Surgical Technology International
39th Edition
November 2021 - ISSN:1090-3941
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The Utility of Telehealth in the Recovery From the COVID-19 Pandemic
Zhongming Chen, MD, John M. Tarazi, MD, Hytham S. Salem, MD, Giles R. Scuderi, MD, Michael A. Mont, MD, Northwell Health Orthopaedics, Lenox Hill Hospital, New York, New York
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Telehealth has recently been used more often in an attempt to protect practitioners and patients during the 2019 coronavirus infectious disease (COVID-19) crisis. Despite telehealth’s existence, there was no prior need to fully realize its potential. Recently, technological innovations in orthopaedic surgery have assisted in making this modality more useful. However, it is important to continually educate the medical community regarding these technologies and their interplay to improve patient care. Therefore, our purpose is to provide information on telehealth by assessing: (1) steps the hospital/system are taking to reduce COVID-19 exposure for teams and patients; (2) new technologies allowing for the optimization of patient safety; and (3) use of telehealth for postoperative follow up. We will demonstrate that telehealth and its associated strategies can be used effectively to decrease COVID-19 exposure risks for both medical staff and patients during these rapidly changing and uncertain times.
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In Vitro User Assessment of a Novel Wound Protection and Specimen Extraction System for Laparoscopic Procedures Involving Morcellation
Adriana Olaru, MD, Tom Walsh, LRCP & SI, MB, BCh, NUI, Donal Brennan, MB, BCh, NUI, PhD, Associate Professor, Mater Misericordiae University Hospital, Dublin, Ireland, Mohammad F Khan, LRCP & SI, MB, BCh, NUI, Ronan A Cahill, MB, BAO, BCh, FRCS, MD, Full Professor, University College Dublin, Dublin, Ireland
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Introduction: The risk of unknowingly disseminating leiomyosarcoma by morcellation in women undergoing laparoscopic hysterectomy has massively impacted gynaecological practice. Here, we present the results of an in vitro assessment of a novel protection system developed to mitigate this hazard.
Methods: The Tissue Containment System for Manual Morcellation (Guardenia™, Advanced Surgical Concepts, Wicklow, Ireland) is an evolved wound protection/specimen extraction guarded bag system compatible with any 12mm trocar. Device use was assessed by device-naïve gynaecological and general surgeon volunteers (providing expert and inexpert morcellation cohorts, respectively) on a bench model consisting of biological tissue in a custom-built moulded rig with camera control after the operators were instructed in its use.
Results: Twenty surgeons (10 gynaecologists/10 general surgeons, median duration of practice experience: 8 years, median annual number of laparoscopic operative procedures: 150 and 80, respectively) completed the user assessment. All subjects understood and correctly performed each step; i.e., (i) placement of the bag through the trocar, (ii) specimen bagging, (iii) incision extension (range 25-60 mm) after tethering the bag through the port, (iv) insertion of the device guard through the mouth of the bag after trocar removal, and (v) sufficient tissue morcellation within the bag to enable complete specimen removal (mean specimen weight 390g, range 201-1800g). There was 100% bag integrity by water-leak testing following use, despite scalpel contact with the guard in 14/20 cases (70%).
Conclusion: Among first-time clinical users, this novel device enabled complete containment of morcellation debris and removal of a laparoscopic specimen, which would support further submission for regulatory approval.
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The Thermal Safety Profile of a New Bipolar Vessel Sealing Device for Thyroid Surgery
Aman Prasad, BS, University of Pennsylvania, Philadelphia, Pennsylvania, Jessica Durrant, MS, DVM, Emeritus Professor of Surgery, Dallas Tissue Research, Farmers Branch, Texas, Daniel D. Smeak, DVM,
College of Veterinary Medicine and Biomedical Sciences, Fort Collins, Colorado, Jason G. Newman, MD, Professor, Perelman School of Medicine, Philadelphia, Pennsylvania
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Introduction: Bipolar electrocautery devices used to achieve intraoperative hemostasis carry risk of imparting thermal energy to adjacent tissue, leading to postoperative morbidity. The aim of this study was to compare a new vessel sealing device, the CoolSeal™ Reveal (Bolder Surgical, Louisville, Colorado), with an established industry standard device, the LigaSure™ Exact Dissector (Valleylab, Boulder, Colorado), to assess their safety and the extent to which they impart thermal damage to tissue during thyroid surgery.
Materials and Methods: Vascular bundles associated with the thyroid gland in anesthetized sheep were exposed and sealed with a single activation of each device and excised en bloc. Additionally, vascular structures of the sheep were also sealed 0, 1, or 2mm adjacent to the recurrent laryngeal nerve (RLN). Vascular and RLN samples were processed for histopathologic evaluation and assessed for extent of thermal injury, seal width, and coagulative changes.
Results: The mean thermal injury extent across all sample sizes and vessel types was significantly lower for the CoolSeal™ Reveal device (547.2 ± 27.9μm) compared to the LigaSure™ device (802.7± 48.6μm) (p<0.001). Seal widths were significantly smaller in samples sealed with the CoolSeal™ Reveal device (899.0 ± 14.9μm) than samples sealed with the LigaSure™ device (1645.3 ± 160.3μm) (p<0.001).
Conclusion: The CoolSeal™ Reveal device demonstrates significantly lower thermal spread in vivo compared to the LigaSure™ Exact Dissector. These results indicate that the CoolSeal™ Reveal is an effective tool for sealing blood vessels and minimizing thermal damage to adjacent structures during delicate surgeries or in narrow surgical fields associated with the thyroid gland.
New Method for Surgical Diagnostics - a Robotic Telemedical Approach
Jonas Fuchtmann, MSc, Roman Krumpholz, MSc, Daniel Ostler, MSc, Dirk Wilhelm, Prof. Dr. med, MD, Hubertus Feussner, Prof. Dr. med., MD, Maximilian Berlet, MD, Abdeldjallil Naceri, PhD, Sami Haddadin, Prof. Dr. Ing., Daniela Macari, MSc, Technical University Munich, Munich, Germany
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Apart from the tremendous increase in the demand for telemedicine during the COVID-19 pandemic, the use of telemedical technology offers many advantages, such as better coverage of rural areas and improved access to specialists. While current telediagnostic possibilities are often limited to a verbal consultation, the field of surgery has already made use of robotics for one of the most challenging areas of medicine: invasive procedures. Since comprehensive diagnostics are a prerequisite for each surgery, we built upon the knowledge gained in telesurgery and developed a telediagnostic system that allows for an extensive perioperative and emergency examination. It is based on a robotic platform consisting of a remote lead robotic arm at the physician’s site and a follower robot at the patient’s site. Mirroring all movements directly and using force-feedback, both parties can precisely interact, enabling tasks such as auscultation, percussion, and palpation without the need for extensive training. Our overall setup also includes the possibility to measure and monitor all relevant vital parameters and can be used to perform ear and nasopharyngeal inspections as well as an automatic swab to screen for COVID or other contagious diseases prior to hospital admission.
In this paper, we focus on the potential of this technology for the surgical community by demonstrating the ease of adding an ultrasound probe to our modular setup to perform a high-quality emergency ultrasound examination. While the system is not yet ready for everyday use in a hospital and drawbacks such as a high cost persist, our setup paves the way for the future use of telediagnostics in surgery.
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Healthcare Simulation Use to Support Guidelines Implementation: An Integrative Review
Amina Silva, PhD(c), Kevin Woo, PhD, Professor, Jacqueline Galica, PhD, Associate Professor, Rosemary Wilson, PhD, Associate Professor, Marian Luctkar-Flude, PhD, Associate Professor, Queen’s University, Kingston, Canada, Maria Ligia Bellaguarda, PhD, Associate Professor, Federal University of Santa Catarina, Florianópolis, Brazil, Vanessa Silva e Silva, PhD, Children’s Hospital of Eastern Ontario, Ottawa, Canada
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Introduction: Simulation-based education is a useful teaching and learning strategy that can help to implement guidelines into healthcare settings. Therefore, the purpose of this paper is to collate, synthesize, and analyze the literature focusing on the use of simulation as an educational strategy to support guidelines implementation among healthcare providers (HCPs).
Materials and Methods: Integrative literature review using the methodology proposed by Ganong.
Results/Discussion: Twenty-three articles were selected, the majority (n=19, 82%) used simulation in practice settings and pre- and post-test measurement (n=16, 69%). All studies that assessed simulation effects highlighted that the use of simulation improved the measured outcomes related to guideline implementation. Simulation-based education can be an effective strategy to support guidelines implementation among HCPs, but aspects such as cost involved, time constraints, training of educators, and the HCPs’ learning needs can affect its applicability. Future research should focus on more transparent reports related to the guidelines for simulation content, virtual learning, costs of simulation, and measurement of the long-term effects of simulation-based education.
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