Training, efficiency and ergonomics in minimally invasive surgery

Knoopsgatchirurgie (laparoscopie) heeft een aantal bewezen voordelen voor de patiënt. Voor het operatieteam gaat er een aantal uitdagingen gemoeid met deze manier van opereren. Met name op het gebied van de ergonomie en de efficiëntie van het operatieproces en op het gebied van training van chirurgen die deze techniek willen toepassen zijn verbeteringen nodig. Hierover gaat dit proefschrift. In deel 1 van dit proefschrift onderzoeken we wat de beste houding is om laparoscopische chirurgie te kunnen uitvoeren. Met name de positie van de monitor is daarbij van belang. De monitor dient ruim onder ooghoogte, dicht bij het operatieveld en in lijn met de werkrichting van de chirurg geplaatst te worden. We tonen aan dat een speciaal voor laparoscopie ontworpen operatiekamer een significante verbetering van de ergonomie en een verbeterde efficiëntie tussen de operaties door kan opleveren. In deel 2 van dit proefschrift onderzoeken we een nieuwe manier van proceduretraining op de operatiekamer. Een cohort assistenten doorloopt een curriculum voor laparoscopische galblaasoperaties. Nadat zij hun basisvaardigheden hebben geleerd op een simulator begonnen ze met proceduretraining op de operatiekamer. Gedurende 6 operaties kregen ze tijdens elke ingreep herhaaldelijk korte video-instructies over de volgende stap die moest worden uitgevoerd. Na het zien van de instructie mochten ze die stap van de operatie uitvoeren. De beoordelingen van de assistenten die op deze manier zijn getraind verbeterden sneller dan in een controle groep. We tonen aan dat deze methode effectief en uniform is terwijl de efficiëntie van het operatieproces niet benadeeld wordt

Identification of risk factors in minimally invasive surgery: a prospective multicenter study

Development and application of statistical models for medical scientific researc

Mental and physical workload in laparoscopic surgery

Imperial Users onl

25th International Congress of the European Association for Endoscopic Surgery (EAES) Frankfurt, Germany, 14-17 June 2017 : Oral Presentations

Introduction: Ouyang has recently proposed hiatal surface area (HSA) calculation by multiplanar multislice computer tomography (MDCT) scan as a useful tool for planning treatment of hiatus defects with hiatal hernia (HH), with or without gastroesophageal reflux (MRGE). Preoperative upper endoscopy or barium swallow cannot predict the HSA and pillars conditions. Aim to asses the efficacy of MDCT’s calculation of HSA for planning the best approach for the hiatal defects treatment. Methods: We retrospectively analyzed 25 patients, candidates to laparoscopic antireflux surgery as primary surgery or hiatus repair concomitant with or after bariatric surgery. Patients were analyzed preoperatively and after one-year follow-up by MDCT scan measurement of esophageal hiatus surface. Five normal patients were enrolled as control group. The HSA’s intraoperative calculation was performed after complete dissection of the area considered a triangle. Postoperative CT-scan was done after 12 months or any time reflux symptoms appeared. Results: (1) Mean HSA in control patients with no HH, no MRGE was cm2 and similar in non-complicated patients with previous LSG and cruroplasty. (2) Mean HSA in patients candidates to cruroplasty was 7.40 cm2. (3) Mean HSA in patients candidates to redo cruroplasty for recurrence was 10.11 cm2. Discussion. MDCT scan offer the possibility to obtain an objective measurement of the HSA and the correlation with endoscopic findings and symptoms. The preoperative information allow to discuss with patients the proper technique when a HSA[5 cm2 is detected. During the follow-up a correlation between symptoms and failure of cruroplasty can be assessed. Conclusions: MDCT scan seems to be an effective non-invasive method to plan hiatal defect treatment and to check during the follow-up the potential recurrence. Future research should correlate in larger series imaging data with intraoperative findings

Resiliency in the Operating Room: Exploring Trainee Stress During Surgery and the Role of Individual Resilience

Surgical trainees experience significant intraoperative stress, which can negatively impact performance and learning. Psychological resilience suggests why some individuals excel despite severe stress. This study explores the relationship between trainee resilience and intraoperative stress. A novel instrument was developed to assess Surgical TRainee Experiences of StresS in the Operating Room (STRESSOR). Focus groups and a literature review identified eight domains of intraoperative stress. STRESSOR was used in a survey of orthopaedic residents in Canada and surgical trainees at Western University. Resiliency was assessed using the 10-item Connor-Davidson Resiliency Scale. 171 responses were received for a 38 percent response rate. The STRESSOR instrument had strong reliability and construct validity using confirmatory factor analysis. Increasing resilience correlated with lower intraoperative stress. Trainees with higher stress or lower resilience were more likely to have considered leaving residency. Resiliency training may reduce intraoperative stress, potentially improving surgical performance and learning while reducing resident attrition

Gallstone Disease: The Cost Of Treatment

This paper presents the methodology and results from the costing analysis of gallstone disease treatments. This was part of a larger cost utility analysis undertaken by the National Centre for Health Program Evaluation. Preliminary results from this are available in Cook, Richardson and Street (1993a). Issues relating to the assessment of the outcomes of treatment are discussed in Cook and Richardson (1993a and 1993b). The final report, which provides an overview of the economic evaluation, is forthcoming (Cook, Richardson and Street 1993b). The present paper discusses the estimation of hospital, patient and indirect costs associated with the three treatment options, open cholecystectomy, laparoscopic cholecystectomy, and extra-corporeal shockwave lithotripsy (ESWL). Results are based on a clinical trial conducted over a three year period at St Vincent's Hospital, Melbourne beginning in 1989. The methodology and various issues arising in the estimation of costs are described in detail. It was found that when only hospital costs were considered laparoscopic cholecystectomy was unambiguously the least expensive treatment. The inclusion of indirect and patient costs reduced the relative cost advantage of laparoscopic cholecystectomy over ESWL but did not negate it. Open cholecystectomy had lower hospital costs than ESWL but the inclusion of costs incurred outside the hospital resulted in ESWL being less expensive than open cholecystectomy. The cost of ESWL varied by stone size and number, the treatment for those with large stones (>20 mm diameter) costing approximately 50% more than for those with small stones (<10 mm diameter)