88 research outputs found
Contemporary concepts in hernia prevention: Selected proceedings from the 2017 International Symposium on Prevention of Incisional Hernias.
Incisional hernia is a frequent complication of midline laparotomy and enterostomal creation and is associated
with high morbidity, decreased quality of life, and high costs. The International Symposium on
Incisional Hernia Prevention was held October 19 â20, 2017, at the InterContinental Hotel in San Francisco,
CA, hosted by the Department of Surgery, University of California, San Francisco. One hundred and
three attendees included general and plastic surgeons from 9 countries, including principal participants
for several of the seminal studies in the field. Over the course of the 2-day meeting, there were 38 oral
presentations, 3 keynote lectures, and 2 panel discussions. The Symposium was a combination of new
information but also a comprehensive review of the existing data so as to assess the current state of the field and to set the stage for future research. Further, the Symposium sought to increase awareness and
thus emphasize the importance of preventing the formation of incisional and enterostomal hernias.pre-print443 K
Wrist-Squeezing Force Feedback Improves Accuracy and Speed in Robotic Surgery Training
Current robotic minimally invasive surgery (RMIS) platforms provide surgeons
with no haptic feedback of the robot's physical interactions. This limitation
forces surgeons to rely heavily on visual feedback and can make it challenging
for surgical trainees to manipulate tissue gently. Prior research has
demonstrated that haptic feedback can increase task accuracy in RMIS training.
However, it remains unclear whether these improvements represent a fundamental
improvement in skill, or if they simply stem from re-prioritizing accuracy over
task completion time. In this study, we provide haptic feedback of the force
applied by the surgical instruments using custom wrist-squeezing devices. We
hypothesize that individuals receiving haptic feedback will increase accuracy
(produce less force) while increasing their task completion time, compared to a
control group receiving no haptic feedback. To test this hypothesis, N=21
novice participants were asked to repeatedly complete a ring rollercoaster
surgical training task as quickly as possible. Results show that participants
receiving haptic feedback apply significantly less force (0.67 N) than the
control group, and they complete the task no faster or slower than the control
group after twelve repetitions. Furthermore, participants in the feedback group
decreased their task completion times significantly faster (7.68%) than
participants in the control group (5.26%). This form of haptic feedback,
therefore, has the potential to help trainees improve their technical accuracy
without compromising speed.Comment: 6 figures, 8 page
Impact of the mesh fixation technique on operation time in laparoscopic repair of ventral hernias
Definitions for Loss of Domain: An International Delphi Consensus of Expert Surgeons
BACKGROUND: No standardized written or volumetric definition exists for 'loss of domain' (LOD). This limits the utility of LOD as a morphological descriptor and as a predictor of peri- and postoperative outcomes. Consequently, our aim was to establish definitions for LOD via consensus of expert abdominal wall surgeons. METHODS: A Delphi study involving 20 internationally recognized abdominal wall reconstruction (AWR) surgeons was performed. Four written and two volumetric definitions of LOD were identified via systematic review. Panelists completed a questionnaire that suggested these definitions as standardized definitions of LOD. Consensus on a preferred term was pre-defined as achieved when selected by â„80% of panelists. Terms scoringâ<20% were removed. RESULTS: Voting commenced August 2018 and was completed in January 2019. Written definition: During Round 1, two definitions were removed and seven new definitions were suggested, leaving nine definitions for consideration. For Round 2, panelists were asked to select all appealing definitions. Thereafter, common concepts were identified during analysis, from which the facilitators advanced a new written definition. This received 100% agreement in Round 3. Volumetric definition: Initially, panelists were evenly split, but consensus for the Sabbagh method was achieved. Panelists could not reach consensus regarding a threshold LOD value that would preclude surgery. CONCLUSIONS: Consensus for written and volumetric definitions of LOD was achieved from 20 internationally recognized AWR surgeons. Adoption of these definitions will help standardize the use of LOD for both clinical and academic activities
Support vector machines improve the accuracy of evaluation for the performance of laparoscopic training tasks
Despite technological advances in the tracking of surgical motions, automatic evaluation of laparoscopic skills remains remote. A new method is proposed that combines multiple discrete motion analysis metrics. This new method is compared with previously proposed metric combination methods and shown to provide greater ability for classifying novice and expert surgeons.
For this study, 30 participants (four experts and 26 novices) performed 696 trials of three training tasks: peg transfer, pass rope, and cap needle. Instrument motions were recorded and reduced to four metrics. Three methods of combining metrics into a prediction of surgical competency (summed-ratios, z-score normalization, and support vector machine [SVM]) were compared. The comparison was based on the area under the receiver operating characteristic curve (AUC) and the predictive accuracy with a previously unseen validation data set.
For all three tasks, the SVM method was superior in terms of both AUC and predictive accuracy with the validation set. The SVM method resulted in AUCs of 0.968, 0.952, and 0.970 for the three tasks compared respectively with 0.958, 0.899, and 0.884 for the next best method (weighted z-normalization). The SVM method correctly predicted 93.7, 91.3, and 90.0% of the subjectsâ competencies, whereas the weighted z-normalization respectively predicted 86.6, 79.3, and 75.7% accurately (p < 0.002).
The findings show that an SVM-based analysis provides more accurate predictions of competency at laparoscopic training tasks than previous analysis techniques. An SVM approach to competency evaluation should be considered for computerized laparoscopic performance evaluation systems
Biodegradable hyaluronan hydrogel coatings on acellular dermis graftsâA potential strategy to improve biologic graft durability in hernia repair application
Predictive factors for breast lesion excision system (BLES) accuracy and safety in stereotactic biopsy of suspicious calcifications
Successful 2-channel cold snare polypectomy of a colorectal lesion involving the appendiceal orifice
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