Laparoscopic Surgical Instruments Research Articles

ビデオラリンゴスコープ下の手術支援機器の応用について

ビデオラリンゴスコープ下の手術支援機器の応用について

How to use laparoscopic surgical instruments safely

The development of laparoscopic surgery has been accompanied by a rapid increase in the number of laparoscopic surgical procedures carried out in the field of urology. In 2002 laparoscopic nephrectomy was approved for coverage under Japanese national health insurance, and in 2003 there were over 1000 registered cases in which this procedure was carried out. This suggests that laparoscopic nephrectomy, a procedure formerly conducted at only a few institutions, is now spreading to hospitals across Japan. Laparoscopic surgery involves the use of specialized instruments within a restricted field of vision, and risky surgical techniques can potentially result in visceral or vascular damage. In order to promote the use of safe laparoscopic surgery procedures, the Japanese Urological Association and the Japanese Society of Endourology and Extracorporeal Shock Wave Lithotripsy (ESWL) have inaugurated a certification program for urologic laparoscopy. This program not only encourages development in this field of surgery and provides technical certification to ensure appropriate levels of expertise, but also reviews methods for the correct use of instruments such as trocars and hemostats. The purpose of this video is to present correct methods for the use of a variety of laparoscopic instruments, in order to increase the safety of this procedure. The video has been designed to be useful not only for practitioners who are just beginning laparoscopy, but also for those who already have extensive laparoscopic experience. The video discusses five laparoscopic instruments (trocar, electric surgical devices, ultrasonic surgery devices, clips and clip appliers and endo-staplers), and demonstrates their correct use. In addition, animal models are used to illustrate the potential complications that can be associated with some methods of use.

Robotic surgery in gynecologic oncology: evolution of a new surgical paradigm.

Robotic surgical platforms were first developed with telesurgery in mind. Conceptualized by NASA and the military to provide surgical expertise to remote locations, some telesurgical success has been documented, but progress has been held back by communication bandwidth limitations. Telepresence surgery, where the surgeon is in proximity to the patient but is provided with an ergonomic console equipped with three-dimensional vision and autonomous control of wristed laparoscopic surgical instruments and energy sources, has shown efficacy first in cardiac and then urologic cancer surgery. Interest is currently focused on the application of this technology in the field of gynecology, with techniques being described to perform simple hysterectomy, myomectomy, tubal anastomosis, and pelvic reconstruction procedures. This article will review the application of robotic- and computer-assisted surgery in the specialty of gynecologic oncology.

Disposable Laparoscopic Surgical Instruments and the Economic Effects of Repackaging

The purpose of this study was to evaluate the economic effects of repackaging disposable laparoscopic surgical instruments. We repacked a total of 28 disposable instruments for gynecologic laparoscopic surgery into one package. The time of preparation of surgical instruments, the amount of medical waste, and other economic effects were compared before and after the repackaging of disposable instruments. The time required for the preparation of surgical instruments was shortened by 22 minutes per operation, and medical waste decreased by 400 g, by repackaging the instruments, resulting in an estimated direct economic saving of $10,000 per year. Indirect economic effects might include savings due to a reduced inventory of surgical instruments and simplified cost-accounting for each operation. It is likely that preparation for surgery can be significantly improved and the cost reduced by repackaging the laparoscopic surgical instruments.

Endoscopic Cross-Trigonal Ureteral Reimplantation Under Carbon Dioxide Bladder Insufflation: A Novel Technique

To report on a novel technique of endoscopic intravesical ureteral mobilization and cross-trigonal ureteral reimplantation under carbon dioxide insufflation of the bladder (pneumovesicum) for correcting primary vesicoureteral reflux (VUR) in infants and children. Ten boys and six girls with dilating primary VUR (7 bilateral; 23 refluxing ureters) associated with recurrent urinary-tract infections and multiple pyelonephritic renal scars underwent endoscopic Cohen's cross-trigonal ureteral reimplantation with CO(2) pneumovesicum. Their ages ranged from 10 months to 13 years (mean 4.1 years). The endoscopic procedure was preceded by distention of the bladder with saline and insertion of a 5-mm Step port over the bladder dome under cystoscopic guidance. The bladder was then drained and insufflated with CO(2) to 10 to 12 mm Hg pressure with a suction catheter inserted per urethra to occlude the internal urethral meatus. A 5-mm 30 degrees endoscope was used to provide intravesical vision. Two more 3- to 5-mm working ports were inserted on the lateral bladder wall on either side. Endoscopic intravesical mobilization of the ureter, dissection of a submucosal tunnel, and a Cohen's type of crosstrigonal ureteral reimplantation using interrupted 5-0 monofilament sutures was then performed under videoscopic guidance. Bladder drainage by a urethral catheter was maintained for 24 hours postoperatively. Endoscopic cross-trigonal ureteral reimplantation under CO(2) pneumovesicum was successfully performed in all except one patient, who had displacement of a port into the extravesical space after completion of the ureteral reimplantation necessitating a small vesicotomy for closure of the mucosal defect. The mean operating time was 136 minutes (range 80-230 minutes), being 112 minutes for unilateral cases and 178 minutes for bilateral cases. Two boys developed mild suprapubic and scrotal emphysema postoperatively that subsided spontaneously. All other patients recovered uneventfully and remained well. Follow-up cystograms showed complete resolution of VUR in all except one unit that had persistent grade I reflux, thus giving a success rate of 96%. This early experience illustrates that endoscopic intravesical ureteral mobilization and crosstrigonal ureteral reimplantation can be performed safely and effectively with routine laparoscopic surgical techniques and instruments under CO(2) insufflation of the bladder, achieving a high success rate in reflux resolution that is equivalent to that obtained with the open technique but with minimal invasiveness and much faster recovery. The longer-term outcome and potential physiological effects of CO(2) pneumovesicum on the bladder and upper-tract function will need to be evaluated further.

The relationship between hand size and difficulty using surgical instruments: A survey of 726 laparoscopic surgeons

Hand size is an important variable to consider when designing hand tools. Laparoscopic surgical instruments have been reported to cause hand and upper extremity discomfort. This study investigates the correlation between surgical glove size, preexisting musculoskeletal problems, and difficulty using laparoscopic instruments. Approximately 11,000 questionnaires were sent to SAGES, AAGL, and AWS members. Questions included basic demographic and practice data, surgical glove size, the presence of musculoskeletal problems, and the perceived difficulty using several types laparoscopic instruments. There were 726 responses (from 159 women and 567 men). Subjects were grouped by hand size (Small < or =6.5, Medium 7.0-7.5, Large >7.5; female group only: Small < or =6.0, Medium 6.5, Large >6.5). ANOVA was used to test for differences between groups. The percentage of time subjects reported having difficulty using all laparoscopic instruments was greater for the Small glove size group compared to both the Medium and Large groups ( p < 0.001). In females, the scissors and staplers were more difficult to use for the Small and Medium glove size group compared to the Large group ( p < 0.001). Subjects who reported musculoskeletal problems ( n = 145) performed a significantly greater percent of laparoscopic cases and found the stapler and graspers difficult to use for a greater percentage of time than those not reporting problems ( n = 559). Hand size is a significant determinant of difficulty using laparoscopic surgical instruments. Individuals using glove sizes 6.5 or smaller experience significantly more difficulty using common laparoscopic instruments, and in particular laparoscopic staplers. Manufacturers of surgical hand tools should consider hand size when designing future surgical instruments.

A review of mechanism used in laparoscopic surgical instruments

Many surgical instruments consist of basic mechanical components such as gears, links, pivots, sliders, etc., which are common in mechanical design. This paper introduces a reference table that was created by investigating the mechanical characteristic and the differences between 16 patented laparoscopic surgical devices, most of which are surgical staplers [1–16]. Laparoscopic surgical instruments were chosen for this paper because of the complex mechanical systems used in performing their required functions. For the similar functions of stapling and kinematic maneuvering, each instrument investigated varies widely in design and the type of mechanical components used. The reference table created will benefit engineers, designers, and students in analyzing the mechanical subsystems used in surgical instruments and suggest alternative options available for replacing existing designs. Although the table was created for laparoscopic surgical devices, its application could be extended to other surgical and non-surgical devices.

Improving realism of a surgery simulator: linear anisotropic elasticity, complex interactions and force extrapolation

AbstractIn this article, we describe the latest developments of the minimally invasive hepatic surgery simulator prototype developed at INRIA. The goal of this simulator is to provide a realistic training test bed to perform laparoscopic procedures. Therefore, its main functionality is to simulate the action of virtual laparoscopic surgical instruments for deforming and cutting tridimensional anatomical models. Throughout this paper, we present the general features of this simulator including the implementation of several biomechanical models and the integration of two force‐feedback devices in the simulation platform. More precisely, we describe three new important developments that improve the overall realism of our simulator. First, we have developed biomechanical models, based on linear elasticity and finite element theory, that include the notion of anisotropic deformation. Indeed, we have generalized the linear elastic behaviour of anatomical models to ‘transversally isotropic’ materials, i.e. materials having a different behaviour in a given direction. We have also added to the volumetric model an external elastic membrane representing the ‘liver capsule’, a rather stiff skin surrounding the liver, which creates a kind of ‘surface anisotropy’. Second, we have developed new contact models between surgical instruments and soft tissue models. For instance, after detecting a contact with an instrument, we define specific boundary constraints on deformable models to represent various forms of interactions with a surgical tool, such as sliding, gripping, cutting or burning. In addition, we compute the reaction forces that should be felt by the user manipulating the force‐feedback devices. The last improvement is related to the problem of haptic rendering. Currently, we are able to achieve a simulation frequency of 25 Hz (visual real time) with anatomical models of complex geometry and behaviour. But to achieve a good haptic feedback requires a frequency update of applied forces typically above 300 Hz (haptic real time). Thus, we propose a force extrapolation algorithm in order to reach haptic real time. Copyright © 2002 John Wiley &amp; Sons, Ltd.

Study Shows That $250 Million Could Be Saved in Laparoscopic Surgery by Improving Gas Flow

A new study estimates that $250 million could be saved annually on laparoscopic surgery in the United States alone by improving gas flow into the patient’s abdominal cavity. Carbon dioxide gas is pumped into the patient during surgery to expand the abdomen and tion system, the components that make up the supply line by which gas is pumped into the body. A key component in the insufflation system is the trocar, the device that punctures the abdominal wall, serves as an entry point for gas and the surgeon’s instruments, and seals the cavity to minimize pressure loss. The Veress needle is the device used to establish pneumoperitoneum before trocar insertion. Jacobs et al. evaluated a wide range of American and German brand name needles, trocars, and other laparoscopic surgical instruments in common use among surgeons today and found that in the majority of cases, insufficient annular clearance was available within the trocar to provide the needed gas flow into the abdominal cavity. They have compiled the results of their study, including specific flow and resistance properties of various needle-trocar combinations, and are disseminating this information to surgeons and equipment manufacturers in order to promote improved surgical methods.

Cleaning, Decontamination and Sterilization Procedures of Laparoscopic Surgical Instruments(&lt;Special Issue&gt;Disinfection and Sterilization of Medical Instruments)

Cleaning, Decontamination and Sterilization Procedures of Laparoscopic Surgical Instruments(&lt;Special Issue&gt;Disinfection and Sterilization of Medical Instruments)

Laparoscopic Transperitoneal Anterior Lumbar Interbody Fusion With Cylindrical Threaded Cortical Allograft Bone Dowels

Advances in laparoscopic surgical techniques and instruments have enabled surgeons to use minimally invasive techniques for the placement of lumbar interbody implants.

Surgical technology and the ergonomics of laparoscopic instruments.

Laparoscopic surgery provides patients with less painful surgery and a more rapid recovery, while requiring that surgeons work harder and in a more remote manner from the operating field. Cost-containment pressures on surgeons demand efficient surgery, whereas the increased technological complexity and sometimes poorly adapted equipment have led to increased complaints of surgeon fatigue and discomfort during laparoscopic surgery. There is, therefore, a need to evaluate the ergonomic integration and suitability of the laparoscopic operating room environment to address the issues of efficiency, safety, and comfort for the operating team. This approach is particularly important in the design of laparoscopic surgical instruments. A review of the literature on the biomechanics of laparoscopic surgical instrument use was combined with data from the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Ergonomics Questionnaire and demonstration station. Laparoscopic instruments suffer from ergonomically inadequate handle designs and inefficient handle to tip force transmission, which lead to surgeon fatigue, discomfort, and hand paresthesias. Improvements in the design of laparoscopic instruments are needed to decrease the work and discomfort of tissue manipulation during video-endoscopic surgery.

Single-use versus reusable laparoscopic surgical instruments: A comparative cost analysis

OBJECTIVE: Our purpose was to determine and compare the total annual costs for reusable and single-use laparoscopic surgical instruments. STUDY DESIGN: Records were kept over a 12-month period of all laparoscopic operations (performed only with reusable instrumentation), the surgical instruments used, depreciation costs, and all associated expenses (repairs, maintenance, replacements, cleaning, sterilization, wages). The total cost was then calculated and compared with the total cost (purchase price plus disposal fees) that single-use instruments would have caused for the same operations. RESULTS: The total cost for single-use instruments would have been more than seven times that for reusable instruments. CONCLUSION: We have decided to continue using reusable instrumentation for most of our laparoscopic operations. However, single-use instruments are used in situations in which they present a definite advantage. A proper balance is thus sought between the importance of cost factors, on the one hand, and the recognition of the need for the best instrument available for certain procedures, on the other.

Present and Future Applications of Shape Memory and Superelastic Materials

AbstractThe utility of superelastic Ni-Ti alloys in the medical industry has been rather dramatically demonstrated in recent years. A great number of devices are now in production, and still others are staged to enter production during the next few years. This surge in interest from the medical community stems from an increased acceptance of Ni-Ti because of its biocompatibility, advances in micromachining techniques and trends towards less-invasive surgical techniques. In addition, there are a variety of new developmental concepts that will have a major influence on this and other markets during the next 5 years of commercialization. This review will highlight many of the properties of Ni-Ti by illustration in a variety of recent medical applications, and then discuss some of the newer developmental concepts. Medical applications that will be presented here include guidewires, laparoscopic surgical instruments, implants, stents, retrieval baskets, and bone anchors. Some of the new concepts and capabilities that are reviewed include microvalves made from thin films, high temperature alloys, fatigue resistant composites, and robotic actuators with tactile feedback.