Abstract:

Technical limitations, mostly related to the issue of time delay for transmission of digitized information, had prevented the development of remote surgery intended as performance of a complete surgical procedure from long distances. To overcome the issue of time delay, tests and researches performed with the joined effort of surgeons, robotic and telecommunication engineers convinced our group that use of the high-speed terrestrial network [asynchronous transfer mode (ATM) service], rather than satellite connections, would significantly reduce the time lag for transmission of data. Using ATM technology, our group demonstrated the feasibility of performing surgery across transoceanic distances by safely carrying out a laparoscopic cholecystectomy, first on an animal model and later (September 7, 2001), on a patient. Using ATM technology, the mean time lag for transmission of data and images was 155 msec despite a total roundtrip distance of 14,000 km. Teletransmission of active surgical manipulations have the potential to ensure availability of surgical expertise in remote locations for difficult or rare operations, and improve surgical training worldwide. However, several limitations remain for remote surgery to become commonplace. Among these, the need to render ATM network available to hospitals, costs of technology, ethical and liability issues, and possible conflicts of jurisdictions between countries involved.

Authors:

Jacques Marescaux, M.D., F.R.C.S.-University Louis Pasteur, Strasbourg, France; Francesco Rubino, M.D.-IRCAD-EITS, Strasbourg, France; Catholic University, Rome, Italy

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Abstract:

Biosynthesized cellulose is produced by the bacteria, Acetobacter xylinum, and possesses unique properties not present in other biomaterials. The material is formed during fermentation having a multi-layered structure composed of fine, nonwoven, cellulose hydrophilic fibers. This structure allows biosynthesized cellulose to have a high-fluid capacity, superior strength, and biocompatibility, which makes it suitable for topical and implantable biomedical applications. Initial product development of biosynthesized cellulose has focused on advanced wound-care applications. The product, XCell® (Xylos® Corporation, Langhorne, PA, USA), has been bioengineered to have the ability to both donate and absorb moisture, depending on the wound environment. Comparative bench testing has shown that XCell® is the only wound dressing with this unique dual-fluid-handling capability. The product has been studied thoroughly using animal models and proved to be safe and biocompatible. Human clinical testing has demonstrated its effectiveness in providing a moist environment, essential to treating hard-to-heal chronic wounds. The major clinical benefits of the product include: 1) help in removal of non-viable tissue and promotion of autolytic debridement, which results in increased granulation tissue; 2) cleansing of wound margins that leads to epithelial migration and reduction of wound size; and 3) healing of various types of chronic wounds.

Authors:

Victor H.Frankel, M.D., Ph.D., K.N.O.- Hospital for Joint Diseases Orthopaedic Institute, New York, New York; Gonzalo C.Serafica, Ph.D.-Xylos® Corporation, Langhorne, Pennsylvania; Christopher J.Damien, Ph.D.-Xylos® Corporation, Langhorne, Pennsylvania

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Abstract:

Minute pieces of debris left in the surgical site can interfere with optimal wound healing. Even when these microbodies are not obvious without magnification, their presence can cause post-surgical complications including infections, amplified and prolonged inflammation, permanent tissue damage, exaggerated and reduced quality scarring, granulomas, adhesions, organ dysfunction, infertility, and other pathological consequences. This chapter reviews foreign debris-initiated, post-surgical complications; presents associated pathological mechanisms; identifies sources of debris contamination; describes foreignmicrobody characteristics that can further amplify pathological responses; and presents recommendations for minimizing their presence.

Authors:

Wava Truscott, Ph.D.- Kimberly-Clark Health Care, Roswell, Georgia

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Abstract:

The serious clinical and economic impact of venous thromboembolic (VTE) disease is undisputed. What concerns practitioners and researchers alike is the seeming inability to truly mitigate the ramifications of VTE, especially in the post-surgical or postoperative subpopulation, in whom the risk of VTE is disproportionately high and often asymptomatic. Ironically, current approaches to the diagnostic evaluation of suspected VTE patients tend to favor the application of anatomic modalities, either invasive or technically challenging (eg, venography) or the performance of which is clinically inadequate (eg, ultrasonography) for post-surgical/postoperative patients. These modalities' primary principle of detection rely on the effects or results of an intricate pathophysiologic process, seemingly ignoring the critical role and potentially better prognostic value of endogenous hemostatic mechanisms. In other words, are we using the correct tools to seek the appropriate types of information in patients with suspected VTE? Research in nuclear medicine techniques for detecting VTE began approximately 25 years ago. Recently, the emergence of radiolabeled peptides as a clinically applicable technology platform has encouraged a different approach to evaluating VTE. Many radiolabeled peptide candidates are undergoing preclinical and clinical research. Currently, only one, 99mTc-apcitide (AcuTect), has been approved (since 1998) for clinical use in the United States. The growing numbers of physicians with experience using 99mTc-apcitide (including those who remember using 111In-fibrinogen) has fueled ongoing clinical research to further elucidate the benefits of this unique peptide technology. Consequently, significant insight has been gained from large prospective clinical trials, of which one was conducted to support the approval of 99mTc-apcitide in Europe. Furthermore, this insight has kindled increasing interest in 99mTc-apcitide and potential new entrants into this special "diagnostic class" (ie, radiolabeled peptides). Unlike the more popular anatomic modalities, radiolabeled peptides circumvent many of the clinical and anatomic challenges to objectively and accurately diagnose VTE. The importance of an objective and accurate diagnosis is understood, because it is paramount to a cost-effective treatment strategy. In addition to describing the current activities concerning the development and use of radiolabeled peptides for clinical practice, this manuscript is intended to promulgate a thought-provoking argument for changing our current approach to the diagnostic evaluation of VTE, which also may transcend the post-surgical/postoperative subpopulation.

Authors:

Marc P.Bernarducci, Pharm.D., M.B.A.- Current Medical Directions, Inc., New York, New York

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Abstract:

Telemedicine, the use of telecommunications technologies to deliver health services over a distance, is emerging as an innovative tool for the field of surgery. Recent feasibility and demonstration projects have documented the potential of telesurgery, the performance of a surgical intervention by a surgeon not physically located with the patient. However, the use of telemedicine for surgical services expands beyond telepresence surgery to include telementoring, teleproctoring, teleconferencing, and teleconsulting. This chapter overviews the current status of telemedicine applications across the full range of surgical care, which include training, preoperative, operative, and postoperative follow up. Although telesurgery garners the most attention, the paper concludes with the argument that the actual mainstay for telesurgery is the telemedicine components offered in the continuum of surgical services.

Authors:

Pamela Whitten, Ph.D.- Department of Telecommunications, Michigan State University, East Lansing, Michigan; Frances Mair, M.D.- Department of Primary Care University of Liverpool, Liverpool, Great Britain

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