Surgical Technology International
31nd Edition
Contains 59 peer-reviewed articles featuring the latest advances in surgical techniques and technologies.
408 pages
December-2017 - ISSN:1090-3941
1 year Institutional Subscription
both electronic and print versions
The Development of Augmented Reality to Enhance Minimally Invasive Surgery
Keith Dodd, BS, Research Assistant, Nathaniel P. Brooks, MD, Associate Professor/Director, University of Wisconsin, Madison, Wisconsin
Minimally invasive surgery (MIS) reduces unnecessary tissue damage to the patient but obscures the natural surgical interface that is provided by open surgical procedures. Multiple feedback mechanisms, mainly visual and tactile, are greatly reduced in MIS. Microscopes, endoscopes, and image-guided navigation traditionally provide enough visual information for successful minimally invasive procedures, although the limited feedback makes these procedures more difficult to learn. Research has been performed to develop alternative solutions that regain additional feedback. Augmented reality (AR), a more recent guidance innovation that overlays digital visual data physically, has begun to be implemented in various applications to improve the safety and efficacy of minimally invasive procedures. This review focuses on the recent implementation of augmented display and direct visual overlay and discusses how these innovations address common feedback concerns associated with minimally invasive surgeries.
883
7-09-2017
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Surgical Skills Improvement Using a Low-Cost Laparoscopic Simulator for Ventral Incisional Hernia
Vincenzo Consalvo, MD, General Surgeon Assistant, Clinique Clementville,
Montpellier, France, Vincenzo Salsano, MD, Director, Clinique du Parc Montpellier,
Clinique Clementville, Montpellier, France
Introduction: Ventral incisional hernia is one of the most common procedures in laparoscopic surgery, however, it requires proper training before doing it in the operating room. We propose a low-cost mechanical simulator with a new optical system to learn the basic steps of the procedure and improve surgical laparoscopic skill.
Materials and Methods: From November 3, 2014 to January 4, 2015, five residents and five surgeons with no prior laparoscopic experience, as well as two laparoscopic expert surgeons, participated in our study. They repeated the procedure three times per day for seven days. From January 10, 2015 to April 21, 2015, the five trained and five non-trained residents performed (each) five real laparoscopic ventral or median incisional hernia repairs under senior supervision. Operative time, decision making capabilities, number of errors, laparoscopic skill, and depth perception were compared between the two groups.
Results: A multiple regression (R) model was calculated and F-test showed a significant relation between operative time and numbers of procedures with the laparoscopic simulator (p<0.001) for the resident and non-laparoscopic surgeons groups and a multiple R-squared = 0.9974 (highly significant) of the model. No statistical difference was found between residents and non-laparoscopic surgeons (p<0.001), but both groups reached the same level as the expert surgeons after intensive training. Kruskal-Wallis was used to show an increased operative time for non-trained group. Pearson test and t-test showed a lower number of errors and failure in the trained group.
Conclusions: These results indicate that this new model of simulator could shorten the learning curve of surgical trainees for laparoscopic incisional hernia.
879
24-06-2017
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Fluorescent Imaging Evaluation of Lidocaine Distribution Following Bier Block in the Upper Extremity
Andrea L. Gale, MD, Fellow in Orthopedic Surgery, Shari R. Liberman, MD, Board-Certified Orthopedic Surgeon, Suzanne Berry, MD, Board-Certified Anesthesiologist, Dmitry Zavlin, MD, Postdoctoral Research Fellow in Plastic Surgery, Anthony Echo, MD, Board-Certified Plastic Surgeon, Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, Texas
Introduction: Bier block regional anesthesia has been used as an alternative to general anesthesia for years. Despite multiple theories and multiple techniques to delineate the location of the action of lidocaine during Bier block anesthesia, there has not been a consensus on the location of action. The purpose of this study was to use fluorescent imaging to further investigate the site of action of lidocaine during Bier block.
Materials and Methods: Three patients with carpal tunnel syndrome underwent open carpal tunnel release with Bier block anesthesia performed in the standard fashion with 1cc of Indocyanine green (IcG) mixed with lidocaine. Fluorescent images were obtained at the time of injection and after 10 minutes to allow patients to reach the level of surgical anesthesia. Repeated imaging was obtained at the time of completion of the procedure or at 30 minutes of tourniquet time.
Results: At time 0, IcG was distributed along the superficial venous system of the hand and forearm. At 10 minutes, the distribution of IcG was within the capillary system and infiltrating the dermis. The distribution later saturated the capillary beds and remained present until release of the tourniquet.
Conclusions: The authors demonstrate that some lidocaine action occurs at the cutaneous level during the administration of a Bier block. Due to limited field depth of view provided by the SPY® Elite System (Novadaq Technologies Inc., Mississauga, Canada), we are unable to draw any conclusions as to the distribution of the IcG or lidocaine at the level of the larger nerves at the site of the tourniquet.
884
21-06-2017
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Reproducibility and Reliability of Repeated Quantitative Fluorescence Angiography
Nikolaj Nerup, MD, PhD, PHD-Fellow, Senior Resident, Kristine Bach Korsholm Knudsen, MD, PhD, PHD-Fellow, Resident, Rikard Ambrus, MD, PhD, Resident, Morten Bo Søndergaard Svendsen, MScEng, PhD, Engineer, Inge Botker Rasmussen Ifaoui, MD, PhD, Consultant, Lars Bo Svendsen, MD, DMSc, Consultant, Professor, Michael Patrick Achiam, MD, PHD, DMSc, Consultant, Associate Professor, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark, Thomas Thymann, DVM, PhD, Veterinarian, Associate Professor, Copenhagen University, Frederiksberg, Denmark
Introduction: When using fluorescence angiography (FA) in perioperative perfusion assessment, repeated measures with re-injections of fluorescent dye (ICG) may be required. However, repeated injections may cause saturation of dye in the tissue, exceeding the limit of fluorescence intensity that the camera can detect. As the emission of fluorescence is dependent of the excitatory light intensity, reduction of this may solve the problem. The aim of the present study was to investigate the reproducibility and reliability of repeated quantitative FA during a reduction of excitatory light.
Materials and Methods: Six preterm piglets were used as a model of humans with compromised liver function and slow ICG clearance, as well as mimicking a situation with close camera tissue distance. In three piglets, FA was performed laparoscopically and in another three, FA was performed after laparotomy. Measurements were performed in the same three regions of interest in each measurement with excitatory light intensities of 100%, 60%, and 20%.
Results: We found an excellent agreement of the normalized slope with an intraclass correlation coefficient of 0.940 (95% CI: 0.870–0.976), and a Cronbach’s alpha of 0.944 indicating high consistency. In addition, Bland Altmann plots found acceptable levels of agreement with minimal proportion bias.
Conclusions: This study indicates that problems with hyper saturation of ICG, when performing repetitive perfusion assessment with FA, may be overcome by using the normalized slope and a reduction of the excitatory light intensity. This may especially be relevant in patients with compromised liver function or when a close camera tissue distance is necessary.
892
27-07-2017
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Design and Development of a Novel Distance Learning Telementoring System Using Off-the-Shelf Materials and Software
James C. Rosser, MD, FACS, Clinical Professor of Surgery, University of Central Florida College of Medicine, Orlando, Florida, Director of the Center for the Advanced Treatment of Heartburn, Grant Medical Center, Lancaster, Wisconsin, Jeffrey P. Fleming, BS, Timothy B. Legare, MS, Katherine M. Choi, BS, Jamie Nakagiri, BS, Elliot Griffith, MS, Medical Student, University of Central Florida College of Medicine, Orlando, Florida
Objective: To design and develop a distance learning (DL) system for the transference of laparoscopic surgery knowledge and skill constructed from off-the-shelf materials and commercially available software.
Introduction: Minimally invasive surgery offers significant benefits over traditional surgical procedures, but adoption rates for many procedures are low. Skill and confidence deficits are two of the culprits. DL combined with simulation training and telementoring may address these issues with scale.
Materials and Methods: The system must be built to meet the instruction requirements of a proven laparoscopic skills course (Top Gun). Thus, the rapid sharing of multimedia educational materials, secure two-way audio/visual communications, and annotation and recording capabilities are requirements for success. These requirements are more in line with telementoring missions than standard distance learning efforts.
Results: A DL system with telementor, classroom, and laboratory stations was created. The telementor station consists of a desktop computer and headset with microphone. For the classroom station, a laptop is connected to a digital projector that displays the remote instructor and content. A tripod-mounted webcam provides classroom visualization and a Bluetooth® wireless speaker establishes audio. For the laboratory station, a laptop with universal serial bus (USB) expander is combined with a tabletop laparoscopic skills trainer, a headset with microphone, two webcams and a Bluetooth® speaker. The cameras are mounted on a standard tripod and an adjustable gooseneck camera mount clamp to provide an internal and external view of the training area. Internet meeting software provides audio/visual communications including transmission of educational materials.
Conclusion: A DL system was created using off-the-shelf materials and commercially available software. It will allow investigations to evaluate the effectiveness of laparoscopic surgery knowledge and skill transfer utilizing DL techniques.
899
17-08-2017
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