Development of a Virtual Laparoscopic Trainer using Accelerometer Augmented Tools to Assess Performance in Surgical training

Previous research suggests that virtual reality (VR) may supplement conventional training in laparoscopy. It may prove useful in the selection of surgical trainees in terms of their dexterity and spatial awareness skills in the near future. Current VR training solutions provide levels of realism and in some instances, haptic feedback, but they are cumbersome by being tethered and not ergonomically close to the actual surgical instruments for weight and freedom of use factors. In addition, they are expensive hence making them less accessible to departments than conventional box trainers. The box trainers in comparison, although more economical, lack tangible feedback and realism for handling delicate tissue structures. We have previously reported on the development of a modified digitally enhanced surgical instrument for laparoscopic training, named the Parkar Tool. This tool contains wireless accelerometer and gyroscopic sensors integrated into actual laparoscopic instruments. By design, it alleviates the need for both tethered and physically different shaped tools thereby enhancing the realism when performing surgical procedures. Additionally the software (Valhalla) has the ability to digitally record surgical motions, thereby enabling it to remotely capture surgical training data to analyse and objectively evaluate performance. We have adapted and further developed our initial single training tool method as used with a laparoscopic pyloromyotomy scenario, to an enhanced method using multiple Parkar wireless tools simultaneously, for use in several different case scenarios. This allows the use and measurement of right and left handed dexterity with the benefit of using several tasks of differing complexity. The development of a 3D tissue-surface deformations solution written in OpenGL gives us several different virtual surgical training scenario approximations to use with the instruments. The trainee can start with learning simple tasks e.g. incising tissue, grasping, squeezing and stretching tissue, to more complex procedures such as suturing, herniotomies, bowel anastomoses, as well as the original pyloromyotomy as used in the first model

Heterotopic pregnancy in an assisted reproduction conception; case report and literature review

Infertility management by assisted reproduction techniques has had rapid increase. While there is robust evidence supporting the efficacy and safety of assisted reproduction technique (ART), complications are encountered. Heterotopic pregnancy, defined as the presence of both an intrauterine and an ectopic gestation, is a rare eventuality of early pregnancy. A 42 years old patient (Para 0+1) with a diagnosis of secondary infertility is presented; she had In Vitro fertilization (IVF) with egg donation. Two weeks after the IVF, a positive serum Beta Human Chorionic Gonadotropin confirmed the pregnancy and she continued with intake of progestins for luteal phase support. At 7 weeks gestation she presented at a local hospital with acute pelvic pain. A diagnosis of heterotopic pregnancy was made after transvaginal showed right slow leaking ectopic pregnancy andintrauterine missed abortion. Laparoscopic surgery, right salpingectomy and manual vacuum aspiration were performed with good subsequent recovery. The case presented, discusses the aetiology, clinical presentation, diagnosis and management of heterotopic pregnancy

Day care laparoscopic surgery in gynaecology at a dedicated unit in Nairobi, Kenya

Objective: To evaluate and audit the outcomes of Gynaecological Day care Laparoscopic Surgery inNairobi,KenyaDesign: Retrospective case analysisSetting: The International Centre for Minimal Access Surgery, NairobiSubjects: one thousand three hundred and seventy nine patients undergoing Laparoscopic SurgeryResults: Between January 2011 to December 2015 a total of 1,379 Laparoscopic procedures were undertaken during the reporting period of which 1,121 ( 88.5 % ) were done as day procedures. In total 137 patients ( 9.9 % ) spent one night at ICMAS, 21 ( 1.5 % ) were transferred to a Major Hospital and 41 patients (2.9 %) underwent conversion to Laparotomy. There were two Hospital re-admissions (0.14 % ) and one complication ( 0.07% ), a bladder injury was encountered.Conclusions: Daycare surgery is a continually evolving speciality being competently performed by several units by various disciplines world over , including Kenya. In recent years the complexity of the procedures has increased with a wider range of patients being considered for challenging surgeries including those presenting with acute conditions. Our experiences have been favourable

Investigation of complete and incomplete fusion in 7^{7}Li+124^{124}Sn reaction around Coulomb barrier energies

The complete and incomplete fusion cross sections for $^{7}$Li+$^{124}$Sn reaction were measured using online and offline characteristic $\gamma$-ray detection techniques. The complete fusion (CF) cross sections at energies above the Coulomb barrier were found to be suppressed by $\sim$ 26 \% compared to the coupled channel calculations. This suppression observed in complete fusion cross sections is found to be commensurate with the measured total incomplete fusion (ICF) cross sections. There is a distinct feature observed in the ICF cross sections, i.e., $\textit{t}$-capture is found to be dominant than $\alpha$-capture at all the measured energies. A simultaneous explanation of complete, incomplete and total fusion (TF) data was also obtained from the calculations based on Continuum Discretized Coupled Channel method with short range imaginary potentials. The cross section ratios of CF/TF and ICF/TF obtained from the data as well as the calculations showed the dominance of ICF at below barrier energies and CF at above barrier energies.Comment: 9 pages, 8 figure

BATSE spectroscopy analysis system

The Burst and Transient Source Experiment (BATSE) Spectroscopy Analysis System (BSAS) is the software system which is the primary tool for the analysis of spectral data from BATSE. As such, Guest Investigators and the community as a whole need to know its basic properties and characteristics. Described here are the characteristics of the BATSE spectroscopy detectors and the BSAS