Ureteric Injury in Gynecology Surgery

It is the most serious and trouble-some complication of pelvic surgery and common reason for medico-legal action by the patient. It can be unilateral or bilateral. Lowest 3 cm of ureter is usually injured. 75% of injuries result from gynecological operations - 3/4th during abdominal and 1/4th during vaginal operations. As most injuries can be diagnosed intraoperatively, systematic assessment of urinary tract integrity should be part of the surgical plan. Intraoperative cystoscopy using either flexible or rigid instruments can aid in the diagnosis or exclusion of urinary tract injury. Identification of the mechanism of injury and its location guides immediate or delayed repair. Mobilization should be sufficient to allow a tension-free closure. Tissue interposition is typically recommended. Common sites for ureteral injury are found beneath the uterine vessels near the cardinal ligament and beneath the infundibulopelvic ligament and the tunnel of Wertheim. Successful ureteral repair relies on careful mobilization, wide spatulation, use of fine absorbable suture (4-0, 5-0), and temporary stenting. Postoperative signs and symptoms of ureteral injury may include unilateral flank pain, fever, prolonged ileus, and abdominal or pelvic fluid collection (urinoma).

An intuitive surgical handle design for robotic neurosurgery

Purpose The expanded endoscopic endonasal approach, a representative example of keyhole brain surgery, allows access to the pituitary gland and surrounding areas through the nasal and sphenoid cavities. Manipulating rigid instruments through these constrained spaces makes this approach technically challenging, and thus, a handheld robotic instrument could expand the surgeon’s capabilities. In this study, we present an intuitive handle prototype for such a robotic instrument. Methods We have designed and fabricated a surgical instrument handle prototype that maps the surgeon’s wrist directly to the robot joints. To alleviate the surgeon’s wrist of any excessive strain and fatigue, the tool is mounted on the surgeon’s forearm, making it parallel with the instrument’s shaft. To evaluate the handle’s performance and limitations, we constructed a surgical task simulator and compared our novel handle with a standard neurosurgical tool, with the tasks being performed by a consultant neurosurgeon. Results While using the proposed handle, the surgeon’s average success rate was $$80\%$$ 80 % , compared to $$41\%$$ 41 % when using a conventional tool. Additionally, the surgeon’s body posture while using the suggested prototype was deemed acceptable by the Rapid Upper Limb Assessment ergonomic survey, while early results indicate the absence of a learning curve. Conclusions Based on these preliminary results, the proposed handle prototype could offer an improvement over current neurosurgical tools and procedural ergonomics. By redirecting forces applied during the procedure to the forearm of the surgeon, and allowing for intuitive surgeon wrist to robot-joints movement mapping without compromising the robotic end effector’s expanded workspace, we believe that this handle could prove a substantial step toward improved neurosurgical instrumentation.

Eight Forms of Abuse: The Validation and Reliability of Two Multidimensional Instruments of Intimate Partner Violence

Many researchers are still relying on older and more rigid instruments focusing mostly on the physical aspect of intimate partner violence (IPV). This way multidimensionality of IPV and complex experiences of IPV survivors’ are overlooked by many researchers, practitioners and decision-makers. Therefore, our study aimed to adopt to Lithuanian two multidimensional scales: the Composite Abuse Scale (CAS) and the Scale of Economic Abuse (SEA). As well as confirm its validity and reliability for the use for determining the experiences of Lithuanian women in intimate partner relationships. Through various channels 311 women, survivors of IPV were recruited. The structure of both measurements was validated using Confirmatory Factor Analysis (CFA) and internal consistency using McDonald’s omega coefficient. Relying on the newest research we confirmed a five-factor structure for the CAS with the five factors being: Severe Combined Abuse, Sexual Abuse, Emotional Abuse, Physical Abuse, and Harassment. We also confirmed the three-factor structure for the SEA, resulting in Economic Control, Economic Exploitation, and Employment Sabotage. The instruments demonstrated high internal consistency. The validated instruments that measure multidimensionality of IPV will allow a more comprehensive data and knowledge collection of women’s experiences in abusive relationships.

Endoscopic Transoral Hybrid Supracricoid Partial Laryngectomy with Cricohyoidoepiglottopexy

Objectives: The hybrid supracricoid partial laryngectomy with cricohyoidoepiglottopexy (SCPL-CHEP, that is, open partial horizontal laryngectomies OPHL Type IIa) has been described using a flexible next generation robotic surgical platform for manipulation. We sought to evaluate the feasibility of performing this procedure using endoscopic transoral (EndoT) surgical techniques without robotics. Methods: Preclinical cadaveric study using two human cadavers. Hybrid SCPL-CHEP was performed with a flexible endoscope for visualization and hand-held instruments for manipulation (SILS Hook monopolar and Dissect, HAVAS LaryngoFIT malleable straight jaw instruments, and Stratafix 4-0 spiral knotless barbed suture). Results: EndoT hybrid SCPL-CHEP was successfully performed. The hand-manipulated rigid instruments allowed for transoral incisions and mucosal suturing. We provide the procedural steps of EndoT hybrid techniques. Conclusions: EndoT hybrid SCPL-CHEP was technically feasible in the preclinical cadaveric laboratory setting and appeared comparable to the hybrid SCPL-CHEP via transoral robotic surgery (TORS). Selected handheld instruments and flexible endoscopy appear to facilitate minimally invasive surgery of the larynx. This novel procedure and technique warrant further clinical study for consideration of feasibility, applicability, and patient benefit.

Robotic-assisted simultaneous resection of a left-sided thymic neoplasm and a right-sided lower thoracic paravertebral neoplasm via the same ports and two docking steps: a case report

Background The authors presented a 63-year old female synchronously complicated with a thymic tumor located at the left-side of the superior mediastinum, and a paravertebral tumor located at the right-side of the lower thorax. Conventional thoracoscopic surgical procedure using rigid instruments to simultaneously resect the two tumors via the same ports might be technically challenging. To our knowledge, the use of a surgical robot allowed the surgeon to perform precise dissection from extreme angles with the characteristic of articulating surgical instruments. Case presentation Two lesions were successfully dissected using the da Vinci Surgical System through the same four ports on the right side of the chest and two-step docking. Firstly, the patient cart came from the dorsal side of the patient and the paravertebral neoplasm was dissected. Afterwards, the patient cart was undocked and the operation table was rotated 180 degrees counterclockwise. The robot was re-introduced and the patient cart came from the ventral side of the patient and the whole thymus was resected. Conclusion This case report suggests that two-step docking via the same four ports for these two tumors located at different directions of the thorax was safe and effective, demonstrating a clear advantage of the surgical robot.

Articulated Instruments and 3D Visualization: A Synergy? Evaluation of Execution Time, Errors, and Visual Fatigue

Objective. The introduction of advanced endoscopic systems, such as the Storz Image1S and the Olympus Endoeye, heralds a new era of 3-dimensional (3D) visualization. The aim of this report is to provide a comprehensive overview of the neurophysiology of 3D view, its relevance in videoscopy, and to quantify the benefit of the new 3D technologies for both rigid and articulated instruments. Method. Sixteen medical students without any laparoscopic experience were trained each for a total of 27 hours. Proficiency scores were determined for rigid and articulated instruments under 2D and 3D visualization conditions. Results. A reduction in execution time of 14%, 28%, and 36% was seen for the rigid instruments, the da Vinci, and Steerable instruments, respectively. A reduction in errors of 84%, 92%, and 87% was seen for the rigid instruments, the da Vinci, and Steerable instruments, respectively. Conclusion. 3D visualization greatly augments endoscopic procedures. The advanced endoscopic systems employed in the recent study caused no visual fatigue or discomfort. The benefit of 3D was most distinct with articulated instruments.

Evaluation of Bendable Surgical Suction Devices Made of Shape-Memory Alloy for the Endonasal Transsphenoid Removal of Pituitary Tumors

In minimally invasive surgeries, it can be difficult to reach desired anatomic areas with rigid instruments, especially when obstacles are present in the surgical corridor (e.g., during transnasal pituitary surgery). We developed a new kind of suction device constructed of the shape-memory alloy Nitinol (nickel titanium), which is adaptable to a patient's specific anatomy. Use of this device minimizes surgical risks by allowing physicians to use an endonasal transsphenoid approach. The suction device, which is equipped with a cannula made of the shape-memory alloy, was planned and manufactured with three different handpiece designs. Experienced pituitary surgeons tested the prototypes in human cadaver skulls and rated the devices on specific questionnaires. The results of their evaluation indicate that this device is a suitable tool for improving the surgical procedure. Its potential benefits include a more effective surgery and reductions in the risk of injury, the duration of surgery, and costs.

Design of a Modular, Partially Disposable Robot for Minimally Invasive Surgery

Most robots for minimally invasive surgery (MIS) are large, bulky devices which mimic the paradigm of manual MIS by manipulating long, rigid instruments from outside the body [1]. Some of these incorporate “wristed” instruments to place some local dexterity at or near the tool tip [2]. In contrast, a small number of MIS robot designs place all of the degrees of freedom inside the patient’s body in order to increase the local dexterity [3].

Homemade Glove Port for Single-Incision Pediatric Endosurgery (SIPES) Appendectomy—How We Do It

Introduction Single-incision pediatric endosurgery (SIPES) for the treatment of acute appendicitis in children has recently gained popularity due to its advantages including minimization of postoperative scars or less incisional pain. The principal disadvantages of SIPES include the limited degrees of freedom of movement and high health care costs. To overcome these issues, some surgeons have reported to use noncommercial ports for SIPES appendectomy. Case Report In this report, we present a case of a 10-year-old female patient with acute appendicitis undergoing SIPES appendectomy using own homemade glove port and straight rigid instruments. Conclusion SIPES appendectomy using the glove port is a low-cost alternative to commercially available port systems. It is easy to set up and use.