scholarly journals Assessment of Laparoscopic Instrument Reprocessing in Rural India: A Mixed Methods Study

2021 ◽  
Author(s):  
Daniel Robertson ◽  
Jesudian Gnanaraj ◽  
Linda Wauben ◽  
Jan Huijs ◽  
Vasanth Mark Samuel ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Minimally Invasive ◽  
Surgical Care ◽  
Medical Practitioner ◽  
Surgical Instruments ◽  
Rural India ◽  
Laparoscopic Instrument ◽  
Minimally Invasive Surgical Procedure ◽  
Standard Operating ◽  
Sterile Processing

Abstract Background Laparoscopy is a minimally-invasive surgical procedure that uses long slender instruments that require much smaller incisions than conventional surgery. This leads to faster recovery times, fewer infections and shorter hospital stays. For these reasons, laparoscopy could be particularly advantageous to patients in low to middle income countries (LMICs). Unfortunately, sterile processing departments in LMIC hospitals are faced with limited access to equipment and trained staff and poses an obstacle to safe surgical care. The reprocessing of laparoscopic devices requires specialised equipment and training. Therefore, when LMIC hospitals invest in laparoscopy, an update of the standard operating procedure in sterile processing is required. Currently, it is unclear whether LMIC hospitals, that already perform laparoscopy, have managed to introduce updated reprocessing methods that minimally invasive equipment requires. The aim of this study was to identify the laparoscopic sterile reprocessing procedures in rural India and to test the effectiveness of the sterilisation equipment. Methods We assessed laparoscopic instrument sterilisation capacity in four rural hospitals in different states in India using a mixed-methods approach. As the main form of data collection, we developed a standardised observational checklist based on reprocessing guidelines from several sources. Steam autoclave performance was measured by monitoring the autoclave cycles in two hospitals. Finally, the findings from the checklist data was supported by an interview survey with surgeons and nurses. Results The checklist data revealed the reprocessing methods the hospitals used in the reprocessing of laparoscopic instruments. It showed that the standard operating procedures had not been updated since the introduction of laparoscopy and the same reprocessing methods for regular surgical instruments were still applied. The interviews confirmed that staff had not received additional training and that they were unaware of the hazardous effects of reprocessing detergents and disinfectants. Conclusion As laparoscopy is becoming more prevalent in LMICs, updated policy is needed to incorporate minimally invasive instrument reprocessing in medical practitioner and staff training programmes. While reprocessing standards improve, it is essential to develop instruments and reprocessing equipment that is more suitable for resource-constrained rural surgical environments.

scholarly journals Assessment of laparoscopic instrument reprocessing in rural India: a mixed methods study

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Daniel Robertson ◽  
Jesudian Gnanaraj ◽  
Linda Wauben ◽  
Jan Huijs ◽  
Vasanth Mark Samuel ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Minimally Invasive ◽  
Surgical Care ◽  
Medical Practitioner ◽  
Surgical Instruments ◽  
Rural India ◽  
Laparoscopic Instrument ◽  
Minimally Invasive Surgical Procedure ◽  
Standard Operating ◽  
Sterile Processing

Abstract Background Laparoscopy is a minimally-invasive surgical procedure that uses long slender instruments that require much smaller incisions than conventional surgery. This leads to faster recovery times, fewer post-surgical wound infections and shorter hospital stays. For these reasons, laparoscopy could be particularly advantageous to patients in low to middle income countries (LMICs). Unfortunately, sterile processing departments in LMIC hospitals are faced with limited access to equipment and trained staff which poses an obstacle to safe surgical care. The reprocessing of laparoscopic devices requires specialised equipment and training. Therefore, when LMIC hospitals invest in laparoscopy, an update of the standard operating procedure in sterile processing is required. Currently, it is unclear whether LMIC hospitals, that already perform laparoscopy, have managed to introduce updated reprocessing methods that minimally invasive equipment requires. The aim of this study was to identify the laparoscopic sterile reprocessing procedures in rural India and to test the effectiveness of the sterilisation equipment. Methods We assessed laparoscopic instrument sterilisation capacity in four rural hospitals in different states in India using a mixed-methods approach. As the main form of data collection, we developed a standardised observational checklist based on reprocessing guidelines from several sources. Steam autoclave performance was measured by monitoring the autoclave cycles in two hospitals. Finally, the findings from the checklist data was supported by an interview survey with surgeons and nurses. Results The checklist data revealed the reprocessing methods the hospitals used in the reprocessing of laparoscopic instruments. It showed that the standard operating procedures had not been updated since the introduction of laparoscopy and the same reprocessing methods for regular surgical instruments were still applied. The interviews confirmed that staff had not received additional training and that they were unaware of the hazardous effects of reprocessing detergents and disinfectants. Conclusion As laparoscopy is becoming more prevalent in LMICs, updated policy is needed to incorporate minimally invasive instrument reprocessing in medical practitioner and staff training programmes. While reprocessing standards improve, it is essential to develop instruments and reprocessing equipment that is more suitable for resource-constrained rural surgical environments.

Uniportal thoracoscopic right anterior basal (S8) segmentectomy using unidirectional dissection

2021 ◽  
Keyword(s):  
Minimally Invasive ◽  
Surgical Procedure ◽  
Lower Lobe ◽  
Lung Parenchyma ◽  
Surgical Instruments ◽  
Thoracoscopic Approach ◽  
Minimally Invasive Surgical Procedure ◽  
Small Incision ◽  
Minimally Invasive Surgical ◽  
The Right

Anterior basal (S8) segmentectomy is one of the most challenging procedures among the uncommon pulmonary segmentectomies because the surgeon has to identify dominant pulmonary vein branches located deep in the lung parenchyma. Moreover, with the uniportal thoracoscopic approach, the angulation of inserted surgical instruments via a single small incision is extremely limited, which causes technical difficulties. However, adoption of a suitable procedure such as unidirectional dissection enables us to perform this type of minimally invasive surgical procedure. We describe the successful results of a patient undergoing uniportal thoracoscopic S8 segmentectomy of the right lower lobe and explain the nuances of performing it.

scholarly journals The impact of a sterile processing program in Northwest Tanzania: a mixed-methods study

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Olive Fast ◽  
Faith-Michael Uzoka ◽  
Alexander Cuncannon ◽  
Christina Fast ◽  
Aliyah Dosani ◽  
...  
Keyword(s):  
Health Care ◽  
Mixed Methods ◽  
Health Care Workers ◽  
Test Scores ◽  
Professional Growth ◽  
Resource Constraints ◽  
Surgical Instruments ◽  
Care Workers ◽  
Sterile Processing ◽  
The Impact

Abstract Background Inadequate training of health care workers responsible for the sterilization of surgical instruments in low- and middle-income countries compromises the safety of workers and patients alike. Methods A mixed methods research study was initiated in the Lake Zone areas of Northwestern Tanzania in the summer of 2018. The goal was to identify the impact of education and training on sterile processing practices at ten hospitals. Quantitative data analyzed included hospital assessments of sterile processing practices prior to and 4 months after training, as well as participant test scores collected at the beginning of training, after 5 days of classes, and 4 months after mentorship was completed. Thematic analysis of interviews with participants 4 months post-training was completed to identify associated impact of training. Results Improvement in test scores were found to be directly related to sterile processing training. The greatest sterile processing practice changes identified through hospital assessments involved how instruments were cleaned, both at point of use and during the cleaning process, resulting in rusted and discoloured instruments appearing as new again. Themes identified in participant interviews included: changes in practice, challenges in implementing practice changes, resource constraints, personal and professional growth, and increased motivation, confidence and responsibility. Conclusions Providing education and follow up support for workers in sterile processing resulted in increased knowledge of best practices, application of knowledge in practice settings, and awareness of issues that need to be overcome to decrease risks for patients and health care workers alike. Further research is needed to identify the impact of mentorship on hospital sterile processing practices in order to provide clear direction for future spending on training courses.

scholarly journals Design and control of a 3-DOF hydraulic driven surgical instrument

2015 ◽  
Vol 1 (1) ◽  
pp. 140-144 ◽  
Author(s):  
Timo Cuntz ◽  
Laura Comella
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Degrees Of Freedom ◽  
Power Transmission ◽  
Kinematic Model ◽  
Inverse Kinematic ◽  
Surgical Instruments ◽  
Laparoscopic Instrument ◽  
Technical Problems

AbstractAlthough the use of minimally invasive surgery techniques has steadily increased, the development of new tools for these procedures has stagnated. Indeed a new generation of surgical instruments, with tips that have multiple degrees of freedom, has been developed. However, they are facing so many technical problems that none have been able to establish themselves in the medical market. To overcome the problems these instruments are facing, a micro hydraulic power transmission system has been developed and been presented in [1]. With these driving units it was possible to design an instrument for minimally invasive surgery with a tip which is movable in 3 degrees of freedom (DOF) and that is light in weight, small in size and powerful in movements and gripping. This paper presents the mechanical setup (including dimensions and materials), describes the theoretical basis for the control with the inverse kinematic model, discusses the external drives setup and gives first performance data of this novel hydraulically actuated laparoscopic instrument with 3 degrees of freedom.

scholarly journals Video-assisted minimal access surgery for complicated mitral valve endocarditis, tricuspid valve insufficiency and progressive coronary disease after previous CABG - in the time of COVID-19: a case report

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Terézia B. Andrási ◽  
Nunijiati Abudureheman ◽  
Alannah Glück ◽  
Maximilian Vondran ◽  
Gerhard Dinges ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Mitral Valve ◽  
Minimally Invasive ◽  
Tricuspid Valve ◽  
Surgical Instruments ◽  
Tricuspid Valve Repair ◽  
Long Term Outcome ◽  
Tricuspid Valve Insufficiency ◽  
Valve Insufficiency ◽  
Neurosurgical Intervention

Abstract Background The timing for heart surgery following cerebral embolization after cardiac valve vegetation is vital to postoperative recovery being uneventful, additionally Covid-19 may negatively affect the outcome. Minimally invasive methods and upgraded surgical instruments maximize the benefits of surgery also in complex cardiac revision cases with substantial perioperative risk. Case presentation A 68 y.o. patient, 10 years after previous sternotomy for OPCAB was referred to cardiac surgery on the 10th postoperative day after neurosurgical intervention for intracerebral bleeding with suspected mitral valve endocarditis. Mitral valve vegetation, tricuspid valve insufficiency and coronary stenosis were diagnosed and treated by minimally invasive revision cardiac surgery on the 14th postoperative day after neurosurgery. Conclusion The present clinical case demonstrates for the first time that the minimally invasive approach via right anterior mini-thoracotomy can be safely used for concomitant complex mitral valve reconstruction, tricuspid valve repair and aorto-coronary bypass surgery, even as a revision procedure in the presence of florid endocarditis after recent neurosurgical intervention. The Covid-19 pandemic and prophylactic patient isolation slow down the efficacy of pulmonary weaning and mobilisation and prolong the need for ICU treatment, without adversely affecting long-term outcome.

scholarly journals The PROMISES study: a mixed methods approach to explore the acceptability of salivary progesterone testing for preterm birth risk among pregnant women and trained frontline healthcare workers in rural India

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e040268
Author(s):  
Danielle Ashworth ◽  
Pankhuri Sharma ◽  
Sergio A Silverio ◽  
Simi Khan ◽  
Nishtha Kathuria ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Preterm Birth ◽  
Pregnant Women ◽  
Barriers And Facilitators ◽  
Rural India ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Thematic Framework

IntroductionIndia has an overall neonatal mortality rate of 28/1000 live births, with higher rates in rural India. Approximately 3.5 million pregnancies in India are affected by preterm birth (PTB) annually and contribute to approximately a quarter of PTBs globally. Embedded within the PROMISES study (which aims to validate a low-cost salivary progesterone test for early detection of PTB risk), we present a mixed methods explanatory sequential feasibility substudy of the salivary progesterone test.MethodsA pretraining and post-training questionnaire to assess Accredited Social Health Activists (ASHAs) (n=201) knowledge and experience of PTB and salivary progesterone sampling was analysed using the McNemar test. Descriptive statistics for a cross-sectional survey of pregnant women (n=400) are presented in which the acceptability of this test for pregnant women is assessed. Structured interviews were undertaken with ASHAs (n=10) and pregnant women (n=9), and were analysed using thematic framework analysis to explore the barriers and facilitators influencing the use of this test in rural India.ResultsBefore training, ASHAs’ knowledge of PTB (including risk factors, causes, postnatal support and testing) was very limited. After the training programme, there was a significant improvement in the ASHAs’ knowledge of PTB. All 400 women reported the salivary test was acceptable with the majority finding it easy but not quick or better than drawing blood. For the qualitative aspects of the study, analysis of interview data with ASHAs and women, our thematic framework comprised of three main areas: implementation of intervention; networks of influence and access to healthcare. Qualitative data were stratified and presented as barriers and facilitators.ConclusionThis study suggests support for ongoing investigations validating PTB testing using salivary progesterone in rural settings.

Kinematics of a Fully-Decoupled Remote Center-of-Motion Parallel Manipulator for Minimally Invasive Surgery

2012 ◽  
Vol 6 (2) ◽  
Author(s):  
Chin-Hsing Kuo ◽  
Jian S. Dai
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Inverse Kinematics ◽  
Parallel Manipulator ◽  
Degrees Of Freedom ◽  
Surgical Instruments ◽  
End Effector ◽  
Minimally Invasive Surgical ◽  
Inverse Kinematics Problem

A crucial design challenge in minimally invasive surgical (MIS) robots is the provision of a fully decoupled four degrees-of-freedom (4-DOF) remote center-of-motion (RCM) for surgical instruments. In this paper, we present a new parallel manipulator that can generate a 4-DOF RCM over its end-effector and these four DOFs are fully decoupled, i.e., each of them can be independently controlled by one corresponding actuated joint. First, we revisit the remote center-of-motion for MIS robots and introduce a projective displacement representation for coping with this special kinematics. Next, we present the proposed new parallel manipulator structure and study its geometry and motion decouplebility. Accordingly, we solve the inverse kinematics problem by taking the advantage of motion decouplebility. Then, via the screw system approach, we carry out the Jacobian analysis for the manipulator, by which the singular configurations are identified. Finally, we analyze the reachable and collision-free workspaces of the proposed manipulator and conclude the feasibility of this manipulator for the application in minimally invasive surgery.

Minimally Invasive Surgery: Equipment and Troubleshooting

2019 ◽  
Author(s):  
Jacob A. Greenberg ◽  
Laura E. Fischer
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Surgical Instruments ◽  
Single Site ◽  
Processing Unit ◽  
Solid Organ ◽  
Video Monitor ◽  
Energy Devices ◽  
Basic Set

The field of minimally invasive surgery has evolved rapidly since the first laparoscopic appendectomies and cholecystectomies were performed nearly 30 years ago.1 Minimally invasive approaches are now widely used for gastrointestinal resection, hernia repair, antireflux surgery, bariatric surgery, and solid-organ surgery, such as hepatic, pancreatic, adrenal, and renal resections. Although the techniques and equipment needed to access, expose, and dissect vary according to the type of operation and surgeon’s preference, a basic set of equipment is essential for any laparoscopic or robotic procedure: endoscope, camera, light source, signal processing unit, video monitor, insufflator and gas supply, trocars, and surgical instruments. Understanding how to use and troubleshoot this equipment is critical for any surgeon who performs minimally invasive surgery. We review the essentials of basic laparoscopic equipment, including the mechanics of normally functioning equipment and the various types of laparoscopic trocars and instruments. We also discuss robotic equipment and the fundamental differences from laparoscopy. Minilaparoscopy and single-site equipment are briefly explained. Additionally, we discuss potential technical difficulties that surgeons may encounter while performing minimally invasive procedures and provide suggestions for troubleshooting these problems. This review 13 figure, 2 tables, and 64 references.Key Words: Laparoscopy, Robotic Surgery, Minimally Invasive Surgery, Laparoscopic Surgery, Trocars, Surgical Energy Devices, Insufflator, Laparoscopic Instrumentation, Ergonomics, Single Site Surgery

scholarly journals Mesh complications: best practice in diagnosis and treatment

2020 ◽  
Vol 12 ◽  
pp. 175628722094299
Author(s):  
Paulina Bueno Garcia Reyes ◽  
Hashim Hashim
Keyword(s):  
Urinary Tract ◽  
Minimally Invasive ◽  
Best Practice ◽  
Treatment Options ◽  
Urinary Stress Incontinence ◽  
Mesh Complications ◽  
Treatment Pathways ◽  
Mesh Placement ◽  
Minimally Invasive Surgical Procedure ◽  
Tract Infections

Mesh was a promising, minimally invasive, and ‘gold standard’ treatment for urinary stress incontinence. Time has shown that complications from these devices can happen early, or even several years, after mesh placement and can be catastrophic. Pain, erosion, voiding dysfunction, infection, recurrent UTIs [urinary tract infections (UTIs)], fistulae, organ perforation, bleeding, vaginal scarring, neuromuscular alterations, LUTS (lower urinary tract symptoms), bowel complications and even immune disorders have been linked to mesh. Various tools, such as imaging, endoscopic and functional studies, are available for diagnosis of mesh complications. Since the spectrum of complications is wide, involvement of other specialties is usually beneficial in the diagnosis and management of these complications. There is still much to learn on the accuracy and utility of diagnostic studies in each type of complication. Evidence on the best diagnostic and treatment pathways for these complications is scarce but continuously growing as information is being reported, and we continue to gain expertise in dealing with patients affected by mesh. Treatment options include conservative and medical management initially and then open or minimally invasive surgical procedure approaches. This article will describe diagnostic and treatment pathways for mesh complications.

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