Abstract:

Objective: To introduce a new telesurgical concept and system, we describe the TELELAP Alf-X system and report the results of the preliminary laboratory experiments on dry lab skill exercises.
Methods: The TELELAP Alf-X system offers a novel approach to remotely operated 3-dimension endoscopy by adding haptic sensation, an eye-tracking system, and a high degree of configuration versatility. The Alf-X system consists of a remote control unit, manipulator arms, connection node, and reusable endoscopic instruments. To test the hand-eye coordination, manual dexterity, depth of field, and ability to make optimal sutures and knots, the Alf-X system was used in a laparoscopic trainer utilizing specific tools by a single surgeon (SG) who repeated three different exercises ten times. The time and accuracy of the exercises were recorded.
Results: By using the TELELAP Alf-X system, the surgeon was able to work repeatedly and to perform all the exercises scheduled. In all exercises, the best results were achieved after the first five cases.
Conclusion: The TELELAP Alf-X system shows excellent stability, easy-to-use interface, and ability to perform essential endoscopic skills. Further experimentation, especially in live tissue, could identify the role of this new technology for the surgical repertoire.

Authors:

Stefano Gidaro, Assistant Professor, Department of Surgical Science 
"G.D'Annunzio" University School of Medicine, Chieti-Pescara, Italy
Maurizio Buscarini, Associate Professor, Department of Urology
Campus Biomedico, University School of Medicine, Roma, Italy
Emilio Ruiz, ALF-X Surgical Robotics Department, SOFAR S.p.A., Milan, Italy Michael Stark, The New European Surgical Academy, Berlin, Germany, Anna Labruzzo, Eng., Head of Alf-X Surgical Robotics, Department, SOFAR SpA., Milan, Italy

PMID: 23225591

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Abstract:

The principle of fluorescence angiography using indocyanine green has been known for a long time and was used especially by photographs and ophthalmologists for retinal diagnostics. After one publication about perfusion control in open surgery we were the first who examined the perfusion of colorectal anastomoses by laparoscopic fluorescence angiography intraoperatively. Since 2008, 49 laparoscopic operations (45 colorectal anastomoses, 4 gastric sleeve resections) were performed using the fluorescence control. In all cases a correct perfusion of the anastomotic/stapler region could be shown. In cases of decreased perfusion a resection of this area could have been necessary. The laboratory tests with isolated, perfused pig colon could show areas with hypoperfusion after dissection of segmental arteries. Laparoscopic fluorescence angiography could become a standard method to detect a decreased perfusion intraoperatively. Further studies will be needed to show if the rate of anastomotic insufficiency can be lowered by using this new method.

Authors:

Thomas Carus, MD Professor of Minimally Invasive Surgery Department of Surgery, Center for Minimally Invasive Surgery University of Bremen, Klinikum Bremen-Ost, Head of Surgery, Hospital Bremen-Ost, Bremen, Germany, Professor, Department Of Medical Engineering University of Applied Sciences, Bremerhaven, Germany, Rainer Dammer PhD, Professor, Department of Medical Engineering, University of Applied Sciences, Bremerhaven, Germany

PMID: 23315721

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Abstract:

Recently, extensive data has been published about the safety and efficacy of endoscopic radiofrequency ablation (RFA) of Barrett's esophagus (BE) with early cancer and dysplasia as well as without dysplasia. RFA has been shown to be effective and safe. Circumferential RFA is delivered using the HALO360+ Ablation System (Covidien,Inc., Mansfield, MA), which consists of a high-power energy generator, a sizing balloon catheter, and a number of balloon-based ablation catheters with varying outer diameters. Focal RFA is delivered using the HALO90 or HALO60 Ablation Systems (Covidien,Inc., Mansfield, MA), consisting of a radiofrequency energy generator and an endoscope-mounted electrode. Both RFA systems have official approval to be used in the United States, Europe, and other countries for the treatment of BE as well as in patients with gastric antral vascular ectasia and radiation proctopathy. With increasing widespread use of these systems, a full mastery of the equipment and therapeutic technique is essential to maximize eradication rates of BE while maintaining patient safety. The cost-effective patient selection and eradication protocol for RFA are essential to success with this technique in patients with BE. This article will discuss our experience with RFA treatment of BE using the HALO system for effective eradication of Barrett's dysplasia and early Barrett's cancer and available data especially from the U.S. National Registry.

Authors:

Umut Sarpel, MD, Assistant Professor of Surgery Mount Sinai School of Medicine New York, NY Diego M. Ayo, MD, Surgical Resident, New York University School of Medicine New York, NY, Elliott J. Newman, MD, Associate Professor of Surgery New York University School of Medicine New York, NY

PMID: 23023571

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Abstract:

There are few options for the treatment of fistulas, leaks, and perforations endoscopically. Here we describe our experience with an endoscopic clipping system. A retrospective review of all cases using the Over-The-Scope-Clip system (Ovesco Endoscopy AG, Tuebingen, Germany) was performed. The system was utilized in ten patients with gastrointestinal surgical complications. Four patients had gastric leaks following sleeve gastrectomy, one had a post-operative colonic leak, two had gastro-gastric fistulas following gastric bypass, and three had esophageal perforations. Two leak patients had complete resolution, one had a contained leak following clip placement that was clinically insignificant, and the fourth patient had a persistent leak despite two clipping procedures. Two patients had gastro-gastric fistulas following roux-en-y gastric bypass surgery and, while they both had initial success, the fistulas recurred. One patient presented with anastomotic leak following colon resection but the system was unable to reach the treatment site. Three patients were successfully treated for esophageal perforation. There were no complications.

Authors:

Alisa M. Coker, MD, Research Fellow, University of California San Diego, La Jolla, CA , Garth R. Jacobsen, MD, FACS, Assistant Professor of Surgery, University of California San Diego , Department of Surgery, Division of Minimally Invasive Surgery. San Diego, California, Geylor Acosta, MD, Research Fellow, University of California San Diego, Department of Surgery, Division of Minimally Invasive Surgery, San Diego, California, Mark A. Talamini, MD, Professor of Surgery, Chairman,University of California San Diego, Department of Surgery, Division of Minimally Invasive Surgery, San Diego, California,Thomas J. Savides MD, Professor of Clinical Medicine, Clinical Service Chief, University of California San Diego, Department of Medicine, Division of Gastroenterology, San Diego, California, Santiago Horgan, MD, FACS, Professor of Surgery, Division Chief, University of California San Diego, Department of Surgery, Division of Minimally Invasive Surgery, San Diego, California

PMID: 23225590

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Abstract:

Adequate hemostasis in cranial and spinal surgery is of paramount importance in a neurosurgeon's daily practice. Generalized ooze bleeding from the surgical wall cavities, coming from the dura mater or nervous tissue may be troublesome and may limit visualization in minimally invasive neurosurgery. Hemostatic matrix is a mixture of a flowable gelatin matrix (bovine or porcine) and a thrombin component mixed together. A total of 318 patients undergoing cranial, craniospinal, and spinal procedure with the use of gelatin hemostatic matrix (Floseal and Surgiflo) were enrolled in this clinical study. We compared the different hemostatic techniques using the gelatin hemostatic matrix, and investigated indications, time to bleeding control, and its efficacy and safety in neurosurgery.

Authors:

Roberto Gazzeri, MD, Marcelo Galarza, MD, Alex Alfier, MD, Department of Neurosurgery, San Giovanni Addolorata Hospital, Rome, Italy

PMID: 22915500

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Abstract:

Vesicovaginal fistula (VVF), commonly caused by prolonged obstructed labor, is one of the worst complications of childbirth and poor obstetric care in the developing world. We investigated the clinical efficacy and outcome of technical modifications of the current transperitoneal supravesical technique for supratrigonal and complex vesicovaginal fistula. We studied a total of 20 patients with iatrogenic supratrigonal and complex vesicovaginal fistula following obstetric trauma and hysterectomy. All patients underwent a modified transabdominal technique: the modifications consisted of passing a Foley catheter through the fistulous opening, inflating the balloon, and applying traction on the catheter to provide effective anchorage and to minimize the oozing from the cystotomy edges. The cystotomy was directed in the parasagittal line, and medial side of the bladder was rotated as a flap into the bladder defect; the urethral de Pezzare catheter was used for urinary drainage. We used hemostatic matrix sealant (FloSeal, Baxter BioSurgery, Westlake Village, California) to promote healing and hemostasis. The vesicovaginal fistula was successfully corrected in all patients after the first attempt, and no significant bladder dysfunction or decrease in bladder capacity was seen after repair. Interposition flaps were used in all patients, and six patients (30%) required ancillary procedures for other associated anomalies at the time of fistula repair. At a mean follow-up of two years, fourteen women were sexually active, and 5 (35%) from this group of patients complained of mild-to-moderate dyspareunia. In our study, supratrigonal VVFs were repaired with a transabdominal, transperitoneal, transvesical approach. Tailoring the cystotomy in a parasagittal line permitted closure of fistula by rotation of bladder flap into the defect. This excellent method should be a viable option when repairing complex VVF.

Authors:

Ashraf Abou-Elela, M.D., Professor of Urology, Faculty of Medicine, Cairo University, Cairo, Egypt., Haitham Torky, M.D., Lecturer in Gynecology, 6th of October University, Cairo, Egypt, Hany Alfaiomy, M.D., Assistant Professor of Urology, Cairo University, Cairo, Egypt, Ehab Reyad, M.D., Consultant in Urology, Well Care Medical Center, Abu Dhabi, United Arab Emirates (UAE), Sameh Azazy, M.D.,Consultant in Gynecology, Well Care Medical Center, Abu Dhabi, United Arab Emirates (UAE)

PMID: 23225588

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