The Evolution of VATS Lobectomy

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Patterns of injury and violence in Yaoundé Cameroon: an analysis of hospital data.

BackgroundInjuries are quickly becoming a leading cause of death globally, disproportionately affecting sub-Saharan Africa, where reports on the epidemiology of injuries are extremely limited. Reports on the patterns and frequency of injuries are available from Cameroon are also scarce. This study explores the patterns of trauma seen at the emergency ward of the busiest trauma center in Cameroon's capital city.Materials and methodsAdministrative records from January 1, 2007, through December 31, 2007, were retrospectively reviewed; information on age, gender, mechanism of injury, and outcome was abstracted for all trauma patients presenting to the emergency ward. Univariate analysis was performed to assess patterns of injuries in terms of mechanism, date, age, and gender. Bivariate analysis was used to explore potential relationships between demographic variables and mechanism of injury.ResultsA total of 6,234 injured people were seen at the Central Hospital of Yaoundé's emergency ward during the year 2007. Males comprised 71% of those injured, and the mean age of injured patients was 29 years (SD = 14.9). Nearly 60% of the injuries were due to road traffic accidents, 46% of which involved a pedestrian. Intentional injuries were the second most common mechanism of injury (22.5%), 55% of which involved unarmed assault. Patients injured in falls were more likely to be admitted to the hospital (p < 0.001), whereas patients suffering intentional injuries and bites were less likely to be hospitalized (p < 0.001). Males were significantly more likely to be admitted than females (p < 0.001)DiscussionPatterns in terms of age, gender, and mechanism of injury are similar to reports from other countries from the same geographic region, but the magnitude of cases reported is high for a single institution in an African city the size of Yaoundé. As the burden of disease is predicted to increase dramatically in sub-Saharan Africa, immediate efforts in prevention and treatment in Cameroon are strongly warranted

Recent Advances in Minimally Invasive Surgery

Minimally invasive surgery has become a common term in visceral as well as gynecologic surgery. It has almost evolved into its own surgical speciality over the past 20 years. Today, being firmly established in every subspeciality of visceral surgery, it is now no longer a distinct skillset, but a fixed part of the armamentarium of surgical options available. In every indication, the advantages of a minimally invasive approach include reduced intraoperative blood loss, less postoperative pain, and shorter rehabilitation times, as well as a marked reduction of overall and surgical postoperative morbidity. In the advent of modern oncologic treatment algorithms, these effects not only lower the immediate impact that an operation has on the patient, but also become important key steps in reducing the side-effects of surgery. Thus, they enable surgery to become a module in modern multi-disciplinary cancer treatment, which blends into multimodular treatment options at different times and prolongs and widens the possibilities available to cancer patients. In this quickly changing environment, the requirement to learn and refine not only open surgical but also different minimally invasive techniques on high levels deeply impact modern surgical training pathways. The use of modern elearning tools and new and praxis-based surgical training possibilities have been readily integrated into modern surgical education,which persists throughout the whole surgical career of modern gynecologic and visceral surgery specialists

A novel approach to assess minimally invasive surgical device failure utilizing adverse event outcome severity and design complexity.

Medical device failure and misuse have the potential to cause serious injury and death. Given the intricate nature of the instruments utilized specifically in minimally invasive surgery (MIS), users and manufacturers of surgical devices share a responsibility in preventing user error and device failure. A novel approach was presented for the evaluation of minimally invasive device failures, which involved assessing the severity of adverse event outcomes associated with the failures modes and investigating aspects of the devices’ design that may contribute to failure. The goals of this research were to 1) characterize the design attributes, failure modes, and adverse events associated with minimally invasive surgical devices and 2) describe the relationship between minimally invasive surgical device design complexity and the severity of adverse events. The types of failure modes, phases of operation in which failure occurs, severity of adverse event outcomes, and design complexity associated with four minimally invasive surgical devices were determined. An association was shown to exist between phases of surgical device operation and the severity of outcomes that occur in each phase (p \u3c 0.05). Across both device types, the majority of failure occurred during execution of the devices’ main function which involved securing and transecting tissue. The least amount of failures occurred during the results and post-op phase of operation; however, the failures that occurred during this phase resulted in the highest average outcome severity. The endoscopic staplers assessed resulted in overall higher average outcome severities relative to that of the tissue sealers. The methods employed are the first to evaluate medical device design, function, and failure outcomes from a complexity perspective. While statistical conclusions regarding the overall research goal could not be drawn, heuristic methods support development of the approach presented. The work herein assists the enhancement of risk awareness and prevention techniques and serves as a contribution to filling the knowledge gap regarding device use and failure outcomes. Bridging the gap between surgeons and engineers is crucial to the successful implementation and evaluation of new technology in the operating room, which was an essential component of this research

Optimizing Working Space in Laparoscopy: Studies in a porcine model

__Abstract__ Adequate working space is essential for safe and effective laparoscopic surgery. However, the factors that determine working space have not been sufficiently studied. Working space can be very limited, especially in children. A literature review was undertaken to search for factors that can be influenced to increase working space in laparoscopy