Surgical Technology International
38th Edition
Contains 63 peer-reviewed articles featuring the latest advances in surgical techniques and technologies.
June 2021 - ISSN:1090-3941
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Role of Artificial Intelligence (AI) in Surgery: Introduction, General Principles, and Potential Applications
Alberto Mangano, MD, Valentina Valle, MD, Nicolas H. Dreifuss, MD, Gabriela Aguiluz, MD, Mario A. Masrur, MD, Assistant Professor of Surgery, University of Illinois at Chicago, Chicago, IL, USA
1369
AI (Artificial intelligence) is an interdisciplinary field aimed at the development of algorithms to endow machines with the capability of executing cognitive tasks. The number of publications regarding AI and surgery has increased dramatically over the last two decades. This phenomenon can partly be explained by the exponential growth in computing power available to the largest AI training runs. AI can be classified into different sub-domains with extensive potential clinical applications in the surgical setting. AI will increasingly become a major component of clinical practice in surgery.
The aim of the present Narrative Review is to give a general introduction and summarized overview of AI, as well as to present additional remarks on potential surgical applications and future perspectives in surgery.
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VITOM® 3D in Arterio-Venous Fistulas: Single Centre Preliminary Surgical Experience
Vincenzo Davide Palumbo, MD, PhD, Salvatore Fazzotta, MD, Giuseppe Damiano, MD, PhD, Gaetano Di Vita, MD, PhD, FACS, Professor, Attilio Ignazio Lo Monte, MD, PhD, FACS, Associate Professor, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
1379
Background: Arteriovenous fistula (AVF) is the vascular access of choice for hemodialysis patients. A correct microsurgical vascular anastomoses is essential to the optimal care of patients. Loupes can help surgeons perform such procedures, but often cause neck or back pain and fatigue.
Aim: This study aimed to evaluate whether a video telescopic operating microscope (VITOM®; Karl Storz Endoscopy GmbH, Tuttlingen, Germany) could be used as a substitute for loupes to create microsurgical vascular anastomoses.
Methods: We evaluated microsurgical anastomoses with VITOM® in 10 patients (6 male, 4 female) from January 2019 to December 2019. The created anastomoses were 7 side-to-side, 2 side-to-end and 1 end-to-end.
Results: A valid thrill was always present on palpation. Surgical procedures had an average time of 87.6 min, ranging from 49 to 110 min. Eight patients had AVF maturation; in the remaining 2, one had a thrombosis after 25 days and one couldn’t be dialyzed due to low flow in AVF.
Conclusions: The VITOM® system makes it possible to carry out anastomosis in difficult cases. It is both safe and useful for the training of young surgeons.
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The Artisential® Articulated Laparoscopic Forceps: A Dry Lab Study to Examine Dexterity and Learning Effects in Operators with Different Levels of Laparoscopic Experience
Ibrahim Darwich, MD, Mohammad Abuassi, MD, Dietmar Stephan, MD, Professor of Gastroentrological Surgery, Frank Willeke, MD, PhD, Professor for Visceral, Vascular and General Surgery, Department of Surgery, St. Marienkrankenhaus Siegen, Siegen, Germany, Christel Weiss, PhD, Dipl.-Math, Head of the Department of medical statistics and biomathematics, Department of medical statistics and biomathematics, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer, Mannheim, Germany
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Purpose: The advent of robotic surgery has highlighted the advantages of articulation. This dry-lab study examined the dexterity and learning effect of a new articulated laparoscopic instrument: the ArtiSential® forceps (LIVSMED, Seongnam, Republic of Korea).
Methods: A peg board task was designed. Three groups of volunteers with varying levels of laparoscopic expertise were organized to perform the task: expert, intermediate and novice. The participants performed the task using articulated and straight instruments, once before a 30-min training session and once afterwards. The times required to perform the task were recorded. The performances were analyzed and compared between the groups as well as between the straight and articulated instruments.
Results: The experts were significantly faster than the novices with both instruments before the 30-min training session (p = 0.0317 for each instrument). No significant time difference was found among the three groups after the 30-min training session. The decrease in the time required to perform the peg-transfer task with the articulated instrument was significantly greater in the novice and intermediate groups (p = 0.0159 for each group). No significant difference in time reduction was observed between the groups with the straight instrument. Regardless of the user, the articulated device was associated with faster task performance than the straight device after 8 hours of training (p = 0.0039).
Conclusion: The ArtiSential® articulated device can improve dexterity. A significantly greater learning effect was observed in the novice and intermediate groups in comparison with experts. A plateau in the learning curve was observed after a few hours of training.
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Current Robotic Platforms in Surgery and the Road Ahead
Aram Rojas, MD, Mahir Gachabayov, MD, PhD, Roberto Bergamaschi, MD, PhD, FRCS, FASCRS, ACS, Professor of Surgery and Chief, Rifat Latifi, MD, FACS, FICS, The Felicien Steichen, Professor and Chairman of Surgery, New York Medical College, School of Medicine, Westchester Medical Center Health, Valhalla, New York, Ziad E. Abouezzi, MD, FACS, MidHudson Regional Hospital, Westchester Medical Center Health Network, Poughkeepsie, New York
1419
Minimally invasive surgery has rapidly evolved from the once novel laparoscopic approach to advanced robotic surgery. In the past few decades alone, robotic systems have gone from systems which were significantly limited to full-fledged platforms featuring 3D vision, articulated instruments, integrated ultrasound and fluorescence capabilities, and even the latest wireless connectivity, as is now standard. In this review, we aimed to summarize features of currently commercialized and utilized robotic surgical systems as well as currently unfolding platforms. The pros and cons of different robotic surgical systems were discussed. In addition, we discussed the future perspectives of robotic platforms used in general surgery. In this regard, we emphasized that the market, once dominated by Intuitive Surgical Inc., has become occupied by several worthy competitors with new technological giants such as Google. Eventually, the question facing hospital systems will not be of whether or not to invest in robotic surgery, but instead of how they will strike balance between price, features, and availability when choosing robots from the growing market to best equip their surgeons.
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Tracheostomy and Improvement in Utilization of Hospital Resources During SARS-CoV-2 Pandemic Surge
Rachel S. Sier, BS, Western University of Health Sciences COMP
Pomona, California, Osita I. Onugha, MD, MBA, Assistant Professor, John Wayne Cancer Institute, Santa Monica, California
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The SARS-CoV-2 pandemic has affected millions across the world. Significant patient surges have caused severe resource allocation challenges in personal protective equipment, medications, and staffing. The virus produces bilateral lung infiltrates causing significant oxygen depletion and respiratory failure thus increasing the need for ventilators. The patients who require ventilation are often requiring prolonged ventilation and depleting hospital resources. Tracheostomy is often utilized in patients requiring prolonged ventilation, and early tracheostomy in critical care patients has been shown in some studies to improve a variety of factors including intensive care unit (ICU) length of stay, ventilation weaning, and decreased sedation medication utilization. In a patient surge setting, as long as adequate personal protective equipment (PPE) is available to minimize spread to healthcare workers, early tracheostomy may be a beneficial management of these patients. Decreasing sedative medication utilization may help prevent shortages in future waves of infection and improve patient-provider communication as patients are more alert. Tracheostomy care is easier than endotracheal intubation and may have decreased viral aerosolization risk, particularly if repeat intubation is necessary after a weaning trial. Additionally, tracheostomy patients can be monitored with less staff, decreasing total healthcare worker exposure to infection. To manage risk of exposure, coordination of ventilation controlled by an anesthesiologist or a critical care physician with a surgeon during the procedure can minimize aerosolization to the team. Risk management and resource allocation is of the utmost importance in any global crisis and procedures must be appropriately planned and benefits to patients, as well as minimized exposure to healthcare providers, must be considered. Early tracheostomy could be a beneficial procedure for severe SARS-CoV-2 patients to minimize long-term virus aerosolization and exposure for healthcare workers while decreasing sedation, allowing for earlier transfer out of the ICU, and improving hospital resource utilization.
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Robotic-Assisted Surgery Training (RAST) Program: An Educational Research Protocol
Maria Castaldi, MD, FACS, Professor of Surgery, Mathias Palmer, BA, Jorge Con, MD, FACS, Assistant Professor of Surgery, Rifat Latifi, MD, FACS, FICS, Professor and Chairman of Surgery, New York Medical College, Westchester Medical Center, Valhalla, New York, Roberto Bergamaschi, MD, PhD, FRCS, FACS, Professor and Chief, New York Medical College, Westchester Medical Center, Valhalla, New York, Ziad Abouezzi, MD, FACS, Assistant, Professor of Surgery, New York Medical College, MidHudson Regional Hospital, Poughkeepsie, New York
1428
Technology has had a dramatic impact on how diseases are diagnosed and treated. Although cut, sew, and tie remain the staples of surgical craft, new technical skills are required. While there is no replacement for live operative experience, training outside the operating room offers structured educational opportunities and stress modulation. A stepwise program for acquiring new technical skills required in robotic surgery involves three modules: ergonomic, psychomotor, and procedural. This is a prospective, educational research protocol aiming at evaluating the responsiveness of general surgery residents in Robotic-Assisted Surgery Training (RAST). Responsiveness is defined as change in performance over time. Performance is measured by the following content-valid metrics for each module. Module 1 proficiency in ergonomics includes: cart deploy, boom control, cart driving, camera port docking, targeting anatomy, flex joint, clearance joint and port nozzle adjusting, and routine and emergent undocking. Module 2 proficiency in psychomotor skills includes tissue handling, accuracy error, knot quality, and operating time. Module 3 proficiency in procedural skills prevents deviations from standardized sequential procedural steps in order to test length of specimen resection, angle for transection, vessel stump length post ligation, distance of anastomosis from critical landmarks, and proximal and distal resection margins. Resident responsiveness over time will be assessed comparing the results of baseline testing with final testing. Educational interventions will include viewing one instructional video prior to module commencement, response to module-specific multiple-choice questions, and individual weekly training sessions with a robotic instructor in the operating room. Residents will progress through modules upon successful final testing and will evaluate the educational environment with the Dundee Ready Educational Environment Measure (DREEM) inventory.
The RAST program protocol outlined herein is an educational challenge with the primary endpoint to provide evidence that formal instruction has an impact on proficiency and safety in executing robotic skills.
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Use of Vivostat® Autologous Fibrin Sealant in Thyroid Surgery
Antonella Pino, MD, Gianlorenzo Dionigi, MD, PhD, FACS, Professor of Surgery, ''G. Barresi'', University Hospital G. Martino, University of Messina, Messina, Italy, Francesco Frattini, MD, Ospedale di Circolo e Fondazione Macchi di Varese - ASST dei Sette Laghi, Italy, Hui Sun, MD, Professor of Surgery, Daqi Zhang, MD, PhD, Professor of Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Changchun, China, Che Wei Wu, MD, PhD, Professor of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, Hoon Yub Kim¸ MD, Professor of Surgery, KUMC Thyroid Center Korea University, Anam Hospital, Seoul, Republic of Korea
1441
Introduction: Post-thyroidectomy hemorrhage is a rare but potentially life-threatening and unpredictable complication of thyroid surgery. Therefore, intraoperative bleeding control and hemostasis are crucial. However, the most efficient, cost-effective, and standardized way to achieve this is not clear. This study aimed to evaluate the outcome of total thyroidectomy (TT) and partial thyroidectomy (PT) performed using the Vivostat® hemostatic system (Vivostat A/S, Lillerod, Denmark).
Methods: Patients underwent TT and PT for benign and malignant diseases (multinodular goiter, Graves’ disease, differentiated thyroid carcinoma). The primary endpoint was 1st-day postoperative drain output and bleeding that required reintervention. Secondary endpoints included surgery duration and postsurgical complications (vocal fold palsy, hypocalcemia, seroma, wound infection).
Results: Between October 2020 and December 2020, 56 patients were enrolled; 69.6% female; mean age 49.5 years. The mean 24-h drain output was 40 ml. No redo surgery was needed. Seroma was present in 5.3% of cases; no permanent vocal palsy or hypocalcemia was observed.
Conclusion: This study shows that the Vivostat® system is both safe and effective for hemostasis during thyroid surgery.
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