An Isomorphic Interactive Device for the Interventional Surgical Robot after In Vivo Study

Interventional surgical robots are widely used in neurosurgery to improve surgeons’ working environment and surgical safety. Based on the actual operational needs of surgeons’ feedback during preliminary in vivo experiments, this paper proposed an isomorphic interactive master controller for the master–slave interventional surgical robot. The isomorphic design of the controller allows surgeons to utilize their surgical skills during remote interventional surgeries. The controller uses the catheter and guidewire as the operating handle, the same as during actual surgeries. The collaborative operational structure design and the working methods followed the clinical operational skills. The linear force feedback and torque feedback devices were designed to improve the safety of surgeries under remote operating conditions. An eccentric force compensation was conducted to achieve accurate force feedback. Several experiments were carried out, such as calibration experiments, master–slave control performance evaluation experiments, and operation comparison experiments on the novel and previously used controllers. The experimental results show that the proposed controller can perform complex operations in remote surgery applications and has the potential for further animal experiment evaluations.

Step, Error, and Event Frameworks in Endovascular Aortic Repair

Objective: Competency-based surgical education requires detailed and actionable feedback to ensure adequate and efficient skill development. Comprehensive operative capture systems such as the Operating Room Black Box (ORBB; Surgical Safety Technologies, Inc), which continuously records and synchronizes multiple sources of intraoperative data, have recently been integrated into hybrid rooms to provide targeted feedback to endovascular teams. The objective of this study is to develop step, error, and event frameworks to evaluate technical performance in elective endovascular aortic repair (EVAR) comprehensively captured by the ORBB (Surgical Safety Technologies, Inc; Toronto, Canada). Methods: This study is based upon a modified Delphi consensus process to create evaluation frameworks for steps, errors, and events in EVAR. International experts from Vascular Surgery and Interventional Radiology were identified, based on their records of publications and invited presentations, or serving on relevant journal editorial boards. In an initial open-ended survey round, experts were asked to volunteer a comprehensive list of steps, errors, and events for a standard EVAR of an infrarenal aorto-iliac aneurysm (AAA). In subsequent survey rounds, the identified items were presented to the expert panel to rate on a 5-point Likert scale. Delphi survey rounds were repeated until the process reached consensus with a predefined agreement threshold (Cronbach α>0.7). The final frameworks were constructed with items achieving an agreement (responses of 4 or 5) from greater than 70% of experts. Results: Of 98 invited proceduralists, 38 formed the expert consensus panel (39%), consisting of 29 vascular surgeons and 9 interventional radiologists, with 34% from North America and 66% from Europe. Consensus criteria were met following the third round of the Delphi consensus process (Cronbach α=0.82–0.93). There were 15, 32, and 25 items in the error, step, and event frameworks, respectively (within-item agreement=74%–100%). Conclusion: A detailed evaluation tool for the procedural steps, errors, and events in infrarenal EVAR was developed. This tool will be validated on recorded procedures in future work: It may focus skill development on common errors and hazardous steps. This tool might be used to provide high-quality feedback on technical performance of trainees and experienced surgeons alike, thus promoting surgical mastery.

Improving teamwork and communication in the operating room by introducing the theatre cap challenge

Objective One of the steps of the Surgical Safety Checklist is for the team members to introduce themselves. The objective of this study was to implement a tool to help remember and use each other’s names and roles in the operating theatre. Methods This study was part of a pilot study in which a video and medical data recorder was implemented in one operating theatre and used as a tool for postoperative multidisciplinary debriefings. During these debriefings, name recall was evaluated. Following the implementation of the medical data recorder, this study was started by introducing the theatre cap challenge, meaning the use of name (including role) stickers on the surgical cap in the operating theatre. Findings In total, 41% (n = 40 out of 98) of the operating theatre members were able to recall all the names of their team at the team briefings. On average 44.8% (n = 103) was wearing the name sticker. Conclusions The time-out stage of the Surgical Safety Checklist might be inadequate for correctly remembering and using your operating theatre team members’ names. For this, the theatre cap challenge may help.

Compliance of WHO Surgical Safety Checklist at a Pediatric Surgical Unit in a Tertiary Level Hospital: A Descriptive Cross-sectional Study

Introduction: The Surgical safety checklist by World Health Organization has been used for the last two decades. There is every chance of unwanted expected disasters in Operating-Room in Pediatricsurgical cases. Our study is to observe the utilization of the safety checklist and evaluate occurrence of never-events in Tertiary Level Pediatric Surgery Unit in Nepal. Methods: A descriptive cross-sectional study was done at Nepal Medical College Teaching Hospital from January 2021-June 2021 with record-based data of children from 0-15 years operated in Pediatric Surgery unit from March 2017-July 2018. Ethical approval (Reference number: 049-077-078) was taken from the Institution review committee of the institute. Convenience sampling was done. Self-designed Pro-forma with demographic data along with World Health Organization-Surgical-safety-checklist used was collected and entered in Microsoft-Excel. Data were analyzed using Statistical-Package-for-the-Social-Sciences-version-25. Results: Out of 267 cases enrolled, 103 (38.6%) (35.6-41.6 at 95% Confidence Interval) were fully compliant with the checklist, 69 (25.8%) partially compliant. Among compliant cases, 148 (55.4%) Sign-in part, 128 (47.9%) cases -Time-out part and 152 (56.9%) cases Sign-out part were complete. Conclusions: Compliance with World Health Organization-Surgical-safety-checklist has a major role in preventing morbidity and mortality in Pediatric surgical cases. With proper use of the checklist, the unwanted never-events can be prevented with better surgical outcomes.

Reducing surgical site infections and mortality among obstetric surgical patients in Tanzania: a pre-evaluation and postevaluation of a multicomponent safe surgery intervention

IntroductionDespite ongoing maternal health interventions, maternal deaths in Tanzania remain high. One of the main causes of maternal mortality includes postoperative infections. Surgical site infection (SSI) rates are higher in low/middle-income countries (LMICs), such as Tanzania, compared with high-income countries. We evaluated the impact of a multicomponent safe surgery intervention in Tanzania, hypothesising it would (1) increase adherence to safety practices, such as the WHO Surgical Safety Checklist (SSC), (2) reduce SSI rates following caesarean section (CS) and (3) reduce CS-related perioperative mortality rates (POMRs).MethodsWe conducted a pre-cross-sectional/post-cross-sectional study design to evaluate WHO SSC utilisation, SSI rates and CS-related POMR before and 18 months after implementation. Our interventions included training of inter-professional surgical teams, promoting use of the WHO SSC and introducing an infection prevention (IP) bundle for all CS patients. We assessed use of WHO SSC and SSI rates through random sampling of 279 individual CS patient files. We reviewed registers and ward round reports to obtain the number of CS performed and CS-related deaths. We compared proportions of individuals with a characteristic of interest during pre-implementation and post implementation using the two-proportion z-test at p≤0.05 using STATA V.15.ResultsThe SSC utilisation rate for CS increased from 3.7% (5 out of 136) to 95.1% (136 out of 143) with p<0.001. Likewise, the proportion of women with SSI after CS reduced from 14% during baseline to 1% (p=0.002). The change in SSI rate after the implementation of the safe surgery interventions is statistically significant (p<0.001). The CS-related POMR decreased by 38.5% (p=0.6) after the implementation of safe surgery interventions.ConclusionOur findings show that our intervention led to improved utilisation of the WHO SSC, reduced SSIs and a drop in CS-related POMR. We recommend replication of the interventions in other LMICs.

ADRC-Based Control Method for the Vascular Intervention Master–Slave Surgical Robotic System

In vascular interventional surgery, surgeons operate guidewires and catheters to diagnose and treat patients with the assistance of the digital subtraction angiography (DSA). Therefore, the surgeon will be exposed to X-rays for extended periods. To protect the surgeon, the development of a robot-assisted surgical system is of great significance. The displacement tracking accuracy is the most important issue to be considered in the development of the system. In this study, the active disturbance rejection control (ADRC) method is applied to guarantee displacement tracking accuracy. First, the core contents of the proportional–integral–derivative (PID) and ADRC methods are analyzed. Second, comparative evaluation experiments for incremental PID and ADRC methods are presented. The results show that the ADRC method has better performance of than that of the incremental PID method. Finally, the calibration experiments for the ADRC control method are implemented using the master–slave robotic system. These experiments demonstrate that the maximum tracking error is 0.87 mm using the ADRC method, effectively guaranteeing surgical safety.

Surgical safety criteria for burr hole surgery with urokinase in patients with acute subdural hematoma: Retrospective comparison between burr hole surgery and craniotomy

Background: Acute subdural hematoma (ASDH) is a common disease and craniotomy is the first choice for removing hematoma. However, patients for whom craniotomy or general anesthesia is contraindicated are increasing due to population aging. In our department, we perform burr hole surgery under local anesthesia with urokinase administration for such patients. We compared the patient background and outcomes between burr hole surgery and craniotomy to investigate the surgical safety criteria for burr hole surgery. Methods: We reviewed 24 patients who underwent burr hole surgery and 33 patients who underwent craniotomy between January 2010 and April 2020 retrospectively. Results: The median age of the burr hole surgery group was older (P = 0.01) and they had multiple pre-existing conditions. Compared with the craniotomy group, neurological deficits and CT findings were minor in the burr hole surgery group, whereas the maximum hematoma thickness was not significantly different. The hematoma was excreted after a total of 54,000 IU of urokinase was administered for a median of 3 days. The Glasgow Coma Scale score improved in all patients in the burr hole surgery group and there were no deaths. Age, especially over 65 y.o., (OR 1.16, 95% CI 1.04–1.30) and the absence of basal cistern disappearance (OR 0.04, 95% CI 0.004–0.39) were significant factors. Conclusion: Burr hole surgery was performed safely in all patients based on the age, especially older than 65 y.o., and the absence of basal cistern disappearance. ASDH in the elderly is increasing and less invasive burr hole surgery with urokinase is suitable for the super-aging society.

HUBUNGAN TINGKAT STRES KERJA PERAWAT DENGAN PELAKSANAAN SURGICAL SAFETY CHECKLIST DI KAMAR OPERASI

Introduction: Nurse work stress is a condition where nurses are faced with work demands that can result in physiological, psychological & behavioral disorders and can affect performance. The purpose of this study was to determine the relationship of nurses work stress levels with the implementation of Surgical Safety Checklist in the operating room. Methods: This research method uses correlational with cross-sectional approach and 18 respondents with a sampling technique using the entire population. The independent variable in this study is the level of work stress nurses with the dependent variable implementation of the Surgical Safety Checklist. The research instrument used a questionnaire on nurses' work stress levels and the Surgical Safety Checklist observation sheet. Scatterplot analysis results obtained negative direction which means that the increase in the variable level of work stress nurses will be followed by a decrease in the implementation of the Surgical Safety Checklist. Result: The results of the correlation coefficient 0.637 with strong interpretation and t count 3.24 more than the results of t table 1.76 means that there is a linear relationship of. Conclussion: There are relationship of nurses work stress levels with the implementation of Surgical Safety Checklist in the operating room. Discussion for the results of research where the increasing level of work stress nurses, the implementation of the Surgical Safety Checklist decrease. The recommendation for further research is to conduct research into work stress factors for nurses with the impact that can result from work stress with a higher number of respondents