Advanced Endoscopic Procedures Research Articles

The Vale knot: an intracorporeal slipknot.

Mastering intracorporeal ligation and suturing is an essential skill for the performance of most advanced endoscopic surgical procedures. Although many disposable instruments have become available for various tasks necessitating the construction of sutures and knots; issues of performance, safety, and cost-efficiency remain to be settled. The authors believe that training should aim at the development of manual skills that could realize the clinical and cost-efficiency benefits of using conventional surgical tasks in the endoscopic setting.

Medical Service and Robotics in 21st Century. Robotic devices for advanced endoscopic surgical procedures. An overview.

The advent of endoscopic techniques had considerable influence on surgery in many clinical areas. This paper intends to describe an overview about robotics technologies facilitating endoscopic surgery.A major enhancement for endoscopic techniques is the introduction of robotic technology to design assisting devices for solo-surgery and manipulators for microsurgical instrumentation to provide the surgeon with ad-ditional degrees of freedom of instrumentation. In 1996 a first prototype of an endoscopic manipulator system, named ARTEMIS, could be used in experimental applications. Master slave systems consist of a user station (master) and an instrument station (slave) . The surgeon sits at a console which integrates endoscopic monitors, communication facilities and two master devices to control the slave arms which are mounted to the operating table. Systems developed by industry quickly gained the interest of the surgical community and are today employed at several specialised centers around the world in clinical use, mainly in the area of cardiac surgery. The combination of telecomunication technology with robotic instruments will open new frontiers, such as teleconsulting, teleassistance and telemanipulation.With the increasing complexity of endoscopic surgery in the various clinical specialties, such as general, cardiac or other fields of surgery, came the demand for more sophisticated instrumentation. Robotics was soon identified as a major pacemaker towards the technological future of minimally invasive surgery. The first steps in the use of robotics for increasing instrument functions were made in the area of endoscope guidance, where robotic instrument holders got used to direct the endoscope during the operation [1] [3] . Robotic endoscope holders demonstrated to be efficient and safe in clinical use and are today accepted as assisting devices among endoscopic surgeons [4] . The field of robotics for enhancing surgical instrumentation did not emerge so fast as the former because of its technical complexity and safety concerns linked to the use of robotic devices for surgical operations.

Robotics and systems technology for advanced endoscopic procedures: experiences in general surgery*1

Robotics and systems technology for advanced endoscopic procedures: experiences in general surgery*1

Robotics and systems technology for advanced endoscopic procedures: experiences in general surgery

The advent of endoscopic techniques changed surgery in many regards. This paper intends to describe an overview about technologies to facilitate endoscopic surgery. The systems described have been developed for the use in general surgery, but an easy application also in the field of cardiac surgery seems realistic. The introduction of system technology and robotic technology enables today to design a highly ergonomic solo-surgery platform. To relief the surgeon from fatigue we developed a new chair dedicated to the functional needs of endoscopic surgery. The foot pedals for high frequency, suction and irrigation are integrated into the basis of the chair. The chair is driven by electric motors controlled with an additional foot pedal joystick to achieve the desired position in the OR. A major enhancement for endoscopic technology is the introduction of robotic technology to design assisting devices for solo-surgery and manipulators for microsurgical instrumentation. A further step in the employment of robotic technology is the design of 'master-slave manipulators' to provide the surgeon with additional degrees of freedom of instrumentation. In 1996 a first prototype of an endoscopic manipulator system. named ARTEMIS, could be used in experimental applications. The system consists of a user station (master) and an instrument station (slave). The surgeon sits at a console which integrates endoscopic monitors, communication facilities and two master devices to control the two slave arms which are mounted to the operating table. Clinical use of the system, however, will require further development in the area of slave mechanics and the control system. Finally the implementation of telecommunication technology in combination with robotic instruments will open new frontiers, such as teleconsulting, teleassistance and telemanipulation.

ERCP training: for the few, not for all

See article on page 154 Endoscopic retrograde cholangiopancreatography (ERCP) is an advanced endoscopic procedure that requires considerable training and experience to perform effectively and safely.1 It is the most dangerous...

Experience with minimally invasive surgery in infants

Background: This study evaluates the feasibility, safety, and efficacy of performing advanced endoscopic procedures in infants under 5 kg. Methods: Over a 51-month period 183 infants weighing 1.3 to 5.0 kg underwent 195 procedures using minimally invasive techniques. The majority of the procedures were performed using 3.5-mm instruments and 2.7-mm scopes. Procedures include Nissen fundoplication, pyloromyotomy, colon pull-through, patent ductus arteriosus closure, Ladd’s procedure, colon resection, congenital diaphragmatic hernia repair, ovarian cyst excision, and exploration. Results: All but two procedures were completed successfully endoscopically. There were two intraoperative complications and no mortality. Days to discharge for patients admitted for their specific procedure were Nissen 2.1, patent ductus arteriosus 2, pyloromyotomy 1, and pull-through 3.4. Conclusions: This study demonstrates that advanced endosurgical techniques in infants is safe, effective, and associated with the same benefit as that seen in older patients.

Gastrointestinal Endoscopy—Beyond the Basics

1Associate Professor of Medicine, Emory University School of Medicine Eugene R Schiff; John Baillie Butterworth-Heineman, Boston, 1997, 158 pp.$55.00, ISBN 0-750695552

Laparoscopic tissue fragmentation under visual control: Concept and experimental experience

The extraction of resected tissue is a specific problem of advanced endoscopic procedures in different fields of minimally invasive therapy. The retrieval of parenchymatous organs like the kidney or the spleen requires either laparotomy or intracorporeal morcellation. Most of the current morcellation techniques result in uncontrolled fragmentation or liquidization of the organ. The post-operative pathologic work-up is therefore severely limited. Our concept of organ fragmentation and retrieval is based on a large bag which we called TRIPORTBAG (three port bag) with two supplemental access tubes. After organ entrapment the three access points are withdrawn from the abdominal cavity. An endoscope and specific instruments can be introduced into the bag. Tissue fragmentation is carried out under continuous video imaging and recording. The fragmentation can be performed with various tools, e.g. scissors of HF-electrodes. This procedure allows selective intracorporeal work-up of the pathologic organ similar to ...

A hospital review of advanced gynecologic endoscopic procedures

OBJECTIVE: Our purpose was to review the findings of a Gynecologic Endoscopic Review Committee established to monitor and review operative endoscopic procedures performed by the staff at a large private hospital, Swedish Hospital Medical Center, in Seattle. STUDY DESIGN: Hospital charts of patients undergoing the endoscopic procedures under review are pulled monthly, and the data are extracted, particularly as related to performance of the procedures, length of surgery and hospitalization, and occurrence of complications. This study is a compilation of the committee's review of a 15-month interval, Jan. 1, 1992, to March 31, 1993. RESULTS: Forty-two surgeons performed 227 endoscopic procedures on 218 patients, 100 hysteroscopically and 127 laparoscopically. Significant complication rates were associated with the transhysteroscopic operative procedures and with many of the translaparoscopic procedures, including oophorectomy, ovarian cystectomy, myomectomy, pelviscopic lysis of adhesions, and laparoscopic-assisted vaginal hysterectomy. CONCLUSIONS: A significant complication rate was found for many of the advanced endoscopic procedures performed at Swedish Hospital Medical Center. This is likely related to operator inexperience in performing relatively difficult endoscopic procedures involving new and ever-expanding arrays of techniques and instruments. (AM J Obstet Gynecol 1994;170:1635-42.)

A hospital review of advanced gynecologic endoscopic procedures

A hospital review of advanced gynecologic endoscopic procedures

Applications of the laparoscopic ultrasonic aspirator for advanced gynecologic operative endoscopic procedures

We evaluated the efficacy of a new laparoscopic ultrasonic aspirator and applied it in gynecologic endoscopy. Two procedures were selected for preliminary evaluation of the instrument: ultrasonic aspiration for selective presacral neurectomies and total laparoscopic hysterectomy (TLH). The aspirator worked successfully in evaluating soft tissue and in adequately exposing the presacral plexus. In TLH we were able to skeletonize the broad ligament adventilia all the way to the level of the uterine arteries bilaterally, including exposure of the ureters. The time required for the procedures varied from case to case, and strongly depended on tissue type and on instruments used to dissect and improve visualization of the operative field. The aspirator may prove useful as an adjunctive in the surgical management of endometriosis, in laparoscopic lymphadenectomy, and in treating complex adhesions after further evaluation is completed.