1
|
Lai TJ, Roxburgh C, Boyd KA, Bouttell J. Clinical effectiveness of robotic versus laparoscopic and open surgery: an overview of systematic reviews. BMJ Open 2024; 14:e076750. [PMID: 39284694 PMCID: PMC11409398 DOI: 10.1136/bmjopen-2023-076750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2024] Open
Abstract
OBJECTIVE To undertake a review of systematic reviews on the clinical outcomes of robotic-assisted surgery across a mix of intracavity procedures, using evidence mapping to inform the decision makers on the best utilisation of robotic-assisted surgery. ELIGIBILITY CRITERIA We included systematic reviews with randomised controlled trials and non-randomised controlled trials describing any clinical outcomes. DATA SOURCES Ovid Medline, Embase and Cochrane Library from 2017 to 2023. DATA EXTRACTION AND SYNTHESIS We first presented the number of systematic reviews distributed in different specialties. We then mapped the body of evidence across selected procedures and synthesised major findings of clinical outcomes. We used a measurement tool to assess systematic reviews to evaluate the quality of systematic reviews. The overlap of primary studies was managed by the corrected covered area method. RESULTS Our search identified 165 systematic reviews published addressing clinical evidence of robotic-assisted surgery. We found that for all outcomes except operative time, the evidence was largely positive or neutral for robotic-assisted surgery versus both open and laparoscopic alternatives. Evidence was more positive versus open. The evidence for the operative time was mostly negative. We found that most systematic reviews were of low quality due to a failure to deal with the inherent bias in observational evidence. CONCLUSION Robotic surgery has a strong clinical effectiveness evidence base to support the expanded use of robotic-assisted surgery in six common intracavity procedures, which may provide an opportunity to increase the proportion of minimally invasive surgeries. Given the high incremental cost of robotic-assisted surgery and longer operative time, future economic studies are required to determine the optimal use of robotic-assisted surgery capacity.
Collapse
Affiliation(s)
- Tzu-Jung Lai
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK
| | - Campbell Roxburgh
- School of Cancer Sciences, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK
| | - Kathleen Anne Boyd
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK
| | - Janet Bouttell
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK
| |
Collapse
|
2
|
Sturgill D, How J, Blajda T, Davis Z, Ali M, O'Malley G, Patel NV, Khan MF, Goldstein I. Are the Clinical Outcomes and Cost-Effectiveness of Robot-Assisted Pedicle Screw Placement in Lumbar Fusion Surgery Superior to Computed Tomography Navigation and Freehand Fluoroscopy-Guided Techniques? A Systematic Review and Network Meta-Analysis. World Neurosurg 2024; 191:81-90. [PMID: 39127382 DOI: 10.1016/j.wneu.2024.08.018] [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: 04/15/2024] [Revised: 08/01/2024] [Accepted: 08/03/2024] [Indexed: 08/12/2024]
Abstract
OBJECTIVE Spinal fusion surgery is known to be an expensive intervention. Although innovative technologies in the field aim at improving operative efficiency and outcomes, total costs must be considered. The authors hope to elucidate any differences between robot-assisted (RA) and computed tomography navigation (CT-nav) or freehand fluoroscopy-guided (FFG) pedicle screw placement in relation to patient outcomes and cost-effectiveness in lumbar fusion surgery (LFS). METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the authors performed a systematic review to identify studies comparing clinical outcomes between CT-nav or RA versus FFG in LFS patients. All included studies utilized bilateral pedicle screws. Statistical analysis was performed using R. RESULTS Of the 1162 identified studies, 5 were included in the analysis. Direct evidence showed that RA decreased hospital length of stay when compared to FFG (mean difference [MD]: -2.67 days; 95% confidence interval [CI]: -4.25 to -1.08; P < 0.01). Indirect evidence showed that RA decreased operative time when compared to CT-nav (MD: -65.57 minutes; 95% CI: -127.7 to -3.44; P < 0.05). For estimated blood loss, direct evidence showed that RA was superior to FFG (MD: -120.62 mL; 95% CI: -206.39 to -34.86; P < 0.01). However, no significant difference was found between RA and CT-nav for estimated blood loss (MD: 14.88 mL; 95% CI: -105.54 to 135.3; P > 0.05). There were no other significant differences in Oswestry Disability Index, visual analog scale, or complication or reoperation rates between RA and FFG or CT-nav. CONCLUSIONS This study shows that RA pedicle screw placement in LFS provides similar patient outcomes to CT-nav and FFG. Robot-assisted operations were found to give rise to cost savings via decreased length of stay when compared to both CT-nav and FFG techniques. Cost-savings of $4086-$4865/patient and $7317-$9654/patient could be achieved when utilizing RA over CT-nav and FFG, respectively. However, extra upfront and maintenance costs may impact full adoption of RA in LFS.
Collapse
Affiliation(s)
- Drew Sturgill
- Department of Neurosurgery, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA.
| | - Justine How
- Department of Neurosurgery, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
| | - Timothy Blajda
- Department of Neurosurgery, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
| | - Zachary Davis
- Department of Neurosurgery, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
| | - Mir Ali
- Department of Neurosurgery, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
| | - Geoffrey O'Malley
- Department of Neurosurgery, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
| | - Nitesh V Patel
- Department of Neurosurgery, HMH-Jersey Shore University Medical Center, Neptune, New Jersey, USA
| | - Mohammed F Khan
- Department of Neurosurgery, Hackensack University Medical Center, Nutley, New Jersey, USA
| | - Ira Goldstein
- Department of Neurosurgery, Hackensack University Medical Center, Nutley, New Jersey, USA
| |
Collapse
|
3
|
Gill RK, Gupta A, Kaur P, Sidhu B, Saxena P, Saini NS, Gupta M. The Effect of Pneumoperitoneum on the Ankle-brachial Index of the Patients Undergoing Laparoscopic Cholecystectomy: An Observational Study. Int J Appl Basic Med Res 2024; 14:94-100. [PMID: 38912362 PMCID: PMC11189268 DOI: 10.4103/ijabmr.ijabmr_498_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/23/2024] [Accepted: 03/28/2024] [Indexed: 06/25/2024] Open
Abstract
Background Improvement in the perioperative care has led to increased use of minimally invasive surgeries. Multiple physiological changes during minimally invasive surgeries are attributed to the creation of pneumoperitoneum. Materials and Methods One hundred and nine patients who underwent laparoscopic cholecystectomy at a tertiary care hospital in north India meeting the inclusion and exclusion criteria were enrolled. Results Out of the total 109 patients, 13 were males and 96 females (M:F = 1:7.3), the mean basal metabolic rate was 28.95 kg/m2. The mean systolic and diastolic blood pressure of the upper limb were 134.33 + 17.545 and 80.69 + 11.59 respectively. The mean systolic and diastolic blood pressure in lower limb (LL) were 142.32 + 21.552 and 79.44 + 11.94, respectively. Significant rise in the SBP was noticed in LL at the time of creation of Pneumoperitoneum and after changing the position for surgery (P < 0.05). The diastolic pressure in the LL rises significantly in the LL after creation of pneumoperitoneum, at induction, after reverse Trendelenburg position and extubation (P < 0.05). The mean arterial pressure increased significantly in the LL after the creation of pneumoperitoneum and persisted till the extubation (P < 0.05). A significant rise of ankle-brachial index (ABI) was observed in the patients after the creation of pneumoperitoneum and it remained significant till 15 min into surgery (P < 0.05). There was no correlation of ABI with weight and age of the patients on Pearson correlation. Conclusion There is rise in ABI of the patients undergoing laparoscopic cholecystectomy at the time of creation of pneumoperitoneum, after Trendelenburg position and 15 min into surgery.
Collapse
Affiliation(s)
| | - Ashish Gupta
- Department of General Surgery, AIMS, Mohali, Punjab, India
| | - Prabhjot Kaur
- Department of General Surgery, AIMS, Mohali, Punjab, India
| | - Bharti Sidhu
- Department of Anesthesia, AIMS, Mohali, Punjab, India
| | - Puja Saxena
- Department of Anesthesia, AIMS, Mohali, Punjab, India
| | | | - Money Gupta
- Department of General Surgery, AIMS, Mohali, Punjab, India
| |
Collapse
|
4
|
Liu J, Wang Q. Impact of surgical site infection after open and laparoscopic surgery among paediatric appendicitis patients: A meta-analysis. Int Wound J 2024; 21:e14524. [PMID: 38084057 PMCID: PMC10961035 DOI: 10.1111/iwj.14524] [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] [Received: 11/02/2023] [Revised: 11/15/2023] [Accepted: 11/15/2023] [Indexed: 03/25/2024] Open
Abstract
Operative site wound infection is one of the most frequent infections in surgery. A variety of studies have shown that the results of laparoscopy might be superior to those of an open procedure. Nevertheless, there is still a lack of clarity as to whether there is a difference between open and laparoscopy with respect to the occurrence of wound infections in different paediatric operations. In this review, we looked at randomized, controlled studies that directly measured the rate of wound infection following an appendectomy with a laparoscope. We looked up four main databases for randomized, controlled studies that compare the treatment of paediatric appendicitis with laparoscopy. The surgeries included appendectomy. Through our search, we have determined 323 related papers and selected five qualified ones to be analysed according to the eligibility criteria. Five trials were also assessed for the quality of the documents. In the 5 trials, there were no statistically significant differences in the incidence of post-operative wound infection among the paediatric appendectomy and the open-access group (odds ratio [OR], 0.63; 95% confidence interval [CI], 0.34-1.15, p = 0.13). The four trials did not show any statistically significant difference in abdominal abscesses among the laparoscopic and open-access treatment groups (OR, 1.64; 95% CI, 0.90-3.01, p = 0.11). The four trials did not reveal any statistically significant difference in operating time (mean difference, -4.36; 95% CI, -17.31 to 8.59, p = 0.51). In light of these findings, the use of laparoscopy as compared with the open-approach approach in paediatric appendectomies is not associated with a reduction in the risk of wound infection.
Collapse
Affiliation(s)
- Jun Liu
- Maternal and Child Health Hospital of Hubei ProvinceTongji Medical College, Huazhong University of Science and Technology/SurgeryWuhanChina
| | - Qian Wang
- Maternal and Child Health Hospital of Hubei ProvinceTongji Medical College, Huazhong University of Science and Technology/SurgeryWuhanChina
| |
Collapse
|
5
|
Logan CD, Mahenthiran AK, Siddiqui MR, French DD, Hudnall MT, Patel HD, Murphy AB, Halpern JA, Bentrem DJ. Disparities in access to robotic technology and perioperative outcomes among patients treated with radical prostatectomy. J Surg Oncol 2023; 128:375-384. [PMID: 37036165 PMCID: PMC10330024 DOI: 10.1002/jso.27274] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 03/25/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Most radical prostatectomies are completed with robotic assistance. While studies have previously evaluated perioperative outcomes of robot-assisted radical prostatectomy (RARP), this study investigates disparities in access and clinical outcomes of RARP. STUDY DESIGN The National Cancer Database (NCDB) was used to identify patients who received radical prostatectomy for cancer between 2010 and 2017 with outcomes through 2018. RARP was compared to open radical prostatectomy (ORP). Odds of receiving RARP were evaluated while adjusting for covariates. Overall survival was evaluated using a propensity-score matched cohort. RESULTS Overall, 354 752 patients were included with 297 676 (83.9%) receiving RARP. Patients who were non-Hispanic Black (82.8%) or Hispanic (81.3%) had lower rates of RARP than non-Hispanic White (84.0%) or Asian patients (87.7%, p < 0.001). Medicaid or uninsured patients were less likely to receive RARP (75.5%) compared to patients with Medicare or private insurance (84.4%, p < 0.001). Medicaid or uninsured status was associated with decreased odds of RARP in adjusted multivariable analysis (OR 0.61, 95% CI 0.49-0.76). RARP was associated with decreased perioperative mortality and improved overall survival compared to ORP. CONCLUSION Patients who were underinsured were less likely to receive RARP. Improved access to RARP may lead to decreased disparities in perioperative outcomes for prostate cancer.
Collapse
Affiliation(s)
- Charles D. Logan
- Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
- Surgery Service, Jesse Brown VA Medical Center, Chicago, IL
| | - Ashorne K. Mahenthiran
- Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Mohammad R. Siddiqui
- Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Dustin D. French
- Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Matthew T. Hudnall
- Surgery Service, Jesse Brown VA Medical Center, Chicago, IL
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Hiten D. Patel
- Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Adam B. Murphy
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Joshua A. Halpern
- Surgery Service, Jesse Brown VA Medical Center, Chicago, IL
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - David J. Bentrem
- Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
- Surgery Service, Jesse Brown VA Medical Center, Chicago, IL
| |
Collapse
|
6
|
Ramaraju H, McAtee AM, Akman RE, Verga AS, Bocks ML, Hollister SJ. Sterilization effects on poly(glycerol dodecanedioate): A biodegradable shape memory elastomer for biomedical applications. J Biomed Mater Res B Appl Biomater 2023; 111:958-970. [PMID: 36479954 DOI: 10.1002/jbm.b.35205] [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: 01/26/2022] [Revised: 10/31/2022] [Accepted: 11/15/2022] [Indexed: 12/13/2022]
Abstract
Biodegradable shape memory polymers provide unique regenerative medicine approaches in minimally invasive surgeries. Once heated, thermally responsive shape memory polymer devices can be compressed, programmed to fit within a small profile, delivered in the cold programmed state, and expanded when heated to body temperature. We have previously developed a biodegradable shape memory elastomer (SME), poly(glycerol dodecanedioate) (PGD), with transition temperatures near 37°C exhibiting nonlinear elastic properties like numerous soft tissues. Using SMEs in the clinic requires disinfection and sterilization methods that conserve physiochemical, thermomechanical, and shape recovery properties. We evaluated disinfection protocols using 70% ethanol and UV254 nm for research applications and ethylene oxide (EtO) gas sterilization for clinical applications. Samples disinfected with ethanol for 0.5 and 1 min showed no changes in physiochemical material properties, but after 15 min showed slower recovery rates than controls (p < .05). EtO sterilization at 54.4°C decreased transition temperatures and shape recovery rate compared to EtO sterilization at 37.8°C (p < .01) and controls (p < .05). Aging samples for 9 months in a vacuum desiccator significantly reduced shape recovery, and the recovery rate in EtO sterilized samples compared to controls (p < .001). Cytotoxicity testing (ISO-10993.5C:2012) revealed media extractions from EtO sterilized samples, sterilized at 37.8°C, and high-density polyethylene negative control samples exhibit lower cytotoxicity (IC50) than Ethanol 1 min, UV 2 h, and EtO 54.4°C. Cell viability of NIH3T3 fibroblasts on sterilized surfaces was equivalent on EtO 37.7°C, EtO 54.4°C and Ethanol sterilized substrates. Finally, chromogenic bacterial endotoxin testing showed endotoxin levels were below the FDA prescribed levels for devices contacting blood and lymphatic tissues for ethanol 1 min, UV 120 min, EtO 37.7°C, EtO 54.4°C. These findings outline various disinfection and sterilization processes for research and pre-clinical application and provide a pathway for developing custom sterilization cycles for the translation of biomedical devices utilizing PGD shape memory polymers.
Collapse
Affiliation(s)
- Harsha Ramaraju
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Annabel M McAtee
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Ryan E Akman
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Adam S Verga
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Martin L Bocks
- UH Rainbow Babies & Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Scott J Hollister
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| |
Collapse
|
7
|
Diagnosing and Treating Infertility via Transvaginal Natural Orifice Transluminal Endoscopic Surgery versus Laparoendoscopic Single-Site Surgery: A Retrospective Study. J Clin Med 2023; 12:jcm12041576. [PMID: 36836109 PMCID: PMC9966021 DOI: 10.3390/jcm12041576] [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: 12/25/2022] [Revised: 02/03/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) in the treatment of female infertility. MATERIALS AND METHODS This study includes 174 female patients with a history of long-standing female infertility. We retrospectively reviewed 41 patients who underwent hysterolaparoscopy (HL) via transvaginal natural orifice transluminal endoscopic surgery (vNOTES) and 133 patients who underwent laparoendoscopic single-site surgery (LESS). Demographic data, operation records, and pregnancy outcomes were collected and analyzed. The deadline for postoperative follow-up was June 2022. All the included patients were followed up for at least 18 months after surgery. RESULTS Compared with the LESS group, the vNOTES group had a shorter postoperative bowel movement time and less pain at 4 and 12 h (p = 0.004 vs. 0.008); no differences were found in other perioperative indicators. The clinical pregnancy rates of the vNOTES and LESS groups were 87.80% and 74.43% (p = 0.073), respectively. CONCLUSIONS vNOTES represents a new, less invasive approach for infertility diagnosis and treatment that is particularly suitable for women who have special esthetic requirements. vNOTES is safe and practical and may be an ideal choice for scarless infertility surgery.
Collapse
|
8
|
Ramaraju H, Massarella D, Wong C, Verga AS, Kish EC, Bocks ML, Hollister SJ. Percutaneous delivery and degradation of a shape memory elastomer poly(glycerol dodecanedioate) in porcine pulmonary arteries. Biomaterials 2023; 293:121950. [PMID: 36580715 DOI: 10.1016/j.biomaterials.2022.121950] [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: 07/14/2022] [Revised: 11/23/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022]
Abstract
Shape memory biodegradable elastomers are an emergent class of biomaterials well-suited for percutaneous cardiovascular repair requiring nonlinear elastic materials with facile handling. We have previously developed a chemically crosslinked shape memory elastomer, poly (glycerol dodecanedioate) (PGD), exhibiting tunable transition temperatures around body temperature (34-38 °C), exhibiting nonlinear elastic properties approximating cardiac tissues, and favorable degradation rates in vitro. Degree of tissue coverage, degradation and consequent changes in polymer thermomechanical properties, and inflammatory response in preclinical animal models are unknown material attributes required for translating this material into cardiovascular devices. This study investigates changes in the polymer structure, tissue coverage, endothelialization, and inflammation of percutaneously implanted PGD patches (20 mm × 9 mm x 0.5 mm) into the branch pulmonary arteries of Yorkshire pigs for three months. After three months in vivo, 5/8 samples exhibited (100%) tissue coverage, 2/8 samples exhibited 85-95% tissue coverage, and 1/8 samples exhibited limited (<20%) tissue coverage with mild-moderate inflammation. PGD explants showed a (60-70%) volume loss and (25-30%) mass loss, and a reduction in polymer crosslinks. Lumenal and mural surfaces and the cross-section of the explant demonstrated evidence of degradation. This study validates PGD as an appropriate cardiovascular engineering material due to its propensity for rapid tissue coverage and uneventful inflammatory response in a preclinical animal model, establishing a precedent for consideration in cardiovascular repair applications.
Collapse
Affiliation(s)
- Harsha Ramaraju
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology Atlanta, GA 30312, USA.
| | - Danielle Massarella
- UH Rainbow Babies & Children's Hospital, Department of Pediatrics, Division of Pediatric, Cardiology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Courtney Wong
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology Atlanta, GA 30312, USA
| | - Adam S Verga
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology Atlanta, GA 30312, USA
| | - Emily C Kish
- UH Rainbow Babies & Children's Hospital, Department of Pediatrics, Division of Pediatric, Cardiology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Martin L Bocks
- UH Rainbow Babies & Children's Hospital, Department of Pediatrics, Division of Pediatric, Cardiology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Scott J Hollister
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology Atlanta, GA 30312, USA.
| |
Collapse
|
9
|
Gaete MI, Belmar F, Cortés M, Alseidi A, Asbun D, Durán V, Escalona G, Achurra P, Villagrán I, Crovari F, Pimentel F, Varas J. Remote and asynchronous training network: from a SAGES grant to an eight-country remote laparoscopic simulation training program. Surg Endosc 2023; 37:1458-1465. [PMID: 35764838 DOI: 10.1007/s00464-022-09386-5] [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: 03/21/2022] [Accepted: 06/06/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Limitations in surgical simulation training include lack of access to validated training programs with continuous year-round training and lack of experts' ongoing availability for feedback. A model of simulation training was developed to address these limitations. It incorporated basic and advanced laparoscopic skills curricula from a previously validated program and provided instruction through a digital platform. The platform allowed for remote and asynchronous feedback from a few trained instructors. The instructors were continuously available and provided personalized feedback using a variety of different media. We describe the upscaling of this model to teach trainees at fourteen centers in eight countries. METHODS Institutions with surgical programs lacking robust simulation curricula and needing instructors for ongoing education were identified. The simulation centers ("skills labs") at these sites were equipped with necessary simulation training hardware. A remote training-the-administrators (TTA) program was developed where personnel were trained in how to manage the skills lab, schedule trainees, set up training stations, and use the platform. A train-the-trainers (TTT) program was created to establish a network of trained instructors, who provided objective feedback through the platform remotely and asynchronously. RESULTS Between 2019 and 2022, seven institutions in Chile and one in each of the USA, Bolivia, Brazil, Ecuador, El Salvador, México, and Perú implemented a digital platform-based remote simulation curriculum. Most administrators were not physicians (19/33). Eight Instructors were trained with the TTT program and became active proctors. The platform has been used by 369 learners, of whom 57% were general surgeons and general surgery residents. A total of 6729 videos, 28,711 feedback inputs, and 233.7 and 510.2 training hours in the basic and advanced programs, respectively, were registered. CONCLUSION A remote and asynchronous method of giving instruction and feedback through a digital platform has been effectively employed in the creation of a robust network of continuous year-round simulation-based training in laparoscopy. Training centers were successfully run only with trained administrators to assist in logistics and setup, and no on-site instructors were necessary.
Collapse
Affiliation(s)
- María Inés Gaete
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, Zip Code: 8330024, Santiago, Chile
| | - Francisca Belmar
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, Zip Code: 8330024, Santiago, Chile
| | - Matías Cortés
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, Zip Code: 8330024, Santiago, Chile
| | - Adnan Alseidi
- Department of Surgery, University of California, San Francisco, USA
| | - Domenech Asbun
- Hepatobiliary & Pancreatic Surgery, Miami Cancer Institute, Miami, USA
| | - Valentina Durán
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, Zip Code: 8330024, Santiago, Chile
| | - Gabriel Escalona
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, Zip Code: 8330024, Santiago, Chile
| | - Pablo Achurra
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, Zip Code: 8330024, Santiago, Chile
| | - Ignacio Villagrán
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, Zip Code: 8330024, Santiago, Chile
| | - Fernando Crovari
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, Zip Code: 8330024, Santiago, Chile
| | - Fernando Pimentel
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, Zip Code: 8330024, Santiago, Chile
| | - Julián Varas
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, Zip Code: 8330024, Santiago, Chile.
| |
Collapse
|
10
|
Tillu N, Kulkarni J. Multi-quadrant Robotic-Assisted Surgery for Synchronous Tumours Involving the Genitourinary System - Our Experience. Indian J Surg Oncol 2022; 13:842-847. [PMID: 36687229 PMCID: PMC9845482 DOI: 10.1007/s13193-022-01584-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 07/07/2022] [Indexed: 02/07/2023] Open
Affiliation(s)
- Neeraja Tillu
- Asian Cancer Institute, 93, ACI Hospital, 95, August Kranti Rd, Kemps Corner, Cumballa Hill, Mumbai, Maharashtra 400036 India
| | - Jagdeesh Kulkarni
- Asian Cancer Institute, 93, ACI Hospital, 95, August Kranti Rd, Kemps Corner, Cumballa Hill, Mumbai, Maharashtra 400036 India
| |
Collapse
|
11
|
Kitaguchi D, Fujino T, Takeshita N, Hasegawa H, Mori K, Ito M. Limited generalizability of single deep neural network for surgical instrument segmentation in different surgical environments. Sci Rep 2022; 12:12575. [PMID: 35869249 PMCID: PMC9307578 DOI: 10.1038/s41598-022-16923-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 07/18/2022] [Indexed: 12/05/2022] Open
Abstract
Clarifying the generalizability of deep-learning-based surgical-instrument segmentation networks in diverse surgical environments is important in recognizing the challenges of overfitting in surgical-device development. This study comprehensively evaluated deep neural network generalizability for surgical instrument segmentation using 5238 images randomly extracted from 128 intraoperative videos. The video dataset contained 112 laparoscopic colorectal resection, 5 laparoscopic distal gastrectomy, 5 laparoscopic cholecystectomy, and 6 laparoscopic partial hepatectomy cases. Deep-learning-based surgical-instrument segmentation was performed for test sets with (1) the same conditions as the training set; (2) the same recognition target surgical instrument and surgery type but different laparoscopic recording systems; (3) the same laparoscopic recording system and surgery type but slightly different recognition target laparoscopic surgical forceps; (4) the same laparoscopic recording system and recognition target surgical instrument but different surgery types. The mean average precision and mean intersection over union for test sets 1, 2, 3, and 4 were 0.941 and 0.887, 0.866 and 0.671, 0.772 and 0.676, and 0.588 and 0.395, respectively. Therefore, the recognition accuracy decreased even under slightly different conditions. The results of this study reveal the limited generalizability of deep neural networks in the field of surgical artificial intelligence and caution against deep-learning-based biased datasets and models. Trial Registration Number: 2020-315, date of registration: October 5, 2020.
Collapse
|
12
|
Kitaguchi D, Lee Y, Hayashi K, Nakajima K, Kojima S, Hasegawa H, Takeshita N, Mori K, Ito M. Development and Validation of a Model for Laparoscopic Colorectal Surgical Instrument Recognition Using Convolutional Neural Network-Based Instance Segmentation and Videos of Laparoscopic Procedures. JAMA Netw Open 2022; 5:e2226265. [PMID: 35984660 PMCID: PMC9391983 DOI: 10.1001/jamanetworkopen.2022.26265] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IMPORTANCE Deep learning-based automatic surgical instrument recognition is an indispensable technology for surgical research and development. However, pixel-level recognition with high accuracy is required to make it suitable for surgical automation. OBJECTIVE To develop a deep learning model that can simultaneously recognize 8 types of surgical instruments frequently used in laparoscopic colorectal operations and evaluate its recognition performance. DESIGN, SETTING, AND PARTICIPANTS This quality improvement study was conducted at a single institution with a multi-institutional data set. Laparoscopic colorectal surgical videos recorded between April 1, 2009, and December 31, 2021, were included in the video data set. Deep learning-based instance segmentation, an image recognition approach that recognizes each object individually and pixel by pixel instead of roughly enclosing with a bounding box, was performed for 8 types of surgical instruments. MAIN OUTCOMES AND MEASURES Average precision, calculated from the area under the precision-recall curve, was used as an evaluation metric. The average precision represents the number of instances of true-positive, false-positive, and false-negative results, and the mean average precision value for 8 types of surgical instruments was calculated. Five-fold cross-validation was used as the validation method. The annotation data set was split into 5 segments, of which 4 were used for training and the remainder for validation. The data set was split at the per-case level instead of the per-frame level; thus, the images extracted from an intraoperative video in the training set never appeared in the validation set. Validation was performed for all 5 validation sets, and the average mean average precision was calculated. RESULTS In total, 337 laparoscopic colorectal surgical videos were used. Pixel-by-pixel annotation was manually performed for 81 760 labels on 38 628 static images, constituting the annotation data set. The mean average precisions of the instance segmentation for surgical instruments were 90.9% for 3 instruments, 90.3% for 4 instruments, 91.6% for 6 instruments, and 91.8% for 8 instruments. CONCLUSIONS AND RELEVANCE A deep learning-based instance segmentation model that simultaneously recognizes 8 types of surgical instruments with high accuracy was successfully developed. The accuracy was maintained even when the number of types of surgical instruments increased. This model can be applied to surgical innovations, such as intraoperative navigation and surgical automation.
Collapse
Affiliation(s)
- Daichi Kitaguchi
- Surgical Device Innovation Office, National Cancer Center Hospital East, Kashiwanoha, Kashiwa, Chiba, Japan
- Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwanoha, Kashiwa, Chiba, Japan
| | - Younae Lee
- Surgical Device Innovation Office, National Cancer Center Hospital East, Kashiwanoha, Kashiwa, Chiba, Japan
| | - Kazuyuki Hayashi
- Surgical Device Innovation Office, National Cancer Center Hospital East, Kashiwanoha, Kashiwa, Chiba, Japan
| | - Kei Nakajima
- Surgical Device Innovation Office, National Cancer Center Hospital East, Kashiwanoha, Kashiwa, Chiba, Japan
- Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwanoha, Kashiwa, Chiba, Japan
| | - Shigehiro Kojima
- Surgical Device Innovation Office, National Cancer Center Hospital East, Kashiwanoha, Kashiwa, Chiba, Japan
- Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwanoha, Kashiwa, Chiba, Japan
| | - Hiro Hasegawa
- Surgical Device Innovation Office, National Cancer Center Hospital East, Kashiwanoha, Kashiwa, Chiba, Japan
- Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwanoha, Kashiwa, Chiba, Japan
| | - Nobuyoshi Takeshita
- Surgical Device Innovation Office, National Cancer Center Hospital East, Kashiwanoha, Kashiwa, Chiba, Japan
- Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwanoha, Kashiwa, Chiba, Japan
| | - Kensaku Mori
- Graduate School of Informatics, Nagoya University, Nagoya, Aichi, Japan
| | - Masaaki Ito
- Surgical Device Innovation Office, National Cancer Center Hospital East, Kashiwanoha, Kashiwa, Chiba, Japan
- Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwanoha, Kashiwa, Chiba, Japan
| |
Collapse
|
13
|
Scar-Free Laparoscopy in BRCA-Mutated Women. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58070943. [PMID: 35888662 PMCID: PMC9316165 DOI: 10.3390/medicina58070943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: BRCA 1 and 2 mutations have a cumulative risk of developing ovarian cancer at 70 years of 41% and 15%, respectively, while a cumulative risk of breast cancer by 80 years of age was 72% for BRCA1 mutation carriers and 69% for BRCA2 mutation carriers. The NCCN recommends risk-reducing salpingo-oophorectomy (RRSO), typically between 35 and 40 years, and upon completion of childbearing in BRCA1 mutation, while it is reasonable to delay RRSO for management of ovarian cancer risk until age 40–45 years in patients with BRCA2. In recent years there have been two main lines of evolution in laparoscopy. The former concerning the development of a single-site laparoscopic and the latter concerning the miniaturisation of laparoscopic instruments (mini/micro-laparoscopy). Materials and Methods: In this case report, we show our experience in prophylactic adnexectomy, on a mutated-BRCA patient, using the MiniLap® percutaneous surgical system. Results: This type of technique is safe and effective and does not require a particular learning curve compared to single-port laparoscopy. Conclusions: The considerable aesthetic advantage of the scars, we believe, albeit to a lesser extent, is useful to find in these patients burdened by an important stress load.
Collapse
|
14
|
Pirie K, Traer E, Finniss D, Myles PS, Riedel B. Current approaches to acute postoperative pain management after major abdominal surgery: a narrative review and future directions. Br J Anaesth 2022; 129:378-393. [PMID: 35803751 DOI: 10.1016/j.bja.2022.05.029] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/27/2022] [Accepted: 05/28/2022] [Indexed: 11/02/2022] Open
Abstract
Poorly controlled postoperative pain is associated with increased morbidity, negatively affects quality of life and functional recovery, and is a risk factor for persistent pain and longer-term opioid use. Up to 10% of opioid-naïve patients have persistent opioid use after many types of surgeries. Opioid-related side-effects and the opioid abuse epidemic emphasise the need for alternative, opioid-minimising, multimodal analgesic strategies, including neuraxial (epidural/intrathecal) techniques, truncal nerve blocks, and lidocaine infusions. The preference for minimally invasive surgical techniques has changed anaesthetic and analgesic requirements in abdominal surgery compared with open laparotomy, leading to a decline in popularity of epidural anaesthesia and an increasing interest in intrathecal morphine and truncal nerve blocks. Limited research exists on patient quality of recovery using specific analgesic techniques after intra-abdominal surgery. Poorly controlled postoperative pain after major abdominal surgery should be a research priority as it affects patient-centred short-term and long-term outcomes (including quality of life scores, return to function measurements, disability-free survival) and has broad community health and economic implications.
Collapse
Affiliation(s)
- Katrina Pirie
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital, Melbourne, Victoria, Australia; Central Clinical School, Monash University, Melbourne, Victoria, Australia.
| | - Emily Traer
- Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia; Department of Critical Care, University of Melbourne, Melbourne, Australia
| | - Damien Finniss
- Department of Anaesthesia & Pain Management, Royal North Shore Hospital, Sydney, Australia
| | - Paul S Myles
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital, Melbourne, Victoria, Australia; Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Bernhard Riedel
- Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia; Department of Critical Care, University of Melbourne, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| |
Collapse
|
15
|
Hardon SF, Rahimi AM, Postema RR, Willuth E, Mintz Y, Arezzo A, Dankelman J, Nickel F, Horeman T. Safe implementation of hand held steerable laparoscopic instruments: a survey among EAES surgeons. Updates Surg 2022; 74:1749-1754. [PMID: 35416585 PMCID: PMC9481478 DOI: 10.1007/s13304-022-01258-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/14/2022] [Indexed: 10/25/2022]
Abstract
The complexity of handheld steerable laparoscopic instruments (SLI) may impair the learning curve compared to conventional instruments when first utilized. This study aimed to provide the current state of interest in the use of SLI, the current use of these in daily practice and the type of training which is conducted before using SLI in the operating room (OR) on real patients. An online survey was distributed by European Association of Endoscopic Surgery (EAES) Executive Office to all active members, between January 4th and February 3rd, 2020. The survey consisted of 14 questions regarding the usage and training of steerable laparoscopic instruments. A total of 83 members responded, coming from 33 different countries. Twenty three percent of the respondents using SLI, were using the instruments routinely and of these 21% had not received any formal training in advance of using the instruments in real patients. Of all responding EAES members, 41% considered the instruments to potentially compromise patient safety due to their complexity, learning curve and the inexperience of the surgeons. The respondents reported the three most important aspects of a possible steerable laparoscopic instruments training curriculum to be: hands-on training, safe tissue handling and suturing practice. Finally, a major part of the respondents consider force/pressure feedback data to be of significant importance for implementation of training and assessment of safe laparoscopic and robotic surgery. Training and assessment of skills regarding safe implementation of steerable laparoscopic instruments is lacking. The respondents stressed the need for specific hands-on training during which feedback and assessment of skills should be guaranteed before operating on real patients.
Collapse
Affiliation(s)
- S F Hardon
- Department of Surgery, Amsterdam UMC-VU University Medical Center, Room ZH 7F005, De Boelelaan 1117, 1081HV, Amsterdam, The Netherlands. .,Department of BioMechanical Engineering, Delft University of Technology, Delft, The Netherlands.
| | - A M Rahimi
- Department of Surgery, Amsterdam UMC-VU University Medical Center, Room ZH 7F005, De Boelelaan 1117, 1081HV, Amsterdam, The Netherlands
| | - R R Postema
- Department of Surgery, Amsterdam UMC-VU University Medical Center, Room ZH 7F005, De Boelelaan 1117, 1081HV, Amsterdam, The Netherlands.,Department of BioMechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - E Willuth
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Y Mintz
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,Technology Committee, European Association of Endoscopic Surgery (EAES), Veldhoven, The Netherlands
| | - A Arezzo
- Department of Surgical Sciences, Università degli Studi di Torino, Turin, Italy.,Technology Committee, European Association of Endoscopic Surgery (EAES), Veldhoven, The Netherlands
| | - J Dankelman
- Department of BioMechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - F Nickel
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany.,Technology Committee, European Association of Endoscopic Surgery (EAES), Veldhoven, The Netherlands
| | - T Horeman
- Department of BioMechanical Engineering, Delft University of Technology, Delft, The Netherlands.,Technology Committee, European Association of Endoscopic Surgery (EAES), Veldhoven, The Netherlands
| | | |
Collapse
|
16
|
Arroyo Tristán A. Splitting the imaging system from the laparoendoscopic single site surgery device in endoscopic uniportal surgery: ZEUS project. Cir Esp 2022; 100:161-170. [PMID: 35219645 DOI: 10.1016/j.cireng.2022.02.001] [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] [Received: 06/08/2021] [Accepted: 07/10/2021] [Indexed: 06/14/2023]
Abstract
The use of a rigid tube endoscope (RTE) through a laparoendoscopic single site surgery device for intracavitary visualization during endoscopic uniportal surgery (EUS) is directly related to the fulcrum effect and physical competition (externally between surgeons and on instrumentation through the single port). These facts may have precluded a wider spread of EUS. In an attempt to separate the imaging system from the laparoendoscopic single site surgery device, a tiered project (3 models) that can help overcome these drawbacks is detailed. ZEUS1, a new non-RTE imaging system device for EUS was successfully tested in EUS surgery in a pig model. Still under investigation, ZEUS2 becomes a wired structure that serves as the basis for an endoscopic microcamera with intracavitary pan-tilt-zoom functions. ZEUS3 uses the inner ring of the surgical wound protector as a microchamber crown. Further studies are needed to materialize the ZEUS2 and ZEUS3 models and confirm their efficacy and safety.
Collapse
Affiliation(s)
- Andrés Arroyo Tristán
- Servicio de Cirugía de Tórax, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
| |
Collapse
|
17
|
Wijsman PJM, Molenaar L, Voskens FJ, van’t Hullenaar CDP, Broeders IAMJ. Image-based laparoscopic camera steering versus conventional steering: a comparison study. J Robot Surg 2022; 16:1157-1163. [DOI: 10.1007/s11701-021-01342-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/21/2021] [Indexed: 01/30/2023]
|
18
|
Romero-Velez G, Rodriguez-Quintero JH, Moran-Atkin E, Lima DL, Malcher F, Camacho DR. Exploring the Challenges for International Medical Graduates Pursuing Minimally Invasive Surgery Training in the United States and Canada: A Cross-Sectional Analysis. JSLS 2022; 26:JSLS.2021.00084. [PMID: 35444402 PMCID: PMC8993460 DOI: 10.4293/jsls.2021.00084] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: International Medical Graduates (IMGs) are an important component of the US healthcare workforce. Prior studies have investigated bias against IMGs during the general surgery residency application in the United States. Minimally invasive surgery (MIS) is a growing field; The MIS fellowship match was established in 2004 and is a competitive process with a match rate of 47%. Opportunities for applicants who are non-US citizens are limited by a series of factors that are not related to their professional qualifications. Objectives: The aim of the study was to explore the challenges faced by IMG in the MIS fellowship match. Methods: This is a cross-sectional study analyzing the minimally invasive surgery application requirements of all the programs listed in the Fellowship Council. Individual program requirements were collected into a database and a descriptive analysis was performed comparing programs who accept IMGs versus those that do not. Further statistical analysis was performed to explore those differences and associated factors. Results: There were 148 MIS fellowship programs and 187 positions offered during the 2021 match year in the US. Ninety-seven programs (65.5%) were found to accept graduates of foreign medical schools if they were US-citizens, whereas only 49 programs (33.1%) were found to accept IMG and sponsor a visa for their training. University affiliated programs (88.9% vs 75.0%, p = 0.04), programs with a general surgery residency (94.4% vs 75.0%, p = 0.003), and older programs (63.0% vs 45.5%, p = 0.04) were more likely to accept IMGs requiring visa sponsorship. Conclusions: There is a significant bias against IMGs in the MIS fellowship match, with a reduced number of positions available based on factors not related to their professional performance or qualifications. Well established programs, university, and residency affiliated programs are more likely to consider these physicians for training.
Collapse
Affiliation(s)
| | | | | | - Diego L Lima
- Department of Surgery, Montefiore Medical Center, Bronx, NY
| | - Flavio Malcher
- Center for Abdominal Core Health. Division of General Surgery, NYU Langone Health, New York, NY
| | | |
Collapse
|
19
|
Rivkin B, Becker C, Singh B, Aziz A, Akbar F, Egunov A, Karnaushenko DD, Naumann R, Schäfer R, Medina-Sánchez M, Karnaushenko D, Schmidt OG. Electronically integrated microcatheters based on self-assembling polymer films. SCIENCE ADVANCES 2021; 7:eabl5408. [PMID: 34919439 PMCID: PMC8682992 DOI: 10.1126/sciadv.abl5408] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 11/02/2021] [Indexed: 05/22/2023]
Abstract
Existing electronically integrated catheters rely on the manual assembly of separate components to integrate sensing and actuation capabilities. This strongly impedes their miniaturization and further integration. Here, we report an electronically integrated self-assembled microcatheter. Electronic components for sensing and actuation are embedded into the catheter wall through the self-assembly of photolithographically processed polymer thin films. With a diameter of only about 0.1 mm, the catheter integrates actuated digits for manipulation and a magnetic sensor for navigation and is capable of targeted delivery of liquids. Fundamental functionalities are demonstrated and evaluated with artificial model environments and ex vivo tissue. Using the integrated magnetic sensor, we develop a strategy for the magnetic tracking of medical tools that facilitates basic navigation with a high resolution below 0.1 mm. These highly flexible and microsized integrated catheters might expand the boundary of minimally invasive surgery and lead to new biomedical applications.
Collapse
Affiliation(s)
- Boris Rivkin
- Institute for Integrative Nanosciences, Institute for Solid State and Materials Research Dresden (Leibniz IFW Dresden), 01069 Dresden, Germany
| | - Christian Becker
- Institute for Integrative Nanosciences, Institute for Solid State and Materials Research Dresden (Leibniz IFW Dresden), 01069 Dresden, Germany
| | - Balram Singh
- Institute for Integrative Nanosciences, Institute for Solid State and Materials Research Dresden (Leibniz IFW Dresden), 01069 Dresden, Germany
| | - Azaam Aziz
- Institute for Integrative Nanosciences, Institute for Solid State and Materials Research Dresden (Leibniz IFW Dresden), 01069 Dresden, Germany
| | - Farzin Akbar
- Institute for Integrative Nanosciences, Institute for Solid State and Materials Research Dresden (Leibniz IFW Dresden), 01069 Dresden, Germany
| | - Aleksandr Egunov
- Institute for Integrative Nanosciences, Institute for Solid State and Materials Research Dresden (Leibniz IFW Dresden), 01069 Dresden, Germany
| | - Dmitriy D. Karnaushenko
- Institute for Integrative Nanosciences, Institute for Solid State and Materials Research Dresden (Leibniz IFW Dresden), 01069 Dresden, Germany
| | - Ronald Naumann
- Max Planck Institute of Molecular Cell Biology and Genetics, Transgenic Core Facility, Pfotenhauerstrasse 108, 01307 Dresden, Germany
| | - Rudolf Schäfer
- Institute for Metallic Materials, Institute for Solid State and Materials Research Dresden (Leibniz IFW Dresden), 01069 Dresden, Germany
| | - Mariana Medina-Sánchez
- Institute for Integrative Nanosciences, Institute for Solid State and Materials Research Dresden (Leibniz IFW Dresden), 01069 Dresden, Germany
- Corresponding author. (M.M.-S.); (D.K.); (O.G.S.)
| | - Daniil Karnaushenko
- Institute for Integrative Nanosciences, Institute for Solid State and Materials Research Dresden (Leibniz IFW Dresden), 01069 Dresden, Germany
- Corresponding author. (M.M.-S.); (D.K.); (O.G.S.)
| | - Oliver G. Schmidt
- Institute for Integrative Nanosciences, Institute for Solid State and Materials Research Dresden (Leibniz IFW Dresden), 01069 Dresden, Germany
- Material Systems for Nanoelectronics, Chemnitz University of Technology, 09107 Chemnitz, Germany
- Research Center for Materials, Architectures and Integration of Nanomembranes (MAIN), Rosenbergstraße 6, TU Chemnitz, 09126 Chemnitz, Germany
- Nanophysics, Faculty of Physics, TU Dresden, 01062 Dresden, Germany
- Corresponding author. (M.M.-S.); (D.K.); (O.G.S.)
| |
Collapse
|
20
|
Preclinical evaluation of the new EDGE SP 1000 single-port robotic surgical system in gynecology minimal access surgery. Surg Endosc 2021; 36:4780-4785. [PMID: 34697678 DOI: 10.1007/s00464-021-08819-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 10/17/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The aim of this study is to evaluate the feasibility and safety of a new single-port robotic surgical system for gynecological surgery in the porcine model. MATERIALS AND METHODS Six female Tibetan miniature pigs underwent robot-assisted single-port laparoscopic total hysterectomy with the newly developed single-port EDGE SP1000 platform. Estimated blood loss (EBL), docking time, operative time, and intraoperative and postoperative complications were recorded. Postoperative pain was assessed by VAS (visual analog scale) score at 6 h, 12 h, 24 h, and 48 h. Then the experimental animals were observed for one week after surgery to assess their mental status, incisional infections and finally euthanized for necropsy to assess the recovery of the vaginal stump. RESULTS Six hysterectomies of pigs were successfully completed. There were no significant intraoperative complications in the six surgeries. The average total operation time was 113.33 min (95-143 min), and the average docking time was 5.5 min (4-7 min). The average EBL was 10 ml (5 ~ 20 ml). The mean VAS scores at 6, 12, 24, and 48 h postoperatively were 6.3, 5.7, 5, 3, respectively. At 7 days postoperatively, no significant incisional infections or other complications were observed. Post-euthanasia examination of the pelvis showed no significant abnormalities in the vaginal stump. CONCLUSION This preclinical study of a new single-port surgical system for gynecologic procedures demonstrated the safety and feasibility of the EDGE SP1000 system in porcine models. Further studies are required to assess its clinical utility in the future.
Collapse
|
21
|
Kashif K, Ben-David K. Commentary on: Image-Guided Surgical Simulation in Minimally Invasive Liver Procedures: Development of a Liver Tumor Porcine Model Using a Multimodality Imaging Assessment by Vázquez et al. J Laparoendosc Adv Surg Tech A 2021; 31:1104-1105. [PMID: 34491847 DOI: 10.1089/lap.2021.29039.kbd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kareem Kashif
- Mount Sinai Medical Center, Comprehensive Cancer Center, Miami Beach, Florida, USA
| | - Kfir Ben-David
- Mount Sinai Medical Center, Comprehensive Cancer Center, Miami Beach, Florida, USA
| |
Collapse
|
22
|
Arroyo Tristán A. Splitting the imaging system from the laparoendoscopic single site surgery device in endoscopic uniportal surgery: ZEUS project. Cir Esp 2021; 100:S0009-739X(21)00246-3. [PMID: 34493374 DOI: 10.1016/j.ciresp.2021.07.005] [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: 06/08/2021] [Revised: 06/30/2021] [Accepted: 07/10/2021] [Indexed: 11/29/2022]
Abstract
The use of a rigid tube endoscope (RTE) through a laparoendoscopic single site surgery device for intracavitary visualization during endoscopic uniportal surgery (EUS) is directly related to the fulcrum effect and physical competition (externally between surgeons and on instrumentation through the single port). These facts may have precluded a wider spread of EUS. In an attempt to separate the imaging system from the laparoendoscopic single site surgery device, a tiered project (3 models) that can help overcome these drawbacks is detailed. ZEUS1, a new non-RTE imaging system device for EUS was successfully tested in EUS surgery in a pig model. Still under investigation, ZEUS2 becomes a wired structure that serves as the basis for an endoscopic microcamera with intracavitary pan-tilt-zoom functions. ZEUS3 uses the inner ring of the surgical wound protector as a microchamber crown. Further studies are needed to materialize the ZEUS2 and ZEUS3 models and confirm their efficacy and safety.
Collapse
Affiliation(s)
- Andrés Arroyo Tristán
- Servicio de Cirugía de Tórax, Hospital Universitario Virgen de la Arrixaca, Murcia, España.
| |
Collapse
|
23
|
Intraoperative and postoperative complications of gynecological laparoscopic interventions: incidence and risk factors. Arch Gynecol Obstet 2021; 304:1259-1269. [PMID: 34417837 PMCID: PMC8490211 DOI: 10.1007/s00404-021-06192-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 08/14/2021] [Indexed: 11/17/2022]
Abstract
Purpose The aims of this study were to determine the incidence of intraoperative and postoperative complications of laparoscopic gynecological interventions and to identify risk factors for such complications. Methods All patients who underwent laparoscopic interventions from September 2013 to September 2017 at the Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital were identified retrospectively using a prospectively compiled clinical database. Binary logistic regression analysis was used to identify independent risk factors for intra- and postoperative complications. Results Data from 3351 patients were included in the final analysis. Overall, 188 (5.6%) intraoperative and 219 (6.5%) postoperative complications were detected. On multivariate analysis, age [odds ratio (OR), 1.03; 95% confidence interval (CI) 1.01–1.04], surgery duration (OR, 1.02; 95% CI 1.02–1.03), carbon dioxide use (OR, 0.99; 95% CI 0.99–1.00), and surgical indication (all p ≤ 0.01) were independent risk factors for intraoperative and duration of surgery (OR, 1.01; 95% CI 1.01–1.02; p ≤ 0.01), carbon dioxide use (OR, 0.99; 95% CI 0.99–1.00; p ≤ 0.01), hemoglobin drop (OR, 1.41; 95% CI 1.21–1.65; p ≤ 0.01), and ASA status (p = 0.04) for postoperative complications. Conclusion In this large retrospective analysis with a generally low incidence of complications (5.6% intraoperative and 6.5% postoperative complications), a representative risk collective was identified: Patients aged > 38 years, surgery duration > 99 min, benign or malignant adnex findings were at higher risk for intraoperative and patients with surgery duration > 94 min, hemoglobin drop > 2 g/dl and ASA status III at higher risk for postoperative complications.
Collapse
|
24
|
Alganabi M, Biouss G, Pierro A. Surgical site infection after open and laparoscopic surgery in children: a systematic review and meta-analysis. Pediatr Surg Int 2021; 37:973-981. [PMID: 33934183 DOI: 10.1007/s00383-021-04911-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 12/29/2022]
Abstract
Surgical site infections (SSIs) are the most common healthcare-associated infections in patients undergoing surgery. Various randomised control trials (RCTs) indicate that laparoscopic procedures can be associated with better outcomes compared to open procedures. However, how open versus laparoscopic approaches compare across various paediatric procedures with respect to SSI rate remains poorly defined. In this review, we examined RCTs that directly compare SSI rates after open versus laparoscopic operations for appendicitis, gastro-esophageal reflux, inguinal hernia, and pyloric stenosis. MEDLINE, Embase, and Web of Science were searched for RCTs comparing four types of open versus laparoscopic operations in children. The operations included appendectomy, fundoplication for gastro-esophageal reflux, inguinal hernia repair, or pyloromyotomy. 364 records were identified and screened, 54 full-text articles were assessed for eligibility, and 17 RCTs were included in the analysis. SSI rate was the primary outcome. Operative time and length of stay (LOS) were the secondary outcomes. A meta-analysis was conducted using RevMan 5.4 software. Laparoscopic appendectomy had a lower SSI rate than open appendectomy (odds ratio of 2.22 [1.19, 4.15] p = 0.01). Laparoscopic fundoplication for gastro-esophageal reflux, inguinal hernia repair, or pyloromyotomy for pyloric stenosis were not associated with lower SSI rate compared to open surgery. Operative time was shorter in open fundoplication (- 71.22 min [- 89.79, - 52.65] p < 0.00001) than laparoscopic fundoplication. There was no significant difference in operative time of any of the other procedures. There was no significant difference in LOS between open and laparoscopic procedures for all types of operations analysed. Based on the findings of this review, it is recommended to utilise the laparoscopic approach over the open approach to reduce SSI risk in paediatric appendectomy.
Collapse
Affiliation(s)
- Mashriq Alganabi
- Division of General and Thoracic Surgery, Translational Medicine Program, University of Toronto, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - George Biouss
- Division of General and Thoracic Surgery, Translational Medicine Program, University of Toronto, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Agostino Pierro
- Division of General and Thoracic Surgery, Translational Medicine Program, University of Toronto, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
| |
Collapse
|
25
|
Perioperative Outcomes of Robotic Pancreaticoduodenectomy: a Propensity-Matched Analysis to Open and Laparoscopic Pancreaticoduodenectomy. J Gastrointest Surg 2021; 25:1795-1804. [PMID: 33201457 DOI: 10.1007/s11605-020-04869-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/06/2020] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Robotic pancreaticoduodenectomy is slowly gaining acceptance within pancreatic surgery. Advantages have been demonstrated for robotic surgery in other fields, but robust data for pancreaticoduodenectomy is limited. The aim of this study was to compare the short-term outcomes of robotic pancreaticoduodenectomy (RPD) to open pancreaticoduodenectomy (OPD) and laparoscopic pancreaticoduodenectomy (LPD). METHODS Patients who underwent a pancreaticoduodenectomy between January 2011 and July 2019 at the Johns Hopkins Hospital were included in this retrospective propensity-matched analysis. The RPD cohort was matched to patients who underwent OPD in a 1:2 fashion and LPD in a 1:1 fashion. Short-term outcomes were analyzed for all three cohorts. RESULTS In total, 1644 patients were included, of which 96 (5.8%) underwent RPD, 131 (8.0%) LPD, and 1417 (86.2%) OPD. RPD was associated with a decreased incidence of delayed gastric emptying (9.4%) compared to OPD (23.5%; P = 0.006). The median estimated blood loss was significantly less in the RPD cohort (RPD vs OPD, 150 vs 487 mL; P < 0.001, RPD vs LPD, 125 vs 300 mL; P < 0.001). Compared to OPD, the robotic approach was associated with a shorter median length of stay (median 8 vs 9 days; P = 0.014) and a decrease in wound complications (4.2% vs 16.7%; P = 0.002). The incidence of other postoperative complications was comparable between RPD and OPD, and RPD and LPD. CONCLUSION In the hands of experienced surgeons, RPD may have a modest yet statistically significant reduction in estimated blood loss, postoperative length of stay, wound complications, and delayed gastric emptying comparing to OPD in similar patients.
Collapse
|
26
|
Khachfe HH, Salhab HA, Fares MY, Chahrour MA, Jamali FR. Landscape of interventional clinical trials involving gastrectomy for gastric cancer. Ecancermedicalscience 2021; 15:1218. [PMID: 34158822 PMCID: PMC8183643 DOI: 10.3332/ecancer.2021.1218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Indexed: 01/14/2023] Open
Abstract
Background Gastric cancer (GC) is the third most common cause of malignancy associated mortality globally. The cornerstone of curative treatment involves surgical gastrectomy. In this study, we explore clinical trials involving gastrectomy for GC, highlighting inadequacies and underlining promising surgical interventions and strategies. Materials and methods On 1 May 2020, ClinicalTrials.gov was explored for interventional trials related to gastrectomy for GC, without adding limitations for location or date. All data pertaining to the trials were collected. Characteristics such as phase, duration, enrolment size, location, treatment allocation, masking and primary endpoint were analysed. Results One hundred thirty-eight clinical trials met the search criteria. Clinical trials were performed in only 14 countries; most of them occurring in China. Most trials (33%) were still in the recruiting phase. On average, the length of trials was 3.9 years. Most trials had parallel assignment, were randomised and masked. The primary endpoint which was mostly commonly studied was overall survival (33%). The most common intervention studied is laparoscopic gastrectomy in 43 (31%) trials. Conclusions Our study exposed a small number of trials, publication rate, absence of geographic variety in clinical trials involving gastrectomy for GC. Adequate management of trial design can help decrease duration and increase validity of results. More trials comparing different surgical techniques are needed to update the surgical practice of gastrectomy for GC.
Collapse
Affiliation(s)
- Hussein H Khachfe
- Faculty of Medicine, American University of Beirut Medical Center, Beirut 00000, Lebanon.,Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15260, USA.,Division of GI Surgical Oncology, UPMC Pancreatic Cancer Center, University of Pittsburgh Medical Center, UPMC Cancer Pavilion, Pittsburgh, PA 15260, USA
| | - Hamza A Salhab
- Faculty of Medicine, American University of Beirut Medical Center, Beirut 00000, Lebanon.,Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut 00000, Lebanon
| | - Mohamad Y Fares
- Faculty of Medicine, American University of Beirut Medical Center, Beirut 00000, Lebanon.,Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut 00000, Lebanon
| | - Mohamad A Chahrour
- Faculty of Medicine, American University of Beirut Medical Center, Beirut 00000, Lebanon
| | - Faek R Jamali
- Division of General Surgery, Department of Surgery, Sheikh Shakhbout Medical City, Abu Dhabi 11001, UAE
| |
Collapse
|
27
|
Hue JJ, Bingmer K, Zhao H, Ammori JB, Wilhelm SM, Towe CW, Rothermel LD. Reassessing the impact of tumor size on operative approach in adrenocortical carcinoma. J Surg Oncol 2021; 123:1238-1245. [PMID: 33577722 DOI: 10.1002/jso.26418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Adrenocortical carcinoma (ACC) is often a contraindication to minimally invasive adrenalectomy (MIA). We used an administrative data set to analyze postoperative outcomes. We hypothesized that small tumors would have better short- and long-term outcomes, independent of the operative approach. METHODS The National Cancer Database (2010-2016) identified patients with ACC who underwent adrenalectomy. Tumors were grouped: <5 cm (n = 125), 5-10 cm (n = 431), and >10 cm (n = 443). The primary and secondary outcomes were margin positivity and overall survival, respectively. RESULTS Nine hundred and ninety-nine patients were analyzed: 37% MIA and 63% open adrenalectomy (OA). As the size increased, the rate of attempted MIA decreased. Larger tumors were associated with conversion to open. Although tumors with local invasion and those which required conversion to open were associated with an increased likelihood of a positive margin, tumor size was not. Although "complete" MIA (vs. OA) and tumor size were not associated with differences in survival, conversion (HR = 1.83, p = .02), positive margins (HR = 1.54, p = .01), and local invasion (HR = 1.84, p < .001) were associated with poor survival. CONCLUSION Positive margins are associated with poor survival in ACC. Tumors ≥ 5 cm were associated with an increased conversion rate and subsequent increase in margin positivity. MIA may be considered for select patients with small tumors but adequate oncologic resection is critical.
Collapse
Affiliation(s)
- Jonathan J Hue
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Katherine Bingmer
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Heming Zhao
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - John B Ammori
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Scott M Wilhelm
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Christopher W Towe
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Luke D Rothermel
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| |
Collapse
|
28
|
Damiescu R, Banerjee M, Lee DYW, Paul NW, Efferth T. Health(care) in the Crisis: Reflections in Science and Society on Opioid Addiction. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:E341. [PMID: 33466370 PMCID: PMC7795923 DOI: 10.3390/ijerph18010341] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/28/2020] [Accepted: 12/30/2020] [Indexed: 12/21/2022]
Abstract
Opioid abuse and misuse have led to an epidemic which is currently spreading worldwide. Since the number of opioid overdoses is still increasing, it is becoming obvious that current rather unsystematic approaches to tackle this health problem are not effective. This review suggests that fighting the opioid epidemic requires a structured public health approach. Therefore, it is important to consider not only scientific and biomedical perspectives, but societal implications and the lived experience of groups at risk as well. Hence, this review evaluates the risk factors associated with opioid overdoses and investigates the rates of chronic opioid misuse, particularly in the context of chronic pain as well as post-surgery treatments, as the entrance of opioids in people's lives. Linking pharmaceutical biology to narrative analysis is essential to understand the modulations of the usual themes of addiction and abuse present in the opioid crisis. This paper shows that patient narratives can be an important resource in understanding the complexity of opioid abuse and addiction. In particular, the relationship between chronic pain and social inequality must be considered. The main goal of this review is to demonstrate how a deeper transdisciplinary-enriched understanding can lead to more precise strategies of prevention or treatment of opioid abuse.
Collapse
Affiliation(s)
- Roxana Damiescu
- Department of Pharmaceutical Biology, Institute of Pharmaceutical and Biomedical Sciences, Johannes Gutenberg University, 55128 Mainz, Germany;
| | - Mita Banerjee
- Department of English and Linguistics, Obama Institute for Transnational American Studies, Johannes Gutenberg University, 55128 Mainz, Germany;
| | - David Y. W. Lee
- McLean Hospital, Harvard Medical School, Boston, MA 02478, USA;
| | - Norbert W. Paul
- Institute for History, Philosophy and Ethics of Medicine, Johannes Gutenberg University Medical Center, 55128 Mainz, Germany;
| | - Thomas Efferth
- Department of Pharmaceutical Biology, Institute of Pharmaceutical and Biomedical Sciences, Johannes Gutenberg University, 55128 Mainz, Germany;
| |
Collapse
|
29
|
Roß T, Reinke A, Full PM, Wagner M, Kenngott H, Apitz M, Hempe H, Mindroc-Filimon D, Scholz P, Tran TN, Bruno P, Arbeláez P, Bian GB, Bodenstedt S, Bolmgren JL, Bravo-Sánchez L, Chen HB, González C, Guo D, Halvorsen P, Heng PA, Hosgor E, Hou ZG, Isensee F, Jha D, Jiang T, Jin Y, Kirtac K, Kletz S, Leger S, Li Z, Maier-Hein KH, Ni ZL, Riegler MA, Schoeffmann K, Shi R, Speidel S, Stenzel M, Twick I, Wang G, Wang J, Wang L, Wang L, Zhang Y, Zhou YJ, Zhu L, Wiesenfarth M, Kopp-Schneider A, Müller-Stich BP, Maier-Hein L. Comparative validation of multi-instance instrument segmentation in endoscopy: Results of the ROBUST-MIS 2019 challenge. Med Image Anal 2020; 70:101920. [PMID: 33676097 DOI: 10.1016/j.media.2020.101920] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/22/2020] [Accepted: 11/24/2020] [Indexed: 12/27/2022]
Abstract
Intraoperative tracking of laparoscopic instruments is often a prerequisite for computer and robotic-assisted interventions. While numerous methods for detecting, segmenting and tracking of medical instruments based on endoscopic video images have been proposed in the literature, key limitations remain to be addressed: Firstly, robustness, that is, the reliable performance of state-of-the-art methods when run on challenging images (e.g. in the presence of blood, smoke or motion artifacts). Secondly, generalization; algorithms trained for a specific intervention in a specific hospital should generalize to other interventions or institutions. In an effort to promote solutions for these limitations, we organized the Robust Medical Instrument Segmentation (ROBUST-MIS) challenge as an international benchmarking competition with a specific focus on the robustness and generalization capabilities of algorithms. For the first time in the field of endoscopic image processing, our challenge included a task on binary segmentation and also addressed multi-instance detection and segmentation. The challenge was based on a surgical data set comprising 10,040 annotated images acquired from a total of 30 surgical procedures from three different types of surgery. The validation of the competing methods for the three tasks (binary segmentation, multi-instance detection and multi-instance segmentation) was performed in three different stages with an increasing domain gap between the training and the test data. The results confirm the initial hypothesis, namely that algorithm performance degrades with an increasing domain gap. While the average detection and segmentation quality of the best-performing algorithms is high, future research should concentrate on detection and segmentation of small, crossing, moving and transparent instrument(s) (parts).
Collapse
Affiliation(s)
- Tobias Roß
- Computer Assisted Medical Interventions (CAMI), German Cancer Research Center, Im Neuenheimer Feld 223, 69120, Heidelberg, Germany; University of Heidelberg, Germany, Seminarstraße 2, 69117 Heidelberg, Germany.
| | - Annika Reinke
- Computer Assisted Medical Interventions (CAMI), German Cancer Research Center, Im Neuenheimer Feld 223, 69120, Heidelberg, Germany; University of Heidelberg, Germany, Seminarstraße 2, 69117 Heidelberg, Germany
| | - Peter M Full
- University of Heidelberg, Germany, Seminarstraße 2, 69117 Heidelberg, Germany; Division of Medical Image Computing (MIC), Im Neuenheimer Feld 223, 69120 Heidelberg, Germany
| | - Martin Wagner
- Department for General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Hannes Kenngott
- Department for General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Martin Apitz
- Department for General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Hellena Hempe
- Computer Assisted Medical Interventions (CAMI), German Cancer Research Center, Im Neuenheimer Feld 223, 69120, Heidelberg, Germany
| | - Diana Mindroc-Filimon
- Computer Assisted Medical Interventions (CAMI), German Cancer Research Center, Im Neuenheimer Feld 223, 69120, Heidelberg, Germany
| | - Patrick Scholz
- Computer Assisted Medical Interventions (CAMI), German Cancer Research Center, Im Neuenheimer Feld 223, 69120, Heidelberg, Germany; HIDSS4Health - Helmholtz Information and Data Science School for Health, Im Neuenheimer Feld 223, 69120 Heidelberg, Germany
| | - Thuy Nuong Tran
- Computer Assisted Medical Interventions (CAMI), German Cancer Research Center, Im Neuenheimer Feld 223, 69120, Heidelberg, Germany
| | - Pierangela Bruno
- Computer Assisted Medical Interventions (CAMI), German Cancer Research Center, Im Neuenheimer Feld 223, 69120, Heidelberg, Germany; Department of Mathematics and Computer Science, University of Calabria, 87036 Rende, Italy
| | - Pablo Arbeláez
- Universidad de los Andes, Cra. 1 No 18A - 12, 111711 Bogotá, Colombia
| | - Gui-Bin Bian
- University of Chinese Academy Sciences, 52 Sanlihe Rd., Beijing, China; State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, 100864 Beijing, China
| | - Sebastian Bodenstedt
- National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany: German Cancer Research Center, Im Neuenheimer Feld 460, 69120 Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany; Helmholtz Association/Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Bautzner Landstraße 400, 01328 Dresden, Germany
| | | | | | - Hua-Bin Chen
- University of Chinese Academy Sciences, 52 Sanlihe Rd., Beijing, China; State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, 100864 Beijing, China
| | - Cristina González
- Universidad de los Andes, Cra. 1 No 18A - 12, 111711 Bogotá, Colombia
| | - Dong Guo
- School of Mechanical and Electrical Engineering, University of Electronic Science and Technology of China, Shahe Campus:No.4, Section 2, North Jianshe Road, 610054
- Qingshuihe Campus:No.2006, Xiyuan Ave, West Hi-Tech Zone, 611731, Chengdu, China
| | - Pål Halvorsen
- SimulaMet, Pilestredet 52, 0167 Oslo, Norway; Oslo Metropolitan University (OsloMet), Pilestredet 52, 0167 Oslo, Norway
| | - Pheng-Ann Heng
- Department of Computer Science and Engineering, The Chinese University of Hong Kong, Chung Chi Rd, Ma Liu Shui, Hong Kong, China
| | - Enes Hosgor
- caresyntax, Komturstraße 18A, 12099 Berlin, Germany
| | - Zeng-Guang Hou
- University of Chinese Academy Sciences, 52 Sanlihe Rd., Beijing, China; State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, 100864 Beijing, China
| | - Fabian Isensee
- University of Heidelberg, Germany, Seminarstraße 2, 69117 Heidelberg, Germany; Division of Medical Image Computing (MIC), Im Neuenheimer Feld 223, 69120 Heidelberg, Germany
| | - Debesh Jha
- SimulaMet, Pilestredet 52, 0167 Oslo, Norway; Department of Informatics, UIT The Arctic University of Norway, Hansine Hansens vei 54, 9037 Tromsø, Norway
| | - Tingting Jiang
- Institute of Digital Media (NELVT), Peking University, 5 Yiheyuan Rd, Haidian District, 100871 Peking, China
| | - Yueming Jin
- Department of Computer Science and Engineering, The Chinese University of Hong Kong, Chung Chi Rd, Ma Liu Shui, Hong Kong, China
| | - Kadir Kirtac
- caresyntax, Komturstraße 18A, 12099 Berlin, Germany
| | - Sabrina Kletz
- Institute of Information Technology, Klagenfurt University, Universitätsstraße 65-67, 9020 Klagenfurt, Austria
| | - Stefan Leger
- National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany: German Cancer Research Center, Im Neuenheimer Feld 460, 69120 Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany; Helmholtz Association/Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Bautzner Landstraße 400, 01328 Dresden, Germany
| | - Zhixuan Li
- Institute of Digital Media (NELVT), Peking University, 5 Yiheyuan Rd, Haidian District, 100871 Peking, China
| | - Klaus H Maier-Hein
- Division of Medical Image Computing (MIC), Im Neuenheimer Feld 223, 69120 Heidelberg, Germany
| | - Zhen-Liang Ni
- University of Chinese Academy Sciences, 52 Sanlihe Rd., Beijing, China; State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, 100864 Beijing, China
| | | | - Klaus Schoeffmann
- Institute of Information Technology, Klagenfurt University, Universitätsstraße 65-67, 9020 Klagenfurt, Austria
| | - Ruohua Shi
- Institute of Digital Media (NELVT), Peking University, 5 Yiheyuan Rd, Haidian District, 100871 Peking, China
| | - Stefanie Speidel
- National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany: German Cancer Research Center, Im Neuenheimer Feld 460, 69120 Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany; Helmholtz Association/Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Bautzner Landstraße 400, 01328 Dresden, Germany
| | | | | | - Gutai Wang
- School of Mechanical and Electrical Engineering, University of Electronic Science and Technology of China, Shahe Campus:No.4, Section 2, North Jianshe Road, 610054
- Qingshuihe Campus:No.2006, Xiyuan Ave, West Hi-Tech Zone, 611731, Chengdu, China
| | - Jiacheng Wang
- Department of Computer Science, School of Informatics, Xiamen University, 422 Siming South Road, 361005 Xiamen, China
| | - Liansheng Wang
- Department of Computer Science, School of Informatics, Xiamen University, 422 Siming South Road, 361005 Xiamen, China
| | - Lu Wang
- School of Mechanical and Electrical Engineering, University of Electronic Science and Technology of China, Shahe Campus:No.4, Section 2, North Jianshe Road, 610054
- Qingshuihe Campus:No.2006, Xiyuan Ave, West Hi-Tech Zone, 611731, Chengdu, China
| | - Yujie Zhang
- Department of Computer Science, School of Informatics, Xiamen University, 422 Siming South Road, 361005 Xiamen, China
| | - Yan-Jie Zhou
- University of Chinese Academy Sciences, 52 Sanlihe Rd., Beijing, China; State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, 100864 Beijing, China
| | - Lei Zhu
- Department of Computer Science and Engineering, The Chinese University of Hong Kong, Chung Chi Rd, Ma Liu Shui, Hong Kong, China
| | - Manuel Wiesenfarth
- Division of Biostatistics, German Cancer Research Center, Im Neuenheimer Feld 581, Heidelberg, Germany
| | - Annette Kopp-Schneider
- Division of Biostatistics, German Cancer Research Center, Im Neuenheimer Feld 581, Heidelberg, Germany
| | - Beat P Müller-Stich
- Department for General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Lena Maier-Hein
- Computer Assisted Medical Interventions (CAMI), German Cancer Research Center, Im Neuenheimer Feld 223, 69120, Heidelberg, Germany
| |
Collapse
|
30
|
Mat E, Kale A, Yıldız G, Başol G, Gündogdu EC. Alternative method for the diagnosis of acid cases of unknown cause: Transvaginal natural orifice transluminal endoscopic surgery. J Obstet Gynaecol Res 2020; 47:645-652. [PMID: 33197989 DOI: 10.1111/jog.14575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/20/2020] [Accepted: 11/03/2020] [Indexed: 12/21/2022]
Abstract
AIM To evaluate the efficacy and reliability of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) technique in making the diagnosis of ascites with unknown cause. METHODS Seven patients with ascites with unknown cause and diagnosed with vNOTES between November 2018 and May 2019 were analyzed retrospectively. The following data were collected retrospectively: body mass index, age, parity, previous abdominal or pelvic surgery, total operating time, perioperative complications and visual analog scale scores for evaluation of postoperative pain. After general anesthesia and disinfection, a 2-3 cm incision was made in the posterior fornix of the vagina. In all of the vNOTES procedures, a handmade glove port system comprised of a glove-wound retractor NOTES port was used. RESULTS Transvaginal natural orifice transluminal endoscopic surgery for diagnostic peritoneoscopy was successfully performed in seven patients. Following postoperative pathological examination; three patients were established to have peritoneal carcinomatosis, one patient abdominal tuberculous, one patient ovarian fibroma, one patient ovarian mature cystic teratoma and one patient stomach cancer. In 1-year follow-up period after vNOTES procedure, no adverse events occurred in patients. CONCLUSION In making histological diagnosis of ascites with unknown cause, vNOTES is a feasible, safe and efficient technique. Due to its high performance in diagnosis, this technique helps to initiate treatment early in some diseases in addition to preventing unnecessary treatment and examination in benign diseases. Besides, via obtaining a detailed and enlarged image of abdominal cavity, this procedure also guides the clinician in the evaluation of the suitability of patient for operation.
Collapse
Affiliation(s)
- Emre Mat
- Department of Obstetrics and Gynecology, University of Health Sciences, Kartal Dr. Lutfi Kirdar Research and Training Hospital, Istanbul, Turkey
| | - Ahmet Kale
- Department of Obstetrics and Gynecology, University of Health Sciences, Kartal Dr. Lutfi Kirdar Research and Training Hospital, Istanbul, Turkey
| | - Gazi Yıldız
- Department of Obstetrics and Gynecology, University of Health Sciences, Kartal Dr. Lutfi Kirdar Research and Training Hospital, Istanbul, Turkey
| | - Gülfem Başol
- Department of Obstetrics and Gynecology, University of Health Sciences, Kartal Dr. Lutfi Kirdar Research and Training Hospital, Istanbul, Turkey
| | - Elif C Gündogdu
- Department of Obstetrics and Gynecology, University of Health Sciences, Kartal Dr. Lutfi Kirdar Research and Training Hospital, Istanbul, Turkey
| |
Collapse
|
31
|
Percutaneous-assisted vs mini-laparoscopic hysterectomy: comparison of ultra-minimally invasive approaches. Updates Surg 2020; 73:2347-2354. [PMID: 32996053 DOI: 10.1007/s13304-020-00893-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/21/2020] [Indexed: 01/28/2023]
Abstract
To assess the feasibility and the safety of the ultra-minimally invasive (U-MIS) approaches in gynecology, we compared our experience in percutaneous assisted hysterectomy (PSS-H) with a series of 3 mm mini-laparoscopy hysterectomy (m-LPS-H). 126 patients affected by benign and malignant gynecological conditions were considered eligible for minimally invasive hysterectomy: 80 patients received PSS approach and 46 m-LPS approach. For both groups, we evaluated intra and perioperative outcomes, post-operative pain and cosmetic outcomes. The baseline characteristics were comparable between the two study groups. As well, no differences were reported in the clinical indications for hysterectomy, principally fibroids/adenomyosis, endometrial hyperplasia and early stage endometrial cancer. The median operative time was 88.5 (40-190) minutes for PSS-H group and 95.0 (42-231) minutes in m-LPS-H group (p = 0.131). No differences were detected in median estimated blood loss (p = 0.104) as well, in the uterine manipulator usage (p = 0.127) between the two different surgical approaches. Only 1 (2.2%) conversion to standard laparoscopy occurred in m-LPS-H group (p = 0.691). One intra-operative complication was recorded 1 (1.3%) in the PSS-H group (p = 0.367). The post-operative early complication was recorded in five cases of PSS-H group (p = 0.158), none for m-LPS-H procedures. The results in post-operative pain detection was statistically significant after 4 h in favor of m-LPS-H group (p = 0.001). After 30 days no differences in cosmetic satisfaction were detected between the two groups (p = 0.206). PSS-H and m-LPS-H are two valid U-MIS alternatives for benign gynecological conditions and low/intermediate risk endometrial cancer.
Collapse
|
32
|
Zhang JF, Zilundu PLM, Zhou L, Guo GQ. Supplementary Regional Anatomy Teaching by Surgeons Enhances Medical Students Mastery of Anatomical Knowledge and Positively Impacts Their Choice of Future Career. JOURNAL OF SURGICAL EDUCATION 2020; 77:1113-1120. [PMID: 32446769 DOI: 10.1016/j.jsurg.2020.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 03/22/2020] [Indexed: 05/22/2023]
Abstract
BACKGROUND Anatomy is fundamental to the practice of medicine and surgery. Anatomy is also increasingly being taught by basic medical scientists or postclinical practice surgeons, thereby potentially detaching it from ongoing clinical realities. OBJECTIVE To evaluate whether supplementing regional anatomy teaching using surgeons enhances medical students' mastery of anatomical knowledge and how it impacts their choice of a future career. DESIGN This was a descriptive study. SETTING An integrated tuition model in which basic regional anatomy was supplemented with clinical correlates taught by surgeons was devised and implemented at Jinan University Medical School. PARTICIPANTS Soon after the third-year medical students finished dissecting each region (e.g., head and neck, limbs, etc.) of the human body, the surgeons from relevant specialties and sub-specialties were invited to give clinical application lectures. A self-administered questionnaire was used to evaluate all the students' perceptions of the integrated teaching model, perceived mastery of anatomical knowledge and determinants of future career choice. RESULTS More than half of the students believe that regional anatomy is more closely related to surgery than systemic anatomy. Over 70% of the students have a positive attitude towards this teaching model where surgeons supplement regional anatomy with clinical correlates, and 98% of the students are in favor of integrating human body structural knowledge into clinical problems to learn anatomy. In addition, 78% of the students believe that the surgeons' participation in the teaching of regional anatomy helps them better understand human body structures and their clinical significance. However, some of their responses point towards the clinical correlate disconnection from the basic anatomy content. Furthermore, the majority of the students plan to become clinical doctors. After studying regional anatomy, the proportion of students who elected to be surgeons decreased slightly. However, the number of students who affirmatively planned to become surgeons in the future increased slightly, and 90% of these students were able to specify a chosen and preferred subspecialty of surgery. CONCLUSIONS Surgeons' involvement in regional anatomy is of major benefit to students in understanding the human anatomy and its clinical significance, as well as positively impact on the decision to pursue a career in surgery.
Collapse
Affiliation(s)
- Ji-Feng Zhang
- Department of Anatomy, Basic Medical College, Jinan University, Guangzhou, China
| | - Prince Last Mudenda Zilundu
- Department of Human Anatomy, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Lihua Zhou
- Department of Human Anatomy, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China; Department of Human Anatomy, Sun Yat-sen Medical School, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Guo-Qing Guo
- Department of Anatomy, Basic Medical College, Jinan University, Guangzhou, China.
| |
Collapse
|
33
|
|
34
|
Yuce TK, Ellis RJ, Chung J, Merkow RP, Yang AD, Soper NJ, Tanner EJ, Schaeffer EM, Bilimoria KY, Auffenberg GB. Association between surgical approach and survival following resection of abdominopelvic malignancies. J Surg Oncol 2020; 121:620-629. [PMID: 31970787 DOI: 10.1002/jso.25841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 01/05/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Recent studies demonstrating decreased survival following minimally invasive surgery (MIS) for cervical cancer have generated concern regarding oncologic efficacy of MIS. Our objective was to evaluate the association between surgical approach and 5-year survival following resection of abdominopelvic malignancies. METHODS Patients with stage I or II adenocarcinoma of the prostate, colon, rectum, and stage IA2 or IB1 cervical cancer from 2010-2015 were identified from the National Cancer Data Base. The association between surgical approach and 5-year survival was assessed using propensity-score-matched cohorts. Distributions were compared using logistic regression. Hazard ratio for death was estimated using Cox proportional-hazard models. RESULTS The rate of deaths at 5 years was 3.4% following radical prostatectomy, 22.9% following colectomy, 18.6% following proctectomy, and 6.8% following radical hysterectomy. Open surgery was associated with worse survival following radical prostatectomy (HR, 1.18; 95% CI, 1.05-1.33; P = .005), colectomy (HR, 1.45; 95% CI, 1.39-1.51; P < .001), and proctectomy (HR, 1.28; 95% CI, 1.10-1.50; P = .002); however, open surgery was associated with improved survival following radical hysterectomy (HR, 0.61; 95% CI, 0.44-0.82; P = .003). CONCLUSIONS These results suggest that MIS is an acceptable approach in selected patients with prostate, colon, and rectal cancers, while concerns regarding MIS resection of cervical cancer appear warranted.
Collapse
Affiliation(s)
- Tarik K Yuce
- Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Northwestern Institute for Comparative Effectiveness Research in Oncology (NICER-Onc), Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ryan J Ellis
- Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Northwestern Institute for Comparative Effectiveness Research in Oncology (NICER-Onc), Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jeanette Chung
- Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Northwestern Institute for Comparative Effectiveness Research in Oncology (NICER-Onc), Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ryan P Merkow
- Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Northwestern Institute for Comparative Effectiveness Research in Oncology (NICER-Onc), Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Anthony D Yang
- Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Northwestern Institute for Comparative Effectiveness Research in Oncology (NICER-Onc), Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Nathaniel J Soper
- Northwestern Institute for Comparative Effectiveness Research in Oncology (NICER-Onc), Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Edward J Tanner
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Edward M Schaeffer
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Karl Y Bilimoria
- Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Northwestern Institute for Comparative Effectiveness Research in Oncology (NICER-Onc), Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Gregory B Auffenberg
- Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| |
Collapse
|
35
|
Neethirajan SGR, Kurada S, Parameswari A. Efficacy of Dexmedetomidine as an Adjuvant to Bupivacaine in Ultrasound-Guided Transverse Abdominis plane Block for Laparoscopic appendicectomy: A Randomised Controlled Study. Turk J Anaesthesiol Reanim 2019; 48:364-370. [PMID: 33103140 PMCID: PMC7556648 DOI: 10.5152/tjar.2019.67689] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 08/10/2019] [Indexed: 12/19/2022] Open
Abstract
Objective Dexmedetomidine is an alpha 2-adrenergic agonist that prolongs analgesia as an adjuvant when added in neuraxial and peripheral nerve blocks. The aim of the present study was to evaluate the efficacy of dexmedetomidine as an adjuvant to bupivacaine in ultrasound (USG)-guided transverse abdominis plane (TAP) block for postoperative analgesia in laparoscopic appendicectomy. Methods A total of 60 American Society of Anesthesiologists I and II adult patients aged between 16 and 60 years planned for laparoscopic appendicectomy were randomised into two groups (A and B). Group A patients received 20 mL of 0.125% bupivacaine+1 μg kg−1 dexmedetomidine, whereas group B patients received 20 mL of 0.125% bupivacaine alone on both sides at the time of USG-guided TAP block. Haemodynamic variables, pain scores, sedation scores, time to first dose of rescue analgesic and side effects, if any, were assessed and compared between the groups. Results Demographic and operative characteristics were comparable in both groups. The mean duration of analgesia was more in group A (7.33 h) than in group B (4.8 h). The requirement of rescue analgesics was more in group B (80%) than in group A (56.7%). The sedation and pain scores at 2, 4 and 6 h were better in group A than in group B (p<0.05). The heart rate, systolic blood pressure and diastolic blood pressure were lower in group A during the postoperative period than in group B. Conclusion The addition of dexmedetomidine as an adjuvant to bupivacaine in TAP block provides prolonged postoperative analgesia and better pain control with reduced need for rescue analgesics than bupivacaine alone in patients undergoing laparoscopic appendicectomy.
Collapse
Affiliation(s)
| | - Santoshi Kurada
- Department of Anaesthesia and Pain Medicine, Sri Ramachandra Medical College, Chennai, India
| | - Aruna Parameswari
- Department of Anaesthesia and Pain Medicine, Sri Ramachandra Medical College, Chennai, India
| |
Collapse
|
36
|
De Pauw T, Kalmar A, Van De Putte D, Mabilde C, Blanckaert B, Maene L, Lievens M, Van Haver AS, Bauwens K, Van Nieuwenhove Y, Dewaele F. A novel hybrid 3D endoscope zooming and repositioning system: Design and feasibility study. Int J Med Robot 2019; 16:e2050. [PMID: 31677219 DOI: 10.1002/rcs.2050] [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: 11/27/2018] [Revised: 09/12/2019] [Accepted: 10/11/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND Manipulation of the endoscope during minimally invasive surgery is a major source of inconvenience and discomfort. This report elucidates the architecture of a novel one-hand controlled endoscope positioning device and presents a practicability evaluation. METHODS AND MATERIALS Setup time and total surgery time, number and duration of the manipulations, side effects of three-dimensional (3D) imaging, and ergonomic complaints were assessed by three surgeons during cadaveric and in vivo porcine trials. RESULTS Setup was accomplished in an average (SD) of 230 (120) seconds. The manipulation time was 3.87 (1.77) seconds for angular movements and 0.83 (0.24) seconds for zooming, with an average (SD) of 30.5 (16.3) manipulations per procedure. No side effects of 3D imaging or ergonomic complaints were reported. CONCLUSIONS The integration of an active zoom into a passive endoscope holder delivers a convenient synergy between a human and a machine-controlled holding device. It is shown to be safe, simple, and intuitive to use and allows unrestrained autonomic control of the endoscope by the surgeon.
Collapse
Affiliation(s)
- Tim De Pauw
- Department of Neurosurgery, Ghent University Hospital, Ghent, Belgium
| | - Alain Kalmar
- Department of Anesthesia and Intensive Care Medicine, Maria Middelares Hospital, Ghent, Belgium
| | - Dirk Van De Putte
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - Cyriel Mabilde
- Department of Basic Medical Sciences, Ghent University, Ghent, Belgium
| | - Bart Blanckaert
- Department of Basic Medical Sciences, Ghent University, Ghent, Belgium
| | - Lieven Maene
- Department of Thoracic and Vascular Surgery, Onze-Lieve-Vrouw Hospital, Aalst, Belgium
| | - Mauranne Lievens
- Department of Basic Medical Sciences, Ghent University, Ghent, Belgium
| | | | - Kevin Bauwens
- Division of Robotic Surgery and Training, ORSI Academy, Melle, Ghent, Belgium
| | - Yves Van Nieuwenhove
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - Frank Dewaele
- Department of Neurosurgery, Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
37
|
Comparison of Major Clinical Outcomes Between Transvaginal NOTES and Traditional Laparoscopic Surgery: A Systematic Review and Meta-analysis. J Surg Res 2019; 244:278-290. [PMID: 31302326 DOI: 10.1016/j.jss.2019.06.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/25/2019] [Accepted: 06/05/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND The advent of transvaginal natural orifice transluminal endoscopic surgery (transvaginal NOTES) aims to minimize surgical trauma and reduce recovery time. MATERIALS AND METHODS Clinical trials comparing transvaginal NOTES and traditional laparoscopy were identified by searching EMBASE, MEDLINE, and Web of Science (from 2004 to March 2018). Major outcomes evaluated were risk of postoperative complications and secondary outcomes were pain on postoperative day (POD) 1, POD2, and POD3, time needed for full recovery, risk of intraoperative complications, the duration of surgery, and hospital stay. The results of the meta-analysis are presented as standardized mean difference (SMD) and risk difference (RD) with 95% confidence intervals (CIs). RESULTS Thirteen trials with 1340 patients were identified. There were no statistical differences for risk of complications between transvaginal NOTES and traditional laparoscopy (intraoperative complications: RD -0.01, 95% CI -0.03 to 0.01; P = 0.37; postoperative complication: RD -0.02, 95% CI -0.05 to 0.01; P = 0.148). The pain score was lower in transvaginal NOTES on POD1 (SMD: -0.71, 95% CI: -1.30 to -0.11, P = 0.019), on POD2 (SMD -0.41, 95% CI -0.75 to -0.07; P = 0.018), and on POD3 (SMD -0.43, 95% CI -0.63 to -0.23; P < 0.001). Patients in transvaginal NOTES needed much shorter time to fully recover after surgery (SMD -1.36, 95% CI -1.84 to -0.87; P < 0.001). In addition, patients underwent transvaginal NOTES had less pain and shorter time of recovery. CONCLUSIONS It is recommended that patients have cholecystectomy, adnexectomy, and appendectomy using transvaginal NOTES as it is safe and minimally invasive.
Collapse
|
38
|
Thomas D, Medoff B, Anger J, Chughtai B. Direct-to-consumer advertising for robotic surgery. J Robot Surg 2019; 14:17-20. [DOI: 10.1007/s11701-019-00989-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 06/17/2019] [Indexed: 12/01/2022]
|
39
|
Short-term Outcomes of Non-robotic Single-incision Laparoscopic Sacrocolpopexy: A Surgical Technique. J Minim Invasive Gynecol 2019; 27:721-727. [PMID: 31146027 DOI: 10.1016/j.jmig.2019.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 04/25/2019] [Accepted: 05/19/2019] [Indexed: 11/21/2022]
Abstract
STUDY OBJECTIVE Our main purpose was to describe the surgical technique and short-term outcomes of single-incision laparoscopic sacrocolpopexy (S-LSC) for the treatment of pelvic organ prolapse (POP). DESIGN This study consisted of a retrospective analysis of 49 consecutive cases. SETTING This study was set at the Third Affiliated Hospital of Guangzhou Medical University from October 2016 to November 2017. PATIENTS The population for this study consisted of women with stage II to IV POP who met eligibility criteria for laparoscopic surgery. INTERVENTIONS S-LSC included the use of V-loc barbed suture and retroperitoneal tunneling, in addition to standard single-incision laparoscopic surgery techniques. All 49 cases were successfully completed. All cases included concomitant procedures; 42 (85.7%) had removal of the uterus and adnexa. The main measured outcomes include patient characteristics, perioperative outcomes, and change in pelvic floor support (Pelvic Organ Prolapse Quantification System), and quality of life (Pelvic Floor Impact Questionnaire). MEASUREMENTS AND MAIN RESULTS All patients were parous, and 42.9% had a history of previous abdominal surgery. The mean operative duration from skin to skin was 201.20 ± 46.53 minutes. The mean estimated blood loss was 27.0 ± 16.6 mL. The mean pre- and post-operative Pelvic Organ Prolapse Quantification System scores were 2.2 ± 1.1 cm versus -2.6 ± 0.5 cm for the Aa point and 3.2 ± 2.8 cm versus -4.6 ± 0.8 cm for the C point (p <.05 for both). The mean pre- and post-operative Pelvic Floor Impact Questionnaire scores were 106.4 ± 18.9 versus 8.9 ± 4.26 (p <.05), suggesting that S-LSC significantly improved physical prolapse and quality of life. Four patients suffered from postoperative complications (3 mesh exposure and 1 lumbosacral pain). Six patients complained of new onset of stress urinary incontinence. CONCLUSIONS Single-incision laparoscopic sacrocolpopexy is a feasible method to manage POP. However, the long-term effects and complications need to be further investigated.
Collapse
|
40
|
Shah AH, Pokholenko O, Nanda HS, Steele TWJ. Non-aqueous, tissue compliant carbene-crosslinking bioadhesives. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 100:215-225. [PMID: 30948055 DOI: 10.1016/j.msec.2019.03.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 01/22/2019] [Accepted: 03/01/2019] [Indexed: 01/06/2023]
Abstract
Surgical adhesives are an attractive alternative to traditional mechanical tissue fixation methods of sutures and staples. Ease of application, biocompatibility, enhanced functionality (drug delivery) are known advantages but weak adhesion strength in the wet environment and lack of tissue compliant behavior still pose a challenge. In order to address these issues, non-aqueous bioadhesive based on blends of polyamidoamine (PAMAM) dendrimer, conjugated with 4-[3-(trifluoromethyl)-3H-diazirin-3-yl] benzyl bromide (PAMAM-g-diazirine) and liquid polyethylene glycol (PEG 400) has been developed. PEG 400 biocompatible solvent reduces the viscosity of PAMAM-g-diazirine dendrimer without incorporating aqueous solvents or plasticizers, allowing application by syringe or spray. Upon UV activation, diazirine-generated reactive intermediates lead to intermolecular dendrimer crosslinking. The properties of the crosslinked matrix are tissue compliant, with anisotropic material properties dependent on the PEG 400 wt%, UV dose, pressure and uncured adhesive thickness. The hygroscopic PAMAM-g-diazirine/PEG 400 blend was hypothesized to absorb water at the tissue interface, leading to high interfacial adhesion, however porous matrices led to cohesive failure. The hydrophilic nature of the polyether backbone (PEG 400) shielded cationic PAMAM dendrimers with cured bioadhesive film displaying significantly less platelet activation than neat PAMAM-g-diazirine or PLGA thin films.
Collapse
Affiliation(s)
- Ankur Harish Shah
- School of Materials Science and Engineering, Division of Materials Technology, Nanyang Technological University, Singapore 639798, Singapore
| | - Oleksander Pokholenko
- School of Materials Science and Engineering, Division of Materials Technology, Nanyang Technological University, Singapore 639798, Singapore
| | - Himanshu Sekhar Nanda
- Department of Mechanical Engineering, PDPM-Indian Institute of Information Technology, Design and Manufacturing (IIITDM)-Jabalpur, Dumna Airport Road, Jabalpur 482005, MP, India
| | - Terry W J Steele
- School of Materials Science and Engineering, Division of Materials Technology, Nanyang Technological University, Singapore 639798, Singapore.
| |
Collapse
|
41
|
Abstract
As the frontiers of minimally invasive surgery (MIS) continue to expand, the availability and implementation of new technology in pediatric urology are increasing. MIS is already an integral part of pediatric urology, but there is still much more potential change to come as both recent and upcoming advances in laparoscopic and robotic surgery are surveyed.
Collapse
|