Seminars in laparoscopic surgery最新文献

Recent advances in visualization technology are being driven by two important trends: (1) continued increases in speed and function of hardware devices and (2) increasingly parallel, distributed, cooperative systems. The incorporation of fast, powerful devices into cooperative systems enables a complex interplay of sensors, displays, and computational components that can create a seamless, perceptually rich and flexible environment. Although these trends have fueled a number of advances in visualization research, the unique requirements of laparoscopy make direct, effective use of visualization technology as it is applied in other contexts extremely challenging. This article discusses promising new capabilities in visualization technology. The costs and tradeoffs create new challenges, which are addressed in some visualization applications, but must be carefully assessed in the context of the laparoscopic environment. Incorporating new visualization technology in a way that captures its benefits and meets stringent laparoscopic requirements will very likely precipitate an enormous surge forward in the capabilities of the surgical team and in the quality of patient care.

The integration of telecommunications and information technologies in medicine, known as telemedicine, has traditionally been outside the operating room. However, with the advent of new technologies, smart systems, and advanced computing, adoption and adaptation of these technologies in the operating room has increased. The operating room has been a place of startling isolation. The operating room is an island within a health system that is only reached by a select few. The application of telemedicine in this inaccessible place offers a huge potential in a variety of ways. These include enhanced education for students, enhanced safety for the patient, enhanced knowledge of the events that occur-a sort of status monitoring of underlying infrastructures-and sharing of the operating environment for collaboration. The Operating Room of the Future will be linked to other islands of expertise by robust telemedicine capabilities, thereby eliminating the isolation. Telemedicine in tomorrow's operating room is a natural fit

The minimally invasive surgical revolution has changed the way surgery is practiced. It has also helped surgical innovators to break the tethers that anchored the practice of surgery in an early 20th century operating room environment. To some in surgery, the Operating Room of the Future will be seen as a revolution but to others, an inevitable evolution of the changes ushered in by the adoption of minimally invasive surgery. Although minimally invasive surgery has conferred considerable advantages on the patient, it has imposed significant difficulties on the surgeon, which in turn, have impacted outcomes. These difficulties were primarily human factor in nature and were poorly understood by critical groups such as device manufacturers, surgeons, and surgery educators and trainers. This article details what these human factors were, how they related to the practice of minimally invasive surgery, and how they will impact on the practice of surgery in the Operating Room of the Future. Much of the technology for the Operating Room of the Future currently exists (eg, surgical robotics, virtual reality, and telemedicine). However, for it to function optimally it must be integrated in a fashion that takes on board the human factor strengths and limitations of the surgeon. These advanced technologies should then be harnessed to optimize surgical practice. In some cases, this will involve rethinking existing technologies (ie, three-dimensional camera systems), applying technologies that currently exist in a manner that is more systematic and better managed (ie, surgical robots and virtual reality), and a reconsideration of who should be applying these technologies for the practice of surgery in the 21st century. In all cases, there will be education and training implications for the practitioner. Lastly, there must be unequivocal demonstration that these changes bring about positive benefits for patients in terms of better outcomes and for surgeons in terms of ability and ease of doing their job. After the experiences of the last decade with minimally invasive surgery, the Operating Room of the Future should be seen as a well-grounded evolution, not a revolution.

The Operating Room of the Future will be characterized by meticulous preoperative planning, full integration of the operating room into the general flow of information, more comprehensive intraoperative diagnostic imaging procedures, and the use of sophisticated visualization processes including augmented reality. Mechatronic support (partially autonomous robots) enhances safety and allows reduction of staff. Integrated operating room systems will allow the wide spectrum of new devices and functionalities to be easily controlled by the operating team. The Operating Room of the Future will no longer be isolated from the rest of the clinical endeavor. Intraoperative teleconsultation and telepresence will help to promote and teach safer evidence-based endoscopic therapeutic surgery. Traditional surgical intervention will expand its definitions by procedures via an interdisciplinary, cooperative approach that will replace the sequential therapeutic process of today.

The Operating Room of the Future is a construct upon which to develop the next generation of operating environments for the patient, surgeon, and operating team. Analysis of the suite of visions for the Operating Room of the Future reveals a broad set of goals, with a clear overall solution to create a safe environment for high-quality healthcare. The vision, although planned for the future, is based upon iteratively improving and integrating current systems, both technology and process. This must become the Operating Room of Today, which will require the enormous efforts described. An alternative future of the operating room, based upon emergence of disruptive technologies, is also presented.

Federal regulation of medical devices began in 1976 with the signing of the Medical Device Amendments to the Food, Drug and Cosmetic Act. For the purpose of regulating medical devices, the Food and Drug Administration is divided into various divisions and branches, including the Office of Device Evaluation. The evolution of the Food and Drug Administration's regulations of laparoscopic devices is described. Also described is the technology of laparoscopic surgical devices and how they are regulated by the Office of Device Evaluation. Trends towards the future of laparoscopic devices, and their regulation, are reviewed.

For many years, computers have supported complex clinical ancillary functions such as the laboratory, radiology, endoscopy, and others. Digital computers have been successfully incorporated into specialized clinical instruments to offer advanced digital devices such as fetal monitors, heart monitors, and imaging equipment. But these devices are often not fully integrated with clinical management and operational systems. Beyond ancillary department applications, the result of almost 30 years of trying to automate the clinical processes in healthcare is large investments in both computer systems and paper medical records that have resulted in paper-based, computer-assisted processes of care. This expensive combination of partial clinical automation and archaic paper-based support processes is a major obstacle to improvements in care delivery and management. The need to use software, informatics, and standards to help manage the operating room and perioperative processes of care is significant. The potential to reduce adverse events, cost of care, and to enhance the quality of care are real and worth attaining. This paper focuses on what medical informatics improvements are needed to support improvements in surgical care and to assist in the management of the highly complex operating room and perioperative care process, and proposes research priorities in these areas.

A culture of safety is an achievable objective for perioperative management. Research in analysis, safety factors, alarms, instruction, and management can make this change rapidly. It is important to build the data and evidence for those practices that show improved patient outcomes. Those practices and the processes that develop them should be sanctioned by responsible organizations in active collaboration.