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Surgical Technology International XXII contains 46 articles with color illustrations.

 

Universal Medical Press, Inc.

San Francisco, December, 2012

ISBN: 1-890131-18-0

 

1 year Institutional Subscription 

both electronic and print versions.

 

 

 

 

 

 

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Sections

Surgical Overview

 

Telelap Alf-X. A novel telesurgical system for the 21st Century

Stefano Gidaro, Assistant Professor, Department of Surgical Science
"G.D'Annunzio" University School of Medicine, Chieti-Pescara, Italy
Maurizio Buscarini, Associate Professor, Department of Urology
Campus Biomedico, University School of Medicine, Roma, Italy
Emilio Ruiz, ALF-X Surgical Robotics Department, SOFAR S.p.A., Milan, Italy Michael Stark, The New European Surgical Academy, Berlin, Germany, Anna Labruzzo, Eng., Head of Alf-X Surgical Robotics, Department, SOFAR SpA., Milan, Italy

PMID: 23225591

Abstract

Objective: To introduce a new telesurgical concept and system, we describe the TELELAP Alf-X system and report the results of the preliminary laboratory experiments on dry lab skill exercises.
Methods: The TELELAP Alf-X system offers a novel approach to remotely operated 3-dimension endoscopy by adding haptic sensation, an eye-tracking system, and a high degree of configuration versatility. The Alf-X system consists of a remote control unit, manipulator arms, connection node, and reusable endoscopic instruments. To test the hand-eye coordination, manual dexterity, depth of field, and ability to make optimal sutures and knots, the Alf-X system was used in a laparoscopic trainer utilizing specific tools by a single surgeon (SG) who repeated three different exercises ten times. The time and accuracy of the exercises were recorded.
Results: By using the TELELAP Alf-X system, the surgeon was able to work repeatedly and to perform all the exercises scheduled. In all exercises, the best results were achieved after the first five cases.
Conclusion: The TELELAP Alf-X system shows excellent stability, easy-to-use interface, and ability to perform essential endoscopic skills. Further experimentation, especially in live tissue, could identify the role of this new technology for the surgical repertoire.

 

 

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Karl Storz
  • Karl Storz Karl Storz

Laparoscopic Fluorescence Angiography with Indocyanine Green to Control the Perfusion of Gastrointestinal Anastomoses Intraoperatively
Thomas Carus, MD Professor of Minimally Invasive Surgery Department of Surgery, Center for Minimally Invasive Surgery University of Bremen, Klinikum Bremen-Ost, Head of Surgery, Hospital Bremen-Ost, Bremen, Germany, Professor, Department Of Medical Engineering University of Applied Sciences, Bremerhaven, Germany, Rainer Dammer PhD, Professor, Department of Medical Engineering, University of Applied Sciences, Bremerhaven, Germany

PMID: 23315721

Abstract

The principle of fluorescence angiography using indocyanine green has been known for a long time and was used especially by photographs and ophthalmologists for retinal diagnostics. After one publication about perfusion control in open surgery we were the first who examined the perfusion of colorectal anastomoses by laparoscopic fluorescence angiography intraoperatively. Since 2008, 49 laparoscopic operations (45 colorectal anastomoses, 4 gastric sleeve resections) were performed using the fluorescence control. In all cases a correct perfusion of the anastomotic/stapler region could be shown. In cases of decreased perfusion a resection of this area could have been necessary. The laboratory tests with isolated, perfused pig colon could show areas with hypoperfusion after dissection of segmental arteries. Laparoscopic fluorescence angiography could become a standard method to detect a decreased perfusion intraoperatively. Further studies will be needed to show if the rate of anastomotic insufficiency can be lowered by using this new method.

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Choice of Device for Parenchymal Transection in Laparoscopic Hepatectomy

Umut Sarpel, MD, Assistant Professor of Surgery Mount Sinai School of Medicine New York, NY Diego M. Ayo, MD, Surgical Resident, New York University School of Medicine New York, NY, Elliott J. Newman, MD, Associate Professor of Surgery New York University School of Medicine New York, NY

PMID: 23023571

Abstract

Background: Laparoscopic hepatic surgery has only recently become an established field. Technological limitations in devices used to transect the liver parenchyma and control hemostasis have been a rate limiting step. However, as a result of advances in products specifically tailored to liver surgery, there has been steady progress in the complexity of laparoscopic hepatectomies performed, from the minimally invasive fenestration of liver cysts, to peripheral wedge resections, major hepatectomy, and recently donor hepatectomy. Herein, we discuss the role of several laparoscopic devices which include the endoscopic stapler, pre-coagulators, ultrasonic dissector, ultrasonic shears, and vessel sealing devices. Conclusion: Laparoscopic liver surgery introduces new challenges to even the experienced surgeon. It is important to have a solid understanding of the advantages and limitations of available instruments in order to safely and effectively expand the use of laparoscopy in hepatic surgery.

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Initial Experience with an Innovative Endoscopic Clipping System
Alisa M. Coker, MD, Research Fellow, University of California San Diego, La Jolla, CA , Garth R. Jacobsen, MD, FACS, Assistant Professor of Surgery, University of California San Diego , Department of Surgery, Division of Minimally Invasive Surgery. San Diego, California, Geylor Acosta, MD, Research Fellow, University of California San Diego, Department of Surgery, Division of Minimally Invasive Surgery, San Diego, California, Mark A. Talamini, MD, Professor of Surgery, Chairman,University of California San Diego, Department of Surgery, Division of Minimally Invasive Surgery, San Diego, California,Thomas J. Savides MD, Professor of Clinical Medicine, Clinical Service Chief, University of California San Diego, Department of Medicine, Division of Gastroenterology, San Diego, California, Santiago Horgan, MD, FACS, Professor of Surgery, Division Chief, University of California San Diego, Department of Surgery, Division of Minimally Invasive Surgery, San Diego, California

PMID: 23225590

Abstract

There are few options for the treatment of fistulas, leaks, and perforations endoscopically. Here we describe our experience with an endoscopic clipping system. A retrospective review of all cases using the Over-The-Scope-Clip system (Ovesco Endoscopy AG, Tuebingen, Germany) was performed. The system was utilized in ten patients with gastrointestinal surgical complications. Four patients had gastric leaks following sleeve gastrectomy, one had a post-operative colonic leak, two had gastro-gastric fistulas following gastric bypass, and three had esophageal perforations. Two leak patients had complete resolution, one had a contained leak following clip placement that was clinically insignificant, and the fourth patient had a persistent leak despite two clipping procedures. Two patients had gastro-gastric fistulas following roux-en-y gastric bypass surgery and, while they both had initial success, the fistulas recurred. One patient presented with anastomotic leak following colon resection but the system was unable to reach the treatment site. Three patients were successfully treated for esophageal perforation. There were no complications.

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The Safety and Biocompatibility of Gelatin Hemostatic Matrix (Floseal and Surgiflo) in Neurosurgical Procedures

Roberto Gazzeri, MD, Marcelo Galarza, MD, Alex Alfier, MD, Department of Neurosurgery, San Giovanni Addolorata Hospital, Rome, Italy

PMID:22915500

Abstract

Adequate hemostasis in cranial and spinal surgery is of paramount importance in a neurosurgeon's daily practice. Generalized ooze bleeding from the surgical wall cavities, coming from the dura mater or nervous tissue may be troublesome and may limit visualization in minimally invasive neurosurgery. Hemostatic matrix is a mixture of a flowable gelatin matrix (bovine or porcine) and a thrombin component mixed together. A total of 318 patients undergoing cranial, craniospinal, and spinal procedure with the use of gelatin hemostatic matrix (Floseal and Surgiflo) were enrolled in this clinical study. We compared the different hemostatic techniques using the gelatin hemostatic matrix, and investigated indications, time to bleeding control, and its efficacy and safety in neurosurgery.

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The Use of Rotational Bladder Flap and Hemostatic Matrix Sealant (FloSeal): A Modified Transabdominal Approach to Repair Supratrigonal and Complex Vesicovaginal Fistula
Ashraf Abou-Elela, M.D., Professor of Urology, Faculty of Medicine, Cairo University, Cairo, Egypt., Haitham Torky, M.D., Lecturer in Gynecology, 6th of October University, Cairo, Egypt, Hany Alfaiomy, M.D., Assistant Professor of Urology, Cairo University, Cairo, Egypt, Ehab Reyad, M.D., Consultant in Urology, Well Care Medical Center, Abu Dhabi, United Arab Emirates (UAE), Sameh Azazy, M.D.,Consultant in Gynecology, Well Care Medical Center, Abu Dhabi, United Arab Emirates (UAE)

PMID: 23225588

Abstract

Vesicovaginal fistula (VVF), commonly caused by prolonged obstructed labor, is one of the worst complications of childbirth and poor obstetric care in the developing world. We investigated the clinical efficacy and outcome of technical modifications of the current transperitoneal supravesical technique for supratrigonal and complex vesicovaginal fistula. We studied a total of 20 patients with iatrogenic supratrigonal and complex vesicovaginal fistula following obstetric trauma and hysterectomy. All patients underwent a modified transabdominal technique: the modifications consisted of passing a Foley catheter through the fistulous opening, inflating the balloon, and applying traction on the catheter to provide effective anchorage and to minimize the oozing from the cystotomy edges. The cystotomy was directed in the parasagittal line, and medial side of the bladder was rotated as a flap into the bladder defect; the urethral de Pezzare catheter was used for urinary drainage. We used hemostatic matrix sealant (FloSeal, Baxter BioSurgery, Westlake Village, California) to promote healing and hemostasis. The vesicovaginal fistula was successfully corrected in all patients after the first attempt, and no significant bladder dysfunction or decrease in bladder capacity was seen after repair. Interposition flaps were used in all patients, and six patients (30%) required ancillary procedures for other associated anomalies at the time of fistula repair. At a mean follow-up of two years, fourteen women were sexually active, and 5 (35%) from this group of patients complained of mild-to-moderate dyspareunia. In our study, supratrigonal VVFs were repaired with a transabdominal, transperitoneal, transvesical approach. Tailoring the cystotomy in a parasagittal line permitted closure of fistula by rotation of bladder flap into the defect. This excellent method should be a viable option when repairing complex VVF.

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OLYMPUS
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Molnlycke
Karl Storz