Surgical Innovation最新文献

Background/needTraditional bone depth gauges are notoriously inaccurate tools, often used in head and neck surgery, that estimate the screw length needed for fracture fixation after bicortical drilling. Complications related to inaccurately sized screws may include soft tissue irritation or weakness of the repair and subsequent refracture. To improve size selection accuracy, a prototype depth gauge was 3D printed and tested in mandibles.MethodsThe prototype was constructed with a rotating deployable hook and intra-operative disassembly feature to extract the device if it became stuck. Ten 3.2 mm holes were drilled in a synthetic mandible, and 12 medical students, 12 residents, and 6 fellows/attendings measured them with industry standard and prototype depth gauges. User measurements from the prototype were compared to the holes' true depths and accuracy for each device was based on a user's closeness to the true depths. Differences between devices and training levels were analyzed with paired t tests and two-way ANOVAs. The device was also tested by 2 attendings in 2 cadavers with 8 holes drilled in each mandible.ResultsIn the synthetic model, differences between true depths and measured depths for the 2 gauges were not significantly different. Total accuracy was greater with the prototype, along with increased medical student accuracy compared to the industry standard. Prototype malfunctions were noted in the cadaveric model with no significant differences in device accuracy.ConclusionA novel 3D-printed depth gauge was tested and found to improve first time user accuracy and perform non-inferiorly to an industry standard depth gauge.

BackgroundDuring laparoscopic surgeries, laparoscopes are inserted through a trocar port into the body cavity, which is then insufflated with carbon dioxide. Laparoscope lens clarity frequently becomes compromised via condensation or smearing of blood and adipose. This problem is well-known in the field, yet a viable in vivo solution has yet to address the issue and be successfully clinically adopted.Research DesignA structured cadaveric study evaluated the cleaning performance and clinician satisfaction with a novel laparoscope lens cleaning device against 2 gold-standard lens cleaning products. The novel device was also tested in a live animal porcine model to assess cleaning performance in a warm body environment qualitatively. The validation in the porcine model did not have the same evaluation process and comparison with other lens clearing methods as the cadaveric experiment.ResultsCleaning events were timed individually and analyzed post hoc. Average times to clean scopes for the novel device, Clearify™, and Fred™ Anti-Fog solution were 5 ± 5, 16 ± 7, and 14 ± 6 seconds, respectively. In 100 cleaning events with the novel device, the laparoscope was removed from the body zero times, with an average of 2 ± 1.29 cleaning actuations per event. Clearify™ and Fred™ Anti-Fog were removed from the body 102 and 116 times, with an average number of cleaning actuations of 1.07 ± 0.26 and 1.19 ± 0.53 per event, respectively. In the live porcine model, the novel device consistently cleared all debris deposited on the lens, including fog, tissue, blood, and bile fluid.ConclusionThis study demonstrates the novel device's reduction in cleaning duration and scope removals compared to gold-standard technologies, suggesting a potential for improved workflow and reduced intra-operative interruptions.

ObjectiveIn a previous randomized controlled trial, we found immersive virtual reality (VR) simulation to be effective for teaching procedural skills to medical students. We further investigated this interface's usability and cognitive load.MethodsThis was a secondary analysis of data from a previous randomized controlled trial. Twenty-two medical students with no or limited experience with VR and chest tube insertion received training for chest tube insertion using a commercially available immersive VR simulation. Participants completed post-training surveys on usability (System Usability Scale, SUS, from 0-100) and cognitive load (Leppink's scale, 11-point, 10 items). Three types of cognitive loads (intrinsic, extraneous, and germane) were evaluated. Modified Objective Structured Assessment of Technical Skills (OSATS, 5-point, 11 items) for technical skills in a mannequin simulation were assessed after VR training, and in knowledge scores before and after training were extracted to analyze their relationships with usability and cognitive load. Data are presented as median (interquartile range).ResultsMedian scores (%) for the knowledge test were 46.7 (40.0-53.3) at baseline and 86.7 (80.0-90.3) after training. The OSATS score was 40.5 (35.5-49.3), and SUS was 82.5 (73.8-88.8, with significant correlation between these variables (r = 0.51, P = 0.04). The intrinsic, extrinsic, and germane cognitive loads were 3.7 (1.8-6.1), 0.15 (0-1.4), and 9.2 (6.0-10), respectively.ConclusionCognitive load and usability of immersive VR simulation were reported to be excellent. Along with its effectiveness shown previously, VR simulation is a highly acceptable approach for teaching technical skills to medical students.

BackgroundThis study aimed to compare the outcomes of a modified submucosal ligation of the fistula tract (MSLOFT) technique with the hybrid seton technique for treating transsphincteric anal fistulas.Material and MethodsA retrospective analysis was conducted with ethical approval from Baskent University. Patients over 18 years of age with a diagnosis of transsphincteric fistula and complete data were included in the study. Patients with fistulas of non-cryptoglandular origin, incontinence, multiple fistula tracts, inflammatory bowel disease, or malignancy were excluded. The study involved 255 patients, divided into: MSLOFT (n = 31) and hybrid seton (n = 224) groups. Propensity score matching (PSM) was performed to balance age, gender, and body mass index between the groups, resulting in 30 patients per group.ResultsThere was no significant difference between the MSLOFT and hybrid seton groups regarding Wexner scores, incontinence rates, recurrence, or reoperation rates, in the overall cohort and after PSM. However, in the overall cohort and after PSM analysis, the operation time (P = 0.047) and follow-up time (P < 0.001) of the MSLOFT group were significantly longer. Recurrence was noted in 3 MSLOFT patients and 2 hybrid seton patients after PSM.ConclusionMSLOFT is a feasible and effective sphincter-preserving technique for transsphincteric anal fistulas, providing low recurrence and incontinence rates similar to the hybrid seton technique.

BackgroudHand-assisted laparoscopic surgery (HALS) is a technique that integrates the use of the surgeon's hand through a hand port device. This approach combines the benefits of open surgery, such as tactile feedback, with the minimally invasive advantages of laparoscopic surgery.PurposeDespite its benefits, the average cost of a gel hand port device is around 60,000 INR, which limits its use in resource-constrained settings such as India. To address this issue, we have developed an innovative low-cost technique ("AIIMS technique"), utilizing a number 8 size surgical glove to create a functional hand port.Study DesignA low cost innovative hand port was made using number 8 size glove sutured to the anterior rectus sheath.ConclusionThis method provides a more affordable alternative, making HALS accessible in regions with limited financial resources.

BackgroundMixed reality (MR) is an emerging technology that has been employed in medicine, providing a holographic representation of patient anatomy.PurposeThe aim of this review is to examine the use of imaging-derived holograms in the management of musculoskeletal conditions.Research DesingA literature search was performed on PubMed, Embase, Web of Science, Scopus, and Google Scholar up to June 2023, a total of 31 studies were included. A random-effects model was employed for the meta-analysis.ResultsMR has been extensively used in orthopedic surgery, spinal surgery, and interventional procedures for pain management. A 3D model is derived from DICOM images and superimposed on the surgical field. The procedure's accuracy has yielded remarkable results, especially for operators with less surgical experience. Furthermore, this technology minimises the need for intra-procedure imaging, thus reducing radiation exposure.ConclusionThe meta-analysis showed an impact of MR in reducing operatory time and improving inexperienced surgeons' accuracy.

BackgroundIn difficult colorectal cases, surgeons may opt for a hand-assisted laparoscopic (HALS) colectomy or attempt a laparoscopic surgery that may require an unplanned conversion to open (LCOS). We aimed to compare the clinical outcomes of these 2 types of surgeries.MethodsColectomies for acute diverticulitis with a HALS or LCOS surgery were selected from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) 2022 Targeted Colectomy Database. After confirming a difference in propensity scores between the cohorts, they were matched using propensity score matching (PSM) based on preoperative factors. RStudio was utilized for filtering and performing the PSM, while Minitab was used for statistical analysis.ResultsWe identified 804 HALS colectomies and 284 LCOS colectomies. After PSM, both cohorts contained 284 patients. Absolute standardized mean errors for all matched factors were less than 0.1, confirming well-balanced cohorts. Following PSM, preoperative and perioperative factors were similar between both colectomy groups. Postoperatively, HALS surgeries had a shorter average length of stay (7.67 ± 0.38 vs 10.57 ± 0.41, P < 0.001) as well as lower rates of ileus (13.73% vs 22.54%, P = 0.007) and superficial surgical site infection (2.11% vs 5.28%, P = 0.045).ConclusionTo the best of our knowledge, this is the first national database study comparing HALS and LCOS colectomies. After accounting for confounding variables, our PSM analysis showed the benefits of HALS colectomies for acute diverticulitis. Future studies may use single-center data containing risk adjustment profiles to create an even more uniform comparison.

Background: This study evaluates the feasibility of Apple Vision Pro goggles as an augmented reality (AR) surgical navigation tool for laparoscopic-assisted ultrasound-guided radiofrequency ablation (RFA) of liver tumors. Traditional RFA is effective but challenging due to the integration of multiple imaging modalities.Purpose: The primary aim of this research is to assess how Vision Pro goggles can enhance the surgical navigation process during RFA, improving tumor localization and the overall effectiveness of the procedure.Research Design: A feasibility study design was used to analyze the implementation of AR technologies in surgical navigation, focusing specifically on their application in laparoscopic surgeries.Study Sample: Participants included patients undergoing laparoscopic-assisted ultrasound-guided RFA, with pre-operative imaging workups involving CT and MRI scans followed by intraoperative laparoscopic sonography.Data Collection and/or Analysis: Data were collected through observations during surgical procedures using the Vision Pro goggles, which displayed various imaging inputs (MRI, 3D reconstruction, and laparoscopic sonography) in the surgeon's field of view. Image manipulation was assessed based on accuracy and effectiveness of tumor ablation.Results: The goggles enhanced tumor localization accuracy and facilitated real-time image manipulation, resulting in effective tumor ablation. Initial results show promising outcomes in the precision and efficiency of the RFA procedure.Conclusions: While the initial results are promising, larger studies are necessary to validate the technology's efficacy and safety. Future research should compare outcomes with traditional methods and explore its applicability to other surgeries, aiming to refine the system further. The Vision Pro goggles potentially represent a significant advancement in surgical technology by improving RFA precision and efficiency.

Objective. This prospective comparative study evaluated the efficacy and relationship between laparoscopic origami crane training (LOCT) and the Fundamentals of Laparoscopic Surgery (FLS) score using 3D vs 2D laparoscopy.Methods. From 2020 to 2023, fourth-year medical students at Asahikawa Medical University created 20 origami cranes (1 per day) in a laparoscopic dry box. FLS scores were assessed 5 times, corresponding to every fifth crane. Primary outcomes included LOCT production time, quality, and FLS scores, analyzed using the Mann-Whitney U test and repeated-measures ANOVA.Results. Eighteen participants were divided into 2 groups: 8 in the 3D laparoscopy (3D) group and ten in the 2D laparoscopy (2D) group. At the end of the study, the 3D group (16.5 min) produced cranes significantly faster than the 2D group (27 min, P = 0.02). Repeated-measures ANOVA showed that the production time, origami crane score, and FLS score improved over time. The 3D group had a significantly shorter production time (F (1, 16) = 8, P = 0.01). The origami crane score was not significantly different between the groups (F (1, 7) = 3, P = 0.13) but tended to be higher in the 3D group. No significant differences were found in the FLS scores between the groups for any task. A significant negative correlation between LOCT production time and FLS score in both groups confirmed that shorter production time correlated with higher FLS scores.Conclusions. LOCT is effective for extraclinical laparoscopic training and correlates with FLS scores. 3D laparoscopy may help beginners develop depth perception, improve bimanual and hand-eye coordination, and enhance LOCT effectiveness.

BackgroundArtificial intelligence (AI) is revolutionizing various aspects of health care, particularly in the surgical field, where it offers significant potential for improving surgical risk assessment, predictive analytics, and research advancement. Despite the development of numerous AI models in surgery, there remains a notable gap in understanding their specific application within the context of hernia surgery.PurposeThis review aims to explore the evolution of AI utilization in hernia surgery over the past 2 decades, focusing on the contributions of Machine Learning (ML), Natural Language Processing (NLP), Computer Vision (CV), and Robotics.ResultsWe discuss how these AI fields enhance surgical outcomes and advance research in the domain of hernia surgery. ML focuses on developing and training prediction models, while NLP enables seamless human-computer interaction through the use of Large Language Models (LLMs). CV assists in critical view detection, which is crucial in procedures such as inguinal hernia repair, and robotics improves minimally invasive techniques, dexterity, and precision. We examine recent evidence and the applicability of various AI models on hernia patients, considering the strengths, limitations, and future possibilities within each field.ConclusionBy consolidating the impact of AI models on hernia surgery, this review provides insights into the potential of AI for advancing patient care and surgical techniques in this field, ultimately contributing to the ongoing evolution of surgical practice.