A Respective Observational Study of Patients on Maintenance Hemodialysis Receiving Parathyroidectomy By Ultrasonic Scalpel

Background Secondary hyperparathyroidism (SHPT) remains a common complication in many patients on maintenance hemodialysis. Kidney Disease Improve Global Outcomes (KDIGO) 2017 guidelines suggest that parathyroidectomy (PTX) should be performed in severe SHPT patients with chronic kidney disease stage 3a-stage 5D. In the present study, we observed the efficacy of ultrasonic scalpel for PTX in SHPT patients on maintenance hemodialysis. Methods A total of 74 patients on maintenance hemodialysis who underwent PTX (34 with traditional electrocautery and 40 with an ultrasonic scalpel) were observed between August 2020 and August 2021 at Xiangyang Central Hospital (Hubei University of Arts and Science). Baseline demographic and clinic characteristics were collected pre- and post-PTX. Moreover, the postoperative complications and operation time were assessed between the two groups. Results The univariate analysis showed that there was no statistical significance in weight, dialysis duration, serum potassium, serum calcium, alkaline phosphate, triglyceride, and intact parathyroid hormone (iPTH) before and after PTX between the two groups (P>0.05). The operation time in the ultrasonic scalpel group was significantly decreased compared with the traditional electrocautery group (P<0.05). Compared with the traditional electrocautery group, the drainage amount was significantly reduced in the ultrasonic scalpel group, and the number of days with drain and postoperative hospital stay were also remarkably decreased (P<0.05). In addition, a higher incidence of recurrent laryngeal nerve injury occurred in the traditional electrocautery group, while the difference was not significant (P>0.05). Conclusions The use of ultrasonic scalpel significantly reduced the operation time and postoperative hospital stay in patients on maintenance hemodialysis undergoing PTX.

Automated recognition of objects and types of forceps in surgical images using deep learning

Analysis of operative data with convolutional neural networks (CNNs) is expected to improve the knowledge and professional skills of surgeons. Identification of objects in videos recorded during surgery can be used for surgical skill assessment and surgical navigation. The objectives of this study were to recognize objects and types of forceps in surgical videos acquired during colorectal surgeries and evaluate detection accuracy. Images (n = 1818) were extracted from 11 surgical videos for model training, and another 500 images were extracted from 6 additional videos for validation. The following 5 types of forceps were selected for annotation: ultrasonic scalpel, grasping, clip, angled (Maryland and right-angled), and spatula. IBM Visual Insights software was used, which incorporates the most popular open-source deep-learning CNN frameworks. In total, 1039/1062 (97.8%) forceps were correctly identified among 500 test images. Calculated recall and precision values were as follows: grasping forceps, 98.1% and 98.0%; ultrasonic scalpel, 99.4% and 93.9%; clip forceps, 96.2% and 92.7%; angled forceps, 94.9% and 100%; and spatula forceps, 98.1% and 94.5%, respectively. Forceps recognition can be achieved with high accuracy using deep-learning models, providing the opportunity to evaluate how forceps are used in various operations.

Comparative study to evaluate ultrasonic verses monopolar electrocautery dissection of gall bladder in laparoscopic cholecystectomy

Background: Gallstones are one of the most common routinely encountered surgical problem in the developed world. Laparoscopic cholecystectomy being the gold standard surgery for gall stones has been modified various times using different instruments in order to improve intraoperative and postoperative outcomes. The aim of the study was to see clinical outcomes of ultrasonic scalpel verses monopolar electrocautery in dissection of gall bladder in laparoscopic cholecystectomy.Methods: A prospective randomized controlled study was done with total 100 patients in which 50 patients underwent laparoscopic cholecystectomy via ultrasonic scalpel while rest 50 patients were operated using monopolar electrocautery. The study was conducted for a period of eighteen months and clinical outcomes were studied in terms of operative time, frequency of lens cleaning, gall bladder perforation, biliary leak, common bile duct injury, bowel perforation and postoperative hospital stay.Results: The two groups were comparable in terms of demographic profile considering age and sex distribution. However, there was a statistically significant reduction in operative time, frequency of lens cleaning and gall bladder perforation in group A (harmonic scalpel) as compared to group B (electrocautery).Conclusions: Harmonic scalpel is not only a safe and effective instrument but also a reliable alternative to electrocautery. Even though the study revealed no significant difference in biliary leak, common bile duct injury, bowel perforation and postoperative hospital stay but it can significantly reduce operative time and incidence of gall bladder perforation. Thus, it can improve the operative course in laparoscopic cholecystectomy.

Automated Recognition of Objects and Types of Forceps in Surgical Images Using Deep Learning

Background: Analysis of operative data with convolutional neural networks (CNNs) is expected to improve the knowledge and professional skills of surgeons. Identification of objects in videos recorded during surgery can be used for surgical skill assessment and surgical navigation. The objectives of this study were to recognize objects and types of forceps in surgical videos acquired during colorectal surgeries and evaluate detection accuracy.Methods: Images (n=1818) were extracted from 11 surgical videos for model training, and another 500 images were extracted from 6 additional videos for validation. The following 5 types of forceps were selected for annotation: ultrasonic scalpel, grasping, clip, angled (Maryland and right-angled), and spatula. IBM Visual Insights software was used, which incorporates the most popular open-source deep-learning CNN frameworks.Results: In total, 1039/1062 (97.8%) forceps were correctly identified among 500 test images. Calculated recall and precision values were as follows: grasping forceps, 98.1% and 98.0%; ultrasonic scalpel, 99.4% and 93.9%; clip forceps, 96.2% and 92.7%; angled forceps, 94.9% and 100%; and spatula forceps, 98.1% and 94.5%, respectively.Conclusions: Forceps recognition can be achieved with high accuracy using deep-learning models, providing the opportunity to evaluate how forceps are used in various operations.

Evaluation of Adverse Events Recorded in FDA/USA and ANVISA/Brazil Databases for Medical Devices: Defibrillator, Infusion Pump, Physiological Monitor, Pulmonary Ventilator and Ultrasonic Scalpel

The use of medical technologies has grown steadily in all health fields, offering numerous benefits to patients. However, related adverse events, which may cause severe consequences for patients, also have increased. Technical factors and human aspects that cause dangers to patients may be related to the complexity of the devices, quality control in manufacturing, software used, maintenance procedures, materials, and mode of use. Thereby, our objective is to present the main alerts, dangers, and failures related to medical equipment and ways to attenuate them. For that purpose, we performed an analysis of adverse events reported for medical equipment in the Food Drugs Administration (FDA/USA) and the Brazilian Health Surveillance Agency (ANVISA) databases, since 2016. Finally, we classified the events into different categories, according to similarity. The results show a total of 3,100 cases registered in the FDA for six types of equipment at the study and 75 cases in ANVISA for two of these equipment. Based on the top ten health hazards (2016-2020) provided by the Emergency Care Research Institute (ECRI) we were able to understand which equipment most offers hazards and the main ways to mitigate them. We found that the risks are common to medical devices, therefore, it is crucial that there are preventative measures to avoid them, for example, training users to use the products, maintenance, improving quality, and reporting adverse events to manufacturers.

Surgical Resection of a Parietal Osteoma in a Domestic Ferret Using Advanced Neurosurgical Techniques

ABSTRACT A 3.5 yr old male neutered ferret presented with progressive enlargement of a right dorsocaudal skull mass that had occurred over 18 mo. Computed tomography imaging revealed a large (2.4 × 2.7 cm), well-defined, pedunculated osseous mass arising from the right parietal bone. Cytology was inconclusive, and surgical biopsy was consistent with an osteoma. Further enlargement of the mass occurred over the next 3 mo, at which time surgical intervention was pursued. The patient recovered well, despite the persistence of a bony defect at the former mass site, and no mass regrowth occurred in the 14 mo following the surgical resection. This is one of only two reports in the literature to document the surgical removal of an osteoma in a ferret, and this is the sole case in which a custom apparatus was fabricated for head stabilization, a multiaxis adjustable surgical table was used to improve access to the surgical site, and an ultrasonic scalpel was used for the mass resection.