Autonomous Surgical Robotics at Task and Subtask Levels

The revolution of minimally invasive procedures had a significant influence on surgical practice, opening the way to laparoscopic surgery, then evolving into robotics surgery. Teleoperated master-slave robots, such as the da Vinci Surgical System, has become a standard of care during the last few decades, performing over a million procedures per year worldwide. Many believe that the next big step in the evolution of surgery is partial automation, which would ease the cognitive load on the surgeon, making them possible to pay more attention on the critical parts of the intervention. Partial and sequential introduction and increase of autonomous capabilities could provide a safe way towards Surgery 4.0. Unfortunately, autonomy in the given environment, consisting mostly of soft organs, suffers from grave difficulties. In this chapter, the current research directions of subtask automation in surgery are to be presented, introducing the recent advances in motion planning, perception, and human-machine interaction, along with the limitations of the task-level autonomy.

Evaluating the COVID-19 impact on surgical practice in Kurdistan Region, Iraq: A cross-sectional study

Background and objective: Surgeons and surgical practice are influenced greatly by the coronavirus disease 2019 (COVID-19) pandemic all over the world, and this impact affects patients who need surgery, especially in emergency cases. This study aimed to assess the impact of COVID-19 on surgery in the Kurdistan Region, Iraq. Methods: A survey that consisted of four sections was prepared and sent by e-mail to over 1000 surgeons with different specialties. The survey was created by google forms and was kept online from 9 October 2020 to 9 November 2020. Results: A total of 207 surgeons have responded to the survey, 146 (70.5%) males and 61 (29.5%) females with different specialists. The data shows that both private and public hospitals were affected by the pandemic equally. Thirty five (16.9%) surgeons indicated that surgery has entirely collapsed in some hospitals. All phases of surgical practice have been affected from partial to complete abandonment of surgery. Conclusion: The pandemic greatly affected surgeons and surgical practice in the Kurdistan region. Additionally, few surgeons indicated that the pandemic did not affect the surgical practice and normal functioning of their hospital. However, most surgeons agreed that the pandemic significantly impels all stages of surgery and surgical practice. Most surgeons have adapted to the situation by using communication technology and new protective measures. Keywords: COVID-19 pandemic; Kurdistan region; Pandemic effects; Surgery; Surgical practice.

The effects of the coronavirus disease 2019 pandemic on neurospine surgery practice in the referral center hospital developing country

Background: The coronavirus disease 2019 (COVID-19) pandemic represents a once in a century challenge to human health care with over 4.5 million cases and over 300,000 deaths thus far. Surgical practice has been significantly impacted with all specialties writing guidelines for how to manage during this crisis. This study reported the effect of the COVID-19 pandemic on the neurosurgical practice, especially neurospine, in the outpatient visit, emergency department, and the surgical procedure. Methods: This study is the comparative retrospective about neurospine practice in the outpatient visit, emergency department, and the surgical procedure among before and during COVID-19 pandemic. We recorded data from January to December 2019 (before COVID-19 pandemic) and compared with the same period in the 2020 (during a COVID-19 pandemic). Results: A total of the outpatient visits, the average number per month was 28 ± 10.5 visits per month before the pandemic. The average number outpatient visit per month during the pandemic was 19 ± 11.1 visits per month, with the lowest in July 2020. The result of the average monthly neurospine surgical procedure before the pandemic was 5 ± 1.9 operations per month. Compared during the pandemic, there was decreased in the neurospine surgical procedure with the average number was 2 ± 2.7 operations per month. The decreased number significantly happens in the surgical procedure and emergency department patient (P < 0.05), while in the outpatient visit, the decreased statistically not significantly (P > 0.05). Conclusion: The COVID-19 pandemic changed all scopes of medical practice and training. Considering the limitation in the available resources, the number of educational cases may decrease in subspecialized disciplines such as neurospine neurosurgery. The COVID-19 pandemic affects in the neurospine and neurosurgery treatment policy in the referral tertiary hospital.

Clinical Practice in Spine Surgery: An International Survey

Background The availability of diverse and sophisticated surgical options to treat spine conditions is compounded by the scarcity of high-level evidence to guide decision-making. Although studies on discrete treatments are frequently published, little information is available regarding real-world surgical practice. We intended to survey spine surgeons to assess clinical management of common spine diagnosis in day-to-day settings. Methods An online survey was distributed among neurosurgeons and orthopaedic surgeons worldwide. The obtained assessment of common surgical practice is contextualized in a review of the best available evidence. Results The survey was answered by more than 310 members of several European, Australasian, and South African professional societies. The submitted responses translate a surgical practice generally grounded on evidence, favoring well-tried techniques, providing comprehensive treatment for the most severe diagnoses. Such practice comes mostly from neurosurgeons focused on spine surgery, practicing in teaching hospitals. Conclusion We believe that the pragmatic, day-to-day approach to spine conditions captured in the present survey offers an informative insight to involved surgeons.

P-B04 Restarting bariatric surgery after the Covid-19 pandemic: a template for safe practice

Background Bariatric surgery virtually ceased with the advent of the Covid-19 pandemic and has been amongst the last sector of operative practice to restart. There have been understandable concerns about restarting bariatric surgery including the risks to patients of contracting Covid infection in the peri-operative period, potential de-skilling of surgeons and theatre teams and the appropriateness of directing scarce and limited resources to bariatric surgery when every surgical specialty is experiencing rapidly rising waiting times and ever lengthening waiting lists. This study describes the restart programme at our NHS bariatric unit and offers a template for safe commencement of complex benign surgeries in the current era. Methods In the months after the pandemic started, our Bariatric MDT reviewed every case on the waiting list and contacted each patient to explain the current waiting times and the importance of not gaining weight to be eligible for surgery when surgical practice resumed. Group education and Support Group sessions were moved from face-to-face appointments to online classrooms and regular input was sought from specialist dieticians, nurses and psychologists. The expected waiting times for patients was pro-actively submitted to the Executive Board of the Trust with details about &gt;104-week waiting patients being clearly articulated. Once approval was given to restart bariatric surgery, every patient was assessed and prioritised in terms of waiting time and clinical need. A bariatric theatre team was brought together and engaged in pre-operative training and a local refresher course on equipment and the planned surgeries. There was engagement with industry to provide on-the-ground support for the first lists to ensure proper and safe use of energy and stapling devices. Each list had two consultant surgeons assigned to it and just two cases per day were planned and patients were managed on an entirely green pathway within the NHS hospital . Results The bariatric restart programme commenced in May 2021; between May 2021 and August 2021, there have been 27 operations carried out (25 Roux-en-Y gastric bypass, 2 sleeve gastrectomy) and two cancellations on the day (both due to patient choice). Each operating list finished between two and three hours before the planned finish time. Formal debrief sessions after each list identified no problems with the operations of the equipment and none of the patients had any post-operative complications. Length of stay was between 1 to 2 days for the entire cohort. Since the restart programme commenced, the requirement for dual consultant operating has ceased and the last 5 cases have been entirely training cases for the operating registrar, again without complication. Each list is now planned to increase to pre-pandemic levels of activity with four cases per list. Conclusions Restarting complex benign surgical practice is complicated and requires engagement with management, theatre and nursing colleagues to ensure that cases are not ‘left behind'. It is important to reduce the risk of complications and of peri-operative covid-19 infection in bariatric patients and development of a pathway that all members of the theatre team have input in to meant that there were few problems or issues with either the planning of the lists or the running of the lists. Such an approach could be considered for restarting any high volume, complex benign surgical practice.

Jacques-Louis Reverdin - pioneer of transplantology, a surgeon who opened the veil of functional importance of the thyroid gland

Jacques-Louis Reverdin is a famous Swiss surgeon, scientist, and entomologist of the nineteenth century. He made a considerable contribution to the development of transplantology — he was one of the first to publish work on allotransplantation, performing the so — called “skin grafting”, urology — he defended his thesis on urethrotomy, endocrinology- he performed surgical operations for the treatment of goiter, observed and described the symptoms of iatrogenic hypothyroidism, introduced the concept of postoperative myxedema. For thirty-four years, he led an active surgical practice, thanks to which he described a large number of operations (the most famous are operations on the thyroid gland), introduced a surgical suture and needle, which are still used today. During the Franco-Prussian war, he commanded a Swiss ambulance. He was a proponent of Lister’s method of asepsis and antiseptics, and introduced it in hospitals in Geneva. He was engaged in teaching and research, and was nominated for the Nobel prize three times. He received the Amuss prize of the Academy of Medicine, the prize of the Paris Academy of medicine for his work on urethrotomy, founded the Revue Medicale de la Suisse Romande, and was a co-founder and later President of the Association of physicians of Geneva. Honorary member of the entomological societies of Switzerland, France, England and Brazil.