Robotic camera holder as good as expert camera holder: a randomized crossover trial.

INTRODUCTION: This study aimed to compare the impact of robotic camera holder (RCH) and human camera holder (HCH) on product quality and procedure effectiveness of a simulated laparoscopic procedure. METHODS: This was a prospective randomized crossover trial including voluntary surgical residents. Block randomization generated RCH-HCH or HCH-RCH sequence allocation. The task was suturing a duodenal perforation on foam stomach with intracorporeally knot tying in a simulator. The camera was operated by the same robot and same expert. Product quality was measured by accuracy error, tissue damage, sliding knot, and leak. Procedure effectiveness was measured by operating time, nongoal directed actions, and dangerous actions. Kendall\u27s coefficient tau_b was used for interrater reliability between 2 blinded assessors. RESULTS: Forty-four subjects performed their tasks as allocated. Product quality and procedure effectiveness were similar when first attempt of task was compared with the repeat task by same subject ignoring the type of camera holder. There was no evidence of significant unequal carryover effect when comparison was stratified by RCH-HCH or HCH-RCH sequences. There were no differences in product quality and procedure effectiveness when RCH was compared with HCH. Coefficient tau_b was \u3e or = 0.80 for all but dangerous actions (0.72, P=0.08). CONCLUSIONS: RCH and HCH had similar impact on product quality and procedure effectiveness of simulated laparoscopic procedure

Complication rates after Hartmann\u27s reversal: open vs. laparoscopic approach.

PURPOSE: This study was performed to compare open Hartmann\u27s reversal to laparoscopic Hartmann\u27s reversal with regard to complication, readmission, and reoperation rates. METHODS: Data of patients who underwent open Hartmann\u27s reversal or laparoscopic Hartmann\u27s reversal between 1998 and 2004 at two institutions were collected. End points were complications in the hospital or after discharge, readmission to the hospital, and reoperation within 6 months after initial surgery. RESULTS: Sixty-one open Hartmann\u27s reversal and 61 laparoscopic Hartmann\u27s reversal patients were well matched except for American Society of Anesthesiology grade (1.9 vs. 1.6; P = 0.008), timing of Hartmann\u27s procedure (14 vs. 6 months; P = 0.001), operation time (210 vs. 154 minutes; P = 0.001), and estimated blood loss (363 vs. 254 ml; P = 0.01). Thirty-day complication rates did not differ (18 vs. 13 percent). At 6 month follow-up, open Hartmann\u27s reversal patients had increased complication (16.4 vs. 3.3 percent; P = 0.015) and reoperation (13.1 vs. 3.3 percent; P = 0.048) rates but the same readmission rates (16.4 percent). CONCLUSIONS: Compared with open Hartmann\u27s reversal, 6 month complication and reoperation rates were lower in laparoscopic Hartmann\u27s reversal patients. Most of the six-month complications and reoperations in open Hartmann\u27s reversal were abdominal wall-related. Readmission rates were similar, but reasons for readmission were surgical in open Hartmann\u27s reversal and medical in laparoscopic Hartmann\u27s reversal