Abstract:

The practice of surgical techniques is constantly improving and evolving. In the last two decades, minimally invasive surgery has gained widespread acceptance. Virtually all procedures can now be performed laparoscopically. This trend not only provides better cosmesis, but offers decreased recovery times as well. The initial trend from open to laparoscopic surgery was to use smaller incisions. The natural continuation of this is to now decrease the number of incisions necessary to perform minimal access surgery. To this end, the authors have seen a constantly evolving stream of technology and instrumentation in laparoscopy. New venues, such as robotics and Natural Orifice. Transluminal Endoscopic Surgery (NOTES), have developed as well. As part of this evolution, the authors developed Single Port Access (SPA™) surgery in April 2007 as a novel and innovative platform of minimal access surgery. Its acceptance through our training programs, as well as the subsequent development of modified Single Port techniques, demonstrates the potential to develop a new platform of minimal access surgery.

Authors:

Paul G. Curcillo II, MD, FACS, Vice Chairman and Associate Professor, Department of Surgery, Director, Robotic and Minimally Invasive Surgery, Stephanie A. King, MD, FACOG, Director, Department of Gynecologic Oncology, Erica R. Podolsky, MD, Department of Surgery Steven J. Rottman, MD, Department of Surgery, Drexel University College of Medicine, Philadelphia, PA

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Abstract:

Natural orifice transluminal endoscopic surgery (NOTES) is currently an intensely discussed topic. The debate is extremely controversial, ranging from euphoric visions to complete refusal, and the future clinical role of natural orifice surgery is difficult to describe. This chapter analyzes the current technological status, and addresses the question of whether to enrich the surgical procedures will become an option. A literature research was undertaken using Medline and Pubmed. Personal experiences and communications were also included in this state-of-the-art report. The individual barriers currently impeding the clinical use, as defined by the NOSCAR group, are addressed in detail. With the exception of the vaginal access, no natural orifice-entering technique is already clinically mature. The selective use-potentially in combination-in a more refined technique than currently, is likely to provide a breakthrough. Most of the remaining obstacles are just a matter of further progress in advanced medical engineering. However, it should not be forgotten that the problems to be solved are less than trivial, and close cooperation between engineers and surgeons is essential. NOTES is still in the early stages of development. Currently available tools and techniques remain in the pioneer stage. However, worldwide activities in research and development will lead to promising solutions, which certainly will help to overcome the existing barriers. Whether "pure NOTES" or hybrid procedures only, surgery will take another step forward toward a less-invasive discipline.

Authors:

Dirk Wilhelm, M.D., Physician, Department of Surgery, Klinikum rechts der Isar der TUM, Working group, "Minimally Invasive Interdisciplinary Therapeutic Intervention" (MITI), München, Germany, Alexander Meining, M.D., Physician, Department of Gastroenterology, Klinikum rechts der Isar der TUM, Armin Schneider, M.Sc., Engineer, Working group, "Minimally Invasive Interdisciplinary Therapeutic Intervention" (MITI), München, Germany, Adam Fiolka, M.Sc., Engineer, Working group, "Minimally Invasive Interdisciplinary Therapeutic Intervention" (MITI), München, Germany, Salman Can, M.Sc., Engineer, Working group, "Minimally Invasive Interdisciplinary Therapeutic Intervention" (MITI), München, Germany, Helmut Friess, M.D., Professor of Surgery, Department of Surgery, Klinikum rechts der Isar der TUM

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Abstract:

This chapter proposes a classification of surgical assistance systems with respect to their type and level of automation. This classification is based on previous work in the field of human factors and takes two aspects into consideration, the type of information-processing function of the surgeon that is supported by the system, as well as the type of function allocation between surgeon and systems. With respect to the former, three basic functions are distinguished, referred to as information acquisition and analysis, decision making and planning, and execution of surgical action. With respect to the type of function allocation, the status of being either "passive" or "active" comes into consideration for both objects of reference (i.e. the surgeon and the machine), depending on whether a given function is mainly performed by the surgeon, by the system, or collaboratively by both. Hence, a classification results for intraoperative assistance systems in six categories, each of these representing a different degree of automation. The classification scheme is explained and illustrated on the basis of examples of surgical assistance systems from various fields.

Authors:

D. Manzey, Ph.D., Professor, Department of Psychology and Ergonomics, Berlin Institute of Technology, Berlin, Germany, G. Strauss, M.D., Ph.D., Department of ENT, Innovation Center Computer Assisted Surgery (ICCAS), University of Leipzig, Leipzig, Germany, C. Trantakis, M.D., Department of Neurosurgery, Innovation Center, Computer Assisted Surgery (ICCAS), University of Leipzig, Leipzig, Germany, T. Lueth, Ph.D., Professor, Micro- and Medical Devices, Technical University Munich, Munich, Germany, S. Röttger, Dipl. Psych. Department of Psychology and Ergonomics, Berlin Institute of Technology, Berlin, Germany, J.E. Bahner-Heyne, Ph.D., Department of Psychology and Ergonomics, Berlin Institute of Technology Berlin, Germany, A. Dietz, M.D., Ph.D., Professor, Department of ENT University of Leipzig, Leipzig, Germany, J. Meixensberger, M.D., Ph.D. Professor, Department of Neurosurgery, University of Leipzig, Leipzig, Germany

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Abstract:

In contrast with autographic or allographic repair materials, the use of a xenographic soft tissue repair material could improve patient outcomes following surgery, since such a material would not require a second surgical site and could reduce the risk of human-to-human disease transmission. Veritas® Collagen Matrix (Veritas) is a novel, non-crosslinked soft tissue repair material derived from bovine pericardium. Physical property testing shows this material is strong, malleable, of uniform thickness, and easily sutureable. Biocompatibility testing, as well as viral safety and extractable deoxyribonucleic acid (DNA) studies demonstrate the acellularity, safety, and immunological inertness of the material. Animal studies in pigs and rabbits, in a variety of surgical procedures that include abdominal wall implant, unilateral hysterectomy, urethral sling implant, and dural substitute studies demonstrate Veritas does not adhere readily to tissues of the chest wall or abdomen under conditions that promote adhesions. In addition, these studies show that Veritas is remodelable and, in time, becomes histologically indistinguishable from the host tissue. These findings indicate Veritas is an ideal soft tissue repair material and it may serve as an ideal scaffold for tissue engineering.

Authors:

B. Nicholas Oray, Ph.D., Retired Vice-President of Research and Development, Sheila Kelly, R&D Manager , Tracy Konobeck , Scientist Amy Lambert, Process Engineering Technician, Daniel L. Mooradian, Ph.D., Vice-President of , Research and Development, Synovis Life Technologies, Inc. , Research and Development Department, St. Paul, MN, USA

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Abstract:

Postoperative venous thromboembolism (VTE) represents a serious and potentially fatal complication that affects 40% to 60% of patients undergoing major orthopedic surgery and not receiving antithrombotic prophylaxis. Several prophylactic modalities, including pharmacological agents such as oral vitamin K antagonists (VKA) and low molecular weight heparins (LMWH), have been shown to be effective and safe for most patients at high risk for VTE. However, some patients undergoing cancer or major orthopedic surgery remain at some residual VTE risk despite the use of these methods. Approaches to improve the results of prophylaxis include optimizing the timing and duration of pharmacological prophylaxis, combining mechanical methods with anticoagulants, and the development of new antithrombotics.

Authors:

Juan I. Arcelus, M.D., Ph.D., Professor of Surgery, Hospital Virgen de las Nieves, University of Granada Medical School, Granada, Spain

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Abstract:

Although lasers have been used in clinical neurosurgery for over 40 years, technological advancements have expanded their use and improved technical application. Originally applied to brain tumors to confer destructive oncolysis, lasers have been used over the last few decades to incise, fenestrate, and repair tissues and now are being used for cerebrovascular bypass techniques. In this chapter, a brief history on the evolution of lasers in neurosurgery will be discussed, and technical and clinical aspects of current applications will presented. Such applications include: laser scalpel for spinal cord tumors and lipomas, fenestration of arachnoid cysts, cerebrovascular bypass with the ELANA device, laser-induced interstitial thermotherapy for brain tumors, laser tissue soldering for dural repair, and percutaneous laser disc decompression.

Authors:

Li-Mei Lin, M.D., Neurosurgical Resident, Division of Pediatric Neurosurgery, Johns Hopkins University, Baltimore, Maryland, Daniel M. Sciubba, M.D., Neurosurgical Resident, Division of Pediatric Neurosurgery, Johns Hopkins University, Baltimore, Maryland, George I Jallo, M.D., Associate Professor, Department of Neurosurgery, Division of Pediatric Neurosurgery, Johns Hopkins University, Baltimore, Maryland

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Abstract:

Theoretically, robotic surgery is likely to overcome the intrinsic limitations of laparoscopic surgery, such as a view not under the direct surgeon's control, two-dimensional imaging, and limited motion of instruments. In this chapter, the preliminary experience with a robotic laparoscopic surgery system in the Surgical Department of the Alessandria Hospital, Italy, is reported. From November 2005 to August 2007, a total of 162 laparoscopic robotic operations were performed, in which robotic surgery was found to be feasible and safe. It takes a longer time than standard laparoscopy but seems able to reduce the need of a steep learning curve.

Authors:

Giuseppe Spinoglio, M.D., Director, Department of Surgery, Massimo Summa, M.D., Surgeon, Department of Surgery, Fabio Priora, M.D., Surgeon, Department of Surgery, Raoul Quarati, M.D., Surgeon, Department of Surgery, Silvio Testa, M.D., Surgeon, Department of Surgery, SS Antonio e Biagio Hospital, Alessandria, Italy

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Abstract:

Elective nephron-sparing surgery (NSS) for renal cell carcinoma (RCC) has gained general acceptance as an alternative to radical nephrectomy. To achieve hemostasis without risk of local ischemia and necrosis of kidney parenchyma after standard hemostatic suturing, we investigated oxidized cellulose hemostats' efficacy and safety as atraumatic hemostatic treatment and for the closure of a large parenchymal defect after kidney tumor resection. Our approach has been particularly helpful for repairing large and irregular renal parenchymal defects. This study demonstrates the use of oxidized cellulose hemostats is effective for rapid, hemostatic closure of the kidney in association with partial nephrectomy.

Authors:

Ashraf Abou-Elela, Ph.D., Professor of Urology, Cairo University, Cairo, Egypt, Ahmad Morsy, Ph.D., Professor of Urology, Cairo University, Cairo, Egypt, Hesham Badawy, Ph.D., Professor of Urology, Cairo University, Cairo, Egypt, Mongy Fathy, Ph.D., Professor of Urology, Cairo University, Cairo, Egypt

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