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Monthly publications

#January 2014
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Transumbilical single access laparoscopic right adrenalectomy with 1.8mm epigastric trocarless grasping forceps
Background: Single access laparoscopic adrenalectomy has been reported in supine and prone patient positioning. The authors report the technique with the patient in supine position, with the umbilicus as access site, and with all adopted material as reusable.

Video: A 43-year-old woman was admitted to the hospital for symptomatic primary hyperaldosteronism. A right-side adrenal adenoma was diagnosed, and surgery was proposed. The patient was placed in a supine position with a mild semi-lateral left-sided decubitus. The technique was performed using an 11mm reusable trocar to accommodate a 10mm, 30-degree rigid and regular length scope, in addition to curved reusable instruments according to DAPRI (Karl Storz Endoskope, Tuttlingen, Germany). The right liver lobe was retracted using the 1.8mm trocarless grasping forceps according to DAPRI (Karl Storz Endoskope), inserted percutaneously under the 12th right rib. The procedure started with the adhesiolysis between the hepatic surface and right Gerota’s fascia. Then, after having identified the adrenal gland, it was dissected and the inferior adrenal arteries and veins were clipped between 5mm Hem-o-lok® clips (Teleflex Medical, Research Triangle Park, NC, US). The middle adrenal vein was clipped as well using the 5mm Hem-o-lok® ligation systems. Once the specimen was completely mobilized, a plastic bag (used for suction drain) was custom-made and introduced into the abdomen through the 11mm trocar. The specimen was removed transumbilically, and the procedure finished with the closure of the access site by absorbable figure of 8 sutures.

Results: Laparoscopic time was 98 minutes, estimated blood loss was 20cc, and the final scar length was 16mm. The patient was discharged from the hospital after 2 days.

Conclusions: Transumbilical single access laparoscopic right adrenalectomy is feasible and safe. With this technique, the cost of the procedure is not increased, the final scar length is minimal, and the working triangulation is established intrabdominally as well as externally.
G Dapri, L Gerard, M Bortes, V Zulian, GB Cadière
Surgical intervention
4 years ago
1818 views
25 likes
0 comments
06:24
Transumbilical single access laparoscopic right adrenalectomy with 1.8mm epigastric trocarless grasping forceps
Background: Single access laparoscopic adrenalectomy has been reported in supine and prone patient positioning. The authors report the technique with the patient in supine position, with the umbilicus as access site, and with all adopted material as reusable.

Video: A 43-year-old woman was admitted to the hospital for symptomatic primary hyperaldosteronism. A right-side adrenal adenoma was diagnosed, and surgery was proposed. The patient was placed in a supine position with a mild semi-lateral left-sided decubitus. The technique was performed using an 11mm reusable trocar to accommodate a 10mm, 30-degree rigid and regular length scope, in addition to curved reusable instruments according to DAPRI (Karl Storz Endoskope, Tuttlingen, Germany). The right liver lobe was retracted using the 1.8mm trocarless grasping forceps according to DAPRI (Karl Storz Endoskope), inserted percutaneously under the 12th right rib. The procedure started with the adhesiolysis between the hepatic surface and right Gerota’s fascia. Then, after having identified the adrenal gland, it was dissected and the inferior adrenal arteries and veins were clipped between 5mm Hem-o-lok® clips (Teleflex Medical, Research Triangle Park, NC, US). The middle adrenal vein was clipped as well using the 5mm Hem-o-lok® ligation systems. Once the specimen was completely mobilized, a plastic bag (used for suction drain) was custom-made and introduced into the abdomen through the 11mm trocar. The specimen was removed transumbilically, and the procedure finished with the closure of the access site by absorbable figure of 8 sutures.

Results: Laparoscopic time was 98 minutes, estimated blood loss was 20cc, and the final scar length was 16mm. The patient was discharged from the hospital after 2 days.

Conclusions: Transumbilical single access laparoscopic right adrenalectomy is feasible and safe. With this technique, the cost of the procedure is not increased, the final scar length is minimal, and the working triangulation is established intrabdominally as well as externally.
Laparoscopic sigmoidectomy for benign diverticular disease
Dr. Armando Melani beautifully demonstrates a laparoscopic sigmoidectomy technique for a benign diverticular condition. He provides tips and tricks to perfectly expose the operating field and recommends an extensive approach to the left colon with primary mobilization of the splenic flexure using a posterior medial approach with a late vascular approach. The technique and its performance is amply discussed by the panel of experts present, hence providing a very instructive demonstration.
The operator also discusses the different types of energy devices available as well as the tricks to safely perform an upper colorectal anastomosis. This film provides plenty of detailed information for beginners and experts alike to allow them to perform a laparoscopic sigmoidectomy in a perfect fashion.
J Leroy, A Melani, J Marescaux
Surgical intervention
4 years ago
5812 views
137 likes
3 comments
33:07
Laparoscopic sigmoidectomy for benign diverticular disease
Dr. Armando Melani beautifully demonstrates a laparoscopic sigmoidectomy technique for a benign diverticular condition. He provides tips and tricks to perfectly expose the operating field and recommends an extensive approach to the left colon with primary mobilization of the splenic flexure using a posterior medial approach with a late vascular approach. The technique and its performance is amply discussed by the panel of experts present, hence providing a very instructive demonstration.
The operator also discusses the different types of energy devices available as well as the tricks to safely perform an upper colorectal anastomosis. This film provides plenty of detailed information for beginners and experts alike to allow them to perform a laparoscopic sigmoidectomy in a perfect fashion.
Transgastric laparoscopic resection of a GIST
Laparoscopic intragastric surgery (LIGS) represents a minimally invasive technique for lesions that mainly exist in the gastric lumen or at the gastroesophageal junction. Ohashi initially described this technique in 1995 to resect early gastric cancers that could not be treated by Endoscopic Mucosal Resection (EMR). Since then, it has evolved with respect to both technological advances (e.g., development of cuffed ports) and tactical innovations. As the peritoneal cavity represents the working space for laparoscopic surgeons, they have imagined to work directly into the stomach by respecting the same principles of basic laparoscopy, namely insufflation to create a new operating space, introduction of surgical instruments through working ports and the use of different techniques of dissection. The aim of this video is to describe the technical principles of this new approach as it offers a valuable option for the surgeon in the management of gastric tumors and early cancers. It may avoid major surgical procedures, especially for the management of lesions located at the esophagogastric junction. Selected indications have to be identified thanks to adequate preoperative workup including endoscopy, endoscopic ultrasonography, and conventional imaging (CT-scan and MRI).
Our standard approach for a laparoscopic intragastric surgery is represented by multiple intragastric ports approach. Resection can be performed as a standard submucosal dissection, but most of the time, the use of stapling is preferred for many reasons, including speed, safety and reliability as illustrated in this video. In well-selected cases (pedunculated tumors), the advantage of this technique is to obtain resection and hemostasis simultaneously, with the same instrument. However, achieving adequate margins can be difficult, and the risk of tumor rupture might be increased, particularly in case of gastrointestinal stromal tumors (GISTs).
When all inclusion criteria and technical principles are respected, this new minimally invasive approach offers major benefits for patients. It ensures the preservation of an almost normal anatomy by preserving the gastroesophageal junction as well as a simple postoperative course.
D Mutter, M Nedelcu, J Marescaux
Surgical intervention
4 years ago
2593 views
49 likes
0 comments
06:36
Transgastric laparoscopic resection of a GIST
Laparoscopic intragastric surgery (LIGS) represents a minimally invasive technique for lesions that mainly exist in the gastric lumen or at the gastroesophageal junction. Ohashi initially described this technique in 1995 to resect early gastric cancers that could not be treated by Endoscopic Mucosal Resection (EMR). Since then, it has evolved with respect to both technological advances (e.g., development of cuffed ports) and tactical innovations. As the peritoneal cavity represents the working space for laparoscopic surgeons, they have imagined to work directly into the stomach by respecting the same principles of basic laparoscopy, namely insufflation to create a new operating space, introduction of surgical instruments through working ports and the use of different techniques of dissection. The aim of this video is to describe the technical principles of this new approach as it offers a valuable option for the surgeon in the management of gastric tumors and early cancers. It may avoid major surgical procedures, especially for the management of lesions located at the esophagogastric junction. Selected indications have to be identified thanks to adequate preoperative workup including endoscopy, endoscopic ultrasonography, and conventional imaging (CT-scan and MRI).
Our standard approach for a laparoscopic intragastric surgery is represented by multiple intragastric ports approach. Resection can be performed as a standard submucosal dissection, but most of the time, the use of stapling is preferred for many reasons, including speed, safety and reliability as illustrated in this video. In well-selected cases (pedunculated tumors), the advantage of this technique is to obtain resection and hemostasis simultaneously, with the same instrument. However, achieving adequate margins can be difficult, and the risk of tumor rupture might be increased, particularly in case of gastrointestinal stromal tumors (GISTs).
When all inclusion criteria and technical principles are respected, this new minimally invasive approach offers major benefits for patients. It ensures the preservation of an almost normal anatomy by preserving the gastroesophageal junction as well as a simple postoperative course.
Total gastrectomy for early gastric cancer and giant paraesophageal hernia
This video shows a total gastrectomy in an 83-year-old woman with a giant type III paraesophageal hernia and an early gastric cancer located at the middle third of the stomach. First, type III paraesophageal hernia dissection with complete resection of the hernia sac is shown. A D1 lymphadenectomy is performed.
The esophagus is transected high in the posterior mediastinum and an end-to-side esophago-jejunostomy is performed using the Orvil™ orogastric tube and the EEA™ DST XL 25 circular stapling device. The esophago-jejunostomy is performed in a Roux-en-Y fashion. The alimentary limb is ascended through the transverse mesocolon. The skin incision used for trocar placement in the upper left abdomen (right hand of the surgeon) was slightly enlarged to allow for specimen extraction. Through this incision, the side-to-side jejuno-jejunostomy was performed extracorporeally.
P Vorwald, M de Vega Irañeta, E Bernal, D Cortés, S Ayora González, A Gomez Valdazo
Surgical intervention
4 years ago
3088 views
36 likes
1 comment
16:26
Total gastrectomy for early gastric cancer and giant paraesophageal hernia
This video shows a total gastrectomy in an 83-year-old woman with a giant type III paraesophageal hernia and an early gastric cancer located at the middle third of the stomach. First, type III paraesophageal hernia dissection with complete resection of the hernia sac is shown. A D1 lymphadenectomy is performed.
The esophagus is transected high in the posterior mediastinum and an end-to-side esophago-jejunostomy is performed using the Orvil™ orogastric tube and the EEA™ DST XL 25 circular stapling device. The esophago-jejunostomy is performed in a Roux-en-Y fashion. The alimentary limb is ascended through the transverse mesocolon. The skin incision used for trocar placement in the upper left abdomen (right hand of the surgeon) was slightly enlarged to allow for specimen extraction. Through this incision, the side-to-side jejuno-jejunostomy was performed extracorporeally.
Minimally invasive redo esophagojejunostomy for postoperative dehiscence after laparoscopic total gastrectomy for gastric cancer
This is the case of an 87-year-old man receiving dual antiplatelet therapy, with aortic steno-insufficiency, chronic heart and renal failure, admitted to our service for anemia due to lesser curvature gastric cancer.
The patient underwent an uneventuful laparoscopic total gastrectomy with D1 lymph node dissection with Roux-en-Y reconstruction. Pathological findings were consistent with a poorly differentiated pT4bN2M0 adenocarcinoma (TNM classification, 7th edition).
A fifth postoperative day gastrografin swallow revealed a large anastomotic leak at the esophagojejunostomy.
A conservative approach was considered to treat this complication with a multispecialty approach. However, this approach was rejected for two reasons:
- Firstly, the occurrence of a broad anastomotic leakage in the early postoperative period is often due to necrosis of perianastomotic tissues;
- Secondly, the patient’s age, the poor nutritional status and the early signs of hemodynamic instability - hypertension and tachycardia - called for a more timely and potentially resolutive approach.
Additionally, in our experience, the use of self-expandable metallic stents is associated with a high rate of stent migration in the setting of end-to-side anastomoses.
As a result, a decision was made to perform an emergency explorative laparoscopy with a minimally invasive redo esophagojejunostomy.
The procedure was performed using 5 trocars through the same incisions as the first surgery. Operative time was 180 minutes, with minimal blood loss and no intraoperative transfusion.

Results:
After surgery, the patient required admission to the postoperative intensive care unit for 9 days because of respiratory failure, hemodynamic instability, and the development of a subdiaphragmatic collection, treated by percutaneous drainage.
An upper gastrointestinal gastrografin swallow on postoperative day 10 showed a patent esophagojejunostomy without any leak. The patient was started on a clear fluid diet, and advanced to a solid diet as tolerated, until discharge on postoperative day 14.
I Maruri Chimeno, I Otero Martinez, V Vigorita, M Bertucci Zoccali, H Pardellas Rivera, P Troncoso Pereira , JE Casal Núñez
Surgical intervention
4 years ago
1412 views
16 likes
0 comments
12:54
Minimally invasive redo esophagojejunostomy for postoperative dehiscence after laparoscopic total gastrectomy for gastric cancer
This is the case of an 87-year-old man receiving dual antiplatelet therapy, with aortic steno-insufficiency, chronic heart and renal failure, admitted to our service for anemia due to lesser curvature gastric cancer.
The patient underwent an uneventuful laparoscopic total gastrectomy with D1 lymph node dissection with Roux-en-Y reconstruction. Pathological findings were consistent with a poorly differentiated pT4bN2M0 adenocarcinoma (TNM classification, 7th edition).
A fifth postoperative day gastrografin swallow revealed a large anastomotic leak at the esophagojejunostomy.
A conservative approach was considered to treat this complication with a multispecialty approach. However, this approach was rejected for two reasons:
- Firstly, the occurrence of a broad anastomotic leakage in the early postoperative period is often due to necrosis of perianastomotic tissues;
- Secondly, the patient’s age, the poor nutritional status and the early signs of hemodynamic instability - hypertension and tachycardia - called for a more timely and potentially resolutive approach.
Additionally, in our experience, the use of self-expandable metallic stents is associated with a high rate of stent migration in the setting of end-to-side anastomoses.
As a result, a decision was made to perform an emergency explorative laparoscopy with a minimally invasive redo esophagojejunostomy.
The procedure was performed using 5 trocars through the same incisions as the first surgery. Operative time was 180 minutes, with minimal blood loss and no intraoperative transfusion.

Results:
After surgery, the patient required admission to the postoperative intensive care unit for 9 days because of respiratory failure, hemodynamic instability, and the development of a subdiaphragmatic collection, treated by percutaneous drainage.
An upper gastrointestinal gastrografin swallow on postoperative day 10 showed a patent esophagojejunostomy without any leak. The patient was started on a clear fluid diet, and advanced to a solid diet as tolerated, until discharge on postoperative day 14.
Robot-assisted left upper lobectomy for T1N0M0 adenocarcinoma
This is the case of a robotic left upper lobectomy with lymphadenectomy in a woman aged 52 who has had 9 children and who was a regular smoker (50 packs per year). She is presenting with an isolated cT1N0M0 adenocarcinoma in the left upper pulmonary lobe. PET-scan was positive for the lesion without any other pathological finding in the mediastinum or far metastasis. Histology was obtained by CT-guided transthoracic needle aspiration biopsy.
This minimally invasive technique, assisted by the da Vinci® robotic surgical system, is sure, comfortable, and efficient to perform a pulmonary lobectomy with lymphadenectomy in the early stages of lung cancer.
3D vision and the accuracy of dissection appear to be better than in conventional VATS.
As in VATS lobectomy, hospital stay is reduced to 3-4 days and postoperative pain appears to be more acceptable.
N Santelmo, F Antonacci, G Massard
Surgical intervention
4 years ago
503 views
6 likes
0 comments
11:59
Robot-assisted left upper lobectomy for T1N0M0 adenocarcinoma
This is the case of a robotic left upper lobectomy with lymphadenectomy in a woman aged 52 who has had 9 children and who was a regular smoker (50 packs per year). She is presenting with an isolated cT1N0M0 adenocarcinoma in the left upper pulmonary lobe. PET-scan was positive for the lesion without any other pathological finding in the mediastinum or far metastasis. Histology was obtained by CT-guided transthoracic needle aspiration biopsy.
This minimally invasive technique, assisted by the da Vinci® robotic surgical system, is sure, comfortable, and efficient to perform a pulmonary lobectomy with lymphadenectomy in the early stages of lung cancer.
3D vision and the accuracy of dissection appear to be better than in conventional VATS.
As in VATS lobectomy, hospital stay is reduced to 3-4 days and postoperative pain appears to be more acceptable.
Video-assisted thoracoscopic surgery (VATS): left upper lobectomy and complete lymphadenectomy by fissureless anterior approach
The surgical management of non-small cell lung cancer (NSCLC) involves anatomical lung resection and systematic mediastinal lymph node dissection.
Video-assisted thoracic surgery (VATS) lobectomy for early NSCLC is currently preferred over a thoracotomy in experienced centers.
Possible advantages described of VATS lobectomy are decreased postoperative pain, less blood loss, shortened hospital stay, fewer overall complications, diminished immunologic suppression, as well as an increased ability to deliver adjuvant therapy. Oncological results are at least equivalent as thoracotomy in terms of long-term recurrence and survival rates.
We present the case of a 58-year-old woman with suspicion of peripheral pulmonary cT1 cN0 cancer who initially underwent wedge resection by VATS of the lesion with preoperative localization using a CT-guided hook wire. Frozen section revealed the presence of squamous cell carcinoma, and completion lobectomy with complete mediastinal lymph node dissection was finally performed by VATS.
M Gonzalez, JY Perentes, T Krueger
Surgical intervention
4 years ago
1636 views
34 likes
0 comments
10:43
Video-assisted thoracoscopic surgery (VATS): left upper lobectomy and complete lymphadenectomy by fissureless anterior approach
The surgical management of non-small cell lung cancer (NSCLC) involves anatomical lung resection and systematic mediastinal lymph node dissection.
Video-assisted thoracic surgery (VATS) lobectomy for early NSCLC is currently preferred over a thoracotomy in experienced centers.
Possible advantages described of VATS lobectomy are decreased postoperative pain, less blood loss, shortened hospital stay, fewer overall complications, diminished immunologic suppression, as well as an increased ability to deliver adjuvant therapy. Oncological results are at least equivalent as thoracotomy in terms of long-term recurrence and survival rates.
We present the case of a 58-year-old woman with suspicion of peripheral pulmonary cT1 cN0 cancer who initially underwent wedge resection by VATS of the lesion with preoperative localization using a CT-guided hook wire. Frozen section revealed the presence of squamous cell carcinoma, and completion lobectomy with complete mediastinal lymph node dissection was finally performed by VATS.
Functional reconstruction with motoneuron integrated striated muscles (MISM)
This study is made up of two parts. The first part is an animal experiment to develop a novel surgical technology named motoneuron-integrated striated muscles (MISM) technology. The second part is the introduction of a new human machine interface technology based on tacit learning. By combining the two advanced technologies, we have been trying to develop a future treatment for currently untreatable nerve palsies.
Re-innervation of denervated muscle by motoneurons transplanted into the peripheral nerve may provide the potential to excite muscles artificially with functional electrical stimulation (FES). We transplanted embryonic motoneurons into the peripheral nerve of adult Fischer 344 rats after transection of the sciatic nerve. One week after sciatic nerve transection, medium with or without dissociated embryonic spinal neurons was injected into the distal stump. Electrophysiological and tissue analyses were performed 12 weeks after transplant, as well as a naive control group which received no surgery. In the cell transplant group, the ankle angle was measured during gait with and without FES of the peroneal nerve. Transplanted motoneurons survived in the peripheral nerve and formed functional motor units. In the cell transplantation group, ankle angle at mid-swing was more flexed during gait with FES (26.6 ± 8.7°) than gait without FES (51.4 ± 12.8°, p=0.011), indicating that transplanted motoneurons in conjunction with FES restored ankle flexion in gait, even though no neural connection between central nervous system and muscle was present. These results indicate that transplant of embryonic motoneurons into peripheral nerve combined with FES can provide a new treatment strategy for paralyzed muscles. For the successful clinical application of MISM technology, the development of a human machine interface is key. We have developed a novel computer program, the tacit learning program, which can analyze patient intention and automatically adjust limb motion with minimum mental/physical burden on the human side. I am going to introduce a newly developed multi-degree of freedom electric-powered arm based on tacit learning to demonstrate the efficacy of the technology.
H Hirata
Lecture
4 years ago
170 views
5 likes
0 comments
12:07
Functional reconstruction with motoneuron integrated striated muscles (MISM)
This study is made up of two parts. The first part is an animal experiment to develop a novel surgical technology named motoneuron-integrated striated muscles (MISM) technology. The second part is the introduction of a new human machine interface technology based on tacit learning. By combining the two advanced technologies, we have been trying to develop a future treatment for currently untreatable nerve palsies.
Re-innervation of denervated muscle by motoneurons transplanted into the peripheral nerve may provide the potential to excite muscles artificially with functional electrical stimulation (FES). We transplanted embryonic motoneurons into the peripheral nerve of adult Fischer 344 rats after transection of the sciatic nerve. One week after sciatic nerve transection, medium with or without dissociated embryonic spinal neurons was injected into the distal stump. Electrophysiological and tissue analyses were performed 12 weeks after transplant, as well as a naive control group which received no surgery. In the cell transplant group, the ankle angle was measured during gait with and without FES of the peroneal nerve. Transplanted motoneurons survived in the peripheral nerve and formed functional motor units. In the cell transplantation group, ankle angle at mid-swing was more flexed during gait with FES (26.6 ± 8.7°) than gait without FES (51.4 ± 12.8°, p=0.011), indicating that transplanted motoneurons in conjunction with FES restored ankle flexion in gait, even though no neural connection between central nervous system and muscle was present. These results indicate that transplant of embryonic motoneurons into peripheral nerve combined with FES can provide a new treatment strategy for paralyzed muscles. For the successful clinical application of MISM technology, the development of a human machine interface is key. We have developed a novel computer program, the tacit learning program, which can analyze patient intention and automatically adjust limb motion with minimum mental/physical burden on the human side. I am going to introduce a newly developed multi-degree of freedom electric-powered arm based on tacit learning to demonstrate the efficacy of the technology.
Transaxillary first rib resection from an endoscopic concept to robotic technology, 30 years of experience
Introduction:
Our interest in minimally invasive vascular surgery dates back to 1982. We designed our endoscope, attached to a micro-video camera, making the transaxillary first rib and cervical band resection safer for the surgical treatment of disabling thoracic outlet syndrome. Over the following two decades, we evolved with the rapid technological development of minimally invasive surgery.

Material and methods:
644 total surgical procedures were performed between 1983 and 2013, including various stages. Video presentation of the “final product” in evolution during the past 10 years using the da Vinci® robotic system will be shown.

Results:
There were no mortalities, no permanent nerve, artery, or vein damage. The following could be noted: 8% complications, 4% respiratory, 3% temporary neurological dysfunctions, 0.8% infection, 0.4% transient renal insufficiency. Conversion rate was 1.1%, scar tissue formation of 0.4%, and length of stay: 3.3 days.

Conclusions:
The endoscopic transaxillary approach has helped us to understand the pathogenesis of the cervical bands frequently present in thoracic outlet syndrome. The procedure has evolved over the last 3 decades and the da Vinci® robotic system definitely offers great advantages, improving the surgical procedure and clinical outcome.
B Martinez
Lecture
4 years ago
323 views
7 likes
0 comments
14:10
Transaxillary first rib resection from an endoscopic concept to robotic technology, 30 years of experience
Introduction:
Our interest in minimally invasive vascular surgery dates back to 1982. We designed our endoscope, attached to a micro-video camera, making the transaxillary first rib and cervical band resection safer for the surgical treatment of disabling thoracic outlet syndrome. Over the following two decades, we evolved with the rapid technological development of minimally invasive surgery.

Material and methods:
644 total surgical procedures were performed between 1983 and 2013, including various stages. Video presentation of the “final product” in evolution during the past 10 years using the da Vinci® robotic system will be shown.

Results:
There were no mortalities, no permanent nerve, artery, or vein damage. The following could be noted: 8% complications, 4% respiratory, 3% temporary neurological dysfunctions, 0.8% infection, 0.4% transient renal insufficiency. Conversion rate was 1.1%, scar tissue formation of 0.4%, and length of stay: 3.3 days.

Conclusions:
The endoscopic transaxillary approach has helped us to understand the pathogenesis of the cervical bands frequently present in thoracic outlet syndrome. The procedure has evolved over the last 3 decades and the da Vinci® robotic system definitely offers great advantages, improving the surgical procedure and clinical outcome.
Use of Konnyaku Shirataki for robotic microsurgery training
The aim of this study was to test the potential implementation of a type of Japanese noodle, named konnyaku shirataki, for microsurgery training in the operating room.
Thirteen surgical residents without experience in microsurgery had to perform two microsurgical anastomoses: rat femoral artery model (control) and one on a konnyaku shirataki model. Two quantitative variables (time in minutes and number of stitches to perform the anastomosis) and two qualitative variables (patency and watertightness of the anastomosis) were measured. Sixty anastomoses were performed with the control model and 62 anastomoses with the konnyaku model. The time of the anatomosis was significantly higher in the control group. The number of stitches was similar in the 2 groups. Patency of the anastomosis was significantly lower in the control group. Watertightness of the anastomosis was significantly higher in the control group.
The konnyaku shirataki model, by its availability, low cost and close structure to the animal model could improve the teaching of microsurgery and tele-microsurgery (robotic microsurgery).
G Prunières
Lecture
4 years ago
277 views
6 likes
0 comments
07:54
Use of Konnyaku Shirataki for robotic microsurgery training
The aim of this study was to test the potential implementation of a type of Japanese noodle, named konnyaku shirataki, for microsurgery training in the operating room.
Thirteen surgical residents without experience in microsurgery had to perform two microsurgical anastomoses: rat femoral artery model (control) and one on a konnyaku shirataki model. Two quantitative variables (time in minutes and number of stitches to perform the anastomosis) and two qualitative variables (patency and watertightness of the anastomosis) were measured. Sixty anastomoses were performed with the control model and 62 anastomoses with the konnyaku model. The time of the anatomosis was significantly higher in the control group. The number of stitches was similar in the 2 groups. Patency of the anastomosis was significantly lower in the control group. Watertightness of the anastomosis was significantly higher in the control group.
The konnyaku shirataki model, by its availability, low cost and close structure to the animal model could improve the teaching of microsurgery and tele-microsurgery (robotic microsurgery).