Abstract:

Laparoscopy has gained a place in everyday surgical routine as an alternative surgical approach that decreases morbidity and postoperative hospitalization. Single port laparoscopic surgery has been introduced as a further development of laparoscopy. The feasibility and safety of single port laparoscopy is under extensive evaluation in specialized laparoscopic centers. Nevertheless, wide acceptance of the technique requires adequate documentation of the advantages of the approach over conventional laparoscopy and further refinement of surgical instrumentation to overcome intraoperative ergonomic problems.

Authors:

Evangelos Liatsikos, M.D., Ph.D., Assistant Professor, Department of Urology, University of Patras, Rio Patras, Greece, Department of Urology, University of Leipzig, Leipzig, Germany, Iason Kyriazis, M.D., Department of Urology, University of Patras, Rio Patras, Greece, Panagiotis Kallidonis, M.D., Department of Urology, University of Patras, Rio Patras, Greece, Minh Do, M.D., Department of Urology, University of Leipzig, Leipzig, Germany, Anja Dietel, M.D., Department of Urology, University of Leipzig, Leipzig, Germany, Christos Rigopoulos, M.D.,Department of Urology, University of Patras, Rio Patras, Greece, Abdulrahman Al-Aown, M.D., Department of Urology, University of Patras, Rio Patras, Greece, Jens-Uwe Stolzenburg, M.D, Ph.D., Professor, Department of Urology, University of Leipzig, Leipzig, Germany

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Abstract:

Recurrent laryngeal nerve (RLN) palsy during thyroidectomy is associated with multiple risk factors as patient- and surgeon-related bailiff. The risk is greater for thyroid cancer, Graves' disease, re-operation, and mediastinal goiter in less experienced centers and in patients in whom the RLN could not be identified during operation. Anatomical landmarks exist to identify RLN. Nevertheless, transient and permanent RLN injuries still exist. Intraoperative neuromonitoring (IONM) has been introduced to facilitate identification and verify functional integrity of the RLN in thyroid surgery. In this chapter, we present relevant medical literature and personal experience on thyroid surgery with IONM. Technical, medical, and legal aspects of monitoring are discussed.

Authors:

Gianlorenzo Dionigi, M.D., F.A.C.S., Associate Professor of Surgery, Director, Endocrine Surgery Research Center, Alessandro Bacuzzi, M.D., Endocrine Surgery Research Center, Luigi Boni, M.D., F.A.C.S., Associate Professor of Surgery, Endocrine Surgery Research Center, Francesca Rovera, M.D., Endocrine Surgery, Research Center, Stefano Rausei, M.D., Endocrine Surgery Research Center, Francesco Frattini, M.D., Endocrine Surgery Research Center, Renzo Dionigi, F.A.C.S., F.R.C.S. (Hon. Edin.), Full Professor of Surgery, Endocrine Surgery Research Center, Director, Department of Surgical Sciences, University of Insubria, Varese-Como, Italy

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Abstract:

In natural orifice transluminal endoscopic surgery (NOTES) using a single endoscope, the visual field moves unstably and a wide blind space is formed. We used wireless two wireless CCD cameras (270,000 and 380,000 pixels) placed on the abdominal wall of pigs and a conventional endoscope (410,000 pixels) at the same time to assess whether it was possible to observe the entire process of sigmoidectomy by NOTES. The titanium dioxide-coated lens was used as an antifogging apparatus. To control the CCD image frames, a magnetic body was affixed to the back of the CCD camera unit. To select a suitable visual-transmitter, three frequency bands were assessed: 0.07 GHz, 1.2 GHz, and 2.4 GHz. The cameras showed good performance for monitoring all procedures of the sigmoidectomy. The magnetic force most suitable to control the cameras was found to be 360 mT, and the best transmission frequency was 1.2 GHz. The battery could be used for up to 4 hours with intermittent use. The issue of lens fogging could be resolved by a water supply into the anal canal and a more than 12-hour ultraviolet irradiation. We verified that the CCD camera with the titanium dioxide-coated lens may be useful as the second eye in NOTES.

Authors:

Takeshi Ohdaira, M.D., Department of Advanced Medicine and Innovative Technology, Kyushu University Hospital, Hukuoka, Japan, Yoshikazu Yasuda, M.D., Professor, Department of Gastrointestinal/General Surgery, Jichi Medical University, Tochigi, Japan, Makoto Hashizume, M.D., Professor, Department of Advanced Medicine and Innovative Technology, Kyushu University Hospital, Hukuoka, Japan

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Abstract:

Brain tissue retraction is frequently required to reach deep intra-axial lesions, and the quest for an ideal retractor that would protect the underlying brain tissue continues. Despite the availability of multiple retractors, the incidence of brain retraction injury remains high and has been reported to be 5% to 10%. A recently developed transparent tubular retractor appears to provide several advantages in surgery for deep intra-axial tumors and intracerebral hematomas. We used a new commercially available transparent tubular retractor in 16 craniotomies. Fourteen of these patients were operated upon for deep tumors and cysts, including two intraventricular tumors and two for deep intracerebral hemorrhages. In all patients, the tubular retractor was directed toward the lesion through a small corticotomy and guided by a navigation system. Each lesion was completely removed through the retractor's lumen. In all cases, the tubular retractors provided excellent visualization of the underlying pathology and facilitated its surgical removal, dissection, and hemostasis. The tubular nature of the retractor allowed the rotation and changing the angle of approach without putting extra pressure on the brain tissue, which inevitably occurs when malleable or other ribbon-type retractors are used. There were no hematomas on routine postoperative CT scans in this series. Transparent tubular retractors provide a unique means of deep visualization and even force distribution at the retracted brain tissue. Although these retractors were originally designed for the removal of deep subcortical tumors, they may be used to access and evacuate intracerebral hematomas. In our experience, the use of tubular retractors allows one to achieve safe access to deep intracerebral lesions and decreases the rate of retraction-related complications.

Authors:

Sebastian R. Herrera, M.D., Neurosurgery Resident, John H. Shin, M.D., Neurosurgery Resident, Michael Chan, M.D., Neurosurgery Resident, Pelagia Kouloumberis, M.D., Neurosurgery Resident, Eduardo Goellner, M.D., Neurosurgery Fellow, Konstantin V. Slavin, M.D., Associate Professor, Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA

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Abstract:

The aim of the study was to determine if the concept of face and construct validity may apply to the SurgicalSim Educational Platform (SEP) "robot" simulator. The SEP robot simulator is a virtual reality (VR) simulator aiming to train users on the Da Vinci Surgical System. To determine the SEP's face validity, two questionnaires were constructed. First, a questionnaire was sent to users of the Da Vinci system (reference group) to determine a focused user-group opinion and their recommendations concerning VR-based training applications for robotic surgery. Next, clinical specialists were requested to complete a pre-tested face validity questionnaire after performing a suturing task on the SEP robot simulator. To determine the SEP's construct validity, outcome parameters of the suturing task were compared, for example, relative to participants' endoscopic experience. Correlations between endoscopic experience and outcome parameters of the performed suturing task were tested for significance. On an ordinal five-point, scale the average score for the quality of the simulator software was 3.4; for its hardware, 3.0. Over 80% agreed that it is important to train surgeons and surgical trainees to use the Da Vinci. There was a significant but marginal difference in tool tip trajectory (p = 0.050) and a nonsignificant difference in total procedure time (p = 0.138) in favor of the experienced group. In conclusion, the results of this study reflect a uniform positive opinion using VR training in robotic surgery. Concepts of face and construct validity of the SEP robotic simulator are present; however, these are not strong and need to be improved before implementation of the SEP robotic simulator in its present state for a validated training curriculum to be successful.

Authors:

O.A.J. van der Meijden, M.D., Resident, Department of Orthopaedic Surgery, Medical Center Alkmaar, Alkmaar, The Netherlands, I.A.M.J. Broeders, M.D., Surgeon, Twente University, Institute of Technical Medicine, Department of Surgery, Meander Medical Centre, M.P. , Schijven, M.D., Surgeon, Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands

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