Proof‐of‐concept of a laser mounted endoscope for touch‐less navigated procedures

Background and Objectives

During navigated procedures a tracked pointing device is used to define target structures in the patient to visualize its position in a registered radiologic data set. When working with endoscopes in minimal invasive procedures, the target region is often difficult to reach and changing instruments is disturbing in a challenging, crucial moment of the procedure. We developed a device for touch less navigation during navigated endoscopic procedures.

Materials and Methods

A laser beam is delivered to the tip of a tracked endoscope angled to its axis. Thereby the position of the laser spot in the video‐endoscopic images changes according to the distance between the tip of the endoscope and the target structure. A mathematical function is defined by a calibration process and is used to calculate the distance between the tip of the endoscope and the target. The tracked tip of the endoscope and the calculated distance is used to visualize the laser spot in the registered radiologic data set.

Results

In comparison to the tracked instrument, the touch less target definition with the laser spot yielded in an over and above error of 0.12 mm. The overall application error in this experimental setup with a plastic head was 0.61 ± 0.97 mm (95% CI ?1.3 to +2.5 mm).

Conclusion

Integrating a laser in an endoscope and then calculating the distance to a target structure by image processing of the video endoscopic images is accurate. This technology eliminates the need for tracked probes intraoperatively and therefore allows navigation to be integrated seamlessly in clinical routine. However, it is an additional chain link in the sequence of computer‐assisted surgery thus influencing the application error. Lasers Surg. Med. 45:377–382, 2013. © 2013 The Authors. Lasers in Surgery and Medicine published by Wiley Periodicals, Inc.

     

Feasibility case‐controlled study of day‐case haemorrhoidectomy

Introduction: Haemorrhoidectomy is traditionally an inpatient procedure. With many benefits, the day‐surgery arrangement is an attractive alternative. The feasibility of day‐surgery haemorrhoidectomy was explored and the hospital days were calculated in a case controlled design. Methods: A single surgeon’s experience of day‐surgery haemorrhoidectomy between 1 July 1999 and 31 March 2000 was compared with inpatient haemorrhoidectomy during the same period. The operations were performed at United Christian Hospital Department of Surgery, Hong Kong (a government‐funded public hospital). Statistical tests were applied where appropriate. Results: There were 30 day‐surgery and 15 inpatient haemorrhoidectomies. The groups were comparable in terms of age, gender, severity of haemorrhoids, method and duration of haemorrhoidectomy, blood loss, residual haemorrhoids, duration of follow up and unplanned readmission rate. Significantly more day‐patients received general than spinal anaesthesia. Twenty‐six of 30 (87%) patients were successfully discharged after day surgery. Two were admitted for transient fever (< 24 h), one for micturition syncope and one for acute urinary retention. There were four unplanned readmissions after day surgery: one for pain and three for secondary bleeding. All stopped spontaneously. All three unplanned readmissions after inpatient surgery were for secondary bleeding. All stopped spontaneously. Patient stay was significantly shorter for day surgery (1 ± 1 day) than for the inpatient arrangement (4 ± 1.6 days). Conclusion: Day‐surgery haemorrhoidectomy is feasible. The significantly shorter hospital stay implies savings in public medical expenses.     

Single‐incision laparoscopic colonic surgery

Aim SILS is an area of growing interest in colorectal surgery. We report our preliminary experience of 13 consecutively selected patients undergoing colonic surgery using SILS. Method From July 2009 to January 2010, 13 patients (five men) of median age 56 (23–82) years and a body mass index (BMI) of 23.5 (18–30) kg/m² underwent colonic surgery. Procedures included subtotal colectomy (1), ileocolic resection (2), right colectomy (4) and sigmoidectomy for benign disease (6). Three instruments (including camera) were introduced through a single 2.5‐cm port (SILS? Port Multiple Instrument Access Port; Covidien Inc., Norwalk, Connecticut, USA) inserted at the umbilicus. Results The median operating time was 150 (100–240) min, and the median size of the umbilical port incision was 32 (25–50) mm. There was no postoperative mortality and morbidity, and the median hospital stay was 6 (4–10) days. The cosmetic result was judged to be excellent in 12 of 13 patients who felt it to be better than expected. Conclusion This preliminary experience shows that SILS is technically feasible and safe for colonic resection.     

Computer‐assisted Orthopaedic Surgery

Nowadays, operating rooms can be inefficient and overcrowded. Patient data and images are at times not well integrated and displayed in a timely fashion. This lack of coordination may cause further reductions in efficiency, jeopardize patient safety, and increase costs. Fortunately, technology has much to offer the surgical disciplines and the ongoing and recent operating room innovations have advanced preoperative planning and surgical procedures by providing visual, navigational, and mechanical computerized assistance. The field of computer‐assisted surgery (CAS) broadly refers to surgical interface between surgeons and machines. It is also part of the ongoing initiatives to move away from invasive to less invasive or even noninvasive procedures. CAS can be applied preoperatively, intraoperatively, and/or postoperatively to improve the outcome of orthopaedic surgical procedures as it has the potential for greater precision, control, and flexibility in carrying out surgical tasks, and enables much better visualization of the operating field than conventional methods have afforded. CAS is an active research discipline, which brings together orthopaedic practitioners with traditional technical disciplines such as engineering, computer science, and robotics. However, to achieve the best outcomes, teamwork, open communication, and willingness to adapt and adopt new skills and processes are critical. Because of the relatively short time period over which CAS has developed, long‐term follow‐up studies have not yet been possible. Consequently, this review aims to outline current CAS applications, limitations, and promising future developments that will continue to impact the operating room (OR) environment and the OR in the future, particularly within orthopedic and spine surgery.     

SINGLE‐ VERSUS MULTIPLE‐DOSE ANTIBIOTICS PROPHYLAXIS FOR CARDIAC SURGERY

Background : This study was carried out to determine if single‐dose antimicrobial prophylaxis is sufficient for cardiac surgery. Methods : The study was a prospective non‐randomized trial of 353 consecutive patients undergoing cardiac surgery. Group A (n = 151) received 48 h of prophylaxis and Group B (n = 202) received a single dose. Cephazolin was used in all patients except those at high risk from methicillin‐resistant Staphylococcus aureus (MRSA) who received teicoplanin and timentin. Results : There was an overall in‐hospital infection rate of 2.8%. There was no significant difference in rate or type of infection between the two groups. Conclusions : An in‐hospital infection rate of 2.8% compares favourably with other reported series. Single‐dose antimicrobial prophylaxis is as effective as a 48‐h regimen. Targeting high‐risk groups is effective.