Laparoscopic Transgastric Cyst Gastrostomy for an Unresectable Mucinous Cyst Adenoma of the Pancreas
IntroductionCystic neoplasms of pancreas represent less than 10 percent of all cystic lesions and less than 1 percent of all exocrine pancreatic neoplasms. They can be benign or malignant. Mucinous cystic neoplasms are the most common cystic pancreatic tumors accounting for 45 to 50 percent. These neoplasms have a natural evolution from benign to malignant… Continue Reading
Laparoscopic Management of Symptomatic Cystic Disease of the Liver
Background: Benign cystic diseases of the liver have recently been treated by non-surgical procedures such as alcohol injection and trans arterial embolization (TAE); however symptomatic or complicated cysts often need surgery. Traditionally, laparotomy is the procedure of choice. We present our experiences with laparoscopic management of both symptomatic multiple liver cysts and polycystic liver disease.… Continue Reading
A New Application of Biliary Tract Identification Based on Indocyanine Green Fluorescent Imaging At Laparoscopic Surgery
Background: Although biliary tract injuries are lethal, many difficulties in identifying it have been encountered during laparoscopic surgery. We report a novel method of biliary tract identification using an endoscopic device with fluorescent imaging of indocyanine green. Method: During operation 1.0-2.0 ml of 0.25% ICG had been intravenously injected in a patient with multiple liver… Continue Reading
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
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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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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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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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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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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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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- Posters
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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- Posters
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
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
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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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