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Lyu K, Yang L, Song C. Motion Measurement and Analysis of Different Instruments for Single-Incision Laparoscopic Surgery. Appl Bionics Biomech 2022; 2022:3057485. [PMID: 35694278 PMCID: PMC9177342 DOI: 10.1155/2022/3057485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/21/2022] [Accepted: 05/10/2022] [Indexed: 11/29/2022] Open
Abstract
Objective To objectively compare and analyze the range of motion of three types of instruments for single-incision laparoscopic surgery. Material and Methods. Ten experienced participants were recruited. Straight instruments (Group A), straight/articulating instruments (Group B), and precurved instruments (Group C) were used to complete the transferring task through one site in a laparoscopic simulator. Straight instruments via two separate sites (Group D) served as control. The operation time of each group was recorded. Instrument positions were measured by an optical tracking system. The inserted length and pivoting angles were derived via MATLAB. Results There was a significant difference in operation time between groups (D < A < B < C, p < 0.01). The range of motion of instruments was different on instrument types and surgical approaches. A significant difference in the inserted length was found between groups. Instrument conflicts and inadequate triangulation were found in Group A; instrument conflicts were found in Group B; no obvious conflicts and triangulation problems were observed in Group C. The operation in Group C was similar to the operation in Group D but differed on the left/right pivoting angles. Conclusion Different types of instruments have different ranges of motion in single-incision laparoscopic surgery. Working with precurved instruments seems like a compromise to traditional laparoscopic surgery if the transmission property, and shaft curvature of the instruments could be improved. An integrated mechanical platform or robotic system might be the ultimate solution for single-incision laparoscopic surgery to pursue even less trauma.
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Affiliation(s)
- Kunyong Lyu
- School of Information Science and Technology, ShanghaiTech University, Shanghai 201210, China
| | - Lixiao Yang
- Equipment Department, Shanghai Changhai Hospital, Shanghai 200433, China
| | - Chengli Song
- Shanghai Institute for Minimally Invasive Therapy, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China
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2
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Özozan ÖV, Güldoğan CE, Gündoğdu E, Özmen MM. Obesity and appendicitis: Laparoscopy versus open technique. Turk J Surg 2020; 36:105-109. [PMID: 32637882 DOI: 10.5578/turkjsurg.4714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 01/29/2020] [Indexed: 11/15/2022]
Abstract
Objectives The clinical results of obese patients who have undergone open or laparoscopic appendectomy, whether one technique is superior to the other is still not clearly known.In our study, we compared the clinical results of obese patients operated with laparoscopic or open technique for acute appendicitis. Material and Methods We performed retrospective analyses of patients operated for acute appendicitis between the dates of July 2016 and July 2019 at Istinye University Faculty of Medicine Bahcesehir Liv Training and Research Hospital and Liv Hospital Ankara. Of the 241 patients whose height and weight information was accessible, 57 had a body mass index of 30 kg/m2 or higher. Eighteen of these patients underwent open surgery while the other 39 underwent laparoscopic surgery. The primary result criterion was complication ratio. Secondary criteria were operation time and length of hospital stay. Results Upon comparison of laparoscopic and open techniques in terms of intraoperative-postoperative complications (p= 0.01), operation time (p= 0.02) statistically significant differences were found between the groups. However the mean length of hospital stay (p= 0.181) was similar in both groups. Conclusion In obese appendicitis patients, the laparoscopic technique proved to be superior to the open technique in criteria such as perioperative-postoperative complications, operation time, and etc. Length of hospital stay was determined to be similar between the groups.
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Affiliation(s)
- Ömer Vefik Özozan
- Department of General Surgery, Istinye University Hospital, Liv Hospital Bahcesehir, Istanbul, Turkey
| | - Cem Emir Güldoğan
- Department of General Surgery, Istinye University Hospital, Liv Hospital Ankara, Ankara, Turkey
| | - Emre Gündoğdu
- Department of General Surgery, Istinye University Hospital, Liv Hospital Ankara, Ankara, Turkey
| | - Mehmet Mahir Özmen
- Department of General Surgery, Istinye University Hospital, Liv Hospital Ankara, Ankara, Turkey
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Cawich SO, FaSiOen P, Singh Y, Francis W, Mohanty SK, Naraynsingh V, Dapri G. Single incision laparoscopic surgery from a caribbean perspective. Int J Surg 2019; 72S:13-18. [PMID: 31132463 DOI: 10.1016/j.ijsu.2019.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/16/2019] [Indexed: 12/20/2022]
Abstract
Conventional laparoscopy with multiple ports has recently gained a strong foothold in the Caribbean, but single incision laparoscopic surgery (SILS) has lagged behind. In this paper, we compare the data on SILS and conventional multi-port laparoscopy in the English-speaking Caribbean.
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Affiliation(s)
- Shamir O Cawich
- Department of Surgery, University of the West Indies, St. Augustine, West Indies, Trinidad and Tobago.
| | - Patrick FaSiOen
- Department of Surgery, St Elizabeth Hospital, Dutch Caribbean, Curacao
| | - Yardesh Singh
- Department of Surgery, University of the West Indies, St. Augustine, West Indies, Trinidad and Tobago
| | - Wesley Francis
- Department of Surgery, Princess Margaret Hosptial, Nassau, Bahamas
| | - Sanjib K Mohanty
- Department of Surgery, Cayman Islands Hospital, West Indies, Cayman Islands
| | - Vijay Naraynsingh
- Department of Surgery, University of the West Indies, St. Augustine, West Indies, Trinidad and Tobago
| | - Giovanni Dapri
- Department of Surgery, Saint Pierre University Hospital, Brussels, Belgium
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Morales-Conde S, Peeters A, Meyer YM, Antoniou SA, Del Agua IA, Arezzo A, Arolfo S, Yehuda AB, Boni L, Cassinotti E, Dapri G, Yang T, Fransen S, Forgione A, Hajibandeh S, Hajibandeh S, Mazzola M, Migliore M, Mittermair C, Mittermair D, Morandeira-Rivas A, Moreno-Sanz C, Morlacchi A, Nizri E, Nuijts M, Raakow J, Sánchez-Margallo FM, Sánchez-Margallo JA, Szold A, Weiss H, Weiss M, Zorron R, Bouvy ND. European association for endoscopic surgery (EAES) consensus statement on single-incision endoscopic surgery. Surg Endosc 2019; 33:996-1019. [PMID: 30771069 PMCID: PMC6430755 DOI: 10.1007/s00464-019-06693-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 02/06/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Laparoscopic surgery changed the management of numerous surgical conditions. It was associated with many advantages over open surgery, such as decreased postoperative pain, faster recovery, shorter hospital stay and excellent cosmesis. Since two decades single-incision endoscopic surgery (SIES) was introduced to the surgical community. SIES could possibly result in even better postoperative outcomes than multi-port laparoscopic surgery, especially concerning cosmetic outcomes and pain. However, the single-incision surgical procedure is associated with quite some challenges. METHODS An expert panel of surgeons has been selected and invited to participate in the preparation of the material for a consensus meeting on the topic SIES, which was held during the EAES congress in Frankfurt, June 16, 2017. The material presented during the consensus meeting was based on evidence identified through a systematic search of literature according to a pre-specified protocol. Three main topics with respect to SIES have been identified by the panel: (1) General, (2) Organ specific, (3) New development. Within each of these topics, subcategories have been defined. Evidence was graded according to the Oxford 2011 Levels of Evidence. Recommendations were made according to the GRADE criteria. RESULTS In general, there is a lack of high level evidence and a lack of long-term follow-up in the field of single-incision endoscopic surgery. In selected patients, the single-incision approach seems to be safe and effective in terms of perioperative morbidity. Satisfaction with cosmesis has been established to be the main advantage of the single-incision approach. Less pain after single-incision approach compared to conventional laparoscopy seems to be considered an advantage, although it has not been consistently demonstrated across studies. CONCLUSIONS Considering the increased direct costs (devices, instruments and operating time) of the SIES procedure and the prolonged learning curve, wider acceptance of the procedure should be supported only after demonstration of clear benefits.
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Affiliation(s)
- Salvador Morales-Conde
- Unit of Innovation in Minimally Invasive Sugery, Department of General and Digestive Surgery, University Hospital "Virgen del Rocio", Sevilla, Spain
| | - Andrea Peeters
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Yannick M Meyer
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Stavros A Antoniou
- Colorectal Department, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Isaías Alarcón Del Agua
- Unit of Innovation in Minimally Invasive Sugery, Department of General and Digestive Surgery, University Hospital "Virgen del Rocio", Sevilla, Spain
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Simone Arolfo
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Amir Ben Yehuda
- Surgery division, Assaf Harofe medical center, Zeriffin, Israel
| | - Luigi Boni
- Department of Surgery, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Elisa Cassinotti
- Department of Surgery, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | | | - Tao Yang
- Unit of Innovation in Minimally Invasive Sugery, Department of General and Digestive Surgery, University Hospital "Virgen del Rocio", Sevilla, Spain
| | - Sofie Fransen
- Department of Surgery, Laurentius Ziekenhuis Roermond, Roermond, The Netherlands
| | | | | | - Shahin Hajibandeh
- Department of General Surgery, Stepping Hill Hospital, Stockport, UK
| | | | - Marco Migliore
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | | | | | - Antonio Morandeira-Rivas
- Department of Surgery, "La Mancha Centro" General Hospital, Alcázar de San Juan, Ciudad Real, Spain
| | - Carlos Moreno-Sanz
- Department of Surgery, "La Mancha Centro" General Hospital, Alcázar de San Juan, Ciudad Real, Spain
| | | | - Eran Nizri
- Surgery division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Myrthe Nuijts
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jonas Raakow
- Center for Innovative Surgery- ZIC, Charité - Universitätsmedizin, Chirurgische Klinik, Campus Charité Mitte/ Campus Virchow-Klinikum, Berlin, Germany
| | | | | | | | - Helmut Weiss
- SJOG Hospital - PMU Teaching Hospital, Salzburg, Austria
| | - Michael Weiss
- SJOG Hospital - PMU Teaching Hospital, Salzburg, Austria
| | - Ricardo Zorron
- Department of Surgery, University of Insubria, Varese, Italy
| | - Nicole D Bouvy
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
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Stabilization of Single-incision Laparoscopic Cholecystectomy by Needle Puncture and Bendable Retractor. Surg Laparosc Endosc Percutan Tech 2018; 28:375-379. [DOI: 10.1097/sle.0000000000000539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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6
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Favaro MDL, Gabor S, Pedroso RFP, Ribeiro L, Rosa OM, Ribeiro-Junior MAF. SINGLE PORT LAPAROSCOPIC CHOLECYSTECTOMY: TECHNICAL ASPECTS AND RESULTS. ACTA ACUST UNITED AC 2018; 31:e1388. [PMID: 30133680 PMCID: PMC6097110 DOI: 10.1590/0102-672020180001e1388] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 05/22/2018] [Indexed: 01/13/2023]
Abstract
Background: The search for less traumatic surgical procedures without compromising
efficacy and safety, together with the technological advances and greater
experience of the teams, led to the development of operative techniques with
increasingly smaller incisions, the so-called “minimally invasive
surgeries”. Aim: To evaluate the technical aspects and results of single port
cholecystectomy. Method: Were analyzed 170 patients between 18-74 years submitted to
videolaparoscopic cholecystectomies by single port, regardless of elective
or urgent indication, without restriction of patient selection. Results: Among the 170 operations, 158 were exclusively performed by single port, and
the conversion rate was 7% (inclusion of other accessory trocars or
conversion to multiportal). Conversion to open surgery occurred in three
cases (1.76%). The mean surgical time was 67.97 min, showing a marked
decrease when was reached close to 50 cases and a stabilization after 100
surgeries. The overall complication rate was 10%, with minor complications
such as: incisional pain, hematomas, granulomas, port access hernias
(9.41%). Conclusion: Single port cholecystectomy can, after standardization and surgical team
training, be a safe surgical procedure associated with a recognized
aesthetic advantage.
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Affiliation(s)
- Murillo de Lima Favaro
- General Surgery Department, University of Santo Amaro.,Private Clinic, São Paulo, SP, Brazil
| | - Silvio Gabor
- General Surgery Department, University of Santo Amaro.,Private Clinic, São Paulo, SP, Brazil
| | | | - Ligia Ribeiro
- General Surgery Department, University of Santo Amaro
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Single-incision surgery trocar-site hernia: an updated systematic review meta-analysis with trial sequential analysis by the Minimally Invasive Surgery Synthesis of Interventions Outcomes Network (MISSION). Surg Endosc 2017; 32:14-23. [DOI: 10.1007/s00464-017-5717-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 07/10/2017] [Indexed: 02/07/2023]
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Hallbeck MS, Lowndes BR, McCrory B, Morrow MM, Kaufman KR, LaGrange CA. Kinematic and ergonomic assessment of laparoendoscopic single-site surgical instruments during simulator training tasks. APPLIED ERGONOMICS 2017; 62:118-130. [PMID: 28411722 DOI: 10.1016/j.apergo.2017.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 12/22/2016] [Accepted: 02/02/2017] [Indexed: 06/07/2023]
Abstract
While laparoendoscopic single-site surgery (LESS) appears to be feasible and safe, instrument triangulation, tissue handling, and other bimanual tasks are difficult even for experienced surgeons. Novel technologies emerged to overcome LESS' procedural and ergonomic difficulties of "tunnel vision" and "instrument clashing." Surgeon kinematics, self-reported workload and upper body discomfort were used to compare straight, bent and two articulating instruments while performing two basic surgical tasks in a LESS simulator. All instruments resulted in bilateral elevation and rotation of the shoulders, excessive forearm motion and flexion and ulnar deviation of wrists. Surgeons' adopted non-neutral upper extremity postures and performed excessive joint excursions to compensate for reduced freedom of movement at the single insertion site and to operate the instrument mechanisms. LESS' cosmetic benefits continue to impact laparoscopic surgery and by enabling performance through improved instruments, ergonomic improvement for LESS can reduce negative impact on surgeon well-being and patient safety.
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Affiliation(s)
- M Susan Hallbeck
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Mayo Clinic, Rochester, MN 55905, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, USA; Department of Surgery, Mayo Clinic, Mayo Clinic, Rochester, MN 55905, USA; Department of Mechanical and Materials Engineering, College of Engineering, University of Nebraska, Lincoln, NE 68588, USA.
| | - Bethany R Lowndes
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Mayo Clinic, Rochester, MN 55905, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, USA; Department of Mechanical and Materials Engineering, College of Engineering, University of Nebraska, Lincoln, NE 68588, USA
| | - Bernadette McCrory
- Department of Mechanical and Materials Engineering, College of Engineering, University of Nebraska, Lincoln, NE 68588, USA; Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Melissa M Morrow
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Mayo Clinic, Rochester, MN 55905, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, USA
| | - Kenton R Kaufman
- Division of Orthopedic Research, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Chad A LaGrange
- Department of Surgery, Division of Urology, University of Nebraska Medical Center, Omaha, NE 68198, USA
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Chow G, Chiu CJ, Zheng B, Panton ON, Meneghetti AT. Rigid vs articulating instrumentation for task completion in single-port surgery. Am J Surg 2016; 211:903-7. [PMID: 27083064 DOI: 10.1016/j.amjsurg.2016.01.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 01/18/2016] [Accepted: 01/26/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Single-port access surgery (SPA) may provide benefits but there is a steep learning curve. We compare traditional in-line instruments with articulating instruments. METHODS Fundamentals of laparoscopic surgery peg transfer task was performed using a 3-port approach or SPA device. Standard rigid instrumentation was compared with articulating instrumentation. RESULTS Twenty surgeons completed all tasks. Average time using a conventional approach was shorter than SPA (144 ± 54 vs 198 ± 74 seconds, P < .001). Articulating instruments required longer procedural time than rigid instrumentation (201 ± 66 vs 141 ± 58 seconds, P < .001). In the conventional model, task time was lower with rigid instruments than with articulating instruments (108 vs 179 seconds, P < .001). Task time in the SPA model was lower with rigid instruments (173 vs 223 seconds, P =.013). CONCLUSIONS All tasks required longer time to complete in SPA when compared with a conventional approach. Articulating instruments have an increased benefit in SPA surgery.
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Affiliation(s)
- Geoffrey Chow
- Department of Surgery, Division of General Surgery, University of British Columbia, 2775 Laurel Street, Vancouver, British Columbia, V5Z 1M9, Canada
| | - Chieh Jack Chiu
- Department of Surgery, Division of General Surgery, University of British Columbia, 2775 Laurel Street, Vancouver, British Columbia, V5Z 1M9, Canada
| | - Bin Zheng
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Ormond Neely Panton
- Department of Surgery, Division of General Surgery, University of British Columbia, 2775 Laurel Street, Vancouver, British Columbia, V5Z 1M9, Canada
| | - Adam T Meneghetti
- Department of Surgery, Division of General Surgery, University of British Columbia, 2775 Laurel Street, Vancouver, British Columbia, V5Z 1M9, Canada.
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