Psychomotor skills assessment by motion analysis in minimally invasive surgery on an animal organ.

Background: A high level of psychomotor skills is required to perform minimally invasive surgery (MIS) safely. To be able to measure these skills is important in the assessment of surgeons, as it enables constructive feedback during training. The aim of this study was to test the validity of an objective and automatic assessment method using motion analysis during a laparoscopic procedure on an animal organ.

Are cold light sources really cold?

Background: A fiber optic light source is the central part of endoscopic surgery. However, the light generation process causes heat transmission from a source to tip of a scope. In this study, we measured the amount of heating and pathologic effects of direct contact with the tip of scopes on the small bowel in an experimental set-up.

Hemodynamic and tissue blood flow responses to long-term pneumoperitoneum and hypercapnia in the pig.

Background: Increased peritoneal blood flow may influence the ability of cancer cells to adhere to and survive on the peritoneal surface during and after laparoscopic cancer surgery. Carbon dioxide (CO2) pneumoperitoneum is associated with a marked blood flow increase in the peritoneum. However, it is not clear whether the vasodilatory effect in the peritoneum is related to a local or systemic effect of CO2.

Clinical evaluation of a new ultrasonic Doppler instrument (SonoDoppler) for the detection of blood flow during laparoscopic procedures.

Complications may be avoided by exactly clarifying the structures in the operative field during laparoscopic surgery. We aimed to study the efficiency of a new ultrasonic Doppler device, SonoDoppler, which offers an easy and efficient way of mapping the anatomy. The design of the study was prospective, open observational and carried out on a sample of 51 patients who were operated on in four hospitals.

Preserving the superior rectal artery in laparoscopic sigmoid resection for complete rectal prolapse.

Sigmoid resection is indicated in the treatment of complete rectal prolapse (CRP) in patients with prolonged colorectal transit time (CTT). Its use however has been limited due to fear of anastomotic leakage. This study challenges the current practice of dividing the mesorectum by prospectively evaluating the impact of sparing the superior rectal artery (SRA) on leak rates after laparoscopic sigmoid resection (LSR) for CRP.

An experimental operating room project for advanced laparoscopic surgery.

With the challenges that the health sector now faces in accordance with readjustments and demands for increased efficiency, resource utilization, and innovation, we have initiated a project to develop the future operating room for advanced laparoscopic surgery. New hospitals are being built that contain numerous operating room theaters. To share experiences and avoid repeating the same mistakes as others, we find it suitable to build an "experimental" operating room theater where we can try out and study new equipment, logistics, and communications, and operating forms and new technology that both benefit the establishment of our hospital, as well as the establishment of other hospitals and their laparoscopic operating rooms nationally and internationally.

Laparoscopic navigation pointer for three-dimensional image-guided surgery.

Background: The main drawback with the laparoscopic approach is that the surgeon is unable to palpate vessels, tumors, and organs during surgery. Furthermore, the laparoscope provides only surface view of organs. There is a need for more advanced visualizations that can enhance the view to include information below the surface of the organs for planning of the procedure and for control and guidance during treatment.

Preserving the superior rectal artery in laparoscopic sigmoid resection for complete rectal prolapse.

Sigmoid resection is indicated in the treatment of complete rectal prolapse (CRP) in patients with prolonged colorectal transit time (CTT). Its use, however, has been limited because of fear of anastomotic leakage. This study challenges the current practice of dividing the mesorectum by prospectively evaluating the impact of sparing the superior rectal artery (SRA) on leak rates after laparoscopic sigmoid resection (LSR) for CRP.

Effect of carbon dioxide pneumoperitoneum on tissue blood flow in the peritoneum, rectus abdominis, and diaphragm muscles.

Background: Changes in local blood flow may play a role in the pathogenesis of port-site metastasis. This study aimed to investigate the effect of pneumoperitoneum induced by carbon dioxide (CO2) on the blood flow in the peritoneum and abdominal wall muscle layers, which are target structures for this phenomenon.

Methods: The study was performed on domestic farm swine of both genders weighing 20 to 25 kg.

Laparoscopic bowel resection: a comparison of three ultrasonically activated devices.

Background And Objectives: To compare resection time and collateral thermal damage of 3 currently available ultrasonically activated devices in laparoscopic small bowel surgery.

Methods: AutoSonix, SonoSurg, and UltraCision were compared in laparoscopic small bowel mesentery resection in a porcine model. A resection was defined as 12 endarcade arteries supplying the intended bowel segment.

Technology and application of the reusable Olympus Ultrasonic Dissector.

With US scalpels a new era of laparoscopic surgery has begun. We have given instances of the striking advantages of modern ultrasonic dissectors in general, and of the SonoSurg system in particular. Key aspects are reusability, modularity and multi-functionality.

Laparoscopic intracorporeal bowel resection with ultrasound versus electrosurgical dissection.

Background And Objectives: We assessed resection time and collateral thermal tissue damage of ultrasonically activated surgery (UAS) and high-frequency blade-enhanced bipolar electrosurgery (BE) in laparoscopic bowel surgery.

Methods: We compared UAS laparoscopic intracorporeal small bowel mesentery re-section with an equivalent procedure performed with BE in a porcine model. Resection was defined as 12 end-arcade arteries supplying the intended bowel segment.

Effect of increased intraabdominal pressure on cardiac output and tissue blood flow assessed by color-labeled microspheres in the pig.

Background: Studies of the hemodynamic effects associated with the pneumoperitoneum have had controversial results. We set out to investigate the effect of increased intraabdominal pressure (IAP) on cardiac output and tissue blood flow in various intraabdominal and extraabdominal organs using the color-labeled microsphere (CLM) technique.

Methods: IAP was induced by CO2 insufflation in anesthetized pigs; 0, 5, and 10 mmHg was used in the low-pressure group and 0, 15, and 24 mmHg in the high-pressure group.

Nonrestoration of pneumoperitoneum in laparoscopic-assisted left colon resection.

Laparoscopic-assisted left colon resection entails reestablishing pneumoperitoneum and laparoscopic colorectal anastomosing, if performed through a left lower-quadrant incision. A horizontal suprapubic incision allows direct view of the colorectal anastomosis obviating the need for reestablishing pneumoperitoneum. Performing colorectal anastomoses in an open fashion via a suprapubic incision and with nonrestoration of pneumoperitoneum will contain operating time in laparoscopic-assisted left colectomy.

A comparative experimental study evaluating the performance of surgical robots aesop and endosista.

The aim of this study was to experimentally assess and compare the accuracy of the surgical robots Aesop and Endosista as camera holders for use in laparoscopic surgery. The performance of these two robotic systems was examined for linear (upwards, downwards, diagonal), complex, and "in and out" movements using laparoscopic training boxes. Standard distances and tests were used for each system, and the time required to achieve each task was measured.

Open vs laparoscopic repair of perforated peptic ulcer.

Background: Most studies have found that the only advantage to the laparoscopic treatment of perforated peptic ulcer is a reduced need for postoperative analgesia. Therefore, we set out to assess the short-term outcome of open (OR) versus laparoscopic (LR) repair of perforated peptic ulcer.

Methods: A total of 62 consecutive OR patients were compared with a concurrent cohort of 17 diagnosis-matched LR controls treated at the same hospital between 1991 and 1996.

Open versus laparoscopic gastrojejunostomy for palliation in advanced pancreatic cancer.

To assess short-term outcome of open (OGJ) versus laparoscopic (LGJ) gastrojejunostomy in palliation of gastric outlet obstruction (GOO) caused by advanced pancreatic cancer, 22 OGJ patients were compared with 9 diagnosis-matched LGJ controls operated on at the same hospital between 1991 and 1996. Patients undergoing OGJ and LGJ were comparable for age, gender, weight, American Society of Anesthesiologists grading, and previous extensive abdominal surgery, but not for gastroenterostomy performed as a prophylactic procedure (9 vs. 0, respectively).