Implementing a perioperative efficiency initiative for orthopedic surgery instrumentation at an academic center: A comparative before-and-after study.

Optimizing surgical instrumentation may contribute to value-based care, particularly in commonly performed procedures. We report our experience in implementing a perioperative efficiency program in 2 types of orthopedic surgery (primary total-knee arthroplasty, TKA, and total-hip arthroplasty, THA).A comparative before-and-after study with 2 participating surgeons, each performing both THA and TKA, was conducted. Our objective was to evaluate the effect of surgical tray optimization on operating and processing time, cost, and waste associated with preparation, delivery, and staging of sterile surgical instruments. The study was designed as a prospective quality improvement initiative with pre- and postimplementation operational measures and a provider satisfaction survey.A total of 96 procedures (38 preimplementation and 58 postimplementation) were assessed using time-stamped performance endpoints. The number and weight of trays and instruments processed were reduced substantially after the optimization intervention, particularly for TKA. Setup time was reduced by 23% (6 minutes, P = .01) for TKA procedures but did not differ for THA. The number of survey respondents was small, but satisfaction was high overall among personnel involved in implementation.Optimizing instrumentation trays for orthopedic procedures yielded reduction in processing time and cost. Future research should evaluate patient outcomes and incremental/additive impact on institutional quality measures

Supporting laparoscopic general surgery training with digital technology: The United Kingdom and Ireland paradigm

Surgical training in the UK and Ireland has faced challenges following the implementation of the European Working Time Directive and postgraduate training reform. The health services are undergoing a digital transformation; digital technology is remodelling the delivery of surgical care and surgical training. This review aims to critically evaluate key issues in laparoscopic general surgical training and the digital technology such as virtual and augmented reality, telementoring and automated workflow analysis and surgical skills assessment. We include pre-clinical, proof of concept research and commercial systems that are being developed to provide solutions. Digital surgical technology is evolving through interdisciplinary collaboration to provide widespread access to high-quality laparoscopic general surgery training and assessment. In the future this could lead to integrated, context-aware systems that support surgical teams in providing safer surgical care

Mental and physical workload in laparoscopic surgery

Imperial Users onl

Factors influencing wider acceptance of Computer Assisted Orthopaedic Surgery (CAOS) technologies for Total Joint Arthroplasty

Computer-assisted orthopaedic surgery (CAOS) promises to improve outcomes of joint arthroplasty through better alignment and orientation of implants, but take up has so far been modest. Following an overview of CAOS technologies covering image-guided surgery, image-free and robotic systems, several factors for lack of penetration are identified. These include poor validation of accuracy, lack of standardisation, inappropriate clinical outcomes measures for assessing and comparing technologies, unresolved debate about the effectiveness of minimally invasive surgery, and issues of medical device regulations, cost, autonomy of surgeons to choose equipment, ergonomics and training. The paper concludes that dialogue between surgeons and manufacturers is needed to develop standardised measurements and outcomes scoring systems that are more appropriate for technology comparisons, and encourages an increased awareness of user requirements

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

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

Medical Robotics

The first generation of surgical robots are already being installed in a number of operating rooms around the world. Robotics is being introduced to medicine because it allows for unprecedented control and precision of surgical instruments in minimally invasive procedures. So far, robots have been used to position an endoscope, perform gallbladder surgery and correct gastroesophogeal reflux and heartburn. The ultimate goal of the robotic surgery field is to design a robot that can be used to perform closed-chest, beating-heart surgery. The use of robotics in surgery will expand over the next decades without any doubt. Minimally Invasive Surgery (MIS) is a revolutionary approach in surgery. In MIS, the operation is performed with instruments and viewing equipment inserted into the body through small incisions created by the surgeon, in contrast to open surgery with large incisions. This minimizes surgical trauma and damage to healthy tissue, resulting in shorter patient recovery time. The aim of this book is to provide an overview of the state-of-art, to present new ideas, original results and practical experiences in this expanding area. Nevertheless, many chapters in the book concern advanced research on this growing area. The book provides critical analysis of clinical trials, assessment of the benefits and risks of the application of these technologies. This book is certainly a small sample of the research activity on Medical Robotics going on around the globe as you read it, but it surely covers a good deal of what has been done in the field recently, and as such it works as a valuable source for researchers interested in the involved subjects, whether they are currently “medical roboticists” or not