“Informed consent-’da Vinci code’ for our safety in empowered patient’s safety.”
Agarwal, B. B. (2009).
Surg Endosc.
“Priority setting for technology adoption at a hospital level: Relevant issues from the literature.”
Lettieri, E. and C. Masella (2009).
Health Policy 90(1): 81-8.
OBJECTIVES: The increasing pace of development of healthcare technologies obliges hospitals to increase both the rationality and the accountability of priority setting for technology adoption. This paper aims at identifying which are the relevant issues for technology assessment and selection at a hospital level and at grouping them in a reference framework. METHODS: An electronic search from January 1990 onwards, covering PubMed, Medline and CILEA, has been carried out in order to collect the relevant contributions. A total of 20 studies were selected from the fields of health policy, management of technology and biomedical engineering. RESULTS: Two main assessment perspectives have been identified and detailed: value generation at a hospital level and level of sustainability in the implementation stage. Four types of investment in technology at a hospital level have been identified combining the perspectives. Moreover, the two perspectives have been deployed in a list of 19 relevant issues that should be reviewed during the budget process. CONCLUSION: The proposed framework can aid priority setting for technology adoption at a hospital level and contribute to increase both the rationality and the accountability of technology assessment and selection in the budget process.
“Postural mechatronic assistant for laparoscopic solo surgery (PMASS).”
Minor Martinez, A., J. Villalobos Gomez, et al. (2009).
Surgical Endoscopy 23(3): 663-667.
Background and purpose: Laparoscopes used in laparoscopic surgery are manipulated by human means, passive systems or robotic systems. All three methods accumulate downtime when the laparoscope is cleaned and the optical perspective is adjusted. This work proposes a new navigation system that autonomously handles the laparoscope, with a view to reducing latency, and that allows real-time adjustment of the visual perspective. Methods: The system designed is an intuitive mechatronic system with three degrees of freedom and a single active articulation. The system uses the point of insertion as the invariant point for navigation and has a work space that closely resembles an inverted cone. Results: The mechatronic system has been tested in a physical trainer, cutting and suturing chicken parts, as well as in laparoscopic ovariohysterectomies in dogs and pediatric surgeries. In all the procedures, surgeons were able to auto-navigate and there was no visual tremor while using the system. Surgeons performed visual approaches in real time and had both hands free to carry out the procedure. Conclusion: This new mechatronic system allows surgeons to perform solo surgery. Cleaning and positioning downtime are reduced, since it is the surgeon him/herself who handles the optics and selects the best visual perspective for the surgery. © 2008 Springer Science+Business Media, LLC.
“Two concomitant robot-assisted procedures in one anesthesia session: Our experience.” Nayyar, R., N. P. Gupta, et al. (2009).
Journal of Endourology 23(2): 263-267.
Purpose: To evaluate the feasibility and safety of two concomitant robot-assisted procedures in the same patient in one anesthesia setting. Patients and Methods: Data were reviewed for 15 patients for whom two concomitant robot-assisted surgeries at our center were planned. Preoperative details, port position, intraoperative problems encountered, surgical and anesthesia time, blood loss, complications, hospital stay, and postoperative recovery were analyzed. Results: Fifteen patients underwent two concomitant robot-assisted procedures; at least one of the two surgeries was a urologic procedure. The second procedure added <50 mL of blood loss. Surgical time was increased by 58 minutes and 30 minutes in cases in which the primary procedure involved the upper and lower urinary tract, respectively, while anesthesia time was increased by 82 minutes and 30 minutes, respectively. There were no added complications during the second procedure, and hospital stay was not increased, being limited only by the first procedure. Conclusion: Planned robot-assisted surgery for two different operations is feasible in one anesthesia session, thereby reducing cost and overall hospital stay for the patient without any increased risk of perioperative morbidity. The decision to continue with the second procedure depends on the successful completion of the first procedure in a reasonable time and without any complications. © Mary Ann Liebert, Inc. 2009.
“Minimally invasive surgical training: Challenges and solutions.”
Pierorazio, P. M. and M. E. Allaf (2009).
Urol Oncol 27(2): 208-13.
Treatment options for urological malignancies continue to increase and include endoscopic, laparoscopic, robotic, and image-guided percutaneous techniques. This ever expanding array of technically demanding management options coupled with a static training paradigm introduces challenges to training the urological oncologist of the future. Minimally invasive learning opportunities continue to evolve, and include an intensive experience during residency, postgraduate short courses or mini-apprenticeships, and full time fellowship programs. Incorporation of large animal surgery and surgical simulators may help shorten the necessary learning curve. Ultimately, programs must provide an intense hands-on experience to trainees in all minimally invasive surgical aspects for optimal training.
“Validation of a novel virtual reality robotic simulator.”
Sethi, A. S., W. J. Peine, et al. (2009).
J Endourol 23(3): 503-8.
PURPOSE: We evaluated the face, content, and construct validity of what is, to our knowledge, the only available virtual reality simulator based on a complete kinematic representation of the da Vinci surgical system. MATERIALS AND METHODS: A total of 5 experts (EPs) and 15 novices (NVs) completed exercises on the Mimic dV-Trainer (MdVT). All participants completed three repetitions of the following tasks: (1) Ring and Cone, (2) String Walk, and (3) Letterboard. Participants rated parameters of face and content validity on a five-point Likert-scale questionnaire. Workload imposed by the simulator was assessed using a NASA Task Load Index questionnaire (TLX). RESULTS: Face validity of the MdVT was established as all 20 participants rated the simulator between average to easy-to-use and above-average to high in all parameters of realism. Participants in both EP and NV groups rated the MdVT’s overall relevance to robotic surgery as very high. All five EPs assessed the simulator to be a very good practice format and very useful for training residents, thereby affirming content validity. A preliminary assessment of construct validity suggested that the MdVT could differentiate EPs from NVs. The overall TLX workload scores were lower in the EP group for all parameters except for temporal demand. CONCLUSIONS: The MdVT demonstrated excellent face and content validity as well as reasonable workload parameters. The use of this simulator in resident training may help bridge the gap between the safe acquisition of surgical skills and effective performance during live robot-assisted surgery.
“Performance of basic manipulation and intracorporeal suturing tasks in a robotic surgical system: single- versus dual-monitor views.”
Shah, R. D., A. Cao, et al. (2009).
Surg Endosc 23(4): 727-33.
BACKGROUND: Technical advances in the application of laparoscopic and robotic surgical systems have improved platform usability. The authors hypothesized that using two monitors instead of one would lead to faster performance with fewer errors. METHODS: All tasks were performed using a surgical robot in a training box. One of the monitors was a standard camera with two preset zoom levels (zoomed in and zoomed out, single-monitor condition). The second monitor provided a static panoramic view of the whole surgical field. The standard camera was static at the zoomed-in level for the dual-monitor condition of the study. The study had two groups of participants: 4 surgeons proficient in both robotic and advanced laparoscopic skills and 10 lay persons (nonsurgeons) who were given adequate time to train and familiarize themselves with the equipment. Running a 50-cm rope was the basic task. Advanced tasks included running a suture through predetermined points and intracorporeal knot tying with 3-0 silk. Trial completion times and errors, categorized into three groups (orientation, precision, and task), were recorded. RESULTS: The trial completion times for all the tasks, basic and advanced, in the two groups were not significantly different. Fewer orientation errors occurred in the nonsurgeon group during knot tying (p=0.03) and in both groups during suturing (p=0.0002) in the dual-monitor arm of the study. Differences in precision and task error were not significant. CONCLUSIONS: Using two camera views helps both surgeons and lay persons perform complex tasks with fewer errors. These results may be due to better awareness of the surgical field with regard to the location of the instruments, leading to better field orientation. This display setup has potential for use in complex minimally invasive surgeries such as esophagectomy and gastric bypass. This technique also would be applicable to open microsurgery.