scholarly journals Visual Measurement of Suture Strain for Robotic Surgery

2011 ◽  
Vol 2011 ◽  
pp. 1-9 ◽  
Author(s):  
John Martell ◽  
Thomas Elmer ◽  
Nachappa Gopalsami ◽  
Young Soo Park
Keyword(s):  
Robotic Surgery ◽  
Minimally Invasive ◽  
Surgical Procedures ◽  
Video Processing ◽  
Postoperative Recovery ◽  
Hospital Length ◽  
Tactile Feedback ◽  
Hospital Length Of Stay ◽  
Visual Interpretation ◽  
Suture Tension

Minimally invasive surgical procedures offer advantages of smaller incisions, decreased hospital length of stay, and rapid postoperative recovery to the patient. Surgical robots improve access and visualization intraoperatively and have expanded the indications for minimally invasive procedures. A limitation of the DaVinci surgical robot is a lack of sensory feedback to the operative surgeon. Experienced robotic surgeons use visual interpretation of tissue and suture deformation as a surrogate for tactile feedback. A difficulty encountered during robotic surgery is maintaining adequate suture tension while tying knots or following a running anastomotic suture. Displaying suture strain in real time has potential to decrease the learning curve and improve the performance and safety of robotic surgical procedures. Conventional strain measurement methods involve installation of complex sensors on the robotic instruments. This paper presents a noninvasive video processing-based method to determine strain in surgical sutures. The method accurately calculates strain in suture by processing video from the existing surgical camera, making implementation uncomplicated. The video analysis method was developed and validated using video of suture strain standards on a servohydraulic testing system. The video-based suture strain algorithm is shown capable of measuring suture strains of 0.2% with subpixel resolution and proven reliability under various conditions.

scholarly journals Abdominal emergency surgery in patients over 90 years old: is it worthwhile? An Italian multicenter retrospective study

2016 ◽  
Author(s):  
Antonio Tarasconi ◽  
Fausto Catena ◽  
Hariscine K. Abongwa ◽  
Belinda De Simone ◽  
Federico Coccolini ◽  
...  
Keyword(s):  
Survival Rate ◽  
Length Of Stay ◽  
Abdominal Surgery ◽  
Surgical Procedures ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Asa Score ◽  
Abdominal Emergency ◽  
Emergency Abdominal Surgery

Unlike other surgical fields, such as cardiac surgery, where many trials have been made about safety, feasibility and outcome of surgical procedures in the elderly, there is lack of literature about emergency abdominal surgery in very old patients, especially in people over 90 years of age. The available data reported survival of about 50% one year after the operation. The aim of the study is to determine the survival rate two years after emergency abdominal surgery in a nonagenarian population and to identify any demographic and surgical parameters that could predict a poor outcome in this type of patient. The study was a retrospective multicenter trial. Patient inclusion criteria were: age 90 years old or older, urgent abdominal surgery. The medical charts reviewed and data collected were: gender, age, the American Society of Anesthesiologists (ASA) score and comorbidities, diagnosis, time elapsed between arrival to the Emergency Room and admission to the Operatory Room, surgical procedures, open versus laparoscopic procedure, type of anesthesia and outcomes with hospital length of stay. Phone call follow-up was performed for patient discharged alive and Kaplan-Meier analysis was used to evaluate survival. We identified 72 (20 males and 52 females) nonagenarian patients who underwent abdominal emergency surgery at 6 Italian hospitals (Parma, Bergamo, Bologna, Brescia, Chiari, Adria). Mean age was 92.5 years [range 90-100, standard deviation (SD) 2.6], median ASA score was 3 (range 2-5, mean 3.32) and only 7 patients were without comorbidities. Mean hospital length of stay was 13 days (range 1-60, SD 11.52); 56 patients (77.7%) were discharged alive; 2 years survival rate was 23% [mean follow-up=10 months (range 1-27)]. Among all the parameters analyzed, only ASA score was significantly correlated with survival. Neither the presence of malignancy nor the absence of comorbidities seems to correlate with survival. Nonagenarian patients undergoing emergent abdominal surgical procedures have a high overall in-hospital mortality rate (23%) and a low 2 years survival rate (51.4%). Except for ASA score, there are no other factors predicting poor outcome. Based on the present study emergency abdominal surgery in frail patients over 90 years of age has to be carefully evaluated: only 1 out 5 patients will be alive after 2 years.

PS01.212: OUTCOMES OF HYBRID VERSUS FULLY MINIMALLY INVASIVE 2-STAGE ESOPHAGECTOMY FOR CANCER OF THE DISTAL ESOPHAGUS AND GASTRO-ESOPHAGEAL JUNCTION

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 110-110
Author(s):  
Kanatheepan Shanmuganathan ◽  
Temisanren Akitikori ◽  
Oluwasunmisola Soile ◽  
Aadil Hussain ◽  
Neda Farhangmehr ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Minimally Invasive ◽  
Anastomotic Leak ◽  
Minimally Invasive Esophagectomy ◽  
Hospital Length ◽  
Leak Rate ◽  
Hospital Length Of Stay ◽  
Cardiac Complications ◽  
Invasive Esophagectomy ◽  
Anastomotic Leak Rate

Abstract Background Esophagectomy is associated with high complication rate and mortality. Numerous approaches have been introduced over the last two decades, with the ambition of reducing rate of complications, morbidity and mortality. Two-stage minimally invasive esophagectomies include hybrid (laparoscopic/thoracotomic) and fully minimally invasive and have recently gained popularity in the treatment of distal esophageal and gastro-esophageal junction cancer. We aim to compare the short-term outcomes between 2-stage hybrid and fully minimally invasive esophagectomy with intrathoracic hand-sewn anastomosis. Methods A retrospective analysis of a 4-year period prospectively collected data of 100 consecutive 2-stage minimally invasive esophagectomies was conducted. All operations were performed in a UK tertiary centre by a single surgical team between 2014 and 2018. All 3-stage and open esophagectomies were excluded from the study. A comparison of anastomotic leak rate, ITU length of stay, hospital length of stay, pulmonary complications, cardiac complications and 30 and 90-day mortality rates was made. Statistical analysis was performed using Graph-Prism 7.04. Results Seventy patients underwent hybrid and 30 underwent fully minimally invasive esophagectomy with intra-thoracic manual anastomosis. Chest infection and anastomotic leak rate were higher in the hybrid group (21.4% vs 16.8% and 10% vs 3.3%); however, cardiac complications were two times more common in fully minimally invasive compared to hybrid esophagectomies (3.3% vs 1.4%). Fully minimally invasive esophagectomies were associated with a shorter ITU stay as well as hospital length of stay compared to hybrid esophagectomies (5.5 vs 6.2 days, P = 0.47 and 10.5 vs 15.6 days P = 0.0018). Complete tumour resection (R0) rate was slightly higher in hybrid compared to fully minimally invasive esophagectomies (70.8% vs 64.3%). Thirty and 90-day mortality rate was 6.67% (1 cardiac and 1 respiratory arrest) in fully minimally invasive and 1.43% in hybrid esophagectomies. None of the mortality cases were related to surgical complications like anastomotic leak or conduit necrosis. Conclusion In our study 2-stage fully minimally invasive esophagectomy is associated with reduced post-operative complication rates compared to 2-stage hybrid oesophagectomy. Further larger studies are needed to assess the 30- and 90-day mortality risk associated with both procedures. Disclosure All authors have declared no conflicts of interest.

scholarly journals Biliary Surgery Via Minilaparotomy — A Limited Procedure for Biliary Lithiasis

HPB Surgery ◽  
1993 ◽  
Vol 6 (4) ◽  
pp. 245-254 ◽  
Author(s):  
Takukazu Nagakawa
Keyword(s):  
Operation Time ◽  
Skin Incision ◽  
Postoperative Recovery ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Limited Area ◽  
Biliary Surgery ◽  
The Right ◽  
Upper Abdomen ◽  
Surgical Manipulation

Cholelithiasis until now has been treated using solvents, lithotripsy via a biliary endoscope, laser or shock wave lithotripsy, and laparoscopic cholecystectomy. have developed a new surgical treatment for cholelithiasis in which a cholecystectomy is performed through a minilaparotomy. This paper presents this new technique and discusses the principles of surgery for cholelithiasis using this technique. This procedure is performed by a 2 to 3 cm subcostal skin incision in the right hypochondrium. More than 400 patients were treated by this technique. This procedure is not different in terms of blood loss .or operation time from conventional methods, and no significant complications have occurred. Intraoperative X-ray examination is performed routinely because of easy insertion of a tube from the cystic duct into the bile duct. Reduction of the length of the incision greatly facilitates postoperative recovery, shortening the hospital length-of-stay to within 3 days. The surgical manipulation of only a limited area of the upper abdomen is unlikely to induce postoperative syndromes, such as adhesions or ileus. Following this experience, a biliary drainage procedure based on cholangionmanomery and primary closure of the choledochotomy was introduced. This approach allowed even patients with choledocholithiasis to undergo a minilaparotomy and be discharged within one week.

Case-Controlled Comparison of Video-Assisted and Conventional Minimally Invasive Parathyroidectomy

2012 ◽  
Vol 78 (1) ◽  
pp. 125-132 ◽  
Author(s):  
Adrienne L. Melck ◽  
Michael J. Armstrong ◽  
Linwah Yip ◽  
Sally E. Carty
Keyword(s):  
Minimally Invasive ◽  
Hospital Stay ◽  
Hospital Length ◽  
Minimally Invasive Parathyroidectomy ◽  
Hospital Length Of Stay ◽  
Complication Rates ◽  
Invasive Parathyroidectomy ◽  
Video Assisted ◽  
Imaging Results ◽  
Added Benefit

Video-assisted parathyroidectomy (VAP) is a new approach to parathyroid exploration for primary hyperparathyroidism (PH). We examined the VAP learning curve and hypothesized that compared with conventional minimally invasive parathyroidectomy (MIS), VAP has similar complication rates and the added benefit of a shorter hospital length of stay. Using a case-control study design, patients with PH with single-focus imaging results undergoing VAP or MIS were compared during a 5-year VAP implementation period. VAP was possible in 18 per cent of patients undergoing initial parathyroid exploration. In comparing 125 VAP cases with 95 MIS control subjects, patients undergoing MIS had higher mean preoperative levels of calcium ( P = 0.007) and parathyroid hormone ( P = 0.008), greater mean adenoma weight ( P < 0.001), and increased long-term mortality (4% MIS vs 0% VAP, P = 0.03). Mean operative time, in-house analgesia use, and operative complications did not differ. The rate of conversion from VAP to MIS was 14 per cent. Patients undergoing VAP were less likely to require an overnight hospital stay ( P = 0.01). VAP is a safe surgical option for selected patients with PH, offering improved cosmesis with operative times comparable to conventional MIS. VAP can be done with a low conversion rate even during implementation and allows the added benefit of shorter hospital stay.

scholarly journals Surgical approach to solid pseudopapillary neoplasms of the proximal pancreas: minimally invasive vs. open

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Emmanuel II Uy Hao ◽  
Seoung Yoon Rho ◽  
Ho Kyoung Hwang ◽  
Jae Uk Chung ◽  
Woo Jung Lee ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Head And Neck ◽  
Surgical Approach ◽  
Tumor Size ◽  
Open Surgery ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Minimally Invasive Surgical ◽  
Solid Pseudopapillary Neoplasms

Abstract Background Solid pseudopapillary neoplasms (SPN) of the pancreas are rare pancreatic neoplasms where complete resection is the cornerstone in management. It has been demonstrated in previous studies that minimally invasive surgical approaches are effective management options in treating SPNs of the distal pancreas. The purpose of this study is to evaluate the feasibility of minimally invasive surgery in treating SPNs of the uncinate, head, and neck of the pancreas. Methods Data from 2005 to 2017 at Severance Hospital of the Yonsei University Health systems in Seoul, South Korea, were retrospectively collected for 25 patients who were diagnosed with SPN of the uncinate, head, and neck of the pancreas and who underwent curative resection. Three groups of patients were considered, depending on the year of surgery, in order to determine trends in the surgical management of SPN. The patients were also divided into two groups corresponding to the type of operation done (minimally invasive surgery vs. open surgery). Perioperative patient data, including age, gender, body mass index (BMI), tumor size, and operation done, were compared and analyzed statistically. Long-term nutritional effects were measured using the Controlling Nutritional Status (CONUT) scoring system. Results There were no statistically significant differences in age, gender, BMI, symptomatic presentation, operation type, tumor size, and tumor stage between the three time periods. In comparing between minimally invasive and open surgery, there were no statistically significant differences in age, gender, symptomatic presentation, BMI, tumor size, preoperative stage, type of operation, operation time, pancreatic duct size, post-operative pancreatic fistula (POPF) grade, death associated with disease, recurrence, pathological parameters, and change in CONUT score. There was a significant difference in tumor size (4.5 ± 1.8 vs. 2.6 ± 1.0 cm, p = 0.004), blood loss (664.2 ± 512.4 vs. 277.7 ± 250.8 mL, p = 0.024), need to transfuse (33% vs. 0%, p = 0.023), hospital length of stay (27.4 ± 15.3 vs. 11.5 ± 5.3 days, p = 0.002), and complication rate (75% vs. 30.8%, p = 0.027) between the two groups. Conclusions In appropriately selected patients with SPNs of the uncinate, head, and neck of the pancreas, a minimally invasive surgical approach offers at least equal oncologic and nutritional outcomes, while demonstrating decreased complications and decreased hospital length of stay compared with that of an open surgical approach.

scholarly journals Two-Level Minimally Invasive Lumbar Laminectomy and Foraminotomy: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Ethan S Srinivasan ◽  
Clifford L Crutcher ◽  
Timothy Y Wang ◽  
Peter M Grossi ◽  
Khoi D Than
Keyword(s):  
Minimally Invasive ◽  
High Speed ◽  
Hospital Length ◽  
Spinal Nerve ◽  
Hospital Length Of Stay ◽  
Foraminal Stenosis ◽  
Tubular Retractor ◽  
Open Operation ◽  
Spinous Processes ◽  
Patient Reported

Abstract Minimally invasive lumbar laminectomies utilize tubular retractors to minimize tissue disturbance, blood loss, and hospital length of stay compared to open operations. Here, we highlight the operative treatment of a 68-yr-old male entailing a 2-level minimally invasive lumbar laminectomy and foraminotomy at L2-L3 and L3-L4. The patient initially presented with symptoms of treatment-refractory lower extremity numbness and limited ambulation. His imaging demonstrated coronal scoliosis and severe lumbar central and foraminal stenosis at L2-L3 and L3-L4, with enlarged spinous processes, laminae, and facets. The patient consented to the procedure and publication of their image. The operation proceeded with the patient in a prone position with paramedian dissection to the lamina through a minimally invasive tubular retractor. Laminectomies and foraminotomies were performed at each level with high-speed drill and a Kerrison rongeur, with care to identify and protect the relevant spinal nerve roots. Postoperatively, the patient reported significantly reduced numbness and improved ambulation, with a well-healed surgical incision notably smaller than those produced in an open operation.

Is the Laparotomy Here to Stay? A Review of the Disadvantages of Laparoscopy

2020 ◽  
Vol 30 (02) ◽  
pp. 181-186
Author(s):  
Brian C. Gulack ◽  
Kaitlyn Wong ◽  
Eric Sparks ◽  
Joshua Ramjist ◽  
Haitao Zhu ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Air Embolism ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Aesthetic Results ◽  
Abdominal Operations ◽  
Pediatric Patient Population ◽  
Laparoscopic Techniques ◽  
Neonates And Infants ◽  
Thoracic And Abdominal

AbstractMinimally invasive procedures have seen increasing utilization in the pediatric patient population since the 1990s. Most thoracic and abdominal operations in pediatric surgery can be performed in a minimally invasive manner including those performed in neonates and infants. Thoracoscopic or laparoscopic operations can reduce hospital length of stay, minimize postoperative pain, and lead to more aesthetic results. However, it is important to be aware of the inherent risks, limitations, and adverse effects associated with these thoracoscopic and laparoscopic techniques, particularly in special populations. In this article, we will review the risks and limitations of laparoscopy in pediatric patients such as cost, operative time, reduced effectiveness, air embolism, hypercarbia, hypothermia, and access-related injuries.

scholarly journals Educational note: teaching and training in robotic surgery. An opinion of the Minimally Invasive and Robotic Surgery Committee of the Brazilian College of Surgeons

2020 ◽  
Vol 47 ◽  
Author(s):  
MIGUEL PRESTES NACUL ◽  
ARMANDO GERALDO FRANCHINI MELANI ◽  
BRUNO ZILBERSTEIN ◽  
DYEGO SÁ BENEVENUTO ◽  
LEANDRO TOTTI CAVAZZOLA ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Minimally Invasive ◽  
Surgical Procedures ◽  
Surgical Simulation ◽  
Clinical Stage ◽  
Psychomotor Skills ◽  
Specific Knowledge ◽  
The Creation ◽  
And Performance ◽  
Bedside Assistant

ABSTRACT With the expansion of robotic surgical procedures, the acquisition of specific knowledge and skills for surgeons to reach proficiency seems essential before performing surgical procedures on humans. In this sense, the authors present a proposal to establish a certification based on objective and validated criteria for carrying out robotic procedures. A study was carried out by the Committee on Minimally Invasive and Robotic Surgery of the Brazilian College of Surgeons based on a reviewing strategy of the scientific literature. The study serves as a reference for the creation of a standard for the qualification and certification in robotic surgery according to a statement of the Brazilian Medical Association (AMB) announced on December 17, 2019. The standard proposes a minimum curriculum, integrating training and performance evaluation. The initial (pre-clinical) stage aims at knowledge and adaptation to a specific robotic platform and the development of psychomotor skills based on surgical simulation. Afterwards, the surgeon must accompany in person at least five surgeries in the specialty, participate as a bedside assistant in at least 10 cases and perform 10 surgeries under the supervision of a preceptor surgeon. The surgeon who completes all the steps will be considered qualified in robotic surgery in his specialty. The final certification must be issued by the specialty societies affiliated to AMB. The authors conclude that the creation of a norm for habilitation in robotic surgery should encourage Brazilian hospitals to apply objective qualification criteria for this type of procedure to qualify assistance.

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