Analysis of visualization index using technique of simultaneous laparoscopic operations

Fatigue is a temporary decrease in the efficiency of an organism or organ due to intensive or long-term work, which is manifested in a decrease in quantitative and qualitative indicators of work and deterioration of coordination of work functions. Groups of simultaneous operations (411 patients) and group of single operations (746 patients) were formed. In both groups these changes were insignificant in most cases (except for marginal values in obese patients III, there were 6 such cases in the first group and8 inthe second), corrections of the port administration scheme were performed when performing vertical gastrectomy in both groups. After the calculation, the average deviations were1.2 cmin the first group and1.4 cmin the second. When using a laparoscope with a viewing angle of 0 o, the approach distance of the laparoscope with its own method of access on average during normal surgery is (6.92 ± 0.306) cm and is slightly smaller than standard methods, the average value of the studied parameter in the control group is - (6.98 ± 0.258) cm (p <0.001). Visualisation during simultaneous laparoscopic operations using our developed technique was on the level with single laparoscopic operation, performed classically

Ergonomic problems originating in the use of high-frequency and ultrasonic medical devices

Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG geförderten) Allianz- bzw. Nationallizenz frei zugänglich.This publication is with permission of the rights owner freely accessible due to an Alliance licence and a national licence (funded by the DFG, German Research Foundation) respectively.High-frequency and ultrasonic medical devices are widely used in laparoscopic surgical procedures. Using these devices can result in ergonomic problems. Two studies were performed: in a questionnaire surgeons were asked to evaluate laparoscopic surgical instruments. Based on the resulting 74 data sets it was possible to define various improvements to the design of instruments. In a subsequent field study 70 surgical procedures were observed to comprise user caused problems in the interaction with medical devices

Ergonomics of the Operative Field in Paediatric Minimal Access Surgery

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The Investigation of Laparoscopic Instrument Movement Control and Learning Effect

Laparoscopic surgery avoids large incisions for intra-abdominal operations as required in conventional open surgery. Whereas the patient benefits from laparoscopic techniques, the surgeon encounters new difficulties that were not present during open surgery procedures. However, limited literature has been published in the essential movement characteristics such as magnification, amplitude, and angle. For this reason, the present study aims to investigate the essential movement characteristics of instrument manipulation via Fitts' task and to develop an instrument movement time predicting model. Ten right-handed subjects made discrete Fitts' pointing tasks using a laparoscopic trainer. The experimental results showed that there were significant differences between the three factors in movement time and in throughput. However, no significant differences were observed in the improvement rate for movement time and throughput between these three factors. As expected, the movement time was rather variable and affected markedly by direction to target. The conventional Fitts' law model was extended by incorporating a directional parameter into the model. The extended model was shown to better fit the data than the conventional model. These findings pointed to a design direction for the laparoscopic surgery training program, and the predictive model can be used to establish standards in the training procedure

Mental and physical workload in laparoscopic surgery

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Prevalence of haptic feedback in robot-mediated surgery : a systematic review of literature

© 2017 Springer-Verlag. This is a post-peer-review, pre-copyedit version of an article published in Journal of Robotic Surgery. The final authenticated version is available online at: https://doi.org/10.1007/s11701-017-0763-4With the successful uptake and inclusion of robotic systems in minimally invasive surgery and with the increasing application of robotic surgery (RS) in numerous surgical specialities worldwide, there is now a need to develop and enhance the technology further. One such improvement is the implementation and amalgamation of haptic feedback technology into RS which will permit the operating surgeon on the console to receive haptic information on the type of tissue being operated on. The main advantage of using this is to allow the operating surgeon to feel and control the amount of force applied to different tissues during surgery thus minimising the risk of tissue damage due to both the direct and indirect effects of excessive tissue force or tension being applied during RS. We performed a two-rater systematic review to identify the latest developments and potential avenues of improving technology in the application and implementation of haptic feedback technology to the operating surgeon on the console during RS. This review provides a summary of technological enhancements in RS, considering different stages of work, from proof of concept to cadaver tissue testing, surgery in animals, and finally real implementation in surgical practice. We identify that at the time of this review, while there is a unanimous agreement regarding need for haptic and tactile feedback, there are no solutions or products available that address this need. There is a scope and need for new developments in haptic augmentation for robot-mediated surgery with the aim of improving patient care and robotic surgical technology further.Peer reviewe

Improving Health Care Quality and Safety: The Development and Assessment of Laparoscopic Surgery Instrumentation, Practices and Procedures

Adverse events due to medical errors are a leading cause of death in the United States exceeding the mortality rates of motor vehicle accidents, breast cancer and AIDS. Improvements can and should be made to reduce the rates of preventable surgical errors since they account for nearly half of all adverse events within hospitals. Although minimally invasive surgery has proven patient benefits such as reduced postoperative pain and hospital stay, its operative environment imposes substantial physical and cognitive strain on the surgeon increasing the risk of error. In order to mitigate errors and protect patients, a multidisciplinary approach was taken to improve minimally invasive surgery. Clinical, human factors, and biomedical engineering principles and methodologies were used to develop and assess laparoscopic surgery instrumentation, practices and procedures. First, the foundational understanding and the imperative to transform health care into a high quality and safe system is discussed. Next, a generalized perspective is presented on the impact of the design and redesign of surgical technologies and processes on human performance. The remainder of this dissertation presents the experimental results of four studies used to develop and assess laparoscopic surgery instrumentation, practices and procedures. In the first experiment, a novel hand-controlled electrosurgical laparoscopic grasper was developed and evaluated to eliminate the use of foot pedals, reduce surgery-related discomfort, and minimize the risk of actuation errors. The final three studies compared the emerging technique of single-incision surgery to conventional laparoscopic surgery to determine whether there were any technical, physical or subjective performance differences across the two surgical techniques. In all, these studies contribute towards the improvement of the quality and safety of minimally invasive surgery. Advisor: M. Susan Hallbec

Improving Health Care Quality and Safety: The Development and Assessment of Laparoscopic Surgery Instrumentation, Practices and Procedures

Adverse events due to medical errors are a leading cause of death in the United States exceeding the mortality rates of motor vehicle accidents, breast cancer and AIDS. Improvements can and should be made to reduce the rates of preventable surgical errors since they account for nearly half of all adverse events within hospitals. Although minimally invasive surgery has proven patient benefits such as reduced postoperative pain and hospital stay, its operative environment imposes substantial physical and cognitive strain on the surgeon increasing the risk of error. In order to mitigate errors and protect patients, a multidisciplinary approach was taken to improve minimally invasive surgery. Clinical, human factors, and biomedical engineering principles and methodologies were used to develop and assess laparoscopic surgery instrumentation, practices and procedures. First, the foundational understanding and the imperative to transform health care into a high quality and safe system is discussed. Next, a generalized perspective is presented on the impact of the design and redesign of surgical technologies and processes on human performance. The remainder of this dissertation presents the experimental results of four studies used to develop and assess laparoscopic surgery instrumentation, practices and procedures. In the first experiment, a novel hand-controlled electrosurgical laparoscopic grasper was developed and evaluated to eliminate the use of foot pedals, reduce surgery-related discomfort, and minimize the risk of actuation errors. The final three studies compared the emerging technique of single-incision surgery to conventional laparoscopic surgery to determine whether there were any technical, physical or subjective performance differences across the two surgical techniques. In all, these studies contribute towards the improvement of the quality and safety of minimally invasive surgery. Advisor: M. Susan Hallbec

Risk-sensitive events during laparoscopic cholecystectomy: the influence of the integrated operating room and a preoperative checklist tool

Background - Awareness of the relative high rate of adverse events in laparoscopic surgery created a need to safeguard quality and safety of performance better. Technological innovations, such as integrated operating room (OR) systems and checklists, have the potential to improve patient safety, OR efficiency, and surgical outcomes. This study was designed to investigate the influence of the integrated OR system and Pro/cheQ, a digital checklist tool, on the number and type of equipment- and instrument-related risk-sensitive events (RSE) during laparoscopic cholecystectomies. Methods - Forty-five laparoscopic cholecystectomies were analyzed on the number and type of RSE; 15 procedures were observed in the cart-based OR setting, 15 in an integrated OR setting, and 15 in the integrated OR setting while using Pro/cheQ. Results - In the cart-based OR setting and the integrated OR setting, at least one event occurred in 87% of the procedures, which was reduced to 47% in the integrated OR setting when using Pro/cheQ. During 45 procedures a total of 57 RSE was observed—most were caused by equipment that was not switched on or with the wrong settings. In the integrated OR while using Pro/cheQ the number of RSE was reduced by 65%. Conclusions - Using both an integrated OR and Pro/cheQ has a stronger reducing effect on the number of RSE than using an integrated OR alone. The Pro/cheQ tool supported the optimal workflow in a natural way and raised the general safety awareness amongst all members of the surgical team. For tools such as integrated OR systems and checklists to succeed it is pivotal not to underestimate the value of the implementation process. To further improve safety and quality of surgery, a multifaceted approach should be followed, focusing on the performance and competence of the surgical team as a whole.Industrial DesignIndustrial Design Engineerin