Use of an exoscope for enhanced visualization of a Schwab grade 5 osteotomy to correct kyphotic deformity

The development of the 3D exoscope has advanced intraoperative visualization by providing access to visual corridors that were previously difficult to obtain or maintain with traditional operating microscopes. Favorable ergonomics, maneuverability, and increased potential for instruction provide utility in a large range of procedures. Here, the authors demonstrate the exoscope system in a patient with progressive thoracolumbar junctional kyphosis with bony retropulsion of a T12–L1 fracture requiring a Schwab grade 5 osteotomy and fusion. The utilization of the exoscope provides visual access to the ventrolateral dura for the entire surgical team (surgeons, learners, and scrub nurse). The video can be found here: https://stream.cadmore.media/r10.3171/2021.10.FOCVID21190

High-Definition 3-D Exoscope for Micro-Laryngeal Surgery: A Preliminary Clinical Experience in 41 Patients

Objective: The aim of this prospective clinical study is to evaluate the feasibility of the micro-laryngeal surgery (MLS) using a 3D operating exoscope (OE) in substitution to a conventional operating microscope (OM). Methods: A total of 41 consecutive patients were included (male: 26; median age: 55.0 years; IQR: 46.0-68.0). After each procedure, the surgeon and the scrub nurse were asked to fill out a tailored questionnaire on a 3-point Likert scale (1—not acceptable, 2—acceptable, 3—good) including 12 items. Results: The majority of the procedures were therapeutic (n = 31, 75.6%), while the remaining were diagnostic (n = 10, 24.4%). All surgeries were successfully completed without the support of the OM, and no complications or unwanted delays were detected. The majority of the individual items were judged “good” either by surgeons (n = 399, 81.1%) and scrub nurses (n = 287, 87.5%). The natural posture during the procedure, and the ease of use the joystick and focusing were the best-rated items by the surgeons. Conclusions: This study demonstrates the feasibility of MLS using the OE. Further comparative clinical studies are needed to clarify its real value in substitution to a conventional operating microscope and to better define advantages and disadvantages.

TP10.1.7New Minor Surgical Set as a way to improve surgical efficiency during COVID-19 pandemic

Aims Large number of paediatric plastic surgical procedures were identified in Evelina Hospital during COVID-19 pandemic as not requiring large conventional surgical operative sets that can contain at average 35 instruments. Large sets are more expensive, take longer preparation time due to instrument counting and as a consequence take more total operating time. Furthermore, more instruments need to be unnecessarily purchased, stored and cleaned post procedure. Simple paediatric plastic surgery procedures including nailbed repair or laceration repair require limited and largely replicating operative instrument set. We have therefore introduced Small Minor Plastic Surgical set (MS) containing only 10 instruments. We audited its effectiveness and introduced a revised version of the set as per feedback, permanently arranged into theatre operative set collection. Methods MS set was introduced and used at senior surgeons discursion for paediatric plastic surgical procedures. Feedback was gathered from the surgeon and scrub nurse via specially designed questionnaire at post operation and theatre team debrief. Suggested alterations were implemented and New Minor Surgical (NMS) set was introduced and re-audited using revised questionnaire. Results 61% of surgeons and 89% of scrub personnel thought MS set contained everything that was needed for the case. Following revision 91% of surgeons and 95% of scrub nurses thought NMS set contained all necessary equipment for the operation. Conclusions NMS set introduced into daily surgical practice in Evelina Hospital theatres improved overall staff satisfaction when considering both surgeon and nursing staff. It provided cost- and time-effective operative set now vastly used across surgical specialities.

“Jahwari’s Position” – A Novel Operating Room Setup for Antegrade Humeral Nailing: Surgical Technique and Initial Experience

Introduction:Ante Grade Humeral Nailing (AGHN) with traditional positioning causes crowding at the patient's head end, cramming for the surgeon and anaesthetist, scarcity of space available for the scrub nurse and X-ray technician, and neurovascular risks while performing distal interlocking. Minimal literature is available regarding the optimal position and set up in the operating theatre (OT). The primary objective was to describe, how effective novel Jahwari’s position is by assessing the ergonomics for OT personnel, OT time, and radiation exposure. A secondary objective was to evaluate the safety of inserting distal interlocking screws. Case Report:The head of the patient is placed away from the anaesthetist and their equipment, which were placed at the foot end of the patient. The patients were connected to the anaesthesia machine with a long airway extension, which was anchored to the table. The C arm machine was brought from the contralateral side and did not have to be moved. The scrub nurse and the surgeon were placed at the head end of the patient. Pregnant patients, those aged <18 years, and those with open fractures were excluded from our study. A single consultant operated on all cases for standardization. OT time and radiation exposure were monitored. Conclusion:Inspired by our use of this position for cervical spine patients for more than a decade, Jahwari’s position and setup were innovated. This setup gives ample room for the anaesthetist at the foot end. The surgeon and assistants are free from cramming at the head end. Complementarily, it provides ample space for the X-ray technician and scrubs nurse. Keywords:Jahwari position, antegrade humeral nailing, modified lateral position.

789 New Minor Surgical Set as A Way to Improve Surgical Efficiency During COVID-19 Pandemic

Introduction Large number of paediatric plastic surgical procedures were identified in Evelina Hospital during COVID-19 pandemic as not requiring large conventional surgical operative sets that can contain at average 35 instruments. Large sets are more expensive, take longer preparation time due to instrument counting and as a consequence take more total operating time. Furthermore, more instruments need to be unnecessarily purchased, stored and cleaned post procedure. Simple paediatric plastic surgery procedures including nailbed repair or laceration repair require limited and largely replicating operative instrument set. We have therefore introduced Small Minor Plastic Surgical set (MS) containing only 10 instruments. We audited its effectiveness and introduced a revised version of the set as per feedback, permanently arranged into theatre operative set collection. Method MS set was introduced to Evelina Theatres and used at senior surgeons’ discursion for paediatric plastic surgical procedures. Feedback was gathered from the surgeon and scrub nurse via specially designed questionnaire at post operation and theatre team debrief. Suggested alterations were implemented and New Minor Surgical (NMS) set was introduced and re-audited using revised questionnaire. Results 61% of surgeons and 89% of scrub personnel thought MS set contained everything that was needed for the case. Following revision 91% of surgeons and 95% of scrub nurses thought NMS set contained all necessary equipment for the operation. Conclusions NMS set introduced into daily surgical practice in Evelina Hospital theatres improved overall staff satisfaction when considering both surgeon and nursing staff. It provided cost- and time-effective operative set now vastly used across surgical specialities.

Collaborative Robot as Scrub Nurse

Under-staffing of nurses is a significant problem in most countries. It is expected to rise in the coming years, making it challenging to perform crucial tasks like assessing a patient's condition, assisting the surgeon in medical procedures, catheterization and Blood Transfusion etc., Automation of some essential tasks would be a viable idea to overcome this shortage of nurses. One such task intended to automate is the role of a 'Scrub Nurse' by using a robotic arm to hand over the surgical instruments. In this project, we propose to use a Collaborative Robotic-arm as a Scrub nurse that can be controlled with voice commands. The robotic arm was programmed to reach the specified position of the instruments placed on the table equipped with a voice recognition module to recognize the requested surgical instrument. When the Surgeon says "Pick Instrument", the arm picks up the instrument from the table and moves it over to the prior defined handover position. The Surgeon can take over the instrument by saying the command "Drop". Safe pathways for automatic movement of arm and handover position will be predefined by the Surgeon manually. This concept was developed considering the convenience of the Surgeon and the patient's safety, tested for collision, noisy environments, positioning failures and accuracy in grasping the instruments. Limitations that need to be considered in future work are the recognition of voice commands which as well as the returning of the instruments by the surgeon in a practical and safe way.