Abstract:

This article describes the basic technology and technique behind modified virtual colonoscopy (MVC). It is accompanied by images illustrating the possibility of MVC to advance the imaging for endometriosis beyond the current modalities of magnetic resonance imaging (MRI) and ultrasound. A quantification system is described that will ultimately make staging and multicenter prospective scientific studies possible for rectogenital and disseminated endometriosis.

Authors:

Johan van der Wat, MBBCh, FCOG, Director, Endometriosis and Endoscopic Surgery Unit, Netcare Parklane Hospital, Honorary Consultant, Endoscopic Surgery, Department of Obstetrics/Gynecology, University of Witwatersrand, Johannesburg, South Africa, Mitch D. Kaplan, MBBCh FFRAD(D), Director, Scan for Life, Radiology Department, The Rosebank Hospital, Johannesburg, South Africa

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Abstract:

We know that experienced endoscopic surgeons, despite having extensive training, may make a rare but fatal mistake. Prof. Takeshi Ohdaira developed a device visualizing brain action potential to reflect the latent psychological instability of the surgeon. The Ohdaira system consists of three components: a real-time brain action potential measurement unit, a simulated abdominal cavity, and an intra-abdominal monitor. We conducted two psychological stress tests by using an artificial laparoscopic simulator and an animal model. There were five male subjects aged between 41 to 61 years. The psychological instability scores were considered to reflect, to some extent, the number of years of experience of the surgeon in medical care. However, very high inter-individual variability was noted. Furthermore, we discovered the following: 1) bleeding during simulated laparoscopic surgery—an episode generally considered to be psychological stress for the surgeon—did not form the greatest psychological stress; 2) the greatest psychological stress was elicited at the moment when the surgeon became faced with a setting in which his anatomical knowledge was lacking or a setting in which he presumed imminent bleeding; and 3) the excessively activated action potential of the brain possibly leads to a procedural error during surgery. A modified brain action potential measurement unit can reveal the latent psychological instability of surgeons that possibly leads to errors in surgical procedures.

Authors:

Saori Akimoto, MS, Technical Staff, Takeshi Ohdaira, MD, Professor, Seiji Nakamura, MS, Technical Staff, Tokihisa Yamazaki, MS, Technical Staff, Shinichiro Yano, BA, Technical Staff, Nobuhiko Higashihara, BA, Technical Staff, Center for Advanced Medical Initiatives, Kyushu University, Fukuoka, Japan

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Abstract:

Medical treatment of patients always entails the risk of undesired complications or side effects. This is particularly poignant in surgery as both the disease to be treated and the surgical intervention to be performed can be life threatening. Hence, it is essential to inform a surgical patient in detail about the expectations desired, but also the possible undesired outcomes and complications, especially when new surgical techniques are introduced. Apart from communication about available evidence regarding treatment options, the patient’s preference needs to be invoked to make sure the surgeon’s advice matches the patient’s preference. Shared decision-making (SDM) invokes the bidirectional communication between physicians and patients required to involve the patient’s preference in the eventual treatment choice. SDM is considered as an essential part of evidence-based medicine as it helps determine whether the available evidence on the possible benefits and harms of treatment options match the patient’s characteristics and preferences. This paper will exemplify what SDM is, why it is important, and how it can be performed in surgical practice. Several tools to facilitate SDM are presented.

Authors:

Dirk T. Ubbink, MD PhD, Senior Research Physician and Clinical Epidemiologist, Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands, Michiel G. J. S. Hageman, MD, Resident in Orthopedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands,  Dink A. Legemate, MD PhD, Professor of Surgery and Clinical Epidemiologist, Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands

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Abstract:

Gastroschisis (GS) is a structural defect of the anterior abdominal wall, usually diagnosed antenatally, that occurs with a frequency of approximately 4 per 10,000 pregnancies. Babies born with GS require neonatal intensive care and surgical management of the abdominal wall defect soon after birth. Although contemporary survival rates for GS are over 90%, these babies are at risk for significant morbidity, and require 4 to 6 weeks of costly, resource-intensive care in specialized neonatal units. Much consideration has been given to how best to treat the abdominal wall defect of GS. The traditional approach, necessitated by a need to establish enteral feeding as quickly as possible, consists of early postnatal visceral reduction and sutured abdominal closure. Advances in neonatal nutritional support have enabled the development of surgical approaches, which permit gradual visceral reduction and delayed abdominal closure. In cases where early visceral reduction cannot be achieved, delayed closure enabled by the initial placement of a prosthetic silo has been a life-saving alternative. The development of preformed silos has simplified their use and led to an interest in treating all cases with a delayed closure philosophy. Most recently, a sutureless technique of abdominal closure has been reported, which has the benefit of avoiding general anesthesia and offers other outcome improvements over sutured closure of the defect. The debate over primary closure versus silo placement and delayed closure continues to receive much attention. The goal of this article is to review historical aspects of gastroschisis closure, and then focus on current surgical techniques, including the innovative sutureless closure, with an analysis of the comparative clinical effectiveness of these approaches to treatment of the abdominal wall defect in GS.

Authors:

Arash Safavi, MD, General Surgery Resident, Department of Surgery, University of Arizona, Tucson, Arizona, Erik D. Skarsgard, MD, Surgeon-in-Chief, Division of Pediatric Surgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada

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Abstract:

Currently, there is a tendency to perform surgical procedures via laparoscopic or thoracoscopic access. However, even with the impressive technological advancement in surgical materials, such as improvement in quality of monitors, light sources, and optical fibers, surgeons have to face simple problems that can greatly hinder surgery by video. One is the formation of “fog” or residue buildup on the lens, causing decreased visibility. Intracavitary techniques for cleaning surgical optics and preventing fog formation have been described; however, some of these techniques employ the use of expensive and complex devices designed solely for this purpose. Moreover, these techniques allow the cleaning of surgical optics when they becomes dirty, which does not prevent the accumulation of residue in the optics. To solve this problem we have designed a device that allows cleaning the optics with no surgical stops and prevents the fogging and residue accumulation. The objective of this study is to evaluate through experimental testing the effectiveness of a simple device that prevents the accumulation of residue and fogging of optics used in surgical procedures performed through thoracoscopic or laparoscopic access. Ex-vivo experiments were performed simulating the conditions of residue presence in surgical optics during a video surgery. The experiment consists in immersing the optics and catheter set connected to the IV line with crystalloid solution in three types of materials: blood, blood plus fat solution, and 200 mL of distilled water and 1 vial of methylene blue. The optics coupled to the device were immersed in 200 mL of each type of residue, repeating each immersion 10 times for each distinct residue for both thirty and zero degrees optics, totaling 420 experiments. A success rate of 98.1% was observed after the experiments, in these cases the device was able to clean and prevent the residue accumulation in the optics.

Authors:

Igor Renato Louro Bruno de Abreu, MD, Thoracic Surgeon, Hospital Santa Marcelina Itaquera, São Paulo, Brazil, Fernando Conrado Abrão, MD, Thoracic Surgeon, Hospital Santa Marcelina Itaquera, São Paulo, Brazil, Alessandra Rodrigues Silva, Medical Student, Faculdade Santa Marcelina, São Paulo, Brazil, Larissa Teresa Cirera Corrêa, Medical Student, Faculdade Santa Marcelina, São Paulo, Brazil, Riad Nain Younes, MD, Professor and Thoracic Surgeon, Hospital São José, São Paulo, Brazil

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