A Discrete Event Simulation model to evaluate the treatment pathways of patients with Cataract in the United Kingdom

Background The number of people affected by cataract in the United Kingdom (UK) is growing rapidly due to ageing population. As the only way to treat cataract is through surgery, there is a high demand for this type of surgery and figures indicate that it is the most performed type of surgery in the UK. The National Health Service (NHS), which provides free of charge care in the UK, is under huge financial pressure due to budget austerity in the last decade. As the number of people affected by the disease is expected to grow significantly in coming years, the aim of this study is to evaluate whether the introduction of new processes and medical technologies will enable cataract services to cope with the demand within the NHS funding constraints. Methods We developed a Discrete Event Simulation model representing the cataract services pathways at Leicester Royal Infirmary Hospital. The model was inputted with data from national and local sources as well as from a surgery demand forecasting model developed in the study. The model was verified and validated with the participation of the cataract services clinical and management teams. Results Four scenarios involving increased number of surgeries per half-day surgery theatre slot were simulated. Results indicate that the total number of surgeries per year could be increased by 40% at no extra cost. However, the rate of improvement decreases for increased number of surgeries per half-day surgery theatre slot due to a higher number of cancelled surgeries. Productivity is expected to improve as the total number of doctors and nurses hours will increase by 5 and 12% respectively. However, non-human resources such as pre-surgery rooms and post-surgery recovery chairs are under-utilized across all scenarios. Conclusions Using new processes and medical technologies for cataract surgery is a promising way to deal with the expected higher demand especially as this could be achieved with limited impact on costs. Non-human resources capacity need to be evenly levelled across the surgery pathway to improve their utilisation. The performance of cataract services could be improved by better communication with and proactive management of patients.Peer reviewedFinal Published versio

Optical techniques for 3D surface reconstruction in computer-assisted laparoscopic surgery

One of the main challenges for computer-assisted surgery (CAS) is to determine the intra-opera- tive morphology and motion of soft-tissues. This information is prerequisite to the registration of multi-modal patient-specific data for enhancing the surgeon’s navigation capabilites by observ- ing beyond exposed tissue surfaces and for providing intelligent control of robotic-assisted in- struments. In minimally invasive surgery (MIS), optical techniques are an increasingly attractive approach for in vivo 3D reconstruction of the soft-tissue surface geometry. This paper reviews the state-of-the-art methods for optical intra-operative 3D reconstruction in laparoscopic surgery and discusses the technical challenges and future perspectives towards clinical translation. With the recent paradigm shift of surgical practice towards MIS and new developments in 3D opti- cal imaging, this is a timely discussion about technologies that could facilitate complex CAS procedures in dynamic and deformable anatomical regions

Special Topics in Cardiac Surgery

This book considers mainly the current perioperative care, as well as progresses in new cardiac surgery technologies. Perioperative strategies and new technologies in the field of cardiac surgery will continue to contribute to improvements in postoperative outcomes and enable the cardiac surgical society to optimize surgical procedures. This book should prove to be a useful reference for trainees, senior surgeons and nurses in cardiac surgery, as well as anesthesiologists, perfusionists, and all the related health care workers who are involved in taking care of patients with heart disease which require surgical therapy. I hope these internationally cumulative and diligent efforts will provide patients undergoing cardiac surgery with meticulous perioperative care methods

Preoperative digital three-dimensional planning for rhinoplasty

BACKGROUND: This report describes preoperative digital planning for rhinoplasty using a new three-dimensional (3D) radiologic viewer that allows both patients and surgeons to visualize on a common monitor the 3D real aspect of the nose in its inner and outer sides. METHODS: In the period 2002 to 2008, 210 patients underwent rhinoplasty procedures in the authors' clinic. The patients were randomly divided into three groups according to the type of preoperative planning used: photos only, a simulated result by Adobe Photoshop, or the 3D radiologic viewer. The parameters evaluated included the number of patients that underwent surgery after the first consultation, the number of patients who asked for a reintervention, patient satisfaction (according to a test given to the patients 12 months postoperatively), the surgical time required for a functional intervention, and the improvement in nasal function by postoperative rhinomanometry and subjective evaluation. RESULTS: Computer-aided technologies led to a higher number of patients deciding to undergo a rhinoplasty. Simulation of the postoperative results was not as useful in the postoperative period due to the higher number of reintervention requests. CONCLUSION: The patients undergoing rhinoplasties preferred new technologies in the preoperative period. The advantages of using the 3D radiologic viewer included improved preoperative planning, reduction in intraoperative stress, a higher number of patients undergoing surgery, reduction in postoperative surgical corrections, reduction in surgical time for the functional intervention, a higher rate of improvement in nasal function, a higher percentage of postoperative satisfaction, and reduced costs

New Technologies in Eye Surgery — A Challenge for Clinical, Therapeutic, and Eye Surgeons

Eye surgery is always progresses as the same way that the science advances. New emerging technologies such as bio-printing in 3D, developments and mathematical modeling in prototyping lab- on- a chip, visual implants, new biopolymers started to use in eye enucleation, detection of eye biomarkers at the cellular level, bio-sensors and new diagnostic tests should be considered to improve the quality of life of patients after surgery. This chapter provides a review of new and emerging technologies which are already working on global research centers. Emerging and converging technologies are terms used interchangeably to indicate the emergence and convergence of new technologies with demonstrated potential as disruptive technologies. Among them are: nanotechnology, biotechnology, information technology and communication, cognitive science, robotics, and artificial intelligence that have been launched as innovative products that promise to improve the quality of life and vision of patients with ocular compromised or low vision impairment. Some acronyms for these are: NBIC: Nanotechnology, Biotechnology, Information technology and Cognitive science. GNR: Genetics, Nanotechnology and Robotics. GRIN: Genetic, Robotic, Information, and Nanotechnology. BANG: Bits, Atoms, Neurons and Genes. Otherwise, to training ophthalmologist on news techniques, sophisticated simulation machines has been developing around the world

Anesthesia for Urological Surgery

Because of the variable techniques and patients’ positions used in urological surgery, anesthesia for urologic surgery requires advanced knowledge and special transactions. In this matter, it is important to follow current approaches for anesthesiologists. Different surgical procedures and complications due to different positions or anesthesia were evaluated separately to be more concise. We have researched recent literature and created this chapter about new technologies in urological surgery and development in anesthesia for urological surgery

Bronchial thermoplasty: implementing best practice in the era of cost containment.

Increasing dependence on advanced technologies in the 21st century has created a dilemma between the practice and business of medicine. From information technology to robotic surgery, new technologies have expanded treatment possibilities and have potentially improved patient outcomes and safety. Simultaneously, their escalating costs limit access for certain patients and health care facilities. Nevertheless, medical decisions should not simply be based on cost. Input from physicians and other health care specialists as well as adherence to best practice position statements, are vital to implementing truly cost-effective strategies in medicine. Bronchial thermoplasty (BT), a US Food and Drug Administration approved bronchoscopy procedure in difficult-to-control persistent asthma, is a prime example of a new technology facing cost and implementation challenges. We discuss the specific indications and contraindications for BT and review recent real-world experiences that can provide the foundation for building a comprehensive asthma program that provides BT for difficult-to-control asthma patients who fail national guideline treatment recommendations after an adequate clinical trial of one. We also offer insight into the barriers to implementing a successful BT program and strategies for overcoming them

Disseminating technology in global surgery.

BACKGROUND:Effective dissemination of technology in global surgery is vital to realize universal health coverage by 2030. Challenges include a lack of human resource, infrastructure and finance. Understanding these challenges, and exploring opportunities and solutions to overcome them, are essential to improve global surgical care. METHODS:This review focuses on technologies and medical devices aimed at improving surgical care and training in low- and middle-income countries. The key considerations in the development of new technologies are described, along with strategies for evaluation and wider dissemination. Notable examples of where the dissemination of a new surgical technology has achieved impact are included. RESULTS:Employing the principles of frugal and responsible innovation, and aligning evaluation and development to high scientific standards help overcome some of the challenges in disseminating technology in global surgery. Exemplars of effective dissemination include low-cost laparoscopes, gasless laparoscopic techniques and innovative training programmes for laparoscopic surgery; low-cost and versatile external fixation devices for fractures; the LifeBox pulse oximeter project; and the use of immersive technologies in simulation, training and surgical care delivery. CONCLUSION:Core strategies to facilitate technology dissemination in global surgery include leveraging international funding, interdisciplinary collaboration involving all key stakeholders, and frugal scientific design, development and evaluation