scholarly journals Robot-assisted pancreatic surgery—optimized operating procedures: set-up, port placement, surgical steps

2021 ◽  
Author(s):  
Matthäus Felsenstein ◽  
Karl H. Hillebrandt ◽  
Lea Timmermann ◽  
Mathilde Feist ◽  
Christian Benzing ◽  
...  
Keyword(s):  
Pancreatic Surgery ◽  
High Volume ◽  
Minimal Invasive ◽  
Learning Curves ◽  
High Morbidity ◽  
Port Placement ◽  
Robotic Assisted ◽  
Post Marketing ◽  
Set Up ◽  
The One

AbstractEven in most complex surgical settings, recent advances in minimal-invasive technologies have made the application of robotic-assisted devices more viable. Due to ever increasing experience and expertise, many large international centers now offer robotic-assisted pancreatic surgery as a preferred alternative. In general however, pancreatic operations are still associated with high morbidity and mortality, while robotic-assisted techniques still require significant learning curves. As a prospective post-marketing trial, we have established optimized operating procedures at our clinic. This manuscript intends to publicize our standardized methodology, including pre-operative preparation, surgical set-up as well as the surgeons’ step-by-step actions when using pancreatic-assisted robotic surgery. This manuscript is based on our institutional experience as a high-volume pancreas operating center. We introduce novel concepts that should standardize, facilitate and economize the surgical steps in all types of robotic-assisted pancreatic surgery. The “One Fits All” principle enables single port placement irrespective of the pancreatic procedure, while the “Reversed 6-to-6 Approach” offers an optimized manual for pancreatic surgeons using the robotic console. Novel and standardized surgical concepts could guide new centers to establish a robust, efficient and safe robotic-assisted pancreatic surgery program.

scholarly journals Learning Curve for Laparoscopic Hysterectomy: An Experience from Kathmandu University Hospital

2018 ◽  
Vol 13 (3) ◽  
pp. 32-36
Author(s):  
Suman Raj Tamrakar ◽  
N. Pradhan ◽  
Suresh Kayastha
Keyword(s):  
Retrospective Study ◽  
Operating Time ◽  
Laparoscopic Hysterectomy ◽  
Minimal Invasive ◽  
Learning Curves ◽  
University Hospital ◽  
Demographic Parameters ◽  
Set Up ◽  
Duration Of Operation ◽  
Low Rate

Aims: The aim of this study is to assess learning curves for laparoscopic hysterectomies, compare the performance of surgeons and review demographic parameters of the patients, varieties of complications experienced and indications of the procedures. Methods: A retrospective study was conducted in Kathmandu University Hospital, Kavre of January 1, 2011 to June 30, 2018. Results: A total of 1849 cases were already performed by mid 2018. Of them, 261 (14.12%) cases were LAVH and TLH cases. Mean duration for laparoscopic hysterectomies (for both LAVH and TLH) was 142.21±43.46 minutes (range 55 to 310 minutes) and one third of the cases performed in a range of 121 to 150 minutes. There is difference in mean duration of operation between surgeons which is statistically significant (p <0.001). Beside one of four surgeons (surgeon B) had significant reduction in mean duration for LAVH surgery (p=0.004). Same surgeon has significant reduction in mean duration for performing TLH (p=0.0047). Of the 261 laparoscopic hysterectomies, 8 cases (3.07%) turned into laparotomy. Conclusions: Laparoscopic hysterectomies are feasible with reducing mean operating time across the period. These minimal invasive surgeries are safe with low rate of complications and less conversion to open even in our set up.

scholarly journals Robotic-assisted pancreatic surgery in the elderly patient: experiences from a high-volume centre

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Karl H. Hillebrandt ◽  
Sebastian Knitter ◽  
Lea Timmermann ◽  
Matthäus Felsenstein ◽  
Christian Benzing ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Pancreatic Surgery ◽  
Length Of Hospital Stay ◽  
High Volume ◽  
The Elderly ◽  
Robotic Assisted ◽  
Conversion To Open Surgery ◽  
Number Of Patients ◽  
Group 2

Abstract Background Robotic-assisted pancreatic surgery (RPS) has fundamentally developed over the past few years. For subgroups, e.g. elderly patients, applicability and safety of RPS still needs to be defined. Given prognosticated demographic developments, we aim to assess the role of RPS based on preoperative, operative and postoperative parameters. Methods We included 129 patients undergoing RPS at our institution between 2017 and 2020. Eleven patients required conversion to open surgery and were excluded from further analysis. We divided patients into two groups; ≥ 70 years old (Group 1; n = 32) and < 70 years old (Group 2; n = 86) at time of resection. Results Most preoperative characteristics were similar in both groups. However, number of patients with previous abdominal surgery was significantly higher in patients ≥ 70 years old (78% vs 37%, p < 0.0001). Operative characteristics did not significantly differ between both groups. Although patients ≥ 70 years old stayed significantly longer at ICU (1.8 vs 0.9 days; p = 0.037), length of hospital stay and postoperative morbidity were equivalent between the groups. Conclusion RPS is safe and feasible in elderly patients and shows non-inferiority when compared with younger patients. However, prospectively collected data is needed to define the role of RPS in elderly patients accurately. Trial registration Clinical Trial Register: Deutschen Register Klinischer Studien (DRKS; German Clinical Trials Register). Clinical Registration Number: DRKS00017229 (retrospectively registered, Date of Registration: 2019/07/19, Date of First Enrollment: 2017/10/18).

A prospective study of the components of operating room utilisation time for robotic urological surgery in a public teaching hospital setting

2020 ◽  
pp. 205141582094271
Author(s):  
Mark P Broe ◽  
Jarlath M Bolger ◽  
Sarah Norton ◽  
Silviu David ◽  
John C Coffey ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Operating Room ◽  
Outcome Measures ◽  
Operative Time ◽  
Significant Proportion ◽  
Learning Curves ◽  
Secondary Outcome ◽  
Port Placement ◽  
Depth Analysis ◽  
Set Up

Introduction and aim: Although there are several publications on learning curves and patient outcomes in robotic surgery, the literature is lacking in depth analysis of operating room (OR) utilisation time which is an expansive healthcare resource for robotic surgery, especially in urology. Thus, we aimed to study individual operating theatre component times in order to improve performance and efficacy. Method: A cross-specialty robotic-surgery programme was established at our institution in mid-June 2016 using the daVinci Xi dual console robot. A detailed database was established before initiation of the project. The times taken for each element of the preparation and completion of robotic urological procedure were collected by an independent nurse for all the procedures. Primary outcome measures were total OR time, operative time and console time. Secondary outcome measures were port placement time, set-up time and non-operative time. The statistical significance was calculated by using the Student’s t-test, Fisher’s exact test or Wilcoxon matched pairs test where appropriate. Result: Thirty consecutive urological cases were analysed. Mean total OR time, operative time and console time were 320.86 (range 172–485), 235.7 (124–295) and 152.3 min (66–219) respectively. Console time accounted for about less than half of OR time. A significant proportion of OR time was non-operative time (almost one third). After an initial learning curve, set-up time was consistently maintained for most robotic procedures. Conclusions: The findings of this study have three implications for clinical practice. Firstly, console time contributed about half of the OR time. This can be optimised with experience. Secondly robot set-up time is likely to reduce with the experience of the whole team. Finally, non-operative OR time constitute a significant one third of the OR time during robotic surgery. Efforts to reduce non-surgical aspect of OR time will have potential to reduce cost and improve efficiency. Level of Evidence: 4

scholarly journals Effects of COVID-19 Pandemic on the Treatment of Pancreatic Cancer: A Perspective from Central Europe

2021 ◽  
Vol 38 (2) ◽  
pp. 158-165
Author(s):  
Ilaria Pergolini ◽  
I. Ekin Demir ◽  
Christian Stöss ◽  
Klaus Emmanuel ◽  
Robert Rosenberg ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Cancer Patients ◽  
Central Europe ◽  
Pancreatic Surgery ◽  
Online Survey ◽  
Viral Infections ◽  
High Volume ◽  
Tumor Board ◽  
Standards Of Care ◽  
The Impact

Background: This survey aimed to register changes determined by the COVID-19 pandemic on pancreatic surgery in a specific geographic area (Germany, Austria, and Switzerland) to evaluate the impact of the pandemic and obtain interesting cues for the future. Methods: An online survey was designed using Google Forms focusing on the local impact of the pandemic on pancreatic surgery. The survey was conducted at 2 different time points, during and after the lockdown. Results: Twenty-five respondents (25/56) completed the survey. Many aspects of oncological care have been affected with restrictions and delays: staging, tumor board, treatment selection, postoperative course, adjuvant treatments, outpatient care, and follow-up. Overall, 60% of respondents have prioritized pancreatic cancer patients according to stage, age, and comorbidities, and 40% opted not to operate high-risk patients. However, for 96% of participants, the standards of care were guaranteed. Discussion/Conclusions: The first wave of the COVID-19 pandemic had an important impact on pancreatic cancer surgery in central Europe. Guidelines for prompt interventions and prevention of the spread of viral infections in the surgical environment are needed to avoid a deterioration of care in cancer patients in the event of a second wave or a new pandemic. High-volume centers for pancreatic surgery should be preferred and their activity maintained. Virtual conferences have proven to be efficient during this pandemic and should be implemented in the near future.

scholarly journals The Swiss National Park

Oryx ◽  
1955 ◽  
Vol 3 (2) ◽  
pp. 64-70
Author(s):  
G. N. Zimmerli
Keyword(s):  
National Park ◽  
Swiss Society ◽  
Large Area ◽  
Nature Protection ◽  
Swiss National Park ◽  
Plant Life ◽  
Eastern Border ◽  
Set Up ◽  
The One ◽  
Protection Commission

The idea of a Swiss national park originated with the Swiss Society for Nature Research and this Society played the leading part in its realization. In 1906 the Society set up as part of its own organization a Swiss Nature Protection Commission and charged it to search for an area in Switzerland suitable for establishment as a reserve, in which all the animal and plant life could be protected against interference by man and so could be left entirely to the play of natural forces. It was not easy to find in Switzerland a suitably large area which still retained its original characteristics, was virtually free from human settlement, and contained some wealth of fauna and flora. After a careful survey of the whole country it became clear that the most suitable region was the Lower Engadine, with its isolated valleys on the eastern border of the country. The district in which, at the beginning of the century, bears had still lived was the one in which primitive nature could be found in its truest state.

Pancreatic surgery: Evolution at a high-volume center

Surgery ◽  
2010 ◽  
Vol 148 (4) ◽  
pp. 702-710 ◽  
Author(s):  
Kathryn M. Ziegler ◽  
Attila Nakeeb ◽  
Henry A. Pitt ◽  
C. Max Schmidt ◽  
Sarah N. Bishop ◽  
...  
Keyword(s):  
Pancreatic Surgery ◽  
High Volume ◽  
High Volume Center

Comparing the Quality of the Suture Anastomosis and the Learning Curves Associated with Performing Open, Freehand, and Robotic-Assisted Laparoscopic Pyeloplasty in a Swine Animal Model

2009 ◽  
Vol 208 (4) ◽  
pp. 576-586 ◽  
Author(s):  
Carlo C. Passerotti ◽  
Ana Maria A.M.S. Passerotti ◽  
Marcos F. Dall'Oglio ◽  
Katia R.M. Leite ◽  
Ricardo L.V. Nunes ◽  
...  
Keyword(s):  
Animal Model ◽  
Learning Curves ◽  
Laparoscopic Pyeloplasty ◽  
Robotic Assisted ◽  
Suture Anastomosis

scholarly journals High concentration Brownian coagulation in jet flow using two enhancement formulations

2012 ◽  
Vol 16 (5) ◽  
pp. 1519-1523
Author(s):  
Pei-Feng Lin ◽  
Di-Chong Wu ◽  
Ze-Fei Zhu
Keyword(s):  
Volume Fraction ◽  
Taylor Series Expansion ◽  
Expansion Method ◽  
High Volume ◽  
Jet Flow ◽  
High Concentration ◽  
Brownian Coagulation ◽  
Planar Jet ◽  
Ultra Fine Particle ◽  
The One

Ultra-fine particle coagulation by Brownian motion at high concentration in planar jet flow is simulated. A Taylor-Series Expansion Method of Moments is employed to solve the particle general dynamic equation. The volume fraction gets high value, very closes to that at the nozzle exit. As the vortex pairing develops, the high volume fraction region rolls out and mixes with the low value region. The enhancement factor given by Trzeciak et al. will be less than one at some specific outer positions, which seems to be less accurate than the one given by Heine et al.

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