Letteratura scientifica selezionata sul tema "Laparoscopy Surgical Procedures"
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Articoli di riviste sul tema "Laparoscopy Surgical Procedures"
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Santarelli, Stefano, Matthias Zeiler, Tania Monteburini, Rosa Maria Agostinelli, Rita Marinelli, Giorgio Degano e Emilio Ceraudo. "Videolaparoscopic Catheter Placement Reduces Contraindications to Peritoneal Dialysis". Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis 33, n. 4 (luglio 2013): 372–78. http://dx.doi.org/10.3747/pdi.2011.00314.
Testo completoAbstract (sommario):
BackgroundVideolaparoscopy is considered the reference method for peritoneal catheter placement in patients with previous abdominal surgery. The placement procedure is usually performed with at least two access sites: one for the catheter and the second for the laparoscope. Here, we describe a new one-port laparoscopic procedure that uses only one abdominal access site in patients not eligible for laparotomic catheter placement.MethodWe carried out one-port laparoscopic placement in 21 patients presenting contraindications to blind surgical procedures because of prior abdominal surgery. This technique consists in the creation of a single mini-laparotomy access through which laparoscopic procedures and placement are performed. The catheter, rectified by an introducer, is inserted inside the port. Subsequently, the port is removed, leaving the catheter in pelvic position. The port is reintroduced laterally to the catheter, confirming or correcting its position. Laparotomic placement was performed in a contemporary group of 32 patients without contraindications to blind placement. Complications and long-term catheter outcome in the two groups were evaluated.ResultsAdditional interventions during placement were necessary in 12 patients of the laparoscopy group compared with 5 patients of the laparotomy group ( p = 0.002). Laparoscopy documented adhesions in 13 patients, with need for adhesiolysis in 6 patients. Each group had 1 intra-operative complication: leakage in the laparoscopy group, and intestinal perforation in the laparotomy group. During the 2-year follow-up period, laparoscopic revisions had to be performed in 6 patients of the laparoscopy group and in 5 patients of the laparotomy group ( p = 0.26). The 1-year catheter survival was similar in both groups. Laparoscopy increased by 40% the number of patients eligible to receive peritoneal dialysis.ConclusionsVideolaparoscopy placement in patients not eligible for blind surgical procedures seems to be equivalent to laparotomic placement with regard to complications and long-term catheter outcome. The number of patients able to receive peritoneal dialysis is substantially increased.
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Malik, Ajaz A. "DIAGNOSTIC LAPAROSCOPY: Utility and solving diagnostic dilemmas". JMS SKIMS 21, n. 2 (1 gennaio 2019): 70–71. http://dx.doi.org/10.33883/jms.v21i2.368.
Testo completoAbstract (sommario):
Diagnostic laparoscopy is the basic procedure in laparoscopic surgery that has wide utility in practice, thus avoiding morbidity associated with open surgery. Laparoscopy is a minimally invasive technique wherein a fibre optic instrument is inserted through the abdominal wall to view the organs in abdomen/pelvis and permit the diagnosis and necessary surgical procedure. Nowadays, almost all general surgical procedures can be performed using minimal invasive techniques. Laparoscopy can be performed both for diagnostic as well as for therapeutic purposes. JMS 2018: 21 (2):70-71
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Hossain, Tahmina, e Md Ashraf Ul Huq. "Pediatric Laparoscopic Surgery: Four Years Experience in Dhaka Medical College Hospital". Journal of Paediatric Surgeons of Bangladesh 4, n. 1 (30 giugno 2015): 11–18. http://dx.doi.org/10.3329/jpsb.v4i1.23929.
Testo completoAbstract (sommario):
Purpose: Laparoscopy is gaining popularity over laparotomy in various surgical conditions. Now a day, an increasing number of diagnostic and therapeutic surgical procedures are being done laparoscopically. The aim of this study was to assess the safety and feasibility of laparoscopy in children.Materials and Methods: This retrospective study was carried out in the Department of Pediatric Surgery of Dhaka Medical College Hospital over a period of 52 (Fifty two) months from June 2009 to August 2013. A total of 123 patients were operated laparoscopically up to 12 years of age for different surgical conditions. Data was collected from the hospital records and analyzed retrospectively.Results: Out of these 123 laparoscopically performed cases, Appendectomy was performed in 39 cases, closure of internal inguinal ring for Inguinal Hernia was done in 36 patients, 20 patients underwent Cholecystctomy, 16 patients had laparoscopic procedures for impalpable Undescended Testis (UDT), 5 patients were operated for Adnexal Mass of which one case was converted into open procedure due to technical difficulties and 1 for Pancreatic Pseudo cyst. Diagnostic Laparoscopy was performed for 2 patients with Biliary Atresia and 4 patients for Ambiguous Genitalia. Median age of the patients was 6.08 years (ranging from 2 months to 12 years of age). The length of post operative hospital stay was 2-3 days. All the laparoscopic procedures for Inguinal Hernia and impalpable UDT were performed as day care surgery. Operative and post operative complications were minimal. Other advantages of the laparoscopic procedures were smaller incisions, incidental diagnosis of other associated pathology, lesser post operative pain, earlier oral feeding, quicker mobilization and a better cosmetic result.Conclusion: With the recent development of laparoscopic surgical techniques and equipments, laparoscopic surgical procedures are becoming popular day by day and can be performed safely for both diagnostic and therapeutic purposes in pediatric surgical patients.J. Paediatr. Surg. Bangladesh 4(1): 11-18, 2013 (January)
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Trombetta, C., G. Liguori, G. Savoca, S. Siracusano e E. Belgrano. "Urological laparoscopy: Some unusual applications". Urologia Journal 63, n. 1_suppl (gennaio 1996): 124–28. http://dx.doi.org/10.1177/039156039606301s31.
Testo completoAbstract (sommario):
Since its introduction in 1991 laparoscopy has gained a strong foothold in Urology and during the last 5 years laparoscopic technology has been applied to many urological procedures. Today, better skills in laparoscopic techniques and availability of laparoscopic instruments in urological operating theatres, make these procedures suitable for a large number of surgical purposes, some even unusual. Laparoscopy appears to be an increasingly valid alternative to traditional surgery, being minimally invasive, safe and effective. Availability of proper technological devices and experience in laparoscopic techniques allow a considerable reduction in post-operative pain, hospitalization and recovery times.
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Paw, Patrick, e Jonathan M. Sackier. "Complications of Laparoscopy and Thoracoscopy". Journal of Intensive Care Medicine 9, n. 6 (novembre 1994): 290–304. http://dx.doi.org/10.1177/088506669400900604.
Testo completoAbstract (sommario):
Laparoscopy was first performed at the turn of the century, but it was not until the introduction of laparoscopic cholecystectomy that the procedure became widely adopted by general surgeons. Since then, traditional open procedures, including cholecystectomy, exploratory laparotomy, colectomy, hernia repair, and appendectomy, are being widely performed laparoscopically. The advantages of laparoscopic surgery, including less postoperative pain due to smaller surgical incisions, shorter hospital stay, quicker return to preoperative activity, and superior cosmesis, resulted in widespread popularity with both surgeons and patients. In certain situations, the traditional method may be superior to the laparoscopic approach, as may be the case with laparoscopic hernia repair. It is difficult to justify converting a local, extraperitoneal, 45-minute, outpatient inguinal hernia repair in a virgin groin into a general anesthetic, transperitoneal, 2-hour plus, possibly inpatient laparoscopic procedure with the implantation of mesh. However, data may indicate that this operation does indeed have benefits. We must, therefore, carefully study such new operations. With the advent of a new surgical procedure, both surgeons and anesthesiologists must be familiar with the various complications unique to this technique. If recognized early, potentially life-threatening complications, including gas embolization and tension pneumothorax, can be corrected.
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Burgmeier, Christine, e Felix Schier. "The Role of Laparoscopy in the Acute Neonatal Abdomen". Surgical Innovation 23, n. 6 (9 luglio 2016): 635–39. http://dx.doi.org/10.1177/1553350616646476.
Testo completoAbstract (sommario):
Introduction.The surgical treatment of the acute neonatal abdomen still poses a challenge in pediatric surgery. Various underlying etiologies require different surgical procedures. Until today the role of laparoscopy in the surgical treatment of the acute neonatal abdomen is controversial. The aim of this study was to analyze our experiences with laparoscopy and to perform a review of the literature. Methods. Retrospective, single-institution study including all term and preterm neonates initially undergoing laparoscopy due to an acute abdomen. Results. Altogether, 17 neonates presenting with an acute neonatal abdomen initially underwent laparoscopy. Unnecessary laparotomy could be avoided in 9 of 17 (53%) neonates. After diagnostic laparoscopy, 2 patients did not require any further surgical intervention. Eight neonates presented midgut atresia intraoperatively, 5 of them underwent laparoscopic-assisted correction. Successful laparoscopic derotation of an acute volvulus (n = 1) and laparoscopic appendectomy (n = 1) could be performed. Conversion to open surgery was necessary in 8 neonates (47%) due to creation of a stoma (n = 5), multiple intestinal bands causing poor visualization (n = 2), and bowel necrosis (n = 1). Conclusions. Laparoscopy is a useful diagnostic tool to evaluate the need for further surgical intervention in the acute neonatal abdomen and enables immediate surgical treatment of acute volvulus, appendicitis, or intestinal atresia. In case of conversion to laparotomy, precise localization of the incision is guaranteed. Minimization of the surgical trauma and avoidance of unnecessary laparotomy are the most important benefits of the minimal-invasive approach for the critically ill neonate.
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Bergström, Bo S. "Lift-Assisted Laparoscopy in Hysterectomy: A Retrospective Study of 32 Consecutive Cases". ISRN Minimally Invasive Surgery 2013 (7 ottobre 2013): 1–4. http://dx.doi.org/10.1155/2013/989727.
Testo completoAbstract (sommario):
A large uterus is the most commonly reported obstacle to laparoscopic hysterectomy. It reduces the intra-abdominal free space, limits visualization and instrumentation, causes technical difficulties, and increases the potential for complications. The logical solution to this dilemma is to address the underlying problem and increase the intra-abdominal free space. This can be done readily by supplementing the conventional pneumoperitoneum by concurrent mechanical lifting of the abdominal wall using the camera trocar as an anchoring device. Such lift-assisted laparoscopy augments the intra-abdominal free space formation, and lifts the laparoscope to a higher position to give a panoramic view, even when the uterus is large. This retrospective study of 32 consecutive cases of laparoscopic hysterectomy indicates that the use of lift-assisted laparoscopy is safe for the patient and that a large uterus is not a contraindication. The operations were long, but complications were few. Lift-assisted laparoscopy is an option to improve patient care by modifying surgical procedures. Operating time, per se, is not a valid measure of quality in laparoscopic hysterectomy. The more traumatic abdominal hysterectomy procedures need not be selected in preference over lengthy minimally invasive techniques. Other techniques, such as solo surgery and in-office surgery, are also discussed.
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Jernigan, Amelia M., Melinda Auer, Amanda N. Fader e Pedro F. Escobar. "Minimally Invasive Surgery in Gynecologic Oncology: A Review of Modalities and the Literature". Women's Health 8, n. 3 (maggio 2012): 239–50. http://dx.doi.org/10.2217/whe.12.13.
Testo completoAbstract (sommario):
Minimally invasive surgery is one of the newest and most exciting areas of development in procedural medicine. This field shows tremendous potential to increase therapeutic benefit while minimizing some of the painful or dangerous side effects of surgical interventions. Minimally invasive surgery has strong historic ties to the field of gynecology and has come a long way as technology and techniques have improved. This has increasingly allowed the application of laparoscopy to more complex procedures and the treatment of gynecologic malignancies. Three laparoscopic approaches, traditional laparoscopy, robotic assisted laparoscopy and laparoendoscopic single-site surgery are reviewed here. We discuss the basic approaches to these three laparoscopic techniques, and then review their applications in gynecologic oncology. We also touch on the evidence behind outcomes associated with their use.
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Conrad, Lesley B., Pedro T. Ramirez, William Burke, R. Wendel Naumann, Kari L. Ring, Mark F. Munsell e Michael Frumovitz. "Role of Minimally Invasive Surgery in Gynecologic Oncology: An Updated Survey of Members of the Society of Gynecologic Oncology". International Journal of Gynecologic Cancer 25, n. 6 (luglio 2015): 1121–27. http://dx.doi.org/10.1097/igc.0000000000000450.
Testo completoAbstract (sommario):
ObjectivesTo evaluate the current patterns of use of minimally invasive surgical procedures, including traditional, robotic-assisted, and single-port laparoscopy, by Society of Gynecologic Oncology (SGO) members and to compare the results to those of our 2004 and 2007 surveys.MethodsThe Society of Gynecologic Oncology members were surveyed through an online or mailed-paper survey. Data were analyzed and compared with results of our prior surveys.ResultsFour hundred six (32%) of 1279 SGO members responded. Eighty-three percent of respondents (n = 337) performed traditional laparoscopic surgery (compared with 84% in 2004 and 91% in 2007). Ninety-seven percent of respondents performed robotic surgery (compared with 27% in 2007). When respondents were asked to indicate procedures that they performed with the robot but not with traditional laparoscopy, 75% indicated radical hysterectomy and pelvic lymphadenectomy for cervical cancer. Overall, 70% of respondents indicated that hysterectomy and staging for uterine cancer was the procedure they most commonly performed with a minimally invasive approach. Only 17% of respondents who performed minimally invasive surgery performed single-port laparoscopy, and only 5% of respondents indicated that single-port laparoscopy has an important or very important role in the field.ConclusionsSince our prior surveys, we found a significant increase in the overall use and indications for robotic surgery. Radical hysterectomy or trachelectomy and pelvic lymphadenectomy for cervical cancer and total hysterectomy and staging for endometrial cancer were procedures found to be significantly more appropriate for the robotic platform in comparison to traditional laparoscopy. The indications for laparoscopy have expanded beyond endometrial cancer staging to include surgical management of early-stage cervical and ovarian cancers, but the use of single-port laparoscopy remains limited.
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Jahan, Samsad, Tripti Rani Das, Samira Humaira Habib, Akter Jahan, Mahjabin Joarder, Nurun Nahar e Manisha Banarjee. "A Comparative Study Between Laparoscopic Management of Ectopic Pregnancy and Laparotomy: Experience in Tertiary Care Hospital in Bangladesh: A Prospective Trial". Bangladesh Journal of Endosurgery 2, n. 1 (18 luglio 2014): 1–4. http://dx.doi.org/10.3329/bje.v2i1.19570.
Testo completoAbstract (sommario):
Objectives: To compare the efficiency and surgical morbidity associated with laparoscopic management of tubal ectopic pregnancy (EP) compared with that of open laparotomy. Materials and methods: During November 2008 to October 2012, there were 89 with a confirmed ectopic pregnancy These patients were admitted through emergency or outpatient department and managed by laparoscopy (number 70) and by laparotomy (number 19). The diagnosis of ectopic pregnancy was based on history, clinical symptoms, physical examination, a positive serum B-human chorionic gonadotropin (B-HCG), transvaginal ultrasonography. Patients were informed pre-operatively about the surgical procedures. The main outcome measured included operative time, blood loss, and complications.Results: Laparoscopic surgery gives an overall success rate of 98.9%. Linear salpingostomy was the main procedure performed in both groups. Estimated blood loss was significantly lower in the laparoscopy group compared with laparotomy group (p<0.001). Only 3 (3.81%) patients in the laparoscopy group required blood transfusion, whereas 16 (74.94%) in the laparotomy group needed transfusion (P<0.0001). The duration of operation in laparoscopy group was 53.2 ± 16.8 minutes and 84.5 ± 30.3 minutes in the laparotomy group. The duration of hospitalization was significantly shorter in the laparoscopy group 1.12±0.5 days compared to 5.25±0.1days in the laparotomy group (p<0.0001). ). In the laparoscopy group 57(72.4%) patients did not need analgesia after surgery compared with laparotomy group where all the patients needed analgesia.Conclusion: Laparoscopic treatment (Salpingostomy or Salpingectomy) of EPs offers major benefits superior to laparotomy in terms of less blood loss, less need for blood transfusion and postoperative analgesia, a shorter duration of hospital stay. Laparoscopic management of ectopic pregnancy might be the most beneficial procedure with maximal safety and efficacy.
Tesi sul tema "Laparoscopy Surgical Procedures"
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Bringman, Sven. "Minimally invasive hernia surgery /". Stockholm, 2003. http://diss.kib.ki.se/2003/91-7349-466-6/.
Testo completo
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Brown, Jeffrey Dale. "In-vivo and postmortem biomechanics of abdominal organs under compressive loads : experimental approach in a laparoscopic surgery setup /". Thesis, Connect to this title online; UW restricted, 2003. http://hdl.handle.net/1773/8005.
Testo completo
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Pimentel, Marcelo. "Influência da experiência prévia em laparoscopiaavançada nas habilidades básicas em cirurgia robótica avaliadas pelo simulador virtual de cirurgia dV-Trainer". reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2017. http://hdl.handle.net/10183/172101.
Testo completoAbstract (sommario):
Objetivo: O impacto da experiência em laparoscopia nas habilidades de cirurgia robótica ainda não está claramente estabelecido. Nosso estudo tem como objetivo comparar habilidades básicas em cirurgia robótica, usando o simulador de realidade virtual dVTrainer ®, entre cirurgiões com experiência laparoscópica e residentes de cirurgia do primeiro ano. Métodos: Vinte cirurgiões com experiência em laparoscopia (grupo 1) e vinte residentes de cirurgia do primeiro ano (grupo 2) foram incluídos no estudo. Cada participante completou quatro tentativas dos exercícios Peg Board 2, Ring and Rail 1 e Suture Sponge 1 no dVTrainer ®. O desempenho foi avaliado utilizando um algoritmo de pontuação computadorizado incorporado ao simulador. As pontuações e as métricas foram comparadas entre os grupos 1 e 2, e entre a primeira tentativa e as demais Resultados: Os escores gerais para os exercícios Peg Board 2 (738,04 ± 267,83 vs 730,39 ± 225,31; p = 0,57), Ring and Rail 1 (919,03 ± 242,69 vs 965,84 ± 222,96; p = 0,13) e Suture Sponge 1 (563,62 ± 185,50 vs 560,99 ± 152,71; p = 0,67) não apresentaram diferença significativa entre os grupos 1 e 2. O grupo 1 apresentou melhores resultados na área de trabalho dos controles mestres nos exercícios Peg Board 2 e Ring and Rail 1. O grupo 2 apresentou melhores resultados na economia de movimentos nos exercícios Peg Board 2 e Ring and Rail 1 e na força excessiva dos instrumentos no exercício Ring and Rail 1. Nos dois grupos os escores gerais na terceira ou quarta tentativas foram significativamente melhores em comparação com a primeira. Conclusões: Não há diferença significativa nas habilidades básicas da cirurgia robótica entre cirurgiões com experiência laparoscópica e residentes de cirurgia sem experiência em laparoscopia. Algumas diferenças existem quando consideramos métricas específicas, mas essas diferenças não foram capazes de modificar os resultados finais. Podemos considerar que a experiência em laparoscopia pode não se constituir em requisito essencial na aprendizagem da cirurgia robótica.Objective: The actual impact of laparoscopic experience on robotic skills is uncertain. This study aimed to compare basic robotic surgical skills using the virtual reality simulator dVTrainer ® between laparoscopically experienced surgeons and first-year surgical residents. Methods: Twenty laparoscopically experienced surgeons (group 1) and 20 first-year surgical residents (group 2) were included. Each participant completed four trials of the following tasks on the dV-Trainer®: Peg Board 2, Ring and Rail 1 and Suture Sponge 1. Performance was recorded using a computerized built-in scoring algorithm. Scores and metrics were compared between groups 1 and 2 and between the 1st and subsequent trials Results: The overall scores for Peg Board 2 (738.04 ± 267.83 vs 730.39 ± 225.31, p = 0.57), Ring and Rail 1 (919.03 ± 242.69 vs 965.84 ± 222.96, p = 0.13) and Suture Sponge 1 (563.62 ± 185.50 vs 560.99 ± 152.71, p = 0.67) did not differ significantly between groups 1 and 2. Group 1 had better results for master workspace range in Peg Board 2 and Ring and Rail 1. Group 2 had higher scores for economy of motion in Peg Board 2 and Ring and Rail 1 and for excessive instrument force in Ring and Rail 1. In both groups, the overall scores in the 3rd or 4th trials were significantly higher than those in the 1st trial. Conclusions: There is no significant difference in basic robotic surgical skills between laparoscopically experienced surgeons and laparoscopically naïve surgical residents. Some slight differences were observed in specific metrics, but these differences were not sufficient to change the final results. We may assume that laparoscopic experience should not be an essential step in the learning curve of robotic surgery.
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Tormena, Renata Assef. "Histerectomia laparoscópica: estudo comparativo entre laparoscopia com múltiplas punções e punção única umbilical". Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/5/5139/tde-04112016-114650/.
Testo completoAbstract (sommario):
A histerectomia é um dos procedimentos cirúrgicos mais frequentes em Ginecologia. As técnicas minimamente invasivas trazem benefícios às pacientes e possibilitam o retorno precoce às atividades diárias. O presente estudo envolveu 42 pacientes do Setor de Laparoscopia da Divisão de Clínica Ginecológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo com indicação de histerectomia. As pacientes foram randomizadas em dois grupos: HLM (21 pacientes submetidas à histerectomia total laparoscópica com 3 punções) e HLU (21 pacientes submetidas à histerectomia total laparoscópica com punção única umbilical). Foram analisados tempo cirúrgico, sangramento operatório (variação de hemoglobina pré e pós-operatória, e volume de sangue aspirado durante a cirurgia), resposta inflamatória aguda (dosagens seriadas de Proteína C Reativa, de citocinas: interleucina-6, interleucina-10, fator de necrose tumoral alfa, fator de crescimento endotelial vascular e de leucócitos), complicações operatórias imediatas e tardias, dor pós-operatória (escala visual analógica de dor) e grau de satisfação das pacientes (questionário validado de qualidade de vida SF36). O tempo cirúrgico foi significativamente maior no grupo das histerectomias por punção única umbilical comparado ao grupo de múltiplas punções (p= 0,001). O sangramento operatório foi semelhante entre os dois grupos. Não ocorreram complicações imediatas maiores, porém, em um caso de HLU, houve necessidade de realização de duas punções auxiliares para lise de extensas aderências pélvicas. Em relação à resposta inflamatória, os grupos se comportaram de forma semelhante nas dosagens de IL-6 (p = 0,833), IL-10 (p = 0,420), TNF alfa (p = 0,098), VEGF (p =0,092) e leucograma (p = 0,712). Embora o comportamento da proteína C-reativa tenha sido diferente entre os dois grupos, seus valores médios não apresentaram diferença estatisticamente significativa em nenhum momento avaliado (p = 0,666). A análise subjetiva da dor foi semelhante nos dois grupos estudados. Um ano após a cirurgia, verificamos a presença de hérnia umbilical em três pacientes submetidas à histerectomia por punção única umbilical, sem diferença significativa em relação à cirurgia com múltiplas punções (p = 0,09). Além disso, houve melhora da qualidade de vida em ambos os grupos, segundo avaliação feita antes e um ano após a cirurgia. Conclusões: A HLU apresentou tempo cirúrgico maior do que HLM; entretanto, não observamos diferença entre os grupos em relação ao sangramento operatório, à resposta inflamatória, à dor pós-operatória, às complicações e à qualidade de vida. As duas técnicas propostas para realização de histerectomia laparoscópica foram viáveis e seguras. Há limitações da técnica com punção umbilical única para pacientes com úteros volumosos ou com múltiplas aderências pélvicasHysterectomy is one of the most common surgical procedures in gynecology. Minimally invasive techniques bring benefits to patients and including early return to normal activities. This study included 42 women candidates to hysterectomy at the Gynecological Clinic Division of Clinics Hospital of São Paulo University Medical School. The patients were randomized in two groups: HLM (21 patients underwent to total laparoscopic hysterectomy with three abdominal incisions) and HLU (21 patients underwent to total laparoscopic hysterectomy with single umbilical incision). The surgical time, blood loss (pre and postoperative hemoglobin variation and total blood volume aspirated during the surgery), complications rate, acute inflammatory response (C-reactive protein, interleukin-6, interleukin-10, tumor necrosis factor alpha, vascular endothelium growth factor and leucogram), postoperative pain (Visual Analogical Pain Score) and patient satisfaction (Short Form 36 Health Survey) were analyzed. The operative time was significantly larger in the umbilical single incision hysterectomy group compared to the multiple incisions group (p = 0,001). Blood loss was similar in both groups. There were no major immediate complications; however, one hysterectomy started with single incision needed two additional trocars to remove extensive pelvic adhesions. In terms of inflammatory response, both groups were similar in terms of IL-6 (p = 0,833), IL- 10 (p = 0,420), TNF alfa (p = 0,098), VEGF (p =0,092) and leucogram (p = 0,712) measures. Although the C-reactive protein behavior was different between the groups, their average values showed no statistically significant difference in any evaluated moment (p = 0,666). Pain evaluation was similar in both groups. Twelve months after surgery we observed the presence of umbilical hernia in three patients submitted to single-port hysterectomy, with no significant difference compared to multiport hysterectomy (p = 0,098). There was improvement in quality of life, according assessment before and after surgery in both groups. Conclusions: Singleport laparoscopic hysterectomy did have significantly larger operative time than multiport laparoscopic hysterectomy; however, no difference was observed between the groups in terms of operative bleeding, inflammatory response, postoperative pain and quality of life. Both techniques for laparoscopic hysterectomy were feasible and safe. Single-port hysterectomy presented technical limitations in patients with large uterus or extensive pelvic adhesions
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Araújo, Marleny Novaes Figueiredo de. "Tratamento cirúrgico da doença de Crohn:estudo comparativo entre desfechos precoses após laparoscopia primária, laparoscopia repetida ou laparoscopia após laparotomia na recidiva". Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/5/5168/tde-11052017-160736/.
Testo completoAbstract (sommario):
Introdução: o uso da videolaparoscopia na doença de Crohn (DC) teve seu início nos anos 90, com ressalvas à possível dificuldade técnica que a DC complexa ou recorrente poderia impor à sua realização. Diversos estudos ao longo das décadas de 90 e 2000 mostraram ser a mesma factível, quando comparada à laparoscopia para DC primária, além de demonstrarem maior benefício da laparoscopia comparada à cirurgia aberta/convencional nos casos de DC recorrente. Entretanto, não houve estudos sobre resultados cirúrgicos após repetidas ressecções laparoscópicas. Objetivo: avaliar resultados pós-operatórios em curto prazo no tratamento da DC, comparando pacientes submetidos a uma segunda ressecção intestinal laparoscópica e pacientes sem cirurgia prévia. Além disso, comparar os mesmos resultados pós-operatórios entre pacientes submetidos a uma segunda ressecção intestinal laparoscópica e pacientes sendo submetidos a laparoscopia para DC e história prévia de ressecção intestinal prévia por laparotomia. Materiais e métodos: foi realizado análise retrospectiva a partir de base de dados mantida prospectivamente de pacientes submetidos a laparoscopia para tratamento da DC no Hospital Beaujon, França, entre 2005 e 2010. Os desfechos analisados foram: conversão para cirurgia aberta, tempo operatório, taxa de enterotomias inadvertidas no intra-operatório, morbidade, necessidade de reintervenção (cirúrgica ou radiológica) e tempo total de hospitalização. Resultados: foram analisados 18 pacientes com laparoscopia prévia (grupo A), 90 pacientes sem cirurgia prévia (grupo B) e 26 pacientes com laparotomia prévia (grupo C). Em nossa análise principal, comparando os grupos A e B, vemos grupos semelhantes em relação a dados demográficos, exceto maior número de casos complexos no grupo A (83,3 vs 46,7%; p=0,005) e tipo de operação realizada (p < 0,001). Quanto aos resultados, apenas o tempo operatório foi significativamente mais longo no grupo A (180 minutos vs. 150 minutos; p=0,013). A taxa de conversão, enterotomia inadvertida, morbidade, necessidade de reintervenção e tempo de hospitalização foram similares entre os grupos. Em nossa segunda análise, entre os grupos A e C, não houve diferença significativa quanto aos mesmos resultados analisados. Conclusão: apesar de um maior tempo operatório, uma segunda ressecção laparoscópica mantém os mesmos benefícios vistos em uma ressecção intestinal laparoscópica primária. Os mesmos benefícios são vistos quando os resultados são comparados com pacientes submetidos previamente a uma ressecção intestinal por laparotomia, em especial quando nas mãos de equipe experienteIntroduction: the use of laparoscopy in Crohn\'s disease (CD) had its beginning in the 90s, despite the possible challenge of technical difficulty that the complex or recurrent CD could impose to its realization. Numerous studies over the decades of 90 and 2000 showed laparoscopy in recurrent CD to be feasible compared to laparoscopy for primary CD, and have also shown the benefits of laparoscopic compared to open conventional surgery in patients with recurrent CD. However, there were no studies on surgical outcomes after repeated laparoscopic resections. Objective: 1. to evaluate postoperative short-term results regarding surgical treatment of CD, comparing patients who underwent a second laparoscopic bowel resection and patients without prior surgery. 2. to compare the same postoperative results among patients who underwent a second laparoscopic bowel resection patients and patients undergoing laparoscopic resection with history of prior intestinal resection by laparotomy. Materials and methods: a retrospective analysis from prospectively maintained database of patients undergoing laparoscopy for treatment of CD in Hospital Beaujon, France, between 2005 and 2010, was performed. The outcomes analyzed were: conversion to open surgery, operative time, intraoperative inadvertent enterotomy, morbidity, need for re-intervention (surgical or radiological) and length of hospitalization. Results: 18 patients with previous laparoscopy (group A), 90 patients without previous surgery (group B) and 26 patients with previous laparotomy (group C) were included. In our main analysis, comparing the groups A and B, groups were similar in respect to demographic data, except number of complex cases in group A (83.3 vs 46.7%; p = 0.005) and type of surgery performed (p < 0.001). As for the results, operative time was significantly longer in group A (180 minutes vs. 150 minutes; p = 0.013). Conversion rate, inadvertent enterotomy, morbidity, need for re-intervention and hospital stay were similar between groups. In our second analysis, between groups A and C, there was no significant difference between groups regarding the same variables. Conclusion. In spite of a longer operative time, a second laparoscopic resection guarantees the same benefits seen in a primary laparoscopic bowel resection. The same benefits are kept compared to patients who underwent prior bowel resection by laparotomy, especially when in the hands of experienced staff
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Carvalhal, Eduardo Franco. "Neobexiga gastroileal ortotópica e gastroileocistoplastia laparoscópicas: viabilidade técnica e análise crítica de um modelo experimental em suínos". Universidade de São Paulo, 2004. http://www.teses.usp.br/teses/disponiveis/5/5153/tde-19032007-101151/.
Testo completoAbstract (sommario):
Introdução: Reservatórios gastroileais (GI) compostos podem apresentar vantagens em relação a segmentos intestinais isolados em cirurgias de reconstrução urinária em pacientes selecionados. Apresentamos aqui as técnicas laparoscópicas de gastroileocistoplastia (ampliação vesical) e de neobexiga gastroileal ortotópica (substituição vesical), realizadas de forma completamente intracorpórea em um modelo suíno experimental. Avalia-se sua viabilidade técnica e resultados funcionais. Métodos: Após padronização da técnica em estudo piloto (três animais), realizaram-se as cirurgias de gastroileocistoplastia (Grupo I; N = 5) e neobexiga GI ortotópica (Grupo II; N = 10), envolvendo os mesmos princípios de ressecção laparoscópica de cunha gástrica e íleo. No grupo II, a criação da neobexiga GI incluiu reimplante ureteral bilateral no segmento gástrico com técnica antirefluxo e anastomose uretro-ileal. Foram utilizados exclusivamente grampeadores e técnicas de sutura livre laparoscópica, de forma completamente intracorpórea. Análise pré e pós-operatória de dados laboratoriais, capacidade vesical, avaliação histológica e por imagem (uretrocistografia, urografia venosa) dos reservatórios resultantes foi concluída ao final do seguimento de 8 a 12 semanas (Grupo I) e quatro a oito semanas (Grupo II). Resultados: Os segmentos ileal e gástrico alcançaram a pelve do animal em todos os casos. Tempo cirúrgico foi de 5,2 h para o Grupo I e 7,4 h para o Grupo II. Não houve conversões ou óbitos intra-operatórios. Todos os reservatórios GI apresentavam-se viáveis por ocasião da eutanásia em ambos os grupos. No Grupo I, quatro dos cinco animais completaram sem intercorrências o seguimento de 8 (N = 2) e 12 (N = 2) semanas. Um animal apresentou deterioração clínica, sendo levado precocemente à eutanásia por pielonefrite e alcalose metabólica. Houve aumento da capacidade vesical (a uma pressão vesical de 20cmH2O) de 650ml para 1025ml (p < 0,05) após a cirurgia de ampliação vesical. No Grupo II, cinco dos 10 animais completaram o seguimento previsto em quatro (N = 3) e oito (N = 2) semanas, com mínima alteração da função renal (Cr pré e pós-operatório=1,4 e 2,2mg/dl, respectivamente; p = 0,09). Três animais tiveram a eutanásia antecipada devido a obstrução ureteral com pielonefrite (N = 2) e alcalose hipoclorêmica severa (N=1). Dois óbitos foram associados a obstrução ureteral bilateral e sepse. Capacidade vesical média das neobexigas foi de 400ml. Não houve casos de refluxo vesico-ureteral à cistografia. Porém, sete das 20 unidades renais (35%) apresentaram estenose uretero-gástrica. Obstrução intestinal (N = 1), fístula gástrica (N = 1) e urinoma (N = 1) foram outras complicações do Grupo II. Conclusões: A ressecção gástrica laparoscópica para ampliação e substituição vesicais é viável e reprodutível. A gastroileocistoplastia laparoscópica apresenta adequado resultado funcional após três meses no modelo suíno. A neobexiga GI laparoscópica é tecnicamente viável no modelo suíno, apesar de sua complexidade. A descrição inicial é apresentada. Aperfeiçoamento da técnica de reimplante ureteral anti-refluxo laparoscópico é necessário antes de sua aplicação clínica.Introduction: Composite gastroileal (GI) urinary reservoirs may present advantages over the use of isolated intestinal segments for urinary reconstructive procedures in selected patients. Herein, we present the laparoscopic techniques of gastroileocystoplasty (bladder augmentation) and GI orthotopic neobladder (bladder substitution), performed completely intracorporeally in a porcine model. Technical feasibility and functional results of these procedures are evaluated. Methods: After a pilot study (three animals) to technically standardize the procedures, gastroileocystoplasty (Group I, N = 5) and GI orthotopic neobladder (Group II; N = 10) were performed applying the same principles of wedge gastric resection and ileal resection. In Group II, creation of the neobladder included bilateral ureteral reimplantation into the gastric segment with an anti-reflux technique and an urethro-ileoanastomosis. Staplers and free-hand laparoscopic suture techniques were utilized exclusively, in a completely intracorporeal manner. Preop and postoperative analysis of laboratory data, bladder capacity, image (cystourethrography, intravenous urography) and histological evaluation of the resulting GI reservoirs was concluded at the end of follow-up, at eight and 12 weeks (Group I) and four and eight weeks (Group II). Results: Ileal and gastric patches reached the animal pelvis in all cases. Operative times were 5.2h for Group I and 7.4h for Group II. No conversions or intraoperative deaths occurred. All GI reservoirs were viable by the time of euthanasia in both groups. In Group I, four of the five animals completed the scheduled follow-up of 8 (N = 2) and 12 (N = 2) weeks without complications. One animal received early euthanasia due to pyelonephritis and metabolic alkalosis. Bladder capacity (at a bladder pressure of 20cmH2O) increased from 650ml to 1025ml (p < 0.05) after the bladder augmentation procedure. In Group II, five of 10 animals completed the scheduled follow-up at four (N = 3) and eight (N = 2) weeks, with minimal alteration on renal function (pre and postoperative Cr = 1.4 and 2.2mg/dl, respectively; p = 0.09). Three animals had an early euthanasia due to ureteral obstruction and pyelonephritis (N=2) and severe hipochloremic alkalosis (N = 1). Two deaths were associated to bilateral ureteral obstruction and sepsis. Mean bladder capacity for the neobladders was 400ml. No cases of vesico-ureteral reflux were seen at cystourethrography. However, seven of 20 renal units (35%) presented with uretero-gastric stenosis. Bowel obstruction (N = 1), gastric fistula (N = 1) and urinoma (N = 1) were other complications in Group II. Conclusions: Laparoscopic gastric resection for bladder augmentation and substitution purposes is feasible and reproducible. Laparoscopic gastroileocystoplasty presents adequate functional results after three months in the porcine model. Laparoscopic GI neobladder is technically viable in the porcine model, despite its complexity. The initial report is presented. Refinements of laparoscopic anti-reflux ureteral reimplantation techniques are necessary before its clinical application.
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Jelena, Antić. "Klinički značaj minimalno invazivne hirurgije u terapiji akutnog apendicitisa u dečjem uzrastu". Phd thesis, Univerzitet u Novom Sadu, Medicinski fakultet u Novom Sadu, 2016. http://www.cris.uns.ac.rs/record.jsf?recordId=100926&source=NDLTD&language=en.
Testo completoAbstract (sommario):
Uvod: Akutni apendicitis predstavlja jedno od najčešćih abdominalnih hirurških oboljenja u dečjem uzrastu. Lečenje je operativno, primenom otvorene hirurgije ili primenom minimalno invazivne hirurgije tj. laparoskopske apendektomije. Iako je laparoskopska apendektomija, zbog svojih prednosti, stekla popularnost kod mnogih hirurga, još uvek nije široko primenjena metoda na našim prostorima. Prednost izvođenja laparoskopske apendektomije u odnosu na otvorenu metodu u dečjem uzrastu je i dalje nedovoljno definisana i predmet je mnogih istraživanja. Cilj istraživanja je da se utvrdi da li je dužina hospitalizacije kod dece operisane laparoskopski zbog akutnog apendicitisa kraća u odnosu na otvorenu metodu, kao i da se utvrdi da li postoji razlika u pojavi postoperativnih komplikacija između ove dve hirurške metode. Pored toga, cilj istraživanja je i da se utvrdi uticaj obe metode lečenja na kvalitet života i brzinu uspostavljanja svakodnevnih aktivnosti. Metodologija: Na Klinici za dečju hirurgiju, Instituta za zdravstvenu zaštitu dece i omladine Vojvodine, sprovedena je prospektivna, kontrolisana randomizirana studija, u trajanju od deset meseci, u koju su bili uključeni svi pacijenti sa akutnim apendicitisom, kod kojih je planirana apendektomija, a čiji roditelji su dali pismeni pristanak za učešće u istraživanju. Svi ispitanici su podeljeni u dve osnovne grupe u odnosu na operativnu tehniku: otvorena i laparoskopska apendektomija. Potom su svi ispitanici podeljeni u tri podgrupe, u zavisnosti od stepena upaljenosti crvuljka (negativni, nekomplikovani i komplikovani apendicitis). Svaki ispitanik je imao svoj individualni protokol istraživanja gde su preoperativno zabeleženi: uzrast, pol, simptomi (vrsta i dužina), fizikalni pregled, laboratorijske analize (broj leukocita, hematokrit), ultrazvučni nalaz, procena opšteg stanja, udružena oboljenja, vreme od prijema do operacije, preoperativna antibiotska terapija. Intraoperativno je analizirano: vrsta hirurgije, nalaz na apendiksu, prisustvo peritonitisa, udružena patologija, dužina operacije i trajanje pneumoperitoneuma (kod laparoskopske apendektomije), patohistološki nalaz apendiksa, bakteriološki bris abdomena. Postoperativno su analizirani: antibiotska terapija (vrsta i dužina), započinjanje peroralnog unosa, utvrđivanje postoperativnog bola, febrilnost, uspostavljanje peristaltike creva, izgled rane, postoperativne komplikacije (infekcija rane, intraabdominalni apscesi, ileus) i dužina hospitalizacije. Posebno su analizirani kvalitet života pacijenata nakon operacije pomoću modifikovanog upitnika SF 10 za dečji uzrast, kao i uspostavljanje svakodnevnih aktivnosti pomoću Activity Assessment Scale (AAS), modifikovane za dečji uzrast, nakon svakog postoperativnog dana, prvih sedam dana, nakon mesec dana, tri i šest meseci od operacije. Svi pacijenti su operisani u uslovima opšte anestezije. Klasična, otvorena apendektomija je vršena kroz naizmenični rez u desnoj ilijačnoj jami. Po otvaranju peritoneuma, cekum je izvučen i načinjena je klasična apendektomija. Laparoskopska apendektomija je vršena kroz tri 5 mm porta. Pneumoperitoneum je kreiran otvorenom metodom po Hasson-u, kroz infraumbilikalnu inciziju, a preostala dva porta su postavljena desno i levo ilijačno. Mezenteriolum je zbrinut pomoću ultrazvučnih makaza. Postavljene su intrakorporalne ligature i apendiks je odstranjen kroz desni port. Rezultati: Tokom perioda od deset meseci operisano je ukupno 125 pacijenata uzrasta od 2 do 18 godina, zbog akutnog apendicitisa. Laparoskopskom tehnikom je operisano 60 pacijenata (48%), a otvorenom metodom 61 (48,8%). Kod 4 pacijenta je načinjena konverzija, tj. promena operativne tehnike iz laparoskopske u otvorenu metodu. Nije bilo statistički značajne razlike između terapijskih grupa u odnosu na stepen upaljenosti apendiksa, vrstu i dužinu trajanja simptoma, u dijagnostičkim procedurama, kao ni u vremenu proteklom od prijema u bolnicu do operacije. Srednje operativno vreme je iznosilo 65 minuta (25-185 min) za laparoskopsku grupu i 45,49 minuta (25-90 min) za otvorene apendektomije (razlika je statistički značajna, p<0,001). Crevna peristaltika, kao i započinjanje peroralnog unosa, se statistički značajno ranije uspostavljaju u grupi laparoskopsko operisanih. U grupi laparoskopskih apendektomija, postoperativne komplikacije (infekcija rana i formiranje intraabdominalnih apscesa) su se javile kod 8,33% ispitanika (5/60), a u otvorenoj grupi kod 4.91%, (3/61), što nije bilo statistički značajno (c2 = 0,152; df = 1; p = 0,696). Dužina hospitalizacije kod dece operisane laparoskopski je iznosila 5,95 } 1,21 dana, a otvoreno 6,43 } 1,09 dana, što je statistički značajna razlika (t = -2,206; p = 0,029). Rezultati Man-Vitnijevog U testa su pokazali statistički značajno bolji ukupni skor svakodnevnih aktivnosti za grupu laparoskopskih apendektomija (Z = -7,608; p = 0,000). U svim ispitivanim indikatorima kvaliteta života, deca laparoskopske grupe su imala veći skor. Deca sa akutnim apendicitisom operisana laparoskopski značajno ranije postižu visok stepen kvaliteta života (t = 2,407; p = 0,018). Zaključak: Prednost minimalno invazivne hirurgije u terapiji akutnog apendicitisa u dečjem uzrastu ogleda se u bržem uspostavljanju ponovnog funkcionisanja gastrointestinalnog trakta, kraćoj hospitalizaciji, a samim tim i bržem sveukupnom oporavku, vraćanju svakodnevnim aktivnostima i dobrom kvalitetu života. Postoperativne komplikacije se podjednako javljaju, kako kod otvorene, tako i kod laparoskopske operativne tehnike.Introduction: Acute appendicitis is one of the most common abdominal surgical diseases in children. Operative treatment means open surgery or minimally invasive surgery (laparoscopic appendectomy). Although laparoscopic appendectomy, gained popularity among many surgeons, it is still not widely accepted in our region. The advantage of laparoscopic appendectomy compared to the open method in children is still not sufficiently defined and is the subject of further research. The aim of the research was to determine whether the length of hospital stay after laparoscopic surgery in children with acute appendicitis is shorter compared to the open method, as well as to determine whether there is a difference in the occurrence of postoperative complications after these two operative techniques. In addition, the aim of the research was to determine the effect of both methods of treatment on quality of life and everyday functioning. Methodology: This prospective, randomized controlled study was performed at the Clinic for Pediatric Surgery, Institute of Children and Youth Healthcare of Vojvodina, during a period of ten months. All patients with acute appendicitis, whose parents have given written consent, were included in research. All patients were divided into two basic groups, in relation to the surgical technique: open or laparoscopic appendectomy. Then, all of them were divided into three groups, depending on the degree of appendicitis (negative, uncomplicated and complicated appendicitis). Each participant had their own individual research protocol where we recorded preoperatively: age, sex, symptoms (type and length), physical examination, laboratory tests (white blood cell count, hematocrit), ultrasound finding, general state (ASA classification), associated diseases, time from admission to surgery, preoperative antibiotic therapy. During the operation we analyzed: type of surgery, degree of the appendicitis, the presence of peritonitis, associated pathology, length of surgery and duration of pneumoperitoneum (in laparoscopic appendectomy), hystopathologic findings of the appendix, a bacteriology. Postoperatively we analyzed: antibiotic therapy (type and length), oral intake, postoperative pain, fever, establishing peristalsis, the appearance of postoperative complications (wound infections, intra-abdominal abscesses, ileus) and length of hospitalization. Especially, we analyzed the quality of life of patients after surgery using the modified questionnaire SF 10 for children; and the establishment of daily activities using Activity Assessment Scale (AAS), modified for children; after each postoperative day, the first seven days, one month, three and six months after surgery. All patients were operated under general anesthesia. Open appendectomy was performed through incision in the right iliac fossa. Peritoneum was opened, the cecum was pulled out and classic appendectomy was made. Laparoscopic appendectomy is performed through three 5 mm ports. Pneumoperitoneum was created by the Hasson techique, through the infraumbilical incision, and the remaining two ports are set at right and left iliac region. Mezenteriolum was ligated by ultrasonic scissors. After putting intracorporal ligature, appendix was removed through the right port. Results: Over a period of ten months we operated 125 patients , aged 2 to 18 years, due to acute appendicitis. Laparoscopic technique was performed in 60 patients (48%), and the open method in 61 (48,8%). In 4 patients the conversion was made (operative technique changed from laparoscopic to open method). There were no statistically significant differences between the treatment groups with respect to the degree of appendix inflammation, the type and duration of symptoms, the diagnostic procedures, as well as the time from hospital admission to the surgery. Medium operative time was 65 minutes (25-185 min.) for laparoscopic group and 45,49 minutes (25-90 min.) for open appendectomy (the difference is statistically significant, p<0,001). Intestinal peristalsis, as well as the initiation of oral intake was significantly sooner established in the laparoscopic group. Postoperative complications (wound infections and intra-abdominal abscess formation In laparoscopic appendectomy) occurred after laparoscopy in 8,33% of patients (5/60), and in the open group in 4,91% (3/61), which was not statistically significant (c2 = 0,152, df = 1; p = 0,696). Length of hospital stay in children operated by laparoscopy was 5,95 } 1,21 days and by open technique 6,43 } 1,09 days, which is significantly longer (t = -2,206; p = 0,029). Results of the Mann-Whitney U test showed significantly better overall record of daily activities for a group of laparoscopic appendectomy (Z = -7,608; p = 0,000). In all tested indicators of quality of life, children from laparoscopic group had a higher score. Children with acute appendicitis treated by laparoscopic surgery achieved a high level of quality of life, significantly earlier (t = 2,407; p = 0,018). Conclusion: The advantage of minimally invasive surgery in the treatment of acute appendicitis in children is reflected in the faster re-establishment of functioning of the gastrointestinal tract, shorter hospitalization and therefore, a faster overall recovery, resuming normal activities and a good quality of life. Postoperative complications occur equally in both, open as well as in laparoscopic operative techniques.
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Valpas, A. (Antti). "Evaluation of laparoscopic colposuspension and the tension-free vaginal tape procedure in the surgical treatment of female stress urinary incontinence". Doctoral thesis, University of Oulu, 2005. http://urn.fi/urn:isbn:9514278275.
Testo completoAbstract (sommario):
Abstract
Though not a life threatening condition, involuntary loss of urine is a miserable situation. It has a multidimensional effect on the afflicted individuals, both men and women – and for the society. The purpose of this study was to evaluate two modern, minimally invasive surgical techniques for the treatment of female stress urinary incontinence (SUI). The techniques evaluated were laparoscopic colposuspension with mesh and staples (LCM) and the tension-free vaginal tape procedure (TVT).
The study consisted of four parts. The first part (Study I) was an observational retrospective follow-up study. Data on the first forty patients operated on with LCM at Oulu University Hospital were collected. Patients had SUI or mixed urinary incontinence (MUI) with predominantly stress incontinence. The Studies II–IV were parts of a randomized, multicenter clinical trial, where LCM was compared with TVT. According to the predefined inclusion criteria 128 SUI women were randomly allocated into two treatment groups: 70 patients received TVT treatment as allocated and 51 LCM. There were seven drop-outs after randomization.
After one year of follow-up the cure and improvement rate of the patients operated with LCM were ~ 90%. Also a significant improvement was found in Urinary Incontinence Severity Scores (UISS). At base line the score was 12.1 and after one year follow-up 2.7 (p < 0.001). The bladder perforation rate was 15%. In Study II immediate cure rates and complications of LCM and TVT were studied. After six weeks of follow-up there was no difference in cure rates (~ 90%) between the procedures. There was no difference in complication rates. A significant difference was found in the use of anti-inflammatory / opioid drugs in the immediate post-operative period to relief the pain in favour for TVT. Hospital care was also significantly shorter after TVT than LCM. After one year of follow-up (Study III) TVT was found to give better result both objectively and subjectively. Negative stress test result was recorded in 85.7% in the TVT group and 56.9% in the LCM group. A significant difference was also found, when Visual Analoque Scale (VAS), King's College Health Questionnaire (KHQ) and UISS were used as outcome measures, in the favour of TVT. When 48-hour pad test was used as outcome measure there was no statistically significant difference between the groups. The cost-effectiveness (Study IV) of TVT was found to be better than that of LCM after one year of follow-up.
In conclusion, the results of this study suggest, that TVT procedure is on the whole a cost-effective alternative for LCM in the treatment of female SUI.
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Ohlin, Eva. "Positionsrelaterade nervsymtom efter operation med laparoskopisk teknik och dess betydelse för patientens dagliga liv". Thesis, Kristianstad University College, School of Health and Society, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:hkr:diva-5202.
Testo completoAbstract (sommario):
Det har länge varit känt att patientens perioperativa position kan orsaka symtom som förmodas uppstå genom tryck och sträckningar. Positionen vid laparosko-piska operationer anses öka risken för symtom och därför är perioperativ om-vårdnad av betydelse. Syftet var därför att undersöka hur frekvent positions- relaterade symtom förekommer vid laparoskopiska ingrepp och vilken betydelse de har för patienten. Studien genomfördes som en deskriptiv tvärsnittstudie och datainsamlingen gjordes med hjälp av symtomskattning och semistrukturerade intervjuer. Totalt 60 respondenter i åldern 19 till 75 år deltog i studien som pågick under åtta månader. Resultatet visade att en fjärdedel av respondenterna drab-bades av nytillkomna eller förvärrade symtom. Dessa uppmärksammades postoperativt eller några dagar efter operationen och var oberoende av ingrepp, perioperativ tid eller armarnas position. Några av respondenterna upplevde smärta och domningar i nacke, axlar och händer som ledde till inskränkningar i det dagliga livet och krävde hjälp av närstående. Det är viktigt att fortsätta arbetet med att förebygga positionsrelaterade skador, för att förhindra postoperativa symtom, genom att placera patienten så nära ett neutralläge som möjligt och ge denne möjlighet att känna efter hur det känns före nedsövning.
It has long been assumed that a patient’s perioperative position can cause symp-toms which appear from pressure and strains on the body. The position in lapa-roscopic surgery is considered to increase the risk of symptoms, perioperative care is therefore important. The scope of this study was therefore to survey how frequent symptoms associated with the patient’s position occur and why they are important to the patient. The survey was made as a descriptive cross-section study. The data collection was made by way of patients own estimates of their symptoms and by semistructured interviews. 60 respondents aged between 19 and 75 took part in the study. The result showed that a fourth of the respondents experienced new or aggravated symptoms. These were observed postoperatively or a few days after surgery and were independent of operations, perioperative time or position of the arms. Some of the respondents felt pain and numbness in the neck, shoulders and hands which led to restrictions in their daily life and required help from someone close. It is important to continue working with preventing postoperative symptoms, by placing the patient as close to a neutral position as possible and give her the possibility to feel comfortable before the anesthetization.
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"Design and development of a robotic assistant for total laparoscopic hysterectomy". 2013. http://library.cuhk.edu.hk/record=b5549278.
Testo completoAbstract (sommario):
子宮切除術是最常進行的婦科手術之一，據統計，美國每年平均錄得約600,000宗進行子宮切除術的病例。全腹腔鏡子宮切除術為子宮切除術的一種，在手術中，病人的子宮將經由完全使用腹腔鏡的模式被摘除。在普遍全腹腔鏡子宮切除術的流程中，名為舉宮器的手術儀器會被應用於手術中，以改變病人子宮的位置及方向。手術室內，除了負責為病人摘除子宮的醫生外，還需額外一名負責操作舉宮器的醫生在場，以促進手術的進行。於手術的過程中，為使摘除手術能更有效及順利地進行，這名醫生需以人手操作舉宮器以控制病人體內子宮的方位。一般而言，這項工作都是枯燥而疲憊的。然而，在負責進行摘除手術的醫生眼中，縱子宮的方位已被調整，其方位仍然未如理想的情況亦不屬罕見。
故此，一個能勝任代替醫生負責操作舉宮器的機械人助手將會是可行的解決方案之一。與此同時，機械人亦能將病人子宮方位的控制權交回負責進行摘除手術的醫生手中。
本論文提出一套以把醫生從操作舉宮器的工作中釋放為目標，並使子宮方位操作變得更準確及穩定的機械人系統。機械人系統由兩個部分構成，分別為一支一個自由度的電動舉宮器以及一台三個自由度的舉宮器方位操作機械人。
舉宮器方位操作機械人旨在模仿以往醫生操作舉宮器的動作，以負責把固定在它身上的舉宮器移動到及固定在指定的位置。舉宮器方位操作機械人共有三個關節，分別為旋轉關節、滑動關節以及線性關節。關節的佈置滿足特定的幾何約束以構成遠程運動中心，使機械人能把手術儀器從細小的開口（例如：子宮頸）中進行操作。本論文提出的舉宮器方位操作機械人備有配適器以兼容不同款式的舉宮器，例如市場上現存的舉宮器以及本論文提出的電動舉宮器，均可應用在本系統中。
本論文提出的電動舉宮器為系統中可選擇性的元件，它是個一自由度附帶可轉動末端的裝置，旨在延伸機械人系統末端執行器的可到達範圍。
本論文將論述這套機械人系統的設計，包括其機械設計與電子系統的部分、運動學與及工作空間。一台實驗用的樣機已被建造以作驗證設計之用。該樣機以醫學人體模型為對象的實驗結果亦會在本論文中提出。
Hysterectomy is one of the most frequently performed gynecologic procedures. In average, around 600,000 cases are recorded annually in the United States. Total laparoscopic hysterectomy (TLH) is one of the approaches of performing hysterectomy in which uterus of a patient is removed from an entirely laparoscopic approach.
In ordinary TLH procedures, a surgical apparatus, uterus manipulator, used for changing the position and orientation of the patient’s uterus is involved. In the operating theatre, apart from the primary surgeon who is responsible for the removal of uterus, an assisting surgeon is also involved for operating the uterus manipulator. Throughout the surgery, she/he has to manipulate the patient’s uterus using the uterus manipulator manually to facilitate the removal procedure. This task is generally tiring and boring. In addition, it is also common that the manipulated position is not satisfactory from the primary surgeon’s point of view.
Thus, a robotic assistant which is capable of taking up the task of this assisting surgeon as well as allowing the primary surgeon to have full control on the position of the patient’s uterus may be one of the potential solutions.
In this thesis, a robotic system aiming at providing more precise and stable manipulating motion and freeing the assisting surgeon who is responsible for operating the uterus manipulator is presented. The presented robotic system is composed of two parts, a motorized uterus manipulator of one degree of freedom and a robotic uterus manipulator positioner of three degrees of freedom.
Objective of the uterus manipulator positioner presented is to imitate what is doing by the assisting surgeon when operating the uterus manipulator. It holds and manipulates the uterus manipulator attached to it. The uterus manipulator positioner is a robotic system consisted of three joints, a revolute joint, a sliding joint and a translational joint. Arrangement of the joints is forced to satisfy specific geometric constraints so that a remote center of motion (RCM) is created to allow manipulation through small openings such as the cervix. Adaptors are included to enable the use of different uterus manipulators. Existing uterus manipulators and the motorized uterus manipulator presented in this thesis can be adapted to the system.
The motorized uterus manipulator presented in this thesis is an optional element of the robotic system. It is a device of one degree of freedom with a movable tip aiming at enhancing the reaching capability of the end-effector of the robotic system.
In this thesis, design of the robotic system in both mechanical and electronic aspects is presented. Kinematics and workspace of the system is also discussed. To verify the design, a prototype is built. Finally, verification experiments with the prototype on manikin are provided.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Yip, Hiu Man.
Thesis (M.Phil.)--Chinese University of Hong Kong, 2013.
Includes bibliographical references (leaves 96-98).
Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Abstracts also in Chinese.
Abstract --- p.i
摘要 --- p.iv
Acknowledgement --- p.vi
Table of Contents --- p.viii
List of Figures --- p.x
Chapter Chapter 1. --- Introduction --- p.1
Chapter 1.1. --- Total Laparoscopic Hysterectomy --- p.1
Chapter 1.2. --- Existing Uterus Manipulators --- p.4
Chapter 1.3. --- Existing Uterus Manipulator Positioners --- p.6
Chapter 1.4. --- Existing Medical Robots --- p.9
Chapter 1.5. --- Existing RCM Mechanisms --- p.11
Chapter 1.6. --- Motivation and Contribution --- p.12
Chapter Chapter 2. --- Conceptual Design --- p.15
Chapter 2.1. --- Design Requirements --- p.15
Chapter 2.2. --- Conceptual Design of Prototype --- p.16
Chapter Chapter 3. --- Design of Prototype --- p.23
Chapter 3.1. --- Mechanical Design of the Robotic System --- p.25
Chapter 3.1.1. --- Design of the Robotic Uterus Manipulator Positioner --- p.25
Chapter 3.1.2. --- Adaptor --- p.35
Chapter 3.1.3. --- Design of the Motorized Uterus Manipulator --- p.36
Chapter 3.2. --- Kinematics of the Robotic System --- p.38
Chapter 3.2.1. --- Coordinates of Points on a Sphere --- p.39
Chapter 3.2.2. --- The 2-DOF Uterus Manipulator Positioner --- p.40
Chapter 3.2.3. --- The 3-DOF Uterus Manipulator Positioner --- p.42
Chapter 3.2.4. --- The 4-DOF robotic system --- p.45
Chapter 3.2.5. --- Velocity --- p.50
Chapter Chapter 4. --- Design of Control System --- p.52
Chapter 4.1. --- Robot Controlling Unit --- p.52
Chapter 4.1.1. --- Size Reduced Controlling Unit --- p.53
Chapter 4.2. --- User Interface --- p.62
Chapter 4.2.1. --- Foot-Controlled Interface --- p.63
Chapter 4.2.2. --- Hand-Controlled Panel --- p.68
Chapter Chapter 5. --- Prototype and Experiments --- p.70
Chapter 5.1. --- Developed Prototype --- p.70
Chapter 5.2. --- Experiments --- p.72
Chapter 5.2.1. --- Robot Controller --- p.73
Chapter 5.2.2. --- Control Algorithm --- p.77
Chapter 5.2.3. --- Experiment on the Prototype --- p.79
Chapter 5.2.4. --- Experiment with Manikin --- p.87
Chapter Chapter 6. --- Conclusion and Future Work --- p.90
Chapter 6.1. --- Conclusion --- p.90
Chapter 6.2. --- Robot Positioning Platform --- p.92
Chapter 6.3. --- Reinforcement of the Robotic System --- p.94
Chapter 6.4. --- Extension of User Interfaces --- p.95
List of References --- p.96
Libri sul tema "Laparoscopy Surgical Procedures"
1
Highlights in the history of laparoscopy: The development of laparoscopic techniques-- a cumulative effort of internists, gynecologists, and surgeons. Frankfurt/Main: Barbara Bernert Verlag, 1996.
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2
Kavic, Michael S. Laparoscopic hernia repair. Amsterdam, the Netherlands: Harwood Academic Publishers, 1997.
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3
Advanced therapy in minimally invasive surgery. Oxford: B.C. Decker, 2006.
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4
Talamini, Mark A. Advanced therapy in minimally invasive surgery. Oxford: B.C. Decker, 2006.
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5
A, Cuschieri, e Carter Fiona, a cura di. Minimal access surgical anatomy. Philadelphia: Lippincott Williams & Wilkins, 2000.
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6
Frantzides, Constantine T., e Mark A. Carlson. Video atlas of advanced minimally invasive surgery. Philadelphia, PA: Saunders/Elsevier, 2013.
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8
EVC, 2004 (2004 Amsterdam Netherlands). Hybrid vascular procedures. Malden, Mass: Futura, 2004.
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9
2004, EVC. EVC 2004: Hybrid vascular procedures. Armonk, NY: Futura, 2004.
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10
Falcone, Tommaso. Basic, advanced, and robotic laparoscopic surgery. Philadelphia, PA: Saunders/Elsevier, 2010.
Cerca il testo completoCapitoli di libri sul tema "Laparoscopy Surgical Procedures"
1
Weiss, Helmut G., Jan Schirnhofer, Eberhard Brunner, Katharina Pimpl, Christof Mittermair, Christian Obrist e Michael Weiss. "Single Incision Laparoscopy". In Surgical Principles of Minimally Invasive Procedures, 275–83. Cham: Springer International Publishing, 2017. http://dx.doi.org/10.1007/978-3-319-43196-3_39.
Testo completo
2
Montgomery, Agneta. "Diagnostic Laparoscopy in Suspected Appendicitis and Laparoscopic Appendectomy". In Surgical Principles of Minimally Invasive Procedures, 189–95. Cham: Springer International Publishing, 2017. http://dx.doi.org/10.1007/978-3-319-43196-3_27.
Testo completo
3
Sandler, Anthony. "Pediatric Laparoscopy: Specific Surgical Procedures I". In The SAGES Manual, 389–95. Berlin, Heidelberg: Springer Berlin Heidelberg, 1999. http://dx.doi.org/10.1007/978-3-642-88454-2_45.
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Lobe, Thom E. "Pediatric Laparoscopy: Specific Surgical Procedures II". In The SAGES Manual, 396–98. Berlin, Heidelberg: Springer Berlin Heidelberg, 1999. http://dx.doi.org/10.1007/978-3-642-88454-2_46.
Testo completo
5
Lindsetmo, Rolv-Ole, e Conor P. Delaney. "Laparoscopic Rectal Procedures". In Minimally Invasive Surgical Oncology, 235–50. Berlin, Heidelberg: Springer Berlin Heidelberg, 2011. http://dx.doi.org/10.1007/978-3-540-45021-4_19.
Testo completo
6
Chung, Wiley, e Teodor P. Grantcharov. "Laparoscopic Gastrectomy". In Surgical Principles of Minimally Invasive Procedures, 61–69. Cham: Springer International Publishing, 2017. http://dx.doi.org/10.1007/978-3-319-43196-3_10.
Testo completo
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Khatkov, Igor E., Victor V. Tsvirkun, Roman E. Izrailov e Pavel S. Tyutyunnik. "Laparoscopic Pancreaticoduodenectomy". In Surgical Principles of Minimally Invasive Procedures, 161–66. Cham: Springer International Publishing, 2017. http://dx.doi.org/10.1007/978-3-319-43196-3_23.
Testo completo
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Belli, Giulio, Corrado Fantini, Alberto D’Agostino, Luigi Cioffi, Gianluca Russo, Andrea Belli e Paolo Limongelli. "Laparoscopic Liver Resection". In Surgical Principles of Minimally Invasive Procedures, 125–30. Cham: Springer International Publishing, 2017. http://dx.doi.org/10.1007/978-3-319-43196-3_18.
Testo completo
9
Boni, Luigi, Giulia David e Elisa Cassinotti. "Laparoscopic Right Colectomy". In Surgical Principles of Minimally Invasive Procedures, 197–200. Cham: Springer International Publishing, 2017. http://dx.doi.org/10.1007/978-3-319-43196-3_28.
Testo completo
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Boni, Luigi, Stefano Rausei, Matteo Di Giuseppe, Elisa Cassinotti e Gianlorenzo Dionigi. "Laparoscopic Transperitoneal Adrenalectomy". In Surgical Principles of Minimally Invasive Procedures, 253–58. Cham: Springer International Publishing, 2017. http://dx.doi.org/10.1007/978-3-319-43196-3_36.
Testo completoAtti di convegni sul tema "Laparoscopy Surgical Procedures"
1
Rentschler, Mark E., Ben S. Terry e Austin D. Ruppert. "A Laparoscopic Camera-Enabled Cannula Port". In ASME 2009 Summer Bioengineering Conference. American Society of Mechanical Engineers, 2009. http://dx.doi.org/10.1115/sbc2009-204598.
Testo completoAbstract (sommario):
This project is exploring a potential new approach in providing visual feedback during minimally invasive surgery (MIS) that involves integrating a CMOS camera imager and lens into a traditional cannula entry port. Initial research has focused on developing this device for abdominal surgery (laparoscopy). Such a device can provide vision assistance without positioning and orientation constraints associated with current laparoscopes. Patients who undergo laparoscopic surgery experience less pain, shorter hospital stays, and a more rapid return to normal activities compared to patients who undergo conventional surgery. The benefits of laparoscopic surgery, however, are generally restricted to patients undergoing less complex procedures. The primary reason for limited application of laparoscopy to more complex procedures is two-fold. The first drawback is the limitation of the laparoscope to view all aspects of the abdominal cavity including looking back towards the entry site. Secondly, to view the video image from the scope the surgeon must turn focus away from the patient and towards a recorded video image on a monitor placed away from the patient. These constraints impose severe perception and orientation limitations that degrade surgical task performance. The long-term goal of this project is to develop a camera and sensor module that can be placed within traditional trocar ports for insertion, and that deploy outward from the cannula port after insertion. This approach will allow these ports to still be utilized by all traditional laparoscopic surgical tools, while potentially removing the need for the laparoscope. In addition, a small LCD display is placed at the port’s proximal end restore natural perception and orientation for the surgical team.
2
Fernandez, Raul, Richard A. Bergs, Robert C. Eberhart, Linda A. Baker e Jeffrey A. Cadeddu. "Development of a Transabdominal Anchoring System for Trocar-Less Laparoscopic Surgery". In ASME 2003 International Mechanical Engineering Congress and Exposition. ASMEDC, 2003. http://dx.doi.org/10.1115/imece2003-42404.
Testo completoAbstract (sommario):
Compared with open surgery, laparoscopy results in significantly less pain, faster convalescence, and less morbidity. However, eye-hand dissociation, a two-dimensional field-of-view and fixed instrumentation with limited degrees of freedom contribute to a steep learning curve and demanding dexterity requirements for many laparoscopic procedures. One of the main limitations of laparoscopy is the fixed working envelope surrounding each trocar, often necessitating placement of multiple ports to accomodate changes in position of the instruments or laparoscope to improve visibility and efficiency. The placement of additional working ports contributes to post-operative pain and carries a small risk of bleeding or adjacent organ damage. In order to provide for greater flexibility of endoscopic viewing and instrument usage and to further reduce morbidity, a novel adjunct laparoscopic system has been developed consisting of a platform capable of supporting various laparoscopic tools which is secured magnetically to the abdominal wall and subsequently positioned within the abdominal cavity through surgeon-controlled, external magnetic couples on the patient’s abdomen. Using this technique, instruments such as miniature endoscopic cameras used to augment the surgical field of view and surgical retractors have been successfully evaluated in a dry laboratory as well as in porcine models, with several others currently under investigation. This document elaborates on the theoretical and empirical process which has led to anchoring designs optimized for size, strength and surgical compatibility, as well as the benefits, limitations and prospects for the use of incisionless, magnetically-coupled tooling in laparoscopic surgery.
3
Platt, Stephen R., Jeff A. Hawks, Mark E. Rentschler, Lee Redden, Shane Farritor e Dmitry Oleynikov. "Modular Wireless Wheeled In Vivo Surgical Robots". In ASME 2008 International Design Engineering Technical Conferences and Computers and Information in Engineering Conference. ASMEDC, 2008. http://dx.doi.org/10.1115/detc2008-49157.
Testo completoAbstract (sommario):
Minimally invasive abdominal surgery (laparoscopy) results in superior patient outcomes as measured by less painful recovery and an earlier return to functional health compared to conventional open surgery. However, the difficulty of manipulating traditional laparoscopic tools from outside the patient’s body generally limits these benefits to patients undergoing procedures with relatively low complexity. The use of miniature in vivo robots that fit entirely inside the peritoneal cavity represents a novel approach to laparoscopic surgery. Our previous work has demonstrated that mobile and fixedbased in vivo robots can successfully operate within the abdominal cavity and provide surgical vision and task assistance. All of these robots used tethers for power and data transmission. This paper describes recent work focused on developing a modular wireless mobile platform that can be used for in vivo sensing and manipulation applications. The robot base can accommodate a variety of payloads. Details of the designs and results of ex vivo and in vivo tests of robots with biopsy grasper and physiological sensor payloads are presented. These types of self-contained surgical devices are much more transportable and much lower in cost than current robotic surgical assistants. These attributes could ultimately allow such devices to be carried and deployed by non-medical personnel at the site of an injury. A remotely located surgeon could then use these robots to provide critical first response medical intervention irrespective of the location of the patient.
4
Rentschler, Mark, Jason Dumpert, Adnan Hadzialic, Stephen R. Platt, Shane Farritor, Dmitry Oleynikov e Karl Iagnemma. "Theoretical and Experimental Analysis of In Vivo Wheeled Mobility". In ASME 2004 International Design Engineering Technical Conferences and Computers and Information in Engineering Conference. ASMEDC, 2004. http://dx.doi.org/10.1115/detc2004-57468.
Testo completoAbstract (sommario):
Laparoscopy is abdominal surgery performed with long tools inserted through small incisions. The use of small incisions reduces patient trauma, but also eliminates the surgeon’s ability to directly view and touch the surgical environment. These limitations generally restrict the application of laparoscopy to less complex procedures. Large robots external to the patient have been used to aid in the manipulation of the tools and improve dexterity. This paper presents a theoretical and experimental analysis of miniature in vivo robots. The objective is to develop a wireless mobile imaging robot that can be placed inside the abdominal cavity during surgery. Such robots will allow the surgeon to view the surgical environment from multi-angles. The motion of these in vivo robots will not be constrained by the insertion incisions.
5
Mishra, Kaustuv, Rachana Sathish e Debdoot Sheet. "Learning Latent Temporal Connectionism of Deep Residual Visual Abstractions for Identifying Surgical Tools in Laparoscopy Procedures". In 2017 IEEE Conference on Computer Vision and Pattern Recognition Workshops (CVPRW). IEEE, 2017. http://dx.doi.org/10.1109/cvprw.2017.277.
Testo completo
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Aguirre, Milton E., e Mary Frecker. "Design and Optimization of Hybrid Compliant Narrow-Gauge Surgical Forceps". In ASME 2010 Conference on Smart Materials, Adaptive Structures and Intelligent Systems. ASMEDC, 2010. http://dx.doi.org/10.1115/smasis2010-3732.
Testo completoAbstract (sommario):
This work describes a design and optimization method for developing hybrid, multi-material, compliant instruments which are expected to be useful in mini-laparoscopy and natural orifice translumenal endoscopic surgery. These two-material devices are designed specifically for Penn State’s lost mold rapid infiltration process, which is capable of fabricating hundreds of freestanding meso-scale parts in parallel. New narrow-gauge surgical procedures impose severe geometric constraints that challenge traditional compliant mechanism design methods. Since narrow-gauge constraints leave geometry optimization ineffective, new design methods are explored to improve the performance of a 1 mm diameter contact-aided compliant forceps. By considering hybrid designs, new design possibilities are enabled through material variation. The hybrid forceps has desired regions of flexibility and stiffness that can be isolated to improve tool performance. For instance, a hybrid forceps can be designed with greater flexibility in some regions to provide larger jaw openings while maintaining high stiffness in other regions to obtain large grasping forces, both vital features in a surgical forceps. Using ANSYS to model large deformation and contact, an optimization problem is formulated to maximize tool performance and to determine optimal segregation of hybrid materials considering a range of modulus ratios. Materials under consideration include nanoparticulate 3 mol% yttria partially stabilized zirconia (3YSZ) and austenitic (300 series) stainless steel. All results are compared to previously optimized homogeneous designs.
7
Shiomi, Hisanori, Kazuaki Yamashiro, Yuka Takai, Akihiko Goto e Hiroyuki Hamada. "Learning System on Surgical Technique of Laparoscopic Cholecystectomy". In ASME 2016 International Mechanical Engineering Congress and Exposition. American Society of Mechanical Engineers, 2016. http://dx.doi.org/10.1115/imece2016-68021.
Testo completoAbstract (sommario):
In this research, eye movement measurement was performed for the process of the operation under laparoscopy to two or more persons. The knack of advanced technique was understood through numerical method and the difference in technology were evaluated, and it aimed at showing the influence of years of experience on eye movement by comparing the operation for the operators with different level of skill. The target operation was laparoscopic cholecystectomy. We decided to carry out under the same conditions using a simulator, and the subject was taken as two experts and one unskilled operator from which years of experience differ so that comparison between two or more subjects might be attained. According to the procedure in which it is most worked by the whole operation by actual laparoscopic cholecystectomy, it classified into nine items and measured the factor about working hours and a view at each process.
8
Onal, Sinan, Susana Lai-Yuen e Stuart Hart. "Design of a Universal Laparoscopic Suturing Device". In ASME 2011 Summer Bioengineering Conference. American Society of Mechanical Engineers, 2011. http://dx.doi.org/10.1115/sbc2011-53187.
Testo completoAbstract (sommario):
Minimally invasive surgery (MIS) or laparoscopic surgery has changed the focus of surgery and has become an alternative to open surgical procedures. Operations are performed through small incisions in the abdomen thus avoiding the need for large incisions. This results in less tissue trauma, less scarring, and faster post-operative recovery time. However, the inherent challenges of laparoscopic procedures include limited visibility, constrained working space and the need for advanced surgical tools to safely and efficiently perform the surgical procedure. It is also necessary for surgeons to obtain advanced surgical training to perform these procedures.
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Katoch, Rohan, Boao Xia, Yoshinori Yamakawa, Jun Ueda e Hiroshi Honda. "Design and Analysis of a Symmetric Articulated Single-Port Laparoscopic Surgical Device". In 2017 Design of Medical Devices Conference. American Society of Mechanical Engineers, 2017. http://dx.doi.org/10.1115/dmd2017-3441.
Testo completoAbstract (sommario):
Laparoscopic surgery is a practice of minimally invasive surgery (MIS) performed in the abdominal area. Prior to surgery, instead of exposing the target region to air as in a typical conventional open surgery, “key holes” are opened for positioning ports, through which surgical tools (e.g. laparoscope, needle drivers, etc.) are inserted. MIS therefore minimizes trauma and reduces the risk of hemorrhaging and infection. MIS also generates economic benefits such as shorter hospitalization time for patients and better utilization of operating rooms and wards for hospitals. MIS procedures, however, require extra dexterity from surgeons: they must use instruments with little to none haptic feedback to remotely manipulate tissue within a limited range of motion, assisted by an indirect view from laparoscope. Such unintuitive operations not only require additional training, but also increase the risk of medical errors. Thus, the development of novel surgical devices that can provide a better operating experience will allow surgeons to deliver safer and more effective surgeries. At the advent of MIS only rigid straight laparoscopic instruments were available. Therefore, surgeons used multiple incisions to position the tools and achieve triangulation. In single port laparoscopic surgeries (SPLS), only one incision is made for positioning a port. Two rigid straight instruments inserted through one incision cannot provide sufficient triangulation for operations. Rigid bent, or articulated, instruments can achieve triangulation, but the tools must intersect at a point. The mapping to control the end-effector, therefore, must be inverted such that the right hand controls the left end-effector, and vice versa [1]. Given this inverted mapping, surgeons need to undergo extra training to intuitively control the end-effector, and greater attention is required toward operating the device, which can potentially detract from the ability of surgeons to focus on procedures. The disadvantage of an inverted mapping can be overcome by providing additional mobility with flexible tools and actuating structures [2]. For example, Transenterix has developed a flexible laparoscopic device which utilizes a cable-driven system for articulation of the end-effectors. However, using flexible elements as the driving mechanism can result in new problems such as diminished force feedback [3]. In 2015, a novel design of an articulated single port laparoscopic device was presented with 6 degrees of freedom (DOF). The system provides intuitive control, accurate force feedback, and sufficient manipulation for laparoscopic procedures. The design proposed in this paper keeps much of the functional features in the previous model, including 1:1 mapping and force feedback, while incorporating flexible hydraulic graspers. The articulated mechanism was redesigned to have a symmetrical structure, which is more intuitive to control and provides better operating angles for surgeons. Joint structures are redesigned for enhanced robustness and misalignment prevention. Kinematic analysis is presented for the proposed mechanisms, which is used to determine the manipulator workspace.
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Mirbagheri, A., F. Farahmand, A. Meghdari, H. Sayyaadi, L. Savoj e E. Mirbagheri. "Design of a Robotic Cameraman With Three Actuators for Laparoscopic Surgery". In ASME 2006 Frontiers in Biomedical Devices Conference. ASMEDC, 2006. http://dx.doi.org/10.1115/nanobio2006-18024.
Testo completoAbstract (sommario):
Laparoscopic surgery is a specific branch of minimally invasive surgery (MIS) that is performed on the abdomen and endoscopic tools are passed through the incision points and trocars on the abdominal wall, so they can reach the surgical site [1]. Robotic systems have been proved to be very useful as a cameraman in laparoscopic surgery; they are more stable with no fatigue and inattention and reduce the supernumerary staff required, provide excellent geometrical accuracy and improved personal control for the surgeon over the procedure, etc. The available robots for handling and control of laparoscopic lens include at least 4 actuators to fulfill the surgeon’s requirements [2]. The purpose of the present study was to develop a novel design for the laparoscope robotic arm in which while the systems move ability is maintained its active degrees of freedom are reduced.