Shape memory alloy fixator system for suturing tissue in minimal access surgery.

A new technique for suturing human tissue is described in which tissue closure is achieved by means of small fixators made from shape memory alloy. The aim of the development is to provide an alternative to thread suturing in minimal access surgery, which is quicker and requires less skill to achieve the required suturing quality. The design of the fixators is described in terms of the thermal shape recovery of shape memory alloy and a novel form of finite element analysis, which uses a nonlinear elastic element for the material property.

E.A.E.S. multicenter prospective randomized trial comparing two-stage vs single-stage management of patients with gallstone disease and ductal calculi.

Background: The current management of patients with gallstone disease and ductal calculi consists of endoscopic stone extraction (ESE) followed by laparoscopic cholecystectomy (LC). Following the advent of techniques of laparoscopic ductal stone clearance, an alternative single-stage laparoscopic treatment was introduced for these patients. The European Association of Endoscopic Surgery (E.

Rocker handle for endoscopic needle drivers. Technical and ergonomic evaluation by infrared motion analysis system.

Background: The design of the handle on instruments for endoscopic surgery determines comfort and efficiency of use by the surgeon. This applies particularly to needle drivers.

Methods: A novel rocker handle was designed to provide holding comfort and intuitive function.

Initial experience with laparoscopic ultrasound-guided radiofrequency thermal ablation of hepatic tumours.

Background And Study Aims: Radiofrequency (RF) thermal ablation has been applied almost exclusively through the percutaneous approach under radiological/external ultrasound guidance. We have embarked on a programme of laparoscopic ultrasound-guided RF ablation of hepatic tumours in view of the potential advantages of this approach, i. e.

Laparoscopic cholecystectomy.

Laparoscopic cholecystecomy is now the gold standard for the treatment of gallstones. When it was first introduced there were some concerns about its safety owing to its rapid adoption by untrained surgeons. However, when a careful, correct technique is employed, the operation is extremely safe.

Do patients with acute abdominal pain wait unduly long for analgesia?

A prospective audit of 100 emergency admissions was carried out to determine local surgical practice for analgesia administration in patients with acute abdominal pain. The main outcome measure investigated was waiting time for analgesia and how this was influenced by (i) severity of pain, (ii) clinical diagnosis, (iii) clinical setting. The data were correlated with the results of a questionnaire on timing of analgesia.

Methods for improving performance under reverse alignment conditions during endoscopic surgery.

Background: There are times during endoscopic procedures when the surgeon has to operate ahead of the camera/telescope assembly. As a result, the image displayed on the monitor will be an inverted mirror image of the operative field (reverse alignment). The present study addresses the extent of these difficulties and suggests some techniques that may be used to overcome the problem.

Assessment of innate ability and skills for endoscopic manipulations by the Advanced Dundee Endoscopic Psychomotor Tester: predictive and concurrent validity.

Background: This work was undertaken to evaluate the concurrent and predictive validity of the Advanced Dundee Endoscopic Psychomotor Tester (ADEPT) for clinical competence in endoscopic manipulations.

Method: Ten specialist registrars completed 200 structured tasks on ADEPT involving manipulation of switches and dials using standard endoscopic imaging and surgical instruments. This performance was correlated with blind ratings on clinical endoscopic operative competence by four consultant surgeons.

Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial. Surgical Co-operative Group.

Controversy still exists on the optimal surgical resection for potentially curable gastric cancer. Much better long-term survival has been reported in retrospective/non-randomized studies with D2 resections that involve a radical extended regional lymphadenectomy than with the standard D1 resections. In this paper we report the long-term survival of patients entered into a randomized study, with follow-up to death or 3 years in 96% of patients and a median follow-up of 6.

Ultrasonic dissection for endoscopic surgery. The E.A.E.S. Technology Group.

With the development of endoscopic surgery, new hazards of high-frequency (HF) electrosurgery have been recognized. The potential risks of monopolar electrosurgery, the limitations of bipolar technique, and the need to reduce instrument interchange have favored the use of ultrasonic technology, which becomes more and more popular. This work aims at presenting the main features of the currently available ultrasonically activated scalpels, as well as their advantages, limitations, and indications.

Influence of the optical axis-to-target view angle on endoscopic task performance.

Background: The location of the optical port and the choice of endoscope determine the angle subtended between the optical axis of the endoscope and the plane of the operation target: the optical axis-to-target view (OATV) angle. The aim of the study was to investigate the influence OATV angle on endoscopic task performance.

Methods: The Dundee Endoscopic Psychomotor Tester was used for objective assessment of endoscopic task performance.

Safety of adrenal vein ligation during endoscopic adrenalectomy: a technical note.

Endoscopic adrenalectomy has been recommended for the treatment of several benign adrenal diseases. The safety of this procedure largely depends on a careful surgical dissection and appropriate hemostatic technique. An established slipknotting technique was employed to control the main adrenal vein in a consecutive series of 14 patients undergoing endoscopic adrenalectomy.

Tetralogy of Fallot in a patient with Killian-Pallister syndrome.

Killian-Pallister syndrome is a rare dysmorphic condition characterized by specific clinical manifestations and tetrasomy 12p. Although the association of this condition with congenital heart disease has been previously documented, no cases have been reported in association with Fallot's tetralogy. We report one such case.

Effective hepatic cryoablation: does it enhance tumor dissemination?

This experimental study was designed to investigate the risk of tumor dissemination by hepatic cryosurgery and to determine the final subzero temperature required for effective hepatic tumor cryoablation. Although cryosurgery is now one of the established modalities for the treatment of some liver tumors and has been used for two decades, controversy remains regarding the final subzero temperature needed to destroy tumor masses. One experimental report has indicated that hepatic cryosurgery may enhance tumor dissemination.

Percutaneous endoscopic external ring hernioplasty using Dundee inguinal canal retractor.

The percutaneous endoscopic external ring (PEER) hernioplasty is a novel technique that uses a minimal access approach to the inguinal canal by the anterior route and reproduces the conventional open tension-free mesh repair. The procedure consists of two stages: an open phase through a 2.5-cm incision over the external ring followed by an endoscopic repair of the defect.

Ergonomic evaluation of laparoscopic bowel suturing.

Background: Ergonomic assessment of the instrument to needle to tissue relationship on efficiency and accuracy of laparoscopic suturing.

Methods: Video records of nine laparoscopic surgeons were analyzed for five technical variables of laparoscopic suturing. Surgeons undertook closure of 60 mm enterotomy using continuous 3/0 seromuscular atraumatic sutures.

Errors enacted during endoscopic surgery--a human reliability analysis.

The aim of the study was to document the nature and incidence of surgical errors enacted during laparoscopic surgery in order to direct future research and surgical training. A modified Human Reliability Analysis (HRA) approach, based on direct observation, was adopted to categorise and record errors encountered during the practice of laparoscopic cholecystectomy. This study confirmed the applicability and usefulness of an observational methodology in the assessment of human error in endoscopic surgical performance.

Chemical composition of smoke produced by high-frequency electrosurgery in a closed gaseous environment. An in vitro study.

Background: High-frequency (HF) electrocoagulation and cutting procedures produce smoke by high-temperature pyrolysis of tissues. As distinct from the experience of conventional surgery, electrosurgical smoke is produced in a closed gaseous environment during laparoscopic operations. As a result, toxic chemicals may be absorbed into the circulation.

Computer-controlled endoscopic performance assessment system.

We have devised an advanced computer-controlled system (ADEPT) for the objective evaluation of endoscopic task performance. The system's hardware consists of a dual gimbal mechanism that accepts a variety of 5.0-mm standard endoscopic instruments for manipulation in a precisely mapped and enclosed work space.