Gripping the difficult gall bladder during laparoscopic cholecystectomy

Journal compilation © 2009 Royal Australasian College of SurgeonsGrasping a tense, inflamed gall bladder during laparoscopic cholecystectomy for acute cholecystitis is often a problem. Although many surgeons have developed techniques to deal with this, the published work lacks information about how to manage this problem. To collate experience about how to deal with this we interviewed 20 experienced Australian surgeons and compiled a repertoire of tactics that might help deal with this clinical situation. Most surgeons indicated that they deflated the gall bladder using a needle and suction as a preliminary step. Most respondents also described the use of a specific type of forceps for the task. Various manoeuvres, such as displacement of the gall bladder with forceps, dislodging an impacted stone to make it easier to grasp, the use of a retraction suture through the gall bladder were described. The various tactics are summarized in the paper. A range of strategies applied by experienced surgeons for the task of gripping a difficult gall bladder has been documented in this paper. The variety of approaches suggests that surgeons should be prepared to flexibly apply different approaches to this task.Michael Patkin and David I. Watso

Применение многорежимных моделей при моделировании динамики российских фондовых индексов

We propose a novel architecture for face and emotion recognition and discuss modifications for different types of mobile applications. Emotion recognition task is challenging due to the absence of large-scale datasets and non-uniform labelling. We propose easy-to-implement five class classification approach and suggest modifications for large-scale emotion recognition on three different platforms: desktop, mobile and VPU, and compare the resulting speed and performance. We demonstrate that our results can be compared with the performance of state-of-the-art neural networks and can be implemented on mobile and stand-alone devices

Face and emotion recognition with neural networks on mobile devices: Practical implementation on different platforms

We propose a novel architecture for face and emotion recognition and discuss modifications for different types of mobile applications. Emotion recognition task is challenging due to the absence of large-scale datasets and non-uniform labelling. We propose easy-to-implement five class classification approach and suggest modifications for large-scale emotion recognition on three different platforms: desktop, mobile and VPU, and compare the resulting speed and performance. We demonstrate that our results can be compared with the performance of state-of-the-art neural networks and can be implemented on mobile and stand-alone devices

Dissection efficiency during laparoscopic oesophageal dissection

© 2005 Taylor & Francis Group LtdAdvanced techniques in laparoscopic surgery have led to an increased need for appropriate training in instrument handling and dissection. Recent developments in computer video technology have facilitated critical analysis of surgical technique. Video deconstruction of oesophageal hiatal dissection during six laparoscopic fundoplication procedures was undertaken. The procedures were performed by surgeons with a wide range of surgical experience, and the investigators analysing performance were blinded to their level of training. Sequential five-second video segments were analysed in detail by 3 investigators. A taxonomy list was developed to describe individual types of movement. The number and time per movement was assessed and a degree of efficiency was assigned. An efficient movement was defined as one that advances the dissection towards a recognised goal. The total oesophageal dissection time varied from 10 minutes (min) to 25 min (mean 16 min). The mean number of actions performed was 173 (range 120-272). A mean of 7 min was spent separating tissues (range 5-13), with 6 min spent grasping and positioning tissue (range 3-8). The amount of time spent in inefficient movement varied from 3 to 14 min (mean 7 min). The greatest variation between operators was seen in the efficiency of tissue separation when using dissecting instruments. Inexperienced operators spent a lot more time performing additional movements such as scope cleaning, observation and instrument exchange. This technique of video deconstruction can identify key areas for improvement. This could be used for trainee assessment and to provide constructive feedback. Future development in this area could enhance training in advanced laparoscopic techniques.P. C. Leeder, M. Patkin, J. Stoddard and D. I. Watso