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Surgical Technology International

33rd edition

 

Contains 45 peer-reviewed articles featuring the latest advances in surgical techniques and technologies.

ISSN:1090-3941

 

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Surgical Overview

Medical Applications of Drones for Disaster Relief: A Review of the Literature

James “Butch” Rosser, Jr, MD, FACS, Director of the Center for the Advanced Treatment of Heartburn, Grant Regional Healthcare Center, Lancaster, WI, Clinical Professor of Surgery, University at Buffalo, Buffalo, NY, Brett C. Parker, MD, Resident Physician, University at Buffalo, Buffalo, NY, Vudatha Vignesh, BSE, University of Central Florida College of Medicine, Orlando, FL

956

 

Abstract


Introduction: Rapid progress has been made with unmanned aerial systems (UAS), which are now used in a wide variety of different fields, including media, agriculture, wildlife, and infrastructure. However, the application of UAS for medical purposes, and in particular disaster relief efforts, has been slower to develop. This paper will review and present pertinent studies in the literature.
Methodology: Studies related to drones and medical applications for disaster relief were identified as part of a larger search regarding the civilian application of drones. A search for civilian drone applications was performed in the EBSCO (Elton B. Stephens Company) database. Non-civilian applications as well as redundant sources were excluded.
Results: The search identified 711 sources pertaining to civilian drone applications. Of these, 117 involved drone applications in disaster relief, and 28 articles specifically addressed medical uses.
Conclusion: Drones can be useful during immediate and non-immediate medical disaster relief efforts. They can provide an instant telecommunications infrastructure, assist in telemedicine-enabled clinical services, perform equipment/drug/patient delivery, enhance search and rescue efforts, assess damage and map disaster zones. Rapid processing of permission for emergency operations, promotion of industry expansion, public awareness, and public participation must be emphasized for these to become routine applications. There is a major concern about the organizational umbrella that would promote this initiative. Creation of an organization such as a Drone Civil Air Patrol Wing (DCAPW) could improve our ability to provide post-disaster healthcare delivery services.

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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, Changlin Li, MD, Tie Wang, MD, 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, 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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Blended Learning Methods for Surgical Education
Roger Smith, PhD, Chief Technology Officer, Danielle Julian, MS, Research Scientist, Nicholson Center, Florida Hospital, Celebration, Florida, Alyssa Tanaka, PhD, Principal Investigator, Intelligent Training Division, SoarTech Inc., Orlando, Florida

1038

 

Abstract


The emergence and maturation of the concept of blended learning in public and military education may prove equally valuable in CME surgical education and training. Creating a learner-centric environment in which multiple modes of education are encouraged, available, integrated, and accredited can increase the level of competence achieved in CME courses. This paper defines a framework for blended surgical training using principles developed for the military and it is applied in courses at a major post-graduate surgical education center.

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A Retrospective Comparative Analysis of 2D Versus 3D Laparoscopy in Total Laparoscopic Hysterectomy for Large Uteri (≥ 500g)
Rakesh Sinha, MD, Senior Gynecological Endoscopic Surgeon, and Founder, Latika Chawla, DNB, MRCOG, Gynecological Endoscopic Surgeon, Shweta Raje, MD, DNB, Senior Gynecological Endoscopic Surgeon, Gayatri Rao, DGO, DNB, Senior Obstetrician and, Gynecological Endoscopic Surgeon, Women’s Hospital, Mumbai, Maharashtra, India

1051

 

Abstract


Study objective: To evaluate the outcomes of total laparoscopic hysterectomy using 3D vision in comparison with 2D vision in women with large uteri (³500g).
Design: Retrospective analytical study
Design Classification: Canadian Task Force II-1
Setting: Tertiary referral center for advanced gynecological surgery.
Patients: Five hundred forty six women who underwent total laparoscopic hysterectomy over a period of 13 years were studied: 301 under 2D vision and 245 under 3D vision.
Interventions: Total laparoscopic hysterectomy
Measurements: Surgical time, blood loss and complications were recorded for every case in both groups.
Main Results: The duration of surgery for hysterectomy in the 3D laparoscopy group (88.01±36.95 min) was significantly shorter than that in the 2D group (112.61±42.59 min, p=.0001). Blood loss in the 500-1000g group was significantly less in the 3D group (p=.005). The total complication rates for 3D surgery (3.37 %) and 2D surgery (6.64%) were comparable (p=.25).
Conclusion: Three-dimensional laparoscopy provides stereoscopic vision and increases precision and safety. The availability of depth perception adds to the ease of surgery, especially in cases of large uteri, leading to reductions in both the duration of surgery and blood loss, which improves patient outcomes.

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