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Alsowaina KN, Atashzar SF, Pur DR, Eagleson R, Patel RV, Elnahas AI, Hawel JD, Alkhamesi NA, Schlachta CM. Video Context Improves Performance in Identifying Operative Planes on Static Surgical Images. J Surg Educ 2022; 79:492-499. [PMID: 34702691 DOI: 10.1016/j.jsurg.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/10/2021] [Accepted: 10/03/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Correct identification of the surgical tissue planes of dissection is paramount at the operating room, and the needed skills seem to be improved with realistic dynamic models rather than mere still images. The objective is to assess the role of adding video prequels to still images taken from operations on the precision and accuracy of tissue plane identification using a validated simulation model, considering various levels of surgeons' experience. METHODS A prospective observational study was conducted involving 15 surgeons distributed to three equal groups, including a consultant group [C], a senior group [S], and a junior group [J]. Subjects were asked to identify and draw ideal tissue planes in 20 images selected at suitable operative moments of identification before and after showing a 10- second videoclip preceding the still image. A validated comparative metric (using a modified Hausdorff distance [%Hdu] for object matching) was used to measure the distance between lines. A precision analysis was carried out based on the difference in %Hdu between lines drawn before and after watching the videos, and between-group comparisons were analyzed using a one-way analysis of variance (ANOVA). The analysis of accuracy was done on the difference in %Hdu between lines drawn by the subjects and the ideal lines provided by an expert panel. The impact of videos on accuracy was assessed using a repeated-measures ANOVA. RESULTS The C group showed the highest preciseness as compared to the S and J groups (mean Hdu 9.17±11.86 versus 12.1±15.5 and 20.0±18.32, respectively, p <0.001) and significant differences between groups were found in 14 images (70%). Considering the expert panel as a reference, the interaction between time and experience level was significant ( F (2, 597) = 4.52, p <0.001). Although the subjects of the J group were significantly less accurate than other surgeons, only this group showed significant improvements in mean %Hdu values after watching the lead-in videos ( F (1, 597) = 6.04, p = 0.014). CONCLUSIONS Adding video context improved the ability of junior trainees to identify tissue planes of dissection. A realistic model is recommended considering experience-based differences in precision in training programs.
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Affiliation(s)
- Khalid N Alsowaina
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), London, Ontario, Canada; Department of Surgery, Western University, London, Ontario, Canada
| | - Seyed F Atashzar
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), London, Ontario, Canada; Department of Electrical and Computer Engineering, Western University, London, Ontario, Canada
| | - Daiana R Pur
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
| | - Roy Eagleson
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), London, Ontario, Canada; Department of Surgery, Western University, London, Ontario, Canada
| | - Rajni V Patel
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), London, Ontario, Canada; Department of Electrical and Computer Engineering, Western University, London, Ontario, Canada
| | - Ahmad I Elnahas
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), London, Ontario, Canada; Department of Surgery, Western University, London, Ontario, Canada
| | - Jeffrey D Hawel
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), London, Ontario, Canada; Department of Surgery, Western University, London, Ontario, Canada
| | - Nawar A Alkhamesi
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), London, Ontario, Canada; Department of Surgery, Western University, London, Ontario, Canada
| | - Christopher M Schlachta
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), London, Ontario, Canada; Department of Surgery, Western University, London, Ontario, Canada
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Remacha J, Navarro-Díaz M, Larrosa F. Experience with three-dimensional exoscope-assisted surgery of giant mastoid process osteoma. J Laryngol Otol 2022;:1-3. [PMID: 34991763 DOI: 10.1017/S0022215121004588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The excision of a giant mastoid process osteoma can be challenging. In such situations, the three-dimensional exoscope intra-operative optic may be a promising tool. CASE REPORT This paper provides a technical description of a giant mastoid osteoma excised under three-dimensional exoscope magnification. A fragmented excision by intralesional curettage was adopted to prevent peri-tumoural damage. This technique had been previously described for the excision of large osteomas of the sinus. CONCLUSION The three-dimensional exoscope magnification tool had excellent applicability during surgery of a rare mastoid osteoma. In complex anatomical areas, the cavitation and fragmented excision of the tumour may prevent complications and is therefore recommended.
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Saibene AM, Bulfamante AM, Lozza P, De Pasquale L. The role of narrow-band imaging in parathyroid surgery: a preliminary evaluation in five parathyroid adenoma cases. J Laryngol Otol 2019; 133:1009-11. [PMID: 31625484 DOI: 10.1017/S0022215119002160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Narrow-band imaging uses selective haemoglobin light absorption to emphasise vascular visualisation and capillary networks. OBJECTIVE This study aimed to evaluate the application of this technique to parathyroid surgery. METHOD This preliminary evaluation was carried out on five consecutive patients with single parathyroid adenoma being considered for minimally invasive video-assisted parathyroidectomy. The adenomas were checked for narrow-band imaging vascular patterns. Minimally invasive video-assisted parathyroidectomy was then carried out in accordance with our standard protocol. RESULTS In four out of the five cases, narrow-band imaging integrated the white endoscopic light and direct vision, but in one case narrow-band imaging allowed distinction between the hidden neoplastic tissue and the surrounding structures thanks to the different vascular patterns. CONCLUSION Narrow-band imaging was helpful in properly identifying adenoma. It is suggested that this technique be considered as a means for surgeons to improve their confidence in selected surgical treatments and to improve treatment quality.
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Ergin G, Doluoglu OG, Kıraç M, Kilinc MF, Köprü B, Keseroglu BB, Hoscan MB. Comparison of renal function after robot - assisted laparoscopic radical prostatectomy versus retropubic radical prostatectomy. Int Braz J Urol 2019; 45:83-88. [PMID: 29757580 PMCID: PMC6442145 DOI: 10.1590/s1677-5538.ibju.2018.0103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 04/04/2018] [Indexed: 11/28/2022] Open
Abstract
Purpose: To investigate the effect of robot assisted laparoscopic radical prostatectomy (RALP) and open retropubic radical prostatectomy (RRP) on early renal function in this study. Materials and Methods: Preoperative and postoperative urea, creatinine, Hb, eGFR values of patients who had undergone RALP and RRP with prostate cancer (PCa) diagnosis were recorded in our clinic. The percentages of change in these values are calculated. Preoperative and postoperative urea, creatinine, Hb and eGFR changes were compared with each other. Student-t test was used for intergroup comparison, and paired sample t test was used to compare changes between preoperative and postoperative values of the same group. Results: There were 160 and 93 patients in the RALP and RRP group, respectively. In the RALP group, postoperative urea and creatinine increased significantly compared to preoperative baseline values while eGFR was decreased (p = 0.0001, p = 0.001, p = 0.0001, respectively). Except for Hb in the RRP group, the changes in these values were statistically insignificant (p = 0.50, p = 0.75, p = 0.30, respectively). Conclusions: We should be more careful when we perform RALP in patients at risk of impaired renal function despite being a minimally invasive surgical method with superior visual characteristics.
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Affiliation(s)
- Giray Ergin
- Department of Urology Clinic, Yuksek Ihtisas University, Medical Faculty, Koru Hospital, Ankara, Turkey
| | - Omer Gokhan Doluoglu
- Department of Urology Clinic, Ankara Training and Research Hospital, Ankara, Turkey
| | - Mustafa Kıraç
- Department of Urology Clinic, Yuksek Ihtisas University, Medical Faculty, Koru Hospital, Ankara, Turkey
| | | | - Burak Köprü
- Department of Urology Clinic, Yuksek Ihtisas University, Medical Faculty, Koru Hospital, Ankara, Turkey
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Porreca A, D'Agostino D, Dente D, Dandrea M, Salvaggio A, Cappa E, Zuccala A, Del Rosso A, Chessa F, Romagnoli D, Mengoni F, Borghesi M, Schiavina R. Retroperitoneal approach for robot-assisted partial nephrectomy: technique and early outcomes. Int Braz J Urol 2018; 44:63-68. [PMID: 29211396 PMCID: PMC5815533 DOI: 10.1590/s1677-5538.ibju.2017.0104] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 08/07/2017] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES The aim of our study is to present early outcomes of our series of retroperitoneal-RAPN (Robot Assisted Partial Nephrectomy). MATERIALS AND METHODS From September 2010 until December 2015, we performed 81 RAPN procedures (44 at left kidney and 37 at right). Average size was 3cm (1-9). Average PADUA score 7.1 (5-10). Average surgical time (overall and only robot time), ischemia time, blood loss, pathological stage, complications and hospital stay have been recorded. RESULTS All of the cases were completed successfully without any operative complication or surgical conversion. Average surgical time was 177 minutes (75-340). Operative time was 145 minutes (80-300), overall blood loss was 142cc (60-310cc). In 30 cases the pedicle was late clamped with an average ischemia time of 4 minutes (2-7). None of the patient had positive surgical margins at definitive histology (49pT1a, 12pT1b, 3pT2a, 2pT3a). Hospital stay was 3 days (2-7). CONCLUSIONS The retroperitoneal robotic partial nephrectomy approach is safe and allows treatment of even quite complex tumors. It also combines the already well known advantages guaranteed by the da Vinci® robotic surgical system, with the advantages of the retroperitoneoscopic approach.
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Affiliation(s)
- A Porreca
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy
| | - D D'Agostino
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy
| | - D Dente
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy
| | - M Dandrea
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy
| | - A Salvaggio
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy
| | - E Cappa
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy
| | - A Zuccala
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy
| | - A Del Rosso
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy
| | - F Chessa
- Department of Urology, University of Bologna, Bologna, Italy
| | - D Romagnoli
- Department of Urology, University of Bologna, Bologna, Italy
| | - F Mengoni
- Department of Urology, University of Bologna, Bologna, Italy
| | - M Borghesi
- Department of Urology, University of Bologna, Bologna, Italy
| | - R Schiavina
- Department of Urology, University of Bologna, Bologna, Italy
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Gobbo RDR, Rangel VDO, Karam FC, Pires LAS. PHYSICAL EXAMINATIONS FOR DIAGNOSING MENISCAL INJURIES: CORRELATION WITH SURGICAL FINDINGS. Rev Bras Ortop 2015; 46:726-9. [PMID: 27047833 PMCID: PMC4799353 DOI: 10.1016/s2255-4971(15)30332-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 12/23/2011] [Indexed: 02/05/2023] Open
Abstract
Objective: A set of five maneuvers for meniscal injuries (McMurray, Apley, Childress and Steinmann 1 and 2) was evaluated and their sensitivity, specificity, accuracy and likelihood were calculated. The same methods were applied to each test individually. Methods: One hundred and fifty-two patients of both sexes who were going to undergo videoarthroscopy on the knee were examined blindly by one of five residents at this hospital, without knowledge of the clinical data and why the patient was going to undergo an operation. This examination was conducted immediately before the videoarthroscopy and its results were recorded in an electronic spreadsheet. The set of maneuvers was considered positive when one was positive. In the individual analysis, it was enough for the test to be positive. Results: The analysis showed that the set of five meniscal tests presented sensitivity of 89%, specificity of 42%, accuracy of 75%, positive likelihood of 1.53 and negative likelihood of 0.26. Individually, the tests presented accuracy of between 48% and 53%. Conclusion: The set of maneuvers for meniscal injuries presented a good accuracy and significant value, especially for ruling out injury. Individually, the tests had less diagnostic value, although the Apley test had better specificity.
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Affiliation(s)
- Ricardo da Rocha Gobbo
- Member of the Brazilian Society of Knee Surgery (Sociedade Brasileira de Cirurgia do Joelho); Member of the Brazilian Society of Orthopedics and Traumatology (Sociedade Brasileira de Ortopedia e Traumatologia); Former Resident of the Knee Group of the Orthopedics and Traumatology Clinic of Hospital São Lucas, PUCRS - Porto Alegre, RS, Brazil
| | - Victor de Oliveira Rangel
- Member of the Brazilian Society of Orthopedics and Traumatology; Former Resident Physician of the Orthopedics and Traumatology Clinic of Hospital São Lucas, PUCRS - Porto Alegre, RS, Brazil
| | - Francisco Consoli Karam
- Master's degree in Human Movement Sciences; Doctor's degree in Medicine; Member of the Knee Group of the Orthopedics Clinic of Hospital São Lucas, PUCRS - Porto Alegre, RS, Brazil
| | - Luiz Antônio Simões Pires
- Master's degree in Human Movement Sciences; Head of the Orthopedics and Traumatology Clinic of Hospital São Lucas, PUCRS - Porto Alegre, RS, Brazil
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Socher JA, Santos PG, Correa VC, Silva LCDBE. Endoscopic surgery in the treatment of crista galli pneumatization evolving with localizated frontal headaches. Int Arch Otorhinolaryngol 2015; 17:246-50. [PMID: 25992021 PMCID: PMC4423267 DOI: 10.7162/s1809-97772013000300003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 03/19/2013] [Indexed: 11/06/2022] Open
Abstract
Introduction: The crista galli is part of the ethmoid bone and thus may suffer from the process of pneumatization. Pneumatization occurs in between 3% and 14% of patients, resulting from air cells in the frontal or ethmoid sinuses. Aim: To describe 3 cases of crista galli pneumatization in which the patients developed infection and were treated surgically by endoscopic techniques. Method: We present 3 case studies of patients complaining of severe frontal headaches. The patients underwent ENT evaluation, examination by video-endoscopy, and computed tomography, which identified crista galli pneumatization with mucosal thickening and the presence of fluid. Patients underwent treatment with antibiotics and corticosteroids; however, they showed no symptomatic improvement, displayed recurrence of symptoms, and maintained radiographic changes. Thus, patients then underwent drainage through the crista galli via an endoscopic procedure. Discussion: During surgery, mucopurulence and/or mucosal thickening and edema were identified in the pneumatized crista galli. There were no complications during or after surgery. Postoperatively, headache was improved in patients after a minimum follow-up of 6 months. Conclusion: Crista galli pneumatization can result in infection, simulating rhinosinusitis. When there is little response to drug therapy, endoscopic surgical treatment is required; the current cases demonstrate that this technique is safe and effective.
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Affiliation(s)
- Jan Alessandro Socher
- Doctor of Otolaryngology Faculty of Medicine, University of Sao Paulo. Professor of Otorhinolaryngology in FURB - Regional University of Blumenau
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Abstract
Traumatic asphyxia, or Perthe's syndrome, is a rare clinical syndrome characterized by cervicofacial cyanosis, petechiae, subconjunctival hemorrhage, neurological symptoms, and thoracic injury. It affects both adults and children after blunt chest traumas. The diagnosis of this condition is based mainly on the specific clinical signs, which should immediately bring to mind the severity of the trauma, the various probable types of pulmonary injuries, and the need for screening and careful assessment of other organs that might also be injured. In this report, we describe the case of a 39-year-old male who developed traumatic asphyxia after severe blunt chest trauma during his work at a construction site. The patient had multiple injuries to the chest, abdomen, head and neck, which were treated conservatively. An associated diaphragmatic injury was successfully treated by video-assisted thoracic surgery. This patient is one of five patients who were admitted to Saqr Hospital in the United Arab Emirates, diagnosed with traumatic asphyxia, and treated by mechanical ventilator, supportive measures, and fiberoptic bronchoscopy, for both diagnostic and therapeutic indications, in our unit in the period between July 2006 and June 2013. As traumatic asphyxia is a systemic injury, careful assessment of the patient and looking for other injuries is mandatory. Treatment usually involves supportive measures to the affected organs, but surgical intervention may sometimes prove to be an important part of the treatment. Bronchoscopy should be performed for diagnostic and therapeutic reasons because of the associated pulmonary and possible tracheobronchial injuries.
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Affiliation(s)
- Hussein Lateef
- Thoracic and Vascular Surgery Department, Saqr Hospital, Ras Al Khaima, United Arab Emirates
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Dal Molin FF, Mothes FC, Feder MG. EFFECTIVENESS OF THE VIDEOARTHROSCOPY LEARNING PROCESS IN SYNTHETIC SHOULDER MODELS. Rev Bras Ortop 2012; 47:83-91. [PMID: 27027086 PMCID: PMC4799361 DOI: 10.1016/s2255-4971(15)30350-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 10/21/2011] [Indexed: 11/30/2022] Open
Abstract
Objectives: The authors evaluate the learning of the videoarthroscopic technique, using the video surgery simulator SAM® (Shoulder Arthroscopy Model). Methods: Twenty medical residents in Orthepaedics, without prior knowledge of the arthroscopic technique, were evaluated before and after training. The tasks consisted of positioning, in holes that simulated portals, four surgical threads attached to an anchor placed in the anatomical neck of the humerus in the synthetic model. Time, number of movements, number of attempts, amount of errors and comparison between the two phases of training before and after - were observed and noted. Results: The data was submitted to statistical analysis, and a significant difference was found in the comparison of the variables before and after the training. Conclusion: The result of this study enables us to conclude that training in the videoarthroscopic technique using the video surgery simulator SAM enables the surgeon to execute essential tasks involved in these techniques, in less time, making less mistakes, and developing the ability to deal better with the videoarthrocopic image.
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Affiliation(s)
- Fabio Farina Dal Molin
- Master's Degree in Orthopedics and Traumatology from FCMSCSP, Specialist Orthopedist in Shoulder and Elbow at the Hospital Moinhos de Vento - Porto Alegre, RS, Brazil
- Correspondence: Av Mariland, 1314. Ap 602 - Mont Serrat – Porto Alegre – RS. CEP 90440-190Correspondence: Av Mariland, 1314. Ap 602 - Mont SerratPorto AlegreRSCEP 90440-190
| | - Fernando Carlos Mothes
- Specialist Ortopedist in Shoulder and Elbow at the Hospital Moinhos de Vento and Santa Casa de Porto Alegre, RS, Brazil
| | - Marta Goldman Feder
- Master's Degree in Sciences of Human Movement from UFRGS, Specialist Orthopedist in Shoulder and Elbow at the Hospital Moinhos de Vento - Porto Alegre, RS, Brazil
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