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Surgical Technology International XXV contains 41 peer-reviewed articles featuring the latest advances in surgical techniques and technologies.

 

Oct, 2014 - ISSN:1090-3941

 

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Robotic Camera Assistance and Its Benefit in 1033 Traditional Laparoscopic Procedures: Prospective Clinical Trial Using a Joystick-guided Camera Holder
Sebastian W. Holländer, MD, Assistant Physician, Department of Surgery, Protestant Hospital Zweibrücken, Academic Teaching Hospital of Saarland University, Zweibrücken, Germany, Hans Joachim Klingen, MD, Senior Consultant, Department of Surgery, Protestant Hospital Zweibrücken, Academic Teaching Hospital of Saarland University, Zweibrücken, Germany, Marliese Fritz, MD, Senior Physician, Department of Surgery, Protestant Hospital Zweibrücken, Academic Teaching Hospital of Saarland University, Zweibrücken, Germany, Peter Djalali, MD, Senior Physician, Department of Surgery, Protestant Hospital Zweibrücken, Academic Teaching Hospital of Saarland University, Zweibrücken, Germany, Dieter Birk, MD, PhD, Medical Director and Head of Department, Department of Surgery, Protestant Hospital Zweibrücken, Academic Teaching Hospital of Saarland University, Zweibrücken, Germany

PMID: 25419950

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Abstract

Despite advances in instruments and techniques in laparoscopic surgery, one thing remains uncomfortable: the camera assistance. The aim of this study was to investigate the benefit of a joystick-guided camera holder (SoloAssist®, AKTORmed, Barbing, Germany) for laparoscopic surgery and to compare the robotic assistance to human assistance. 1033 consecutive laparoscopic procedures were performed assisted by the SoloAssist®. Failures and aborts were documented and nine surgeons were interviewed by questionnaire regarding their experiences. In 71 of 1033 procedures, robotic assistance was aborted and the procedure was continued manually, mostly because of frequent changes of position, narrow spaces, and adverse angular degrees. One case of short circuit was reported. Emergency stop was necessary in three cases due to uncontrolled movement into the abdominal cavity. Seven of eight surgeons prefer robotic to human assistance, mostly because of a steady image and self-control. The SoloAssist® robot is a reliable system for laparoscopic procedures. Emergency shutdown was necessary in only three cases. Some minor weak spots could have been identified. Most surgeons prefer robotic assistance to human assistance. We feel that the SoloAssist® makes standard laparoscopic surgery more comfortable and further development is desirable but it cannot fully replace a human assistant.

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The New HARMONIC ACE®+7 Shears: A Game Changer in Ultrasonic Hemostasis
James Dana Kondrup, MD, FACOG, Assistant Clinical Professor, Department of Obstetrics/Gynecology, Upstate Medical Center, Syracuse, New York – Binghamton Campus, Binghamton, New York, Fran Anderson, PhD, RN, Research Coordinator, Our Lady of Lourdes Hospital, Binghamton, New York, Brenda Sylvester, PA-C, Lourdes Operating Room Physician Assistant, Our Lady of Lourdes Hospital, Binghamton, New York, Michelle Branning, CST, Lourdes Operating Room Surgical Technician, Our Lady of Lourdes Hospital, Binghamton, New York

PMID: 25419951

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Abstract

The latest version of HARMONIC®, the HARMONIC ACE®+7 Shears by Ethicon US, LLC, is now commercially available. While earlier models also had easy-to-use handles and a fine, non-stick tip, the HARMONIC ACE®+7 Shears adds a new hemostasis feature. The “7” in HARMONIC ACE®+7 stands for the device’s ability to coagulate and divide 7-mm vessels. This is accomplished via an Advanced Hemostasis Mode and button located on both sides of the handle. The HARMONIC ACE®+7 will prove itself the leader in the ultrasonic energy field.

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European Initial Hands-On Experience with HEMOPATCH, a Novel Sealing Hemostatic Patch: Application in General, Gastrointestinal, Biliopancreatic, Cardiac, and Urologic Surgery
Abe Fingerhut, MD, DSC (Hon), FACS, FRCPS (g), FRCS (Ed), Professor, Section for Surgical Research, Department of Surgery, Medical University of Graz, Graz, Austria, Selman Uranues, MD, FACS, Professor and Head Section for Surgical Research, Giuseppe Maria Ettorre, MD, Professor, Emanuele Felli, MD, Surgeon, Marco Colasanti, MD, Surgeon, Gregorio Scerrino, MD, PhD, Surgeon, Unit of General and Emergency Surgery, Department of General, Emergency and Transplant Surgery, Giusepina Irene Melfa, MD, Surgeon, Cristina Raspanti, MD, Surgeon, Unit of General and Emergency Surgery, Department of General, Emergency and Transplant Surgery, Gaspare Gulotta, MD, Professor, Alexander Meyer, Dr.med, Head of Department, Martin Oberhoffer, MD, Consultant, Michael Schmoeckel, MD, PhD, Professor, Head of Department, Luca Paolo Weltert, MD, G Vignolini, MD, Surgeon, M Salvi, MD, Surgeon, Department of Urology, Careggi Hospital, University of Florence, Florence, Italy, L Masieri, MD, Surgeon, G Vittori, MD, Surgeon, G Siena, MD, Surgeon, A Minervini, MD, Surgeon, S Serni, MD, Surgeon, M Carini, MD, Surgeon

PMID: 25433173

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Abstract

Topical hemostatic agents that can seal tissues and assist in the coagulation cascade of patients undergoing surgery have been readily available for several decades. Using either synthetic or animal/plant-derived materials, these agents represent a powerful tool to reduce postoperative bleeding complications in cases where mechanical or energy-driven hemostasis is not possible or insufficient. Recently, a novel sealing hemostatic patch, HEMOPATCH (Baxter International, Deerfield, IL), was developed. The device is a thin and flexible patch consisting of a specifically-formulated porous collagen matrix, coated on one side with a thin protein-binding layer. This gives the patch a dual mechanism of action, in which the two components interact to achieve hemostasis by sealing off the bleeding surface and initiating the body’s own clotting mechanisms. Here we present a series of case reports that outline the quick, effective hemostatic sealing of HEMOPATCH in a variety of clinical applications, including solid organ, gastrointestinal, biliopancreatic, endocrine, cardiovascular, and urologic surgeries. Essentially a feasibility study, these reports demonstrate how HEMOPATCH can be applied to seal almost any bleeding surface encountered during a range of procedures. Our results show that the device is eminently capable in both via laparotomy and laparoscopic approaches, and in patients with impaired coagulation or highly variable anatomies. In conclusion, our cases document the ease-of-use, application, and immediate hemostatic effect of the patch across a broad range of surgical settings and paves the way for future randomized clinical trials with more extensive follow-up.

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Experimental Nephrectomies Using a Novel Telesurgical System:  (The Telelap ALF-X)–A Pilot Study
Cristina Falavolti, MD, Urology Resident, Urology Department, Campus Biomedico, Roma, Italy, Stefano Gidaro, MD, Urology Surgeon, Biomedical Science, University “G.D’Annunzio” Chieti-Pescara, Chieti-Pescara, Italy, Emilio Ruiz, B. Eng, Technology Engineer, Robotic Department, Sofar S.p.A.,Trezzano Rosa, Italy, Emanuela Altobelli, MD, Urology Resident, Urology Department, Campus Biomedico, Roma, Italy, Michael Stark, MD, Urology Surgeon, Urology Department, The New European Surgical Academy, Berlin, Germany, Giuliano Ravasio, DVM, Veterinarian, Department of Veterinary Science and Public Health, Milano, Italy, Sara Simona Lazzaretti, DVM, Veterinarian, Department of Veterinary Science and Public Health, Milano, Italy, Maurizio Buscarini, MD, Urology Professor/Head of Department, Urology Department, Campus Biomedico, Roma, Italy

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PMID: 25433265

Abstract

Purpose: The SOFAR® Telelap Alf-X (Milan, Italy) is a novel telesurgical system which combines the advantages of both laparoscopy and open surgery. It offers some new features like tactile perception, open site view, eye-tracking control of the camera, and optimal ergonomics.
Objective: The aim of this study is to examine the feasibility and the safety of nephrectomy using a novel telesurgical system with haptic sensation: the Telelap Alf-X.
Materials and Methods: Twelve female swine underwent nephrectomies using the Telelap Alf-X system. Data regarding operative times, estimated blood loss (EBL), surgical methodology, and intraoperative complications are presented.
Results: The Telelap Alf-X’s docking took less than one minute, the system was versatile during each step of the nephrectomy and the operative times have reduced dramatically along the learning curve. One intraoperative complication was recorded (Vena Cava injury—repaired using the robotic system) and the estimated blood loss was minimal.
Conclusions: The Telelap Alf-X proved to be safe and reliable and can be easily used by the surgeon. The porcine model nephrectomies proved to be an excellent way to gain experience and avoid future complications.

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Karl Storz
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