STI Volume 32

 

$195.00

Surgical Technology International

 

32nd Edition

 

New Online Studies

 

Online First - April, 2018

 

 

1 year Institutional Subscription 

both electronic and print versions

 

Surgical Overview

Virtual Reality Simulator Systems in Robotic Surgical Training
Alberto Mangano, MD, Robotic Surgery Research Specialist, Division of General, Minimally Invasive, and Robotic Surgery, University of Illinois at Chicago, Chicago, IL, Federico Gheza, MD, Robotic Surgery Research Specialist, Division of General, Minimally Invasive, and Robotic Surgery, University of Illinois at Chicago, Chicago, IL, Pier Cristoforo Giulianotti, MD, FACS, Vice Head, Department of Surgery, Head, Division of General, Minimally Invasive and Robotic Surgery, Professor of Surgery, Distinguished Lloyd M. Nyhus Chair in Surgery, University of Illinois at Chicago, Chicago, IL

967

 

Abstract


The number of robotic surgical procedures has been increasing worldwide. It is important to maximize the cost-effectiveness of robotic surgical training and safely reduce the time needed for trainees to reach proficiency. The use of preliminary lab training in robotic skills is a good strategy for the rapid acquisition of further, standardized robotic skills. Such training can be done either by using a simulator or by exercises in a dry or wet lab. While the use of an actual robotic surgical system for training may be problematic (high cost, lack of availability), virtual reality (VR) simulators can overcome many of these obstacles. However, there is still a lack of standardization. Although VR training systems have improved, they cannot yet replace experience in a wet lab. In particular, simulated scenarios are not yet close enough to a real operative experience. Indeed, there is a difference between technical skills (i.e., mechanical ability to perform a simulated task) and surgical competence (i.e., ability to perform a real surgical operation). Thus, while a VR simulator can replace a dry lab, it cannot yet replace training in a wet lab or operative training in actual patients. However, in the near future, it is expected that VR surgical simulators will be able to provide total reality simulation and replace training in a wet lab. More research is needed to produce more wide-ranging, trans-specialty robotic curricula.

 

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A Prospective Clinical and Instrumental Study on the Effects of a Transcutaneous Cosmeceutical Gel that is Claimed to Produce CO2

Gustavo H Leibaschoff, MD, Gynecologist, President of International Consulting in Aesthetic Medicine (ICAM), President of the International Union of Lipoplasty, Dallas, TX, Luis Coll, MD, Dermatologist, Director of the Center of Research in Video Capillaroscopy, Buenos Aires, Argentina, Wendy E. Roberts, MD, FAAD, Generational and Cosmetic Dermatology, Rancho Mirage, CA

976

 

Abstract


Carboxytherapy is the therapeutic use of carbon dioxide (CO2) in its gaseous state. Since 1933, carboxytherapy has referred to either the subcutaneous injection of CO2 or percutaneous application in a warm bath. The present clinical study was performed to determine if there were any changes in the dermis after the application of a transcutaneous gel, which is claimed to produce CO2, and, if so, how these changes compared to those with CO2 injection. Ten patients received transcutaneous treatment with the gel on one side of the face and the other side without any product was used as a control. We used videocapillaroscopy with an optic probe (VCSO) to evaluate the changes in the microcirculation of the skin. VCSO was performed for the treated right and untreated left ear lobes in each patient. VCSO was performed before treatment was started (VCSO1) and after 7 days of treatment (VCSO2).A comparison of VCSO1 to VCSO2 showed an increase in the microcirculation, an increase in vertical and horizontal capillaries, and a reduction in the area of ischemia. These results are similar to those observed in other studies with CO2 injection. In conclusion, use of this transcutaneous CO2 gel produced changes in the dermis similar to those observed with subcutaneous injection of CO2.

 

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Translational Study to Standardize the Safe Use of Bipolar Forceps, LigaSure™, Sonicision™ and PlasmaBlade™ Around the Recurrent Laryngeal Nerve in Thyroid Surgery
Yishen Zhao, MD, Doctor, Changlin Li, MD, Doctor, Tie Wang, MD, Doctor, Le Zhou, MD, PhD, Clinical Assistant Professor, Xiaoli Liu, MD, PhD, Clinical Assistant Professor, Jingwei Xin, MD, PhD, Clinical Assistant Professor, Shijie Li, MD, PhD, Doctor, Hui Sun, MD, PhD, Professor, Division of Thyroid Surgery, China–Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Changchun, China, Gianlorenzo Dionigi, MD, FACS, Professor, Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood ''G. Barresi'', University Hospital G. Martino, University of Messina, Messina, Italy

990

 

Abstract


Purpose: We investigated the function of the recurrent laryngeal nerve (RLN) in a live porcine model during adjacent activation with bipolar forceps (BF), LigaSure™ small jaw (LSJ), Sonicision™ and PlasmaBlade™ (PB) devices.
Methods: Each of the energy-based devices (EBD) was activated for 3 seconds at different power settings at 5, 3, 2, and 1 mm from the RLN. Nerve root function and thermal spread were measured by continuous intraoperative neuromonitoring and infrared thermal imaging.
Results: BF: The EMG amplitude decreased to 87% of baseline at a standardized distance. The highest thermal reading was 120°C at 1 mm (average 80.7°C). LSJ: EMG amplitudes were 99% (5mm), 90% (3mm) and 66% (2mm) of the baseline amplitude. At 1mm, the temperatures of the RLN surface and the LSJ tip reached 80.6°C and 100.8°C, respectively. Sonicision™: Under both the minimum and maximum settings, EMG amplitudes remained above 80% of the baseline amplitude. The highest temperatures of the device tip and RLN surface were 135°C and 117.3°C, respectively, at 1 mm. PB: The temperatures of the device tip and RLN surface increased gradually with an increase in the setting (tip 38.3°C to 163.8°C; nerve 34.8°C to 46.2°C). Loss of nerve function occurred at settings 9 and 10. There were no changes in the latency profile under any of the applications.
Conclusions: RLN roots were exposed to increased temperatures when EBDs were applied at close spacing. The results suggest that these 4 EBDs are unsafe when applied at a distance of 1-3 mm from the RLN due to their effects on both EMG and temperature.

 

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