The application of virtual reality simulators in laparoscopic surgery training (a review)

Introduction: The last decade saw a significant introduction of minimally invasive surgery into medical practice. Laparoscopy has even become the gold standard for some interventions. This has led to an increased demand for qualified specialists. The acquisition of laparoscopic surgery skills entrains a time investment both on part of the trainee and the instructor. The need for an accelerated development of specific psycho-motor perceptions which are a requirement for the execution of laparoscopic procedures, led to the establishment of virtual reality simulator training. For the first time in Bulgaria, in 2016, the Medical University of Varna introduced formal education via the way of virtual reality laparoscopic simulators. They permit the development of laparoscopic skills even at the level of a medical student.Aim: The aim of the article is to analyze the efficiency of existing virtual reality simulators and their application in laparoscopic surgery training.Materials and Methods:  А systematic literature analysis was performed via the databases PubMed, Web of Science, Scopus and Google Scholar using various combinations of the following keywords: “simulation”, “virtual*”, “VR”, “laparoscopic*”, “surgery”, “education”, “LapMentor”, “LapSim”, for articles published in the past 10 years. The keywords were in combination with Boolean operators “and”, “or”. After a thorough review of all pertinent articles the most relevant publications were selected.Results: The electronic inquiry yielded 106 articles in total. After the application of suitable inclusion and exclusion criteria, 98 of them were deemed unfit, leaving 8 randomized control trials. To meet the inclusion criteria, the publications needed to be systemized random prospective studies regarding virtual reality simulators in laparoscopic surgery.Conclusion: Advancements in the field of surgery follow closely the introduction of new technologies. This leads to the need for a change of traditional surgery training practices. The need of laparoscopic surgery specialists becomes greater with every passing year. The new generation of virtual reality simulators provides a complete set of basic skill procedures and complete operative procedures. Due to their limitless repeatability, an expert level of proficiency is able to be reached in a relatively short period of time. The surgical community must take note of the practices that have already been adopted by aviation training and introduce mandatory laparoscopic surgery training programs, which all specialists must undergo before undertaking procedures in the operating theater.

Role of Magnetic Resonance Imaging in Patients with Rectal Cancer

In a chapter about rectal cancer there is content about rectal anatomy in relation to magnet-resonanse imaging and TME- surgery (total mesorectal excision). Secondly there is content about imaging methods used in diagnosis and follow-up of rectal cancer. Very important topic is concerning the novel imaging strategies in surgical and radiotherapy planning in the era of individual oncologic approach to the patient. At last there is detailed desctiption and metaanalysis of imaging strategies concerning neoadjuvant and adjuvant radiotherapy and chemotherapy for rectal cancer patients. All imaging markers correspond to substantial oncologic parameters such as survival rates. The connecting bridge is magnet-resonance imaging

Diagnostic modalities for early rectal cancer - review of the literature

Rectal carcinoma represents a significant health problem in the modern world. Its high rate of occurrence and mortality in the late stages of the disease stresses the need for better diagnostic, prognostic and predictive methods. We present a review of the literature concerning the staging modalities, including the characteristics of early rectal carcinoma. Endoscopy, endoluminal ultrasound and magnetic resonance imaging play a major role in the preoperative staging and the restaging of rectal carcinoma. The new devices and technologies improve the diagnostic process thus providing an option for new management strategies and better results

Laparoscopic treatment of liver hydatid disease

Surgical treatment has been considered the only available treatment of liver hydatid disease because of the complete removal of the parasite. According to the new standards for clinical approach to hepatic hydatid disease, there is no golden rule and the individual approach to every patient and cyst is of greatest importance. The laparoscopic method in the treatment of liver hydatid disease includes complete excision of the cyst, unroofing, evacuation and obliteration of the cyst cavity. Some authors perform a direct exploration of the cyst cavity in order to reject or confirm the presence of the communication of the cyst with the biliary tree. The laparoscopic method has advantages as a minimally invasive method with shorter hospital stay and minimal risk of wound complications. All the arguments prove the laparoscopy to be feasible and effective method of treatment of liver hydatid disease.Scripta Scientifica Medica 2013; 45(1): 17-20

Diagnostics of liver hydatid disease

E. granulosis is the species that prevails in most countries around the world and especially in the Mediterranean region. It is one of the most severe infestations in humans. Biological diagnosis is based on serological tests. Eosinophily  is considered variable because it does occur in cases of hydatid cyst disease but its absence does not exclude the possibility of hydatid cyst existence. Imaging diagnostics is important for the classification of the hydatid cysts. Ultrasound is a noninvasive, widely available method with high sensitivity for the diagnosis of hepatic echinococcosis and low price and is a method of choice. CT is the method of a doubt for suppuration of hydatid  cyst. MRI with high contrast resolution of T1 and T2 images demonstrated better pericyst , daughter cysts and matrix. We reviewed the current trends in the diagnosis of liver cystic echinococcosis

Open surgery for liver hydatid disease

Hydatid cyst disease is a cosmopolitan parasitosis. E. granulosis species prevails in most countries around the world and especially in the Mediterranean region. We performed a retrospective literature search on liver hydatid cysts was carried out in ScienceDirect, Scopus, Web of Knowledge, InCites, and MEDLINE data-bases for the period 2000-2012. According to recent literature data, liver is the most commonly affected organ. The principles of surgical approach to the liver hydatid disease include the following: i) neutralization of the parasite; ii) evacuation of the cyst and removal of the germinative layer, and iii) treatment of the remaining cavity. The marsupialization of the remaining cyst is not accepted in case of suppurated hydatid cyst. There are numerous opinions about the most efficient scolicidal solution. The most intractable problem is the approach to the residual cavity of hydatid cyst. Major postoperative complications reported by different authors are mainly inflammatory processes. The radical surgical method is indicated in case of peripherally located hydatid cysts, several cysts grouped in a liver segment or lobe, and cysts located in the left lateral hepatic lobe. The surgical method still remains the golden standard for treatment of liver hydatid cysts.Scripta Scientifica Medica 2013; 45(3): 23-26

Endoscopic Submucosal Dissection for Early Colon Cancer

Endoscopic submucosal dissection (ESD) was first implemented in early gastric cancer allowing for en-bloc resection of the lesions. With the experience came the expertise to introduce ESD for early colon cancer (ECC). ESD demonstrates several advantages in comparison with the endoscopic mucosa resection. It allows accurate histological assessment of the depth of invasion, minimizes the risk of local recurrence and helps in the determination of additional therapy. Indications for ESD are placed only after adequate endoscopic morphological classification of the lesions excluding higher risk of nodal metastases. This chapter provides an overview of the application of ESD techniques in ESD for ECC and provides assessment on its technical aspects and complications. In order to decrease the rate of complications a standard protocol for the ESD should be adopted. The protocol includes recommendations for patient selection, bowel and patient preparation, appropriate equipment (knives, endoscopes, and power devices). The chapter will review the current ESD techniques and oncological results. ESD could have great impact on the treatment of early colon cancer. Its role is already proven in rectal localizations and despite the challenges it should be adopted for the colon. Safe strategy for ESD is the cornerstone in decreasing complications, which includes suitable resection of specialized ESD devices

Comparative analysis of application of conventional colonoscopy and NBI colonoscopy for detection of early colorectal cancer

PURPOSE: Extending life expectancy is one of the major causes for increasing cancer incidence rate. The objective of the present investigation is to compare the diagnostic value of conventional and narrow band imaging (NBI) colonoscopy for the early diagnosis of colorectal cancer.MATERIAL AND METHODS: We examined 163 patients hospitalized in the First Clinic of Surgery, St. Marina University Hospital of Varna, for a period from 2010 to 2012 and compared the diagnostic modalities of conventional colonoscopy and NBI-colonoscopy.RESULTS: NBI colonoscopy with magnifying endoscopy had the potential to detect more lesions remaining not identified by conventional endoscopy. The relative share of newly-increased mucosal changes increased by 1.9 times (52%). The newly-diagnosed lesions were mostly small sized. We diagnosed by 2.7 times more lesions sized less than one mm as well as by two times, 1.7 and 1.3 times more lesions sized 1-3 mm, 3-5 mm and 5-9 mm, respectively. The method did not establish any new formations larger than one cm or more. The main part of the newly-detected lesions presented with non-specific inflammatory changes, i.e. by 9.2 times more often when compared to conventional endoscopy and represented hyperplastic/ inflammatory polyps by 2-3 times more often. In four new lesions there were either an early cancer, or areas of high-grade dysplasia while in 12 ones there was a low-grade dysplasia.CONCLUSION: NBI colonoscopy with magnifying endoscopy represents a reliable method for the diagnosis of small neoplasms of the colon.Scripta Scientifica Medica 2013; 45(2): 43-47

Hydatid liver disease - a review of the literature

Hydatid cyst disease of the liver is a worldwide parasitosis with significant debilitating effect on the patients. In Bulgaria, the most important biological reservoir and the final host is the dog. The distribution of the disease in the territory of the country is variable. Advances of laboratory and imaging diagnostic methods provide new options for multimodal approach. Surgery has been mainstay of treatment, however, new minimally invasive methods such as laparoscopic surgery and PAIR present with advantages in selected patients. Perioperative therapy diminishes postoperative relapses. In the present review, new data about the epidemiology and recent achievements in diagnosis and management of hydatid liver disease are presented.Scripta Scientifica Medica 2013; 45(2): 17-22