A Comparison of Independence of Motion in Single Port Access Techniques
A number of different access techniques have emerged within reduced port laparoscopy. The multi-trocar approach via separate fascial incisions and multichanneled single trocar devices have challenged reliable paradigms of multiport laparoscopy (MPL). Although benefits of the reduced port technique have yet to be proven, change has begun without comprehensive evaluation. Given that this new platform… Continue Reading
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A New Multi-view (mv) Rigid Laparoscope
Background: Minimally invasive surgery is based on visualization with less reliance on tactile feedback. Therefore, the type of laparoscope, location of the laparoscopic working port, light transmission, viewing angle, depth of view, camera, magnification, image display and clarity are critical. Rigid laparoscopes with fixed viewing angles are the most employed worldwide because of their ease… Continue Reading
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A Pilot Study of Using Multiphoton Microscopy to Diagnose Gastric Cancer
Introduction: Using a combination of autofluorescence from cells and second harmonic generation signal from collagen, multiphoton microscopy (MPM) imaging can provide detailed information on tissue architecture and cellular morphology. The purpose of this study was to evaluate the feasibility of using MPM to diagnose gastric cancer, compared with gold standard hematoxylin-eosin (H-E) stained histopathology.Methods: A… Continue Reading
Application of Hem-o-lok Clip in Basic Laparoscopic Procedures: A Single Center Experience on 856 Cases and Review of Data From Food and Drug Administration
Introduction: There are several methods for ligation of structures during laparoscopic operations. Several studies have studied the efficacy, safety and cost of the various devices in different situations. Each technique has its own potential drawbacks. Applications of endoloop require dexterity and training. Endoscopic staplers are expensive instruments. Titanium clips may be slipped from its primary… Continue Reading
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Effects of Different Types of Staple Line Reinforcement on Tissue Handling and Slippage During Laparoscopic Stapling
Introduction: Staple line reinforcement (SLR) has been used to prevent staple line leaks and reduce bleeding in a variety of surgical procedures. Tissue extrusion and slippage from stapler jaws can affect tissue handling and the number of staple loads used during a procedure. We hypothesized that tissue handling and extrusion with stapler closure and firing… Continue Reading
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Ergonomic Performance with Crossed and Uncrossed Instruments in Single Port Laparoscopic Surgery
IntroductionThe Single Port Laparoscopic Surgery (SPLS) approach has recently emerged from efforts to reduce skin incisions and their related pain and morbidity. Preliminary research has indicated the need for instruments to be crossed at their point of insertion for reduction of the diameter of the single port. The primary objectives of this study was to… Continue Reading
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Evaluation of Commercially Available Port Access Devices for Single Incision Laparoscopic Surgery
Objectives: to evaluate three different commercially available single incision laparoscopy access devices for their ease of use. Methods: Four expert laparoscopic surgeons performed laparoscopic cholecystectomy, suturing, small bowel resection, and gastrojejunostomy through a single incision in a porcine model. A cylindrical, a disc shaped, and a sleeve based access device were evaluated for performance. Seven… Continue Reading
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First Human Experience with a Novel Laparoscopic Port Site Closure Device
Introduction: One of the most frustrating, difficult, time-consuming, and sometimes unreliable parts of laparoscopic surgery is closing the trocar sites, especially in obese patients. If these sites are closed improperly or not closed, the patients are at increased risk of port hernias (0.23% - 3.1%) and/or bowel incarceration possibly placing the patients’ life at risk.… Continue Reading
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Gallbladder Retraction Without Transcutaneous Sutures During Single-incision Laparoscopic Cholecystectomy
INTRODUCTION – Several techniques of retracting the gallbladder were suggested to facilitate performance of single-incision laparoscopic cholecystectomies. All require placement of transcutaneous sutures with resulting scarring, bruising and postoperative pain. We propose a new technique where gallbladder is secured to the diaphragm using intracorporeal sutures, thus allowing for more precise retraction and elimination of any… Continue Reading
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Going back to open technique (fundus 1t) SILC
INTRODUCTION: Traditionally laparoscopic cholecystectomies are done with dissection just in the region of Calot’s triangle. With the advent of single incision laparoscopic cholecystectomies, the Calot’s triangle approach makes the procedure technically difficult to perform. In our seres of single incision laparoscopic cholecystectomies,the fundus first approach made the procedure technically easier and easily reproducible. METHODS AND… Continue Reading
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Laparoscopic Cholecystectomy Poses Physical Injury Risk to Surgeons: Analysis of Hand Technique and Standing Position
Introduction: This study compares the effects of surgical techniques (one-handed versus two-handed) and surgeon’s standing position (side-standing versus between-standing) during laparoscopic cholecystectomy (LC) and its outcomes on surgeons’ learning, performance, and ergonomics. There is little homogeneity in how to perform and train for LC. Variations in standing position (“American” or side-standing technique where the surgeon… Continue Reading
Management of the Ultrasonically Activated Scalpel Handpiece with Self-check “bme Mode”.
Background:Recently the ultrasonically activated scalpels have been used in many kinds of operation. Clinical Engineers (CEs) need to check the ultrasonically activated scalpel handpiece after operations. We check the handpiece by working the tip of blade in water, however, it is impossible to inspect the deterioration of the handpiece. So, self-check “BME Mode” of Harmonic®… Continue Reading
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Neuroergonomic Assessment of the Robotic Enhancement of Minimally Invasive Surgery
Objective of the StudyMinimally invasive surgery (MIS) offers clear benefits to patients yet places increased demands on the surgeon. This is in part due to a lack of depth perception and haptic feedback and poor instrument ergonomics. Robotic assisted MIS aims to address these challenges. An example of this is Gaze-Contingent Motor Channelling (GCMC). GCMC… Continue Reading
Optimal Design of Instruments for Single Port Laparoscopic Surgery Using Motion Analysis
Objective: Instruments featuring articulation of the distal tip are highly desirable when access to the surgical site is restricted, as in Single Port Laparoscopic Surgery. This study compares two types of articulating instruments which have different means of controlling the distal articulation - a controlling wheel and a controlling joint - in terms of ergonomics… Continue Reading
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Quantitative Ergonomics Assessment of NOTES Techniques: A Study of Physical Workload, Body Movement and Posture
Introduction: This study investigates through biomechanical analyses NOTES and laparoscopic physical workloads. Research confirms that surgeons experience physical symptoms due to the unfavorable ergonomics of MIS performance. The ergonomics of NOTES—potentially the next evolutionary surgical step—is only now being quantitatively and systematically assessed Methods and Procedures: Six surgeons with varying MIS experience were recruited for… Continue Reading