Y, Fan Z, Zhang X, Fu X, Li J, Yuan J, Guo S. A brief overview of single-port laparoscopic appendectomy as an optimal surgical procedure for patients with acute appendicitis: still a long way to go. J Int Med Res 2023; 51:3000605231183781. [PMID: 37466195 PMCID: PMC10363874 DOI: 10.1177/03000605231183781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
Single-port laparoscopic appendectomy (SPLA) has become a good alternative to the traditional surgical treatment of acute appendicitis, due to its advantages of small incision, mild postoperative pain, short hospital stay, and good cosmetic effect. However, the further application of SPLA has been restricted by its relatively long operating time, high level of operating difficulty, and increased equipment and technical requirements. Clinical teams worldwide have attempted to improve and optimize SPLA technical protocols and equipment to maintain stable intraoperative pneumoperitoneal pressure, improve the 'triangle relationship' of operating angles, and develop new surgical procedures with less trauma and higher cost-effectiveness. Here, new SPLA techniques reported over the past decade are reviewed and compared, with the aim of providing new insights into technical improvements, equipment upgrades and clinical studies in the coming years.
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Affiliation(s)
- Yang Chen
- Department of General Surgery, Chaoyang Central Hospital, Chaoyang, Liaoning Province, China
| | - Zongqi Fan
- Department of General Surgery, Chaoyang Central Hospital, Chaoyang, Liaoning Province, China
- Graduate School, Jinzhou Medical University, Jinzhou, Liaoning Province, China
| | - Xiaoxin Zhang
- Department of General Surgery, Chaoyang Central Hospital, Chaoyang, Liaoning Province, China
- Graduate School, Jinzhou Medical University, Jinzhou, Liaoning Province, China
| | - Xinao Fu
- Department of General Surgery, Chaoyang Central Hospital, Chaoyang, Liaoning Province, China
- Graduate School, China Medical University, Shenyang, Liaoning Province, China
| | - Jushang Li
- Department of General Surgery, Chaoyang Central Hospital, Chaoyang, Liaoning Province, China
- Graduate School, China Medical University, Shenyang, Liaoning Province, China
| | - Jieqing Yuan
- Department of General Surgery, Chaoyang Central Hospital, Chaoyang, Liaoning Province, China
| | - Shigang Guo
- Department of General Surgery, Chaoyang Central Hospital, Chaoyang, Liaoning Province, China
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21
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Hasan SMK, Simon RA, Linte CA. Inpainting surgical occlusion from laparoscopic video sequences for robot-assisted interventions. J Med Imaging (Bellingham) 2023; 10:045002. [PMID: 37649957 PMCID: PMC10462486 DOI: 10.1117/1.jmi.10.4.045002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/21/2023] [Accepted: 07/28/2023] [Indexed: 09/01/2023] Open
Abstract
Purpose Medical technology for minimally invasive surgery has undergone a paradigm shift with the introduction of robot-assisted surgery. However, it is very difficult to track the position of the surgical tools in a surgical scene, so it is crucial to accurately detect and identify surgical tools. This task can be aided by deep learning-based semantic segmentation of surgical video frames. Furthermore, due to the limited working and viewing areas of these surgical instruments, there is a higher chance of complications from tissue injuries (e.g., tissue scars and tears). Approach With the aid of digital inpainting algorithms, we present an application that uses image segmentation to remove surgical instruments from laparoscopic/endoscopic video. We employ a modified U-Net architecture (U-NetPlus) to segment the surgical instruments. It consists of a redesigned decoder and a pre-trained VGG11 or VGG16 encoder. The decoder was modified by substituting an up-sampling operation based on nearest-neighbor interpolation for the transposed convolution operation. Furthermore, these interpolation weights do not need to be learned to perform upsampling, which eliminates the artifacts generated by the transposed convolution. In addition, we use a very fast and adaptable data augmentation technique to further enhance performance. The instrument segmentation mask is filled in (i.e., inpainted) by the tool removal algorithms using the previously acquired tool segmentation masks and either previous instrument-containing frames or instrument-free reference frames. Results We have shown the effectiveness of the proposed surgical tool segmentation/removal algorithms on a robotic instrument dataset from the MICCAI 2015 and 2017 EndoVis Challenge. We report a 90.20% DICE for binary segmentation, a 76.26% DICE for instrument part segmentation, and a 46.07% DICE for instrument type (i.e., all instruments) segmentation on the MICCAI 2017 challenge dataset using our U-NetPlus architecture, outperforming the results of earlier techniques used and tested on these data. In addition, we demonstrated the successful execution of the tool removal algorithm from surgical tool-free videos that contained moving surgical tools that were generated artificially. Conclusions Our application successfully separates and eliminates the surgical tool to reveal a view of the background tissue that was otherwise hidden by the tool, producing results that are visually similar to the actual data.
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Affiliation(s)
- S. M. Kamrul Hasan
- Rochester Institute of Technology, Biomedical Modeling, Visualization, and Image-guided Navigation (BiMVisIGN) Lab, Rochester, New York, United States
- Rochester Institute of Technology, Center for Imaging Science, Rochester, New York, United States
| | - Richard A. Simon
- Rochester Institute of Technology, Biomedical Modeling, Visualization, and Image-guided Navigation (BiMVisIGN) Lab, Rochester, New York, United States
- Rochester Institute of Technology, Biomedical Engineering, Rochester, New York, United States
| | - Cristian A. Linte
- Rochester Institute of Technology, Biomedical Modeling, Visualization, and Image-guided Navigation (BiMVisIGN) Lab, Rochester, New York, United States
- Rochester Institute of Technology, Center for Imaging Science, Rochester, New York, United States
- Rochester Institute of Technology, Biomedical Engineering, Rochester, New York, United States
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22
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Walshaw J, Huo B, McClean A, Gajos S, Kwan JY, Tomlinson J, Biyani CS, Dimashki S, Chetter I, Yiasemidou M. Innovation in gastrointestinal surgery: the evolution of minimally invasive surgery-a narrative review. Front Surg 2023; 10:1193486. [PMID: 37288133 PMCID: PMC10242011 DOI: 10.3389/fsurg.2023.1193486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/04/2023] [Indexed: 06/09/2023] Open
Abstract
Background Minimally invasive (MI) surgery has revolutionised surgery, becoming the standard of care in many countries around the globe. Observed benefits over traditional open surgery include reduced pain, shorter hospital stay, and decreased recovery time. Gastrointestinal surgery in particular was an early adaptor to both laparoscopic and robotic surgery. Within this review, we provide a comprehensive overview of the evolution of minimally invasive gastrointestinal surgery and a critical outlook on the evidence surrounding its effectiveness and safety. Methods A literature review was conducted to identify relevant articles for the topic of this review. The literature search was performed using Medical Subject Heading terms on PubMed. The methodology for evidence synthesis was in line with the four steps for narrative reviews outlined in current literature. The key words used were minimally invasive, robotic, laparoscopic colorectal, colon, rectal surgery. Conclusion The introduction of minimally surgery has revolutionised patient care. Despite the evidence supporting this technique in gastrointestinal surgery, several controversies remain. Here we discuss some of them; the lack of high level evidence regarding the oncological outcomes of TaTME and lack of supporting evidence for robotic colorectalrectal surgery and upper GI surgery. These controversies open pathways for future research opportunities with RCTs focusing on comparing robotic to laparoscopic with different primary outcomes including ergonomics and surgeon comfort.
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Affiliation(s)
- Josephine Walshaw
- Academic Vascular Surgical Unit, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - Bright Huo
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Adam McClean
- Department of General Surgery, Bradford Teaching Hospitals NHS Trust, Bradford, United Kingdom
| | - Samantha Gajos
- Emergency Medicine Department, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, United Kingdom
| | - Jing Yi Kwan
- Department of General Surgery, Bradford Teaching Hospitals NHS Trust, Bradford, United Kingdom
- Department of Vascular Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - James Tomlinson
- Department of Spinal Surgery, SheffieldTeaching Hospitals, Sheffield, United Kingdom
| | - Chandra Shekhar Biyani
- Department of Vascular Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Safaa Dimashki
- Department of General Surgery, Bradford Teaching Hospitals NHS Trust, Bradford, United Kingdom
| | - Ian Chetter
- Academic Vascular Surgical Unit, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - Marina Yiasemidou
- NIHR Academic Clinical Lecturer General Surgery, University of Hull, Hull, United Kingdom
- Hull York Medical School, University of York, York, United Kingdom
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23
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Gillespie AM, Wang C, Movassaghi M. Ergonomic Considerations in Urologic Surgery. Curr Urol Rep 2023; 24:143-155. [PMID: 36580226 DOI: 10.1007/s11934-022-01142-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW This paper aims to discuss the various work-related musculoskeletal disorders (WRMDs) among urologists and provide an overview of the latest recommendations to improve awareness of ergonomic principles that can be applied in the operating room, with special consideration of challenges faced during pregnancy. RECENT FINDINGS Urologists suffer from a large burden of WRMDs. The main drivers of pain associated with the various surgical approaches include repetitive movements, static and awkward body positions, and the use of burdensome equipment. Pregnant surgeons are at an even greater risk of WRMDs and face high rates of pregnancy complications. Laparoscopy, endoscopy, robot-assisted surgeries, and open surgeries present unique ergonomic challenges for the practicing urologist. Proper posture and equipment use, optimal operating room setup, intraoperative stretching breaks, and an emphasis on teaching ergonomic principles can reduce the risk of WRMDs. Surgeons are also at increased risk of WRMDs during pregnancy but may continue to operate while taking measures to limit physical exertion and fatigue. Improving awareness of and incorporating ergonomic principles early in a urologist's career may reduce the risk of injury and improve operative performance and longevity.
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Affiliation(s)
- Anton M Gillespie
- Columbia University Vagelos College of Physicians & Surgeons, 630 W 168th St, New York, NY, 10032, USA
| | - Connie Wang
- Department of Urology, Columbia University Irving Medical Center, 161 Fort Washington Ave, New York, NY, 10032, USA
| | - Miyad Movassaghi
- Department of Urology, Columbia University Irving Medical Center, 161 Fort Washington Ave, New York, NY, 10032, USA.
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24
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Filicori F, Bitner DP, Fuchs HF, Anvari M, Sankaranaraynan G, Bloom MB, Hashimoto DA, Madani A, Mascagni P, Schlachta CM, Talamini M, Meireles OR. SAGES video acquisition framework-analysis of available OR recording technologies by the SAGES AI task force. Surg Endosc 2023:10.1007/s00464-022-09825-3. [PMID: 36729231 DOI: 10.1007/s00464-022-09825-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/06/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Surgical video recording provides the opportunity to acquire intraoperative data that can subsequently be used for a variety of quality improvement, research, and educational applications. Various recording devices are available for standard operating room camera systems. Some allow for collateral data acquisition including activities of the OR staff, kinematic measurements (motion of surgical instruments), and recording of the endoscopic video streams. Additional analysis through computer vision (CV), which allows software to understand and perform predictive tasks on images, can allow for automatic phase segmentation, instrument tracking, and derivative performance-geared metrics. With this survey, we summarize available surgical video acquisition technologies and associated performance analysis platforms. METHODS In an effort promoted by the SAGES Artificial Intelligence Task Force, we surveyed the available video recording technology companies. Of thirteen companies approached, nine were interviewed, each over an hour-long video conference. A standard set of 17 questions was administered. Questions spanned from data acquisition capacity, quality, and synchronization of video with other data, availability of analytic tools, privacy, and access. RESULTS Most platforms (89%) store video in full-HD (1080p) resolution at a frame rate of 30 fps. Most (67%) of available platforms store data in a Cloud-based databank as opposed to institutional hard drives. CV powered analysis is featured in some platforms: phase segmentation in 44% platforms, out of body blurring or tool tracking in 33%, and suture time in 11%. Kinematic data are provided by 22% and perfusion imaging in one device. CONCLUSION Video acquisition platforms on the market allow for in depth performance analysis through manual and automated review. Most of these devices will be integrated in upcoming robotic surgical platforms. Platform analytic supplementation, including CV, may allow for more refined performance analysis to surgeons and trainees. Most current AI features are related to phase segmentation, instrument tracking, and video blurring.
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Affiliation(s)
- Filippo Filicori
- Intraoperative Performance Analytics Laboratory (IPAL), Department of General Surgery, Northwell Health, Lenox Hill Hospital, New York, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Daniel P Bitner
- Intraoperative Performance Analytics Laboratory (IPAL), Department of General Surgery, Northwell Health, Lenox Hill Hospital, New York, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Hans F Fuchs
- Department of Surgery, Division of Surgical Robotics and Artificial Intelligence, University of Cologne, Cologne, Germany
| | - Mehran Anvari
- Center for Surgical Invention and Innovation, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Ganesh Sankaranaraynan
- Artificial Intelligence and Medical Simulation (AIMS) Lab, Department of Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Matthew B Bloom
- Minimally Invasive Surgery Laboratory, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel A Hashimoto
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Amin Madani
- Surgical Artificial Intelligence Research Academy, Department of Surgery, University Health Network, Toronto, ON, Canada
| | - Pietro Mascagni
- Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
- Institute of Image-Guided Surgery, IHU-Strasbourg, Strasbourg, France
| | - Christopher M Schlachta
- Canadian Surgical Technologies & Advanced Robotics (CSTAR), London Health Sciences Centre, London, ON, Canada
| | - Mark Talamini
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Ozanan R Meireles
- Surgical Artificial Intelligence and Innovation Laboratory (SAIIL), Department of General Surgery, Massachusetts General Hospital, 15 Parkman Street, WAC 339, Boston, MA, 02139, USA.
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Komai Y, Nakajima K, Saito K, Tomioka Y, Masuda H, Ogawa A, Yonese J, Kobayashi E, Ito M. Development of a New Two-Arm Transurethral Surgical System for En Bloc Resection of Bladder Tumor: A Preclinical Study. J Endourol 2023; 37:165-170. [PMID: 36322793 DOI: 10.1089/end.2021.0917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Backgrounds and Objectives: To overcome the piecemeal nature of bladder tumor resection, en bloc resection of bladder tumor (ERBT) has been introduced. ERBT is difficult for surgeons to perform using the currently available system because it has only one arm. Herein, we aimed to develop a new transurethral surgical system to facilitate two-arm ERBT and to report the results of preclinical experiments using tumor phantoms. Methods: Initially, we aimed to develop a brand-new surgical system for ERBT but, after trial and error, we redirected our development to the creation of three elements: the left arm to grasp the tumor; the right arm to cut the tumor; and the system to operate the arms that can be attached to the existing surgical system (UES-40 SurgMaster® [Olympus Co. Ltd., Tokyo, Japan]). The current system was evaluated by performing simulated ERBTs using tumor phantoms made from konjac jelly. Results: Following the assembly of developed arms into the UES-40 SurgMaster, we conducted preliminary ERBTs. After performing several resections, we adopted a basket-shaped forceps as the left arm instead of grasping forceps and an arched electrode as the right arm. The two arms and single endoscope were placed in an equilateral triangle. We performed ERBT for the tumor phantoms that ranged from 0.5 to 2.0 cm without major redo. Conclusion: Herein, we introduced our development for two-arm ERBT. The current concept of "two-hand transurethral surgery" has the potential to be developed in future in vivo and clinical trials.
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Affiliation(s)
- Yoshinobu Komai
- Department of Urology, Canter Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.,Surgical Device Innovation Office, National Cancer Center Hospital East, Kashiwa, Japan
| | | | | | - Yutaka Tomioka
- Surgical Device Innovation Office, National Cancer Center Hospital East, Kashiwa, Japan
| | - Hitoshi Masuda
- Department of Urology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Akira Ogawa
- R&D Department, Actment Co., Ltd., Kasukabe, Japan
| | - Junji Yonese
- Department of Urology, Canter Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Etsuko Kobayashi
- Department of Precision Machinery Engineering, Faculty of Engineering, The University of Tokyo, Tokyo, Japan
| | - Masaaki Ito
- Surgical Device Innovation Office, National Cancer Center Hospital East, Kashiwa, Japan
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26
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Skovsen AP. Veres needle. Br J Surg 2022; 110:22-23. [PMID: 36301582 DOI: 10.1093/bjs/znac362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/27/2022] [Accepted: 10/03/2022] [Indexed: 12/31/2022]
Affiliation(s)
- Anders P Skovsen
- Department of Surgery, University of Copenhagen Hospital, North Zealand, Hillerød, Denmark
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27
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Tazeoglu D, Esmer AC, Benli S. Isolated Appendectomy Technique Without Mesoappendix in Laparoscopic Appendectomy. Surg Laparosc Endosc Percutan Tech 2022; 32:720-723. [PMID: 36468896 DOI: 10.1097/sle.0000000000001116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/27/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Laparoscopic appendectomy is among the most common general surgical procedures performed in developed countries. Among the most critical steps in laparoscopic appendectomy is transection of the appendix meso. This study evaluates the postoperative and economic outcomes between total mesoicular excision and isolated (traditional) appendectomy technique during appendix transsection, in line with the patients' clinicopathologic data. MATERIALS AND METHODS Patients who were operated on with the diagnosis of acute appendicits in our clinic between October 2021 and January 2022 were evaluated retrospectively. Patients were divided into 2 groups. In the first group, there is the isolated appendectomy technique in which the appendix meso is dissection from the tip of the appendix to the base of the cecum, while in the second group there is the technique in which the appendix meso is dissected from the base of the cecum. In addition, demographic data (age, sex), body mass index, presence of comorbid disease, operation time, postoperative hospital stay, health care costs, appendix size of the patients included in the study were recorded. RESULT During the study, 157 patients were included in the study. Seventy-one (45.2%) of the patients were in group 1, and 86 (54.8%) were in group 2. There was no difference between the groups regarding age, sex, body mass index, presence of comorbid disease, appendix size, and postoperative hospital stay ( P >0.05). However, operation time and health care costs were statistically higher in group 2 than in group 1 ( P =0.01). CONCLUSION Although there was no difference in postoperative complications between the isolated appendectomy technique and the mesoicular technique, the operation time was shorter, and the operation cost was lower in the isolated appendectomy technique.
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Affiliation(s)
- Deniz Tazeoglu
- Department of General Surgery, Osmaniye State Hospital, Osmaniye
| | - Ahmet C Esmer
- Department of General Surgery, Marmara University Pendik Training and Research Hospital, Istanbul
| | - Sami Benli
- Department of General Surgery, Kutahya Evliya Celebi Training and Research Hospital, Kutahya, Turkey
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28
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Wong HJ, Attaar M, Campbell M, Wu H, Kuchta K, Linn JG, Haggerty SP, Denham W, Ujiki MB. A modular simulation curriculum to teach endoscopic stenting to practicing surgeons: an "Into the fire" approach. Surg Endosc 2022; 36:6859-6867. [PMID: 35102426 DOI: 10.1007/s00464-022-09016-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 01/03/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Flexible endoscopy is a valuable tool for the gastrointestinal (GI) surgeon, creating a need for effective and efficient training curricula in therapeutic endoscopic techniques for trainees and practicing providers. Here, we present a simulation-based modular curriculum using an "into the fire" approach with hands-on pre- and post-testing to teach endoscopic stenting to practicing surgeons. METHODS Three advanced flexible endoscopy courses were taught by expert surgical endoscopists from 2018 to 2019. The stenting module involved using self-expandable metal stents to manage simulated esophageal and gastroduodenal strictures on a non-tissue GI model. Based on the educational theories of inquiry-based learning, the simulation curriculum was designed with a series of pre-tests, didactics, mentored hands-on instructions, and post-tests. Assessments included a confidence survey, knowledge-based written test, and evaluation form specific to the hands-on performance of endoscopic stenting. RESULTS Twenty-eight practicing surgeons with varying endoscopic experiences participated in the course. Most of the participants (67.9%) had completed over 100 upper endoscopic procedures and 57.1% were certified in Fundamentals of Endoscopic Surgery. After completing the modular curriculum, participant confidence survey scores improved from 11.4 ± 4.2 to 20.7 ± 4.0 (p < 0.001). Knowledge-based written test scores also improved from 7.1 ± 1.2 to 8.4 ± 0.9 (p < 0.001). In terms of technical performance, overall hands-on performance scores improved from 21.3 ± 2.7 to 28.9 ± 1.2 (p < 0.001) with significant improvement in each individual component of the assessment (all p values < 0.01) and the greatest improvement seen in equipment handling (88%) and flow of procedure (54%). CONCLUSION Our modular simulation curriculum using an "into the fire" approach to teach endoscopic stenting is effective in improving learner knowledge, confidence, and hands-on performance of endoscopic stenting. This approach to simulation is effective, efficient, and adaptable to teaching practicing surgeons with varying levels of experience.
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Affiliation(s)
- Harry J Wong
- Department of Surgery, NorthShore University Health System, 2650 Ridge Ave, GCSI rmB665, Evanston, IL, 60201, USA.
- Department of Surgery, University of Chicago Medicine, Chicago, IL, USA.
| | - Mikhail Attaar
- Department of Surgery, NorthShore University Health System, 2650 Ridge Ave, GCSI rmB665, Evanston, IL, 60201, USA
- Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Michelle Campbell
- Department of Surgery, NorthShore University Health System, 2650 Ridge Ave, GCSI rmB665, Evanston, IL, 60201, USA
- Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Hoover Wu
- Department of Surgery, NorthShore University Health System, 2650 Ridge Ave, GCSI rmB665, Evanston, IL, 60201, USA
- Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Kristine Kuchta
- Department of Surgery, NorthShore University Health System, 2650 Ridge Ave, GCSI rmB665, Evanston, IL, 60201, USA
| | - John G Linn
- Department of Surgery, NorthShore University Health System, 2650 Ridge Ave, GCSI rmB665, Evanston, IL, 60201, USA
| | - Stephen P Haggerty
- Department of Surgery, NorthShore University Health System, 2650 Ridge Ave, GCSI rmB665, Evanston, IL, 60201, USA
| | - Woody Denham
- Department of Surgery, NorthShore University Health System, 2650 Ridge Ave, GCSI rmB665, Evanston, IL, 60201, USA
| | - Michael B Ujiki
- Department of Surgery, NorthShore University Health System, 2650 Ridge Ave, GCSI rmB665, Evanston, IL, 60201, USA
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Sharma Y, De U. Pneumodissection-Aided Laparoscopic Cholecystectomy (PDLC) Using Innovative Pneumodissector in a Resource-Limited Setting. Indian J Surg 2022. [DOI: 10.1007/s12262-021-03109-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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30
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Omar I, Miller K, Madhok B, Amr B, Singhal R, Graham Y, Pouwels S, Abu Hilal M, Aggarwal S, Ahmed I, Aminian A, Ammori BJ, Arulampalam T, Awan A, Balibrea JM, Bhangu A, Brady RR, Brown W, Chand M, Darzi A, Gill TS, Goel R, Gopinath BR, Henegouwen MVB, Himpens JM, Kerrigan DD, Luyer M, Macutkiewicz C, Mayol J, Purkayastha S, Rosenthal RJ, Shikora SA, Small PK, Smart NJ, Taylor MA, Udwadia TE, Underwood T, Viswanath YK, Welch NT, Wexner SD, Wilson MSJ, Winter DC, Mahawar KK. The first international Delphi consensus statement on Laparoscopic Gastrointestinal surgery. Int J Surg 2022; 104:106766. [PMID: 35842089 DOI: 10.1016/j.ijsu.2022.106766] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/16/2022] [Accepted: 06/28/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Laparoscopic surgery has almost replaced open surgery in many areas of Gastro-Intestinal (GI) surgery. There is currently no published expert consensus statement on the principles of laparoscopic GI surgery. This may have affected the training of new surgeons. This exercise aimed to achieve an expert consensus on important principles of laparoscopic GI surgery. METHODS A committee of 38 international experts in laparoscopic GI surgery proposed and voted on 149 statements in two rounds following a strict modified Delphi protocol. RESULTS A consensus was achieved on 133 statements after two rounds of voting. All experts agreed on tailoring the first port site to the patient, whereas 84.2% advised avoiding the umbilical area for pneumoperitoneum in patients who had a prior midline laparotomy. Moreover, 86.8% agreed on closing all 15 mm ports irrespective of the patient's body mass index. There was a 100% consensus on using cartridges of appropriate height for stapling, checking the doughnuts after using circular staplers, and keeping the vibrating blade of the ultrasonic energy device in view and away from vascular structures. An 84.2% advised avoiding drain insertion through a ≥10 mm port site as it increases the risk of port-site hernia. There was 94.7% consensus on adding laparoscopic retrieval bags to the operating count and ensuring any surgical specimen left inside for later removal is added to the operating count. CONCLUSION Thirty-eight experts achieved a consensus on 133 statements concerning various aspects of laparoscopic GI Surgery. Increased awareness of these could facilitate training and improve patient outcomes.
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Affiliation(s)
- Islam Omar
- Wirral University Teaching Hospital NHS Foundation Trust, UK.
| | - Karl Miller
- King's College Hospital London, Dubai, United Arab Emirates
| | - Brijesh Madhok
- University Hospitals of Derby & Burton NHS Foundation Trust, UK
| | - Bassem Amr
- Taunton & Somerset NHS Foundation Trust, UK
| | - Rishi Singhal
- University Hospital Birmingham NHS Foundation Trust, UK
| | - Yitka Graham
- University of Sunderland, Sunderland, UK; Universidad Anahuac, Anahuac, Mexico
| | - Sjaak Pouwels
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands
| | - Mohammad Abu Hilal
- Department of Surgery, Poliambulanza Hospital Brescia, Italy; Southampton University Hospitals NHS Trust, UK
| | - Sandeep Aggarwal
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - Ali Aminian
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | | | - Altaf Awan
- University Hospitals of Derby & Burton NHS Foundation Trust, UK
| | - José María Balibrea
- Department of Gastrointestinal Surgery, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | | | | | - Wendy Brown
- Monash University Department of Surgery, Alfred Health, Australia
| | | | | | | | | | | | - Mark van Berge Henegouwen
- Department of Surgery, Amsterdam UMC, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, the Netherlands
| | | | | | | | | | - Julio Mayol
- Hospital Clinico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | - Des C Winter
- St Vincent's University Hospital, Dublin, Ireland
| | - Kamal K Mahawar
- University of Sunderland, Sunderland, UK; Bariatric Unit, South Tyneside and Sunderland Foundation Trust, UK
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Bueno MR, Estrela C. A computational modeling method for root canal endoscopy using a specific CBCT filter: A new era in the metaverse of endodontics begins. Braz Dent J 2022; 33:21-30. [PMID: 36043565 DOI: 10.1590/0103-6440202205078] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/04/2022] [Indexed: 01/16/2023] Open
Abstract
A contemporary technological revolution has started a new era in the metaverse of Endodontics, a world of virtual operational possibilities that use an exact replica of the natural structures of the maxillofacial complex. This study describes a modeling method for root canal endoscopy using modern cone-beam CT (CBCT) software in a series of clinical cases. The method consists in acquiring thin CBCT slices (0.10mm) in the coronal, sagittal, and axial planes. A specific 3D volume filter, the pulp cavity filter of the e-Vol DX CBCT software, was used to navigate anatomical root canal microstructures, and to scan them using root canal endoscopy. The pulp cavity filter should be set to synchronize CBCT scans from 2D mode - multiplanar reformations (MPR) - to 3D mode - volumetric reconstruction. This filter, when adopting the option of volumetric reconstruction, the developed algorithm leaves the dentin density in transparent mode so that the pulp cavity may be visualized. The algorithm applied performs the suppression (visual) of areas with dentin density. This ensures 3D visualization of the slices and the microanatomy of the root canal, as well as a dynamic navigation throughout the pulp cavity. This computational modeling method adds new resources to Endodontics, which may impact the predictability of root canal treatments positively. The virtual visualization of the internal anatomy of an exact replica of the canal ensures better communications, reliability, and clinical operationalization. Root canal endoscopy using this novel CBCT filter may be used for clinical applications together with innovative digital and virtual-reality resources that will be naturally incorporated into the principles of Endodontics.
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Affiliation(s)
- Mike R Bueno
- Professor of Radiology, CROIF, Diagnostic Imaging Center, Cuiabá, Brazil
| | - Carlos Estrela
- Professor of Endodontics, Department of Stomatology Sciences, Federal University of Goiás, Goiânia, Brazil
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Special Issue “The Next Generation of Upper Gastrointestinal Endoscopy”. Diagnostics (Basel) 2022; 12:diagnostics12010152. [PMID: 35054319 PMCID: PMC8775017 DOI: 10.3390/diagnostics12010152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 11/17/2022] Open
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Dewan P, Broughton E. The case for digital image capture during procedures. BJU Int 2021; 128 Suppl 3:9-10. [PMID: 34957657 DOI: 10.1111/bju.15649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Paddy Dewan
- Kind Cuts for Kids, Parkville, Vic., Australia.,Oceania University of Medicine Campus, Melbourne, Vic., Australia
| | - Emma Broughton
- Oceania University of Medicine Campus, Melbourne, Vic., Australia
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Nassimizadeh A, Lancer H, Hodson J, Ahmed S. Three-Dimensional Endoscopic Endonasal Surgery: A Systematic Review. Laryngoscope 2021; 132:1895-1903. [PMID: 34800043 DOI: 10.1002/lary.29939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 10/25/2021] [Accepted: 11/01/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To compare participant performance and preference in the use of three-dimensional (3D) endoscopy compared to traditional two-dimensional (2D) endoscopy. METHODS PubMed, Embase, Medline, ClinicalKey, BMJ Case Reports, and the Cochrane library were systematically searched for English-language articles published between 2005 and 2020. Studies reporting comparisons of outcomes between 3D and 2D endoscopes were identified. Data relating to performance-related outcomes, as well as the participants' preferred endoscope were extracted, and pooled using meta-analysis models. RESULTS Ten studies were included in the qualitative synthesis. Six studies reported results of participants completing simulated tasks with endoscopes, while four reported full procedures. Peg transfer tasks (n = 4 cohorts) were found to be completed significantly faster with the 3D versus 2D endoscope (pooled mean difference 6.8 seconds, 95% confidence interval [CI]: 2.3-11.3), while no significant difference in times taken was observed for touch tasks (n = 4; pooled mean difference 3.7 seconds, 95% CI: -1.9 to 9.2). The secondary outcome of participant preference was reported by five studies, in which a significant preference for the 3D endoscope was observed (P = .010), with a pooled total of 72% (95% CI: 59-83) of participants preferring this to the 2D endoscope. CONCLUSIONS There is a growing body of evidence in support of 3D visualization in endoscopy. We have demonstrated 3D endoscopy to be associated with a significantly shorter time to performing simulated, reproducible and controlled tasks, and to be the preference of participants. This study provides grounds for further evaluation of the technology, and the potential for a greater widespread use. Laryngoscope, 2021.
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Affiliation(s)
- Abdul Nassimizadeh
- Department of Otolaryngology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Hannah Lancer
- Department of Otolaryngology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - James Hodson
- Institute of Translational Medicine, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Shahzada Ahmed
- Department of Otolaryngology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
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Major AL, Jumaniyazov K, Yusupova S, Jabbarov R, Saidmamatov O, Mayboroda-Major I. Laparoscopy in Gynecologic and Abdominal Surgery in Regional (Spinal, Peridural) Anesthesia, the Utility of the Technique during COVID-19 Pandemic. MEDICINES (BASEL, SWITZERLAND) 2021; 8:60. [PMID: 34677489 PMCID: PMC8541053 DOI: 10.3390/medicines8100060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/07/2021] [Accepted: 10/12/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND laparoscopic surgery is mainly performed in general anesthesia. Symptomatic patients infected with COVID-19 needing surgery are however at higher risk for COVID-19 complications in general anesthesia than in regional anesthesia. Even so, Covid transfection is a hazard to medical personnel during the intubation procedure and treatment drugs may be in shortage during a pandemic. Recovery and hospital stay are also shorter after laparoscopy. Laparoscopy performed in regional anesthesia may have several advantages in limiting Covid. METHODS international literature on the risk of COVID-19 complications development was searched. 3 topics concerning laparoscopic surgery were reviewed: (1) Achievements in laparoscopy; (2) Advantages of regional anesthesia compared to general anesthesia; (3) Feasibility to perform laparoscopy in regional anesthesia in COVID-19 pandemic. The authors reviewed abstracts and full-text articles concerning laparoscopic surgery, gynecology, anesthesia and COVID-19. Studies published in PubMed, Embase, Cochrane Library and found in Google Scholar before 1st FEB, 2021 were retrieved and analyzed. RESULTS a total of 83 studies were found, all of them written in English. 17 studies could be found in gynecology and in general surgery about laparoscopy with regional anesthesia. In Covid time only one study compared laparoscopic surgery in general anesthesia to laparotomy and another study laparotomy in general anesthesia to regional anesthesia. Laparoscopy showed no disadvantage compared to laparotomy in Covid pandemic and in another study laparotomy in general anesthesia was associated with higher mortality and more pulmonary complications. Trendelenburg position can be a threat if used by inexperienced personnel and can induce unintended anesthesia of breathing organs. On the other hand Trendelenburg position has advantages for cardiovascular and pulmonary functions. Pneumoperitoneum of low CO2 pressure is well tolerated by patients. CONCLUSIONS elective surgery should be postponed in symptomatic Covid patients. In inevitable emergency surgery intubation anesthesia in COVID-19 pandemic is as far as possible to be avoided. In COVID-19 pandemic, regional anesthesia is the preferred choice. The optimum may be the combination of laparoscopic surgery with regional anesthesia. Reducing the pneumoperitoneum is a good compromise for the comfort of patients and surgeons. A special case is gynecology, which needs to be performed in Trendelenburg position to free pelvic organs.
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Affiliation(s)
- Attila Louis Major
- Femina Gynecology Centre, CH-1205 Geneva, Switzerland
- Department of Obstetrics & Gynecology, University of Fribourg, CH-1700 Fribourg, Switzerland
| | - Kudrat Jumaniyazov
- Department of Obstetrics and Gynecology, Urgench Branch of Tashkent Medical Academy, Urgench 220100, Uzbekistan; (K.J.); (S.Y.); (R.J.)
| | - Shahnoza Yusupova
- Department of Obstetrics and Gynecology, Urgench Branch of Tashkent Medical Academy, Urgench 220100, Uzbekistan; (K.J.); (S.Y.); (R.J.)
| | - Ruslan Jabbarov
- Department of Obstetrics and Gynecology, Urgench Branch of Tashkent Medical Academy, Urgench 220100, Uzbekistan; (K.J.); (S.Y.); (R.J.)
| | - Olimjon Saidmamatov
- Faculty of Tourism and Economics, Urgench State University, Urgench 220100, Uzbekistan
| | - Ivanna Mayboroda-Major
- Department of Gynecology and Obstetrics, University Hospital of Geneva, CH-1205 Geneva, Switzerland
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Biswas SK. The Digital Era and the Future of Pediatric Surgery. J Indian Assoc Pediatr Surg 2021; 26:279-286. [PMID: 34728911 PMCID: PMC8515525 DOI: 10.4103/jiaps.jiaps_136_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 07/09/2021] [Indexed: 11/21/2022] Open
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Cabrera Vargas LF, Pedraza M, Rincon FA, Pulido JA, Mendoza-Zuchini A, Gomez D, Moreno-Villamizar MD, Ferrada P, Lopez P, Di Saverio S. Fully therapeutic laparoscopy for penetrating abdominal trauma in stable patients. Am J Surg 2021; 223:206-207. [PMID: 34294385 DOI: 10.1016/j.amjsurg.2021.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/23/2021] [Accepted: 07/08/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Luis Felipe Cabrera Vargas
- Department of Surgery, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio de Bogotá, Colombia; Department of Vascular Surgery, Universidad Militar Nueva Granada, Bogotá, Colombia.
| | - Mauricio Pedraza
- Department of General Surgery, Universidad El Bosque, Bogotá, Colombia.
| | | | | | - Andres Mendoza-Zuchini
- Departamento General Surgery, Cobos Medical Center, Universidad El Bosque, Bogotá Colombia.
| | - Daniel Gomez
- Departamento General Surgery, Universidad Militar Nueva Granada, Bogotá, Colombia.
| | | | - Paula Ferrada
- Department of Surgery, Virginia Commonwealth University Medical Center, 16th Floor, West Hospital, 1200 E. Broad Street, Richmond, VA 23219, USA.
| | - Paula Lopez
- Departament of General Surgery, Universidad El Bosque, Avenida Cra 9 # 131a-20, Bogotá, Colombia.
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Stark M, Witzel K, Benhidjeb T, Becker S. Added value of surgical interdisciplinarity- The Joel-Cohen's abdominal incision. Ann Med Surg (Lond) 2021; 67:102455. [PMID: 34158931 PMCID: PMC8196051 DOI: 10.1016/j.amsu.2021.102455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/26/2021] [Accepted: 05/26/2021] [Indexed: 10/27/2022] Open
Abstract
Background Surgical methods have profited from the exchange of knowledge among different specialties. Endoscopy which was introduced by gynecologists, surgeons, and internists is used now by all disciplines, and most of yesterday's laparotomies have now endoscopic alternatives. However, laparotomies are still needed, and there is no agreement among surgeons about what is the optimal abdominal incision. The Joel-Cohen incision which is used by gynecologists and obstetricians could become a valid alternative to the methods in use. Method The Joel-Cohen Method, which was evolved for abdominal hysterectomy is described here in detail. Only two instruments are used to open the abdomen, usually with no need for hemostasis. Conclusion The Joel-Cohen incision is suggested as a valid alternative for any emergency or elective surgical or urological abdominal operation. Its benefits are short operation time diminished blood loss and less need for analgesics.
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Affiliation(s)
| | - Kai Witzel
- The New European Surgical Academy, Berlin, Germany.,Paracelsus Medical University, Salzburg, Austria
| | - Tahar Benhidjeb
- The New European Surgical Academy, Berlin, Germany.,Department of General and Visceral Surgery, Center of Visceral Medicine, Evangelisches Klinikum Bethel, Bielefeld, Germany
| | - Sven Becker
- The New European Surgical Academy, Berlin, Germany.,Dep. of Gynaecologic Oncology and Specialities, University Hospital Frankfurt, Germany
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Shah AA, Bandari J, Pelzman D, Davies BJ, Jacobs BL. Diffusion and adoption of the surgical robot in urology. Transl Androl Urol 2021; 10:2151-2157. [PMID: 34159097 PMCID: PMC8185660 DOI: 10.21037/tau.2019.11.33] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Over the last two decades, robotic surgery has become a mainstay in hospital systems around the world. Leading this charge has been Intuitive Surgical Inc.’s da Vinci robotic system (Sunnyvale, CA, USA). Through its innovative technology and unique revenue model, Intuitive has installed 4,986 robotic surgical systems worldwide in the last two decades. The rapid rate of adoption and diffusion of the surgical robot has been propelled by many important industry-specific factors. In this review, we propose a model that explains the successful adoption of robotic surgery due to its three core groups: the surgeon, the hospital administrator, and the patient.
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Affiliation(s)
- Anup A Shah
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jathin Bandari
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Daniel Pelzman
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Benjamin J Davies
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Bruce L Jacobs
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Shao MM, Rubino S, DiRisio DJ, German JW. The History of Neurosurgical Spinal Oncology: From Inception to Modern-Day Practices. World Neurosurg 2021; 150:101-109. [PMID: 33771747 DOI: 10.1016/j.wneu.2021.03.082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/16/2021] [Indexed: 02/05/2023]
Abstract
The neurosurgical management of spinal neoplasms has undergone immense development in parallel with advancements made in general spine surgery. Laminectomies were performed as the first surgical procedures used to treat spinal neoplasms. Since then, neurosurgical spinal oncology has started to incorporate techniques that have developed from recent advances in minimally invasive spine surgery. Neurosurgery has also integrated radiotherapy into the treatment of spine tumors. In this historical vignette, we present a vast timeline spanning from the Byzantine period to the current day and recount the major advancements in the management of spinal neoplasms.
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Affiliation(s)
- Miriam M Shao
- Department of Neurosurgery, Albany Medical College, Albany, New York, USA.
| | - Sebastian Rubino
- Department of Neurosurgery, Albany Medical College, Albany, New York, USA
| | - Darryl J DiRisio
- Department of Neurosurgery, Albany Medical College, Albany, New York, USA
| | - John W German
- Department of Neurosurgery, Albany Medical College, Albany, New York, USA
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Smith JP, Thiel J, Singh SS, Allaire C, Warrington S, Murji A. Understanding Minimally Invasive Gynaecologic Surgery Fellowship Training in Canada: A National Survey of Recent Graduates. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:699-706.e8. [PMID: 33581348 DOI: 10.1016/j.jogc.2021.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To characterize fellowship training experiences in the 11 Canadian minimally invasive gynaecologic surgery (MIGS) programs and compare the surgical exposure of fellows in these programs to that of the American Association of Gynecologic Laparoscopists (AAGL) accredited fellowship in MIGS (FMIGS). METHODS In this cross-sectional study, 2017 and 2018 MIGS fellowship graduates across Canada were given a web-based survey via SurveyMonkey software to evaluate 5 key components of postgraduate fellowship curricula: 1) surgical exposure; 2) teaching and evaluation methods; 3) research experience; 4) clinical responsibilities; and 5) pursuit of other academic endeavours. Interest in creating a national standardized curriculum and seeking accreditation for MIGS fellowships were also examined. RESULTS The survey attained a 91% (20/22) response rate of the target population. All Canadian MIGS programs met the minimum standards for at least 62% (8/13) of the surgical competencies listed by the AAGL, with office hysteroscopy being the procedure with the largest discordance. Half of respondents (10/20) attended a program with an established curriculum, and 75% (15/20) believed there would be a benefit to standardizing training nationwide. Seventy percent (14/20) had published at least one manuscript during their fellowship and 60% (12/20) pursued postgraduate degrees. The majority (55%; 11/20) felt certain that MIGS should become a credentialed fellowship in Canada. CONCLUSION Canada has made meaningful progress in MIGS training over the past decade with 11 well-established fellowship programs. Although this survey identifies a general interest in standardized training and accreditation for Canadian MIGS programs, more research is needed on how best to accomplish this.
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Affiliation(s)
- Jessica Papillon Smith
- Department of Obstetrics and Gynecology, McGill University, Glen Hospital, Montréal, QC.
| | - John Thiel
- Department of Obstetrics and Gynaecology, University of Saskatchewan, Saskatchewan Health Authority, Saskatoon, SK
| | - Sukhbir S Singh
- Department of Obstetrics, Gynecology and Newborn Care, University of Ottawa, The Ottawa Hospital, Ottawa, ON
| | - Catherine Allaire
- Department of Obstetrics and Gynecology, University of British Columbia, BC Women's Centre for Pelvic Pain and Endometriosis, Vancouver, BC
| | - Steven Warrington
- Department of Emergency Medicine, Orange Park Medical Center, Orange Park, FL
| | - Ally Murji
- Department of Obstetrics and Gynaecology, University of Toronto, Mount Sinai Hospital, Toronto, ON
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Gordon V, Chowdhury A, Keim S. Etiology and Comorbidity Diagnoses Effect on Outcomes for Patients Undergoing Endoscopic Retrograde Cholangiopancreatography. Cureus 2020; 12:e10209. [PMID: 33042658 PMCID: PMC7534508 DOI: 10.7759/cureus.10209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction Endoscopic retrograde cholangiopancreatography (ERCP) is now the first-line approach to treating choledocholithiasis. As a minimally invasive procedure, it is considered relatively safe but still entails a higher risk than other routine endoscopic procedures. This study aims to look at possible patient etiologies and comorbidities that may affect patient outcomes. Methods This study used the Nationwide Inpatient Sample (NIS) from the years 2012 - 2015 to collect anonymous patient data through the use of International Classification of Diseases, Ninth Revision (ICD-9) codes. Specific codes were used to determine the top five etiologies (or presenting diagnosis) for patients who had this surgery and to separate outpatients with specific comorbidity diagnoses. The IBM Statistical Package for Social Sciences (SPSS) (IBM SPSS Statistics, Armonk, NY) was then used to compare patients with these diagnoses or etiologies to those without to measure differences in patient outcomes, such as mortality, length of stay, and total charges. Results Patients who had an etiological diagnosis of acute kidney failure had worse outcomes than patients who were admitted for ERCP without that etiological diagnosis. There were also specific comorbidity diagnoses that were noted to have worse patient outcomes, including congestive heart failure, diabetes mellitus with complications, a coagulopathy disorder, anemia, or chronic liver disease. Additionally, patients who had both acute kidney disease and chronic liver disease had the worst outcomes. Conclusions This study highlights the need to understand all patient risk factors before having them undergo ERCP, especially in the setting of scheduled surgery. Working to control these factors before surgery can increase the possibility of avoiding negative outcomes like mortality, increased patient costs, and increased length of stay.
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Affiliation(s)
- Victoria Gordon
- Anatomy, Kansas City University of Medicine and Biosciences, Kansas City, USA
| | - Anni Chowdhury
- Anatomy, Kansas City University of Medicine and Biosciences, Kansas City, USA
| | - Sarah Keim
- General Surgery, The University of Kansas Medical Center, Kansas City, USA
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Kauffman JD, Nguyen ATH, Litz CN, Farach SM, DeRosa JC, Gonzalez R, Amankwah EK, Danielson PD, Chandler NM. Laparoscopic-guided versus transincisional rectus sheath block for pediatric single-incision laparoscopic cholecystectomy: A randomized controlled trial. J Pediatr Surg 2020; 55:1436-1443. [PMID: 32247598 DOI: 10.1016/j.jpedsurg.2020.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 01/02/2020] [Accepted: 03/02/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of our study was to compare the effectiveness of transincisional (TI) versus laparoscopic-guided (LG) rectus sheath block (RSB) for pain control following pediatric single-incision laparoscopic cholecystectomy (SILC). METHODS Forty-eight patients 10-21 years old presenting to a single institution for SILC from 2015 to 2018 were randomized to TI or LG RSB. Apart from RSB technique, perioperative care protocols were identical between groups. Pain scores were assessed with validated measures upon arrival in the postanesthesia care unit (PACU) and at regular intervals until discharge. The patients and those assessing them were blinded to RSB technique. The primary outcome was pain score 60 min after PACU arrival. Secondary outcomes included pain scores throughout the PACU stay, opioids (reported as morphine milligram equivalents (MME) per kg bodyweight) administered in PACU, length of stay, outpatient pain scores and opioid use, and adverse events. Groups were compared on outcomes using t test and generalized estimating equations for continuous variables and Fisher's exact test for categorical variables with significance at α = 0.05. RESULTS Mean age of the 48 subjects was 15 years (range = 11-20). The majority (79%) were female. Indications for surgery included symptomatic cholelithiasis (n = 41), acute cholecystitis (n = 4), gallstone pancreatitis (n = 2) and choledocholithiasis (n = 1). Mean (standard deviation) operative time was 61 (±23) min overall. No statistically significant differences in demographics, indication, operative time, or intraoperative analgesia were observed between TI (n = 24) and LG (n = 24) groups. The mean 60-min pain score was 3.4 (±2.6) in the LG group versus 3.8 (±2.1) in the TI group (p = 0.573). No significant differences were detected between groups in overall PACU or outpatient pain scores, PACU or outpatient opioid use, length of stay, or incidence of complications. Overall, mean opioid use was 0.1 MME/kg in the PACU and 0.5 MME/kg in the outpatient setting. Mean postoperative length of stay was 0.2 day. There were no major complications. CONCLUSION Laparoscopic-guided rectus sheath block is not superior to transincisional rectus sheath block for pain control following pediatric single-incision laparoscopic cholecystectomy. The single-incision laparoscopic approach combined with rectus sheath block resulted in effective pain control, low opioid use, and expedited length of stay with no major complications. LEVEL OF EVIDENCE Level I, treatment study, randomized controlled trial.
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Affiliation(s)
- Jeremy D Kauffman
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA.
| | - Anh Thy H Nguyen
- Department of Health Informatics, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA.
| | - Cristen N Litz
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA.
| | - Sandra M Farach
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA.
| | - JoAnn C DeRosa
- Clinical and Translational Research Organization, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA.
| | - Raquel Gonzalez
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA.
| | - Ernest K Amankwah
- Department of Health Informatics, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA.
| | - Paul D Danielson
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA.
| | - Nicole M Chandler
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA.
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Morais PHAD, Silva RFA, Ribeiro TDS, Farias IECD, Lino Junior RDS, Carneiro FP, Durães LDC, Sousa JBD. Does CO2 pneumoperitoneum in laparoscopy interfere with collagen deposition in abdominal surgical wounds? Acta Cir Bras 2020; 35:e202000605. [PMID: 32667584 PMCID: PMC7357835 DOI: 10.1590/s0102-865020200060000005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 05/03/2020] [Indexed: 01/20/2023] Open
Abstract
Purpose To determine by histomorphometric analysis whether CO2 pneumoperitoneum interferes with collagen deposition in surgical wounds in the aponeurosis of rats. Methods This experiment involved 80 male Wistar rats, randomly allocated into four groups according to pneumoperitoneum period (PRE: 30 min preoperatively; POST: 30 min postoperatively; PP: 30 min pre- and postoperatively; C: control group). CO2 pneumoperitoneum was insufflated to 5 mmHg of pressure. A laparotomy was performed; 1 cm of the left colon was then resected, and an end-to-end anastomosis was performed to simulate surgical trauma, after which the abdominal wall was closed. On postoperative days 7 or 14, a sample of the abdominal wall was collected, stained with picrosirius red and observed under polarized light in an optical microscope. The amount of collagen was estimated by computerized histomorphometric analysis. Results There were no significant differences in collagen deposition between the control and experimental groups on postoperative days 7 (p=0.720) or 14 (p=0.933). The amount of collagen increased as expected in all groups between postoperative days 7 and 14 (p=0.0003). Conclusion At 5 mmHg, CO2 pneumoperitoneum does not interfere with collagen deposition in abdominal wall surgical wounds in rats.
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Scott J, Singh A, Valverde A. Pneumoperitoneum in Veterinary Laparoscopy: A Review. Vet Sci 2020; 7:E64. [PMID: 32408554 PMCID: PMC7356543 DOI: 10.3390/vetsci7020064] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 04/27/2020] [Accepted: 05/09/2020] [Indexed: 01/25/2023] Open
Abstract
Objective: To review the effects of carbon dioxide pneumoperitoneum during laparoscopy, evaluate alternative techniques to establishing a working space and compare this to current recommendations in veterinary surgery. Study Design: Literature review. Sample Population: 92 peer-reviewed articles. Methods: An electronic database search identified human and veterinary literature on the effects of pneumoperitoneum (carbon dioxide insufflation for laparoscopy) and alternatives with a focus on adaptation to the veterinary field. Results: Laparoscopy is the preferred surgical approach for many human and several veterinary procedures due to the lower morbidity associated with minimally invasive surgery, compared to laparotomy. The establishment of a pneumoperitoneum with a gas most commonly facilitates a working space. Carbon dioxide is the preferred gas for insufflation as it is inert, inexpensive, noncombustible, colorless, excreted by the lungs and highly soluble in water. Detrimental side effects such as acidosis, hypercapnia, reduction in cardiac output, decreased pulmonary compliance, hypothermia and post-operative pain have been associated with a pneumoperitoneum established with CO2 insufflation. As such alternatives have been suggested such as helium, nitrous oxide, warmed and humidified carbon dioxide and gasless laparoscopy. None of these alternatives have found a consistent benefit over standard carbon dioxide insufflation. Conclusions: The physiologic alterations seen with CO2 insufflation at the current recommended intra-abdominal pressures are mild and of transient duration. Clinical Significance: The current recommendations in veterinary laparoscopy for a pneumoperitoneum using carbon dioxide appear to be safe and effective.
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Affiliation(s)
- Jacqueline Scott
- College of Veterinary Medicine, University of Illinois, Urbana-Champaign, IL 61802, USA
| | - Ameet Singh
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada; (A.S.); (A.V.)
| | - Alexander Valverde
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada; (A.S.); (A.V.)
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Visconti TADC, Otoch JP, Artifon ELDA. Robotic endoscopy. A review of the literature. Acta Cir Bras 2020; 35:e202000206. [PMID: 32348403 PMCID: PMC7184939 DOI: 10.1590/s0102-865020200020000006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 01/28/2020] [Indexed: 12/12/2022] Open
Abstract
Purpose To present new endoscopic robotic devices in the context of minimally invasive procedures with high precision and automation. Methods Review of the literature by December 2018 on robotic endoscopy. Results We present the studies and investments for robotic implementation and flexible endoscopy evolution. We divided them into forceps manipulation platforms, active endoscopy and endoscopic capsule. They try to improve forceps handling and stability and to promote active movement. Conclusion The implementation and propagation of robotic models depend on doing what the endoscopist is unable to. The new devices are moving forward in this direction.
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Loftus TJ, Filiberto AC, Balch J, Ayzengart AL, Tighe PJ, Rashidi P, Bihorac A, Upchurch GR. Intelligent, Autonomous Machines in Surgery. J Surg Res 2020; 253:92-99. [PMID: 32339787 DOI: 10.1016/j.jss.2020.03.046] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/22/2020] [Accepted: 03/08/2020] [Indexed: 02/08/2023]
Abstract
Surgeons perform two primary tasks: operating and engaging patients and caregivers in shared decision-making. Human dexterity and decision-making are biologically limited. Intelligent, autonomous machines have the potential to augment or replace surgeons. Rather than regarding this possibility with denial, ire, or indifference, surgeons should understand and steer these technologies. Closer examination of surgical innovations and lessons learned from the automotive industry can inform this process. Innovations in minimally invasive surgery and surgical decision-making follow classic S-shaped curves with three phases: (1) introduction of a new technology, (2) achievement of a performance advantage relative to existing standards, and (3) arrival at a performance plateau, followed by replacement with an innovation featuring greater machine autonomy and less human influence. There is currently no level I evidence demonstrating improved patient outcomes using intelligent, autonomous machines for performing operations or surgical decision-making tasks. History suggests that if such evidence emerges and if the machines are cost effective, then they will augment or replace humans, initially for simple, common, rote tasks under close human supervision and later for complex tasks with minimal human supervision. This process poses ethical challenges in assigning liability for errors, matching decisions to patient values, and displacing human workers, but may allow surgeons to spend less time gathering and analyzing data and more time interacting with patients and tending to urgent, critical-and potentially more valuable-aspects of patient care. Surgeons should steer these technologies toward optimal patient care and net social benefit using the uniquely human traits of creativity, altruism, and moral deliberation.
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Affiliation(s)
- Tyler J Loftus
- Department of Surge ry, University of Florida Health, Gainesville, Florida
| | - Amanda C Filiberto
- Department of Surge ry, University of Florida Health, Gainesville, Florida
| | - Jeremy Balch
- Department of Surge ry, University of Florida Health, Gainesville, Florida
| | | | - Patrick J Tighe
- Departments of Biomedical Engineering, Computer and Information Science and Engineering, and Electrical and Computer Engineering, University of Florida, Gainesville, Florida
| | - Parisa Rashidi
- Departments of Anesthesiology, Orthopedics, and Information Systems/Operations Management, University of Florida Health, Gainesville, Florida
| | - Azra Bihorac
- Department of Medicine, University of Florida Health, Gainesville, Florida
| | - Gilbert R Upchurch
- Department of Surge ry, University of Florida Health, Gainesville, Florida.
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Zhao J, Samaan JS, Toubat O, Samakar K. Laparoscopy as a Diagnostic and Therapeutic Modality for Chronic Abdominal Pain of Unknown Etiology: A Literature Review. J Surg Res 2020; 252:222-230. [PMID: 32289579 DOI: 10.1016/j.jss.2020.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/14/2020] [Accepted: 03/08/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Investigate the diagnostic and therapeutic utility of laparoscopy in the management of patients with chronic abdominal pain of unknown origin. METHODS Ovid MEDLINE, PubMed, and SCOPUS databases were queried to identify relevant published studies. Data on the diagnostic and therapeutic utility of laparoscopy were abstracted and summarized. RESULTS Laparoscopy achieved a diagnosis in 65% to 94% of patients with chronic abdominal pain of unknown origin. Common intraoperative findings included adhesions, chronic appendicitis, hernias, and enlarged mesenteric lymph nodes. These findings corresponded with the therapeutic procedures that were performed, including laparoscopic adhesiolysis, appendectomy, and hernia repair. Therapeutic utility of laparoscopy based on pain relief, patient satisfaction, and quality of life ranged from 63% to 94%. CONCLUSIONS Based on current available evidence, diagnostic laparoscopy (DL) is a safe and effective method for identifying organic causes of chronic abdominal pain. Laparoscopic treatment also resulted in substantial pain relief for a majority of patients. However, the efficacy of laparoscopic adhesiolysis remains controversial. We would recommend the use of DL as an early diagnostic tool, but more robust studies are needed to establish the breadth of its therapeutic utility in clinical practice.
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Affiliation(s)
- Jasmine Zhao
- Division of Upper GI and General Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Jamil S Samaan
- Department of Medicine, Cedars Sinai Medical Center, Los Angeles, California
| | - Omar Toubat
- Division of Upper GI and General Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Kamran Samakar
- Division of Upper GI and General Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California.
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Big colon surgery, little incisions: Minimally invasive techniques in emergent colon surgery. J Trauma Acute Care Surg 2020; 89:e1-e6. [PMID: 32068715 DOI: 10.1097/ta.0000000000002616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Chiofalo B, Palmara V, Vilos GA, Pacheco LA, Lasmar RB, Shawki O, Giacobbe V, Alibrandi A, Di Guardo F, Vitale SG. Reproductive outcomes of infertile women undergoing "see and treat" office hysteroscopy: a retrospective observational study. MINIM INVASIV THER 2019; 30:147-153. [PMID: 31855088 DOI: 10.1080/13645706.2019.1705352] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION This study aimed to assess the feasibility and efficacy of office hysteroscopy to diagnose and treat the specific uterine pathologies frequently diagnosed and thought to be associated with female infertility. MATERIAL AND METHODS Using office hysteroscopy, we examined the uterine cavity in women with primary or secondary infertility and evaluated the reproductive outcomes of those affected by one or more pathologies, including cervico-isthmic adhesions, intrauterine polyps and intrauterine adhesions. Additional patient characteristics considered were age and parity, uterine pathology, pain during hysteroscopy, and outcomes including spontaneous pregnancies achieved and time between treatment and pregnancy. RESULTS Reproductive outcomes of 200 patients affected by one or more uterine pathologies were evaluated. Cervico-isthmic adhesions were the most frequent findings in older women, with nearly 80% of them achieving pregnancy sooner than the others in our study. Spontaneous pregnancy rates following office hysteroscopy were 76%, 53% and 22% in women with cervico-isthmic adhesions, polyps (< 5 mm) and intrauterine adhesions, respectively. CONCLUSIONS Office hysteroscopy is a feasible and highly effective diagnostic and therapeutic procedure for cervico-isthmic and intrauterine adhesions, as well as for small polyps, allowing the resolution of female infertility related to these pathologies, without trauma and with only minimal discomfort.
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Affiliation(s)
- Benito Chiofalo
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy
| | - Vittorio Palmara
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy
| | - George Angelos Vilos
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Western University, London, Canada
| | | | | | - Osama Shawki
- Department of Obstetrics and Gyneacology, School of Medicine, Cairo University, Cairo, Egypt
| | - Valentina Giacobbe
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy
| | - Angela Alibrandi
- Department of Economics, Unit of Statistical and Mathematical Sciences, University of Messina, Messina, Italy
| | - Federica Di Guardo
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
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