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Surgical Technology International

34th edition

 

Contains 67 peer-reviewed articles featuring the latest advances in surgical techniques and technologies.

521 pages

May 2019 - ISSN:1090-3941

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DIV-SO

 

 

Surgical Overview

 

FOREWORD by Volkmar Falk, MD, Director of the Department of Cardiothoracic Surgery, Charité, Universitätsmedizin Berlin, Berlin, Germany

 

Mechatronic Support System for NOTES and Monoport Surgery – A New Approach
Hubertus Feussner, MD, Founder, MITI Research Group, Professor, Yannick Krieger, MSc, Scientific Head of Medical Robotics & Mechanisms, Dirk Wilhelm, MD, Medical/Clinical Head of MITI, Stephan Brunner, Student, Daniel Ostler, MSc, Scientific Head of MITI, Tim Lueth, MD, Institute of Micro Technology and , Medical Device Technology, Alexander Meining, MD, Chair of InExEn (Interventional &, Experimental Endoscopy), Clinic for Internal Medicine I, Center for Internal Medicine, Ulm University Hospital, Ulm, Germany

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Abstract


To circumvent the drawbacks of currently available platforms for natural orifice transluminal endoscopic surgery (NOTES) and monoport surgery (MPS), we developed a patient-specific, disposable, surgical soft robotic system. The system (Single-Port Overtube; SPOT) is designed as an overtube for standard surgical equipment. The platform body and the manipulators can be quickly adapted to transmural (monoport), NOTES and endoluminal (endoscopic) applications, and 3D-printed overnight as an individualized system. In addition, practical considerations, such as the predicted “ideal” dimensions of the platform, were evaluated. As a result, we found that preoperatively available biometric data currently provide little support for tailored instrument design. Further work is required to provide engineers / developers with more useful preoperative information.

 

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Estimating the Incidence of Stray Energy Burns during Laparoscopic Surgery based on Two Statewide Databases and Retrospective Rates: An Opportunity to Improve Patient Safety
Carlos Guzman, MD, Clinical Assistant Instructor, School of Medicine, Stony Brook Medical Center, Stony Brook, NY, Jared A. Forrester, MD, Resident Physician, General Surgery , School of Medicine, Stanford University, Stanford, CA, Pascal R. Fuchshuber, MD, General and Oncologic Surgery, Wound Care Specialist, Vohra Physicians Associate Professor of Surgery, Walnut Creek, CA, Jeffery L Eakin, MD, Trauma and Hernia Center Director, Jordan Valley Medical Center, Minimally Invasive and Bariatric Surgeons, Salt Lake City, UT

 

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Abstract


Background: The growth of laparoscopic surgery has increased the use of laparoscopic electrosurgical devices based on radiofrequency current. Despite an improvement in most post-operative outcomes, the use of these devices can be associated with inadvertent thermal or mechanical injuries, also called accidental punctures and lacerations (APLs). APLs can occur through either operator error or system error, including insulation failure or capacitive coupling resulting in stray energy burns. Our aim was to estimate the incidence and—as a result—the impact of laparoscopic APLs.
Methods: A retrospective analysis of the Healthcare Cost and Utilization Project (HCUP) State Inpatient Database (SID) was performed for 2009 in California (CA) and Florida (FL). ICD-9 codes and current procedural terminology were used to query for five common general surgery procedures: appendectomy, cholecystectomy, fundoplication, gastric bypass, and gastroplasty with these procedures cross-referenced for any secondary procedure at the time of the initial surgery indicative of APLs. The c2 test was used for comparisons where appropriate.
Results: Overall, 192,794 primary laparoscopic procedures were identified in the HCUP database in CA and FL in 2009, with a similar procedure frequency distribution between CA and FL. Six hundred ninety-four procedures were complicated by APL. Gastric bypass and fundoplication were more commonly associated with APLs.
Conclusion: In this retrospective analysis of procedures performed in CA and FL, the estimated incidence of APL was 3.6 per 1000 cases. Patient morbidity and mortality were likely related to both pilot-error injuries and stray energy burns during laparoscopy. Possible solutions to reduce surgical complications from APL include educational programs to reduce pilot error and the incorporation of fail-safe technologies to eliminate stray energy burns, such as active electrode monitoring and use of non-radiofrequency current (true cautery).

 

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Comparative Thermal Effects of J-Plasma®, Monopolar, Argon, and Laser Electrosurgery in a Porcine Tissue Model
Salome Masghati, MD, Fellow, University of Nevada, Las Vegas, School of Medicine, Las Vegas, Nevada, Jasmine Pedroso, MD, MPH, Associate Fellowship Director, Medical Director, Melissa Gutierrez, MD, Director of Robotic Surgery, Erica Stockwell, DO, MBA, Director of Innovation and Business Education, K. Warren Volker, MD, PhD, Fellowship Program Director, David L. Howard, MD, PHD, Director of Research, WellHealth QualityCare, a DaVita Medical Group, University of Nevada, Las Vegas, School of Medicine, Las Vegas, Nevada

 

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Abstract


Introduction: The objective of this study was to understand how J-Plasma® (Bovie Medical Corporation, Clearwater, Florida) surgical energy compares to monopolar, argon beam, and CO2 laser devices in terms of depth of penetration and lateral thermal spread in a porcine tissue model.
Materials and methods: Using a porcine animal model, we applied the thermal energy of the J-Plasma® laser, Bovie Monopolar Pencil™ (Bovie Medical Corporation, Clearwater, Florida), argon beam coagulator, and CO2 laser to porcine small bowel, bladder, and peritoneal tissues at equivalent settings. Tissue was excised and sent to pathology for histologic evaluation. Primary outcome was depth of penetration and lateral thermal spread.
Results: When applied to peritoneum tissue, CO2 laser had the greatest lateral thermal spread at 2.99mm, while the argon beam had the lowest at just under 1.5mm. With regard to depth of penetration, the monopolar pencil had the highest while J-Plasma® had the lowest. When applied to bladder tissue, the argon beam was associated with the greatest lateral thermal spread (3.1mm) as compared to the other three devices (all less than 1mm). In terms of depth of penetration of bladder tissue, J-Plasma® again had the lowest value, while the monopolar pencil had the highest. When applied to small intestine tissue, the argon beam had the greatest lateral spread (3.51mm), while J-Plasma® had the lowest (less than 1mm). Regarding depth of penetration of small intestine tissue, argon beam had the highest value at 1.8mm compared to the other three devices (all below 0.6mm).
Conclusion: Consistent with our previous study, J-Plasma® had minimal lateral and depth spread when applied to various tissue types. J-Plasma® performed better or similar when compared to monopolar, argon beam, and laser electrosurgical devices. Further studies in-vivo are needed to evaluate safety and surgical application of the J-Plasma® device.

 

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Normothermia is Best Achieved by Warming Above and Below with Pre-warming Adjunct: A Comparison of Conductive Fabric Versus Forced-air and Water
Kenji Ohki, MD, Manager, Mitsuyoshi Yoshida, MD, Anesthesiologist, Kuyo Kanosue, MD, Anesthesiologist, Saiseikai Shimonoseki General Hospital, Shimonoseki, Japan, Kohki Yamamoto, MD, Research Associate, Anesthesiologist, Rumi Kawano, MD, Research Associate, Anesthesiologist, Yamaguchi University Graduate School, of Medicine, Yamaguchi, Japan

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Abstract


Background: Although forced-air warming is the most commonly used method for perioperative patient warming, it is fundamentally problematic because it disturbs the carefully designed airflow in the operating room. Because unintended hypothermia has significant consequences, there is a need for more effective warming strategies. The effectiveness of warming technologies that apply heat through the skin is based on surface-area contact with the heat source and the duration of pre-warming. Therefore, we sought to test the therapeutic effectiveness of combined above- and below-warming therapies. Our hospital prohibits forced-air warming before the patient is draped, so a secondary goal was to determine the effect of preoperative warming using a system that does not interfere with airflow in the operating room.
Methods: We prospectively randomized 35 patients undergoing total knee arthroplasty into two groups: 1) forced-air warming/water mattress, using both WarmTouch® upper-body forced-air warming (Medtronic/Covidien Inc., Dublin, Ireland) and a Norm-O-Temp® underbody water mattress (CSZ/Gentherm Inc., Cincinnati, OH, USA), and 2) conductive fabric warming, using a HotDog® electric upper-body blanket (Augustine Temperature Management LLC, Eden Prairie, MN, USA) and a HotDog® underbody mattress.
Results: Throughout the surgical procedure, group 2 patients had significantly higher temperatures; this group experienced superior pre-warming during preoperative preparations and thus the redistribution temperature drop following the induction of anesthesia was reduced. Both groups achieved 100% normothermia by the end of surgery.
Conclusion: Based solely on the temperatures at the end of surgery, these data indicate that forced-air warming in conjunction with a water mattress warming system is as effective as a conductive fabric electric warming system alone.

 

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