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Decadt, Bart. "Evidence-based laparoscopic surgery." Thesis, University of East Anglia, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.268504.
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Wyles, Susannah Mary. "Training in advanced laparoscopic surgery." Thesis, Imperial College London, 2013. http://hdl.handle.net/10044/1/18015.
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Laparoscopic surgery is an example of a practical technique within medicine that can have a lengthy learning curve to gain competence. A change in NICE guidance in 2006 prompted the development of a National Training Programme (NTP) to train consultant surgeons in laparoscopic colorectal surgery (LCS). Using the NTP and enrolled trainers and trainees as a backbone for the studies within this research, the aim was to address “how” and “who” should be training LCS. A comprehensive search of the literature was performed. Through this, and the application of a qualitative research approach employing interview studies, data were gleaned, items derived, questionnaires developed and using a Delphi consensus technique, item importance determined. From this, three detailed assessment forms (mini-Structured Training Trainer Assessment Report (mini-STTAR) and the STTAR, and GAS form) were created to allow both the trainee and an observer to provide feedback to the trainer regarding their training structure, behaviour, attitudes and role modelling, and also the trainee’s progress to be assessed. A formal analysis of trainer and trainee learning and teaching styles and personality was performed (Honey and Mumford, Staffordshire Evaluation of Teaching Styles (SETS) and 16PF respectively), and the impact of these factors on training outcomes assessed. Detailed questionnaires addressed the trainees’ opinions of different training modalities within courses, and the NTP structure as a whole. The training of advanced laparoscopic surgery was found to best match the educational theory of cognitive apprenticeship. The cadaveric model for LCS training course was thought to be superior to porcine or virtual reality in terms of fidelity and educational value and fidelity. The assessment tools were validated and implemented successfully into the programme. Despite detailed analysis, no single psychometric test could be used to predetermine the good trainers. Overall the NTP in its current format was deemed to be acceptable.
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Avcil, Tuba [Verfasser], and Arkadiusz [Akademischer Betreuer] Miernik. "Single‑incision transumbilical surgery (SITUS) versus single‑port laparoscopic surgery (SPLS) versus conventional laparoscopic surgery (CLS) im Trainingslabor." Freiburg : Universität, 2019. http://d-nb.info/1206537043/34.
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Andersson, Lena. "Haemodynamic and ventilatory effects of laparoscopic surgery /." Stockholm, 2004. http://diss.kib.ki.se/2004/91-7349-754-1/.
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Howard, Thomas. "Haptic feedback for laparoscopic surgery instruments." Thesis, Paris 6, 2016. http://www.theses.fr/2016PA066270.
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La présente thèse traite de l'utilisation de retours haptiques pour fournir des informations aux chirurgiens durant des opérations de chirurgie minimalement invasive dans le but de les aider à améliorer leurs gestes.De meilleurs résultats pour les patients on amené la chirurgie minimalement invasive à devenir le standard pour bon nombre d'interventions. Cependant, la perte de perception de profondeur, la coordination main-oeil compliquée ainsi que les distorsions de sensations haptiques compliquent largement la tâche pour le chirurgien. Nous explorons le potentiel de retours haptiques pour intuitivement assister les chirurgiens durant des gestes de chirurgie minimalement invasive. Les formes de retour évaluées sont principalement haptiques (tactiles et kinesthésiques), avec des comparaisons à des retours visuels et multi-modaux (combinaisons de retours visuels et haptiques).Nos expériences dans le domaine de la navigation d'outils de chirurgie montrent des résultats encourageants quand aux bénéfices obtenus par des retours haptiques en termes d'amélioration de la qualité du geste chirurgical. Les guides par "virtual fixtures" montrent une nette supériorité par rapport aux autres formes de retour étudiées, cependant les retours vibrotactiles permettent aussi des améliorations notables. Des travaux parallèles sur le retour d'informations au sujet des efforts d'intéraction en bout d'outils a mis en évidence des différences importantes en termes des exigences de conception pour le retour tactile. Ceci nous a permis d'effectuer une conception et validation préliminaire de retours tactiles spécifiques à des applications de maitrise d'efforts, en utilisant l'exemple de la sutureThe present thesis focuses on the use of haptic feedback technologies to provide information to surgeons during laparoscopic or minimal access surgery (MAS) with the aim of assisting them in improving their gestures.Better overall outcomes for patients have led MAS to become standard for many surgical interventions. However, loss of visual depth perception, difficult hand-eye coordination and distorted haptic sensation seriously complicate this task for the surgeon. We explore the potential of haptic cues for intuitively assisting surgeons during MAS gestures. Evaluated forms of feedback mainly focus on haptic (tactile and kinaesthetic) cues, but include comparisons to visual and multi-modal combined haptic and visual cues.Experiments on surgical tool navigation show encouraging results for the benefit of haptic cues in improving surgical gestures, with clear superiority of soft guidance virtual fixtures over other forms of feedback. However, promising results for the use of vibrotactile feedback are also obtained. These results are confirmed in preliminary experiments on tool navigation in preliminary experiments on tool navigation during a laparoscopic cutting training task.Parallel work on feeding back interaction forces highlighted significant differences in the usability and design requirements for tactile cues when compared to instrument navigation applications. This led us to design and perform preliminary testing on tactile cues appropriate force information in the case of intra-corporeal suture knot tying
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Fors, Diddi. "Gas Embolism in Laparoscopic Liver Surgery." Doctoral thesis, Uppsala universitet, Anestesiologi och intensivvård, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-171797.
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Laparoscopic liver surgery is complicated due to the structure of this organ with open sinusoids. A serious disadvantage is the risk of gas embolism (GE) due to CO2 pneumoperitoneum. CO2 can enter the vascular system through a wounded vein. A common opinion is that gas fluxes along a pressure gradient, e.g. CVP-intra abdominal pressure (IAP). The occurrence of GE could also be eased by entrainment, a ‘Venturi-like’ effect, due to cyclic differences in thoracic pressure and blood flow caused by mechanical ventilation at normal frequency. The aims of these studies were to survey, in a porcine model, the influence on respiratory and haemodynamic variables by GE, to determine at what frequency, severity and duration GE occurs during laparoscopic liver resection (LLR) and whether there are methods to influence the occurrence or severity of GE. Pulmonary and circulatory variables were monitored and measured as well as continuous blood gas monitoring. Transoesophageal echocardiogram was used to identify GE and, according to the amount of bubbles in the right outflow tract of the heart, GE was graded as 0, 1 and 2. Pneumoperitoneum was created by using CO2and IAP was set to 16 mm Hg. A single bolus dose of CO2 influenced respiratory and haemodynamic variables for at least 4 h. During LLR GE occurred in 65-70% of the animals, of which the more serious caused negative influence on cardiopulmonary variables. Elevated PEEP (15 cm H2O) increased CVP but GE occurred irrespective if CVP was lower than or exceeded IAP. In two last studies, a hepatic vein was cut and left open for 3 m before it was clipped. Interestingly, no signs of GE were seen despite an open vein and IAP > CVP in 8 of 20 animals. In the last study high frequency jet ventilation was used in order to minimise the risk of entrainment. The duration of GE was shortened. The occurrence of GE seemed to be influenced by several different factors. The physiological reaction of a GE is impossible to predict for a specific patient, and depends among other factors on comorbidity, and amount, site and entrance rate of GE.
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Dong, Lin. "Assistance to laparoscopic surgery through comanipulation." Thesis, Paris 6, 2017. http://www.theses.fr/2017PA066305/document.
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La chirurgie laparoscopique conventionnelle apporte des avantages aux patients mais pose des défis aux chirurgiens. Utiliser le robot permet de surmonter certaines des difficultés. Nous utilisons ici le concept de comanipulation, où un bras robotique sert de comanipulateur et génère des champs de force pour aider les chirurgiens. Pour implémenter des fonctions telles que la compensation de la gravité de l’instrument, il est utile de connaître la position du trocart en temps réel par rapport à la base du robot. Nous proposons un algorithme de détection et localisation de trocarts, basé sur la méthode du moins carré. Des expériences in vitro et in vivo valident son efficacité. Considérant des caractéristiques de la chirurgie laparoscopique, i.e., de l’espace de travail grand et de la difficulté de planifier le geste, des champs visqueux sont utilisés. Afin de s’adapter aux mouvements différents, nous utilisons une loi de commande de viscosité variable. Cependant, elle rencontre un problème d’instabilité, qui est analysé théoriquement et expérimentalement. Une solution d’ajout d’un filtre passe-bas de premier ordre est proposée, dont l’efficacité est mise en évidence par une expérience de ciblage point à point. Avec la position du trocart connue, nous pouvons établir «le modèle de levier», une formule décrivant la relation entre les vitesses et les forces appliquées à différents points de l’instrument. Ceci permet de mettre en œuvre une loi de commande de viscosité sans utiliser de signaux bruités, au point de centre de la poignée ou la pointe de l’instrument. Une expérience est menée pour comparer l’influence de la loi de commande sur les comportements de mouvement humainTraditional laparoscopic surgery brings advantages to patients but poses challenges to surgeons. The introduction of robots into surgical procedures overcomes some of the difficulties. In this work, we use the concept of comanipulation, where a 7-joint serial robotic arm serves as a comanipulator and generates force fields to assist surgeons.In order to implement functions like instrument gravity compensation, identifying real-time trocar position with respect to robot base is a prerequisite. Instead of obtaining trocar information from the registration step, we propose a robust trocar detection and localization algorithm based on least square method. Both in-vitro and in-vivo experiments validate its efficiency.Considering the characteristics of laparoscopic surgery, i.e., relatively large workspace and flexible operating objects, viscous fields are employed. To better adapt to different motion, we use a variable viscosity controller. However, this controller encounters an instability problem, which is analyzed both theoretically and experimentally. A solution of adding a first order low pass filter is proposed to slow down the variation of the viscosity coefficient, whose efficiency is evidenced by a point-to-point targeting experiment.With real-time trocar position known, the “lever model”, a formula describing therelationship of the velocities and forces of different instrument points, can be established. This allows implementing viscosity controller without using noisy signals at the center points of instrument handle and tip. Another point-to-point movement experiment is conducted to compare the features of the controller influence on human motion behaviors
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Tran, Hanh Minh. "Advances in Minimally Invasive Hernia Surgery: Single Incision Laparoscopic Surgery." Thesis, The University of Sydney, 2015. http://hdl.handle.net/2123/13646.
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Minimally invasive surgery has become increasingly adopted in the treatment of abdominal wall hernias. Indeed, in 2014, 51% of all inguinal hernias were repaired laparoscopically in Australia. In an attempt to further reduce parietal trauma single-incision laparoscopic surgery (SILS) has potential to reduce trocar-induced injuries, port-site hernias, post-op pain, analgesic requirement, quicken return to work/physical activities and improve cosmetic results. The relative loss of triangulation to perform the repair can be overcome using small and longer laparoscope, modifying dissection techniques and with increasing experience. Our prospective randomized controlled study comparing single-port vs multiport totally extraperitoneal inguinal herniorraphy confirmed safety, efficacy, cosmetic and non-cosmetic benefits of single-port approach and, with further technical refinement, by dissecting the extraperitoneal space under direct vision and hence obviating the need for costly balloon dissectors, we demonstrated it was possible to retain the benefits of single-port surgery while making it highly cost effective compared to multiport surgery. Having overcome technical challenges of single-port technique, we demonstrated that SILS can safely be applied to other types of abdominal wall pathologies including diastasis of the recti, ventral/incisional, spigelian, parastomal and re-recurrent inguinal hernias. This thesis demonstrates that SILS presents a credible alternative to conventional multiport hernia surgery.
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Mouton, Wolfgang Georg. "Effects of humidified gas insufflation in endoscopic surgery /." Title page, contents and abstract only, 1998. http://web4.library.adelaide.edu.au/theses/09MS/09ms934.pdf.
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Baffoe, Seth Kojo Ananse. "Comparing Outcomes of Laparoscopic Adjustable Banding and Laparoscopic Sleeve Gastrectomy Bariatric Surgery." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4996.
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Bariatric surgery is an effective procedure type for morbidly obese patients when all else fails. Because obesity is a chronic disease, prolonged assessment and understanding of the credibility of procedure types and their effects on bariatric surgery outcomes are essential, yet current evidence shows decreasing utilization of one of the dominant procedure types. To better compare outcomes of procedure type, this research was designed to control for volume, hospital size, age, gender, season, month, year, and ethnicity. The goal of the study was to compare the outcomes of laparoscopic adjustable gastric banding (LAGB) and laparoscopic sleeve gastrectomy (LSG) bariatric surgery using the epidemiologic triad model. This study was a retrospective cross-sectional review of Nationwide Inpatient Sample (NIS) from 2009 to 2014. Univariate and multivariate logistic regression were conducted to analyze the data. This study was based on a secondary analysis previously collected from NIS data. A convenience sample of 73,086 patients who underwent bariatric surgery using ICD-9 diagnosis and procedure codes was used. Multiple logistic regression analysis indicated that LAGB (odds ratio [OR] =.043) and LSG (OR =.030) were positively associated with in-hospital mortality. Similarly, LAGB (OR =.041) and LSG (OR =.425) were positively correlated to length of stay (LOS). Finally, LAGB (OR = .461) and LSG (OR = .480) was positively related to reoperation. LAGB, when compared to LSG for LOS, had a substantial advantage over biliopancreatic diversion. The LOS findings may contribute to patients' value proposition, including cost reduction for third party insurance payers and for the community.
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Geryane, Massoud Hemida. "Mental and physical workload in laparoscopic surgery." Thesis, Imperial College London, 2006. http://hdl.handle.net/10044/1/7642.
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Felekidis, Dimitrios. "Advanced Visualization Techniques for Laparoscopic Liver Surgery." Thesis, Linköpings universitet, Medie- och Informationsteknik, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-115727.
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Laparoscopic liver surgery is mainly preferred over the traditional open liver surgery due to its unquestionable benefits. This type of surgery is executed by inserting an endoscope camera and the surgical tools inside the patient’s body through small incisions. The surgeons perform the operation by watching the video transmitted from the endoscope camera to high-resolution monitors. The location of the tumors and cysts is examined before and during the operation by the surgeons from the pre-operative CT scans displayed on a different monitor or on printed copies making the operation more difficult to perform. In order to make it easier for the surgeons to locate the tumors and cysts and have an insight for the rest of the inner structures of the liver, the 3D models of the liver’s inner structures are extracted from the preoperative CT scans and are overlaid on to the live video stream transmitted from the endoscope camera during the operation, a technique known as virtual X-ray. In that way the surgeons can virtually look into the liver and locate the tumors and cysts (focus objects) and also have a basic understanding of their spatial relation with other critical structures. The current master thesis focuses on enhancing the depth and spatial perception between the focus objects and their surrounding areas when they are overlaid on to the live endoscope video stream. That is achieved by placing a cone on the position of each focus object facing the camera. The cone creates an intersection surface (cut volume) that cuts the structures that lay in it, visualizing the depth of the cut and the spatial relation between the focus object and the intersected structures. The positioning of the cones is calculated automatically according to the center points of the focus objects but the sizes of the cones are user defined with bigger sizes revealing more of the surrounding area. The rest of the structures that are not part of any cut volume are not discarded but handled in such way that still depict their spatial relation with the rest of the structures. Different rendering results are presented for a laparoscopic liver test surgery in which a plastic liver model was used. The results include different presets of the cut volumes’ characteristics. Additionally, the same technique can be applied on the 3D liver’s surface instead of the live endoscope image and provide depth and spatial information. Results from that case are also presented.
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Faraz, Ali. "Mechanisms and robotic extenders for laparoscopic surgery." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk2/tape17/PQDD_0028/NQ37699.pdf.
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Bergström, Maria. "Peritoneal fibrinolysis during pneumoperitoneum and laparoscopic surgery /." Göteborg : Göteborg University, 2007. http://hdl.handle.net/2077/7567.
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Alkhamesi, Nawar Abdul-Hadi Saleh. "Intraperitoneal delivery of therapeutics in laparoscopic surgery." Thesis, Imperial College London, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.438982.
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Dowson, Henry Malcolm Pollock. "The cost effectiveness of laparoscopic colorectal surgery." Thesis, University of Surrey, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.529441.
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Foster, Jake. "Objective assessment of laparoscopic rectal cancer surgery." Thesis, Imperial College London, 2015. http://hdl.handle.net/10044/1/51529.
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Background There is growing evidence to support the benefits of laparoscopic rectal cancer resection surgery. Outcomes following rectal cancer resection are dependent upon the technical performance of the surgery and vary between surgeons. Valid and reliable assessment tools are needed to enhance training and ensure safe dissemination of laparoscopic rectal cancer surgery. The aim of this thesis was to develop an assessment tool for objective measurement of technical performance in laparoscopic rectal cancer surgery. Methods The work reported in this thesis was carried out between 2012 and 2014. A systematic review of published literature was performed to identify a quality assurance role for objective assessment in randomised controlled trials investigating surgical procedures. Objective Clinical Human Reliability Assessment (OCHRA) was used to produce a quantitative description of procedural errors enacted in a series of rectal cancer resections. A blinded assessor utilised OCHRA to explore the impact of the interval between chemoradiotherapy and surgery upon complexity of surgery within a randomised controlled trial. A combination of qualitative and quantitative methods was used to develop a bespoke assessment tool for laparoscopic rectal surgery. Results A structured framework was developed for the integration of objective assessment into quality assurance mechanisms of randomised controlled trials investigating surgical procedures. Error frequencies identified by OCHRA during laparoscopic rectal cancer surgery were found to correlate with other indicators of technical performance and had good test-retest reliability. The interval between chemoradiotherapy and surgery did not significantly impact upon the complexity of surgery. A bespoke assessment tool was developed for expert evaluation of performance, and an exploratory experiment has tested its reliability. Conclusions Objective assessment of laparoscopic rectal cancer resection is feasible but complex. Both OCHRA and the assessment tool described in this thesis could be used for such assessment; however larger-scale studies are indicated to further validate these tools.
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Day, Andrew R. "The stress response in laparoscopic colorectal surgery." Thesis, University of Surrey, 2015. http://epubs.surrey.ac.uk/808194/.
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Introduction Laparoscopic colorectal surgery and enhanced recovery programs have been shown to improve patient outcomes and reduce length of stay following surgery. The use of regional analgesia is usually a fundamental element of an enhanced recovery program. A proposed benefit of regional analgesia in colorectal surgery is suppression of the post-operative stress response. No data is available to indicate if this is applicable in laparoscopic colorectal surgery. In addition there is no direct evidence addressing whether there is an appropriate type of fluid, crystalloid or colloid, to use in goal-directed fluid therapy. The aim of this study was to examine the effects the choice of analgesia and intravenous fluid had on physiological and biochemical outcomes following laparoscopic colorectal surgery in patients within an enhanced recovery program. Methods A randomized clinical trial (NCT 01128088) was conducted between 2010-2011 at a single institution. All patients underwent laparoscopic colorectal surgery for benign or malignant conditions within an established enhanced recovery program. Patients were randomly assigned to receive either a spinal or morphine PCA as their primary post-operative analgesia. In addition, patients were randomly allocated to receive either 6% Volulyte or Hartmann’s solution, which was administered as directed by an oesophageal Doppler monitor in order to achieve stroke volume optimisation. Blood was taken to measure aspects of the stress response at pre-op, 3, 6, 12, 24 and 48 hour time intervals. Various other physiological and patient outcomes were measured. Results One hundred and twenty patients were analysed in the study. There was no significant difference in patient characteristics between the groups. No significant difference was seen between the analgesia groups at pre-op, 3, 6, 12, 24 or 48 hours in the levels of insulin, IL-2, 4, 6, 8, 10, 12, TNF-α, VEGF or IFN-γ. Median cortisol (468 nmol/l (IQR: 329-678) vs 701 nmol/l (IQR: 429-820); p=0.004) and glucose (6.1 mmol/l (IQR: 5.4-7.5) vs 7 mmol/l (IQR: 6-7.7); p=0.012) levels were significantly lower at 3 hours post-op in the spinal group and thereafter the same. Patients receiving Hartmann’s solution received significantly greater volumes of fluid in comparison to those receiving 6% Volulyte (20.98ml/kg (IQR: 16.68-25.73) vs 13.95ml/kg (IQR: 11.76-18.1); p<0.0005). There was no significant difference in the median length of stay between either fluid (6% Volulyte 2.75 days [IQR: 2.08-3.6] vs Hartmann’s 2.29 days [IQR: 2.01-3.59]; p=0.807) or analgesia (spinal 2.25 days [IQR: 1.89-3.13] vs PCA 2.9 days [IQR: 2.09-3.93]; p=0.059) groups. The number of complications was no different between the two types of fluids but patients receiving spinal analgesia (20% vs 37%, p=0.013) had a significantly reduced number. Conclusion Following laparoscopic colorectal surgery within an enhanced recovery program the use of spinal analgesia in comparison to morphine PCA significantly reduces the levels of cortisol and glucose at 3 hours only. This difference does not translate to a reduction in length of stay. There is no effect on other aspects of the stress response at various post-operative time intervals. A significantly greater quantity of Hartmann’s solution is required to achieve stroke volume optimisation in comparison to 6% Volulyte. This, however, did not make any difference to the incidence of post-operative complications or length of stay. Either fluid is acceptable in the quantities given in this study.
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Saudrais, Charlélie. "Augmentation of stiffness perception for laparoscopic surgery." Electronic Thesis or Diss., Sorbonne université, 2024. https://accesdistant.sorbonne-universite.fr/login?url=https://theses-intra.sorbonne-universite.fr/2024SORUS205.pdf.
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La chirurgie minimalement invasive est connue pour ses avantages pour le patient, avec entre autre une douleur post-opératoire plus faible, un temps de convalescence réduit et une diminution des dommages causés aux organes. Ces avantages découlent principalement des incisions plus petites qu'elle nécessite comparées à celles d'une chirurgie dite ouverte. Ces incisions permettent l'insertion d'un endoscope et des instruments dans le corps du patient à travers des trocarts. Malgré ses avantages certains, la chirurgie minimalement invasive entraîne une plus grande complexité des gestes pour les chirurgiens. Cette difficulté accrue découle des limites que cette pratique engendre en termes de perception, en particulier de la dégradation de la perception visuelle et de la perception haptique. Plus précisément, la perception des efforts des tissus sur la pointe de l'outil est faussée par le fait qu'elle se fasse au travers d'un outil long en passant par un trocart. Le trocart plus ou moins rigide ajoute du frottement et du jeu, auquel s'ajoutent l'élasticité de la paroi abdominale et l'effet levier, faussant un peu plus les informations sensorielles qui auraient pu être intégrées. Ceci entraine notamment une faible précision lors de tâches de palpation. Dans cette thèse, nous nous intéressons aux systèmes d'augmentation sensorielle permettant de fournir l'information d'effort au chirurgien, ainsi qu'à leur intégration dans la pratique de l'utilisateur. L'objectif est de proposer et d'étudier un système de retour sensoriel portable sous forme de bracelet placé sur l'avant bras du chirurgien qui permettrait de renseigner le porteur sur l'effort mesuré en bout d'un outil laparoscopique, en venant appliquer des efforts tangentiels sur la peau, aidant à améliorer la perception de raideur en bout d'instrument. Cette approche est intéressante dans la mesure où elle combine les avantages de ne pas perturber le geste et de ne pas interférer avec les canaux sensoriels auditif et visuel déjà très chargés, avec la nature intuitive d'un retour par déformation tangentielle de la peau.Dans un premier temps, la preuve de concept du dispositif est faite en se focalisant sur la perception des efforts axiaux où les efforts et le stimulus fourni par le bracelet sont alignés. Les résultats sont ensuite étendus à la perception des efforts radiaux pour lesquels nous étudions l'influence de l'effet levier dans la perception assistée par notre bracelet. Ces études sont menées dans le cadre d'une tâche contrôlée de discrimination de raideur dans un contexte de chirurgie laparoscopique simulé. L'objectif principal est d'étudier les performances et l'intuitivité du retour proposé pour augmenter la perception d'effort en bout d'outil. Dans un second temps, les travaux précédents sont étendus à un contexte médical réaliste. Les performances du retour tactile sont évaluées dans le cadre de discrimination de raideur de fantômesMinimally invasive surgery (MIS) is recognized for its patient benefits, including less post-operative pain, shorter recovery times, and reduced organ damage, primarily due to the smaller incisions required compared to open surgery. These incisions allow the insertion of an endoscope and instruments into the patient's body through sealed cannulas, named trocars. Nevertheless, these benefits must be weighed against the higher gesture complexity surgeons face. This increased difficulty arises from perceptual limitations, in particular, the degradation of both visual perception and haptic perception of forces. Specifically, tissue force perception at the tooltip is distorted due to its conveyance through a long instrument passing through a trocar. The backlash and non-linear friction introduced by the trocar, the stiffness of the abdominal wall, and the lever effect, among others, further skew the sensory information that could have been integrated. This leads to poor palpation precision.This thesis focuses on sensory augmentation systems that provide force information to the surgeon and their integration into user practice. The thesis aims to propose and investigate a wearable sensory feedback system in the form of a forearm wristband, conveying to the wearer the force measured at the tip of a laparoscopic tool by applying tangential skin stretch, thereby enhancing stiffness perception at the tooltip. This approach is promising as it combines the benefits of not disrupting the surgical gesture and not interfering with the already heavily solicited auditory and visual sensory channels with the intuitive nature of skin stretch feedback.Initially, the proof-of-concept of the device is demonstrated by focusing first on the perception of axial forces where the forces and the stimulus provided by the wristband are aligned. The results are then extended to the perception of radial forces for which alignment no longer exists, and we also study the interaction of the lever effect in the perception assisted by our wristband. The main objective is to study the ability of the proposed tactile feedback to increase force perception at the end of the tool and to evaluate its performance in a controlled stiffness discrimination task in a simulated laparoscopic surgery context. Secondly, the previous work is extended to a realistic medical context. The performance of the feedback is evaluated in the context of tissue phantom stiffness discrimination
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Watson, David Ian. "Improving outcomes following surgery for gastro-oesophageal reflux disease : laparoscopic antireflux surgery /." Title page, contents and abstract only, 1997. http://web4.library.adelaide.edu.au/theses/09PH/09phw338.pdf.
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Thesis (M.D.)--University of Adelaide, Dept. of Surgery, 1998.Copies of the just first page of author's previously published articles inserted. Includes bibliographical references (leaves 227-254).
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Tan, Hock Lim. "The development of paediatric endoscopic surgery /." Title page, contents and abstract only, 1999. http://web4.library.adelaide.edu.au/theses/09MD/09mdt161.pdf.
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Texler, Michael Lutz. "Aetiology of tumour cell movement during laparoscopic surgery : patterns of movement and influencing factors." Title page, table of contents and abstract only, 1999. http://web4.library.adelaide.edu.au/theses/09MD/09mdt355.pdf.
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Accompanying CD-ROM contains image files and software. Bibliography: leaves 259-286. Explores the factors affecting the movement of tumour cells from a primary malignancy across the peritoneal cavity to the port-site following laparoscopic intervention. Filter methods and radio-labelled tumour cells provided the most useful way of following cell movement. Concludes spread of tumour cells to the port-site is more likely in the presence of disseminated disease, as well as with inappropriate surgical technique. Metastasis may be reduced by the use of intraperitoneal lavage and appropriate surgical technique.
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Moutsopoulos, Konstantinos. "Physically deformable models for simulation of laparoscopic surgery." Thesis, Imperial College London, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.339157.
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Ben-Ur, Ela. "Development of a force-feedback laparoscopic surgery simulator." Thesis, Massachusetts Institute of Technology, 1999. http://hdl.handle.net/1721.1/55063.
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Thesis (S.M.)--Massachusetts Institute of Technology, Dept. of Mechanical Engineering, 1999.Includes bibliographical references (p. 77-78).
The work presented here addressed the development of an electro-mechanical force-feedback device to provide more realistic and complete sensations to a laparoscopic surgery simulator than currently available. A survey of the issues surrounding haptic (touch) displays and training for laparoscopic or "keyhole" procedures was performed. A number of primary and secondary sources including surgeon consultation , operating room observations, and task analyses were used to accumulate a list of needs. Subsequent requirements analysis translated these into a set of specifications for the kinematics, dynamics and actuators, and configuration of the device. These suggested a design with five actuated axes (pitch and yaw about the entrance to the abdomen, insertion, rotation about the tool axis, and gripper feedback) amenable to a configuration including two actuated tools in a lifelike torso. These specifications were the basis for the generation and selection of design concepts. The PHANTOM haptic interface from Sensable Devices was chosen from among a number of existing devices and original designs to actuate the pitch, yaw, and insertion degrees of freedom. A separate end effector actuator was specified to supply feedback to the handle rotation and gripper. Mechanisms were proposed for each of these axes; a linear cable capstan was selected for the gripper and a cable capstan/drum for the rotation. The kinematics, bearings, transmissions, and user interface for both axes were designed in detail, and first- and second generation prototypes were built. The finished devices were integrated with the PHANTOM hardware, electronics, and software. Performance and design evaluations were performed, and plans for future device improvements and user studies were outlined.
by Ela Ben-Ur.
S.M.
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Deal, Aaron M. "Hybrid Position/Natural Admittance Control for Laparoscopic Surgery." Case Western Reserve University School of Graduate Studies / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=case1323374547.
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Pace, Bedetti Horacio Martin. "The effect of "Postural Freedom" in laparoscopic surgery." Doctoral thesis, Universitat Politècnica de València, 2019. http://hdl.handle.net/10251/122312.
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[ES] La cirugía laparoscopia está considerada uno de los principales avances quirúrgicos en las últimas décadas. Esta técnica ha demostrado numerosas ventajas comparadas con la cirugía convencional abierta y ha sido extensamente usada para procesos quirúrgicos en el área abdominal. Para el paciente, la cirugía laparoscópica supone diversas ventajas, como por ejemplo menor dolor post operativo, tiempos de recuperación menores, menor riesgo de infección, o reducción del trauma.
Para el cirujano en cambio, la situación es completamente diferente, esta práctica requiere mayor esfuerzo, concentración y estrés mental que la práctica convencional abierta. Además fuerza al cirujano a adoptar posiciones no-neutras en falanges, manos, muñecas, y brazos. Estas posturas no-neutras son la principal causa de fatiga muscular y aumentan el riesgo de problemas musculo-esqueléticos.
Estos problemas han sido ampliamente estudiados por diferentes equipos de investigación, los cuales están tratando de mejorar la experiencia del cirujano en el quirófano. El enfoque utilizado en este estudio es diferente del utilizado anteriormente por la mayoría de estos equipos, los cuales suelen propones soluciones basadas en cambios ergonómicos con la intención de mejorar la geometría del mango de pistola convencional, ya que se considera ergonómicamente deficiente. El problema con este enfoque, es que las deficiencias no se encuentran únicamente en el mango, sino en la utilización de un punto de entrada fijo que fuerza a los cirujanos a mantener posiciones desfavorables.
En este trabajo, se introduce el concepto "Libertad Postural" en el ámbito de la cirugía, este se basa en la hipótesis de que, si las herramientas no forzaran la posición de los cirujanos, estos mantendrían posiciones más favorables y cercanas al rango de posiciones neutras durante los procesos laparoscópicos.
Los beneficios de este concepto han sido demostrados por medio de análisis de movimiento y de electromiografía de superficie, los cuales indican que la "Libertad Postural" es causante de un claro aumento de las posiciones neutras y de la reducción de la fatiga muscular, y han sido testeados por cirujanos en entornos simulados, los cuales encuentran beneficioso utilizar la "Libertad Postural" como característica base de este nuevo diseño de herramienta laparoscópica.
En la sección final de este trabajo se propone un diseño que implementa el concepto de libertad postura con el cual se reduciría la fatiga muscular y los problemas musculo esqueléticos asociados a la práctica laparoscópica.
Este diseño tiene la característica de actuar como una nueva sección del brazo, siendo una articulación que soporta los giros y grandes desplazamientos que normalmente tienen que desarrollar los brazos del cirujano. Además, esta solución es económica y fácil de fabricar, lo cual permitiría su uso por cirujanos de todo el mundo.[CAT] La cirurgia laparoscòpia està considerada un dels principals avanços quirúrgics en les últimes dècades. Aquesta tècnica ha demostrat nombrosos avantatges comparats amb la cirurgia convencional oberta i ha sigut extensament usada per a processos quirúrgics en l'àrea abdominal. Per al pacient, la cirurgia laparoscòpica suposa diversos avantatges, com per exemple menor dolor post operatiu, temps de recuperació menors, menor risc d'infecció, o reducció del trauma. Per al cirurgià en canvi, la situació és completament diferent, aquesta pràctica requereix major esforç, concentració i estrés mental que la pràctica convencional oberta. A més força al cirurgià a adoptar posicions no-neutres en falanges, mans, nines, i braços. Aquestes postures no-neutres són la principal causa de fatiga muscular i augmenten el risc de problemes musculo-esquelètics. Aquests problemes han sigut àmpliament estudiats per diferents equips d'investigació, els quals estan tractant de millorar l'experiència del cirurgià en el quiròfan. L'enfocament utilitzat en aquest estudi és diferent de l'utilitzat anteriorment per la majoria d'aquests equips, els quals solen proposes solucions basades en canvis ergonòmics amb la intenció de millorar la geometria del mànec de pistola convencional, ja que es considera ergonòmicament deficient. El problema amb aquest enfocament, és que les deficiències no es troben únicament en el mànec, sinó en la utilització d'un punt d'entrada fix que força als cirurgians a mantindre posicions desfavorables. En aquest treball, s'introdueix el concepte "Llibertat Postural" en l'àmbit de la cirurgia, aquest es basa en la hipòtesi que, si les eines no forçaren la posició dels cirurgians, aquests mantindrien posicions més favorables i pròximes al rang de posicions neutres durant els processos laparoscòpics. Els beneficis d'aquest concepte han sigut demostrats per mitjà d'anàlisi de moviment i de electromiografía de superfície, els quals indiquen que la "Llibertat Postural" és causant d'un clar augment de les posicions neutres i de la reducció de la fatiga muscular, i han sigut testats per cirurgians en entorns simulats, els quals troben beneficiós utilitzar la "Llibertat Postural" com a característica base d'aquest nou disseny d'eina laparoscòpica. En la secció final d'aquest treball es proposa un disseny que implementa el concepte de llibertat postura amb el qual es reduiria la fatiga muscular i els problemes *musculo esquelètics associats a la pràctica laparoscòpica. Aquest disseny té la característica d'actuar com una nova secció del braç, sent una articulació que suporta els girs i grans desplaçaments que normalment han de desenvolupar els braços del cirurgià. A més, aquesta solució és econòmica i fàcil de fabricar, la qual cosa permetria el seu ús per cirurgians de tot el món.
[EN] Laparoscopic surgery is considered one of the main surgical advances in the last decades, this technique has demonstrated numerous advantages compared to open conventional surgery and it is widely used in abdominal procedures around the world. For the patient, laparoscopic surgery suppose less post-operative pain, shorter recovery time, lower risk of infection, and reduction of the trauma among other benefits. For the surgeon, the situation is completely different, this practice requires more effort, concentration and mental stress than conventional open procedures. It forces the surgeon to adopt non-neutral postures with phalanges, hands, wrists, and arms being this non-neutral postures the main cause of muscular fatigue and high risk of musculoskeletal disorders. The poor ergonomic postures accelerate muscle fatigue and pain because, outside the neutral range, muscles require more energy to generate the same contractile force than in neutral position. This increase of muscular fatigue is associated with the potential to commit errors that may harm the patient during the surgery. Because this problem is widely studied and different research centers are already trying to improve their surgeons experience in the operation room, the approach used during this work is different than most of the ones presented in previous works. Generally, the solutions proposed are based on ergonomic changes in the handle shape of the instrument, because the conventional pistol-grip handle is considered ergonomically poor. But the problem is not only in the shape of the handle but also in the fixed point of entrance that force the positions for the surgeon despite the handle¿s shape. In this work, the concept of postural freedom in laparoscopic surgery is introduced and evaluated. The postural freedom concept is based on the hypothesis that the surgeon involuntarily would maintain neutral postures if the instrument does not force him or her to reach extreme position with the upper limbs. The benefits of this concept has been demonstrated, by means of electromyography and motion capture. It reduces the localized muscular fatigue and increases the number of neutral postures during laparoscopic simulations. In the final section it is proposed a design that implements the postural freedom concept with, according on the results, the potential to reduce the localized muscular fatigue and the musculoskeletal problems associated to the practice. The design proposed here acts as a new section on the arm, being an articulation that support the turns and big displacements that currently suffer the surgeon¿s body. The solution is affordable and easy to manufacture and could be used by surgeons worldwide.
Pace Bedetti, HM. (2019). The effect of "Postural Freedom" in laparoscopic surgery [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/122312
TESIS
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Salleh, Rosli. "Minimally invasive surgery training and tele-surgery system using VR and haptic techniques." Thesis, University of Salford, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.365996.
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Jordan-Black, J. A. "Comparisions and evaluations of laparoscopic training programmes." Thesis, Queen's University Belfast, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.246334.
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Motta, Dino César Pereira da [UNESP]. "Avaliação funcional do esfíncter inferior do esôfago nos períodos pré e pós-operatório de fundoplicatura total: estudo comparativo de duas técnicas de abordagem - laparotômica e laparoscópica." Universidade Estadual Paulista (UNESP), 2001. http://hdl.handle.net/11449/88908.
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motta_dcp_me_botfm.pdf: 1151223 bytes, checksum: 1d7fefba88005a4773d3d06cae669504 (MD5)Em 40 coelhos machos foram realizados estudos eletromanométricos do esôfago segundo a técnica de puxada intermitente da sonda e infusão contínua dos catéteres com água destilada. Estes estudos permitiram a análise de dois parâmetros: amplitude da pressão no EIE (mmHg) e comprimento do EIE em condições basais (momento 1). Neste momento foi também realizada avaliação do peso corpóreo dos animais. Os 40 animais foram divididos em quatro grupo de 10, na dependência do procedimento cirúrgico realizado: Grupo 1: Fundoplicatura total laparotômica Grupo2 : Laparotomia mediana e dissecção da transição gastroesofágica Grupo 3: Fundoplicatura total laparoscópica Grupo 4: Pneumoperitôneo e dissecção da transição gastroesofágica No momento 2 (uma semana após os procedimentos cirúrgicos) foram realizados estudos eletromanométricos do esôfago e avaliação ponderal em todos os animais. Nos animais do grupo 1 (fundoplicatura laparotômica) foi observado aumento da amplitude da pressão e do comprimento do EIE (p<0,05). Naqueles do grupo 2 não foi observada alteração da amplitude e do comprimento do EIE (p>0,05). Nos coelhos do grupo 3 houve aumento da amplitude da pressão e do comprimento do EIE (p<0,05). Nos animais do grupo 4 não foi observada alteração dos parâmetros acima citados (p>0,01). Com relação ao peso corpóreo, foi observada redução do mesmo (p<0,05) apenas nos coelhos submetidos a fundoplicatura laparotômica (Grupo 1). Nos demais animais (Grupos 2, 3 e 4) não houve qualquer alteração do peso corpóreo na avaliação realizada uma semana após os procedimentos cirúrgicos (momento 2)
Electromanometric studies of the esophagus were registered in 40 male rabbits, through the pull through technique and continuous infusion of the catheters with distilled water. These exams allowed us to measure the pressure width (mmHg) and the length (cm) of the lower esophageal sphincter (LES) in basal conditions (moment 1). The 40 animals were divided into four groups of 10, according to surgical procedure: Group 1: open total fundoplication Group 2: Median laparotomy and dissection of the gastroesophageal junction Group 3: laparoscopic total fundoplication Group 4: pneumoperitonium and dissection of the gastroesophageal junction. In moment two (one week after surgery) electromanometric studies of the esophagus and weight evaluation were performed in every animals. In group 1 (open fundoplication) an increase of pressure width and of LES was observed (p<0,05). In group 2, the pressure width and length of LES didn’t present any alteration (p>0,05). In group 3 an increase of pressure width and length of LES was observed (p<0,05). In group 4, the pressure width and length LES didn’t present any alteration (p>0,05). In respect to the weight evaluation, a decrease was observed in rabbits submitted to open fundoplication (p<0,05). In other animals (groups 2, 3 and 4) the weight didn’t present any alteration in evaluation performed one week after surgery (moment 2)
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Mohareri, Omid. "Image and haptic guidance for robot-assisted laparoscopic surgery." Thesis, University of British Columbia, 2015. http://hdl.handle.net/2429/54953.
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Surgical removal of the prostate gland using the da Vinci surgical robot is the state of the art treatment option for organ confined prostate cancer. The da Vinci system provides excellent 3D visualization of the surgical site and improved dexterity, but it lacks haptic force feedback and subsurface tissue visualization. The overall objective of the work done in this thesis is to augment the existing visualization tools of the da Vinci with ones that can identify the prostate boundary, critical structures, and cancerous tissue so that prostate resection can be carried out with minimal damage to the adjacent critical
structures, and therefore, with minimal complications. Towards this objective we designed and implemented a real-time image guidance system based on a robotic transrectal ultrasound (R-TRUS) platform that works in tandem with the da Vinci surgical system and tracks its surgical instruments. In addition to ultrasound as an intrinsic imaging modality, the system was first used to bring pre-operative magnetic resonance imaging (MRI) to the operating room by registering the pre-operative MRI to the intraoperative ultrasound and displaying the MRI image at the correct physical location based on the real-time ultrasound image. Second, a method of using the R-TRUS system for tissue palpation is proposed by expanding it to be used in conjunction with a real-time strain imaging technique. Third, another system based on the R-TRUS is described for detecting dominant prostate tumors, based on a combination of features extracted from a novel
multi-parametric quantitative ultrasound elastography technique. We tested our systems in an animal study followed by human patient studies involving n = 49 patients undergoing da Vinci prostatectomy. The clinical studies were conducted to evaluate the feasibility of using these systems in real human procedures, and also to improve and optimize our imaging systems using patient data.
Finally, a novel force feedback control framework is presented as a solution to the lack of haptic feedback in the current clinically used surgical
robots. The framework has been implemented on the da Vinci surgical system using the da Vinci Research Kit controllers and its performance has
been evaluated by conducting user studies.Applied Science, Faculty of
Electrical and Computer Engineering, Department of
Graduate
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Stoyanov, Danail Valentinov. "Recovering 3D structure and motion in robotic laparoscopic surgery." Thesis, Imperial College London, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.430137.
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Abbott, Jason Anthony. "Endometriosis : its clinical symptoms and response to laparoscopic surgery." Thesis, Teesside University, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.411186.
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Sachs, Adam D. "Flexible support scaffold for organ retraction in laparoscopic surgery." Thesis, Massachusetts Institute of Technology, 2014. http://hdl.handle.net/1721.1/92681.
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Thesis: S.B., Massachusetts Institute of Technology, Department of Mechanical Engineering, 2014.Cataloged from PDF version of thesis.
Includes bibliographical references (page 32).
With millions of abdominal surgeries performed annually in the United States alone, abdominal surgery is both a large market and a large medial issue. The entire industry surrounding abdominal surgery has strived to reduce the pain and trauma associated with an operation by reducing the number and size of incisions made in the abdominal wall, but in the process of reducing openings into the abdomen, the difficulty of operating increases. In order to retract organs within the abdominal cavity while further reducing the number of ports required for surgery, the author has previously designed and fabricated a device to be inserted into the abdominal cavity through one small port. Once inside of the abdominal cavity, the device is expands to form a rigid platform across the ventral abdominal wall serving as a platform for organ retraction. While the previously fabricated device functions as intended, it's rigid shape does not match the shape of the ventral abdominal wall, and as such, the device occupies unnecessary operating space. The work of this paper involves the design of a system to permit the existing device to conform to the shape of the ventral abdominal wall while still supporting a load. Two methods were examined to permit the device to conform while still supporting a load: Flexure and Hinged joints. Both flexure and hinged joints were developed, prototyped, and analyzed to meet all functional requirements. Both methods proved ultimately successful in meeting functional requirements, yet flexure joints were significance easier to produce and thus represent a more viable solution for mass production.
by Adam D. Sachs.
S.B.
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Miskovic, Danilo. "Proficiency gain and competency assessment in laparoscopic colorectal surgery." Thesis, Imperial College London, 2012. http://hdl.handle.net/10044/1/9956.
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Aims and objectives: The aim of this thesis was to investigate the proficiency gain curve and competency in laparoscopic colorectal surgery (LCS) for specialist colorectal surgeons. The objectives were (1) to analyse the shortfalls of proficiency gain curve analysis in LCS, (2) to develop methods to describe proficiency gain and competency in LCS and (3) to analyse proficiency gain and competency within the National Training Programme (NTP). Methods: Objective 1: Two systematic reviews and a meta-analysis of current evidence were performed. Objective 2: Semi-structured interviews and a Delphi method were applied to develop proficiency and competency assessment tools and clinical cases were used for validation. A novel observational clinical human reliability analysis (OCHRA) of clinical cases was developed and evaluated. Objective 3: clinical and educational data from the National Training Programme were used for the analysis of proficiency gain and competency using advanced statistical methods. Results: Using clinical data alone is insufficient for the description of proficiency gain and competency. A generic assessment scale (GAS form) and a competency assessment tool (CAT) were developed and validated. A combination of CAT and OCHRA has been shown to be highly sensitive and specific to determine competency. Analysis of clinical and educational data revealed a shortening of the proficiency gain curve using the approach of the NTP without the risk of increased rates adverse outcomes. Conclusion: Tools for proficiency gain and competency assessment of specialist surgeons have been shown to be valid and feasible and are fully implemented in the NTP. Data suggest that a novel technique can be introduced to specialists on a National level using a structured educational approach with safe clinical outcomes.
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Aggarwal, Rajesh. "A proficiency-based technical skills curriculum for laparoscopic surgery." Thesis, Imperial College London, 2009. http://hdl.handle.net/10044/1/11235.
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Salaskar, Swati. "Digital human modeling for ergonomic evaluation of laparoscopic surgery." Diss., Online access via UMI:, 2009.
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Hong, Jonathan Sui-Yin. "Predicting the complexity of laparoscopic rectal surgery with MRI." Thesis, The University of Sydney, 2019. http://hdl.handle.net/2123/21167.
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Rectal cancer surgeons can now choose from at least four different modalities to perform rectal cancer surgery. Technique selection draws on the individual surgeon's preference, enthusiasm, skills, training and comprehension of the evidence. The patient’s characteristics may be a minor contributor to the decision about surgical technique. Recent publications have not been able to demonstrate equivalent pathological outcomes for laparoscopic rectal surgery over open surgery. There may be a subset of patients whose pelvic anatomy is complicated and more suited to open surgery instead of laparoscopic or other minimally invasive procedures. There is no consensus on the radiological criteria to define the difficult surgical pelvis. This research aims to demonstrate the accuracy of the surgeon's intuition in assessing the difficult pelvis, develop objective measures of MRI pelvimetry and assess the relationship between these measurements and surgical outcome. Pelvimetry was performed on MRIs from a randomised controlled trial comparing laparoscopic and open rectal cancer surgery. To define the difficult pelvis, the mean pelvimetry measurements were evaluated for association with successful and unsuccessful surgery as defined by pathological outcomes. The study was unable to identify an objective pelvimetry measure to define the difficult pelvis. A smaller pelvic volume was surprisingly associated with unsuccessful surgery but this was a small effect size. Intuitive judgement of surgical difficulty is inaccurate and inconsistent.
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Tapia, Araya Angelo Elías. "Validity of the laparoscopic simulator simulvet® and its application in training on veterinary laparoscopic surgery." Doctoral thesis, Universitat Autònoma de Barcelona, 2015. http://hdl.handle.net/10803/310432.
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La cirurgia de mínima invasió, en particular la cirurgia laparoscòpica, s'ha convertit en una opció de referència en molts procediments. Això és degut al seus beneficis ja provats en el pacient. No obstant això, per poder realitzar aquestes tècniques és obligat passar per un període d'aprenentatge, on els simuladors juguen un paper molt important en l'adquisició de noves habilitats quirúrgiques. Els objectius d'aquest estudi són descriure el desenvolupament d'un Simulador Laparoscòpic Caní (SLC) per veterinaris, validar el seu programa de formació i determinar la seva utilitat en l'adquisició de noves habilitats quirúrgiques, així com avaluar els problemes ergonòmics durant la realització de tasques de formació laparoscòpica utilitzant el SLC. Els diferents estudis d'aquest treball inclouen un total de 84 veterinaris amb diferent graus d' experiència en cirurgia laparoscòpica. El programa d'entrenament consistia en quatre tasques realitzades sobre el SLC: coordinació, trasllat d'objectes, tall i sutura. Diversos programes informàtics, així com imatges de tomografia d'ordinadors van ser utilitzats per a la realització del SLC. Com a mesures objectives de valoració, s'ha utilitzat el temps d'execució, l'escala GOALS (Global Operative Assessment of Laparoscopic Skills) i una llista de tasques específiques per avaluar el programa d'entrenament laparoscòpic. Quant a l'estudi d' ergonomia, es va analitzar l'activitat muscular mitjançant electromiografia de superfície i es van enregistrar els moviments de la mà mitjançant un guant virtual. El SLC ha tingut una bona acceptació preliminar en les tasques bàsiques de la laparoscòpia. Els resultats de les proves de validació mostraven que el SLC és adequat per l'entrenament i ensenyament de tasques bàsiques laparoscòpiques. És capaç de distingir el grau d'experiència laparoscòpica entre els veterinaris. Les tasques de tall i sutura mostraven un major grau d'activitat muscular. D'altra banda, el mànec axial mostrava millors postures ergonòmiques en comparació amb el mànec anellat durant les diferents tasques del programa de formació en el SLC. En conclusió, el SLC és una bona eina per a la formació en cirurgia laparoscòpica per a veterinaris, encara que té algunes limitacions inherents a tots els simuladors. A més a més, el SLC ha demostrat la seva validesa de continguts i constructiva amb el seu programa de formació laparoscòpica en veterinaris. Finalment, l'ergonomia laparoscòpica en veterinaris es veu afectada pel tipus de tasca, així com pels instruments utilitzats durant l'entrenament amb el SLC.La cirugía de mínima invasión, en particular la cirugía laparoscópica, se ha convertido en una opción de referencia en muchos procedimientos. Esto es debido a sus ya demostrados beneficios para el paciente. Sin embargo, para poder realizar estas técnicas se requiere pasar por un periodo de aprendizaje, en el cual los simuladores juegan un papel muy importante en la adquisición de nuevas destrezas quirúrgicas. Los objetivos de este trabajo son describir el desarrollo de un Simulador Laparoscópico Canino (SLC) para veterinarios, validar su programa de entrenamiento y determinar su utilidad en la adquisición de nuevas habilidades quirúrgicas, así como evaluar los problemas ergonómicos durante la realización de tareas de entrenamiento laparoscópico utilizando el SLC. En los diferentes estudios de este trabajo se incluyeron un total de 84 veterinarios con diferente grado de experiencia en cirugía laparoscópica. El programa de entrenamiento consistió en cuatro tareas realizadas sobre el SLC: coordinación, transferencia de objetos, corte y sutura. Para la realización del SLC se utilizaron diversos programas informáticos, así como imágenes de tomografía computarizada. Como medidas objetivas de valoración, se ha utilizado el tiempo de ejecución, la escala GOALS (Global Operative Assessment of Laparoscopic Skills) y una lista de tareas específicas para evaluar el programa de entrenamiento laparoscópico. En cuanto al estudio de ergonomía, se analizó la actividad muscular mediante electromiografía de superficie y se registraron los movimientos de la mano mediante un guante virtual. El SLC tuvo una buena aceptación preliminar en las tareas básicas de laparoscopia. Los resultados de las pruebas de validación mostraron que el SLC es adecuado para el entrenamiento y la enseñanza en las tareas básicas laparoscópicas, siendo capaz de distinguir el grado de experiencia laparoscópica entre los veterinarios. Las tareas de corte y sutura mostraron mayor grado de actividad muscular. Por otro lado, el mango axial mostró mejores posturas ergonómicas en comparación con el mango anillado durante las diferentes tareas del programa de entrenamiento en el SLC. En conclusión, el SLC es una buena herramienta de formación en cirugía laparoscópica para veterinarios, aunque tiene algunas limitaciones inherentes a todos los simuladores. Además, el SLC ha demostrado su validez de contenidos y constructiva en su programa de formación laparoscópica en veterinarios. Finalmente, la ergonomía laparoscópica en veterinarios se ve afectada por el tipo de tarea, así como por el instrumental utilizado durante el entrenamiento en el SLC.
Minimally invasive surgery, including laparoscopy has become a reference option in many procedures. This is due to its proven benefits for the patient. However, to perform these techniques it is required to go through a learning period in which simulators play an important role in the acquisition of new surgical skills. The objectives of this work are to describe the development of a Canine Laparoscopic Simulator (CLS) for veterinarians, to validate the training program and determine its usefulness in the acquisition of new surgical skills and to assess ergonomic problems while performing laparoscopic training tasks using the CLS. A total of 84 veterinarians with different levels of experience in laparoscopic surgery were included in different studies of this work. The training program consisted of four tasks performed on the CLS: coordination, peg transfer, cutting and suturing. To build the CLS various informatics programs were used, as well as images of computer tomography. As objective measures of evaluation, we used time, GOALS (Global Operative Assessment of Laparoscopic Skills) scale and task-specific checklist to evaluate laparoscopic training tasks. To study the ergonomics, muscular activity was analyzed by surface electromyography, and hand movements were recorded using a virtual glove. The CLS had a good preliminary acceptance in basic laparoscopic tasks. The results of the validation tests showed that the CLS is suitable for training and educating in laparoscopic basic tasks, and is able to distinguish the degree of laparoscopic experience among veterinarians. The tasks of cutting and suturing showed greater muscular activity. On the other hand, the axial handle showed better ergonomic positions compared with ring handle during the different tasks of the training program in the CLS. In conclusion, the CLS is a good tool for the veterinarians' training in laparoscopic surgery, although it has some limitations inherent to all simulators. In addition, the CLS has proven its content and constructive validity in its program of laparoscopic training for veterinarians. Finally, laparoscopic ergonomics in veterinary is affected by the type of task, as well as by the instrument used during training in the CLS.
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Bessell, Justin Raymond. "The development, validation and analysis of new endosurgical procedures in upper gastrointestinal surgery /." Title page, table of contents and summary only, 1995. http://web4.library.adelaide.edu.au/theses/09MD/09mdb557.pdf.
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Wright, David M. "Clinical studies comparing laparoscopic and open inguinal hernia repair." Thesis, University of Glasgow, 2001. http://theses.gla.ac.uk/5401/.
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Twenty-seven consultants from the UK and Ireland contributed 928 patients to a multicentre randomised trial to compare laparoscopic hernia repair with currently used open repairs. The laparoscopic group developed less wound haematomas (7.6% vs. 15.7%; 99% CI: -14.3 to -2.0), but there was no difference in the incidence of wound infection or general complications such as urinary retention. The laparoscopic group reported lower levels of post-operative pain and this was reflected in significantly better 'Short Form 36' functional scores at one week. By one month the only significant difference between groups was a better score for physical function in the laparoscopic group, and by three months there was no significant difference in any of the 'Short Form 36' domains. The early functional advantages for the laparoscopic repair were reflected in an earlier return to normal activities (10 days vs. 14 days; p<0.01) and work (28 days vs. 42 days; p=0.001). A simulator was constructed to measure the ability to perform an emergency stop following totally extraperitoneal or open prosthetic inguinal hernia repaid. Measurements were made pre-operatively and at one, three and six days post-operatively. The laparoscopic group did not demonstrate any increase in reaction times following hernia repair. The open group had significantly prolonged reaction times on days one and three, but had returned to pre-operative levels by day six. Therefore, laparoscopic repair does not impair driver reaction times, and open prosthetic repair appears to allow an earlier return to driving than the ten days previously recommended for open sutured repair.
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Gasiūnaitė, Diana. "Comparison of general and combined anesthesia during laparoscopic colorectal surgery." Doctoral thesis, Lithuanian Academic Libraries Network (LABT), 2013. http://vddb.laba.lt/obj/LT-eLABa-0001:E.02~2013~D_20130930_092313-13566.
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The doctoral dissertation analyses and compares general endotracheal and combined endotracheal epidural anesthesia’s impact on organ systems and describes the systems parameters in laparoscopic colorectal surgery. Comparing two perioperative analgesia techniques used in laparoscopic colorectal surgery the hemodynamic and respiratory parameters trends; the impact of anesthesia and postoperative analgesia methods on patients’ tracheal extubation time, intestinal motility recovery rate, duration of hospitalization and inflammatory response have been determined. Laparoscopic colorectal resection, even being a minimally invasive technique for laparoscopic surgery, stimulates the body's response to stress and pro-inflammatory mediator’s secretion. Perioperative pain management may also influence the immune response. The doctoral dissertation analyses the impact of epidural analgesia method on the body stress response, investigating variations of cortisol and interleukin-6 levels. The results showed that analgesia and patient satisfaction using epidural analgesia method for perioperative pain management were better. Tracheal extubation time was significantly shorter. Recovery of intestinal motility using epidural analgesia was significant and much prior than using intravenous analgesia. The use of epidural analgesia in laparoscopic colorectal surgery caused less stress response – less cortisol levels increase. It has not showed the increase in number of complications.Disertacijoje analizuojama ir lyginama bendrosios endotrachėjinės ir kombinuotos endotrachėjinės epiduralinės anestezijos įtaka atskiroms organų sistemoms ir tas sistemas apibūdinantiems rodikliams laparoskopinių kolorektalinių operacijų metu. Darbe nagrinėjama dviejų perioperacinių skausmo malšinimo būdų įtaka hemodinamikos ir kvėpavimo sistemos parametrų kitimo tendencijoms, pacientų trachėjos ekstubacijos laikui, žarnyno motorikos atsinaujinimo greičiui, hospitalizacijos trukmei bei organizmo uždegiminiam atsakui. Laparoskopinės storosios žarnos rezekcinės operacijos, net ir būdamos minimaliai invazinės dėl laparoskopinės operacijos technikos, sužadina stresinį organizmo atsaką bei uždegimo mediatorių išskyrimą. Perioperacinis skausmo valdymas taip pat gali daryti įtaką imuniniam atsakui. Disertacijoje nagrinėjama epiduralinės analgezijos metodo įtaka organizmo stresiniam atsakui tiriant kortizolio kiekio kitimus ir interleukino-6, kaip vieno pagrindinių uždegimą skatinančių citokinų, koncentracijos kitimą taikant epiduralinę analgezijos metodiką. Gauti rezultatai parodė, kad analgezijai pasitelkiant epiduralinį skausmo malšinimo metodą, perioperacinis pacientų skausmo valdymas ir pasitenkinimas yra geresnis, trachėjos ekstubacijos laikas patikimai trumpesnis, žarnyno peristaltikos atsitaisymas ankstyvesnis, sukeliamas stresinis organizmo atsakas mažesnis (mažesnis kortizolio koncentracijos padidėjimas) ir nenustatyta komplikacijų padaugėjimo.
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Ozaki, Kenʾichi. "Requirements for the display of perceived softness in laparoscopic surgery." Thesis, University of Leeds, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.555969.
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As laparoscopic surgery continues to gain widespread popularity in the world of surgery, the lack of one fundamental sensation at times put surgeons in a state of apprehension. Tactile feedback, the missing sensation, is claimed by surgeons to be an essential process to secure accurate knowledge of the region that is being operated on. In cases where visual cues alone fail to allow distinction of tissues of an area, tactile information may be the only remaining alternative the surgeon can rely upon to make a correct judgement. It is therefore imperative that this form of perceptual feedback may also be portrayed to surgeons using laparoscopic surgery, thereby recreating their more familiar environment, and assist them increase the chances of successfully completing a surgical procedure. In an attempt to remedy the present situation where tactile information in laparoscopic surgery is lacking, conditions that are thought to influence the surgeons' tactual perception during surgery were chosen to be investigated. Namely, these conditions are composed of bare hand, gloved, and the use of an intermediate tool. Unfortunately, the exact tactual dimensions that are relevant during surgery in general remain ambiguous and unclear. Therefore, as a preliminary investigation, it was proposed to take the dimension "softness", a dimension that is in general accepted as one of the fundamental tactual perception dimensions, and examine how the aforementioned examination conditions affect tactual perception for a material that differs in "softness" alone. Modified two alternative forced choice tasks were performed as a first experiment through which fruitful and promising outcomes were seen. To build on the finding of this experiment, a second experiment, which involved the softness magnitude estimations of the stimuli set, again under the same examination conditions, was carried out. The standalone results from the two experiments showed some interesting outcomes, primarily that softness was perceived differently under different examination conditions. Upon comparison, however, behaviours and activities which were to some extent, remarkable and perplexing, were encountered, leading to conclusions which in part were contradictory.
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Qian, Kun. "Essential techniques for improving visual realism of laparoscopic surgery simulation." Thesis, Bournemouth University, 2018. http://eprints.bournemouth.ac.uk/30532/.
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With the prevalence of laparoscopic surgery, the request for reliable training and assessment is becoming increasingly important. The traditional way of training is both time consuming and cost intensive, and may cause ethical or moral issues. With the development of computer technologies, virtual reality has entered the world of consumer electronics as a new way to enhance tactile and visual sensory experiences. Virtual reality based surgical skill training gradually becomes an effective supplementary to the traditional laparoscopic skill training in many surgical theatres. To provide high fidelity virtual surgery training experiences, the presentation of the virtual world should have the same level of realism as what surgeons see and feel during real operations. However, the weak computing power limits the potential level of details on the graphics presentation and physical behaviour of virtual objects, which will further influence the fidelity of tactile interaction. Achieving visual realism (realistic graphics presentation and accurate physical behaviour) and good user experience using limited computing resources is the main challenge for laparoscopic surgery simulation. The topic of visual realism in laparoscopic surgery simulation has not been well researched. This topic mainly relates to the area of 3D anatomy modeling, soft body simulation and rendering. Current researches in computer graphics and game communities are not tailored for laparoscopic surgery simulation. The direct use of those techniques in developing surgery simulators will often result in poor quality anatomy model, inaccurate simulation, low fidelity visual effect, poor user experience and inefficient production pipeline, which significantly influence the visual realism of the virtual world. The development of laparoscopic surgery simulator is an interdiscipline of computer graphics, computational physics and haptics. However, current researches barely focus on the study of tailored techniques and efficient production pipeline which often result in the long term research cycle and daunting cost for simulator development. This research is aiming at improving the visual realism of laparoscopic surgery simulation from the perspective of computer graphics. In this research, a set of tailor techniques have been proposed to improve the visual realism for laparoscopic surgery simulation. For anatomy modeling, an automatic and efficient 3D anatomy conversion pipeline is proposed which can convert bad quality 3D anatomy into simulation ready state while preserving the original model’s surface parameterization property. For simulation, a soft tissue simulation pipeline is pro- posed which can provide multi-layer heterogeneous soft tissue modeling and intuitive physically editable simulation based on uniform polynomial based hyperelastic material representation. For interaction, a collision detection and interaction system based on adaptive circumphere structure is proposed which supports robust and efficient sliding con- tact, energized dissection and clip. For rendering, a multi-layer soft tissue rendering pipeline is proposed which decomposed the multi-layer structure of soft tissue into corresponding material asset required by state-of-art rendering techniques. Based on this research, a system framework for building a laparoscopic surgery simulator is also proposed to test the feasibility of those tailored techniques.
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Delling, Uta. "Hand-assisted laparoscopic ovariohysterectomy in the mare." Thesis, Virginia Tech, 2005. http://hdl.handle.net/10919/32638.
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Conventionally performed equine ovariohysterectomy (OHE) is a technically demanding surgery associated with a high degree of invasiveness and morbidity. Hand-assisted laparoscopic surgical technique allows introduction of a hand through a portal into the laparoscopic field to facilitate surgical manipulation while maintaining abdominal insufflation and laparoscopic visualization. The purpose of this study was to develop and evaluate a hand-assisted laparoscopic OHE technique for dorsally recumbent horses.
The surgical technique was developed in terminal (2 mares) and subsequently evaluated in 6 survival procedures. Mares were fasted 48 hours, anesthetized and positioned in dorsal recumbency for laparoscopic surgery. A hand access device (Omniport) was placed in a caudal midline laparotomy followed by 4 laparoscopic portals. Transection of the ovarian pedicle and broad ligament was achieved using a combination of a laparoscopic stapling instrument, an ultrasonically activated instrument and endoscopic clips. The genital tract was exteriorized through the laparotomy, and the body of the uterus transected and sutured in conventional pattern. Horses were evaluated through postoperative day 14 when a post mortem evaluation was performed.
Four mares recuperated well after surgery, 1 mare was euthanized due to bilateral femur fractures sustained during anesthetic recovery and another developed severe pleuropneumonia. At necropsy all but one abdominal incision was healing routinely. One mare had abscessed along the laparotomy incision and developed visceral adhesions. Uncomplicated healing of transected mesovarial, mesometrial and uterine remnants was observed in all recovered mares.
Hand-assisted laparoscopic OHE technique represents a minimally invasive and technically feasible alternative for conventional OHE. Careful patient selection and preparation may reduce the complications observed in this study.Master of Science
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Jamil, Daniel. "Laparoscopic bariatric surgery - The normal course of liver values after surgery. A prospective cohort study." Thesis, Örebro universitet, Institutionen för medicinska vetenskaper, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-58257.
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OHU, IKECHUKWU POLYCARP NNAMDI. "Analysis of Ergonomics and Highly Non-linear Dynamics of Surgical Motions and Muscle Activations in Minimally Invasive Surgery." OpenSIUC, 2015. https://opensiuc.lib.siu.edu/dissertations/1063.
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Minimally invasive surgery (MIS) is becoming increasing popular and widely adopted on account of relative post-operative advantages (shorter hospital stays, less scarification, trauma and post-operative pain) it offers patients when compared to open surgery. Nonetheless, the surge in demand for MIS procedures are not met with commensurate availability of experts in the field, thus leading to excessive stress attributable to increased case load, and an increase in the number of surgery interns requiring training with far less MIS experts to provide it. Also, musculoskeletal discomforts experienced by MIS surgeons have been attributed to ergonomic factors among other causes, and a required verification of the viability of fundamentals of laparoscopic surgery (FLS) as a valid ergonomic discriminator between traditional MIS and robot-assisted MIS was tested and validated. Real-time, subject-centered, and objective quantification of surgical skills has long been a challenge. A proposed solution is presented here involving the application of complexity theory (time delay and Hurst exponent principles) to the analysis of phase space reconstructions of time series data, generated by periodic changes in Euler coordinates of surgical graspers while being used by MIS novices and experts. A comparison of Hurst exponent and time delay values over multiple iterations of the same task provides quantitative insight on MIS skills improvement and experience.
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Lindemann, Jessica Danielle. "The surgical management and prevention of laparoscopic cholecystectomy associated bile duct injuries." Doctoral thesis, Faculty of Health Sciences, 2020. http://hdl.handle.net/11427/33122.
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Laparoscopic cholecystectomy (LC) is considered the gold standard in the surgical management of gallstone disease and is one of the most commonly performed general surgery operations worldwide. Bile duct injury (BDI) in LC remains a feared complication as it is associated with significant morbidity, prolonged hospital stay, increased costs, and reduced quality of life for patients, as well as the risk of litigation for the injuring surgeon. The initial incidence of BDI after the introduction of LC was reported to be between 0.4 and 0.8%, which was higher than the estimated 0.2% reported during the open cholecystectomy era. However, recent reports from the United States and Europe suggest a return to open cholecystectomy rates. Despite being a frequently performed operation in both the private and public health sectors in South Africa, there is a paucity of data on the incidence of BDI. In the only study to date reporting the frequency of BDI in South Africa, a single centre incidence of 1.2% was documented over an 18-month period, which is significantly higher than previous reports. No data have been published on the implications of BDI for patients treated within the South African healthcare system. This thesis describes the surgical management of BDI at an academic referral centre over a thirty-year period. Potential factors influencing treatment and patient outcome after BDI are investigated. These include the influence of geographic distance from referral centre on the timing of referral and repair, and subsequent long-term patient outcomes. The influence of dual healthcare sectors (public vs. private) on access to diagnostic and interventional modalities, and eventual outcome is also investigated, and the evolution in the management of BDIs over the three studied decades is documented. Factors associated with loss of patency following surgical repair of LC-BDIs are also determined. Based on the findings of this detailed review of the management and outcomes of LC-BDIs, a treatment algorithm for management in resource-constrained environments is proposed. Establishing the optimal management of LC-BDIs in a developing country healthcare setting is important but does not address the source of the problem. In an effort to make LC-BDI a near-never event, a standardized method of performing, documenting and monitoring the quality of LC was developed and implemented for all LCs performed in the Cape Metro West health district. Prospective data collection is scheduled to continue to the end of 2020; however, an interim analysis is presented. A previously published scoring system for assessing quality of the critical view of safety achieved during LC, a critical component of a safe LC, is applied and validated in a large cohort of LC patients. A prospective database was created for data capture along with a Standard Operating Procedure, both designed with the goal of expanding the intervention and database nationally. The studies reported in this thesis make a substantial contribution to the literature and will have a beneficial impact on patient care in two important ways. Firstly, the management of BDI in South Africa is described and a treatment algorithm for resource-constrained environments is proposed, based on local experience. Secondly, a change of practice was implemented and a LC database was established with the possibility of expanding the effort to the national level. Locally, the change in practice has thus far resulted in identification of areas of improvement to limit BDI and increased knowledge about the appropriate steps to take to avoid causing a LC-BDI.
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Lau, Hung, and 劉雄. "Inguinal hernia repair: the impact of ambulatory and minimal access surgery." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2002. http://hub.hku.hk/bib/B25257614.
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Dirksen, Carmen Desirée. "Medical technology assessment of endoscopic surgery costs, effects and diffusion of laparoscopic cholecystectomy and laparoscopic inguinal hernia repair /." [Maastricht : Maastricht : Universiteit Maastricht] ; University Library, Maastricht University [Host], 1998. http://arno.unimaas.nl/show.cgi?fid=8252.
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Poon, Tung-chung Jensen, and 潘冬松. "Laparoscopic colorectal resection: the impacton clinical outcomes & strategies to further optimize its results." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B45205711.
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