Use of a Novel, Self-contained Tissue Retraction Device to Reduce Trocar Site Number in Laparoscopic and NOTES-based Surgical Procedures
In an effort to make laparoscopic surgical procedures even less invasive, single port access and natural orifice transgastric endoscopic surgical (NOTES) approaches have been developed over the past several years. However, the need to maintain basic surgical working principles, such as proper tissue retraction to create tension and counter-tension, is still of critical importance if… Continue Reading
Use of a Novel Percutaneous Retraction Device and Magnetic Anchoring and Guidance System (mags) Helps Re-establish the Critical View and Improves Surgeon Performance While Mimicking the Four Port Technique in Single Site Laparoscopic (ssl) Cholecystectomy
Introduction: SSL, though promising, introduces ergonomic challenges due to loss of instrument triangulation as obtained in conventional laparoscopy. This limitation makes establishing the critical view during dissection of the Triangle of Calot (TOC) difficult and has resulted in a variety of strategies to overcome the problem. This study investigates use of a novel percutaneous grasper… Continue Reading
Single Site Laparoscopic (ssl) Cholecystectomy in Human Cadavers Using Novel Percutaneous Retraction and a Magnetic Anchoring and Guidance System (mags): Re-establishing the Critical View
Introduction: SSL, though promising, introduces ergonomic challenges due to loss of instrument triangulation as obtained in conventional laparoscopy. This limitation makes establishing the critical view during dissection of the Triangle of Calot (TOC) difficult and has resulted in a variety of strategies to overcome the problem. This study investigates use of a novel percutaneous grasper… Continue Reading
Single Port Access Surgery: Performance Difficulty and a Possible Solution
Introduction: During single port access surgery (SPA), surgeons often find it difficult to triangulate their instruments to the target organ. Their hand movements are limited by the single port access to the abdominal cavity. The first goal of this study is to quantify the level of difficulty in performing a SPA procedure as compared to… Continue Reading
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Single-incision Laparoscopic Cholecystectomy Using Novel Powered Articulating Instruments (terumo)
Introduction: Single-incision laparoscopic surgery (SILS) has emerged as a promising way to perform laparoscopic surgery less invasively. Currently, most SILS procedures are performed using standard laparoscopic instruments. This video demonstrates the use of novel powered articulating instruments to perform a SILS cholecystectomy in a cadaver. Methods: SILS cholecystectomy was performed through an umbilical incision in… Continue Reading
Single-incision Laparoscopic Cholecystectomy in Modified Lithotomy Position – Improved Ergonomics for Surgeons and Surgical Assistants
INTRODUCTION – Most single-incision laparoscopic cholecystectomy procedures described to date were done with the patient in supine position. Although convenient for the operating surgeon (standing on the patient’s left), we found this position to be taxing on a surgical assistant (who stands on the patient’s right). To alleviate the strain on the assistant’s back we… Continue Reading
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Real-time Intraoperative Detection of Tissue Hypoxia in Endoscopic Gastrointestinal Surgery By a Novel Wireless Pulse Oximeter (wipox)
ObjectiveDehiscence or leakage following bowel anastomoses occurs at a rate of 0-50% with a high associated mortality. Vascular perfusion and tissue oxygenation (SpO2) at the anastomotic site are fundamental determinates of anastomotic viability. We aimed to construct a wireless pulse oximeter (WiPOX) to monitor intraoperative real-time tissue oxygenation, permitting the identification of unrecognized compromised blood… Continue Reading
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
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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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
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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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
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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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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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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