“Is the health care system the next victim of the financial crisis?”
Frezza, E. E. and M. S. Wachtel (2009).
Surgical Laparoscopy, Endoscopy and Percutaneous Techniques 19(3): 276.
“Accounting for uncertainty about investigator bias: Disclosure is informative.”
Greenland, S. (2009).
Journal of Epidemiology and Community Health 63(8): 593-598.
“Anaesthesia for robot-assisted laparoscopic surgery.”
Irvine, M. and V. M. D. Patil (2009).
Continuing Education in Anaesthesia, Critical Care and Pain 9(4): 125-129.
“Failure and Malfunction of da Vinci Surgical Systems During Various Robotic Surgeries: Experience From Six Departments at a Single Institute.”
Kim, W. T., W. S. Ham, et al. (2009).
Urology.
OBJECTIVES: To analyze the mechanical failures and malfunctions of the da Vinci Surgical (S) System during various robotic surgeries in 6 different departments at our institute and also evaluated the solutions for the failures and malfunctions. METHODS: From July 2005 to December 2008, a total of 1797 robotic surgeries were performed at our institute. The surgeries were performed using 4 da Vinci surgical systems (1 standard da Vinci system from July 2005 to July 2007 and 3 da Vinci S systems from July 2007 to December 2008). Mechanical failures or malfunctions occurred in 43 cases. We evaluated the robotic surgeries according to the type of surgery and the department. We analyzed the cases involving conversion to open or laparoscopic surgeries and those in which there was a malfunction with the instrument. RESULTS: There were 43 cases (2.4%) of mechanical failure with the da Vinci system from a total of 1797 robotic surgeries. This included 24 (1.3%) cases of mechanical failure or malfunction and 19 cases (1.1%) of instrument malfunction. The mechanical malfunction included 1 on/off failure, 5 console malfunctions, 6 robotic arm malfunctions, 2 optic system malfunctions, and 10 system errors. One open and 2 laparoscopic conversions (3 cases; 0.17%) were performed. CONCLUSIONS: Mechanical failure or malfunction occurred during robotic surgery in 43 cases (2.4%), and the open or laparoscopic conversion rate during surgery was very low (0.17%). We found the mechanical failure or malfunction to be rare.
“Quality improvement for doctors – It’s essential.”
Lamb, B. (2009).
Journal of the Royal Society of Medicine 102(8): 310.
“Uncertainty inclusion in budgeting technology adoption at a hospital level: Evidence from a multiple case study.”
Lettieri, E. (2009).
Health Policy.
OBJECTIVES: The shortage of resources for healthcare has risen the quest for more rational models and practices for technology selection at a hospital level. Uncertainty is a critical issue. This paper aims to shed first light on this issue through an investigation on the content and the process of budgeting technology adoption with respect to uncertainty. METHODS: An exploratory multi-case study was carried out to gain a better understanding of the current practice of technology assessment at a hospital level. Five Italian hospitals were selected. Key informants from the budget committees have been interviewed with a structured questionnaire based on the results of an electronic literature search. RESULTS: Five domains of uncertainty have been identified. They have been deployed in a list of 15 relevant issues that should be reviewed during the budget process. The hospitals in the sample cope with these issues in a peculiar manner. Organisational uncertainty is broadly overcome. Reporting about technology performance after the adoption is missing. CONCLUSION: Policy makers should facilitate hospitals: (a) to develop a multi-disciplinary and evidence based practice for technology selection, (b) to assess and manage uncertainty, and (c) to build a reporting system regarding technology performance in order to build fair practices for technology selection and support continuous learning.
“Establishing a training program for residents in robotic surgery.”
Moles, J. J., P. E. Connelly, et al. (2009).
Laryngoscope 119(SUPPL. 1): 46.
“Safety profile of trocar and insufflation needle access systems in laparoscopic surgery.”
Passerotti, C. C., N. Begg, et al. (2009).
J Am Coll Surg 209(2): 222-232.
BACKGROUND: The most common laparoscopic complications are associated with trocar insertion. The purpose of this study was to develop an objective method of evaluating the safety profile of various access devices used in laparoscopic surgery. STUDY DESIGN: In 20 swine, 6 bladed and 2 needle access devices were evaluated. A force profile was determined by measuring the force required to drive the trocar or needle through the fascia and into the peritoneum, at 0 and 10 mmHg. The amount of tissue deformation, the length of blade exposed, and the duration of exposure were measured using a high-speed digital imaging system. RESULTS: The needle system without the sheath required the least driving force and had the most favorable force profile. In contrast, the bladed, nonretractable trocar system required a higher driving force and a rapid loss of resistance. Insertion under a pneumoperitoneum did not significantly alter the force profile of the various access devices except for the amount of tissue deformation. With the bladed system, the blade itself was exposed for an average of 0.5 to 1.0 seconds for a distance of 4.5 to 5.0 cm. In comparison, the needle system was exposed for 0.2 seconds for a distance of 1.8 cm. CONCLUSIONS: We developed a reproducible method of measuring the forces required to place the access systems, their pattern of resistance loss, and the characteristics of the blade exposure. These parameters may provide an adjunctive and objective measurement of safety, allowing for more direct comparison between various trocar designs.
“Robotic and laparoscopic surgery: Cost and training.”
Patel, H. R. H., A. Linares, et al. (2009).
Surgical Oncology 18(3): 242-246.
Robotic prostatectomy training as part of mainstream surgical training will be difficult. The primary problems revolve around the inconsistencies of standard sugery. Many surgeons are still in the learning curve, as is the understanding of the true capabilities of the robot. The important elements of robotic surgery actually enhance basic laparoscopic techniques. The prostate has been shown to be an organ where this new technology has a niche. As we move toward cross specialty use the robot although extremely expensive, may be the best way to train the laparoscopic surgeon of the future. © 2009 Elsevier Ltd. All rights reserved.
“Image Guided Surgical Interventions.”
Perrin, D. P., N. V. Vasilyev, et al. (2009).
Current Problems in Surgery 46(9): 730-766.
“Abdominal laparoscopy: An update.”
Probst, H. and N. Demartines (2009).
Laparoscopie abdominale: Possibilités et limites 5(209): 1432-1436.
Laparoscopic surgery has become a standard approach for many interventions, including oncologic surgery. Laparoscopic instruments have been developed to allow advanced surgical procedure. Imaging and computer assistance in virtual reality or robotic procedure will certainly improve access to this surgery.
“NOTES: a review.”
Mansard, M. J., D. N. Reddy, et al. (2009).
Tropical gastroenterology : official journal of the Digestive Diseases Foundation 30(1): 5-10.
A few years ago a new approach to performing abdominal surgery was presented, i.e. via the natural body orifices using endoscopes. The interest and research in this approach progressed very rapidly, in spite of the initial skepticism. It was initially demonstrated in animal models, then in human beings and has now very nearly become routine practice. This article reviews the development of natural orifice transluminal endoscopic surgery (NOTES), its benefits and the hurdles we have yet to overcome.
“Laparoendoscopic single-site surgery of the kidney with no accessory trocars: An initial experience.” Rais-Bahrami, S., S. Montag, et al. (2009).
Journal of Endourology 23(8): 1319-1324.
Background and Purpose: As laparoscopy becomes more commonplace for urologists, ongoing attempts are under way to minimize the number and size of incisions used for access. Laparoendoscopic single-site surgery (LESS) was developed and has been increasingly attempted as an extension of classic laparoscopy. Investigators hypothesize that LESS may offer a superior cosmetic result, faster recovery, and equivalent efficacy to laparoscopic surgery. Our aim is to present our experience with renal LESS. Patients and Methods: A prospective data collection was performed on all patients who were undergoing renal LESS at our institution. A total of 11 renal LESS procedures were performed between July and November 2008: four LESS donor nephrectomies, two LESS radical nephrectomies, three LESS partial nephrectomies, and two LESS pyeloplasties. All LESS procedures replicated laparoscopic techniques but were performed through a single operative site using a 5-mm flexible-tip laparoscope and flexible working instruments. Results: Six of the patients were men. The mean operative time was 162.4±38.5 minutes. The mean estimated blood loss was 104.5±41.6mL, with a mean length of hospitalization of 2.4±0.8 days. There were no intraoperative complications or blood transfusions. Postoperative pain requirements were tabulated and revealed a mean in-hospital analgesic requirement of 44.8±46.7mg (range 7-158mg) of morphine equivalents with three patients receiving intravenous ketorolac. Conclusion: Renal LESS is feasible as flexible laparoscopes and instruments continue to develop. In our initial experience, expert laparoscopic surgeons were able to perform these LESS procedures with equivalent efficacy without compromising perioperative measures, including operative time, blood loss, and hospital stay. Further prospective investigation through randomized studies is necessary to elucidate differences, if any, in postoperative analgesic requirements and patient satisfaction with postoperative cosmesis, and to confirm equivalent efficacy when compared with current standards. © Copyright 2009, Mary Ann Liebert, Inc. 2009.
“Laparoendoscopic single-site surgery: Early experience with tumor nephrectomy.”
Stolzenburg, J. U., G. Hellawell, et al. (2009).
Journal of Endourology 23(8): 1287-1292.
Background and Purpose: Laparoendoscopic single-site surgery (LESS) represents the closest surgical technique to scar-free surgery. We performed LESS for renal tumor nephrectomy in eight patients to assess feasibility and perioperative outcome. Patients and Methods: Eight patients with a body mass index (BMI) ≤30 underwent single-port nephrectomy for renal tumor by an experienced laparoscopic surgeon. Tri-Ports were used through a transumbilical incision in all cases. A flexible grasper and a 5-mm 30-degree high-definition camera were used in addition to standard laparoscopic equipment. Patient demographics; operative details, including procedure duration, blood loss, and complications; and final pathology results were prospectively recorded. Postoperative evaluation of pain and use of analgesic medication were recorded. Results: All LESS nephrectomy operations were successfully accomplished without the need to convert to conventional laparoscopy. The median patient age was 60.75 years (range 22-76 years) and median BMI was 22.95 (range 18.2-26.1). The median operative duration was 141 minutes (range 120-180min), and the median blood loss was 103mL (range 50-150mL). Histologic evaluation confirmed complete excision of an intact specimen. All cases revealed organ-confined T1 renal-cell carcinoma (two right-sided and six left-sided, tumor diameter range 4-8cm). A tumor with an adjacent simple renal cyst was excised in one patient. No intraoperative or postoperative complications occurred. Conclusions: LESS was a feasible and safe approach in a selected group of patients (low BMI and stage tumor). LESS nephrectomy was made possible with the use of multi-instrument port and flexible instruments. The oncologic outcome was not compromised. Further evaluation of LESS surgery needs prospective, randomized studies. © Copyright 2009, Mary Ann Liebert, Inc. 2009.