Surgical Innovation最新文献

ObjectiveThe aim of this study was to explore the safety and efficacy of retroperitoneal laparoscopic repair of primary lumbar hernia using Self-Gripping mesh.MethodsThis retrospective study included 11 patients with primary lumbar hernias who underwent retroperitoneal laparoscopic repair with Self-Gripping mesh from May 2020 to October 2023 in our hospital. Observation indicators were intraoperative measured diameter of hernia ring defect, operation time, length of hospital stay, postoperative follow-up, complications, postoperative visual analogue scale (VAS) score, chronic pain.ResultsThe operations were completed successfully in 11 cases. The mean diameter of hernia ring was 2.57 ± 0.49 cm (ranged from 2.0 to 3.0 cm), the mean operation time was 53.31 ± 19.33 min (ranged from 35 to 90 min), the intraoperative blood loss was 3.01 ± 1.43 mL (ranged from 2 to 10 mL), and the mean postoperative hospital stay was 2.43 ± 1.41 days (ranged from 1 to 4 days). The mean postoperative VAS scores at 24 h were 1.10 ± 0.32 (ranged from 1 to 2). All cases were followed up for 21.05 ± 16.73 months (ranged from 3 to 42 months) without seroma, hematoma, incision or mesh infection, recurrence and obvious chronic pain.ConclusionRetroperitoneal laparoscopic repair of primary lumbar hernia using Self-Gripping mesh is safe and feasible. Its efficacy in the short term is favorable.

BackgroundThe early 20th century saw pioneering work by Frank and Lillian Gilbreth, regarded as the founders of surgical ergonomics, which brought scientific management in surgery and operating rooms. Through time and motion studies, their research helped improve the operative workflow and surgical efficiency.MethodsTo document the historical work of Gilbreths in surgical ergonomics, we conducted primary archival research at the Purdue University Archives and Special Collections (West Lafayette, IN), and integrated a collection of secondary sources across various formats and modalities.Results and ConclusionWe describes the early works of Gilbreths in surgical ergonomics and highlight how their motion research in the operating room evolved to incorporate ergonomics and decrease operative fatigue. The Gilbreths were proponents of promoting the adoption of management practices for operating rooms and standardization in hospital design, equipment, and patient records to improve efficiency in health care delivery. Through analysis of their published and unpublished work, we describe how their ideas are still in widespread use today to eliminate unnecessary motions and foster ergonomics in the operating room and in the field of surgery in general.

BackgroundThe Veress needle and open (Hasson) approach are common methods for creating pneumoperitoneum in laparoscopic surgery. However, these techniques can be time-consuming and carry the risk of organ or blood vessel injury. The Muyo Hook offers a new approach that allows direct trocar insertion without needing prior pneumoperitoneum. This study compares its effectiveness and evaluates perioperative outcomes with conventional methods in laparoscopic appendectomy and cholecystectomy.Materials and MethodsA comparative study was conducted at Nur Hidayah Hospital from April to August with 40 patients divided into 3 groups: Group A (Muyo Hook, 16 patients), Group B (Veress needle, 14 patients), and Group C (Muyo Hook without Veress, 10 patients). The study measured the time from skin incision to Veress insertion (Groups A and B) and the time for the first trocar insertion. Safety outcomes were also assessed, including organ or vessel injury, hematomas, and pain.ResultsThe Muyo Hook achieved pneumoperitoneum in an average of 18.05 seconds (range: 3.58-39.5 seconds), much faster than the conventional method (95.96 seconds; P < 0.05). Group C (Muyo Hook without Veress) had the quickest times. No complications were reported, such as organ or vessel injuries, skin hematomas, or pain.ConclusionWithin the limitations of this study, the Muyo Hook technique appeared efficient, practical, and cost-effective. No complications were observed in this small cohort; however, larger prospective studies are required before drawing definitive conclusions regarding its safety. The device may simplify the procedure, reduce operative time, and enhance practicality for minimally invasive surgery.

IntroductionMinimally invasive surgery fellowship is a popular choice for general surgery residents in the United States, but it serves an unclear role in an era where laparoscopic surgery has become commonplace. In this study, our goal was to examine the case volume for common open and laparoscopic surgery procedures for general surgery residents over the past 20 years to better understand the training needs that minimally invasive surgery fellowship can fill.MethodsWe reviewed the American Council on Graduate Medical Education (ACGME) Accreditation Data System to determine average case numbers for selected procedures among general surgery residents in the United States. Data was compared across 3 time points from 2002 to 2022. Descriptive statistics and chi-squared tests were used for analysis.ResultsResidents met our predefined competency threshold of twenty cases for 3 laparoscopic procedures in 2022 (cholecystectomy, colectomy, and inguinal hernia repair). There has been a trend towards increasing number of laparoscopic and decreasing number of open surgeries performed amongst our selected cases. Some procedures, including common bile duct exploration and splenectomy, remain rare over the entire study period.ConclusionsGeneral surgery residents receive good exposure to some laparoscopic procedures, but minimally invasive surgery fellowship serves a role in training for advanced laparoscopic cases, including anti-reflux and bariatric surgery.

BackgroundPost-operative anastomotic leaks (AL) are one of the most challenging complications of bariatric surgery and can be detrimental. Indocyanine green (ICG) is a fluorescence dye that can provide a real-time intraoperative assessment of organ tissue perfusion. Its use in bariatric operations is still being debated. The present review aims to evaluate the intraoperative utility of ICG during bariatric surgery to focus future research on a reliable tool to reduce the incidence of postoperative leaks.MethodsA systematic search of PubMed, EMBASE, MEDLINE, Scopus, and the Cochrane Library for published studies took place until December 2024, evaluating the use of ICG during bariatric surgical procedures. Studies were included if they assessed the ICG application in various bariatric operations to prevent and reduce AL rates.ResultsEleven studies were included, which involved a total of 887 patients. 643 patients underwent ICG-based intraoperative assessments, while 244 were in the control group. The mean age of participants was 43.8 years, and the mean BMI was 43.3 kg/m³. All included patients underwent various bariatric procedures. ICG was used alone in most studies, although it was mixed with methylene blue in one study. ICG administration protocols varied significantly. There were no reported complications from ICG administration. The utility of ICG has changed the intraoperative surgical decision-making of 4.2% of patients.ConclusionsICG is a promising technique for successfully preventing or timely managing AL in bariatric surgery. Large, randomised controlled studies are needed to confirm its utility for routine use in primary and revisional bariatric cases.

ObjectivesThe goal of this study was to evaluate whether immersive virtual reality (VR) training used in conjunction with interactive online learning improved procedural skills in medical students, using chest tube insertion as a model.MethodsMedical students (n = 30) with limited or no experience with chest tube insertion were randomized into control and VR groups. All participants received access to a previously developed online module to learn the equipment and steps involved in performing chest tube insertion. The VR group received additional training using commercially available software. All participants were then asked to perform chest tube insertion on a standardized mannequin. Technical skills were assessed by surgical experts, blinded to the group allocation, using a modified Objective Structured Assessment of Technical Skill (OSATS) rating scale (11-items, each scored 1-5). Multiple-choice tests and a 5-point Likert-scale were used to assess theoretical knowledge and to rate confidence level before and after training. Data are presented as median and interquartile range.ResultsAfter training, all participants showed significant improvement in knowledge from baseline; rate of correct answers was 50% pre-training [40.0-66.7]; 80% post-training [73.0-93.3]; P < 0.0001). There was no statistically significant difference between the two groups in knowledge before and after training. The VR group spent <60 min in VR training and had better procedural performance (OSATS scores: controls: 39 [33-45]; VR: 46 [42.0-50]; P = 0.03) and higher confidence (controls: 3 [3-4]; VR: 4 [4-5]; P = 0.002).ConclusionsAdding VR simulation to online learning improved technical skills and confidence in medical students learning chest tube insertion.

A critical problem for wireless capsule endoscopy is to be able to correlate a received image with a location, in order to more precisely locate a pathological condition (such as a lesion, or a tumor) inside the gastrointestinal tract and guide a potential subsequent surgical intervention. We treat the problem of determining the location and orientation parameters of a wireless capsule endoscope inside the human gastrointestinal tract through magnetic techniques. Considering the emerging trend in wireless capsule endoscopy towards remotely maneuverable robotic devices (also known as robotic capsule endoscopy), solving the problem of fast, accurate localization of the capsule becomes even more critical. It is also vital that the performance of different localization algorithms be characterized effectively in a repeatable manner in a controlled environment. Towards this goal, we present a design for a novel cyber-physical system to characterize the magnetic localization performance in robotic capsule endoscopy. We present some sample results for localization performance. The results indicate that highly accurate in-body localization of the capsule (with approximately 3.1 mm localization and 2.2° orientation error) is possible.

PurposeThis study aimed to assess the effectiveness of an innovative intrastromal suturing technique in an experimental rabbit model, comparing it to standard interrupted suturing, loose suture, and suturing with knot exposure.MethodsFourteen adult male New Zealand White rabbits were included in this study. Each rabbit underwent suturing in both eyes, divided into four groups based on suturing techniques. The novel intrastromal suturing technique involved burying the entire suture material within the corneal stroma. Corneal neovascularisation (CoNV) areas were evaluated by image analysis and immune cell densities by in vivo confocal microscopy (IVCM).ResultsThe intrastromal suturing group demonstrated significantly smaller CoNV areas at both 1 week and 1 month post-suturing compared to other interventional groups, indicating effective mitigation of CoNV development and progression. Moreover, this group exhibited lower immune cell densities in the superficial stromal layer and endothelial layer, suggesting a reduced inflammatory response. Both the loose suture and the knot exposure groups exhibited significant levels of CoNV and heightened immune cell densities.ConclusionThis experimental study demonstrated effectiveness of intrastromal suturing technique in limiting CoNV and immune cell infiltration, common contributors to graft rejection and complications. Furthermore, the study revealed that loose sutures and those with exposed knots are likely to cause more severe CoNV and inflammation, compared to the traditional interrupted suturing technique and intrastromal suturing.

BackgroundDeep inferior epigastric artery perforator (DIEP) flap breast reconstruction is the gold standard for autologous breast reconstruction but is complex due to variable vascular anatomy. Traditional imaging modalities like computed tomography angiography (CTA) provide two-dimensional visualization, which can limit spatial understanding. Extended reality (XR) technologies, including virtual reality (VR), augmented reality (AR), and mixed reality (MR) offer immersive three-dimensional visualization that may enhance surgical planning and intraoperative guidance. This systematic review synthesizes current evidence regarding XR applications in DIEP flap breast reconstruction.MethodsA systematic review was conducted following PRISMA 2020 guidelines. PubMed, Embase, and Scopus were searched for original research articles reporting clinical use of XR technologies in DIEP flap breast reconstruction. Data on study characteristics, XR technologies used, outcomes, and key findings were extracted and analyzed.ResultsThirteen studies involving 265 patients met inclusion criteria. Seven studies utilized AR, six used VR, and none focused on MR. XR technologies were associated with improved accuracy in perforator identification, reduced operating times, and enhanced surgical planning. Identified limitations included soft tissue deformation affecting intraoperative application, ergonomic issues with headsets, and technological constraints such as processing power and network.ConclusionXR technologies show significant potential in improving preoperative planning and intraoperative guidance in DIEP flap breast reconstruction. While preliminary results are promising, further large-scale studies are needed to establish efficacy, address limitations, and facilitate integration into clinical practice.