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Wang Y, Ai Q, Shi T, Gao Y, Jiang B, Zhao W, Jiang C, Liu G, Zhang L, Li H, Gao F, Ma X, Li H, Zhang X. Influence of network latency and bandwidth on robot-assisted laparoscopic telesurgery: A pre-clinical experiment. Chin Med J (Engl) 2024:00029330-990000000-01180. [PMID: 39149985 DOI: 10.1097/cm9.0000000000003257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Indexed: 08/17/2024] Open
Abstract
BACKGROUND Telesurgery has the potential to overcome spatial limitations for surgeons, which depends on surgical robot and the quality of network communication. However, the influence of network latency and bandwidth on telesurgery is not well understood. METHODS A telesurgery system capable of dynamically adjusting image compression ratios in response to bandwidth changes was established between Beijing and Sanya (Hainan province), covering a distance of 3000 km. In total, 108 animal operations, including 12 surgical procedures, were performed. Total latency ranging from 170 ms to 320 ms and bandwidth from 15-20 Mbps to less than 1 Mbps were explored using designed surgical tasks and hemostasis models for renal vein and internal iliac artery rupture bleeding. Network latency, jitter, frame loss, and bit rate code were systemically measured during these operations. National Aeronautics and Space Administration Task Load Index (NASA-TLX) and a self-designed scale measured the workload and subjective perception of surgeons. RESULTS All 108 animal telesurgeries, conducted from January 2023 to June 2023, were performed effectively over a total duration of 3866 min. The operations were completed with latency up to 320 ms and bandwidths as low as 1-5 Mbps. Hemostasis for vein and artery rupture bleeding models was effectively achieved under these low bandwidth conditions. The NASA-TLX results indicated that latency significantly impacted surgical performance more than bandwidth and image clarity reductions. CONCLUSIONS This telesurgery system demonstrated safety and reliability. A total of 320 ms latency is acceptable for telesurgery operations. Reducing image clarity can effectively mitigate the potential latency increase caused by decreased bandwidth, offering a new method to reduce the impact of latency on telesurgery.
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Affiliation(s)
- Ye Wang
- Department of Urology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Qing Ai
- Department of Urology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Taoping Shi
- Department of Urology, Hainan Hospital of Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Yu Gao
- Department of Urology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Bin Jiang
- Department of Urology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Wuyi Zhao
- Shenzhen Edge Medical Co., Ltd, Shenzhen, Guangdong 518116, China
| | - Chengjun Jiang
- Shenzhen Edge Medical Co., Ltd, Shenzhen, Guangdong 518116, China
| | - Guojun Liu
- Department of Urology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Lifeng Zhang
- Department of Urology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Huaikang Li
- Department of Urology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Fan Gao
- Department of Urology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Xin Ma
- Department of Urology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Hongzhao Li
- Department of Urology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Xu Zhang
- Department of Urology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
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Kifle F, Kenna P, Daniel S, Maswime S, Biccard B. A scoping review of Enhanced Recovery After Surgery (ERAS), protocol implementation, and its impact on surgical outcomes and healthcare systems in Africa. Perioper Med (Lond) 2024; 13:86. [PMID: 39095850 PMCID: PMC11297632 DOI: 10.1186/s13741-024-00435-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 07/08/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Enhanced Recovery After Surgery (ERAS) is a patient-centered approach to surgery designed to reduce stress responses and facilitate faster recovery. ERAS protocols have been widely adopted in high-income countries, supported by robust research demonstrating improved patient outcomes. However, in Africa, there is limited evidence regarding its implementation. This review aims to identify the existing literature on the implementation of ERAS principles in Africa, the reported clinical outcomes, and the challenges and recommendations for successful implementation. METHODS We conducted a librarian-assisted literature search of electronic research databases between October and November 2023. Titles and abstracts were screened for eligibility, and duplicates were then removed, followed by full-text assessment of potentially eligible studies. We utilized the summative content analysis method to synthesize and group the data into fewer categories based on agreed-upon criteria. Descriptive statistics were used to describe the results. RESULTS The search identified 342 potential studies resulting in 15 eligible studies for inclusion in the review. The publication years ranged from 2016 to 2023. The studies originated from three countries: Egypt (n = 10), South Africa (n = 4), and Uganda (n = 1). Successful implementation was associated with reduced hospital length of stay (n = 12), lower mortality rates (n = 3), and improved pain outcomes (n = 7). Challenges included protocol adherence (n = 5) and limitations of the research design to generate strong evidence (n = 3). Recommendations included formal adoption of ERAS principles (n = 5), the need for sustained research commitment, and exploration of the applicability of ERAS in diverse surgical contexts (n = 8). Large-scale implementation beyond individual institutions was encouraged to further validate its impact on patient outcomes and healthcare costs (n = 1). CONCLUSIONS Despite the limited number of studies on ERAS implementation in Africa, the available evidence suggests that it reduces the length of hospital stays and mortality rates. This is crucial for the region, given its higher mortality rates, necessitating more collaborative, methodically well-designed studies to establish stronger evidence for ERAS in lower-resource environments.
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Affiliation(s)
- Fitsum Kifle
- Global Surgery Division, Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
- Network for Perioperative and Critical Care, Debre Birhan University Asrat Woldeyes Health Sciences Campus, Debre Birhan, Ethiopia.
| | - Peniel Kenna
- Network for Perioperative and Critical Care, Debre Birhan University Asrat Woldeyes Health Sciences Campus, Debre Birhan, Ethiopia
| | - Selam Daniel
- Department of Anesthesiology and Critical Care, Kidus Petros Hospital, Addis Ababa, Ethiopia
| | - Salome Maswime
- Global Surgery Division, Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Bruce Biccard
- Global Surgery Division, Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, Western Cape, South Africa
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Liu RH, Manana W, Tollefson TT, Ntirenganya F, Shaye DA. Perspectives on the state of cleft lip and cleft palate patient care in Africa. Curr Opin Otolaryngol Head Neck Surg 2024; 32:202-208. [PMID: 38695446 PMCID: PMC11340684 DOI: 10.1097/moo.0000000000000979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
PURPOSE OF REVIEW Patients with cleft lip -palate (CLP) experience morbidity and social stigma, particularly in low-income and middle-income countries (LMICs) such as those of sub-Saharan Africa (SSA). Delays in treatment secondary either to lack of awareness, skills, equipment and consumables; poor health infrastructure, limited resources or a combination of them, has led to SSA having the highest rates of death and second highest rates of disability-adjusted life years in patients with CLP globally. Here we review current perspectives on the state of comprehensive cleft lip and palate repair in Africa. RECENT FINDINGS To bridge gaps in government health services, nongovernmental organizations (NGOs) have emerged to provide care through short-term surgical interventions (STSIs). These groups can effect change through direct provision of care, whereas others strengthen internal system. However, sustainability is lacking as there continue to be barriers to achieving comprehensive and longitudinal cleft care in SSA, including a lack of awareness of CLP as a treatable condition, prohibitive costs, poor follow-up, and insufficient surgical infrastructure. With dedicated local champions, a comprehensive approach, and reliable partners, establishing sustainable CLP services is possible in countries with limited resources. SUMMARY The replacement of CLP 'missions' with locally initiated, internationally supported capacity building initiatives, integrated into local healthcare systems will prove sustainable in the long-term.
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Affiliation(s)
- Rui Han Liu
- Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Wayne Manana
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, College of Health Science, University of Zimbabwe, Harare, Zimbabwe
| | - Travis T. Tollefson
- Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California, USA
| | - Faustin Ntirenganya
- Department of Surgery, University Teaching Hospital Kigali
- School of Medicine and Pharmacy, College of Medicine & Health Sciences, University of Rwanda, Kigali, Rwanda
| | - David A. Shaye
- Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, University Teaching Hospital Kigali
- School of Medicine and Pharmacy, College of Medicine & Health Sciences, University of Rwanda, Kigali, Rwanda
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Bandyopadhyay S, Philipo GS, Bokhary ZM, Lakhoo K. A review of twenty-first century developments in paediatric surgery in Africa. Pediatr Surg Int 2024; 40:137. [PMID: 38780635 DOI: 10.1007/s00383-024-05718-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/17/2024] [Indexed: 05/25/2024]
Abstract
This review explores the significant advancements in paediatric surgery in Africa during the twenty-first century, with a particular focus on capacity-building, education, infrastructural development, and research. Historically, paediatric surgery has been an overlooked sector, especially in low-and-middle-income countries in Africa. However, recent years have seen considerable progress. Collaborative efforts such as the Global Initiative for Children's Surgery, and the formation of the Pan African Paediatric Surgery Association, the College of Surgeons of East, Central and Southern Africa and the West African College of Surgeons have facilitated knowledge sharing, collaboration, and advocacy for enhancing surgical standards. Local training programmes, including Master of Medicine programmes and fellowships, have been instrumental in building a skilled workforce. These initiatives have been complemented by infrastructural developments through non-governmental organisations like Kids Operating Room, which have expanded access to paediatric surgical care. Technological advancements, particularly in telemedicine, have further enhanced accessibility. Task-sharing strategies, where non-specialist physicians are trained in paediatric surgical skills, have also been utilised to address the shortage of specialised surgeons. Research in paediatric surgery has experienced an upswing, with local health professionals taking the lead. Research has been crucial for understanding the epidemiology of paediatric surgical conditions, and developing prevention strategies, and is increasingly leading to the inclusion of paediatric surgery in national health plans. Despite the progress, challenges remain, including the need for sustainable funding, continued investment in infrastructure, and training and retention of healthcare professionals. The review emphasises the importance of ongoing efforts in community engagement, innovative technologies, and health systems strengthening for the sustainable development of paediatric surgical services in Africa.
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Affiliation(s)
- Soham Bandyopadhyay
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, Medical Sciences Division, University of Oxford, Oxford, UK.
| | - Godfrey Sama Philipo
- The College of Surgeons of East Central and Southern Africa, Arusha, Tanzania
- The Branch for Global Surgical Care (BGSC), University of British Columbia (UBC), Columbia, Canada
| | - Zaitun Mohamed Bokhary
- Department of Surgery, Muhimbili National Hospital, Dar Es Salaam, Tanzania
- Department of Surgery, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Kokila Lakhoo
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, Medical Sciences Division, University of Oxford, Oxford, UK
- Department of Surgery, Muhimbili National Hospital, Dar Es Salaam, Tanzania
- Department of Surgery, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
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Kravchenko Y, Sikora K, Wireko AA, Lyndin M. Fluorescence visualization for cancer DETECTION: EXPERIENCE and perspectives. Heliyon 2024; 10:e24390. [PMID: 38293525 PMCID: PMC10827512 DOI: 10.1016/j.heliyon.2024.e24390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 12/24/2023] [Accepted: 01/08/2024] [Indexed: 02/01/2024] Open
Abstract
The current review focuses on the latest advances in the improvement and application of fluorescence imaging technology. Near-infrared (NIR) fluorescence imaging is a promising new technique that uses non-specific fluorescent agents and targeted fluorescent tracers combined with a dedicated camera to better navigate and visualize tumors. Fluorescence-guided surgery (FGS) is used to perform various tasks, helping the surgeon to distinguish lymphatic vessels and nodes from surrounding tissues easily and quickly assess the perfusion of the planned resection area, including intraoperative visualization of metastases. The results of the insertion of fluorescence visualization as an auxiliary method to cancer detection and high-risk metastatic lesions in clinical practice have demonstrated enthusiastic results and huge potential. However, intraoperative fluorescence visualization must not be considered as a main diagnostic or treatment method but as an aid to the surgeon. Thus, fluorescence study does not dispense the diagnostic gold standards of benign or malignant tumors (conventional examination, biopsy, ultrasonography and computed tomography, etc.) and can be done usually during intraoperative treatment. Moreover, as fluorescence surgery and fluorescence diagnostic techniques continue to improve, it is likely that they will evolve towards targeted fluorescence imaging probes that will increasingly target a specific type of cancer cell. The most important point remains the search for highly selective messengers of fluorescent labels, which make it possible to identify tumor cells exclusively in the affected organs and indicate to surgeons the boundaries of their spread and metastasis.
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Affiliation(s)
- Yaroslav Kravchenko
- Sumy State University, Sumy, Ukraine
- NanoBioMedical Centre, Adam Mickiewicz University in Poznan, Poznan, Poland
| | | | | | - Mykola Lyndin
- Sumy State University, Sumy, Ukraine
- Institute of Anatomy, Medical Faculty, University of Duisburg-Essen, Essen, 45147, Germany
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Obot O, John A, Udo I, Attai K, Johnson E, Udoh S, Nwokoro C, Akwaowo C, Dan E, Umoh U, Uzoka FM. Modelling Differential Diagnosis of Febrile Diseases with Fuzzy Cognitive Map. Trop Med Infect Dis 2023; 8:352. [PMID: 37505648 PMCID: PMC10386044 DOI: 10.3390/tropicalmed8070352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/26/2023] [Accepted: 06/28/2023] [Indexed: 07/29/2023] Open
Abstract
The report of the World Health Organization (WHO) about the poor accessibility of people living in low-to-middle-income countries to medical facilities and personnel has been a concern to both professionals and nonprofessionals in healthcare. This poor accessibility has led to high morbidity and mortality rates in tropical regions, especially when such a disease presents itself with confusable symptoms that are not easily differentiable by inexperienced doctors, such as those found in febrile diseases. This prompted the development of the fuzzy cognitive map (FCM) model to serve as a decision-support tool for medical health workers in the diagnosis of febrile diseases. With 2465 datasets gathered from four states in the febrile diseases-prone regions in Nigeria with the aid of 60 medical doctors, 10 of those doctors helped in weighting and fuzzifying the symptoms, which were used to generate the FCM model. Results obtained from computations to predict diagnosis results for the 2465 patients, and those diagnosed by the physicians on the field, showed an average of 87% accuracy for the 11 febrile diseases used in the study. The number of comorbidities of diseases with varying degrees of severity for most patients in the study also covary strongly with those found by the physicians in the field.
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Affiliation(s)
- Okure Obot
- Department of Computer Science, University of Uyo, Uyo 520103, Nigeria
| | - Anietie John
- Department of Mathematics and Computer Science, Ritman University, Ikot Ekpene 530101, Nigeria
| | - Iberedem Udo
- Department of Computer Science, University of Uyo, Uyo 520103, Nigeria
| | - Kingsley Attai
- Department of Mathematics and Computer Science, Ritman University, Ikot Ekpene 530101, Nigeria
| | - Ekemini Johnson
- Department of Mathematics and Computer Science, Ritman University, Ikot Ekpene 530101, Nigeria
| | - Samuel Udoh
- Department of Computer Science, University of Uyo, Uyo 520103, Nigeria
| | - Chukwudi Nwokoro
- Department of Computer Science, University of Uyo, Uyo 520103, Nigeria
| | - Christie Akwaowo
- Health Systems Research Hub, University of Uyo Teaching Hospital, Uyo 520103, Nigeria
| | - Emem Dan
- Health Systems Research Hub, University of Uyo Teaching Hospital, Uyo 520103, Nigeria
| | - Uduak Umoh
- Department of Computer Science, University of Uyo, Uyo 520103, Nigeria
| | - Faith-Michael Uzoka
- Department of Mathematics and Computing, Mount Royal University, Calgary, AB T3E 6K6, Canada
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Mehta A, Cheng Ng J, Andrew Awuah W, Huang H, Kalmanovich J, Agrawal A, Abdul-Rahman T, Hasan MM, Sikora V, Isik A. Embracing robotic surgery in low- and middle-income countries: Potential benefits, challenges, and scope in the future. Ann Med Surg (Lond) 2022; 84:104803. [PMID: 36582867 PMCID: PMC9793116 DOI: 10.1016/j.amsu.2022.104803] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 10/23/2022] [Indexed: 11/25/2022] Open
Abstract
Robotic surgery has applications in many medical specialties, including urology, general surgery, and surgical oncology. In the context of a widespread resource and personnel shortage in Low- and Middle-Income Countries (LMICs), the use of robotics in surgery may help to reduce physician burnout, surgical site infections, and hospital stays. However, a lack of haptic feedback and potential socioeconomic factors such as high implementation costs and a lack of trained personnel may limit its accessibility and application. Specific improvements focused on improved financial and technical support to LMICs can help improve access and have the potential to transform the surgical experience for both surgeons and patients in LMICs. This review focuses on the evolution of robotic surgery, with an emphasis on challenges and recommendations to facilitate wider implementation and improved patient outcomes.
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Affiliation(s)
- Aashna Mehta
- University of Debrecen-Faculty of Medicine, Debrecen, 4032, Hungary
| | - Jyi Cheng Ng
- Faculty of Medicine and Health Sciences, University of Putra Malaysia, Serdang, Malaysia
| | | | - Helen Huang
- Royal College of Surgeons in Ireland, University of Medicine and Health Science, Dublin, Ireland
| | | | - Aniket Agrawal
- Department of Pediatric Surgery, Center for Children, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | | | - Mohammad Mehedi Hasan
- Department of Biochemistry and Molecular Biology, Faculty of Life Science, Mawlana Bhashani Science and Technology University, Tangail, Bangladesh,Corresponding author.
| | - Vladyslav Sikora
- Sumy State University and Toufik's World Medical Association, Sumy, Ukraine
| | - Arda Isik
- Istanbul Medeniyet University, Department of General Surgery, Istanbul, Turkey
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