Laparoscopic Abdominal Surgery Research Articles

Effects of pneumoperitoneum and Trendelenburg position on intracranial pressure and cerebral blood flow assessed using transcranial doppler: A prospective observational study.

Laparoscopic lower abdominal surgeries involve carbon dioxide (CO2) insufflation and Trendelenburg position. The raised intra-abdominal pressure can increase intracranial pressure (ICP) and alter cerebral blood flow. This study was conducted to determine the effect of pneumoperitoneum and Trendelenburg position on ICP and cerebral perfusion pressure (CPP) measured using transcranial Doppler (TCD). A prospective observational study was conducted in 43 patients of either sex, aged between 18 and 60 years with American Society of Anesthesiologists physical status I and II, undergoing elective laparoscopic surgery in Trendelenburg position. After standard anesthesia induction, pneumoperitoneum was created to facilitate surgery, maintaining an intra-abdominal pressure of 10-15 mmHg and Trendelenburg position of 25°-30°. End-tidal carbon dioxide (EtCO2) was maintained between 30 and 35 mmHg. The ICP was assessed non-invasively using TCD-based diastolic flow velocities (FVd) and pulsatility index (PI) of middle cerebral artery. Data was represented as mean ± standard deviation and compared using paired t test. A P value of < 0.05 was considered significant. Mean ICPPI at baseline was 14.02 ± 0.89 mmHg which increased to 14.54 ± 1.21 mmHg at pneumoperitoneum and Trendelenburg position (P = 0.005). Mean ICPFVd at baseline was 6.25 ± 2.47 mmHg which increased to 8.64 ± 3.79 mmHg at pneumoperitoneum and Trendelenburg position (P < 0.001). There was no statistically significant change in the CPP or mean arterial pressure values intraoperatively. Laparoscopic procedures with CO2 pneumoperitoneum in Trendelenburg position increase ICP as measured using TCD ultrasonography. The CPP was not significantly altered when EtCO2 was maintained in the range of 30-35 mmHg.

A prospective randomized comparative analysis between opioid based anaesthesia vs opioid free anaesthesia on depth of anaesthesia and intraoperative hemodynamics in patients undergoing elective laparoscopic surgeries lasting less than 3 hours

To avoid the adverse effects of opioid usage, an opioid-free multimodal approach for analgesia can be applied. This study was conducted with an aim to compare the effect of opioid-free anesthesia (dexmedetomidine, lignocaine, dexamethasone and ketamine) and opioid-based anesthesia (fentanyl) on maintaining depth of anaesthesia and intraoperative hemodynamic stability in patients scheduled for Laparoscopic surgeries. We conducted a prospective randomized comparative study on ASA Grade 1 – 2 patients admitted for laparoscopic abdominal surgeries sampling by block Randomization technique with sample size of 60 (30 in each group). In opioid based group, anaesthesia was induced with Inj. Fentanyl 2 mcg/kg before induction while in opioid-free group loading dose of Inj. Dexmedetomidine 1 mcg/kg over 10 min, infusion 0.5 mcg/kg/hr, Inj. Lignocaine 1.5 mg/kg, infusion of 1.5 mg/kg/hr after loading dose, Inj. Dexamethasone 8 mg, Inj. Ketamine 0.5 mg/kg was given. Intraoperatively, the hemodynamic stability and depth of anaesthesia was assessed by measuring the heart rate, blood pressure and BIS values.In the opioid-free group we had few significant decreases in HR and increases in MAP. The depth of anaesthesia was adequate and comparable to the opioid-based group. Hemodynamically, overall heart rates did not vary much between the two groups and the MAP values were higher in the opioid-free group closer to intubation and extubationOpioid-free, multimodal approach can safely replace the single opioid-based approach of anaesthesia management in the conduct of general anaesthesia.

Fragility of statistically significant findings from randomized trials in comparing laparoscopic versus robotic abdominopelvic surgeries.

Utility of robotic over laparoscopic approach has been an area of debate across all surgical specialties over the past decade. The fragility index (FI) is a metric that evaluates the frailty of randomized controlled trials (RCTs) findings by altering the status of patients from an event to non-event until significance is lost. This study aims to evaluate the robustness of RCTs comparing laparoscopic and robotic abdominopelvic surgeries through the FI. A search was conducted in MEDLINE and EMBASE for RCTs with dichotomous outcomes comparing laparoscopic and robot-assisted surgery in general surgery, gynecology, and urology. The FI and reverse fragility Index (RFI) metrics were used to assess the strength of findings reported by RCTs, and bivariate correlation was conducted to analyze relationships between FI and trial characteristics. A total of 21 RCTs were included, with a median sample size of 89 participants (Interquartile range [IQR] 62-126). The median FI was 2 (IQR 0-15) and median RFI 5.5 (IQR 4-8.5). The median FI was 3 (IQR 1-15) for general surgery (n = 7), 2 (0.5-3.5) for gynecology (n = 4), and 0 (IQR 0-8.5) for urology RCTs (n = 4). Correlation was found between increasing FI and decreasing p-value, but not sample size, number of outcome events, journal impact factor, loss to follow-up, or risk of bias. RCTs comparing laparoscopic and robotic abdominal surgery did not prove to be very robust. While possible advantages of robotic surgery may be emphasized, it remains novel and requires further concrete RCT data.

Development and validation of a video-assisted liver biopsy technique using a minimally-invasive device

BackgroundPercutaneous liver biopsy is the gold standard technique for establishing the cause of cirrhosis and liver disease activity assessment. However, some cases of steatohepatitis or other chronic liver diseases show a high number of false negative results in samples obtained via the percutaneous route. This fact justifies performing a liver biopsy via the laparoscopic route. However, this is an expensive technique, with morbidities associated with pneumoperitoneum and anesthetic complications. The main objective of this study is to develop a video-assisted technique that uses only a minimally-invasive device for the liver biopsy and the optical trocar. Without additional trocars, this technique constitutes a less invasive procedure than the existing techniques in clinical practice.MethodsThis is a device development and validation study and patients submitted to abdominal laparoscopic surgery and required liver biopsy for moderate to severe steatosis were recruited. The patients were randomized into two groups: laparoscopic liver biopsy technique (n = 10, control group) and mini-laparoscopic liver biopsy technique (n = 8, experimental group). The times associated with procedure performance in both groups were evaluated using the Mann–Whitney or Kruskal–Wallis tests according to data distribution.ResultsAt baseline, there was no statistical difference regarding gender and type of surgery. The experimental group had a significantly shorter time compared with the group that underwent the traditional procedure in mean procedure time (p = 0.003), biopsy time (p = 0.002) and hemostasis time (p = 0.003).ConclusionsThe mini-laparoscopic biopsy device and technique showed to be capable of safely obtaining sufficient tissue samples, which was minimally invasive and in a shorter time than the classic technique.

A COMPARATIVE STUDY OF INJECTION DICLOFENAC SODIUM VERSUS INJECTION PARACETAMOL INFUSION AS POST-OPERATIVE ANALGESIA IN LAPAROSCOPIC ABDOMINAL SURGERIES UNDER GENERAL ANAESTHESIA

Post operative pain is acommon symptom causing post-operative psychological stress and anxiety leading to physiological effects. This research paper compares the analgesic effect of IV Diclofenac Sodium versus IV Paracetamol infusion in post operative period following laparoscopic abdominal surgeries. Patients are divided into 2 groups and observations are made with regards to the duration of analgesia and drug related post opertaive complications in both these groups.

The comparative study of intraperitoneal access by open versus close method to create pneumoperitoneum in laparoscopic surgeries

Background: Laparoscopy is a Latin word; ‘laparo’ means abdomen and ‘scopein’ means to examine, hence it is an art of examination of abdomen and visceral contents. laparoscopic procedure has been revolutionized and come under routine practice by surgical subspecialties because of it has many advantages over conventional laparotomy like small size scar, short hospital stays, less chance of wound infection, minimal postoperative pain, quick recovery after surgery. The aim of the study was to compare the rates and nature of complication during creation of pneumoperitoneum in open and closed laparoscopic procedure. Methods: This is a single centre, comparative, observational study. Tools of study include, observation, intraoperative and post-operative observation of complications. Nonprobability sampling (purposive sampling) technique was used in this study. Sample size was 44 (in each group). Written and Informed consent has been taken from all patients who were underwent abdominal laparoscopic surgery. Results: This study represents the comparison between different open and closed methods for creation of pneumoperitoneum in laparoscopic abdominal surgeries. In this study, according to classification of complication at entry level in open method omental injury found in 2 (12%) patients; extra peritoneal insufflations 1 (6%), port site gas leakage 10 (59%), loss of space 1 (6%), entry in wrong plane 3 (17%). In closed method omental injury found in 4 (13%) patients; extra peritoneal insufflations 4 (13%), port site gas leakage 8 (27%) loss of space 5 (17%), entry in wrong plane 7 (23%), abdominal wall haematoma 4 (13%). Conclusions: Open method is merely safer than closed technique but due to small number of patients took into study as well as study time period is short. Final judgment for the research, multi centric trials in different institutions are required for the initial, crucial, and technically challenging step of newly emerging field of surgery.

Effect of Quadratus Lumborum Block on Pain and Stress Response after Video Laparoscopic Surgeries: A Randomized Clinical Trial.

There are many surgical and anesthetic factors that affect pain and the endocrine-metabolic response to trauma. The ability of anesthetic agents and neuronal blockade to modify the response to surgical trauma has been widely studied in the last few years. To evaluate if the anterior quadratus lumborum block contributes to improved surgical recovery, using as parameters analgesia, pulmonary function and neuroendocrine response to trauma. We carried out a prospective, randomized, controlled, and blinded study, in which 51 patients scheduled for laparoscopic cholecystectomy. Patients were randomly selected and assigned to 2 groups. The control group received balanced general anesthesia and venous analgesia, and the intervention group was treated under general, venous analgesia and anterior quadratus lumborum block. The parameters evaluated were: demographic data, postoperative pain, respiratory muscle pressure and inflammatory response to surgical stress with the plasma dosage of IL-6 (Interleukin 6), CRP (C-Reactive protein) and cortisol. Anterior quadratus lumborum block induced the slowing of IL-6 cytokine production and a decrease in cortisol release. This effect was accompanied by the significant reduction of postoperative pain scores. Anterior quadratus lumborum block is an important strategy for analgesia in abdominal laparoscopic surgery and contributes to reducing the inflammatory response to surgical trauma with an early return of preoperative baseline physiological functions.

A comparative study between transanal and transabdominal approaches in treatment of complete rectal prolapse

There is a wide variety of surgical methods to treat rectal prolapse; however, to date, no clear agreement exists regarding the most effective surgical method. This study was designed to compare the results according to the surgical approach for complete rectal prolapse in women. This study was conducted from March 2016 to February 2021 on female patients with rectal prolapse who underwent surgery. First, all patients were classified into mucosal and complete layer groups to confirm the difference in results between the two groups, and only complete layer prolapse patients were divided into transanal and abdominal approaches to compare parameters and functional outcomes in each group. A total of 180 patients were included, with an average age of 71.7 years and 102 complete prolapses. The complete layer group was found to have more abdominal access, longer operating time, and higher recurrence rates compared to the mucosal layer group. (p<0.001) When targeting only the complete layer patients, there were 65 patients with the transanal and 37 with the abdominal (laparoscopic) approaches. The abdominal approach group had a longer operating time and hospital stay (p<0.001, respectively) and lower recurrence rate than the transanal group (transanal vs. abdominal, 38% vs. 10.8%, p=0.003), while the Wexner constipation and incontinence scores showed improved results in both groups. Although operating time and hospitalization period were shorter in the transanal group, laparoscopic abdominal surgery is a procedure that can reduce the recurrent rate for complete rectal prolapse.

Influencing factors of parental selections of minimally invasive procedure in children's abdominal surgery: a cross-sectional study in China.

The purpose of our study was to explore the influencing factors of parental selections of minimally invasive procedure including laparoscopic or robotic methods in children's abdominal surgery. The questionnaire survey was conducted among the parents of patients who received abdominal laparoscopic or robotic surgery in our hospital from December 2020 to June 2022. The contents included basic information of the patients and parents, parental educational background, monthly income, insurance details and the parental considerations. Univariate and multivariate logistic regression were applied for the influencing factors analysis. Six categories of diseases involving choledochal cyst (198 cases), spleen related diseases (31 cases), hirschsprung disease (40 cases), inguinal hernia (330 cases), adrenal tumor (15 cases) and ureteropelvic junction obstruction (73 cases) were included in this study. After univariable and multivariable logistic regression analysis accomplished, we discovered that college degree or above (OR = 0.545, P < 0.001), monthly income > 5000 RMB (OR = 0.761, P < 0.001) and involving reconstruction during operation (OR = 0.842, P < 0.001) were the influencing factors for parental selections of robotic surgery. In children's abdominal surgery, parents with college degree or above, monthly income > 5000 RMB and considering the need for reconstruction during operation are more inclined to choose the robotic surgery.

National analysis of cost disparities in robotic-assisted versus laparoscopic abdominal operations

BackgroundAlthough the use of robotic-assisted surgery continues to expand, the cost-effectiveness of this platform remains unclear. The present study aimed to compare hospitalization costs and clinical outcomes between robotic-assisted surgery and laparoscopic approaches for major abdominal operations. MethodsAll adults receiving minimally invasive gastrectomy, cholecystectomy, colectomy (right, left, transverse, sigmoid), ventral hernia repair, hysterectomy, and abdominoperineal resection were identified in the 2012 to 2019 National Inpatient Sample. Records with concurrent operations were excluded. Multivariable linear and logistic regressions were developed to examine the association of the operative approach with costs, length of stay, and complications. An interaction term between the year and operative approach was used to analyze cost differences over time. ResultsOf an estimated 1,124,450 patients, 75.8% had laparoscopic surgery, and 24.2% had robotic-assisted surgery. Compared to laparoscopic, patients with robotic-assisted operations were younger and more commonly privately insured. The average hospitalization cost for laparoscopic cases was $16,000 ± 14,800 and robotic-assisted cases was $18,300 ± 13,900 (P < .001). Regardless of procedure type, all robotic-assisted operations had higher costs compared to laparoscopic operations. Risk-adjusted trend analysis revealed that the discrepancy in costs between laparoscopic and robotic-assisted surgery persisted and widened over time from $1,600 in 2012 to $2,600 in 2019. Compared to laparoscopic procedures, robotic procedures had a 2.2% reduction in complications (9.4 vs 11.6%, P < .001) and a 0.7-day decrement in the length of stay (95% confidence interval −0.8 to −0.7). ConclusionDisparities in costs between robotic and laparoscopic abdominal operations have persisted over time. Given the modest decrement in adverse outcomes, further investigation into the clinical benefits of robotic surgery is warranted to justify its greater costs.

Intraoperative Hypertension Is Associated with Postoperative Acute Kidney Injury after Laparoscopic Surgery.

It is well demonstrated that intraoperative blood pressure is associated with postoperative acute kidney injury (AKI); however, the association between severity and duration of abnormal intraoperative blood pressure (BP) with AKI in patients undergoing laparoscopic surgery remains unknown. This retrospective cohort study included 12,414 patients aged ≥ 18 years who underwent a single elective laparoscopic abdominal surgery during hospitalization between October 2011 and April 2017. Multivariate stepwise logistic regressions were applied to determine the correlation between the severity and duration of intraoperative mean arterial pressure (MAP, (systolic BP + 2 × diastolic BP)/3), acute intraoperative hypertension (IOTH) and postoperative AKI, in different periods of surgery. A total of 482 hospitalized patients (3.9%) developed surgery-related AKI. Compared with those without IOTH or with preoperative mean MAP (80-85 mmHg), acute elevated IOTH (odds ratio, OR, 1.4, 95% CI, 1.1 to 1.7), mean MAP 95-100 mmHg (OR, 1.8; 95% CI, 1.3 to 2.7), MAP 100-105 mmHg (OR, 2.4; 95% CI, 1.6 to 3.8), and more than 105 mmHg (OR, 1.9; 95% CI, 1.1 to 3.3) were independent of other risk factors in a diverse cohort undergoing laparoscopic surgery. In addition, the risk of postoperative AKI appeared to result from long exposure (≥20 min) to IOTH (OR, 1.9; 95% CI, 1.5 to 2.5) and MAP ≥ 115 mmHg (OR, 2.2; 95% CI, 1.6 to 3.0). Intraoperative hypotension was not found to be associated with AKI in laparoscopic surgery patients. Postoperative AKI correlates positively with intraoperative hypertension in patients undergoing laparoscopic surgery. These findings provide an intraoperative evaluation criterion to predict the occurrence of postoperative AKI.

A Comparative Study Between pH and PaCO2 Changes during Laparotomy VS Laparoscopic Abdominal Surgeries

A Comparative Study Between pH and PaCO2 Changes during Laparotomy VS Laparoscopic Abdominal Surgeries

Evaluation of the chemical, cytological and bacteriological compositions of surgical smoke and evaluation of purification of smoke by ultraviolet light and various filters in laparoscopic surgeries

Background: The present study aimed to assess the cytological, bacterial and chemical composition of laparoscopic surgical smoke and the evaluation of purification of surgical smoke by smoke purifying device containing ultraviolet (UV) light and various filters. Methods: Sixty patients undergoing laparoscopic abdominal surgery lasting &gt;45 min were included in this randomized controlled study. The patients were divided into two groups: group A-smoke passing through smoke purifying device and group B-smoke without passing through smoke purifying device. Sample for cytological, bacteriological and chemical analysis were collected from both the groups. The primary outcome measures were to find the cytological, bacteriological and chemical composition of surgical smoke. The secondary outcome measure was evaluation of purification of surgical smoke by smoke purifying device containing ultraviolet light and various filters. Intergroup comparison of categorical and continuous variables was done using the Chi square test/Fisher’s exact test and unpaired t test respectively. Results: The present study shows the group A wherein smoke evacuating device containing various filters were used has no bacterial growth as well as no cells seen on cytological evaluation as compared to the group B wherein 21/30 (70.0%) cases had few lymphocytes and 3/30 (10.0%) cases had coagulase-negative Staphylococci wherein smoke evacuation device was not used. However, the chemical composition was comparable in both the groups. Conclusions: The smoke evacuation and filtration device, filtrates and clears the smoke of cells and bacteria as it passes through it.

THE ANALGESIC EFFICACY OF TRANSVERSUS ABDOMINIS PLANE (TAP) BLOCK VERSUS EPIDURAL ANALGESIA IN LAPAROSCOPIC LOWER ABDOMINAL SURGERIES IN ADULTS: A CASE STUDY

Background: The aim of the study was to compare the analgesic efcacy of epidural analgesia and transversus abdominis plane (TAP) block in laparoscopic lower abdominal surgeries for postoperative pain management. Over time, TAP block has gained popularity, however its superiority versus epidural analgesia is still debatable. Methods: 120 patients undergoing lower abdominal surgeries under general anaesthesia were randomly allocated into two groups, to postoperatively receive lumbar epidural analgesia (Group E) or USG guided TAP block (Group T). Group E received 0.125% bupivacaine (20ml) as a single shot postoperative analgesic via lumbar epidural catheter Group T received 0.125% bupivacaine (20ml) as a single shot postoperative analgesic via USG guided TAP block Pain at rest, Numeric Rating Scale (NRS) and rst request for rescue analgesia (Inj. Paracetamol 20mg/kg IV) were recorded

Fibroadenoma Excision under Thoracic Segmental Spinal Anaesthesia in Isolated Situs Inversus Totalis: A Case Report

Situs inversus totalis is a rare congenital positional anomaly with a predicted incidence of 1: 10,000 amongst the general population described by the transposition of the abdominal and thoracic visceral structures. Local infiltration of the breast is a common technique for fibroadenoma of small sizes. However, its efficacy, including duration of action as well as the extent, can be unreliable and surgeon dependent. Unless otherwise contraindicated, the regional technique of thoracic segmental spinal anesthesia has been proven to be a safe and effective method for even major surgeries including laparoscopic cholecystectomy, breast lumpectomy and abdominal surgeries. Multiple regional anesthetic techniques are available and should be used according to the requirement of the surgery as well as the skill and knowledge of the performing anesthetist. We discuss here, a case of fibroadenoma in a patient with isolated situs inversus totalis, operated under thoracic segmental spinal anesthesia.

Postoperative Discomfort Among Laparotomy Patients from a Selected Hospital at Mangaluru: An Observational Study

Abstract Background Factors causing postoperative discomfort after laparotomy are numerous and must be explored in depth. The postoperative distress may significantly affect the patient's state of well-being. Hence, the present study aims to assess the factors contributing to discomfort after laparotomy. Aim The aim was to assess and compare the discomfort between open and laparoscopic abdominal surgery. Objectives of the Study 1. To analyze the causes of patient's discomfort after abdominal surgery.2. To compare the discomfort between open and laparoscopic abdominal surgery.3. To determine the association between pain and selected variables among open and laparoscopic abdominal surgery. Materials and Methods An exploratory approach with a prospective observational design was adopted for this study. Using the purposive sampling technique, 100 patients were selected to open and 100 to laparoscopic abdominal surgery groups. Data were collected using demographic and clinical proforma and standardized postoperative discomfort inventory 6 and 24 hours after the surgery. The assessment focused on the study variables such as symptoms after the surgery and the factors contributing to the postoperative discomfort. Statistical Analysis The collected data were analyzed using descriptive and inferential statistics using the SPSS software version 20. Results Among 200 participants, most of the open (68%) and laparoscopic abdominal surgeries (42%) belong to 25 to 35 years of age. Also, 54% and 13% were diabetic in open and laparoscopic abdominal surgery groups, respectively. Most samples (56% in open and 68% in laparoscopic surgery) stayed 5 and 10 hours in postoperative ICU. In open and laparoscopic abdominal surgeries, pain is the primary (100%) cause of postoperative discomfort after 6 hours of surgery. Movement restriction is also the reason for significant discomfort both in open (98%) and laparoscopic (100%) abdominal surgeries.In contrast, pain (99% and 100%), movement restriction (92% and 95%), and abdominal distention (61% and 34%) were the major problems contributing to the patient's discomfort after 24 hours of both open and laparoscopic surgeries too. There was a significant difference in causes of patient discomfort between open and laparoscopic abdominal surgery after 6 hours (P &lt; 0.05), except for discomfort related to IV drip (P = 0.852), constipation (P = 0.2), and chills (P = 0.6). Conclusion Even though pain is the major distressing factor both in open and laparoscopic surgeries, the current study highlights a few other factors that affect postoperative recovery. Nurses' attention to such distressing factors will fasten patients' recovery and quality of life after abdominal surgery.

Intraoperative right heart function with individualized mechanical ventilation in laparoscopic surgery with Trendelenburg positioning: A randomized-controlled study

BackgroundThe intraoperative effects of mechanical ventilation with individualized positive end-expiratory pressure guided by dynamic compliance on right heart function remains undefined. ObjectivesTo investigate whether individualized ventilation is superior to standard ventilation in protecting the right heart during abdominal laparoscopic surgery in the Trendelenburg position. MethodsForty patients who underwent abdominal laparoscopic surgery were randomly divided into two groups: Group T (titrimetric positive end-expiratory pressure [PEEP]) and Group I (intentional PEEP, 5 cmH2O). Parameters of right ventricular function were measured using transesophageal echocardiography, which included tricuspid annular plane systolic excursion, early-to-late filing ratio of the right ventricle, and right ventricular end-diastolic area/left ventricular end-diastolic area ratio during mechanical ventilation. ResultsNo significant difference in the tricuspid annular plane systolic excursion or early-to-late filling ratio of the right ventricle was noted between the groups during the whole procedure (P>0.05). We noticed an increase in right ventricular end-diastolic area/left ventricular end-diastolic area ratio at T0 vs. T2 in Group T (0.53±0.02 vs. 0.60±0.06, respectively; P = 0.0208) and Group I (0.54±0.01 vs. 0.62±0.06, respectively; P = 0.0018). ConclusionsIntraoperative lung-protective ventilation with dynamic compliance-guided PEEP does not have obvious side effects on the right heart function when compared with standard protective ventilation during laparoscopic surgery in the Trendelenburg position.

Description of the Current Da Vinci® Training Pathway for Robotic Abdominal Wall Surgery by the European Hernia Society.

Background: Robot assisted laparoscopic abdominal wall surgery (RAWS) has seen a rapid adoption in recent years. The safe introduction of the robot platform in the treatment of abdominal wall hernias is important to safeguard the patient from harm during the learning curve. The scope of this paper is to describe the current European training curriculum in RAWS. Methods and Analysis: The pathway to competence in RAWS will depend on the robot platform, experience in other abdominal procedures (novice to expert) and experience in the abdominal wall repair techniques. An overview of the learning curve effect in the initial case series of several early adopters in RAWS was reviewed. In European centres, current training for surgeons wanting to adopt RAWS is managed by the specific technology-based training organized by the company providing the robot. It consists of four phases where phases I and II are preclinical, while phases III and IV focus on the introduction of the robotic platform into surgical practice. Conclusion: On behalf of the Robotic Surgery Task Force of the European Hernia Society (EHS) we believe that the EHS should play an important role in the clinical phases III and IV training. Courses organized in collaboration with the robot provider on relevant surgical anatomy of the abdominal wall and procedural steps in complex abdominal wall reconstruction like transversus abdominis release are essential. Whereas the robot provider should be responsible for the preclinical phases I and II to gain familiarity in the specific robot platform.

Interactive 3D Force/Torque Parameter Acquisition and Correlation Identification during Primary Trocar Insertion in Laparoscopic Abdominal Surgery: 5 Cases.

Laparoscopic procedures have become indispensable in gastrointestinal surgery. As a minimally invasive process, it begins with primary trocar insertion. However, this step poses the threat of injuries to the gastrointestinal tract and blood vessels. As such, the comprehension of the insertion process is crucial to the development of robotic-assisted/automated surgeries. To sustain robotic development, this research aims to study the interactive force/torque (F/T) behavior between the trocar and the abdomen during the trocar insertion process. For force/torque (F/T) data acquisition, a trocar interfaced with a six-axis F/T sensor was used by surgeons for the insertion. The study was conducted during five abdominal hernia surgical cases in the Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University. The real-time F/T data were further processed and analyzed. The fluctuation in the force/torque (F/T) parameter was significant, with peak force ranging from 16.83 N to 61.86 N and peak torque ranging from 0.552 Nm to 1.76 Nm. The force parameter was observed to positively correlate with procedural time, while torque was found to be negatively correlated. Although during the process a surgeon applied force and torque in multiple axes, for a robotic system, the push and turn motion in a single axis was observed to be sufficient. For minimal tissue damage in less procedural time, a system with low push force and high torque was observed to be advantageous. These understandings will eventually benefit the development of computer-assisted or robotics technology to improve the outcome of the primary trocar insertion procedure.

Comparative Study on Laparoscopic and Open Abdominal Surgery in the Treatment of Uterine Fibroids

Comparative Study on Laparoscopic and Open Abdominal Surgery in the Treatment of Uterine Fibroids