“[Surgical therapy focusing mainly on endoscopic treatment].”
Iwazaki, M., K. Oiwa, et al. (2010).
Nippon Rinsho (Japanese Journal of Clinical Medicine) 68(6): 1015-1018.
Endoscopic surgery was popularized at the beginning of the 1990s in Japan, along with the development of video optical instruments, and it was soon applied to the treatment of solid cancers. Less invasive surgical techniques were sought using various approaches in various fields in the 2000s, and now in 2010 three approaches are notable: (1) single incision laparoscopic surgery using a one window method, which is attracting considerable interest because of its low invasiveness; (2) natural orifice translumenal endoscopic surgery (NOTES); and (3) robotic surgery, which is being pursued as a new modality. Further improvements in all these methods are anticipated as a result of the development of new instruments and the mastery of surgical techniques. However, an assurance of the safety of surgical procedures and a good prognosis are requisites for all these methods, and a level of quality equivalent to that of surgical techniques such as traditional thoracic and abdominal surgery must be maintained. Although these methods seem to represent difference paths, investigations of the various surgical techniques pursued by surgeons reveal that the various paths merge to reach the same goal. Therefore, extensive studies of new surgical techniques in various fields are needed to ensure that these new techniques hold up to the expectations of surgeons.
“Evolution in the operating room.”
Niethard, F. U. and K. Weise (2009).
Evolution im Operationssaal. 147(6): 667-668.
“Evolution of Endoscopic Skull Base Surgery, Current Concepts, and Future Perspectives.”
Nogueira, J. F., A. Stamm, et al. (2010).
Otolaryngologic Clinics of North America 43(3): 639-652.
Endoscopic techniques have influenced almost all of the surgical specialties. From open procedures to minimally invasive approaches, the endoscope and its ability to reach areas within the human body has gained popularity among specialists, creating a revolution in some fields. Two of the fields in which endoscopes provided a true revolution are otolaryngology and neurosurgery. The authors discuss some important factors for the evolution of endoscopic skull base surgery and expanded endonasal approaches, highlighting historical landmarks but also addressing the current concepts, complications, and the future of this promising field for clinical research and surgical techniques and technology. © 2010 Elsevier Inc.
“Australian mens long term experiences following prostatectomy: A qualitative descriptive study.”
O’Shaughnessy, P. K. and T. A. Laws (2009).
Contemporary Nurse 34(1): 98-109.
The experiences of men in the immediate postoperative period following surgery for primary prostate cancer are well reported in the literature. Recognition of the unresolved morbidity encountered by men in the medium term suggests that a more complete understanding of how men cope in the long term is needed. Health professionals are deserving of a more complete literature for the purpose of providing holistic care for this group of men, providing informed advocacy and better support for men living with the diagnosis of prostate cancer. Emerging literature reveals that men’s knowledge of the long term problems associated with prostatectomy was inadequate at the time they consented to treatment; the likely outcomes at all phases of recovery should be taken into account when deciding on choice of treatment or no treatment. This qualitative study aims to describe men’s long term recovery following prostatectomy for the purpose identifying the effects of unresolved post surgical morbidity. The content analysis of focus group interviews revealed that incontinence and impotence were a major source of emotional tension affecting the men’s social interactions and sense of self-worth. The men expressed great regret over the lack of information accessible to them for evaluating the risk and nature of long term problems. The thick description provided in this study identifies the need for empathetic assessment of men with ongoing post surgical issues and alerts the reader to the inadequacies of information provided prior to consent to prostatectomy. © eContent Management Pty Ltd.
“Incidence of vaginal cuff dehiscence after open or laparoscopic hysterectomy: A case report.”
Rivlin, M. E., G. R. Meeks, et al. (2010).
Journal of Reproductive Medicine for the Obstetrician and Gynecologist 55(3-4): 171-174.
BACKGROUND: The incidence of vaginal incision dehiscence after total hysterectomy has been reported to be higher with laparoscopic than with open surgery, but the data are limited. This report documents a case and reviews the literature in order to further estimate the differences in incidence by route of hysterectomy. CASE: A 45-year-old woman underwent successful vaginal repair of postcoital cuff dehiscence with small bowel evisceration 67 days after total laparoscopic hysterectomy and bilateral salpingo-oophorectomy for menometrorhagia. CONCLUSION: Seven observational studies were identified. The comparison of total laparoscopic to robotic hysterectomy was not statistically significant, nor was the comparison of total abdominal to vaginal hysterectomy. However, the incidence of dehiscence for laparoscopic procedures was statistically greater than the incidence for open surgery (p value <0.001). © Journal of Reprensentative Medicine®, Inc.
“The future of endoscopy.”
Roberts-Thomson, I. C., R. Singh, et al. (2010).
Journal of Gastroenterology and Hepatology 25(6): 1051-1057.
Extraordinary developments have occurred in the field of endoscopy over the past 40 years. The era that began with the fiberoptic endoscope (fiberscope) has now moved to the videoscope and, more recently, to the capsule endoscope. Videoendoscopy will remain the major form of endoscopy for the next 5-10 years but, thereafter, diagnostic procedures including colonoscopy will increasingly be performed by capsule endoscopy. This change will be largely driven by patient preference rather than superior results from capsule studies. Image analysis of capsule studies will be accelerated by software that highlights abnormal areas and, by 2025, capsule studies will be ‘read’ by computer. For the next decade, more complex therapeutic procedures will be performed by a new group of therapeutic endoscopists using advanced videoscopes. Several new therapeutic procedures will emerge but natural orifice transluminal approaches will need to compete with advances in laparoscopic techniques. It is also likely that health administrators faced with escalating medical costs will demand that new and more expensive procedures not only facilitate patient care but result in superior health outcomes. © 2010 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd.
“The effects of coronary artery bypass graft surgery on health-related quality of life, cognitive performance, and emotional status outcomes: A prospective 6-month follow-up consultation-liaison psychiatry study.”
Rothenhäusler, H. B., A. Stepan, et al. (2010).
Prospektive untersuchung zu den auswirkungen aortokoronarer bypassoperationen auf die gesundheitsbezogene lebensqualität, kognitive performanz und emotionale befindlichkeit im 6-monats-verlauf: Ergebnisse einer konsiliarpsychiatrischen follow-up-studie 78(6): 343-354.
The success of routine coronary artery bypass graft surgery (CABG) is now no longer judged solely by its effects on traditional end points such as mortality rates but by its influence on biopsychosocial dimensions. The aim of this study was to assess the course of health-related quality of life, cognitive and emotional change during the six months after elective CABG, and to investigate how cognitive impairments, depression and posttraumatic stress symptoms were related to quality of life. In a prospective study, we followed up for 6 months 138 of theoriginal 147 patients who had undergone elective CABG surgery. Preoperatively, and at 6months after surgery, a series of psychometric observer-rating and self-rating scales were administered to evaluate cognitive functioning (SKT), depressive symptoms (BDI), posttraumatic stress symptoms (PTSS-10), and health-related quality of life (SF-36 Health Status Questionnaire). The measurements of health-related quality of life (HRQOL) indicated significantly higher SF-36 values on all of the eight health-related domains from preoperative to 6-month follow-up assessments. However, at 6-month follow-up, patients with clinical depression had significantly lower SF-36 values on all of the eight health-related domains when compared with patients without depression. Also, at 6-month follow-up, patients with posttraumatic stress disorder (PTSD) had significantly lower SF-36 values on six of the eight SF-36 health categories when compared with patients without PTSD. Finally, at 6-month follow-up, patients with cognitive deficits had significantly lower SF-36 values on physical functioning when compared with patients without cognitive impairments. We underscore the need for early and comprehensive bio-psycho-social diagnosis and therapy of post-CABG patients in order to treat emotional distress and CABG-related cognitive impairments and enhance patients quality of life at an early stage after cardiac surgery. © Georg Thieme Verlag KG Stuttgart.
“Optimal acquisition and assessment of proficiency on simulators in surgery.”
Stefanidis, D. (2010).
Surgical Clinics of North America 90(3): 475-489.
Increasingly, trainees are being exposed to simulators for the purpose of acquiring surgical skills. This article addresses the theoretical framework behind surgical skill acquisition and explores the factors that optimize learning on simulators. Furthermore, this article evaluates the role of currently used performance metrics for documentation of skills proficiency and provides suggestions for the incorporation of additional, more sensitive performance metrics that may lead to improved transfer of simulator-acquired skill. © 2010 Elsevier Inc.
“Implementation of Advanced Laparoscopic Surgery in Gynecology: National Overview of Trends.”
Twijnstra, A. R. H., W. Kolkman, et al. (2010).
Journal of Minimally Invasive Gynecology 17(4): 487-492.
Study Objective: To estimate the implementation of laparoscopic surgery in operative gynecology. Design: Observational multicenter study (Canadian Task Force classification II-2). Setting: All hospitals in the Netherlands. Sample: Nationwide annual statistics for 2002 and 2007. Interventions: A national survey of the number of performed laparoscopic and conventional procedures was performed. Laparoscopy was categorized for complexity in level 1, 2, and 3 procedures. Outcomes were compared with results from 2002 to evaluate trends. Measurements and Main Results: In 2002, 21 414 laparoscopic and 9325 conventional procedures were performed in 74 hospitals (response rate, 74%), and in 2007, 16 863 laparoscopic and 10 973 conventional procedures were performed in 80 hospitals (response rate, 80%). Compared with 2002, in 2007, level 1 procedures were performed significantly less often and level 2 and level 3 procedures were performed significantly more often. The mean number of performed laparoscopic procedures per hospital decreased from 289 to 211 procedures. Teaching hospitals performed more than twice as many therapeutic laparoscopic procedures as nonteaching hospitals do. Cystectomy, oophorectomy, and ectopic pregnancy surgery were preferably performed using the laparoscopic approach. Laparoscopic hysterectomy was performed significantly more often, accounting for 10% of all hysterectomies. Annually, 20% of hospitals in which laparoscopic hysterectomy was implemented performed 50% of all laparoscopic hysterectomies, and 50% of the hospitals performed 20% of laparoscopic hysterectomies. Conclusion: This study describes increasing implementation of therapeutic laparoscopic gynecologic surgery. Clinics increasingly opt to perform laparoscopic surgery rather than conventional surgery. However, implementation of advanced procedures such as laparoscopic hysterectomy seems to be hampered. © 2010 AAGL.
“Plans Balk While Patients Clamor for Robotic Surgery.”
(2010).
Managed Care 19(3).
“Robotic-assisted laparoscopic surgery.”
(2010).
Medical Letter on Drugs and Therapeutics 52(1340): 45-46.
“Rhabdomyolysis and compartment syndrome of two forearms after robotic assisted prolonged surgery.”
Deras, P., J. Amraoui, et al. (2010).
Rhabdomyolyse et syndrome des loges des deux avant-bras lors d’une chirurgie robotique de longue durée29(4): 301-303.
Robotic assisted laparoscopic surgery allows for a more precise dissection than classical laparoscopic surgery. However, it sometimes imposes specific exaggerated postures and extralong procedure duration. Combining these two factors may increase the risk for postural complications in at-risk patients. We report the case of an obese 30-year-old female patient who underwent a 12-hour duration robotic laparoscopic surgery for severe endometriosis, in Trendelenburg position. This was complicated by a two forearms rhabdomyolysis, with subsequent compartment syndrome with multiple neuropathy. Physicians must be aware of the cumulative risk for postural complications when extreme positions are associated to long duration procedures in predisposed patients. © 2010 Elsevier Masson SAS.
“Can robots patch-clamp as well as humans? Characterization of a novel sodium channel mutation.”
Estacion, M., J. S. Choi, et al. (2010).
Journal of Physiology 588(Pt 11): 1915-1927.
Ion channel missense mutations cause disorders of excitability by changing channel biophysical properties. As an increasing number of new naturally occurring mutations have been identified, and the number of other mutations produced by molecular approaches such as in situ mutagenesis has increased, the need for functional analysis by patch-clamp has become rate limiting. Here we compare a patch-clamp robot using planar-chip technology with human patch-clamp in a functional assessment of a previously undescribed Nav1.7 sodium channel mutation, S211P, which causes erythromelalgia. This robotic patch-clamp device can increase throughput (the number of cells analysed per day) by 3- to 10-fold. Both modes of analysis show that the mutation hyperpolarizes activation voltage dependence (8 mV by manual profiling, 11 mV by robotic profiling), alters steady-state fast inactivation so that it requires an additional Boltzmann function for a second fraction of total current (approximately 20% manual, approximately 40% robotic), and enhances slow inactivation (hyperpolarizing shift–15 mV by human,–13 mV robotic). Manual patch-clamping demonstrated slower deactivation and enhanced (approximately 2-fold) ramp response for the mutant channel while robotic recording did not, possibly due to increased temperature and reduced signal-to-noise ratio on the robotic platform. If robotic profiling is used to screen ion channel mutations, we recommend that each measurement or protocol be validated by initial comparison to manual recording. With this caveat, we suggest that, if results are interpreted cautiously, robotic patch-clamp can be used with supervision and subsequent confirmation from human physiologists to facilitate the initial profiling of a variety of electrophysiological parameters of ion channel mutations.
“Incidence of Surgical Site Infection Associated with Robotic Surgery.”
Hermsen, E. D., T. Hinze, et al. (2010).
Infection Control and Hospital Epidemiology.
Objective. Robot-assisted surgery is minimally invasive and associated with less blood loss and shorter recovery time than open surgery. We aimed to determine the duration of robot-assisted surgical procedures and the incidence of postoperative surgical site infection (SSI) and to compare our data with the SSI incidence for open procedures according to national data. Design. Retrospective cohort study. Setting. A 689-bed academic medical center. Patients. All patients who underwent a surgical procedure with use of a robotic surgical system during the period from 2000-2007. Methods. SSIs were defined and procedure types were classified according to National Healthcare Safety Network criteria. National data for comparison were from 1992-2004. Because of small sample size, procedures were grouped according to surgical site or wound classification. Results. Sixteen SSIs developed after 273 robot-assisted procedures (5.9%). The mean surgical duration was 333.6 minutes. Patients who developed SSI had longer mean surgical duration than did patients who did not (558 vs 318 minutes; [Formula: see text]). The prostate and genitourinary group had 5.74 SSIs per 100 robot-assisted procedures (95% confidence interval [CI], 2.81-11.37), compared with 0.85 SSIs per 100 open procedures from national data. The gynecologic group had 10.00 SSIs per 100 procedures (95% CI, 2.79-30.10), compared with 1.72 SSIs per 100 open procedures. The colon and herniorrhaphy groups had 33.33 SSIs per 100 procedures (95% CI, 9.68-70.00) and 37.50 SSIs per 100 procedures (95% CI, 13.68-69.43), respectively, compared with 5.88 and 1.62 SSIs per 100 open procedures from national data. Patients with a clean-contaminated wound developed 6.1 SSIs per 100 procedures (95% CI, 3.5-10.3), compared with 2.59 SSIs per 100 open procedures. No significant differences in SSI rates were found for other groups. Conclusions. Increased incidence of SSI after some types of robot-assisted surgery compared with traditional open surgery may be related to the learning curve associated with use of the robot.
“Suture damage after grasping with EndoWrist of the da Vinci Surgical System.”
Hirano, Y., N. Ishikawa, et al. (2010).
Minim Invasive Ther Allied Technol.
Abstract Robotic surgery using the da Vinci Surgical System promises to extend the capabilities of minimally invasive surgery and many surgical specialties are applying this new technology. With the progress of robotic surgery, we have many opportunities to perform intracorporeal anastomosis and knotting. In these procedures, we use needle drivers, and we sometimes experience collapse of sutures after grasping them due to the lack of tactile feedback. In this study, we evaluated the relationship between the decrease of durability and robotic manipulation and whether a difference in endurance can be observed using different types of robotic instruments or needle drivers for conventional laparoscopic surgery. We held 4-0 mono-filament sutures with three types of EndoWrist: Large Needle Driver (LND), Cadiere Forceps (CF) and Debaky Forceps (DF) of the da Vinci surgical system once or three times and measured the decrease of durability of the suture. The mean tensions of the suture were significantly decreased after robotic manipulation with LND. The mean tension after holding three times with LND was significantly less than that with the CF. During intracorporeal anastomosis and knotting in robotic surgery, it is important to decrease the necessity to hold the suture directly with EndoWrist. If needed, the best EndoWrist to use is CF or DF, but not LND.
“Laparoscopic and robotic technology: New era in cancer surgical treatment.”
Hottenrott, C. (2009).
Gastric and Breast Cancer 8(2): 31-35.
Minimally invasive, either laparoscopic or robotic, surgery is dramatically fast altering the landscape in the surgical treatment of solid cancers. Cancer is already a major heath problem and will become the top human challenge in the near future. With an expected increase in cancer incidence by 55% in 2020<sup>1</sup>, patients and their physicians will increasingly seek the best treatment highly specialized institutions.
“Robotic surgery: New era in the treatment of solid cancer.”
Hottenrott, C. (2009).
Gastric and Breast Cancer 8(1): 13-17.
Closed surgery includes laparoscopy-assisted resection and robotic surgery based on the Da Vinci surgical system. Laparoscopyassisted resection in the treatment of solid cancers is increasingly replacing conventional open surgery. Although in the current evidence-based medicine, longer follow-up data are required for guidelines recommendations by International nonprofit Organizations, the future undoubtedly lies in closed surgery. With the aging of the population, a new study [1] estimated an increase of the total number of cancer patients by 55% (11,8 million in 2005 to 18.2 million in 2020) in the United States. Lungs, colorectal or gastrointestinal overall, and prostate cancers, which can be treated by robotic surgery, are already among the most common malignancies (Table 1, Fig 1A&1B). Therefore, it is plausible to forecast the major interest in robotic surgery by public health systems and private sector, regarding safety and cost-effectiveness analysis. Can robotic surgery further improve postoperative quality of life (QOL) in patients with solid cancer? Is there some expectation and hope that robotic surgery might improve, apart of QOL, also oncological outcomes in patients with gastrointestinal cancer? Given the high mortality and increasing trend in the incidence of these tumors, this article describes the future perspectives of robotic surgery.
“Comparing the learning curve for robotically assisted and straight stick laparoscopic procedures in surgical novices.”
Rashid, T. G., M. Kini, et al. (2010).
Int J Med Robot.
INTRODUCTION: Robotically assisted laparoscopic surgery has a different learning curve to straight stick laparoscopic surgery. The learning curve for novices is likely to be different to that for experienced surgeons. We assessed the early learning curve for trainees with 18 months or less of surgical experience. METHODS: Six surgical novices performed 120 exercises using laparoscopic instruments and a DaVinci S robot. The exercise comprised cutting out a computer-generated paper circle. Time to completion, number of instrument changes and accuracy were compared (Kruskal-Wallis test). RESULTS: Trainees required significantly less time using the robot (326 vs. 433 s; p < 0.0001); recorded fewer mistakes (1 vs. 4.5; p < 0.0001) and fewer instrument changes (1 vs. 3; p < 0.0001). Significant improvement was demonstrated in time, number of mistakes and instrument changes for robotically-assisted laparoscopic surgery. CONCLUSION: For surgical novices tested on an in vitro dexterity exercise, a robotically assisted laparoscopic system offers a shorter learning curve and improved accuracy compared to straight stick surgery. Copyright (c) 2010 John Wiley & Sons, Ltd.
“Task versus subtask surgical skill evaluation of robotic minimally invasive surgery.”
Reiley, C. E. and G. D. Hager (2009).
Medical image computing and computer-assisted intervention : MICCAI … International Conference on Medical Image Computing and Computer-Assisted Intervention 12(Pt 1): 435-442.
Evaluating surgical skill is a time consuming, subjective, and difficult process. This paper compares two methods of identifying the skill level of a subject given motion data from a benchtop surgical task. In the first method, we build discrete Hidden Markov Models at the task level, and test against these models. In the second method, we build discrete Hidden Markov Models of surgical gestures, called surgemes, and evaluate skill at this level. We apply these techniques to 57 data sets collected from the da Vinci surgical system. Our current techniques have achieved accuracy levels of 100% using task level models and known gesture segmentation, 95% with task level models and unknown gesture segmentation, and 100% with the surgeme level models in correctly identifying the skill level. We observe that, although less accurate, the second method requires less prior label information. Also, the surgeme level classification provided more insights into what subjects did well, and what they did poorly.
“Robot-Assisted Regional Anesthesia: A Simulated Demonstration.”
Tighe, P. J., S. J. Badiyan, et al. (2010).
Anesthesia and Analgesia.
Recent advances in robotically assisted telesurgery offer expert surgical care for the geographically remote patient. Similar advances in teleanesthesia will be necessary to bring comparable perioperative care to the geographically remote patient. Although many preliminary investigations into teleanesthesia are underway, none involve remote performance of anesthesia-related procedures. Herein, we describe the placement of ultrasound-guided nerve blocks into an ultrasound phantom using the da Vinci multipurpose surgical robotic system (Intuitive Surgical, Sunnyvale, CA). Both single-injection and perineural catheter techniques were successfully performed by an operator who was not physically present at the bedside.
“Robotic surgery of the infratemporal fossa utilizing novel suprahyoid port.”
McCool, R. R., F. M. Warren, et al. (2010).
Laryngoscope.
OBJECTIVES/HYPOTHESIS:: To develop a minimally invasive technique for robotic access to the infratemporal fossa and describe use of a novel suprahyoid port placement. STUDY DESIGN:: A cadaveric study to assess feasibility of robotic dissection of the infratemporal fossa using a novel, midline suprahyoid port placement. METHODS:: Six complete and two partial dissections of the infratemporal fossa were carried out on one fixed and three fresh cadaveric heads using the da Vinci surgical robot (Intuitive Surgical, Inc., Sunnyvale, CA). The suprahyoid port site was utilized to place one robotic arm into the vallecula. The second arm and 30 degrees camera were placed transorally, and dissections were performed through the lateral pharyngeal wall and into the infratemporal fossa with identification and preservation of the lingual nerve, inferior alveolar nerve, internal and external carotid arteries, jugular vein, and cranial nerves IX-XII. Surgical clips were placed at the extent of dissection, and computed tomography (CT) imaging was obtained after dissections. RESULTS:: The transoral and midline suprahyoid port sites provide excellent access to the infratemporal fossa. The midline port site has excellent utility for accessing wide areas of the skull base bilaterally. CT imaging shows surgical clips placed successfully at the skull base foramina of major neurovascular structures. CONCLUSIONS:: Robotic surgery offers several advantages over traditional endoscopic surgery with the addition of tremor-free, two-handed technique and microscopic three-dimensional visualization. A midline suprahyoid port placement provides minimally invasive access for excellent exposure of the infratemporal fossa bilaterally. Laryngoscope, 2010.